Obesity results from many complex factors

June 25, 2013

A reader responds to a previous letter by noting that obesity is a chronic, complex disease with a multifactorial etiology.

I am writing this in response to “Obesity Not An Epidemic” (Medical Economics, May 10, 2013) by Michael Moffat, MD, which I found highly offensive as well as erroneous. Obesity is a chronic, complex disease with a multifactorial etiology. Genetic, environmental, neuroendocrine, perinatal, dietary, and psychosocial factors all contribute to the development of obesity.  In addition, many commonly prescribed medications, such as psychotropic and anti-diabetic medicines, are associated with significant weight gain, so iatrogenic factors cannot be overlooked.

Energy imbalance is the core cause of obesity. Our modern environment is characterized by the avoidance of physical activity and the constant temptation to eat. The lack of fixed-meal patterns at home, abundant food availability outside the home (fast food, vending machines, ready-to-eat foods), increased portion sizes and fewer opportunities to expend energy via physical work produce a net energy excess.

 Genetics, activity patterns, medications, and the food environment all influence energy and weight regulation. Obesity affects all ages and socioeconomic groups. It threatens to overwhelm both developed and developing countries, according to the World Health Organization. Obesity is not only an epidemic, it is a pandemic.  

It is quite unfortunate that obesity is heavily stigmatized by society as well as the medical profession. Obese individuals are not only condemned for their appearance, but blamed for it as well. Weight discrimination has increased by 66% over the past decade and is prevalent even among health professionals.

Patients consistently report disrespectful treatment because of their weight, and weight is blamed for most medical problems. Weight bias negatively affects health outcomes. Obese patients often delay or forgo preventative care because of unsatisfactory experiences, discrimination, embarrassment or discomfort.

Weight discrimination is associated with low self-esteem, depression, maladaptive eating patterns, avoidance of exercise, and impaired ability to engage in healthy lifestyle behaviors. The evidence overwhelmingly points to prejudice, substandard treatment, and unacceptable experiences for the obese population.  All patients deserve sensitive, compassionate and competent care, regardless of their weight.

 Blaming the victim for obesity is archaic and should be obsolete by now.  Haven’t we had enough of this from the food and beverage industries?

Discrimination in any form is unacceptable and should not be tolerated. Weight bias is especially unworthy of the medical profession.

 Joan Temmerman, MD, MS

Connorsville, Indiana