Maverick MD on Privilege

Dr. Yoni Freedhoff, who occupies the roles of Associate Professor of Family Medicine at the University of Ottawa and Medical Director of Ottawa’s Bariatric Medical Institute, has for years been pushing back at what seem to be common assumptions about obesity. Mainly this has to do with personal responsibility, a phrase which often functions as a euphemism for blame.

According to that worldview, whether the issue is treatment with the new weight-loss drugs, or taking part in any other weight-loss regimen, if a person does not sign up for one or the other, their fat body is their own darn fault. His tenets include these:

If any amount of desire, guilt or shame were sufficient to drive sustained change, we’d have been rid of the so-called lifestyle diseases decades ago.

[T]hough everyone possesses the theoretical ability to focus on healthy habits and lives, many people’s realities make lifestyle reform a nearly impossible luxury.

[T]he folks who both read about healthy living and have lives that are appropriately and realistically conducive to change are an incredibly privileged and small subset of the population.

[P]ersonal responsibility-based healthy living efforts require privileges that the vast majority of people don’t possess.

Dr. Freedhoff argues that most people simply do not have the time, the means, or the incentive to do the things they would need to do in order to lose a meaningful amount of body fat. And that’s just ordinary, basically healthy people with families and jobs; who possess “the privilege of life being settled enough to even consider personal responsibility-based healthy lifestyle change.”

Of the people who do not have that privilege, a very large subset are those who live with chronic pain and/or severe fatigue, who “may find purposeful behavior change to be literally too difficult or figuratively too low a priority, given their day-to-day pain and challenges.” To be in that situation without a supportive family and/or a job, is an avalanche of misfortune that few humans have the wherewithal to dig themselves out of.

In Dr. Freedhoff’s view, the society we live in is what needs to change, and in major, consequential ways:

Right now, we’re facing a torrential current of calories, ultra-processed foods and a culture of convenience that considers the use of junk food to reward, pacify and entertain our kids and ourselves at every turn as entirely normal.

We need policies that will help make healthier lifestyles occur by default, or that make purposeful changes easier or more valuable. Whether those changes are sugar-sweetened beverage taxes, front-of-package health claim reforms, banning advertising that targets children, improved school food policies and programs, zoning laws affected where fast food and convenience stores are located and more…

Among other cogent points he makes, one of them is this: The science of weight management is known to involve at least 5,000 genes and 37 hormones whose existence the human body has been fostering and fine-tuning for millions of years, during which time most people on earth have had a hard time getting enough food to sustain life.

We all have ancient genes and we are living in a very non ancient and fairly toxic food environment. When it comes to the availability of calories, they are now everywhere.

Today, almost every aspect of the culture, in almost every corner of the world, tells us to eat eat eat. And, like it or not, there are just some people whose weight will remain stable, or sadly, may increase, even on the most ambitious diet.

Your responses and feedback are welcome!

Source: “Check Your Privilege Before Talking About Obesity and Personal Responsibility,”, 09/27/16
Source: “Obesity (with Dr. Yoni Freedhoff),”, 12/03/20
Image by wp paarz/CC BY-SA 2.0 DEED

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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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