Shaming The Obese

Harriet Brown on our new cultural scapegoats:

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.)

Dr. Puhl said she was especially disturbed at how openly the doctors expressed their biases. "If I was trying to study gender or racial bias, I couldn't use the assessment tools I'm using, because people wouldn't be truthful," she said. "They'd want to be more politically correct."

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."

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."

I think this is basically true, but I'd like to read more about why, precisely, most people are unable to make significant long-term change. Quite frankly, having struggled myself, and having lived in a neighborhood that stands out against the rest of Manhattan for its numbers of overweight people, I suspect deep systemic reasons.

I also suspect that the intersection of weight with beauty, as opposed to health, allows for confusion on the issue. There's a difference between telling our sons that losing a few pounds may give them a few more years with their kids, and telling them that losing a few pounds will make them Brad Pitt.

I'm not clear on precisely how much shame can actually help. It's shame that's created our absurd McWeightLoss culture where Octomom takes to the cover of celebrity magazines to show off her new bikini body, and retired athletes claim to have found the secret to losing five pounds a week. It's symptomatic of who are, of our abiding belief in short-cuts, and our technological ability to elide truth. The truth is that weight loss--like almost anything really worth doing--is long, hard and very lonely. It requires you to live in a way that many of your friends and family almost certainly do not.

As in all things, I'd ask people to be aware of other people as we discuss this. Try to be honest. But don't try to mean.