The obesity blame game

Over the last few decades there have been plenty of theories put forward for obesity rates reaching epidemic proportions throughout the developed and rapidly developing nations. Most of them have some scientific research to back them up, but that is not always the case.

The recent well publicised case of a GP with a special interest in nutrition and environmental medicine being sued by his patient for failing to refer him to a weight loss clinic, or for bariatric surgery, has brought a new twist to the blame game. As a result of his morbid obesity he now has advanced liver cancer.

The concern around this case has been shared by GPs and health authorities who would no doubt be relieved now this case has been overturned in an appeal. The consequences of it succeeding would have been an enormous burden on the health system. GPs would have been forced to practice defensively, thereby dramatically adding to costs.

They would have been influenced to do a lot more referring to specialist weight loss, obesity and bariatric surgery clinics. This may already be happening as a result of the publicity surrounding this case in the medical and broader media.

This is all aside from the issues of access. What about the rural and remote regions where such services do not exist? What about the most disadvantaged in our community? They would not only be unable to afford the private services on offer but even the inadequately resourced, overloaded public services would be hard to access because of transport, accommodation costs etc. And would people in rural and remote regions choose or be motivated to comply with the recommendations from these services?

Blaming GPs, chocolates, lack of self-control for obesity is futile.

Disadvantaged people have high rates of obesity. Social determinants of health are often what matters most, not what new surgical techniques or far away clinics may have to offer in addressing their health needs. GPs and their allied health colleagues are at the forefront of supporting obese people deal with the prevention and management of the chronic diseases resulting from being obese, as challenging as this may be.

And what about the never ending thorny issue: is obesity just a matter of self inflicted ‘sloth and gluttony’ for which an individual should take the blame? Or is it more to do with the environment we live in with ready access to energy dense food, cars and other physical energy sparing technology, widening socioeconomic inequality etc? Or maybe it’s the fructose in soft drinks, too much fat or high GI carbohydrate in our diet, portion sizes too big, too many TV ads promoting junk food aimed at children etc? All such things are no doubt of some relevance.

Blaming GPs, chocolates, computer games, lack of self control or whatever for a complex matter like obesity is a futile exercise. Maybe there would be more benefit in encouraging and promoting lifestyle behaviour change, reducing our carbon footprint by purchasing our food from farmers markets where possible, walking or cycling more, advocating for a more equal, educated and fairer society politically, promoting social cohesion etc. These sorts of measures may do more to address the obesity problem than courtroom rulings directed at GPs.

Further reading: Planet Obesity, Garry Egger & Boyd Swinburn. Allen & Unwin 2010.

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