IN Ireland, 25% of all adults are obese and a further 25% at risk, meaning the condition is an epidemic across our society.
A recent Irish Society for Clinical Nutrition and Metabolism (IrSPEN) pilot study looked at the experience of obesity in Ireland.
The study found that those with the condition are discriminated against in education, in work, in social contexts and while accessing healthcare.
Stigma and discrimination are experienced in every environment and walk of life; shopping for clothes and public transport are particular flash-points. While obesity stigma pervades society, it is of particular importance in healthcare.
If people living with obesity are to effectively address the health issues to which they are exposed, they need to work with their GPs and other healthcare providers to find a therapy that works for them.
International research in recent years has highlighted the impact of obesity stigma in healthcare, both on the part of doctors and nurses, and on the part of the patients themselves.
There is an urgent need to tackle ‘Obesity Stigma’ — and understand the condition as a disease that needs to be treated medically rather than by willpower, or New Year’s resolutions.
The ‘your own fault’ fallacy
Stigmatisation and discrimination on the basis of body shape largely reflects the widely-held perception that obesity is the result of a failure of self-control or will-power, and thus the fault of the individual.
The view is that people would not have obesity if they did not choose to eat unhealthy food, avoid physical exercise, and adopt a lazy lifestyle. This leads to a moral judgement – that persons with obesity deserve the condition, which is of their own making, and do not merit assistance, or healthcare which is publicly funded.
Our research found that this opinion is even held by the people living with obesity themselves; they believe, deep down, that their obesity is their own fault, that they know how to deal with it (by eating less and moving more) and that it is nobody’s responsibility but their own.
This view, coupled with social embarrassment, stops people from reaching out to their doctors for support.
This attitude also prevents proven and cost-effective treatments from being made publicly available in Ireland, which has the lowest per capita funding of obesity care in the EU.
Half of the population has not suddenly become lazy and lost its will power. The time is ripe to educate the population as whole, because so much of the population is directly affected.
Diet and exercise not the whole story
Patients, parents, teachers, doctors, colleagues, school-friends, and everyone else need to be informed that obesity is not a mark of failure or lack of commitment, but a disease response to many factors — and many of these are outside of the individuals’ control.
These include genetic heritage, metabolic illness, an unhealthy environment, or combinations of these and other factors. Medical evidence shows that some people are at a far higher risk of obesity than others — and that this has nothing to do with their willpower.
We need to change and see obesity as a medical disease which we must treat, both to improve quality of life for patients and also to save the health system the enormous costs of treating life-long secondary conditions.
For example, type 2 diabetes is a complication of obesity and affects 200,000 people. This single obesity complication accounts for more than 10% of the overall healthcare budget.
Proven treatments, such as surgery, cost-effective medicines, and scientifically proven diets are available and can transform people’s lives.
While a New Year’s burst of diet and exercise is certainly welcome, we know that it will have little long-term impact on most patients’ disease.
Obesity needs to re-framed away from a ’move more, eat less’ attitude, to a ‘seek help with clinical treatments’ response.
People living with obesity need to learn, and to believe, that ‘it’s not your fault’ – that will-power and self-control are not the sole cause of weight gain or weight loss.
Persons with obesity need to be encouraged to reach out to healthcare professions, to have appointments and conversations focused directly on obesity, and to pursue a medical approach to improving their health, as they would with other chronic illness such as hypertension or dyslipidaemia.
Ireland has had excellent success in recent years with public health information around breast cancer screening, prostate cancer, and dementia.
Similar public awareness change is needed for obesity, so that body shape does not lead to stigma, patients are comfortable looking for medical help, doctors take the disease seriously and address it with the best therapies available, and the healthcare system invests in treatment today, to avoid complications of obesity and their associated high-cost tomorrow.
More information at www.itsnotyourfault.ie or www.irspen.ie