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By: Adaora Yvonne Ntukogu

If you could have one wish, what would it be? A million dollars? World peace? The ability to reach in your pocket and pull out whatever it is that you want? For many, the answer would be a weight loss miracle, which many would consider to be the difference between a joyful life and one of shame and misery. Yes, body size, something seemingly surface level could have profound impacts on our sense of self-worth. Our society’s obsession with thinness has led to a culture that emphasizes dieting and weight-loss remedies. On social media, fitness influencers advertise detox drinks (e.g. Flat Tummy Tea), claiming it decreases bloating and midsection size, and name-brand diets (i.e. Weight Watchers, Jenny Craig, and Slim Fast) claim to offer a more fruitful life.[1]

“Medicalization” describes a process by which human problems become defined and treated as medical problems. Society’s obsession with weight loss and its reinforcement of thinness has urged medical and pharmaceutical companies to define, diagnose, and treat fatness.[2] The medicalization of obesity may lower the threshold between what is viewed as commonly overweight and what is viewed as obesity, increasing the number of people viewed as sick and needing treatment.[1]

For example, constructs such as body mass index (BMI), calculated by dividing a person’s weight (kilograms) by their height (meters-squared), have replaced the need for physical signs and symptoms to justify medical interventions for fatness. BMI has long been used as a way to assess body weight and overall health in the United States. According to the BMI scale, 39.8 percent of American adults age 20 and older are obese. Although research suggests a high BMI is closely tied to several chronic illnesses, despite its widespread use, BMI is seriously flawed.

The BMI scale is based on White European and American male body standards and does not consider a person’s gender or ethnicity. BMI does not distinguish between fat and muscle, meaning it does not always predict when weight could result in health problems. Many people with a high BMI are healthy and this construct can perpetuate weight bias and fat phobia.[3] The negative implications of fatness (e.g. cancer, heart disease, diabetes, etc.) have also created the economic basis for medical and surgical interventions. Pharmaceutical companies advertise weight loss drugs and doctors suggest weight loss surgeries, profiting off of fat phobia. 

The words "weight loss" on a blue plate
Photo by Liam Johnson on Unsplash

Fen-phen, for example, became a wildly popular obesity treatment in the 1990s. It was effective for 60 percent of patients, who lost and average of 10 percent of their body weight. At the height of its popularity, 85,000 people were prescribed fen-phen each week. However, the Food and Drug Administration (FDA) found that fen-phen causes heart-valve problems which led to its withdrawal from the market in 1997. Despite its dangers, millions of Americans were still craving fen-phen. For many, the struggle to lose weight often meant accepting health risks.

Recently, Semaglutide, an anti-obesity drug that produces feelings of satiety, has been gaining attention. In a clinical trial, participants taking the drug have lost an average of 15 percent of their body weight and symptoms of diabetes and pre-diabetes have improved in many patients. Although doctors and researchers have found the side effects of Semaglitude to be marginal, the drug hasn’t been studied long enough at higher dosages to know if it has serious long term consequences (i.e. heart valve complications in fen-phen).[1] 

Weight loss surgery is generally regarded as superior to weight loss drugs in achieving sustained weight loss. However, the invasiveness of surgery often sways patients towards pharmaceutical interventions.[1] Weight loss surgery has been practiced in the US since the 1950s but the demand has grown exponentially due to advancements in the field and cultural reinforcement (i.e. celebrities and social media influencers promoting weight loss supplements) of weight as a proxy for health.[1]

After analyzing weight loss surgery websites, a study found that surgery was marketed in a way that minimizes risks and emphasizes the seriousness of obesity to create a sense of surgical necessity. Weight loss surgery websites tend to include endorsements by medical specialists and first-person testimonials from patients.[1] Physical and emotional transformation through surgery is a prominent theme;[1] 75% of sites with testimonial sections display before-and-after photographs. Comments such as “surgery has given me a new sense of living” reinforce the seriousness of obesity as a disease. Websites emphasize the resolution of other illnesses, improvements in quality of life, and substantial weight loss following surgery. Rarely, however, did the weight loss websites mention the risks and potential side effects. The hyperfocus on weight loss surgery successes and the negligence of weight loss surgery risks can be harmful because it leads to weighing health risks against the chance of losing weight. 

Photo by i yunmai on Unsplash

Although the Centers for Disease Control and Prevention (CDC) notes the numerous health risks associated with being overweight or obese, including hypertension, diabetes, heart disease, and stroke, our obsession with thinness and weight loss miracles has created a paradox – individuals are willing to risk their health for a chance to be thin.

Oftentimes, these weight-loss remedies are temporary. For example, it is expected that patients have to take Semaglutide for a lifetime to prevent the weight from returning.[1] Weight loss surgery patients require constant monitoring and a commitment to permanent lifestyle changes (e.g. participation in support groups, access to a nutritionist, regular exercise, follow-up appointments etc.).[1] In fact, over half of the weight loss surgery websites included in the previous study mention the possibility of insufficient post-surgical weight loss or weight regain. Studies have also shown that over 90% of people who lose weight with dieting will regain the weight within 5 years. 

Because thinness is associated with health and good morals, fat phobia is rampant in American culture. We unconsciously absorb messages from society, from our families, and from the media, that thinness means a person is desirable, successful, and healthy. These societal ideals contribute to an increasingly weight-centric healthcare model, which can ultimately drive people to unhealthy dieting behaviors including consuming detrimental drugs, participating in invasive surgical procedures, and eating disorders. Acknowledging and addressing our own negative attitudes towards fatness could be the first step to ridding society of its obsession with weight. 

References

[1] Salant, T., & Santry, H. P. (2006). Internet marketing of bariatric surgery: Contemporary trends in the medicalization of obesity. Social Science & Medicine, 62(10), 2445-2457.

[2] Blackburn, G. L. (2011). Medicalizing obesity: individual, economic, and medical consequences. AMA Journal of Ethics, 13(12), 890-895.

[3] Sadler, J. Z., Jotterand, F., Lee, S. C., & Inrig, S. (2009). Can medicalization be good? Situating medicalization within bioethics. Theoretical Medicine and Bioethics, 30(6), 411-425.