Health problems of obese 'in the mind’

Press, 30 March 1989, Page 28

Health problems of obese 'in the mind’

PA Dunedin The main health problem suffered by seriously obese people is psychological, stemming from society’s judgment of them, an article in the latest "New Zealand Medical Journal” says.

The article, by the Wellington Medical School’s associate professor of psychological medicine, Anne Hall, and the school’s associate professor of surgery, Richard Stewart, said health professionals must stop moralising to obese people, as many of. them were genetically obese. “There is evidence that many health workers are moralising in their management of obese patients,” they said.

“Our view is that it is time for a change in the attitude of health professionals to serious obesity. There is good evidence that the predominant aetiological factor is genetic and hence unalterable.”

The authors said there was also evidence to suggest conservative (nonsurgical) management of serious obesity by dieting was of only limited benefit.

“If we all ate a lower fat and lower sugar diet and exercised more, then many people would weigh less and be healthier.

“Such a change is unlikely, however, to make difference to severe obesity.” Very fat people were subjected to the belief that fatness was caused by lack of self-control and that they were the architects of their own misfortune.

They were therefore seen as not deserving of the same amount of sympathy and care as other people. “Most obese patients are afraid to see

doctors because of the lecture to which they may be subjected, even from fat doctors,” the authors said. Moralising had no place in the practice of human medicine, they said. “Health professionals should treat people, whoever they are and whatever they are, on the basis of their problems and not on professionals’ perceptions of their patients’ culpability.”

There was abundant evidence that the main problem associated with obesity was society’s negative attitude to it. “This creates an enormous psychological burden for fat people, which may be the most adverse effect of obesity.” This pressure was most severely applied to women, who were judged harshly on the grounds of their physical attractiveness.

Weight and body shape were central determinants of attractiveness, which led to eating disorders such as anorexia nervosa and bulimia which affected up to 5 per cent of young women.

The authors of the article said other health hazards of obesity were modest. People who were twice their ideal body weight had a life expectancy which was only 10 years less than slimmer people. However, cardiovascular disease, diabtes and certain types of cancer could be related to obesity. It health professionals “reflect on these concepts,” obese patients could expect them to take a more realistic and humane approach, the authors said.

"This should result in the alleviation of a significant burden of unnecessary suffering.”