Melissa Musiker is a registered dietician and a member of APCO’s Washington, D.C., health policy team.
January 20 – 26 was National Healthy Weight week. Strategically positioned to be right in the middle of the post holidays and New Year’s resolution use-your-gym-membership season, the premise behind Healthy Weight Week is to remind people concerned about their weight to stop fixating on numbers and focus on building healthy habits and a more positive self-image.
Recognizing the economic difficulties facing society as a result of rising healthcare costs associated with obesity, and the fact that a winning and innovative strategy to address this crisis is needed, Hastings Center bioethicist emeritus Dr. Daniel Callahan, in a recently released controversial paper, posits three potential solutions to addressing the obesity epidemic: strong and somewhat coercive public health measures, childhood prevention programs and extreme social pressure on the overweight.
Arguing that the first two solutions are impossible without first achieving the third, Dr. Callahan mulls over how to stigmatize obesity in the way we have stigmatized smoking, such that, over time what previously had been considered a bad habit becomes “reprehensible behavior” ideal for regulation and aggressive prevention.
Callahan argues that although it might feel culturally uncomfortable to do so, those who are overweight need to be made acutely and constantly aware that they are overweight and that isn’t ok.
We live in a society where there has long been significant cultural pressure to be thin. Obese young people have poorer educational outcomes known to be due to bias in the classroom. Obese individuals have poorer health outcomes due to the increased burden of disease and the fact that across the medical profession, from students to practicing physicians, there is a reluctance, and at times even hostility, towards treating obese patients.
For married couples, weight can become as much of a relationship stressor as finances, and, when the female partner is overweight, there is even more risk for marital conflict as reported last week by the Wall Street Journal. Overweight individuals, but most particularly women, face a new kind of glass ceiling — they are less likely to be promoted and more likely to receive lower salaries.
Men need to be visually obese before they face similar discrimination. Case in point, New Jersey Governor Chris Christie has been described as too fat to be a viable presidential candidate, despite his popularity and an otherwise appropriate resume. By waging a policy war against obesity, experts have noted that increased stigma will be placed on those who are overweight and obese.
So if Dr. Callahan’s theory of change is true and 66 percent of the population who are currently overweight or obese need to be nudged and judged into a state of awareness that their body habitus is problematic at both personal and societal levels and there is clear and convincing evidence that this type of stigma is increasingly institutionalized, then is National Healthy Weight Week aligned with his “modest proposal” or acting against it? I’ll leave the reader to be the judge.