For Obese People, Prejudice in Plain Sight

[alienlovechild 75]

Last August, Dr. Delos M. Cosgrove, a cardiac surgeon and chief executive of the prestigious Cleveland Clinic, told a columnist for The New York Times that if he could get away with it legally, he would refuse to hire anyone who is obese. He probably could get away with it, actually, because no federal legislation protects the civil rights of fat workers, and only one state, Michigan, bans discrimination on the basis of weight.

Dr. Cosgrove may be unusually blunt, but he is far from alone. Public attitudes about fat have never been more judgmental; stigmatizing fat people has become not just acceptable but, in some circles, de rigueur. I’ve sat in meetings with colleagues who wouldn’t dream of disparaging anyone’s color, sex, economic status or general attractiveness, yet feel free to comment witheringly on a person’s weight.

Over the last few years, fat people have become scapegoats for all manner of cultural ills. “There’s an atmosphere now where it’s O.K. to blame everything on weight,” said Dr. Linda Bacon, a nutrition researcher and the author of “Health at Every Size: The Surprising Truth About Your Weight” (Benbella, 2008). “If we’re worried about climate change, someone comes out with an article about how heavier people weigh more, so they require more fuel, and they blame the climate change crisis on fatter people. We have this strong belief system that it’s their fault, that it’s all about gluttony or lack of exercise.”

Some of the most blatant fat discrimination comes from medical professionals. Rebecca Puhl, a clinical psychologist and director of research at the Rudd Center for Food Policy and Obesity at Yale, has been studying the stigma of obesity for more than a decade. More than half of the 620 primary care doctors questioned for one study described obese patients as “awkward, unattractive, ugly, and unlikely to comply with treatment.” (This last is significant, because doctors who think patients won’t follow their instructions treat and prescribe for them differently.)

Despite the abundance of research showing that most people are unable to make significant long-term changes in their weight, it’s clear that doctors tend to view obesity as a matter of personal responsibility. Perhaps they see shame and stigma as a health care strategy.

If so, is it working? Not very well. Many fat people sidestep such judgments by simply avoiding doctor visits, whether for routine checkups, preventive screenings or urgent health problems.

Indeed, Dr. Peter A. Muennig, an assistant professor of health policy at Columbia, says stigma can do more than keep fat people from the doctor: it can actually make them sick. “Stigma and prejudice are intensely stressful,” he explained. “Stress puts the body on full alert, which gets the blood pressure up, the sugar up, everything you need to fight or flee the predator.”

Over time, such chronic stress can lead to high blood pressure, diabetes and other medical ills, many of them (surprise!) associated with obesity. In studies, Dr. Muennig has found that women who say they feel they are too heavy suffer more mental and physical illness than women who say they feel fine about their size — no matter what they weigh.

Even if doctors don’t directly express weight-based judgments, their biases can hurt patients. One recent study shows that the higher a patient’s body mass, the less respect doctors express for that patient. And the less respect a doctor has for a patient, says Dr. Mary Huizinga, the study’s lead author and an assistant professor at Johns Hopkins School of Medicine, the less time the doctor spends with the patient and the less information he or she offers.

Fat stigma affects everyone’s health — fat, thin or in between. Last fall, Lincoln University in southern Pennsylvania announced that it would weigh and measure all freshmen, and require those with a B.M.I. over 30 to enroll in a special fitness class. Fat rights advocates protested it as discrimination: If the fitness class was that important to student health, shouldn’t everyone take it?

Lincoln’s administrators backpedaled after a storm of bad press. But the controversy underscores the fact that fat stigma isn’t about improving people’s health, as doctors like Delos Cosgrove contend. If it were, the conversation would be about health rather than numbers on the scale and the B.M.I. chart.

http://www.nytimes.com/2010/03/16/health/16essa.html

[w¡n9Nµ7 §£@¥€r 123]

Good post. I am fortunate to have found a primary care physician who doesn't give me too much ѕhit about my weight.

[SMR 368]

Actually, it's people who exercise that are causing global warming. All that breathing means more CO2.

But the reality is that people can and should control their weight. While true that many people have difficulty making long term changes in their weight, that is because they don't make long term lifestyle changes. No matter what diet or exercise plan you undertake, it only works as long as you continue to exercise and eat healthy. There isn't a miracle diet or exercise plan that will allow you to lose weight and then go back to donuts, French fries, and couch sitting and keep the weight off.

[Obama 2012 1,714]

The current health care being proposed should tax people based on weight..... There'd be an incentive right there to lose weight...

[Nagishkaw 510]

It's not what your eating, it's what's eating you.

[Bobby+Umit 161]

The only time I get upset around obese people is when I am on an airplane.

Been trapped to many times between flabs of flesh hanging on me than I care to think about.

[Fandango 1,439]

Dr Bacon is defending the rights of obese peeps....no disrespect, but I think that's funny.

[NickD 202]

Did occur to me that my chances of survival would be much greater in a concentration camp since this country is coming to that, if I were obese. Maybe I should put on a couple of pounds.

Is it better to add those to your gut or to your butt?

[SMOKE 1,426]

Did occur to me that my chances of survival would be much greater in a concentration camp since this country is coming to that, if I were obese. Maybe I should put on a couple of pounds.

Is it better to add those to your gut or to your butt?

personal opinion: male guts, female butt

[Peikko 1,575]

It's not really surprising, but stigmatizing the obese is not really the solution.

Obesity is a problem, not a problem of the individual, but certainly a problem for society because statistically, those who are obese impact health care and other services negatively in a significant way. Obesity costs money and people view this as a selfish act on the part of those who are obese.

I don't think that the way to solve an ever increasingly fat population is by marginalizing those that fit into the obese category however, it's a matter for education and probably we need to look at the production and sale of food differently.