Educational interventions are unlikely to work because obese people aren't unhappy enough to lose weight
BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e8487 (Published 17 December 2012) Cite this as: BMJ 2012;345:e8487
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Dear Editor
Your BMJ issue on 5th of january 2013 contains on the 3rd page (not numbered) an image of an obese young man "indulging" on what looks fast food with a footnote "getting obese people to care".
It is regrettable how negative and politicaly incorrect this image selection was. What it transpires to the reader is that obesity is a fundamental lack of discipline. As a prestigious and highly regarded journal your message is totally wrong and needless to say insulting. It lacks sensitivity and encourages a culture of "sizism" amonst doctors.
As a bariatric surgeon at the forefront of the battle for obesity I can reassure you my patients have suffered all their life immense misery, discrimination, and sigmatisation from non-medics and sadly from many doctors who do not understnad that obesity is a disease which at least 70-80% is genetically determined. Images like this only perpetuate amongst many doctors a culture of discrimination against obesity. Most of my patients will give an arm and a leg to slim down and have spent their whole lives on dieting. Unlikely to many chronic diseases and conditions such a diabetes, epilepsy, asthma, alcoholism, drug abuse etc which can be hidden obesity is visible and difficult to hide!!!
If we want obese people to care first of all we as doctors have to care for them in a non-judgemental way and not degrading them with images that create a negative impression. In my humble experience with treating obesity it is an agonising disease and a daily battle which sadly can never be cured but only controlled, even by surgery.
Competing interests: No competing interests
The economic modelling used by Dolan and Kavetsos is part of the problem of obesity (1). Of course, simply providing information and advice on obesity’s harmful long term effects is largely ineffective – we do not need research studies and reports to show us that. More revealing is the nature of the evidence presented by the authors. They seem to take for granted that reducing a human being to an isolated individual with motivations measurable in numbers will produce more than superficial answers to obesity or any other facet of the human condition. In fact, the pervasiveness of this sort of abstract reasoning based on simplistic theoretical economic models is one of the root causes of the pattern of deep loneliness and fear that characterises consumerist societies.
Absent from the calculations are the key bigger-than-self problems: the concern we should feel for our indebted and lonely neighbour, the worry over the unsustainable burden of our lifestyle-related illness on our NHS, the looming catastrophe for our planet of our grotesque over consumption. Of course, manufacturers and advertisers prefer to continue grooming us into lone choosers bent on competitive hedonism (2) and the authors are right, there will have to be legislation of the food industry. But until mainstream economists change the way they think, nothing much will get better.
1. BMJ 2012;345:e8487
2. BMJ 2012;345:e8082
Competing interests: No competing interests
Re: Educational interventions are unlikely to work because obese people aren't unhappy enough to lose weight
This seems to be a new low in blaming the patient. Most people are quite distressed at being overweight and are frustrated by inability to get control of their own weight, frequently because they try to follow the advice of physicians and nutritionists who have an extensive record of failure and an unwillingness to break with the the party line enough to investigate new ideas, in particular, dietary carbohydrate restriction which has good clinical results and which outperforms conventional methods for however long they are compared.
In addition, carbohydrate restriction has numerous followers; the Active Low Carber Forums has almost 150, 000 members who, if asked, would probably say they are much happier than when they tried to follow the standard recommendations. Educational interventions are unlikely to work because health providers are not unhappy enough about their failure to learn something new. Doctor, heal thyself.
Competing interests: No competing interests