Monday, August 11, 2014

Public Health Challenges Require Compassion and Understanding, Not Shame

The health challenges that result from obesity are significant – it increases a wide range of risks and makes medical treatment more complicated. There is a reason why doctors are concerned when their patients are at an unhealthy weight – because, obesity is often a pre-cursor to poor health and may result in poorer outcomes from medical procedures and health challenges (like pregnancy).

The following video from the Huffington Post, shows an obese patient in an ER after suffering a heart attack – the patient is 32, 5’9” and 300 pounds, and the doctor asks “How the hell does that happen?”. The video then rewinds on the man’s life, and shows a litany of what people assume about the obese. Birthday cakes, candy rewards and cheeseburgers, and driving and fast food, and video games, etc. It ends with the mother of the man feeding him as a toddler, some French fries.

This leaves the viewer with the distinct idea that the mother set her child on a journey that ultimately resulted in his death, and that the man was to blame for his eventual fate. It even leaves the impression, that somehow the occasional treat (ie. birthday cake, and suckers for school performance) are unhealthy. I’m somewhat surprised that it doesn’t trot out a can of formula with the rest of the cliché about overweight and obesity and mother blame. It is simple – and it validates the judgement that many seem more than willing to pass on those who struggle with their weight. Further, it justifies the feeling that those who do not struggle with their weight have somehow made the “right” choices, rather than merely being the beneficiaries of the “right” environment.

This neglects the reality of the problem – and propagates the assumptions and myths about those who are obese. It justifies judgment and limits the capacity for compassion and understanding that are really needed to address the problem and strive for a healthier future. In truth, the Huffington Post video is about as helpful in understanding the problem of obesity and the health challenges it presents as an airbrushed picture of a super model is in forming a fair standard by which to judge one’s own self.

It is far easier to tell the obese to exercise more and eat less, than to take a step back to try to understand their lives and the context in which they live, and working with them and empowering them to work towards a healthier future. It is far easier to blame mothers, than to build parks and communities that support families in a healthy lifestyle. It is far easier to assume that a person is fat because they are lazy and without will power, than to understand that their obesity is a symptom of another underlying health problem – after all having a bum knee might make going for a walk a challenge, and the wait to access care might further add to their waste line, or perhaps they are taking a medication that results in weight gain or are struggling with depression. It is easy to criticize a person who drives everywhere – and far more challenging to understand why they must drive in the first place (houses are cheap in the suburbs, they travel with small children, etc.). It is difficult to understand, that for some obesity is an occupational hazard. It is easy to make assumptions about people and why they do what they do, and it is far more difficult to actually understand the lives of people, and the kinds of things that actually make a difference to the outcome.

Shame rarely causes change – but it is highly effective in generating stigma, and stigma rarely results in good health. If we want to tackle obesity (or any other public health challenge), we need to start with compassion and understanding. We need to start by doing what is perhaps most difficult, accepting people for who they are and that means empowering them and accepting their choices even if they are different from our own. It means changing the context in which choices are made in the first place.

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