Obesity is a sign of good health in some cultures

On the first day of the 1st Caribbean Obesity Forum, I presented various talks on obesity – its economic implications, its assessment and the need for firmly anchoring obesity treatment in primary care.

Interestingly, several family doctors in the audience raised the interesting issue that here on Barbados (as probably on other islands) many patients are actually quite happy with their weights.

One family physician noted in his presentation the case of an overweight woman, who presented in his practice with diabetes. A few weeks after starting her on metformin, she came back considerably distressed about the fact, that she had now lost a few kilos. He noted that despite explaining out that her diabetes was now under control and her blood pressure had improved, she remained unconvinced about the benefits of being on this treatment. To her, losing weight equated directly with being unhealthy and “less sexy” to her husband.

This topic came up several times during the day, where the issue of how to address obesity related health problems in a culture, where excess weight is considered both physically attractive and a sign of good health – never mind that the Caribbean (as pointed out by other speakers) now has some of the highest diabetes rates in world – I have heard Jamaica referred to as the world capital of foot amputations.

The notion of obesity as a sign of good health of course is not that surprising – especially in countries where malnutrition, infectious diseases, gut parasites, and other ‘wasting’ conditions, are endemic. Being skinny is a sure sign of sickness and weight loss is most alarming.

One discussant reminded me of the African practice of fattening rooms, where brides-to-be would be sequestered and overfed in order to be their ‘best weight’ on their wedding day – the exact opposite of Western societies, where brides wanting to lose weight provide healthy profits for the weight-loss industry.

Obviously, in such a setting, the very idea that excess weight may adversely affect pregnancy outcomes, is clearly a hard sell – as noted by the colleague speaking on the issue of epigenetic programming in utero.

In the discussions, I did point out that while we certainly did not have an issue with women not wanting to lose weight (in fact our challenge is perhaps the opposite – convincing many women that the few extra pounds they would so desperately like to shave off their butts and thighs may actually protect them from diabetes and other health problems), we do have a problem with men trivialising or denying the problem.

These learnings are nevertheless important to me, especially when practicing in a country like Canada, where we see patients with a wide range of ethnic and cultural backgrounds.

As clinicians, let us be aware that when some of our patients appear unconcerned about their weight-realated health problems, they may not simply be unmotivated to consider obesity treatments – they (and their family and friends) may actively oppose and resist them.

Arya M. Sharma is a Professor of Medicine at the University of Alberta who blogs at Dr. Sharma’s Obesity Notes.

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  • Chris OhMD

    In many countries around the world where war and famine had been the norm for a long time, being obese is definitely construed as a sign of health (Korea for e.g.), The problem is that although those factors that contributed to such thinking (war and famine) are now gone, people still hang onto these ideas – that’s why there is a surge of HTN, DM, hyperchol.

  • Anonymous

    Why wasn’t I born in Barbados??!?!  ;-)

  • Anonymous

    Such things are a part of the human condition.  Potential to addiction is part of the human condition.  Most people in the US know – but don’t do when it comes to eating healthy.  It’s difficult to eat for our DNA.  It is difficult to stop smoking cigarettes but large numbers of people did it when the price when up.  Then the incidence of lung disease went down.   

    However, at least in the US, excessive adipose fat EAF is not just killing people it is killing our economy through over the top healthcare costs for the diseases related to EAF.  I guess a better acronym would be EAT if all adipose fat were considered tissue, but I don’t know.  

    I wouldn’t really care, its not second hand smoke but I am part of this economy and I know I pay a lot of taxes that are subsidizing unhealthy eating and the care for people who consider it “their right to this care” but  don’t take care.  It is not fair and just as unfair as the subsidies that go to Wall Street.   Doctors had some ammunition when the Surgeon General’s report came out about smoking.  We need the same for the potentially addiction substances used in excess in processed foods (sugar, salt and fat) that Big Food pushes on all of us, especially those most vunerable. 

    You should use tough love with your patients irrespective of their culture. 

        

  • http://profile.yahoo.com/HAKL5KH52K6PNG4ODNIC4252PU FreyjaW

    I’m losing weight because treating PCOS properly means weight loss.  I’m still gorgeous in the Caribbean.

  • Anonymous

    Its curious that Dr Sharma is commenting a patient from Barbados because in India, to be obese is a sure sign of well being. It is common practise for a men (if not women) to be overweight as a display of well being or wealth in India. To be thin as age catches up is a sign that one is not financially comfortable in India.