You would think that efforts to prevent obesity would be gaining ground in view of the steady stream of obesity epidemic press coverage and campaigns for healthy eating, but recent research findings and political correctness are making the issue more difficult to address. Combine the risk of being viewed as politically incorrect for confronting patient weight issues, with research that finds some obese individuals appear metabolically healthy, and obesity becomes quite an uncomfortable subject to discuss. While many patients view obesity only as an issue of political correctness, it’s your job as a health care provider to keep the issue focused on health.
A recently launched ad campaign by the Center for Closing the Health Gap (CCHG) features billboards of children eating unhealthy foods along with the grim question, “Are we feeding our kids to death?” The campaign has stirred up reaction from groups such as the National Association to Advance Fat Acceptance, resulting in a clash between health care advocacy and political correctness. A press release from the association states, “Billboards such as these create a pervasive bias against fat children, and it is logical that bias begets discrimination.” Pressure is now on CCHG to discontinue the campaign. While CCHG’s approach may be harsh, backlash can make health care advocates wary about confronting obesity.
Obesity research that appeared in the August 11/25 issue of the Archives of Internal Medicine adds another level of complexity to discussing the subject with patients. The research found that among US adults 20 years and older, 23.5% of normal-weight adults were metabolically abnormal, whereas 51.3% of overweight adults and 31.7% of obese adults were metabolically healthy. In explaining the data from the study, the authors write, “These data show that a considerable proportion of overweight and obese U.S. adults are metabolically healthy. …” Though the study says that some obese and overweight adults are metabolically healthy, they are still more likely to be unhealthy compared to those in the normal weight category. Nevertheless, this data seems to be taken out of context, as indicated by a comment posted in New York Times coverage of the data: “This is why having a large number of ‘overweight’ people is not actually a problem if they are mostly healthy. … So when the anti-fat crowd get all self righteous about how it’s just about our health, it’s a lie. It is because of the beauty myth. Nothing more. Nothing less.”
When research is taken out of context, and it is not PC to discuss weight issues, how can you approach patients about weight problems without offending them or appearing to go against research that is interpreted as saying “being overweight is healthy”? Besides analyzing your attitudes and those of your staff and creating a welcoming environment for obese patients, check the sidebar from Kelly Brownell, PhD, and Rebecca Puhl, PhD, for tips in reducing the chances of bias against obese patients. Be sure to stay updated on obesity by subscribing to our e-newsletter, Sleep Report.
—Franklin A. Holman