Saturday, December 16, 2006

Waistlines with Helplines

A recommendation by European metabolic researchers to place obesity helpline numbers on clothes for fat people appeared yesterday and caught my attention in part due to the concerns of obesity in England, but mainly due the discriminatory nature of the labels. To me, it is yet another example of government and academics overreaching into the private lives of our patients. Unfortunately, with the world-wide distribution of these stories, it is frightening to think that other government officials might think this is a good idea. With this logic, why stop with labels for the obese? Why not place labels appear on the flies of trousers or the thongs sold at Victoria's Secret that say, "Promiscuity is a high risk behavior and could kill you." Or why not put a warning label inside baseball jerseys that says "Excessive beer consumption can be hazardous to your health?" And staying completely mundane, when was the last time you read your pant or shirt label anyway?

Will such labels change eating behaviors? Doubtful.

I have never met an obese individual who didn't know they were obese. Many of them have very real reasons they are obese, including psychosocial issues that are far more resistant to intervention that any warning label will correct. Some of these people are unhappy, others are indifferent, others eat for nurturance, for others it is a compulsion. Others are just exasperated at their inability to gain control over their situation. Whatever the root cause, the psychodynamics of obesity are too complicated to be solved with garment labels. Do we really think government intervention with "labels" will solve these deep seated and very personal issues? On the contrary, these labels might reinforce the very negative perceptions they intend to help, catalyzing the compulsion still further.

Personal responsibility and real medical and social interventions are needed to battle the obesity epidemic. Socioeconomic stressors also play a significant role. Only improved awareness, education, increased physical education and support programs paired with regular physician follow-up will help guide people to lifestyle modifications that will insure a safe, long-term solution to this problem. There is no quick fix.

Significant challenges lie ahead for governments and healthcare providers dealing with the obese. For starters, few individuals see mild or even moderate obesity as a health issue - after all, most of us chubby soles feel fine. We (doctors and educators) have done a poor job educating the population regarding what's good and what's bad: mixed messages abound. We make deamons of trans fats, saturated fats, high-sugar content foods, creams, Oreo cookies, and on, and on, and on, while placing soda machines in our schools and feeding high carbohydrate junk at lunchtime in schools. Exercise, although touted, is seldom granted time to perform in workplaces fixated on productivity. The relentless buzz regarding low-carbohydrate diets, sugar-free diets, and others becomes background noise: blah, blah, blah. They've heard it all, and nothing works for them.

But there are success stories. Some people really do lose weight. Some really do lose their diabetes, hypertension, and chronically painful joints. But most of these successes are due to active intervention by family members, caregivers, and a healthy dose of self-realization of one's situation. Pants labels just aren't in the mix here. Only when each of us takes responsibility, doctors and patients alike, will there be success in this war on fat.


1 comment:

Anonymous said...

Well Done, Dr. Wes.

This was also my first reaction to this plan of putting a "message" to the overweight on labels of clothing. How could this do good? All it will do is to reinforce the perception of failure on the part of the overweight. It seems to me that this is just a way of sneering at the overweight.

Working in practice, those who really lose weight are not those who are beaten over the head. There seems to be something that finally clicks inside them and they "just do what I have known all along." Most overweight people know the problem and are aware of the solution. It is naive to think that telling them again will get them to lose weight. We need to find the emotional keys for our patients that can unlock this, not just give them another reason to loathe themselves.

The key, as you say, is for the patient to take that responsibility instead of blaming others. The only way to change is to change. People want change to happen to them and not to make the change themselves.