Global Health Asia-Pacific September 2020 September 2020 | Page 55

Though on average a higher �MI is associated with
an increased risk of health problems like heart disease
and diabetes, research has also found that a cohort of
overweight or obese individuals typically has a variety
of parameters, like blood pressure, fats, and sugars,
that fall within a healthy range. A 2016 study showed
that healthy people with obesity “have lower risks
for diabetes, CHD [coronary heart disease], stroke,
and mortality compared with unhealthy subjects
regardless of their �MI status,� the authors wrote in
the journal Obesity.
The reasons that different obesity types are not
equal in health have a lot to do with fat distribution and
fat cell size, according to Dr �ensen. �eople can gain
weight in two fundamentally different ways, either by
producing new fat cells or making their existing ones
bigger. �It looks that the bigger the fat cells the more
likely people are to get diabetes, high blood fats” and
other health risk predictors, he said.
Similarly, those who store fat around the intestine
are exposed to higher health risks than people whose
fat builds up under the skin in the legs, arms, or belly.
This type of tissue around the intestines is called
visceral fat, and it’s made of cells that tend to be
more in�amed than other fat cells, thus causing more
damage to organs that are close to the intestines, like
the liver and pancreas.
Experts believe both hereditary and environmental
causes might explain why some people store fat under
the skin or inside the stomach and why some have
bigger fat cells than others.
What this means is that people are not entirely
responsible for the obesity-related health problems
they develop. �orces beyond personal control will
play a role in determining the health effects of being
overweight and obese, just as is the case with excess
pounds.
A new public narrative
Given what we now know about obesity, there’s no
reason the general public should continue to embrace
the misconception that body weight can be easily
managed with just willpower. �ather, we should
recognise obesity as a complex long-term condition
that’s caused by many factors, argues Dr �uhl.
“Instead of blaming people, we should support
them so that they engage in healthy behaviours even
if it means they don’t lose significant amounts of
weight,” she said, while stressing this is an important
message for everybody regardless of their body size.
It’s also important to realise there are strong
emotional and social components to eating. We don’t
just eat to fill the stomach but also to socialise or
because we’re attached to foods that remind us of the
past or that we simply crave since they make us feel
good.
“Hopefully, most of the time people eat because
they have what we call metabolic hunger and want
People who experience weight stigma often turn to food to cope with the stress
to eat high-quality calories the body needs to stay
healthy,� said Dr Dushay. ��ut there are also times
when we all want to indulge in foods that we crave,
foods that are, say, comforting, familiar, part of a
family tradition. That’s also an important part of life.�
Regardless of the body size, then, everybody
deserves to enjoy food in such a way.
“The idea that you’re going to take this other drive
to eat out of your life and eat only the most pristine
calories every single day is completely unrealistic, and
it’s not a healthy way to live,� she said.
As the gatekeepers to health, doctors should
promote this understanding of body weight and
eating, while avoiding any stigmatising that could hurt
their patients.
“Certain words like fat or obese can be viewed
as stigmatising or shaming, at least in the US, and
many patients get turned off or feel blamed when
this language is used,� explained Dr �uhl. �So we
recommend healthcare providers use more neutral
words, like weight, when talking to patients or ask
them what word they feel most comfortable using.�
The use of sensitive language is also likely to help
patients lose weight because research shows weight
stigma in itself is a catalyst for obesity and weight
gain.
“People who experience weight stigma often turn
to food and binge eating as a way to cope with the
emotional distress of being stigmatised,” cautioned Dr
�uhl. n
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