Are we obligated to try to be healthy?

If you have been following the blog for a while, you may remember this post about the fat acceptance movement and the argument that you can be “healthy at every size.” Unfortunately, much as I would love to tell my patients to stop worrying about weight, I actually do treat a LOT of patients with medical problems that are caused at least partially by excess weight.

For example, patients who are obese have more adipose tissue (body fat). Adipose tissue isn’t just dead space, though – it secretes hormones, including estrogen. In women, this excess fat secretes excess estrogen, which increases the risk for endometrial (uterine) cancer. Overweight and obese patients are at 2-4x the risk of endometrial cancer compared to women with a normal body weight. Extremely obese women are at 7x the risk of endometrial cancer compared to normal weight women. Don’t believe me? Check out this summary article from the National Cancer Institute.

It is also widely accepted by the medical community that obesity increases your risk for heart disease, diabetes, high blood pressure, infertility, osteoarthritis, fatty liver, and many other conditions. (Check out this summary from the National Institutes of Health).

So now that people are seeing through the “healthy at every size” argument, the latest catch phrase has become “being healthy isn’t a moral imperative.” The argument goes something like this:

Yes, I am obese, and yes, I am unhealthy because of it. But that doesn’t make me a bad person, and I should be allowed to celebrate my body even though it is unhealthy.

All of those statements, taken by themselves, are true. I don’t think my patients should feel like they are bad people for being obese. For that matter, I currently have a BMI of 26, which puts me in the overweight category, and I don’t think that makes me a bad person.1024px-medical_complications_of_obesity

Where this gets tricky, though, is when we start talking about healthcare. Many of the people whom I see posting things about fat acceptance also post frequently about how healthcare is a human right. It is hard to reconcile the argument that people shouldn’t be expected or required to be healthy with the idea that everyone should be provided with healthcare.

Why is that so tricky, you ask? Just because someone is fat doesn’t mean they should die. That is absolutely true. But we have to consider the economic cost of obesity-related medical care, which has been estimated at $140 million per year. Adults with a BMI of 30-39 spend 42% more on their healthcare than adults at a healthy weight, and adults with a BMI of 40 or higher spend 81% more

If we are going to try to provide healthcare for all, which will be funded by all of us, are we each obligated to be as healthy as possible?

It seems that most people frown on alcoholism, which is seen as a choice to engage in a behavior which endangers your health. If so, what other unhealthy behaviors should we frown on?

What do you think?

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