Is obesity a lifestyle choice or a disease?

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Is it genetic?
Or is obesity just plain gluttony and the result of laziness and the lack of discipline to exercise and watch what one eats?

"Advocacy groups such as The Obesity Collective from Australia are now calling for industrywide regulations that do not discriminate against guests of size.
They posit that obesity is not a lifestyle choice but a disease – a stance shared by bodies such as the WHO and the American Medical Association, even if some medical experts disagree."

Should plus-size travellers get an extra seat on the plane?​

Around the world, waistlines are expanding as airline seats shrink. But clear and compassionate regulations can help larger travellers avoid discomfort and embarrassment.​

Clara Lock
Travel Correspondent

Some plus-size travellers are calling for airlines to offer them an extra seat free of charge. PHOTO: UNSPLASH

Apr 30, 2023

Even at the best of times, flying can be painful. Your neck aches from lolling sideways while you doze, your knees hurt after being bent at 90 degrees for too long and a dull ache is spreading across your lower back.
Now imagine enduring all that as a plus-size traveller. The discomfort and indignity prompted a plus-size woman from the United States to petition airlines to provide larger travellers with an extra seat free of charge. Unsurprisingly, her campaign sparked headlines and heated debates.
Around the world, airline seats are shrinking even as people are getting larger. FlyersRights, a US-based not-for-profit organisation, found that the width of airplane seats has shrunk by about 5cm over the past few decades. The pitch, an industry measure of legroom, has been reduced by about 5cm to 13cm.
Meanwhile, worldwide obesity has nearly tripled since 1975. About 39 per cent of adults are overweight, with a third of them obese, according to the World Health Organisation (WHO). Singapore fares better, with the obesity rate at 10.5 per cent in 2020, though this is the country’s highest in a decade.
Currently, many airlines including Scoot, United Airlines and British Airways require plus-size passengers to purchase an additional seat. Canada-based airlines such as Air Canada and WestJet are an exception, after a 2008 court ruling required them to provide more than one seat to severely obese travellers or disabled people who need an attendant seated with them.
In general, airline websites state that passengers who cannot lower the armrests or fit comfortably into one seat are expected to purchase an extra one.
“Failure to do so may result in you being denied transportation,” states budget carrier Scoot on its website.

Fairer rules across the board​

Are the current rules fair? Some think not. Advocacy groups such as The Obesity Collective from Australia are now calling for industrywide regulations that do not discriminate against guests of size.
They posit that obesity is not a lifestyle choice but a disease – a stance shared by bodies such as the WHO and the American Medical Association, even if some medical experts disagree.
Their main ask is a clearer definition of what constitutes a guest of size. For instance, airlines generally provide their seat width and pitch on their websites but few offer up the length of their seat belt and extender, if the latter is offered.
And what constitutes fitting comfortably into one’s seat? Often, it comes down to a judgment call. If the passenger in the next seat says nothing, flight crew are less likely to intervene.
But what if a passenger genuinely requires more room? Offering them an extra seat would drive up costs for all passengers, though perhaps not as much as one might expect.
In 2008, the Council of Canadians with Disabilities estimated that the new “one-person, one-fare” policy would cost Air Canada about US$6.93 million (S$9.26 million) a year, or an extra 77 Canadian cents (75 Singapore cents) a ticket.

A more inclusive society​

So would you pay an extra 75 cents for each flight ticket in order for larger folks to enjoy a more comfortable flight?
It is a small amount compared to what we shell out for airport or tourism taxes, but realistically, nobody likes a fare hike. Detractors say it is a slippery slope. What else might the majority of passengers be called upon to subsidise? Taller people might point out that they stump up for the exit row, likewise parents for a bassinet seat.
A more compassionate approach is to consider inclusivity.

ST ILLUSTRATION: MANNY FRANCISCO
In recent years, there has been a growing call for disability inclusion, including sensitivity to the intellectually disabled. The Singapore Land Transport Authority’s yellow sticker campaign encourages passengers to offer a seat to those with less visible health conditions, such as people going through cancer treatment.
As a nation, we accept that more of our taxpayer dollars will go to healthcare spending in the years ahead. But obesity remains an outlier.
“It’s one of the few conditions that people still feel OK to mock. People assume you’re fat because you have no discipline or willpower,” says S, who is in his 30s and weighs around 117 kg.
Medical research has found that factors such as medication, hormonal imbalances and genetics can all contribute to obesity. Larger folk know this. But it doesn’t take the sting out of dirty looks from other travellers, or those who outrightly ask flight crew for a change of seat.
To ease potential embarrassment, some plus-size travellers bring their own seat belt extenders, or drink as little as they can during the flight to minimise restroom trips.
Many do their best to reduce inconvenience to seat mates, even at the expense of their own comfort. On a flight from Singapore to Istanbul recently, I sat beside a large man who, despite being in the dreaded middle seat, determinedly avoided using the armrests throughout the 11-hour journey.

Creative and compassionate solutions​

In her book, You Just Need To Lose Weight And 19 Other Myths About Fat People, author and activist Aubrey Gordon talks about navigating the maze of airline policies that determines whether or not she will be allowed to fly, an additional source of travel stress.
In a competitive aviation landscape, companies that can offer a sweeter deal to large travellers might find themselves rewarded by customer loyalty.
In North America, US-based Southwest Airlines has garnered a reputation as having one of the most forgiving policies. Plus-sized travellers have the option to purchase two seats and can get a refund on the additional seat after their flight. According to its website, the airline will grant the refund even if the flight was oversold. Alaska Airlines has a similar policy, but will refund the additional seat only if the flight was not full.
Singapore Airlines staff will, at no cost, shift larger passengers so they have an empty seat next to them as long as one is available on the flight. This applies to travellers who are “unable to be seated without impacting their own safety or those around them”, though the airline did not state how this is defined.

SIA staff will shift larger passengers so they have an empty seat next to them as long as one is available on the flight. PHOTO: ST FILE
Companies do not need to give extra seats away for free – the middle ground is charging a lower price. KLM, for instance, offers a 25 per cent discount to guests of size for their second seat.
Larger seats, costing more, could be demarcated in a “comfort zone” section of the plane, similar to the Scoot-in-silence quiet cabin that the budget airline reserves for those aged 12 and up.
Airlines might reserve exit row seats for those with larger-than-usual measurements, be they plus-size or tall passengers. And if flights are not full, check-in agents could, upon request, offer to block out a free seat next to larger folks.
Airlines, of course, must weigh the commercial viability of such decisions. But I believe some responsibility lies with the non-plus-size majority to make the journey easier for larger folks.
One might groan inwardly if the baby seated next to you begins to wail, but it is poor form to express frustration to the desperately exhausted parents.

Similarly, it is no picnic to be assigned a seat next to someone large. But the kindest approach is to grin and bear it, keep snarky thoughts private and if necessary, request politely that you both try to keep within the armrests. The flight will be over in a matter of hours, but any hostility you express might stay with them for much longer.
In the past few decades, the democratisation of air travel has given us cheaper flights and more routes. Travellers and airlines should take reasonable measures to ensure that everyone can fly comfortably and without discrimination.
S, from earlier, says: “We have to be realistic about how other people will relate to us, but I hope this won’t discourage overweight people from seeing the world.”

 

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Should regular-size i.e., normal, passengers subsidized obese passengers?

US woman campaigns to get airlines to offer free seats, bigger restrooms for plus-size travellers​

Ms Jae’lynn Chaney suggested that plus-size passengers be provided with an extra free seat, “or even two or three seats depending on their size”. PHOTOS: SCREENGRAB FROM JAEBAEPRODUCTIONS/INSTAGRAM, PEXELS

Eileen Ng
Correspondent

APR 17, 2023

A plus-size woman in the United States has started a petition to get airlines to provide free extra seats and bigger restrooms to accommodate larger travellers, in a move that has divided opinions.
In her change.org petition, content creator Jae’lynn Chaney said the US Federal Aviation Administration (FAA) must “protect” bigger-sized travellers by requiring airlines to implement a clear customer-of-size policy that prioritises passengers’ comfort.
The petition, with the hashtag #BodyEqualityinTravel, has been signed by more than 5,600 people.
Ms Chaney suggested that plus-size passengers be provided with an extra free seat, “or even two or three seats depending on their size”.
For plus-size passengers who purchase extra seats on their own, the 26-year-old said airlines should offer a refund.
She also said airlines should have larger restrooms and that all new airplanes have at least one wheelchair-accessible restroom, adding that such change will improve accessibility for passengers of all sizes and abilities.
“Let’s just state facts, plus-size travellers need more space,” Ms Chaney, who is from the US city of Vancouver in Washington state, said in a TikTok video.

“We are not asking for special treatment or luxury accommodations. We simply want enough space to travel comfortably, without being discriminated against because of our size.”
Currently, there are no minimum seat dimensions that airlines have to adhere to, said flyer advocacy group FlyersRights.
The group said US airlines’ seat pitch – the distance from one seat back to the next – has shrunk by 7.6cm to 17.8cm since 1970, while seat width has decreased by more than 2.54cm.


Ms Chaney cited instances where she and her fiance, who is also plus-size, were subjected to discrimination and discomfort when they flew.
“Being forced to occupy only one seat can result in pain and vulnerability, as well as poor treatment from fellow passengers, including hateful comments, disapproving looks, and even refusal to sit next to (plus-size passengers),” she said.
Ms Chaney acknowledged that there would likely be additional costs associated with her demands, but believed it would be worth it.
“Implementing policies to accommodate plus-size passengers may come with associated costs, but these costs must be weighed against the benefits of creating a more welcoming and inclusive travel experience,” she told Fox News.
Her petition and social media posts have touched a chord with people.
“I am plus size and I get the discomfort, but I feel like it’s my responsibility? If it’s too tight, then I either deal with it or buy myself another seat,” said Ms Abby Espejo Enriquez.
Another person, with the user name Syr.Ben, said the FAA “has bigger things to worry about” than Ms Chaney’s petition.

However, Ms Chaney has also received support for her suggestion.
“Seating space is ridiculously small for both large and tall people. Airlines need to make seats larger for everyone’s comfort, especially on long flights,” said Ms Karen Newman.
Some also shared their experiences of being discriminated against due to their size.
“I have experienced discrimination on a plane, not just by other passengers (but) by airline staff. I haven’t flown for 10 years because of my experience with discrimination and bullying as a plus-size traveller,” said Ms Sally-Ann Bentley.

 

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Beyond body positivity: Growing fat acceptance movement in S'pore fights against bias and discrimination​

Miriam Cheong learnt at a young age that her body was "incorrect" through mocking, hurtful comments. ST PHOTO: ALPHONSUS CHERN

Jan Lee

JUL 23, 2022


SINGAPORE- Last month, when actress Xixi Lim first noticed a troll in her Instagram messages mocking her weight, she paid no mind.
The plus-sized host, model and actress - best known for the Ah Girls Go Army (2022) movies - is used to comments both good and bad. But when the 34-year-old posted photos taken with close friend and Ah Girls Go Army co-star Glenn Yong, the same netizen struck again. This time, Lim did not keep quiet.
She tells The Straits Times: "The netizen basically said I was a toad who wants to taste the swan meat and that if I want to partner up with Glenn, I would have to change the way I look to match up to his standards. I'm okay with snide comments most of the time, but someone telling me to change to fit another person's standards? I felt that I needed to respond."
In a series of public Instagram stories that were picked up by several news outlets, Lim clarified that while she is working on losing weight, she is doing it for her own benefit and not to satisfy someone else's ideal.
Her response has sparked a discussion on the toxic culture of fat shaming here.
Plus-sized actress Ross Nasir, 36, co-artistic director of theatre company How Drama, says fat shaming is one of the easiest forms of discrimination to participate in.
"It's just so widely done and accepted. People make fun of other people's weight all the time and get away with it. It's because people think weight is something that can be controlled easily.

"People also do it out of fear - to remind themselves they are not fat and that they shouldn't be. But not everyone is fat because they are gluttonous, lazy and lack self discipline. It's not always something you can control."

Fat discrimination harms​

Ms Aarti Olivia Dubey - a vocal activist on her Instagram account, which has 30,000 followers - has received her fair share of comments about her weight both online and offline.
The 41-year-old former psychotherapist says: "Singaporeans can be quite blatant. I remember the night before I turned 30, I was at the supermarket and a man looked at me, turned to his companion and said, 'Look, at least you're not that fat.'"


Although Ms Dubey's online presence and her photo shoots in magazines such as Vogue Singapore convey the picture of a powerful, confident woman, her journey to self-acceptance was arduous.
A thin child who was thought to be malnourished, she was put on appetite inducers, which led to quick weight gain.
She recalls: "It was a rude awakening going from a skinny kid to a chubby 10-year-old. I received a lot of unsolicited comments about my weight.
"I wasn't sure what I had done to deserve it. I was terribly confused and placed a lot of blame on myself."

Ms Aarti Olivia Dubey has received her fair share of comments about her weight both online and offline. ST PHOTO: GIN TAY
That sparked Ms Dubey's 20-year struggle with disordered eating and body image issues, during which she cycled through all sorts of diets and health regimens.
At her darkest points, she exercised to the point of injury, excused herself in the middle of meals to purge (a term used to refer to self-induced vomiting) in the toilet, and covered up all the mirrors in her home to avoid looking at her reflection.
Few people noticed her disordered eating.
"Anorexia looks very different on a plus-sized person," she explains. "People look at you and just think you're doing something good for yourself. I was congratulated for losing weight."
Anorexia is characterised by unhealthy restrictive eating that causes rapid weight loss. Severe cases can lead to death.
Ms Mok Sook Fern, a senior clinical psychologist at Promises Healthcare who treats adolescents with anorexia, says: "Being praised or congratulated when you lose weight through eating disorders enables the behaviour. Even after the patient reaches his or her target weight, he or she might feel encouraged to keep going."
Years of excessive exercising, restrictive eating, binge eating and purging led to complications, which Ms Dubey still suffers from.
Though she has sought treatment and recovered from her eating disorders, her stomach lining is damaged and her bones are brittle due to over-exercise.
Like Ms Dubey, theatre actress Miriam Cheong learnt at a young age that her body was "incorrect" through mocking, hurtful comments.

Actress Xixi Lim (left) with Glenn Yong at an interview for Ah Girls Go Army Again. PHOTO: LIANHE ZAOBAO
The 27-year-old is the star and writer of The Other F Word - a confessional play last staged in March last year, about her experience as a fat woman whose ambition is to be an actress.
She says: "A stranger shouted at me, 'Get some exercise in, good job', when I was running to catch the bus. I also had a classmate who saw me eating cheesy potatoes and said, 'Oh my God, Miriam, are you really going to do that to yourself?'"
Such remarks have lasting effects. To this day, Cheong still feels anxiety eating around others.
"Unless you're somebody I trust, I'm very careful about what I eat. I'd reject food even if I'm hungry and even eat before a meal with other people, so I'd eat less in front of them."
Lim, who currently appears in Mediacorp's live-streaming e-commerce competition Streamers Go Live, has noticed signs of low self-esteem and body image anxiety in some of her young fans too.
"Some teenage girls will message me on Instagram to ask how to still be happy at my size. They have this idea that you need to look beautiful to be happy or popular," says the actress, adding that she has plans to launch a capsule collection of plus-sized clothing.

More than just buzzwords​

While fat discrimination still runs rampant, the tides are slowly turning, with increased online advocacy against fat bias and more diverse body types in theatre and show business.
Ms Dubey, who started her plus-sized fashion blog Curves Become Her in 2011, says there has since been a "sea change" in how people speak about body politics in Singapore, with more people sharing about fat phobia.
On her Instagram page, she helps to push the conversation forward through her writings on the harm of fat discrimination and the fat acceptance movement.
She also works with The Curve Cult, a local plus-sized fashion label founded by fellow fat acceptance advocate Rani Dhaschainey, to organise panel discussions around the issue and reach out to those struggling with their body image.
Their work is often accused of glorifying obesity, which Ms Dubey says "cannot be further from the truth".
"We never tell people not to lose weight or not take care of themselves. In fact, we emphasise self-care," she adds.
"Fat acceptance is about systemic problems of how society treats and views fat people, and the impact they have. It's about embracing who you are, no matter how you look."
And fat acceptance is more than throwing up buzz phrases such as body positivity.
Cheong says: "Many people want to just stop at 'fat can be beautiful too' without giving more thought to how much anti-fat bias is present in the medical community, and in fitness and diet culture. It's all rooted in the idea that being fat is wrong."
For Ms Dubey, medical fat phobia - implicit biases against fatness among medical practitioners, which can lead to worse health outcomes for fat patients - is one of her top concerns.
She says: "Every time I visit a doctor, I am constantly told to shed weight, but they don't know my story. I have to tell them I can't lose the amount of weight they want me to because I'm no longer willing to subject my body to that torture.
"A certain size does not equate to health. Thin people can have heart conditions too. There's no need to associate fatness with every single health issue out there."

Plus-sized actress Ross Nasir says fat shaming is one of the easiest forms of discrimination to participate in. PHOTO: ESPLANADE - THEATRES ON THE BAY
Dr Donna Tan, a family physician and associate consultant at National Healthcare Group Polyclinics, says that while weight is not the sole indicator of health, obesity is still a major risk factor for chronic diseases that should be managed.
But she acknowledges that pervasive weight stigma can seed reluctance in patients to seek medical treatment, even for conditions unrelated to their weight.
"From the point of view of medical practitioners, all persons deserve respect and we need to better support these individuals with sensitivity."

Encouraging empathy​

Ultimately, the women note, fat acceptance is about fostering civility, respect, understanding and empathy towards fat people.
Last month, Ross staged Big Brown Girl, a musical comedy she co-wrote and starred in, at the Esplanade as part of the arts festival Flipside. It chronicles her dating experiences as a plus-sized minority woman.
She was inspired after speaking to friends who expressed incredulity at the idea of her dating. "Friends who were my allies had their minds blown by the idea that I had a dating life," she says.
"Big women date too. We desire, we dream, we have ambition. We don't have to compensate for our size by having a smaller presence or voice."
While the road to fat acceptance is a long one, Ross is glad the movement is at least being talked about. "I want people to understand our plight and extend empathy to fat people and all people as human beings."

 

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Fat-shaming fuels stigma and discourages people from seeking help for obesity​

There is a misconception that obesity results solely from lifestyle choices​

Tham Kwang Wei, Lee Phong Ching and Marvin Chua

There is largely a misconception that obesity arises solely from poor lifestyle choices. PHOTO ILLUSTRATION: UNSPLASH

MAR 25, 2023


Nearly 60 per cent of Singapore residents aged between 18 and 65 live with an unhealthy weight.
The problem of obesity and other chronic diseases related to the condition will no doubt rise as the country ages rapidly. This will see healthcare expenditures soar, further straining the healthcare system as well as the economy. Continued failure to reduce the prevalence of obesity will result in a total economic impact of $11 billion, or nearly 1.5 per cent of Singapore’s projected gross domestic product in 2035, according to the World Obesity Atlas.
Much effort has been expended on tackling the problem – from the introduction of behavioural change programmes, such as the National Steps Challenge, to making healthier food options more recognisable through the Healthier Choice Symbol, as well as the roll-out of health screening programmes and development of clinical practice guidelines to manage the condition.
But more must be done to address the root cause of the condition: the stigma associated with obesity.

Poor lifestyle choices?​

There is largely a misconception that obesity arises solely from poor lifestyle choices – that people living with it are simply not making the right choices to overcome the condition. In most cases, obesity has a number of causes, including an individual’s genetic and biologic propensity for weight gain coupled with psychosocial factors, lifestyle factors that promote weight gain and an environment stacked with a host of fast-food options.
The erroneous belief of full personal responsibility or the need for more self-discipline to manage excess weight often results in those with obesity struggling for years on their own to lose weight. It can lead to hesitation to seek professional help as a result of past failures and the fear of being discriminated against.
“We constantly face misunderstanding and stigma from others,” a female patient in her 50s said. “They think that our body shape is a result of us not working hard enough, but they don’t know how much work we’ve put in and how frustrated we become when we don’t see results.”

A study in Singapore on patients attending an obesity management clinic found that two-thirds of those surveyed reported being stigmatised, criticised or abused as a direct result of their weight. One in four felt that they had missed out on jobs, were overlooked for promotion, or were retrenched because of their weight.
Research has also shown that weight bias adversely impacts physical and mental health, the quality of care received and the take-up of healthcare. Worse, it could lead to significant physiological and psychological consequences, which include an increased risk of depression, anxiety, disordered eating and decreased self-esteem.

Narrow definition of beauty​

Narrowly defined beauty expectations is another issue. We have seen patients and acquaintances alike turn to weight loss supplements for a “quick fix”, without understanding the complex underlying conditions of obesity.


The promise of drastic weight loss without having to put in the effort and the ease with which such “fixes” are obtainable online make them enticing. But unregulated supplements can be adulterated with medications banned or withdrawn from the market due to safety concerns. Some may advocate a nutritionally unbalanced diet detrimental to health.
The “quick-fix” mentality in those struggling with weight issues can stem from a lack of understanding that obesity is a chronic and progressive health condition. They may fail to see that these “fixes” are only temporary and that a long-term, holistic strategy is needed to address their issue.

ST ILLUSTRATION: MANNY FRANCISCO
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Public education that emphasises safe and effective management of obesity would be useful. The healthcare industry can do well to partner with online and offline retail platforms to develop holistic, scientifically based educational content for shoppers at the point of purchase of such weight management solutions.
While retailers of weight management solutions already proactively indicate the importance of diet and exercise on their products, more can be done. Content that addresses related weight management issues, such as stress, food intake and sleep hygiene, on platforms where people living with obesity are likely to come across this information, will be beneficial.
Having access to this information allows people living with obesity to understand the need for an overall, holistic obesity management journey and make an informed decision about the way forward.

Education, employers and ethnicity​

A change in programmes and services to incorporate the rights of people living with obesity can also go a long way in changing the discourse around obesity and reducing the stigma around weight.
For example, the inclusion of weight management in the Healthier SG plan is one such step, as it helps recognise that obesity is a complex, chronic disease requiring a multidisciplinary – and long-term – approach to tackle.
It is this recognition that has led to an uptick in obesity professional education for medical professionals organised by the Singapore Association for the Study of Obesity, healthcare bodies such as the College of Family Physicians in Singapore, the Singapore Physiotherapy Association and many others in the public and private health sectors.
To build on the momentum of this educational drive, tertiary institutions in Singapore should relook curricula that deal with chronic diseases to include obesity. This should include those in the nursing and allied healthcare sectors, as nurses, nutritionists and psychologists have high touchpoints and provide holistic care for people living with obesity.
Employers also play an important role in obesity management, perhaps even crucial, as many people spend a great portion of their time at work. According to a study, “presenteeism” – or being present at work but unable to be productive due to an illness – is higher among those who do not adopt healthy behaviours. Those who do not eat healthily nor exercise regularly are more than 50 per cent likely to have high presenteeism.
Therefore, employer initiatives should not be disregarded. They should ensure that there are human resource policies in place to create a culture and ecosystem of healthy living at work.
Employer initiatives should include stress management, mental wellness, provision of affordable, tasty and healthy food options, as well as a good work-life balance, incentives to adopting healthy lifestyle activities and access to medical screening packages for chronic conditions with subsidies to allay the cost of obesity treatment.
Obesity exerts a cost on employers in terms of absenteeism and reduced productivity. According to a recent study in Singapore, it found that obesity is estimated to cost Singapore $261 million annually, or approximately 2.3 per cent of the country’s total healthcare expenditure. Thus, a healthier and happier workforce will benefit both employees and employers.
With the multi-ethnic composition of Singapore’s society, targeted and culturally nuanced programmes and initiatives can help to address the unique social and biological factors of each population group. To do so, a wider suite of local research to generate evidence-based approaches to effective clinical and behavioural obesity interventions will be needed.

A study in Malaysia showed that family-based interventions combining face-to-face training sessions and social media were effective at reducing child adiposity, or being severely or morbidly overweight.
The study suggests that a combination of social media and face-to-face intervention may have produced more favourable results compared with a standalone intervention of either Internet-facing or face-to-face intervention.
Obesity is a significant public health challenge that needs holistic, conscientious, and consistent efforts to manage its related costs and health complications. There is no one-size-fits-all blueprint, but through a whole-of-society approach, we can be one step closer to meaningful changes for people living with obesity.

• Dr Tham Kwang Wei is president of the Singapore Association for the Study of Obesity, Dr Lee Phong Ching is a senior consultant for endocrinology at the Singapore General Hospital and Dr Marvin Chua is the secretary of the Singapore Association for the Study of Obesity.

 

[laksaboy]

It is a mental disorder.

 

[mojito]

Its the same thing all the time. Industrial polluters calling for households to recycle plastics; Environmentalists protesting against meat eating coinciding with promotion of bug meats.

Follow the money. Who benefits most from getting other passengers to subsidize miss piggy's flight?

 

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Renaming obesity will not fix weight stigma overnight​

We need to, among other things, move the discussion beyond BMI to the biological, environmental and lifestyle factors associated with it.​

Ravisha Jayawickrama, Blake Lawrence and Briony Hill

Some researchers think the term “obesity” itself is part of the problem, and are calling for a name change to reduce stigma. PHOTO: ST FILE

JUL 31, 2023

The stigma that surrounds people living in larger bodies is pervasive and deeply affects the people it is directed at. It has been described as one of the last acceptable forms of discrimination.
Some researchers think the term “obesity” itself is part of the problem, and are calling for a name change to reduce stigma. They are proposing “adipose-based chronic disease” or “adiposity-based chronic disease” instead.
We study the stigma that surrounds obesity – around the time of pregnancy, among health professionals and health students, and in public health – more widely. Here is what is really needed to reduce weight stigma.

Weight stigma is common​

Up to 42 per cent of adults living in larger bodies experience weight stigma. This is when others have negative beliefs, attitudes, assumptions and judgments towards them, unfairly viewing them as lazy, and lacking in willpower or self-discipline.
People in larger bodies experience discrimination in many areas, including the workplace, intimate and family relationships, education, healthcare and the media.
Weight stigma is associated with harms including increased levels of cortisol (the main stress hormone in the body), negative body image, increased weight gain and poor mental health. It leads to decreased uptake of, and quality of, healthcare.
Weight stigma may even pose a greater threat to someone’s health than increasing body size.

Should we rename obesity?​

Calls to remove or rename health conditions or identifications to reduce stigma are not new. For example, in the 1950s, homosexuality was classed as a “sociopathic personality disturbance”. Following many years of protests and activism, the term and condition were removed from the globally recognised classification of mental health disorders.
In recent weeks, European researchers have renamed non-alcoholic fatty liver disease “metabolic dysfunction-associated steatotic liver disease”. This occurred after up to 66 per cent of healthcare professionals surveyed felt the terms “non-alcoholic” and “fatty” to be stigmatising.
Perhaps it is finally time to follow suit and rename obesity. But is “adiposity-based chronic disease” the answer?

Beyond BMI​

There are two common ways people view obesity.
First, most people use the term for people with a body mass index (BMI) of 30kg per metre squared, or above. Most, if not all, public health organisations also use BMI to categorise obesity and make assumptions about health.
However, BMI alone is not enough to accurately summarise someone’s health. It does not account for muscle mass and does not provide information about the distribution of body weight or adipose tissue (body fat). A high BMI can occur without biological indicators of poor health.

Second, obesity is sometimes used to describe the condition of excess weight when mainly accompanied by metabolic abnormalities.
To simplify, this reflects how the body has adapted to the environment in a way that makes it more susceptible to health risks, with excess weight a by-product of this.
Renaming obesity “adiposity-based chronic disease” acknowledges the chronic metabolic dysfunction associated with what we currently term obesity. It also avoids labelling people purely by body size.

Is obesity a disease anyway?​

“Adiposity-based chronic disease” is an acknowledgement of a disease state. Yet there is still no universal consensus on whether obesity is a disease. Nor is there clear agreement on the definition of “disease”.
People who take a biological-dysfunction approach to disease argue that dysfunction occurs when physiological or psychological systems do not do what they are supposed to.
By this definition, obesity may not be classified as a disease until after harm from the additional weight occurs. That is because the excess weight itself may not initially be harmful.
Even if we do categorise obesity as a disease, there may still be value in renaming it.
Renaming obesity may improve public understanding that while it is often associated with an increase in BMI, the increased BMI itself is not the disease. This change could move the focus from obesity and body size to a more nuanced understanding and discussion of the associated biological, environmental and lifestyle factors.
Before deciding to rename obesity, we need discussions between obesity and stigma experts, healthcare professionals, members of the public and, crucially, people living with obesity.
Such discussions can ensure that robust evidence informs any future decisions and proposed new terms are not also stigmatising.

What else can we do?​

Even then, renaming obesity may not be enough to reduce the stigma.
Our constant exposure to the socially defined and acceptable idealisation of smaller bodies (the “thin ideal”) and the pervasiveness of weight stigma means this stigma is deeply ingrained at a societal level.
Perhaps true reductions in obesity stigma may come only from a societal shift – away from the focus on the “thin ideal” to one that acknowledges health and well-being can occur in a range of body sizes.

• Ravisha Jayawickrama is a PhD candidate at the School of Population Health in Curtin University in Perth, Australia. Blake Lawrence is a lecturer at the same school. Briony Hill is deputy head of the Health and Social Care Unit and a senior research fellow at Monash University in Melbourne, Australia. This article was first published in The Conversation.