Í þessari grein verður fjallað um þá spurningu hvers vegna offita er í síauknum mæli við- fang heilbrigðisstétta og hvort sú þróun sé til hagsbóta fyrir feitt fólk. Þótt Alþjóðaheilbrigðismálastofnunin hafi lýst því yfir að offita sé meðal alvarlegustu heilbrigðisvandamála sem mannkynið glímir nú við er ekki augljóst að nálgun læknisfræðinnar verði til þess að auka lífsgæði hjá feitu fólki. Faraldursfræðilegar rannsóknir og langtímarannsóknir á árangri meðferðar gegn offitu sýna að hún skilar litlum árangri. Í þessari grein mun ég lýsa hinni hefðbundnu raunvísindalegu orðræðu um offitu en jafnframt varpa ljósi á sjúkdómsvæðingu (e. medicalization) feits fólks. Ég mun fjalla um þau gildi og félagslegu öfl sem gætu útskýrt hvers vegna offita er í síauknum mæli viðfang lækna þrátt fyrir lítinn árangur almennra læknismeðferða. Ég byggi hér á greiningu Sadler, Jotterland, Lee og Ingrig (2009) sem hafa skilgreint hugtakið sjúkdómsvæðingu (e. medicalization) og bent á hvernig við getum lagt mat á hana innan lífssiðfræðinnar. Í lokin ræði ég holdafarsfordóma í samfélaginu og hvernig þeir hafa knúið feitt fólk til að tjá sig um líf sitt. Með því að líta til rannsókna feits fólks á eigin lífi og stöðu má varpa enn betra ljósi á sjúkdómsvæðingu offitu og fá betri sýn á það hvort hún sé til hagsbóta fyrir feitt fólk eður ei.
In this article the focus will be on the questions: Why are fat people increasingly subject
to medical interventions? Do such interventions provide long-term health benefits?
Although the World Health Organization (WHO) classifies obesity among the
most serious health threats we are facing, it is not obvious that medical intervention
benefits those who are labelled obese. Epidemiological and long-term treatment results
suggest that the medical approach to obesity is neither improving the health of
the obese in the long run nor lowering the prevalence of obesity. This begs the question
why obesity is medicalized and whether medicalization is beneficial to the fat
person? In this article the mainstream approach to obesity will be outlined, both what
could be labelled the clinical approach and the public health approach. The latter
approach has increasingly centred on the obesogenic environment. The obesogenicity
of an environment has been defined in terms of the surroundings, opportunities,
or conditions of life which promote obesity in individuals or populations. It can refer
to the design of schools and workplaces, public transport and more general factors such as the food industry, the culture regarding food and recreation. Both phrases,
the obese patient and the obesogenic environment, are medical in nature, resting on
the premise that being fat is a disease, problematic and damaging to the fat person´s
health. Hence, since the prevalence of obesity is rising we do have a serious health
problem on our hands that has been labelled the obesity epidemic. By describing
obesity as a disease, healthcare professionals and medical scientists become the
specialists in handling the lives of fat people. The article draws attention to social
forces that might partly explain why bodily appearance is increasingly the subject of
medical attention. In doing so it draws on the works of Sadler et al. (2009) who describe
forces and societal values that drive medicalization in general. By using this insight
and applying it to the obesity debate it is possible to speculate on the forces that
drive the medicalization of obesity. Issues discussed will include: the promise of cure,
healthcare as a commodity, desire for power, eudaimonia, individualism vs. communalism,
depoliticizing politically difficult social problems, technological values and
finally medicalization as a drive to transcend human-existential limitations. These factors
help to explain the social forces at play in the medicalization of obesity. There are
reasons for rejecting the medicalization of obesity: Firstly, as already mentioned, the
long-term benefits of medical treatments of obesity are poor. Secondly, fat people are
stigmatized and marginalized in today’s societies. Medicalization has marginalized
them even further. Medicalization could, therefore, harm fat people by putting them in
ever more oppressive situations in society. There are those who protest the medicalization
of the fat person. Critical voices like health at every size and proponents of
fat studies add new, critical perspectives on the medicalization of obesity. They claim
that appearance is not problematic per se and trying to change the way people look
should not be the aim of health care providers. The focus should rather be on healthy
lifestyles and acceptance of people in all body sizes. When addressing BMI figures
instead of people, health scientists and medical professionals are not focusing on the
core of the real problem. The real problem is not the BMI of the fat person but rather
societal responses to those who are fat. These critical voices harmonize with the voices
of gay people, people with disability and people with mental illnesses. Like gays
and the disabled, fat people increasingly reject the view that scientists are experts in
their lives and that they need to be corrected to become accepted in today’s society.
They want their own voices to be heard and to be accepted as they are.
