Friday, November 16, 2018

Current alarm for Bangladesh: Weight stigma

Fahmida Hashem  :
World Obesity Day passed this year. It was an annual campaign with the goal of stimulating and supporting practical actions that will help people achieve and maintain a healthy weight and lifestyle. World Obesity Day was led by the World Obesity Federation. This World Obesity Day focusing on stigma.
Obesity is rapidly becoming one of the biggest public health priorities globally. Worldwide obesity has nearly tripled since 1975. More than 1.9 billion adults were classified as overweight in 2016 - more than 650 million of whom were living with obesity. The global medical bill to treat the consequences of obesity is estimated to rise to $1.2 trillion a year by 2025.
It’s no surprise that for a Bangladeshi woman, who is slightly on the heavier side of the scale, growing up isn’t just a challenge, it’s a stigma; especially when you’ve got elders and peers pressuring you to fit into the forsha, shukna and sundor boxes.
It doesn’t matter if you’re large from consuming the calories, as long as you pack a few extra pounds, you’re never considered beautiful. Eventually, words like healthy and chubby are suddenly overshadowed by the word FAT and the amount of stress that goes into that word is sure to make anyone of the following body types feel some level of distress.
Further down the line, when your ‘fatty’ cells follow you into your preteens, you become the perfect candidate for weight-centric jokes and nicknames.
By now you’ve earned several titles; moti, haati (elephant), and golla (football) are a few polite ones in the lot. How does this affect women in Asian countries?
After years of criticism, this is the kind of positive reinforcement that is slowly but surely altering our ideas of ‘beauty’ and from the looks of it, one’s lack of thigh gap has nothing to do with it.
Weight stigma is one of the last socially acceptable forms of discrimination. Weight stigma refers to negative behaviours and attitudes that are directed towards individuals solely because of their weight. Despite decades of science documenting weight stigma, its public health implications are widely ignored. Instead, obese persons are blamed for their weight, with common perceptions that weight stigmatization is justifiable and may motivate individuals to adopt healthier behaviours. Negative and inaccurate stereotypes associated with weight include depictions of laziness, lack of will power, bad hygiene, low levels of competence and intelligence and unattractiveness. Notice how it is rarely challenged? The word ‘fat’ has morphed from a simple description into a foul word.  
This aim to: Raise awareness about the presence and impact of weight stigma and what can be done about it, increase member engagement and encourage engagement with advocacy/campaigning on weight stigma, help people overcome the barriers that arise as a result of stigma, which can prevent them getting    the medical treatment they need.
Individual health consequence of weight stigma is unhealthy eating and lower physical activity, psychological disorder, substandard health care and decreased health care utilization. Along this public health consequence of weight stigma is- societal and environmental contributor to obesity, teasing, and bullying, impaired obesity prevention effort, increased health disparities and social inequalities.  
The war on obesity, which attempts to scare and shame everyone into dieting, is partly to blame. The diet industry, which falsely suggests that one can choose one’s weight on the scale, also contributes. In fact, diets rarely work in the long-term.
Currently, weight stigma is relatively absent from the conversation surrounding obesity. If we are to end obesity stigma, it’s important to adjust our language and attitudes, raise awareness and improve our knowledge about the impact of weight stigma. We hope to raise awareness about this the complexity of weight stigma as part of this year’s campaign.
Research has shown that language such as ‘high BMI’ and ‘weight’ are preferred to    words like ‘obese’ and ‘morbidly obese.’ Avoids categorising patients by their medical condition. For example, ‘you have obesity’ as opposed to ‘you are obese.’ Patients with obesity should be treated with the same level of respect and empathy as their slimmer counterparts.
Actions to address obesity include addressing stigma and misconceptions surrounding obesity.
Modern environments encourage and promote unhealthy lifestyles. Obesity is not about individual blame but shared responsibility in society. Telling individuals to ‘eat less, move more’ is too simplistic: reducing risk requires an integrated approach across different sectors, from our town centres to healthcare settings.
Reducing the risk of obesity requires governments to take an integrated approach across different sectors, which should incorporate: Implementation of policies which address obesogenic food environments, improving the availability and access to nutritious food and reducing exposure to  marketing of less healthy options, have green space and are conducive to  more activity as part of people’s daily lives, consideration of health in all policies, to ensure action is taken in all relevant sectors from health, to education, to media and culture, to development and social services.
A positive, supportive narrative between clinicians and their patients will increase the effectiveness of care.
 Independent on the weight loss method, treating obesity should include realistic weight loss goals without being affected by social pressure or weight stigma, especially since stigma can result in further weight gain and decline health issues related to obesity and overweight.
Research shows that healthcare providers, when talking to obese patients, tend to: Provide them with less health information, Spend less time with them; View them as undisciplined, annoying, and noncompliant with treatment. In this case Health care professionals, nutritionist & dieticianscan educate themselves on facts about the complex etiology of obesity and the significant limitations of current behavioural weight loss treatments. Government should commitment to introduce upstream policies to improve the environments we live in, rather than focus on individual responsibility and blame. n
(Fahmida Hashem is Consulting Nutritionist, Weight Management Centre)