The World vs. the Obese

Obesity EpidemicHere is a first-person account by a not-obese woman, of an encounter at a party:

The high tables were pushed together into long strips, with barstool seating along both sides. I talked a bit with the woman next to me, and then she asked if I would mind if she braced one foot against my barstool because it would help her balance more securely. I had noticed her figure was almost round, but hadn’t thought about the logistics of it. It must be incredibly uncomfortable to sit on a barstool. For an obese person, the world must be a torture chamber.

We have these strange moments of insight and awareness into what it’s like to be someone else, with a disability perhaps, or maybe just too big. But the people who are struggling through a 300-pound or 500-pound existence are aware of the problems all the time, yet continue to be drastically overweight. What else could explain this, but an addiction on a massive scale?

Obesity… Food addiction… Massive scale… A professional comedian could make something out of that. A search engine request for some combination of “comedy” and “obesity” returns a startling number of hits. For many comics, obesity is a topic for humor. For some, obese is what they are, and humor on that topic is expected from them.

Childhood Obesity News mentioned the laughs wrested by Kevin Smith from his battle with the airlines, over being “too fat to fly.” Fellow entertainer Mike Birbiglia’s reductive analysis concludes that everything we need to know about nutrition boils down to “not eating any food that has a TV commercial.”

There is an online test anyone can take, to find out how much anti-fat bias lies within their own subconscious. A recent study by Janice A. Sabin, Maddalena Marini, and Brian A. Nosek compared the general public’s answers to the answers given by more than 2,000 doctors. The researchers compared the attitudes of the general public with the attitudes of doctors who also completed Project Implicit’s “Weight Implicit Association Test.”

Incidentally, other interesting research has been done about the validity of online surveys, such as these questions posed by a Harvard University project, or the polls that often appear in the pages of Dr. Pretlow’s Weigh2Rock website. When people are asked about socially sensitive areas like disability, race, age, and so on, the authors say:

[...] Web test takers are more likely to be honest than face-to-face or telephone survey respondents… The quality of data collected on the Web is often better than the quality of data gathered using other methods because the human error rate in the data collection process is reduced.

Even so, the study authors mention a drawback in their exploration of attitudes about obesity, the people who harbor the strongest negative feelings about their obese neighbors probably don’t self-select as volunteers to take this kind of test. Here is the bottom line:

This study is the first to show strong implicit and explicit weight bias among a very large sample of MDs… We found that MDs’ implicit and explicit attitudes about weight follow the same general pattern seen in the very large public samples that hold strong implicit and explicit anti-fat bias. We conclude that implicit and explicit anti-fat bias is as pervasive among MDs as it is among most people in society.

Among the doctors, the women showed less implicit bias. But still, prejudice is out there, and a lot of people, including doctors of every description, feel that it’s okay to openly express anti-fat bias. Where the medical profession is concerned, the researchers are anxious to know how much harmful judgmentalness might spill over into their interactions with patients, and what effect that has on the quality of care.

They say:

Strong negative implicit and explicit attitudes about weight among MDs may contribute to less-than-ideal clinical interactions and subsequent medical avoidance among overweight patients. [...] [P]arallel evidence with implicit racial biases suggest that these are important areas to investigate.

Of the doctors questioned, only about a quarter of them considered their training to have included “good obesity practices,” though many more are motivated to improve their knowledge and skills in this area. The study authors would like to see education for doctors that includes sharpening up the verbal and non-verbal communication skills. And of course, more education on the “causes and treatment of obesity.”

Sounds good, but will the establishment continue to focus on diet and exercise, exercise and diet, forever? Of course, diet is important. As the old computer motto says, “Garbage in, garbage out.” Of course, exercise is important. As one guru puts it, “You don’t lose weight to get healthy, you get healthy to lose weight” — and exercise is important in maintaining general health. So while all these other ambitious plans are underway, let’s give some serious consideration to the addiction paradigm and remember to look through the “psychological food dependence-addiction lens.”

Your responses and feedback are welcome!

Source: “Implicit and Explicit Anti-Fat Bias among a Large Sample of Medical Doctors by BMI, Race/Ethnicity and Gender,” PLOS ONE, 11/07/12
Images by markhealey (Mark Healey) and Of Small Things.

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