Mieke Van Spanje, Netherlands


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Davey, the heaviest ever, fatsos run risks, they don’t walk, they wobble, fatties check sex should be on tv, big ugly shrew, Americans are afraid of obesity. These are some examples of sensational use of language in Dutch media last month, which are abusive to obese persons. But there’s also right out discrimination, heavy turks cannot ride on an elevator, no promotional work for obese women, no social benefits if you are too big, fat tenants are accountable for damage.

Could you imagine that anyone would write this about a person who has cancer, diabetes, heart failure? Yet these are illnesses, just like obesity is. So what is the difference? Researchers, governments and clinicians point out that obesity is a condition that affects people’s health and influences health costs. And therefore it’s a challenge to governments and society.

They want to fight obesity. To get enough funding for further research, they like to stress these arguments. And a lot of obese people agree with this assessment.

On the other hand, obese people point out that the most debilitating and hurtful element in their condition is the stigmatization. More than any physical ailment, stigmatization of the obese is possible because the condition is visible to everyone. From the moment the visible factors of obesity, being heavy and being large, became the focus of the debate and the adjustments, the problems for obese people increased.

Clinicians and researchers look at obesity as a syndrome, should look at obesity as a syndrome in which a number of diseases are combined. Only two elements of this combination of ailment are visible, only two, high weight and large size. Exactly these have become the characteristics of the syndrome.

They came together in the BMI. Everyone in health care knows that BMI is not the best marker for health recognition, but it is the cheapest. Our finances reason to continue to use the BMI.

The more their weight and size are much harder to influence than, for example, blood pressure, cholesterol or blood sugar. Use of BMI is harmful to the patient because it focuses only on the visible sides. BMI can be and is used by persons outside medicine.

Here it becomes an easy tool for laymen, sensation press and corporations in the obesity industry to influence public opinion. The results are abusive language, stigmatization and discrimination. Being large is not unhealthy in itself, nor is being heavyweight.

Both may be unwanted and not standard, but they are no health risks in itself. The movement health at every size proves that, and looking and talking unilaterally about size and weight distracts from real problems. Bringing down weight or size has become a goal in itself.

The main goal should have been getting people healthier by bringing down high sugar values, high cholesterol, high blood pressure, by strengthening their joints and muscles and by empowering them. I do not believe that good informed researchers or clinicians or even managers want to harm obese people, yet it happens on a large scale by everyone who uses the visible markers in this debate about health. I call on you to all work together to stop that.

What can we do? Let go of the term obesity because it’s unwanted side effects. If a generic term is necessary, we might want to replace it with obesity syndrome. Ban the use of BMI completely when talking about health.

It is easy and cheap, but it is inaccurate and has severe unwanted side effects. Better yet, let go of the idea of a collective term completely and focus on the actual health issues such as fat levels, fat storage, satiety markers. Whenever you hear or read about obesity in a disrespectful way, address the offender.

Your local patient’s organization can assist you. And when making a press release on obesity-related issues, take advice from your local patient’s council or organization. I thank you.