The Answer

I'm writing this post before Thanksgiving break, but soon we'll be heading into finals. Speaking of Thanksgiving though, people often associate food, and sometimes overeating, with the holiday season, and dieting and weight loss with New Year's, so this discussion is especially relevant this time of year.

I couldn't possibly talk about food on this blog without including a tribute to Eleanor's love of shrimp, so here's a GIF of Kristen Bell having a moment while eating shrimp.

The final chapter in Medical Ethics is on the ethics of weight management and covers a variety of topics and ethical considerations. 

The take on weight control that was probably the very first is that all of us are responsible for our own weight. Free will and all that. Thanks, Kant. This stance is one that many Americans currently agree with, a 2016 study found that most people think that losing extra weight is always possible through dieting and exercise (Pence 478). It's interesting to note that a 2017 study showed the number of people who gave up on dieting has increased in the last decade, but also that some bioethicists believe that fat-shaming is the correct way to fight the pandemic of obesity. While I can see the makings of logic in this argument, I don't think that social stigma is ever the answer to anything if you want a positive outcome. 

Regardless of age, height, diet, ethnicity, etc., your weight may depend on the genes you inherit and how those genes are expressed. Some researchers believe that roughly half a person's risk for severe obesity is genetic (Pence 479). Various studies back these claims, though many say that these conclusions are speculative at best. 

Metabolism also has a hand in weight, as has been demonstrated by The Biggest Loser and the contestants whose weight and metabolic rates repeatedly had the same result, gaining back the weight that was originally lost. Though there are several reasons why the "results" of the show are a sham, this is a large part of it. Research has shown that even small weight gains and/or losses shift biological homeostasis, so major changes would only have bigger effects. 

This isn't entirely a biological fight though, social factors play a part in this as they do with many other things. Poverty discourages people from access to better resources, including food, exercise, hygiene, and many others. Cheap, processed foods are more widespread, thus leading to "Westernized" diets and poorer health in many countries (Pence 481). 

The biggest question/consideration in this chapter, in my opinion, is whether or not being healthy is the same as being thin. Physician Faith Fitzgerald stated in 1994 that the idea that people can choose healthy lifestyles has, "a very dark side...that leads to a tyranny of health in the United States" (Pence 482). This idea of "wellness" that can be chosen or pursued is dangerous and fits in directly with fat stigma and fat shaming. Language matters. Just because there is a history of dark and prejudiced humor around weight doesn't make it okay to use negative or shaming language around the topic. Physicians get no education in medical school about compassionate ways of dealing with overweight patients, which also contributes to the bias (Pence 485). Research has shown that bias begins early and has been called the last socially acceptable form of prejudice and is as common in society as racial prejudice. Prejudice that is then internalized and leads to a vicious cycle of binge-eating and social withdrawal. This helps nobody. 

One researcher stated that, "the difficulty in keeping weight off reflects biology, not a pathological lack of willpower," and humiliating people in an attempt to motivate them to lose weight is a paradigm of the fallacy of blaming the victim. Victim blaming in this case often leads to self-harm and other destructive behaviors that put them at risk of real danger. Modern societies often have an ideal of thinness, and in a world that was built for "cis, thin, white people" this works, but at the cost of everyone who doesn't fit this definition of "normal" (Pence 485-6). BMI doesn't necessarily describe a person's health, as the location of fat in the human body determines a lot more about a person's health than does the percentage of fat tissue (whether or not the fat is around organs or under the skin). 

Some public policy has been created in an attempt to help with the obesity pandemic, such as soda taxes and policies surrounding bariatric surgeries. Although good intentions come with these, it will be many years before real change is seen.

It is also important to consider the fact that there is not only one cause of weight gain. Some researchers believe that they have discovered about 60 different kinds of obesity, while others have found that 25+ genes contain a powerful contribution to weight, and another claims that they have 40+ therapies to help patients lose weight (Pence 490). What we see from this? Not every case is the same.

There is the fact that some people are able to "live strong" and, even though only about 10% of the population is able to work hard to limit calories, exercise vigorously, and consistently eat fresh foods, it demonstrates that the "ideal" is possible (Pence 491). However, the discovery that some people inherit a genetic variation that mutes their appetite makes this claim questionable. Ultimately, even though these people may be lucky, they are in no way superior or stand on higher ground than the average person because of what they inherited from their biological parents.

So, what does all of this mean for average people in our daily lives? Recognize that biology has a hand in everyone's weight, regardless of their diet or exercise regimen. Understand that it's difficult to maintain weight after a big gain or a big loss and that free will really only works best in not gaining weight in the first place. Realize that some drugs and diets can be helpful, but they often put you on dangerous ground because of the other ingredients in the drugs or nutritional deficiencies that come from depriving your body of what it needs. And most of all, remember that stigmas and shame don't help anyone, so get the education you can and treat people for what they are: people.

Textbook reference:

Pence, Gregory. Medical Ethics: Accounts of Ground-Breaking Cases. 9th ed., McGraw Hill, 2021.