kwlf wrote:
The context of the quote was somewhat specific: knee replacement surgery. The argument went that if you force people to try to lose weight before surgery, for the majority of people this either means never having surgery, or waiting and usually putting more weight on before the surgeon gives in – if joints collapse beyond a certain degree then surgery becomes more complex and you can’t recover function so you have to make a ‘now or never’ decision. Patients with severe arthritis tend to sit around in real pain until their surgery, which can’t be conducive to weight loss… So why not just crack on?
I think the problem here is that “unhealthy lifestyles” and being overweight in particular, are seen primarily as moral deficiencies rather than medical conditions and so people must earn the privilege of surgery etc. by improving their morale (losing weight, eating better etc.). It is of course never stated explicitly, but it is quite clear from the undercurrents whenever this matter is being discussed.
You can see how damaging this is by looking at how drug addiction is dealt with in different countries. Sweden has the highest fatality rate among drug addicts of all European countries, despite having had a strict no-tolerance policy for decades. In fact, many people (including me) argue that it is precisely because of this no-tolerance policy that fatality rates are so high. For example, methadone treatment of heroin addicts used to been strongly opposed (and is still controversial) because methadone is “just another drug”. Addicts have to earn the right to treatment by staying clean and are thrown out of treatment programmes if they relapse etc. This clearly shows that drug addiction is seen as a moral deficiency. (Ok, the situation has improved somewhat in recent years so I may be exaggerating a little. But only a little.)
I’m a strong believer in individuals having agency.
I don’t consider myself to view e.g. obesity or drug addiction as moral deficiencies, but rather as the result of choices that individuals freely take – e.g. whether to eat another cake for breakfast or to inject some heroin this morning. I pass no judgement on them, but the fact that individuals may find it hard to make a decision not to do such things is not really a concern of mine – no-one ever said that life was easy and we all make many mistakes. When I do something that in retrospect I come to view as a poor decision (e.g. to finish the bottle of wine, to fly in marginal weather, to speak sharply to someone) I give it some thought and resolve to try and do better in the future – after all that is the only conceivable way I am going to change anything. I do not look outside myself for things to blame. To do so would be to deny that I freely made the choice and would be unhelpful.
Of course if one is engaged in social planning, the fact that people find certain decisions very difficult is a factor.
IMO its not the decision that is difficult, it is the carrying through on that decision. That is certainly the case for addiction.
gallois wrote:
IMO its not the decision that is difficult, it is the carrying through on that decision. That is certainly the case for addiction.
Very true. And regarding obesity or unhealthy eating behaviour, there is an ongoing discussion that e.g. High sugar intake is also an addiction, as is overeating in general.
Tellingly, the German word for Adipositas is Fettsucht, where fett means “fat” and sucht means “addiction”.
I share the view of @Graham that individuals have agency, yet as a doctor I have to acknowledge that certain factors hamper their decision making and must be taken into account when discussing both individual treatment and public policies.
I know the UK has a sugar tax, I wonder, @kwlf if that has had any demonstrable affects on unhealthy eating behaviour yet?
Graham wrote:
I don’t consider myself to view e.g. obesity or drug addiction as moral deficiencies, but rather as the result of choices that individuals freely take – e.g. whether to eat another cake for breakfast or to inject some heroin this morning.
The choices we make is what determines our morals, is it not?
I pass no judgement on them,
You may not, but it is clear that many people do.
I was trying to be helpful by suggesting that replacing junk with plant matter enables much easier weight loss.
Too many pilots I have known have lost their medicals squarely due to this. Most give up at that point but those who carry on have to spend some 5k, and endure a huge hassle, to get back. Everybody who has been flying some years will know many such pilots.
I wonder, @kwlf if that has had any demonstrable affects on unhealthy eating behaviour yet?
One aspect that I am worried about is that it has led to a move to diet soft drinks. I fear these may turn out to be even more unhealthy than the sugary ones.
I don’t disbelieve in agency, but I don’t think you can disentangle it from wider societal decisions. Lots of kids at my secondary school used to get driven 2 miles to school. Why didn’t they walk? Because there was no pavement.
kwlf wrote:
Lots of kids at my secondary school used to get driven 2 miles to school. Why didn’t they walk? Because there was no pavement.
There is pavements to all the local schools in my area, yet too many kids get ferried to school. Not only that, we have very low crime and low fear of crime, yet some parents still won’t have their kids walk to school. The problem is largely “car brain”, a significant number of people just can’t envision walking a couple of km.
We had a road closure a couple of years ago, and the only route was past a school where the school drop-offs were causing massive traffic problems (I was reliably beating another person into work on my bicycle – he was driving, and I was on my bike, from the same village to the same industrial estate, over a distance of 20km). When I suggested that perhaps children could walk to school instead on Facebook, it was almost as if I had admitted to being literally Hitler the amount of approbrium I received!
eurogaguest1980 wrote:
The US has an additional problem – HFCS – this stuff is particularly evil for the human body, and seems to be in almost every processed food sold in the US, due to the ability to buy laws there.Cutting out sugar is really really hard. Particularly in tea and coffee. One trick I used is to have a rubber band around my wrist – and any time I wanted something with sugar, I snapped it against the inside of my wrist. Ouch! It helped associate the desire for sugar with pain. Worked for me, anyway.
I don’t think HFCS is as evil as people make out. The problem with HFCS is that it’s so cheap (due to subsidies) so it literally ends up in almost everything, even places you wouldn’t expect. For example, bad cheap cuts of meat can be made palatable by the addition of cheap HFCS.
I found cutting out sugar quite easy in tea. When I was in my final year of university, I ran out of sugar, and forgot to buy any more for a couple of weeks. When I did and put it in my tea I wondered how I ever drank it so sickly sweet, and I’ve never put sugar in tea since.
kwlf wrote:
One aspect that I am worried about is that it has led to a move to diet soft drinks. I fear these may turn out to be even more unhealthy than the sugary ones.
Hasn’t this been very extensively researched and found not to come with any health issues? Do you have anything specific in mind?
