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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