Obesity Is Not Smoking – Period!

The recent appointment of the Hon. Sarah Hoffman (NDP) to the post of Health Minister in Alberta has (as expected) prompted a wide range of remarks regarding her suitability for the job – not because of her qualifications as an administrator (these are uncontested) – but her size!

In a slurry of comments ranging from misguided misogynistic remarks (sadly, including by members of the former government) to outright personal insults, the social media frenzy around this topic is anything but unexpected.

The general story line is that someone living with obesity, who is thus obviously “unhealthy”, is not qualified be a health minister.

Indeed, one letter writer in the Edmonton Journal likens putting someone living with obesity in this position, to appointing a health minister who smokes – a fatal (but common) misconception of what obesity actually is.

For one, smoking is a behaviour – living with obesity is not!

When you inhale the smoke of a cigarette you are doing something (a behaviour) – when you gain (or lose) weight, it is something your body does (whether you want it to or not).

This distinction is fundamental: when I stop smoking, I become a non-smoker – end of story!

When I try to lose weight, my body will do everything it possibly can to resist losing weight. My appetite will increase, my metabolic rate will slow down, my body temperature will decrease, my thyroid function will decrease, my sense of taste and smell will increase, as will my risk-taking behaviour and my susceptibilty to stress. All of these changes (often referred to as the “starvation response”) will work day-and-night to “sabotage” my efforts and in 95% of people who set out to lose weight, these mechanism will eventually win out – even years after starting on their diet.

Every person I know who has ever lost a considerable amount of weight and is keeping it off, describes this as a daily on-going struggle. They are well aware that even the slightest interruption to their routine, an illness, an injury, a new medication, even just relationship issues or financial stressors and – boom – their weight is back, whether they like it or not.

This is why the WHO, the FDA, the AMA and a growing number of health organisations around the world are now calling obesity a chronic disease, because sadly, we have yet to find a cure for this condition.

Despite what celebrity pundits and the weight-loss industry may want you to believe, there are no easy solutions and try as they may, most people with excess weight will have to fight hard simply not to get any heavier.

So for one, even if Sarah Hoffman wanted to lose a few pounds, the chances that she will keep them off on her own in the long term are slim (unless of course she happens to belong to the lucky 5%). If she is looking for medical treatment, even surgery, I wish her good luck trying to access those services here in Alberta – welcome to the waiting list!

The other assumption underlying the criticism of Minister Hoffman, is the notion that obesity is a direct reflection of someone’s health behaviours – i.e. eating too much junkfood or not exercising.

Believe me that I have seen many patients in my clinic, who rarely (if ever) touch junk food, who spend hours in the gym, and still weigh in at 350 lbs or more. There is (and has been for a long time) enough scientific evidence to support the fact that people vary remarkably in their susceptibility to weight gain (and weight loss). The amount of weight gained by eating exactly the same amount of excess calories can vary as much as 5-fold between individuals.

So for all we know, Sarah Hoffman (like most people living with excess weight) is already well-informed and concerned about her diet and I’d hardly be surprised if, despite her busy schedule, she does manage to squeeze in as much physical activity into her daily routine as she possibly can.

But, irrespective of all of the above, there are simply so many different causes of weight gain (from genetics, to mental health, to sleep deprivation, to stress, to eating norms and culture, adverse childhood experiences, to medications – even perhaps the bugs that happen to live in your gut), that judging someone about their health knowledge or behaviours by looking at their size is truly laughable.

Indeed, who better to have as a health minister, than someone living with a chronic disease?

Would anyone seriously object to Sarah Hoffman’s appointment as Health Minister, were she living with diabetes, chronic kidney failure, coronary artery disease, HIV/AIDS, depression or for that matter cancer (even lung cancer)?

The only real difference between obesity and any of the above conditions is that obesity is visible for anyone to see (and apparently fair game for anyone to comment on).

Whether or not Sarah Hoffman turns out to be a capable and competent health minister remains to be seen – I am certain that neither her success nor failure will have anything to do with her size.

Perhaps it will take a Health Minister living with obesity, to finally create a health system, where people living with obesity are treated with compassion and respect and, most importantly, can find the help and treatments that they need.

@DrSharma

Edmonton, AB