DSC02665Adam Staten is a GP trainee in Surrey and is on Twitter @adamstaten.

For years there has been deep concern about the dangers to health of girls and young women aspiring to the figures of ‘size zero’ models. How odd then that the signing of a morbidly obese model to a top modelling agency was heralded by many in the press as a triumph despite the vast array of health issues associated with obesity.

Tess Holliday, the size 24 model in question, is a champion of the ‘body positive’ campaign which aims to destigmatise obesity and challenge conventional perceptions of beauty. In many ways this it to be applauded. There is no doubt that obese individuals are widely stigmatised and there is much evidence that the stigma attached to obesity is a major barrier to people seeking help for weight loss and for achieving their weight loss goals¹.  It has even been argued that, as medical practitioners, destigmatising obesity is part of our duty of non-maleficence².

Yet many people would counter that models such as Tess Holliday feed into the increasing normalisation of high BMI. Being overweight or obese in the UK has already become so normal that the majority of adults in the UK who fall into these categories do not recognise that they have a weight problem³. Not recognising the problem is of course a huge hindrance to tackling it.

So where does this leave Ms Holliday? On the one hand she is helping to break down the stigma that causes such difficulty in promoting weight loss, on the other hand she normalises a dangerous health condition.

This is the quandary we all face day to day when we deal with overweight patients. How does one strike the balance between re-affirming a positive self-image and instilling a healthy fear of a condition that demands treatment? How do you make someone feel good enough about themselves to be motivated to change, and yet convince them that the change is necessary?

There is another danger in the debate concerning plus size models. Each time a model such as Tess Holliday makes the headlines the argument surrounding obesity regresses to one of aesthetics and vanity which trivialises an issue that is a major problem both for individuals and our nation as a while. This detracts from the important public health messages. The more normal obesity becomes the harder it will be to bring home the importance of preventing and treating it.

Underlying all this is one further big question. Why does our fashion industry feel compelled to swing between the extremes of dangerously underweight models and dangerously overweight models? It seems to me that between size zero and size twenty four there are at least ten healthier dress sizes. Are there not enough beautiful women to be found amongst them? Is it not possible to re-normalise a healthy weight?

Perhaps, as doctors, there is only so much we can do. For many people issues of vanity will always trump issues of health and it is not till healthy is seen as beautiful that we will begin to win this battle.

References

1 Brewis AA (2014) Stigma and the perpetuation of obesity. Soc Sci Med 2014 Oct; 118:152-8

2.  Abu-Odeh D (2014) Fat Stigma and public health: a theoretical framework and ethical analysis. Kennedy Inst Ethics J 2014 Sep;24(3):247-65.

3. Johnson et al (2014) Do weight perceptions among obese adults in Great Britain match clinical definitions? Analysis of cross-sectional surveys from 2007 and 2012. BMJ Open 2014 Nov 13;4(11)