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One small change: An endocrinologist on how to make Ireland’s health system better

The stigma around obesity is the biggest barrier to getting resources for treatment

As our health system begins to return to normal activity levels following the Covid-19 pandemic, we would like to hear from doctors, nurses, paramedics, medical secretaries, hospital porters, canteen staff and others about one change they would like to see in our health system.

It can be something simple that annoys you, day in, day out, that is easily fixed, or it can be a small change in practice or attitude that would make life easier for everyone.

Dr Donal O’Shea

(Consultant endocrinologist at St Vincent's University Hospital and St Columcille's Hospital, Loughlinstown, Dublin)

The one change I would like to see in our healthcare system is an end to the stigma around obesity. Weight stigma is the single biggest barrier to getting resources for the treatment of obesity over the last 20 years. This stigma appears to be alive, well and still socially acceptable, based on the repeated chanting of “you fat b***ard, ha ha ha” at one player throughout a recent school hurling final. There was no attempt to stop it and no action taken, in spite of robust anti-bullying policies and anti-racism policies being in place. On this occasion it was, “sure he took it well…” or “don’t mind it – they are just poking fun”.

The widely-held view is that obesity is an individual’s choice. But the expert knowledge has changed, and we now have the science that helps us to explain the epidemic of obesity. The majority of factors – genetics, the food environment and the physical activity environment – that impact weight are outside of an individual’s control. Yet many health professionals still hold the view that the treatment for obesity is to eat less and move more. This is overly simplistic, offensive and results in the weight stigma that our patients experience daily.

Weight stigma is often tolerated in society because of beliefs that shame and stigma will motivate people to lose weight. But numerous studies have shown that this is untrue, and experiencing weight stigma has the opposite effect.

Obesity stigma in all forms is not acceptable. It is not a choice to live with obesity

I have been at senior decision-making meetings in the last 12 months where comments have included ,“well, what are we going to do about your fatties” and “how long will we need to run the treatment programmes for before the prevention kicks in?”. This is the ingrained thinking that has seen funding for obesity services lose out annually over the last 10 years to “more worthy” causes.

To secure funding for obesity treatment we must address obesity stigma and its consequences. This will only happen through raising awareness and improving understanding of the disease in ourselves and others. The Irish Coalition for People Living with Obesity (ICPO), a patient-led organisation, does this by sharing their direct experiences of stigma. Many of the members feel it is the worst stigma of all to deny them the right to accessible treatment. Obesity stigma in all forms is not acceptable. It is not a choice to live with obesity.

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