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is not and that is why patients are only referred to it as a tick box
exercise to meet NICE guidance. PLEDGE TO ELIMINATE
WEIGHT BIAS AND STIGMA OF OBESITY
One should question why NICE, which is supposed to ensure finite
healthcare resources are spent on clinically and cost-effective
interventions came up with this requirement of patients spending
some time in Tier 3 services first. What are we achieving by We recognize that
delaying, and in many cases, preventing their access to a highly
successful and sought-after treatment modality? It is a question
• Individuals afflicted by overweight and obesity face a
only NICE can answer but the mechanisms that allow us to question
pervasive form of social stigma based on the typically
NICE guidance do not exist. For scientific publications, you can at
unproven assumption that their body weight derives
least write to the editor of the journal. That option is not there for
a guideline issued by a government body in the public interest. primarily from a lack self-discipline and personal
We are just supposed to accept it as received wisdom howsoever responsibility.
unclear the rationale and the logic.
• Such portrayal is inconsistent with current scientific
The Coronavirus Disease -2019 (COVID-19) pandemic has brought evidence demonstrating that body-weight regulation is
obesity and its co-morbidities into sharp focus as it is now not entirely under volitional control, and that biological,
becoming apparent that obesity is also an independent risk factor genetic, and environmental factors critically contribute
[8]
for poor outcomes with COVID-19 . The condition that is not even to obesity.
perceived as a disease by healthcare professionals and the public
alike seems to be associated with the most dramatic reduction in • Weight bias and stigma can result in discrimination, and
quality and quantity of life. It is difficult to think of any other disease undermine human rights, social rights, and the health of
that wreaks more havoc than obesity – which many still perceive to afflicted individuals.
be a lifestyle condition.
• Weight stigma and discrimination cannot be tolerated in
References: modern societies.
1. https://www.rcplondon.ac.uk/news/recognising-obesity-disease- We condemn
would-help-people-manage-their-condition Last accessed on 3rd
July’ 2020.
2. Rubino F, Puhl RM, Cummings DE, et al. Joint international consensus - The use of stigmatizing language, images, attitudes, policies,
statement for ending stigma of obesity. Nat Med. 2020;26(4):485-497. and weight-based discrimination, wherever they occur.
3. Obesity: Identification, assessment, and management. National
Institute for Health and Care Excellence Clinical Guideline 189. We pledge
https://www.nice.org.uk/guidance/cg189 Last accessed on 3rd July’
2020.
4. Mahawar KK, Small PK. Medical weight management before bariatric • To treat individuals with overweight and obesity with
surgery: is it an evidence-based intervention or a rationing tool? Clin dignity and respect.
Obes 2016;6(6):359-360.
5. Lean ME, Leslie WS, Barnes AC, et al. Primary care-led weight
management for remission of type 2 diabetes (DiRECT): an open- • To refrain from using stereotypical language, images, and
label, cluster-randomised trial. Lancet. 2018;391(10120):541-551. narratives that unfairly and accurately depict individuals
6. Welbourn R, Small P, Finlay, I, Sarela A, Somers S, Mahawar K. Second with overweight and obesity as lazy, gluttonous, and
National Bariatric Surgery Report. http://www.bomss.org.uk/wp- lacking willpower or self-discipline.
content/uploads/2014/04/Extract_from_the_NBSR_2014_Report.
pdf Last Accessed on 3rd July’ 2020.
7. Welbourn R, le Roux CW, Owen-Smith A, Wordsworth S, Blazeby JM. • To encourage and support educational initiatives aimed
Why the NHS should do more bariatric surgery; how much should we at eradicating weight bias through dissemination
do? BMJ. 2016;353: i1472. of current knowledge of obesity and body-weight
8. Tamara A, Tahapary DL. Obesity as a predictor for a poor prognosis regulation.
of COVID-19: A systematic review [published online ahead of print,
2020 May 12]. Diabetes Metab Syndr. 2020;14(4):655-659.
• To encourage and support initiatives aimed at preventing
Prof. Kamal Mahawar is a Consultant General and Bariatric Surgeon at weight discrimination in the place, education, and
Sunderland Royal Hospital, UK and a Visiting Professor at the University of healthcare settings.
Sunderland. Prof. Mahawar takes significant interest in patient safety and is
the safety lead for the South Tyneside and Sunderland NHS Trust. He takes
significant interest in academics and research; and has published over 100 peer Adopted from
reviewed articles. Prof. Mahawar is an Associate Editor of “Obesity Surgery” www.nature.com/naturemedicine (Vol26 April 2020)
and “Clinical Obesity”. He is also recognised widely for his contribution to One
Anastomosis Gastric Bypass. He is a member of the council of the Association
of Surgeons of Great Britain and Ireland (ASGB) and is its Associate Director
for conferences. He is the chair of the Patient Safety Committee of the British "CONGRATULATIONS”
Obesity and Metabolic Surgery Society (BOMSS) and has served on a number
of national and international prestigious committees. He currently serves on Prof. Kamal Kumar Mahawar is now elected on the
the National Bariatric Registry Committee of the BOMSS and on the scientific
committee of International Federation for the Surgery of Obesity and Metabolic Council of British Obesity and Metabolic Surgery
Disorders (IFSO) amongst others.
Prof. Mahawar has also written two books on healthcare (“The Ethical Society.
Doctor” and “Fight with Fat”) published by reputed publishers keeping the lay Well done Prof Mahawar Ji .....Swasthya
public in mind. He is a member of Advisory Board of Swasthya.
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