Diabetes Self-Management Blog

It was all the rage two or three weeks ago. Bioethicist Daniel Callahan, senior research scholar and president emeritus of The Hastings Center, had determined that fat people needed to be shamed into losing weight. After all, it worked for smokers.

In a blog entry I wrote about it, I noted that I tried to access the original article he wrote for The Hastings Center, “Obesity: Chasing an Elusive Epidemic,” but was unsuccessful. So I quoted from an article in The Huffington Post.

I should have known better. I should have looked harder for the original article and not written anything without reading it.

A reader named Katherine sent a copy of the original article to Web Editor Diane Fennell, who forwarded it to me. In Katherine’s e-mail, she noted she had read a newspaper article about Callahan’s paper “which made this article sound absolutely dreadful. However, after reading it, I came away with a different attitude. How the article was portrayed…and how it really reads are totally different…”

I agree.

Yes, Callahan did mention shaming, but he also pointed out early in the article that obesity has many causes, writing, “The causes of obesity include age (the body’s metabolism slows with age); gender differences (more common in women); genetics (obesity tends to run in families); illness (hypothyroidism); cultural acceptance or indifference (poverty, race); sedentary habits (long commutes, sitting at a desk or work bench all day, watching TV, lack of exercise); poor diet (few fruits and vegetables, processed foods, overly large food portions at home and in restaurants, sugared beverages); and, too often neglected, all the luxuries we possess — automatic garage door openers, can openers, food blenders and mixers, escalators, elevators, golf carts, automobiles, and so on.”

Yes, he gets it — and realizes that obesity can be caused by more than too many calories and too little activity.

And it wasn’t exactly shaming he advocates. Instead it’s more of a “nudge,” utilized early in the process, when people first begin to pack on some weight. It’s easier to lose a little rather than a lot, he says, and notes that it’s probably too late for people who are older and very overweight.

Also, while he does say that shaming worked for smoking cessation, smoking and weight are two different animals.

“Three reasons are common,” he writes. “(I)t is wrong to stigmatize people because of their health conditions; wrong to think it will work well, or at all, with obesity; and coun-terproductive with the obese because of evidence that it worsens rather than improves their condition. Ethically speaking, the social pressures on smokers focused on their behavior, not on them as persons. Stigmatizing the obese, by contrast, goes after their character and selfhood, it is said, not just their behavior. Stigmatization in their case also leads demonstrably to outright discrimination, in health care, education, and the job market more generally.”

As part of a larger effort to prevent obesity, Callahan advocates a three-part strategy to address the problem in the realm of government and business: government action and regulation (for example, using taxes to raise the price of unhealthy foods and subsidizing the cost of healthful foods to make them more affordable); calling for private companies to be more public about the steps they’re taking to make foods more healthful; and calling for employers to do more in terms of wellness programs and financial incentives.

As an aside, I got kind of tickled at what Callahan wrote about private companies needing to be being more transparent about steps they were taking, particularly when it came to Darden Restaurants, which is the parent company of a number of chains including Red Lobster, Olive Garden, and LongHorn Steakhouse. Darden plans to reduce sodium by 20% over the next decade but, says a spokesperson, “we are going to be making changes silently and slowly” and adds that their clients won’t even know it’s happening.

So, no, Callahan doesn’t advocate having people point fingers at the overweight and chant, “fatty, fatty!” He understands that there are many underlying reasons for overweight and obesity, and notes that it’s more productive to nudge people into maintaining their weight before the numbers on the scales zoom into the stratosphere.

I would add that environmental changes need to be made, as well. Don’t bring food into the house that isn’t healthful, except on rare occasions. Use smaller dishes. I have a set of dishes from my husband’s family. You’d be amazed at how small the sizes are compared to today’s dinnerware.

And a note for myself: Jan, go back to your newspaper reporting days, when you never would have relied on secondary sources. This goes back to when I was 16 years old and thought I would be a band director when I grew up. We were at band camp when one of the boys dove into the swimming pool and injured his spine. The newspaper story that followed was full of incorrect information. After all, I was there: I was the one who pulled my friend off the bottom of the pool and got him to the side where he could be lifted out and revived.

It was a slap of reality: News reports aren’t always correct. Today, they can be very biased. Sensationalism is frequently at the forefront. When I was in the “business,” we presented the facts on both sides and left it to the reader to interpret what happened. Kind of a Joe Friday’s “just the facts, ma’am.” (He was a sergeant in a 1950’s television series called Dragnet — which you can watch on Hulu.com — and, yes, I’m showing my age!)

I apologize to you, and to Daniel Callahan. And, with thanks to Katherine, I promise — no more secondary sources.

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Comments
  1. Nudge, shame, none of that works - if it did I wouldn’t be carry 100 extra pounds on my body. My mother adopted the shame/nudge tactic beginning when I was an 8 year old with a little extra chub on my body, and continued her campaign into my 30s. She enlisted anyone she could think of to magnify the shame - doctors, family members, friends, boyfriends - figuring that at some point SOMEONE I really cared about would be able to “get through.” It didn’t help a bit - in fact, it made it a whole lot worse. What started out as a simple genetic propensity to gain & retain weight spiraled into an emotional battle that lasted decades.

    Instead of investigating if there may have been either genetic, medical or environmental reasons that contributed to my propensity to put on & keep on weight, no matter what or how hard I tried to take it off, I was just labeled as being too fat and lazy to care about my health. I cared! Immensely!

    After years of trying everything I could to lose weight and keep it off, fighting for every ounce that was shed and then horrified to see it come back (with interest), I finally mustered up the courage to find a doctor who could help me sort through my struggle and try different approaches.

    People who carry extra weight are VERY attuned to the fact that they are overweight - we shame ourselves enough without having other people do so. Shaming, nudging, whatever you call it, just humiliates the person and makes them feel like they are broken, and enables a feeling of helplessness, particularly when the person is TRYING to lose weight and has factors preventing it. Modeling good eating habits, inviting a family member to be more active and, if you’re the one who cooks the meals, making sure they are nutritious and not laden with hidden fats & sugars will go much further than shaming a loved one into losing weight.

    I certainly appreciate your second article and your concession that you should have been more diligent in consulting the primary source. However, Callahan, while conceding that other factors may contribute to an inability to lose weight, is still off the mark in thinking that an overweight person can be “nudged” into losing weight. If there are underlying medical reasons, the nudging does no good and just makes it worse for the person.

    Posted by Marie |
  2. All too common. The media is in the business of selling advertising space. Reporters look for controversial ways to spin a story and headline writers compose disputatious headlines to agitate people into reading. Often the assertions in the headline can’t even be found in the text. Readers need to presume bias in any story, and writers need to be doubly careful.

    Posted by Joe |

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