Overweight Americans Push Back on Health Debate New York Times. I am going to be non-PC. I am not sympathetic. This is a public health crisis (diabetes, for starters) and we have people defending…”weight diversity?”
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The article on overweight Americans conflates several distinct issues, but even the broader questions here (believe me no pun intended) are complex. In the article, the problem is raised of recent exceptionally hostile, and bigoted, remarks made about the unfitness of those of excessive weight for _publicly funded, comprehensive_ health care, to the effect that such folks are unfit and should face punitive rates, restricted coverage, or even more vile formulations. The perspectives raised there are fundamentally discriminatory, and apart from having no place _as posed_ in the debate on health care are tainted in a moral sense as a response to others in a common society. This is a specific issue which needs to be seen as such separate from the ’social politics’ of excessive overweight, to my mind.
Being seriously overweight has a strong correlation with many severe health consequences, however, which are costly to treat, not least because many of those problems are chronic. Getting cancer or your kid having complications from a severe concussion suffered playing sports are also costly, and the latter is a case where the activity was optional. Should we impose penalty fees, or behavioral ‘inhibitors’ to folks with said exposures or consequences so that we don’t have to share in those costs, either? Most would say, No; certainly I would say no. As soon as one accepts that certain health conditions can be acceptably be given a lesser response, discrimination easily becomes pervasive. The point in moving to a national model of health care as a utility is to get as broad a base for as low a cost as possible while forbidding discrimination, in no small part because discrimination becomes pervasive and pernicious very quickly, even to quite insane levels. It’s best to shade social views away from discrimination.
On the other hand, I do not equate negative personal responses to excessive weight in other folks with, say, racial discrimination. In part this is because excessive overweight is, in fact, seriously unhealthy, and it is known that aversive responses to ill health are deeply embedded in perceptual response as opposed to something simply learned, although certainly learning reinforces them. For example, studies have demonstrated that even things like slightly irregular features or unusual body postures indicative of underlying health issues lead to psychological assesstments of lesser desirability, even when those small differences are not conciously perceived by observers. Most animals distance themselves from others of their own kind who are ill or who show even subtle symptoms of physical maladay. In that respect, a moderately aversive response to other human beings of sufficient overweight to definitely degrade their immediate and long-term health is ‘normal.’ Having an aversive response to a person of a different skin color is something learned which has no basis in health or ‘fitness,’ and isn’t something to tolerate much less promote in others. But an aversive response to someone with unhealthy physical fitness has a reality basis. It is a bad thing psychologically to ask people to suppress a reality-based emotional response. (There is the secondary issue of how much weight is ‘excessive’ given a tail distribution of height-weight proportionality, but let’s restrict this argument to those well above any normal range of proportionality who are very strongly at risk of healtch complications.)
To what extent, then, is it reasonable and just to ask individuals to suppress what is substantially an appropriate reaction? Well, those with physical disabilities are manifestly ‘less fit’ but still entirely human and often highly capable in many other respects, despite which they face egregious discrimination in many, many societies around the world. It is reasonable in those cases to expect others to look past an aversive response, should they have it, to the person’s humanity, and to forbid discrimination. But we’re speaking here of often irreversible disabilities. Overweight is typically not seen as such. This is presently a hotly argued topic, and the crux of the issue of where the boundary of mutual expectations lies in shaping a response to those overweight. One argument is that, of course that weight can be lost, and hence being severely overweight is a choice. Another argument is that, well no; in effect that very high weight is a permanent and unavoidable disability, though this is seldom argued directly I might note. I certainly won’t resolve that debate in a comment of this length. Let’s take an analogy, though, if a perilous one and not entirely fair and consider if excessive weight is a comparable state to alcoholism. Some might argue that we should ration health care to alcoholics, but I think most would see this as an unacceptable and discriminatory penalty. Most would insist that we respond to someone alcoholic as a person rather than a condition whatever our emotional response might be to them. That said, since the substantial majority of those with alcohol problems can change their behavior, and further that the consequences of their unchanged behavior is so negative for them and secondarily others around them, most would argue that an expectation of change is appropriate. Or put another way, their is no brief for ‘alcoholic diversity.’ The burden of change is on the individual even while the expectation of non-discrimination is on society.
Mind I am NOT equating severe overweight directly with alcoholism. I am making an analogy here that even with a condition which is arguably worse then overweightness discrimination per se isn’t an acceptable response. But the burden of change in both cases is, to me, on the one with the potential for change. And as such insisting that others supress an aversive response _entirely_ if they have it veers toward an excessive demand. A diversity argument rests upon a condition which, in the first instance, is innate, and/or in the second instance is irreversible. While these surely hold for some of excessive weight, manifestly they do not for many. It is difficult to see that the burden of change rests on society in this one.