Dr Tanvir Kapoor opens up about his journey in overcoming stigma from obesity, saying judgement has no place in medicine.
A few weeks ago, on a popular online forum for Australian general practitioners (GPs), there was a discussion about using the label “obesity” in medical documentation. I want to share my perspective as a patient with this disease who also has the privilege of a medical education.
The first time I was given this label was by a paediatrician when I was 12. I remember him encouraging my mum to give me more fruits and vegetables. This was when my immigrant parents had just arrived in the United States and were working at 7–11. We slept on the floor because we could not afford mattresses. Highly processed carbohydrates were tasty, cheap and in abundance. I did not realise until later this was by marketing and design. To paraphrase my colleague Dr Abby Harwood, we lived in an obesogenic environment, so perhaps it was unsurprising that some of us became obese. And yet the blame seemed to fall on my poor mum alone. As a doctor, I made the same mistake when I told a First Nations person from outback New South Wales with heart failure to cut down on salt. They quickly put me in my place by telling me to go to the local supermarket and report back with their options.
The parameters used to define this disease are also parameters used to define my body. And, hence, the unspoken message is that, instead of something to be celebrated and respected, my body is a problem — a problem that can never be hidden from others. It took me 20 years to unlearn this message and finally enjoy movement without shame. I have been on countless diets, and yet, now that I have refused to weigh myself and instead focused on being kind to my body, I have never felt healthier and happier.
It is curious to me that I generally work hard, and yet, in this one domain of life, I have been told that I am essentially slothful and gluttonous — I need to stop being lazy and eat less. However, the best available evidence shows that this model of treatment does not actually work that well at all (here). Now that highly effective medications are available, we are told as doctors not to prescribe it for one disease but instead prescribe it for another, without any data traditionally used to ration treatment like quality-adjusted life years. As Associate Professor Louise Stone once wrote, there is an unspoken hierarchy of disease (here). Obesity seems to fall very low in that hierarchy indeed.
Of course, medicine has a history of moralising disease it does not fully understand. Cholera was once described as a disease of “moral miasma”, until John Snow discovered it was actually a disease of infection and poverty (here). Acquired immunodeficiency syndrome (AIDS) was once called GRID: gay related immunodeficiency — an accumulation of risk from the “gay lifestyle” instead of something caused by a virus (here). We have known for decades that obesity is an endocrinopathy in the setting of an increasingly obesogenic environment (here), and yet the standard advice feels like one of Victorian moral virtue: to just show restraint and fortitude in the face of temptation.
In the final analysis, you can use any label you would like to describe me. I am always a little disappointed when doctors do not bring it up with me, because it is an important part of my health. I would appreciate it if they asked my permission first, because sometimes I just do not want to deal with a lifelong struggle that is endlessly stigmatised. You might appreciate that this label often entails judgement and bias in almost all domains of life, as has been demonstrated in countless studies (here).
I wrote this essay after a beautiful morning walk without shame about my body. My dear colleagues, it has taken almost my entire life to get to this point: a point where I can, in Walt Whitman’s words, “finally sing the body electric” in order to achieve “the exquisite realisation of health”.
Dr Tanvir Kapoor is Medical Superintendent and Senior Medical Officer at Jandowae Multipurpose Health Service at Darling Downs Health, a Lecturer of Medicine at Griffth University and a Rural Generalist Registrar at Wambo Medical Centre. He is also the RACGP Registrar Liaison Officer for rural Queensland.
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