Fat and obese people need to be treated with more understanding and compassion and offered better support and advice, according to UK-based nutrition specialist John Briffa.
He agrees with the decision of the European Court of Justice, which ruled that, in some cases, obesity should be deemed a disability. He says the matter is often more complex than many think.
“According to conventional wisdom, excess weight is generally lifestyle-driven and ‘our own fault’. However, there exist medical conditions that can make weight control extremely difficult for individuals, even when treated. Examples include hypothyroidism (low thyroid function) and Cushing’s disease (that affects the pituitary gland).
“Recognising the fact that such conditions can be at the root of obesity and the disability this may cause is, to my mind, a good thing,” said Dr Briffa, a UK-based doctor specialising in nutrition and the author of Escape the Diet Trap.
Earlier this month the EU’s highest court ruled that obesity can constitute a disability in certain circumstances.
The case, which originated in Denmark, centred around childminder Karsten Kaltoft who weighs about 160 kilograms. He filed a discrimination case against his employers of 15 years, after he was sacked four years ago. Mr Kaltoft claimed he was sacked because he was obese and insisted he was capable of doing anything required of him and was not disabled.
The Danish courts asked the European Court of Justice to clarify whether obesity was a disability.
Medical conditions exist that can make weight control extremely difficult
The court ruled that if the obesity of the worker “hinders the full and effective participation of that person in professional life on an equal basis with other workers”, then obesity can fall within the concept of disability.
Rulings from the European Court of Justice are binding on all EU member nations. While its implications are still being studied, it means that some obese people will be entitled to disability protection which could mean employers will be obliged to make adjustments such as providing larger chairs or special car parking, and protect such employees from verbal harassment.
This could have even more repercussions in Malta that has a high rate of obesity. Maltese children, aged 11 to 15, are the most obese in Europe, according to the report Health at a Glance – Europe published in 2010. While 29.5 per cent of Maltese children are considered obese or overweight, the EU average stands at just 13.3 per cent.
Parliamentary Secretary for the Rights of People with Disability, Justyne Caruana, said that since not all cases of obesity are of a disabiling nature, each case was to be assessed and considered on the basis of existing criteria.
The chairman of the National Commission Persons with Disability, Oliver Scicluna, said the commission still had to discuss the matter. On a personal level, he said, he agreed with the decision. “We need to steer away from the idea that disability is someone in a wheelchair,” he said. Dr Briffa agreed especially since, in some cases, obesity could be the result of medical conditions the individual had little control over. “Even when a clear underlying medical condition cannot be identified, there are other reasons why we might want to feel more compassionate for those struggling with a weight issue,” he said.
According to conventional wisdom, weight loss was the inevitable consequence of eating less and exercising more, he said.
However, this approach was well known to induce mechanisms in the body that were designed to conserve weight, such as a significant slowing of the metabolism.
Also, he said, the general “fat-phobia” of the last few decades had seen some people seek the solution for any weight issue in low-fat foods. These were, almost by definition, high in carbohydrates.
Such food tends to provoke considerable secretion of insulin – the body’s chief fat-storage hormone. High-carbohydrate diets can also create blood sugar lows that can induce false hunger and food cravings, often for sweet food.
“To me, it seems harsh to judge people who have become trapped in this cycle, when often all they have done is followed advice given to them by the medical profession and official health bodies.
“Whether we regard obesity as a disability is not particularly important, I think. What I believe to be more important is that we offer individuals seeking to lose weight better information and advice, and that we treat them with more understanding and compassion.”