Sunday, January 08, 2012

Sunday Essay – obesity, fads and the failure of specialisation

According to an article the Sydney Morning Herald (A big problem calls for children on scales) by Rachel Brown, school children should be put on the scales and measured every time they have a health check, because parents and doctors can no longer identify weight problems purely on sight.

According to the Wikipedia article on the epidemiology of obesity, the World Health Organisation formally recognised obesity as a global epidemic in 1997. Obesity is most pronounced in developed countries (as early as 1962, 45 per cent of adult Americans were reported to be overweight; 13 per cent obese), but is spreading. It is largely an urban problem, and has spread with urbanisation.

The concern with obesity and with weight has become an obsession that affects every aspect of life.

In public policy and political debate, we look to ban or at least control junk food. We debate controls over advertising looking to protect children. Our papers, magazines and TV screens are full of stories about weight and diet and of ads for magical cures. The Biggest Looser reality TV show gains major ratings.

These concerns affect all aspects of domestic life: conversations centre on diet and healthy life style; the daily routines of life are affected by the need to accommodate specific weight loss diets; family cooking becomes more difficult.

One striking thing about obesity if the way it has been defined as a medical problem. The Sydney Morning Herald article appeared in the health section of the paper and focused on medical responses. The WHO uses the word “epidemic” to describe the spread of obesity, a word with specific medical connotations. Doctors have become the new gurus and advisers to us as individuals and to Governments.

Frankly, I am sick of it.

No one doubts that more people are overweight. No one doubts that obesity can have adverse health affects. Yet obesity itself is not a medical condition as such, it is not a disease. There are cases where obesity does have physiological causes, where it can be classified as a medical condition because the causes properly fall in the field medicine and can be addressed though medicine. However, this is simply not true in most cases. A best, medicine may help delineate some of the causes, may help deal with some of the results.

In my professional writing, I have explored to some degree the way in which specialisation affects the way problems are defined and responded to.

In law, for example, lawyers automatically look at the legal aspects of issues. They give legal responses to problems that are not in fact legal at all. Something similar happens in medicine. The problem and suggested responses are forced into the professional’s mental frame.

To counter this, I have argued in part that we need to develop a general discipline of professional practice, one that applies across professions. I have suggested that one aspect of that should be the diagnostic, the proper identification of the problem to be addressed. This includes the proper identification of those aspects of the problem actually relevant to the professional in question.

The rise of “the professional” was one of the defining features of the last few decades of the twentieth century. We saw a proliferation of specialisation and specialists to the point that much of the work force now carries some professional claim. We also saw an explosion in of Government enforced credentialism to the point that nearly everything now requires some form of ticket; the role of experience and broad based skills has been devalued as a consequence.

In another part of my writing I have focused on the importance of multidisciplinary approaches, trying to explore just what was required to make these work. Central to this was the need to define common frames that would allow different professions to work together, to overcome that blindness created by training and professional practice.

I still regard this as important. However, I also think that it’s sad that interest in multidisciplinary working peaked in the 1990s. Then many of us thought that such working would be central to future work. The explosion in credentials and in professions has increased the need for multidisciplinary approaches, but also reduced real interest in and capacity to actually do real multidisciplinary work.

If we apply this analysis to the obesity issue, you will see that the proliferating “solutions” are dictated by the professional backgrounds of those involved, as well as the perceived need to control actions and symptoms through direct controls.

To my mind, there is remarkably little discussion that looks at obesity in a holistic way as one subset in a range of social issues. Without such discussion, fad and fancy will continue to rule.

Note to readers:

This brief Sunday Essay draws together some of the threads in Belshaw thought. I will add a few links later.


Anonymous said...

Excellent piece Jim. It is a very human failing to frame any problem in terms of one's expertise.

Not completely unrelated, I'm always amused by the many films which gather together a group of 'heroes' to solve a problem - with the first few scenes almost always explaining or demonstrating the particular skillset each brings to the plot.

Maybe life should imitate art, as someone once said.


Jim Belshaw said...

Thanks, kvd. Maybe life should! In putting together teams from different professions, the first thing that I have always done is to start by discussing the problem and different roles.

Evan said...

Thanks Jim. I think professionalism may be part of the problem; I'm quite sure credential ism is.

As to obesity, for health it is about fitness. This shifts the focus to emphasis on exercise and healthy eating rather than looks. (the obesity is a fairly reliable indicator of fitness rather than the cause)

Legal Eagle said...

I am sick of the obesity "epidemic" too. The photo on the website accompanying the story was of a perfectly normal chubby baby. Babies are chubby for a reason. When my daughter was 11 months old she got gastro, and basically, all that chubby baby fat got used up - it's storage for when babies get sick. Babies should be chubby. Children should not be fed low fat foods or anything of the sort unless they have a severe problem.

Jim Belshaw said...

Interesting point, LE. It does make the case!