Thursday, April 21, 2011

Why isn't obesity an election issue?

So here we are in Canada in the midst of an election. Promises are being made, platforms are being unveiled, and politicians are prowling the land.

So let's pretend for a moment there was this problem in Canada. A public health problem, and it was a biggie.

Let's say there was a virus out there, and for arguments sake, let's say it was killing 25,000 Canadians a year while afflicting millions. And if that's not bad enough, lets say that this virus was a particularly nasty one, in that if it didn't kill you, it markedly increased your risk of getting a whole slew of other medical conditions. Worse yet, this virus wasn't silent. Infection with this virus was visible to the naked eye, and consequently sufferers became regular targets of societal bias. Infection also lead many to suffer with marked fatigue, and also made completing activities of daily living more challenging, with difficulty rising with degree of infection.

Let's say too that while there was no vaccine or treatment that worked for everyone, there were both public health and medical interventions that might make a difference, if even just to combat the rising negative bias in society, as sufferers were ridiculed regularly, and even had their visible affliction leading them to lower salaries and fewer promotions. Let's also say that amazingly and shockingly, medical schools and other health care professions weren't being taught how to deal with this virus, and that the media had a bad habit of blaming those with it as being personally responsible for contracting it.

And let's say that one quarter of all Canadians were infected.

I'm guessing that virus would be one hell of an election issue.

And yet the leaders and parties are virtually silent on obesity, a chronic relapsing disease that kills, sickens, stigmatizes, and challenges millions of Canadians. Our medical schools don't teach our young doctors how to deal with it, and our government spends comparatively nothing on it.

Need an example? Just a few short months ago, rather than actually do anything, the government launched a "national dialogue" on childhood obesity. This despite having held a series of public consultations (of which I was a part) that had culminated in a March 2007 House of Commons Standing Committee on Health report of actual actionable steps.

And now 4 years later, there's still been no action, except to suggest we need to repeat the dialogue our tax dollars already paid for back in 2006?

Someone's got to stir things up!

To that end I'm very happy to report the birth of Reality Coalition Canada (RCC). RCC is a group of 15 diverse Canadian clinicians and researchers who have both expertise and passion in advocating for reality as it pertains to obesity prevention, treatment and policy. Our official launch will be a breakfast talk on April 30th during the Canadian Obesity Network's National Summit and we're hoping, through white papers and noise, to help spur Canada out of dialogue and into action.

And maybe, with some media attention next week, maybe, just maybe, one of the parties will be brave enough to actually start thinking about what we as a country ought to be doing to help deal with this very real, yet readily ignored, public health crisis.

[For more thoughts on this topic, later this morning please visit my co-Reality Coalition Canada member, friend, colleague and fellow blogger Dr. Arya Sharma's blog, as well as my other blogging buddies, Travis Saunders' and Dr. Peter Janiszewki's Obesity Panacea]

(And remember, for extra tidbits, or if you'd prefer to follow this blog there, you can also follow Weighty Matters on Facebook)

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  1. So let's say this horrible virus, which you've described in great detail in your post, does exist.

    We've tried appealing to people's amour-propre ("the virus makes you really ugly and unappealing"), we've tried telling people that they are simply morally weak and could beat the virus if they only really tried ("why don't you have enough willpower, you lazy, gluttonous slob?"), we've tried slicing and dicing their bodies in an effort to turn around the virus's effects (aka "weight loss surgery") and for the past few years we've been trying to frighten people into curing themselves of the virus ("you will die a horrible, early death if you don't do something drastic NOW").

    None of this works, at least in 95% of cases. It's a pretty dismal success rate, I'm sure you'll agree.

    So what tactics are we implementing to turn this ship around? All of the above, with a special emphasis on fear-mongering.

    Add to the mix the fact that repeated dieting actually often exacerbates weight gain and, as they say, "look at the fine mess we're in now".

    There has got to be another paradigm. A completely different paradigm. Otherwise, nothing will change. Can I hope against hope that your conference in Montreal (which I would dearly love to attend, but can't) will look at "health at every size"? Even for just a minute or two?

  2. And please allow me to add:

    During our federal election, I agree that we should be talking a lot about health, health promotion and the social determinants of health–these are the issues that are going to improve our health and NOT screaming that we are in the midst of an obesity epidemic and that the only answer is to LOSE WEIGHT NOW.

    Unless you know of a magic formula that people can follow without driving themselves crazy in the process, without making dieting and exercise into a part-time (or even full-time) job, without causing even more cases of disordered eating, medical disasters (what’s the complication rate for weight loss surgery? pretty high, I believe) and further stigmatization of those who aren't slim (and have probably never in their lives agonized over having an extra slice of bread, or a handful of nuts, or god forbid a chocolate sundae just once a year), for goodness sake, please stop concentrating on weight and start thinking about overall health, which is possible even if your BMI is over 25.

  3. Hi NewMe,

    Everyone reads with their own goggles, and I get that, and respect it.

    That said, my statement, "if even just to combat the rising negative bias in society" is something I think we're entirely capable of.


  4. I have to agree with NewMe on this. We've made this an issue about personal failing rather something we've actually tried to develop realistic solutions for.

    I mean to add to it, let's also point out several studies have shown there might be a link between low socioeconomic status and high BMI. So the people who are affected by this virus are disproportionately from the lower and working classes. A study also showed that white men have a more innaccurate perception of their own BMI or being overweight. As in white men are more likely to not realize they themselves are overweight. So the people running the show are more likely to think of this as "other peoples problems." I mean do we have viruses that kill thousands of people a year but in non-voting populations that the politicians tend to ignore or tell us is not a problem here? Do they tell us that lifestyle choices are to blame for this virus and devote no national resources for dealing with it? Do the people affected by this virus tend to come from underrepresented groups and people with little to no political power? Yes there's a virus like that.

  5. Anonymous9:14 pm

    Trust me, I do not want to be "fat" and want to rid this virus more than anyone in my life. I hide inside my house and no longer take part in many of the activities I enjoyed in the past. I have a healthy diet and yes I exercise - yet, I am fat. My mother is fat, my brother is fat, my Aunts and Uncles and many cousins are fat. We don't all sit around eating chips and ice cream and yet although most of the people within my family try to eat healthily our portions are too large. I am in fact a vegetarian, a big fat vegetarian, eating quinqua, vegetables, tofu, soy, lentils and beans and yet fat all the same. Frankly, I never feel full - how does one know when to finish their meal if they never feel full? Imagine for a moment that your tummy never feels sustained and you are always left wanting for more.... how would you feel about the virus then?

    Thank you for thinking and relating to people like me. I look forward to being part of the solution, and following weight loss surgery I plan on dedicating a part of my life to finding a voice for all those suffering of this terrible disease.


  6. Government caused much of the obesity epidemic, and now you want them to fix it?

  7. Anonymous 210:33 pm

    Obesity, at a population level, can only be "cured" by outlawing certain foods, mandating activity, or taxing people for having a high BMI (which will be unfair to muscular people). A virus is an external entity that is attacking people, but on the other hand to attack obesity is to attack personal freedom. Obviously, this difference makes your analogy faulty.

  8. Anonymous11:47 am

    In the States it's a normative shift that you're calling for. To stick with the virus analogy, this is something that crept quietly into our awareness, and spread slowly enough that it is now viewed like a demographic indicator instead of a life threatening disease.

    People got "just a bit bigger" and we were told not to make fun of or single out aunt Bertha--she was just larger, heavier set, but nothing to be ashamed of. There began a shift in the cultural values to include obesity, and the larger consumer dollar supported the obesity norm.

    And now we know bigger Bertha is much too large. Her health is visibly affected. But the precedent she, and any person who inadvertently supported behaviors that reinforced the norm, set is now deeply rooted and rewarded in the culture.

    We have increased awareness--Michelle Obama has her "fight against childhood obesity." But what has to happen to shift the paradigm? And, how does that happen in a manner that is consistent with current societal values and the norms they promote?

    When obesity stops working for us all, it will change.