Weighty Thoughts

by Sean Philpott, Acting Director of the Center for Bioethics and Clinical Leadership

I’ve been thinking a lot about Paula Deen, but not for the reason that you might suspect. I’m not all that interested in the way she allegedly treats her employees, her casual use of ethnic slurs, or her half hearted apologies for the way she has behaved. All of that just confirms what I already know: that despite what five US Supreme Court justices seem to think, there is still a strong undercurrent of racism in American society.

I’m more interested in Paula because of her weight, because of her type II diabetes, and because of the culinary lifestyle that she publicly promotes. But I’m not just interested in her. I’m also interested in James Gandolfini, the rotund actor best known for his portrayal of mobster Tony Soprano, who died last week of an apparent heart attack. And I’m interested in New Jersey Governor Chris Christie, a man whose physical size is exceeded only by his personality, but who recently admitted undergoing gastric bypass surgery.

Put simply, I’m fascinated by fat and by America’s obesity epidemic. The problem has grown so large (pun intended) that, at its annual meeting last week, the American Medical Association adopted a policy that defines obesity as a disease that requires medical intervention. Given that 35% of all US adults are considered obese — defined has having a body mass index, or BMI, of 30 or higher — this means that over a third of Americans are now “sick”.

Is being excessively overweight a sickness? Sure, obesity has been linked to as many as 60 illnesses, including heart disease, high blood pressure, stroke, cancer, and diabetes. Moreover, according to the US Centers for Disease Control and Prevention, obesity-related health care expenses cost Americans over $200 billion annually. But obesity is only a risk factor for these diseases, not a disease itself, and there are plenty of overweight individuals who are actually quite healthy.

But is there any harm in labeling obesity a disease? Supporters see the AMA’s decision as an important step in combating the obesity epidemic. It could, for example, increase access to obesity-related treatments like nutritional counseling or personal training not currently covered by most insurance plans.  In the long run, this could actually lead to significant cost savings should the frequency of obesity-related ailments decrease as Americans eat better and exercise more.

Despite this, there are a number reasons to be concerned with the pathologization of obesity. First and foremost, obesity is rarely the result of actual physiological and metabolic problems. The vast majority of cases are the result of a sedentary lifestyle and poor nutritional habits. The obesity epidemic isn’t a medical problem. Rather, it is a social problem with medical consequences. Social problems require social solutions: educating people from an early age about the lifelong benefits of eating right, creating physical environments that encourage activity, and engaging with the food and restaurant industry so that they provide healthier meals and smaller portions.

Unfortunately, Americans tend to look for the easy answer or the quick fix. For many of us, it may be more tempting to pop a pill rather than make the difficult lifestyle changes necessary to lose weight. Our doctors are also more likely to reach for their prescription pad rather than discuss other approaches like exercise or diet. But these pills can come with substantial physical risks or financial costs. For example, almost all FDA-approved weight loss drugs have been taken off the market because of unexpected side effects.

Finally, there is the problem of stigma. As a society, we are already obsessed with media-constructed but often unattainable notions of beauty and health. Pathologizing obesity compounds this problem. Not only are fat people unattractive, at least according to our deeply entrenched cultural standards, they are now diseased. This gives people a ready excuse to provide unsolicited advice, to make snide comments, or to make snap judgments about fat people: they are just worried about their health. Hating the overweight among us will remain an acceptable form of bigotry. Should Paula Deen’s media empire ever recover from her ill-timed and racially insensitive comments, she would be wise to stick with telling ‘fat jokes’.

[This blog entry was originally presented as an oral commentary on Northeast Public Radio on June 27, 2013. It is also available on the WAMC website. Its contents are solely the responsibility of the author alone and do not represent the views of the Bioethics Program or Union Graduate College.]

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