We’re lucky to live in such a diverse society in which a wide array of views exists on all sorts of issues, whether it be the environment, sports, politics, or health.
The COVID-19 pandemic has only added fuel to the fire on some of those debates. We’ve seen passionate arguments made on both sides of whether we should be wearing masks, whether we should give our children vaccines, and more.
The debate regarding the status of obesity as a disease is one of the most polarising in modern medicine. There are those that cite genetic, physiological, and neurohormonal differences as evidence that it should be regarded as a disease, and there are those who would suggest the rise in obesity is a result of environmental shift towards convenience, socio-economic deprivation, and the ready availability of processed high calorie food.
The reality is that it is likely to be somewhere in between, though the inclusion of obesity as a risk factor for poor outcomes in COVID-19 caused some controversy. On World Obesity Day there is a far more immediate problem beyond semantics that needs tackling.
There are more than 650 million people world-wide living with obesity, and twice as many who are overweight. The prevalence has trebled over the last 40 years, resulting in approximately 4.7 million premature deaths per year in 2017.
Regardless of our cultural perception of obesity, whether disease or risk factor, we know that living with obesity carries a significant stigma, whether through the media or in engagement with the healthcare system.
Every day we choose words that have a profound effect on other people. Language is a powerful tool, through which we communicate our hopes, our feelings, and the vagaries of life.
Words have great potential to help, or to harm and, as clinicians, we know the strong value of good communication in our day-to-day practice. Whilst the science and physiology are complex, and we are always discovering new things about obesity, what we do know for sure is that people living with obesity experience stigma every day.
Complex science is too often distilled into a simplistic narrative... ‘eat less, move more’. This fails to incorporate the evidenced complexity of obesity. Clinicians, by interacting one-to-one with their patients, have the responsibility to ensure their conversations do not inadvertently contribute to this existing stigma. They can instead choose language that is inclusive and supportive.
We must remember to be patient centred and to use non combative language. We must remember that the person living with obesity has a dual role as both ‘patient’ and responsible for almost the entire management plan of a condition which is hard to manage.
We need to focus on the aspirational positive outcomes of weight loss, such as playing in the park with the kids or being able to go out dancing at the weekend, rather than the negative aspects of not losing weight.
We should also avoid making assumptions about diet and physical activity. Changes in lifestyle should be applauded, no matter how slight, as this is likely to stimulate further gains. Trivialising these efforts can demoralise an individual who had made significant lifestyle modifications to achieve relatively minor results.
This is of particular relevance early in the treatment process when great effort is often met with only minor improvements in waist circumference or on the scales. The natural history of a person living with obesity is that weight will progressively climb. Weight neutrality is an achievement for many.
Achieving optimal weight control is difficult, if not impossible for many. This year has seen the introduction of the first new drug for over a decade that offers benefits almost as potent as bariatric surgery. The broad licence indication would make approximately 10 million people in the UK eligible to receive it, though there is a rider that it should only be offered through specialist weight services.
Unfortunately, the lack of these services limits availability to approximately 40,000 people per year. This gap between eligibility and service provision needs addressing if we are to improve the overall health of our nation.
In the interim, however, we as healthcare professionals can have a major role in reducing the obesity stigma within the health care system by getting the conversation right.
There is a role for open discussion but a need for more specific education in the communication of obesity and weight loss. A greater understanding for all of us of the underlying causes of obesity and the use of appropriate and helpful language will improve the experience of people living with obesity.
Until the resources are available to provide the optimum care for people living with obesity, we must all work towards reducing the obesity stigma within society and the health care system.
David Strain is BMA board of science chair