Understanding the Obesity Bill of Rights - Part 1

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You may have heard of the “Ob*sity Bill of Rights” It’s part of what they are calling the “Right2Ob*sityCare Movement” which has, as its immediate goal, lobbying state and federal government for insurance coverage for products and interventions sold by the weight loss industry. From the site:

“Right2Ob*sityCare intends to transform “ob*sity” care, which means changing policy at the national and state levels. An immediate goal is to secure passage of the Treat and Reduce “Ob*sity” Act (TROA), bipartisan legislation that will address inequality in “ob*sity” care for Medicare beneficiaries and reduce stigma and weight bias in the US.”

I’ll go into the TROA in a future post but it’s important to remember that the Medicare beneficiaries they claim to be so concerned about were vastly under-represented in their drug trials and there is a significant body of research suggesting that weight loss in this population will lead to higher mortality. Also, every time they talk about “solving inequalities” you can substitute “increase weight loss industry profits.”

In general, if you wanted to practice the methods from my article “How to spot an effort to trick you into lobbying for Novo Nordisk and Eli Lilly’s weight loss drugs” this would be an extremely easy one to start with.

At any rate, in Part 1 we’ll talk about “rights” 1-5. In part 2 we’ll talk about “rights” 6-10 as well as who is behind all of this.

Let’s take a look at the first five “rights.”

I do want to point out that throughout the website they use the term “ob*sity treatment” and that the only difference between “ob*sity treatment” and “weight loss intervention” is the spelling.

“Right” #1:
 The Right to Accurate, Clear, Trusted, and Accessible Information on ob*sity* as a treatable chronic disease

First, this language comes from Novo Nordisk (and their astroturf group the Ob*sity Action Coalition), Ely Lilly, and other weight loss companies. It is not rooted in science, but in the marketing language that is required for their drugs to be prescribed to the largest possible market, for the longest possible amount of time.

Second, this “right” isn’t possible to achieve. Any “information” about “ob*sity” as a “treatable chronic disease” cannot be trusted because, in truth “ob*sity “is not a “treatable chronic disease” or a disease of any kind. Ob*sity is, in fact, simply a body size. It’s a term (the root of which is “to eat oneself fat”) that was literally made up for the express purpose of pathologizing bodies based on shared size rather than shared symptomatology or cardiometabolic profile like we would see in a real disease, and whose definition has, and continues to be, been malleable based on the profit interests of the weight loss industry, who have been the primary architects of the term and the paradigm upon which this “right” is based. People who are “diagnosed” with “ob*sity” have the exact same health statuses, symptomotologies, and cardiometabolic profiles as people who have smaller bodies. (I wrote about this in-depth here.) 

Finally, note that this “right” isn’t about actual healthcare, it is about “ob*sity” care which, again, means weight loss industry profits.

“Right” #2:
The Right to Respect by all members of the integrated care team when screening, counseling, and providing treatment.

I was hoping that this wasn’t what it sounded like so I clicked for more information. It is exactly what it sounds like:

“All people with “overw*ight” and “ob*sity” have the right to receive timely, effective “ob*sity” screening, counseling and treatment delivered by all members of the integrated care team in a considerate and respectful manner.”

Note that they don’t say anything about ANY OTHER HEALTHCARE that higher-weight people might need – apparently, we only deserve respect when being pathologized and prescribed weight loss, often in ways that risk quality of life and even our lives.

Part of this one is the “right” to 

“Receive information from their health providers in “patient-first” language, which puts a person before a diagnosis, describes the condition the person “has,” and gives the person a sense of dignity when selecting a treatment plan and interacting with members of the care team.”

Just as a reminder, person-first language did not come from higher-weight people, from weight-neutral health community, or from fat activity community. It came from the weight loss industry, and through the advocacy groups and campaigns they fund. While they market it as anti-sigma language, its only goal is to support the idea that simply existing in a higher-weight body is a “disease” and it is, in fact, more stigmatizing. I wrote more about this here https://weightandhealthcare.substack.com/p/inclusive-language-for-higher-weight.

“Right” #3:
The right to make treatment decisions about one’s health goals and ob*sity care in consultation with the individual’s health providers

Here they pile on nonsense like “Receive a clear, understandable diagnosis based on their degree of excess fat accumulation and their risk factors, such as age, smoking, family history and the presence of “ob*sity”-related comorbid conditions.”

Again, this is not science, it’s marketing language. So-called “ob*sity -related comorbid conditions” are conditions that people of all sizes get that are called “ob*sity-related” when fat* people have them. There are plenty of people who meet the classification of “ob*sity” who don’t have these conditions and plenty of thin people who do.

The diagnostic criteria for a disease should be specific to the people who have the disease, it should not be about a group of risk factors that people with and without the “disease” share, nor should it be about body composition, especially given that there is no actual definition of what constitutes “excess” and the fact that, again, two people can have the exact same amount of body fat and/or risk factors and have wildly varying actual health statuses. Based on this definition “ob*sity” is just having some health conditions while being fat. It’s like saying that if you’re 6’7 you are tall, but if you are 6’7 and have hypertension you are now “medical over-tall” and have two health conditions instead of one.

Next under this “right” is

Expect accurate and thorough information from their health provider about all safe and effective treatment options for their care. These include behavior modification, community-based programs, access to nutritional and/or mental health counseling, medical “ob*sity” management, FDA-approved anti-”ob*sity” medications, and bariatric surgery.

“safe and effective” are not terms that can be applied to so-called “ob*sity” treatment. Behavior modification, community-based, programs, nutritional and/or mental health counseling, and medical ob*sity management” have a hundred year track record of abject failure to create significant long-term weight-loss, FDA approval for weight loss drugs and surgeries is a far cry from “safe.”

The closest they come to anything ethical here is the right to:

Give or withhold informed consent.

Refuse treatment.

These actually ARE rights that patients have but note that they don’t say anything about the right to get actual healthcare. Remember, again, that these are rights for the “disease” of simply existing while fat, they are not rights for the actual patients which is why they don’t seem to care here if higher-weight people actually get any kind of healthcare besides weight loss.

“Right” #4
The Right to Treatment from Qualified Health Providers, including counseling and ongoing care from health providers with expertise in ob*sity care

Here they claim that the development of so-called “ob*sity medicine” specialist is a positive development and use it to create yet another bulleted list that is, once again, only focused on weight loss.

The more I read this, the more I fear that this entire preposterous exercise, done in the name of making the weight loss industry money, will simply add to the problem of healthcare practitioners seeing higher-weight patients as walking, talking pathologies, and trying to “Occam’s razor” their way into treating them by focusing any and all attention on making us smaller rather than actually making us healthy. This leads to practitioners who practice stereotypes instead of medicine, it leads to missed diagnoses and it leads to disengagement from care from patients who are sick of being prescribed weight loss for everything from strep throat to a severed limb.

“Right” 5
The right to person-centered care that is personalized, respects the individuals’ cultural beliefs, meets their specific health goals, and considers the person’s whole health and not just their weight status.

This must be the section where they talk about the right to weight-neutral care and to care outside of so-called ““ob*sity” treatment right?

Wrong.

Some highlights:

“All people with overw*ight and ob*sity have the right to receive “ob*sity” care that is personalized, reflects their cultural beliefs, meets their specific health goals and considers their whole health, not just their weight status.”

Choose an interprofessional care team with expertise in ob*sity care

Agree on a personalized care plan prior to the start of treatment that lays out the roadmap for ongoing “ob*sity” care

Have access to and insurance coverage for a health educator trained in ob*sity management

So if a patient wants care that doesn’t drive profit to the weight loss industry (including the people and parts of the healthcare system that are part of that industry) they are fresh out of luck. Patient-centered only if the patient wants to center thinness, apparently.

This is as close as they get so far to the idea that higher-weight people might have their health supported directly rather than through an obsession with their weight but those hopes are dashed in the first sentence which states “Because “ob*sity” is a complex chronic disease, individuals with “ob*sity” are entitled to the same best standards of care as those with other chronic conditions.”

It becomes clear that by “not just their weight” they never mean “without centering their weight.”

This also seems like a good time for a reminder that they are so busy bemoaning the “complexity” of “ob*sity” they’ve never bothered to define it in anything resembling a scientific way.

This “right” is comprised of a bulleted list of sub-rights focused on access and insurance coverage for weight loss interventions. While they insist on the right to medically supervised behavior-based interventions with a century-long track record of failure, they do not recognize a right here to informed consent (especially around failure rates and potential harm) of all these weight loss treatments, nor do they recognize the right of patients to receive (or even be offered as an option) weight-neutral care that isn’t focused on risking their lives and quality of life to make them thinner.

They recognize a “right” to be told (perhaps questionably) that “ob*sity” may change the way that medications work, but fail to recognize a “right” to know how much the medications and weight loss surgeries they recommend can impact the way that medications work.

They suggest that diabetes care and education specialists could be made into “health educator[s] trained in “ob*sity” management.” Eli Lilly has laid the groundwork for this already by giving money to the Association of Diabetes Care and Education Specialists.  It is becoming increasingly more difficult to find entities and people in healthcare who aren’t taking money from these organizations.

So that’s the first half. In part two we’ll look at “rights” 6-10 and find out why this whole thing sounds like it was written by a lobbyist for the weight loss industry.

Note: As I was completing my final proof before publishing, I got an email saying that the Association for Size Diversity and Health (ASDAH) is offering a member forum around this topic on April 26 with Angel Austin and Tigress Osborn, both incredible activists and educators in this space. You can find details and register here! (Full disclosure - I’m an ASDAH member, but receive no compensation if you register, I’m just boosting the signal!)

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More research and resources:
https://haeshealthsheets.com/resources/

*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings’ Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.