Margaret McCartney: Cancer patients should not be shamedBMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k1139 (Published 12 March 2018) Cite this as: BMJ 2018;360:k1139
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Although I am no fan of Cancer Research UK, I think Margaret McCartney is being unfair. We need to explore different ways of getting key messages across to the public. For many years doctors played down the association between cancer and obesity, partly one suspects because of this fear of upsetting patients. In recent years even the media has begun to report it.. Should the association between obesity and Type 2 diabetes not have been mentioned until we grasped a causative association? If we identify an obese child we should not just ignore it because the parents may feel a sense of shame. Given the right incentives, many overweight and obese people seem perfectly capable of losing weight, and perhaps there is some value in encouraging obese patients to be aware and possibly more likely to attend screening programmes for those cancers which seem most closely linked.
The message about cancer and obesity is not just for the obese, but also for those without a significant weight problem as yet. Information about smoking was aimed at discouraging people from starting as well as stopping. It is unclear just why some obese patients feel that the cancer association is seen as a stigma – is this because they do not wish to know or is it because of a perceived “disrespect” of their lifestyle? Smokers and many with a high alcohol intake often seem to react with irritation not shame when risks are pointed out. Evidence from social media that some people feel shamed is not an adequate reason for changing a campaign policy.
Obesity is becoming the major health problem for our Society and strain on the NHS. Although the cancer association and risks for the individual are less than for smoking, for the NHS the numbers – if there is a causative factor – are likely to be greater on account of the prevalence of obesity and excess weight in the population. Our role as the fattest folk in Europe (outside Malta) is something which I find shameful and even more shameful that we have stood by and watched it emerge. If we are to tackle it we may well tread on a few toes both in the food industry and amongst the obese – the old “It’s not your fault” , “You have big bones”, etc … approach did not work either. There is a fine line between trying to ensure people are informed and public awareness campaigns of this type and shaming in the sense of emphasising the damage done to the NHS (and to others) as a result of the demands placed upon it. Cancer Research UK does not seem to have crossed this line.
Competing interests: No competing interests