The following is a guest post by Dr. David L. Katz, director of Yale University’s Prevention Research Center. The article was originally published on Prevention.com, and has been modified and updated for Childhood Obesity News.
About a year ago I appeared on MARTHA: The Martha Stewart Show to talk about — what else — living and eating well. Martha’s other guests on the show were a chef, Marcus Samuelsson, and Saturday Night Live improv comedian/actor, Kenan Thompson.
During the opening of the show, Martha invited the other guests to pose any health questions they had to me, encouraging Kenan to do so by noting, on national TV, “you’re overweight, aren’t you?”
How Mr. Thompson actually felt about this question, and being “outed” on national television, I can’t say. He handled it as one would expect from an improvisational comedian — by improvising and being funny. But I have seen some public outrage on Mr. Thompson’s behalf. A number of bloggers have expressed the equivalent of a wince at Martha’s blunt characterization.
So the question arises: was Martha Stewart’s comment indiscreet?
Kenan Thompson almost certainly knows he’s overweight (he is). And, since our weight — unlike our cholesterol, or blood pressure, or glucose level — manifests itself quite visibly, but for what judiciously-selected clothes can do to conceal it, Kenan, without a doubt, knew that Martha knew that Kenan was overweight. And Martha likely knew that Kenan knew that she knew, so she wasn’t really worried about violating a trade secret by saying so.
But we are nonetheless uncomfortable talking about weight, and the comment did evoke a wince from some. We need to account for that.
For one thing, our mothers told us to say nothing at all when we have nothing nice to say. Presumably, saying that someone is overweight is not especially nice, so it might be covered by this universal maternal dictum.
For another, standards of discretion often prevent us from commenting on what might be characterized as a visible, physical burden. We would not generally say, for instance, “I can see your nose has been broken several times,” or “you walk with a limp, don’t you?” We would not generally comment on a missing digit or limb, or a speech impediment. But is obesity like any of these?
We would, however, routinely comment on a cast or bandage, generally by asking “what happened to you?” Having spent much of my rambunctious youth with one part or another of my anatomy splinted, I can attest to how widely accepted — and ultimately tedious — this practice is.
But the point is simple:
Visible injuries are clearly OK to talk about. But is obesity like these?
There are physical attributes that are also OK to talk about, because they are either positive, or at worst neutral. This list would include eye color, hair color, and within a certain range, height. Height outside of the range becomes something else we would tend not to mention. Weight, it seems, is not at all like eye color.
We could generate much longer lists of both mentionable and unmentionable physical characteristics, but this will suffice to show there is some prevailing, societal notion as to what belongs on which list. Weight is generally on the list of unmentionables, unless it is changing in a desired direction, in which case it very definitely crosses over. “You’ve lost weight, haven’t you?” is not merely acceptable, but seemingly encouraged.
By scanning the items on both lists and looking for common themes, I believe we might better blend overweight with understanding.
Generally, a physical attribute we consider flattering can be mentioned; excess body weight clearly isn’t on this list. Generally, a physical attribute we consider unfortunate but temporary — such as a broken leg — can be mentioned, and indeed should be. Obesity, it seems, is not on this list either. A physical challenge being nobly borne and in which there is no shame — a war wound comes to mind — can be mentioned, albeit discretely. Being overweight does not seem to make this list either.
Finally, we can mention an observable challenge if the intent of doing so is to offer meaningful help addressing it. If the observation is critical or pointless, it should not be made.
Here are a few of the perceptions that seemingly land something on the list of unmentionables: it can’t be fixed; it’s your own fault; it’s embarrassing or shameful; I can’t, or won’t, help you but just want to call you out.
Is this, then, the prevailing view of obesity? If so, it’s completely wrong.
Obesity, at the individual and societal level, can indeed be fixed — and prevented. Doing so may be hard, but it isn’t complicated, and it’s certainly possible. Obesity is not the fault of individuals born into an overwhelmingly, and uniquely, “obesigenic” environment. Gaining weight along with much of the world’s population is neither shameful nor embarrassing — it is simply, it seems, what Homo Sapiens tend to do when they transition abruptly from a world in which calories are scarce and physical activity unavoidable, to a world in which physical activity is scarce and calories unavoidable.
And why shouldn’t we all help one another overcome this problem? Why shouldn’t we exploit the fact that “in unity there is strength,” and all join in one another’s efforts to eat well and be active?
We have heard reports from the CDC that the relentless rise in overweight and obesity rates in the U.S. may have plateaued, but if so, at well over 2/3 of all adults and nearly 1/3 of children. Unless you hang with an unusual crowd, it is highly likely that the majority of people you know are overweight.
Pretending obesity is a secret we can keep from ourselves and one another won’t help solve the problem. Neither will talking about it if we don’t do so with understanding, compassion, and a shared sense of purpose.
We must unweight the stigma of obesity. The pounds will then more readily follow.
Source: “How to Create Lasting Change,” MARTHA: The Martha Stewart Show, 01/26/10
Source: “Obesity Rates Hit Plateau in U.S., Data Suggest,” The New York Times, 01/13/10
Image by Kevin Tostado (Tostie14), used under its Creative Commons license.
David L. Katz MD, MPH, FACPM, FACP is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care. He is a board certified specialist in both Internal Medicine, and Preventive Medicine/Public Health, and Associate Professor (adjunct) in Public Health Practice at the Yale University School of Medicine. Katz is the Director and founder (1998) of the Yale-Griffin Prevention Research Center; Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, CT; founder and president of the non-profit Turn the Tide Foundation; and formerly the Director of Medical Studies in Public Health at the Yale School of Medicine for eight years.