lmost a fourth of the patients that visit a public hospital OPD complain of backache, knee pain, or generalised weakness. These patients come with the hope of a medical diagnosis, only to find out the sole reason for their problem is their weight. Often, you’d hear jokes from senior doctors as they try to put obesity into perspective for the patient. One may find these jokes somewhat funny and true, yet you can’t help but notice the insensitivity behind them. Body shaming isn’t limited to the doctor’s office – from mainstream media to family and friends to strangers – almost everyone finds it necessary to point out your “weight problem”.

For a long time, obesity has been treated as a behavioural issue, a problem that arises through eating junk food, overeating and inactivity. While there is some truth to this, this isn’t the whole truth. Modern medicine has now described multiple causes of obesity, including genetic makeup and body morphology; socioeconomic factors, such as lifestyle and ease of access to healthy food and gyms; mental stress and stress coping behaviours; medical diseases and drugs; cultural preference for particular food items and serving portions, etc. One example of the latter is the difference in obesity rates between the US and the Japanese populations. With high carbohydrate and fat-rich foods being major components of fast food, the US population has a considerably higher obesity rate than Japan, which predominantly consumes healthy proteins and vegetables. The South Asian diet is also rich in fats and carbohydrates. So, when a doctor cautions a patient to eat less roti for weight loss, they don’t understand what they can replace it with as roti serves as their primary energy source.

Along with an unhealthy diet, the general attitude of our population towards obesity is that of indifference. Health and fitness lie at the bottom of their priority list, even for those with access to healthy options. Although experts still struggle to comprehend the complicated science of weight loss, the lack of health awareness in the Pakistani population makes it even more difficult. One often comes across people practicing weight loss methods that are now outdated. The lack of professional nutritionists compounds this problem, leaving people to search for solutions themselves. With so much inaccurate information accessible online, those seeking self-education may become more confused.

Although the WHO recognised obesity as a disease in the late 1990s, like many other issues, we have been slow to catch up. With extensive research available for multiple medical and surgical treatment options, doctors are now treating it as a disease. They prescribe pills for weight loss more generously than before, and morbidly obese patients now have the choice to undergo weight reduction surgeries. 

The complex nature of weight loss and the many hurdles make it difficult for people prone to weight gain to achieve a healthy weight and maintain it. As a result, a journey of repeated weight loss followed by weight gain and self-loathing, disappointment and, eventually, poor mental and physical health ensues. Increased blood pressure and blood sugar leading to complications, increased risk for cancer, body ache due to increased load on the legs and back, low self-esteem, and impaired body image all cause an inferior quality of life.

With multiple causes and a complex interplay between many causative factors, there arises the question of who qualifies as a professional. For most in our setup, it has been your friendly neighbour or an aunt whose niece effectively tried a such-and-such diet. If you’re lucky, it could be the trainer at your gym or an online business that sells a certain diet. The role of dieticians and doctors has so far been minimal.

Although the WHO recognised obesity as a disease in the late 1990s, like many other issues, we have been slow to catch up. With extensive research available for multiple medical and surgical treatment options, doctors are now treating it as a disease. They prescribe pills for weight loss more generously than before, and morbidly obese patients now have the choice to undergo weight reduction surgeries.

As Pakistan has a fragmented healthcare system, one fears doctors may limit weight loss therapy to drugs and surgeries without necessary lifestyle interventions. Undoubtedly, this is a possibility, so the role of clinical dieticians becomes even more crucial. Though they usually aren’t a part of public hospital healthcare teams hopefully, a shift in the attitude towards obesity will create the need for clinical dieticians.

What makes this idea interesting to me is it will lift the burden of weight loss from the patient’s shoulders. With the help and guidance of a professional team, patients will start their weight loss journey earlier, have realistic goals based on their health status, and find support in case they feel hopeless. It will also allow patients to avoid many health complications and improve their quality of life. As for the stigma associated with it, I understand not only society but also professionals are a long way from developing an empathic approach to the condition.

The writer is a doctor with a particular interest in mental health. She can be reached at tahiraabrar@gmail.com