Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK
Fat people eat more ice cream. That’s not an evidence based, statistically validated or methodologically robust observation. It just looks that way to me.
Yet it fits with the Global Burden of Disease Study published this week. “British girls become the fattest in Europe” shouted the Times of London headline on Friday, and this was echoed in almost every other UK newspaper. Canadians will be relieved to know their figures are better, but those for the USA are much worse.
Overall, the world wide prevalence of obesity has increased although, interestingly, it appears that the rate of increase has slowed in developed countries.
Now back to the anecdotal evidence. Just when I fancy an ice cream, and far away from international obesity data, it’s almost certain that I will meet some obese teen ambling along, slurping a giant ice cream cone. It puts me off. It is not politically correct, however, to imply that obesity is someone’s fault. You might think that, as a doctor, you could reasonably suggest in a consultation that someone lose a little weight. But, beware! To imply, even obliquely, that someone might be fat because they eat too many chocolate donuts, candies, or biscuits is to risk a major argument. Like almost everything in health, someone else must be to blame.
Muffin tops are the norm. Jeans bursting at the button. Great wobbly bellies, man boobs, and enormous reinforced bras. Clinicians see the fat mountain daily. We already know about inflated clothes sizes and airplanes with larger seats. But, as a population, we seem blind to the need to re-calibrate portion size and challenge the nature of fast food.
The wrong food is cheap, convenient and there are too may vested interests. We live in a world of giant sized soft drinks and buckets of popcorn where even children going to the cinema consume enough calories to feed a family in Africa. Yet, we cannot accept that we are creating generation O-for-Obesity.
Controversial? I can feel the rage of overweight people saying that I do not understand; they have big bones, eat very little, must have something wrong with their glands, or it’s genetic (it’s not). But, I do concede that we are all a little to blame. We tolerate a fast food society, allow governments to capitulate to the food lobby and make it so difficult for people to be physically active.
Fat is a complicated issue.
This blog does not reflect an official CMAJ stance nor should it be interpreted as such. It is not a peer reviewed academic paper and it was written in an informal style using one dietary choice as an example of personal choice. There is indeed a vast academic literature that identifies the many factors in the cause and treatment of obesity. In writing this blog post I aimed to generate discussion and stimulate debate and did not intend to offend. To anyone who took offence, I unreservedly apologise. I used the blog as a literary vehicle to start a conversation about the difficult issue of rising rates of obesity which, sadly, results in so many medical problems.
Obesity is a major social and medical issue that we need to address. Yet obesity is a personally sensitive issue, and having a conversation about it is always difficult. It is, of course, associated with many factors ranging from the individual to the collective as mentioned in the comments above, and I agree with many of the points raised. However, the blog was not primarily focused on treating obesity, caring for patients who are obese, nor the very difficult struggle that individual patients have about managing their weight. It is about aetiology and our personal, population and health policy responsibilities. David Huynh put it well above: “We have to make the healthy choice the easiest choice. This is the only way we can ever improve the health of the globe.”
This editorial saddens me, and embarrasses me as physician and CMA member. This article only serves to promulgate physician attitudes which alienate, rather than engage, patients in health care. When physicians communicate these beliefs to patients, we not only fail to help; we actually do harm. This bears out not just in the medical literature; anecdotal evidence abounds in my own practice.
I call on Dr. MacAuley and the editorial staff to consult the literature in this area (some of which is referenced by commenters above), consult obesity medicine experts (many of whom have commented above), and reconsider their position.
Please note this is not an editorial but a blog
On top on reams of studies which implicate everything from an infection to genetics to HFCS to slow metabolism,, there is a new paper which shows immune overload from excessive vaccines can also contribute to obesity. Shaming does nothing to treat the underlying issues. In fact, stress hormones have also been implicated and guess what increases stress? Why constant attack and shaming. Stress is ALSO implicated as a culprit in all the major “obesity related diseases”. Perhaps the medical profession would do well to look at their biases and re-examine their understanding of corelation & causation.
I would suggest that the author and anyone else who still thinks that blame and shame are appropriate responses to addressing obesity have a read of our recently published paper – http://qhr.sagepub.com/cgi/content/long/24/6/790
This explores the issue from multiple perspectives, and provides some Canadian evidence for why we need to have a conversation about how we talk about weight issues in health.
The profound ignorance displayed in this post just serves to underscore the attitudes that are at the heart of our inability to get Big Food under control. By using a stream of pejorative terms to describe the overweight, this so-called professor has relieved Big Food of any responsibility in their onslaught of adverts and sponsorships that get kids hooked on hyper-palatable “treats” that are meant to pass as nutrition.
Way to go doc!
How sad that the medical profession still thinks “Shame” is a suitable form of treatment for such a complex disease .
Unfortunately I am not surprised at their lack of knowledge. I am disappointed they do not feel the need to read the real research and get educated on this disease and treatment plans that will work. Shame on you!
What would it take to modify our ‘health’ environments?
Your hospital probably doesn’t sell
It probably doesn’t have
video lottery terminals
Staff probably discourage
Let’s keep junk food and high-sugar drinks outside a healing environment.
This article belittles those who are obese and who may be trying their hardest in order to lose the weight. It stigmatizes them as people who cannot control themselves and as people who gorge on junk food all the time.
Dr. MacAuley should not be using anecdotal evidence as a means to explain the phenomenon of the ever increasing obesity epidemic. This piece of anecdotal evidence is really unfair to those who live in food deserts for example who probably have no choice to consume junk food as a means to survive. Though we all make bad decisions sometimes, like eating ice cream, the message we need to send to people is one that Dr. Freedhoff would often say, which is to “live the healthiest life you can enjoy, and not the healthiest life you can tolerate.” Moreover, for people who are in that food desert situation, we must work together to increase the access of healthy and affordable food them, and this blog post really fails to acknowledge that fact and would simply put them into the category of individuals who don’t care about being obese.
There are a multitude of other factors at play, but to cut to the chase, we have to make the healthy choice the easiest choice. This is the only way we can ever improve the health of the globe.
I find it incredibly telling and hypocritical on the part of the CMAJ that in the blog post for June 3 entitled “Our relationship status with alcohol: it’s complicated”, the author writes: “Individuals with health problems resulting from alcohol use deserve our understanding and compassion; not our judgment. It is hypocritical to attach stigma to such conditions, while permitting alcohol to play such a major role in our lives.” Yes, yes indeed, let’s not be judgmental towards an alcoholic because alcohol plays such a very large role in our lives. But dear god in heaven, let’s shame those awful fat people! After all, they could avoid food if they want! Food doesn’t play nearly as large a role in our lives as alcohol. Oh. Wait. Well, anyway, those horrible ice cream-eating fat people should be ashamed.
Who in the CMAJ gave the clear to publish this ignorant, biased and fat shaming article?
If this is the caliber of the professors in primary care in today’s academy, we have bigger problems than ice cream.
Congratulations to Domhnall MacAuley, for stating it the way it is. Yes, some are obese due to genuine health issues, but given the growing prevalence of the disease, the problem is political correctness, rampant in every sector of our society, blame is placed on everyone other than the individual who is consuming excess calories and living a sedentary life style. The same is true for those smokers who die of cancer, cyclists who refuse to wear helmets, drivers who drive and text, do not wear a seat belt, etc. who expect to be treated, all at the expense of the majority, who are accountable for their own actions.
The author could start by signing up for the Future Learn course https://www.futurelearn.com/courses/obesity Week one discusses some of the prejudices that healthcare professionals hold.
Sara Stein MD
My suggestion? You should only treat thin healthy patients. Nobody who is struggling with weight should have to come to a judgmental undereducated physician in order to be told they are defective. Not only is this ignorant, it’s mind-bogglingly hateful.
On the other hand, nice of you to come out of the closet finally and admit you hate fat patients. Saves them the phone call for an appointment.
Sara Stein MD
Board Certified, Obesity Medicine
“Domhnall MacAuley is a CMAJ Associate Editor”
^^^^The ONLY way this article got published at all, anywhere.
Wow, broad brush. What are you really trying to say here? I would blame obesity on 100 things PRIOR to ice cream. How about a nice study? Some numbers?
So you admit you have no data to back up your assertion, and pad it out with hateful and shaming language and then wonder why your patients don’t respond well to your suggestion? Interesting.
And you rail against people not “taking responsibility” for themselves while nodding to the issue with ubiquitous hyper-palatable food? Which is it? And why is there no mention of the robust literature indicating that economic inequality and systemic racism play a PROFOUND part in access to healthful food, safe places to be active in, knowledge of cooking and nutrition, and the time to shop, prepare, and eat that healthful food? Never mind the impact of consistently high stress hormones on waistlines–hormones that are triggered by poverty, too little sleep, and systemic barriers.
CMAJ should retract this article and apologize. And the author should educate himself.
The Ancestral Chemist
I find it interesting that the author says that “obesity is a complicated issue” after reducing it to the allegedly lazy and greedy behavior of obese people. As it happens, studies have found a strong genetic component to obesity.
Fat is actually very simple. If you don’t want to be fat and you don’t have a superman metabolism then you need to control your calories not your ice cream.
The ignorance and bias in Dr. MacAuley’s rant is shocking, though not nearly as shocking as the CMAJ’s decision to publish it.
Might I suggest that Dr. MacAuley visit some of the medical literature surrounding the impact of fat shaming and weight bias on healthcare. Thankfully folks who do in fact care about evidence rather than personal observations have compiled a whole slew of resources that perhaps might be worth his while to peruse.
Sara Stein MD
The good news is that Dr. Freedhoff in Ottawa is accepting patients for obesity treatment, and has good results. You can read his new book The Diet Fix, and learn what trips people up, no matter which diet you choose. Which also means, if you have a weight problem, you don’t have to deal with doctors like Dr. MacAuley.
Domhnall MacAuley is a first class idiot. With this attitude about obesity I’m guessing that if he were to give his honest opinion, we should shoot drug addicts, execute Type II diabetics, put cancer patients out their misery and put hepatitis and HIV patients in colonies away from society. All of these are diseases that often come about in part because of personal choices. As physicians, our job is not to mock, scorn or judge the afflicted even if their afflictions seem avoidable. You have brought shame to your profession Dr. MacAuley.
Domhnall MacAuley’s ignorance is sadly typical for the attitudes that most health professionals have towards people with excess weight – but reading this type of comment from an Associate Editor of a respected medical journal makes me question just how responsible the editorial board of this journal feels regarding providing empathic and caring support to people living with this condition. Physician – heal thyself!