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I saw this article being shared through Facebook, and got very frustrated on two fronts. There is this terrible culture today where a person's self-esteem is attached to how much they weigh, which ties into the second problem that when I tell a person they are obese, it is not the same as telling them they have hypertension, because in the former, I'm making a judgement on their character, but the latter is informing them of a health condition. This needs to stop. We need to change the attitude people have towards obesity, separate it from being a judgement of the person, and focus on how we can manage the illness.
The article makes good points about having a balanced lifestyle plan which involves making good food choices, exercising regularly, developing self-confidence, practicing good self-care, and receiving social and community support. It should be done no matter your weight! Obsessing over a number like the BMI, or even the number on a scale is not a good attitude towards better health, especially because different ethnicities/races/genetics have different healthy ranges of weight. Instead, a healthy and safe approach to maintaining a good lifestyle should be what everyone strives for.
What irked me is that the article starts off by going too far into trying to prove being obese is not bad. It provides so much misinformation, and twists research findings to back the view that being obese is OK, and that BMI doesn't mean anything. This is simply not true. Just because BMI has "limitations in predicting excess body fat associated with health risk on an individual basis" does not mean it "means absolutely nothing in terms of our individual health". It may not predict things well, but it does not make BMI meaningless.
In one sentence, the author dismisses epidemiological studies that correlates obesity with chronic illnesses because they don't demonstrate causation, in the next one she talks about studies that correlate obesity with better survival. Guess what, they don't demonstrate causation either. The way to demonstrate causation and not correlation is to conduct randomized control trials, where one group of patients are not obese, and one group of patients are, then inflict them with the same chronic illness, then see which group dies. This is why there are no studies that can demonstrate causation based on obesity. The lack of causative evidence on this front is not the same as there being evidence of no causation.
Since I work in acute care and not chronic care, I can't speak from experience about managing an obese patient's health from a chronic care perspective. Let me tell you something I do see often though -- an obese person coming for surgery.
If a patient with a BMI of 45 walks into the ER with right lower quadrant pain, it is harder to diagnose appendicitis because the first line diagnostic tool is ultrasound which would be technically difficult to do since the picture gets distorted going through so much subcutaneous fat. Once they get into the OR, the anesthesia team spends a good five minutes thinking about how to position the patient so we get them intubated as soon as possible because while slim and healthy people have about a 6-10 margin of safety between first dropping off to sleep and intubation, obese and otherwise healthy people may only have a minute because all the extra pressure the chest or belly pushes on the chest wall or diaphragm, causing reduced lung volumes as soon as they relax, and there's dramatic decrease in reserve. Once they are asleep, we bag mask ventilate to make sure they are fully asleep and well paralyzed before we put in the tube so that we minimize injury to teeth and vocal cords. Obese people are harder to bag mask ventilate for because their upper airway has a lot of tissue that will relax and obstruct air flow, their chest and belly makes it harder to get the air down to the bottom of the lungs.
That's just before the operation even starts!
Once the surgeons finish preparing themselves, if the patient had a big pannus, that has to be strategically taped away to make sure they can get to the surgical site. When they perform the laparoscopic appendectomy, these patients some times don't oxygenated well even though there is an endotracheal tube providing a definite delivery of oxygen. The pressure required to push against the external pressures against the chest can be double the amount we expect in non obese people. The surgeons can find the laparoscopic approach so difficult that they convert the procedure to open approach. This happens not infrequently with laparoscopic surgeries.
When we are trying to wake the patient up, there is a higher chance that if anything happens in the process, we will have difficulty securing the airway (because they were difficult to intubate in the first place), and we would need to extubate these patients sitting up and awake. After the surgery, if the wound is under a pannus, in a skin fold, it's harder to heal, more likely to be infected etc. On top of everything, if we need to move the patient emergently, there is not enough bodies in the room to do so.
I'm not saying this is what happens all the time, but elements of this happens very frequently. My frustration is if the patient has bad heart disease, I can have a frank discussion of the risks of a putting them to sleep, and they will understand that I'm concerned about their well-being due to a medical condition. If I have a discussion about the risks of putting an obese person to sleep, it suddenly becomes that I'm commenting on them as a person.
We need to call a spade a spade. Being obese is like having any other illness, and it needs to be acknowledged by the patient, and by the health care provider. The care and management should be delivered in a way that is non-judgemental, non-derogatory, but it needs to be acknowledged. The patient does not need the reinforcement that being obese is "just the way I am". It is not OK!
This brings us back to what I liked about this article. The fact that it encourages a healthy lifestyle, and positive body image is hopefully the takeaway point people walk away with. However, I have a sneaking suspicion that more often than not, people are going to also walk away thinking being obese is OK, and that obesity is in fact going let them live longer.
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