- By Ravi Philemon –
“If you are fat, how do you teach patients?” asks nurse Rajaletchumi Raja Singam.
Discriminatory words like hers are not uncommon. In fact, subtle and invidious discrimination against people who are overweight happens at all levels of society, and they ruin people’s lives.
Professor Linda Bacon, who is a specialist in food and sustainability and an advocate for Health for Every Size movement, says that research supports that you can be both healthy and overweight.
In her book “Health at Every Size”, she says, ”No obesity myth is more potent than the one that says obesity kills. It gives us permission to call our fear of fat a health concern, rather than naming it as the cultural oppression it is. That ‘obesity kills’ has been the backbone of the [U.S] federal public health campaign. Yet that is not supported by evidence examined by federal employees. Their research found that ‘even severe obesity failed to show up as a statistically significant mortality risk’ and suggested that overweight may actually be protective…The most comprehensive review, for instance, pooled data from 26 studies and concluded that overweight individuals were living slightly longer than those of normal weight.”
Although the etymology of the word ‘obese’ means, “that has eaten itself fat”, that is not the truth; for people who are in the ‘obese’ category very often do not eat any differently from people in the ‘normal’ category.
In a culture where people are pre-occupied with food and weight and with the constant message going out (even from well meaning healthcare professionals) that you need to be trim to be fit, instead of emphasising on being healthy, there is a lot of bashing going on, right from the schools to the places of work.
Even the chief executive of Alexandra Health Group (the healthcare group which manages Alexandra Hospital and Khoo Teck Puat Hospital) Mr Liak Teng Lit, equated being trim to being healthy. He recently said, “[If you are overweight) you are going to fall sick”.
He says that he will use ‘weight’ as a key performance indicator (KPI) for the staff in the hospitals managed by him and that overweight staff will not be promoted.
This KPI adds further stress to the staff in the hospital (many of whom are women) who juggle shift work, family commitments and societal pressures.
I asked Association of Women for Action and Research (AWARE) if it had a view on the KPI set by Alexandra Health Group for its staff’s promotion. AWARE responded that in its view, this practice of the health group is clearly discriminatory and unacceptable.
Ms Corinna Lim, the Executive Director of AWARE says, “If the hospitals wish to implement such an unusual policy, the onus is on them to substantiate and justify this.”
Ms Lim further asserted that the health-group has to show – as a matter of fact – that weight and body-shape generally affect work performance or pose a health-risk to the individual and their families, if the health group insists on using body weight of staff as a KPI.
“If so, are the hospitals applying similar considerations to individuals with other types of health risks such as smoking or who suffer from insomnia?” she asks.
This KPI she feels sets a very bad precedent not just for the health-care industry, but also for the country, for if it is accepted as a precedent, “then one can stretch it to every health care establishment in the country and to any other job where there is greater exposure to germs (e.g. cinemas, shopping centres, toilets).”
“What are the job specifications of hospital staff?” she asks. “Is it to promote healthy living or to take care of sick patients when they check in? Surely, what a patient is looking for is caring and competent staff, be they fat, thin or otherwise”, she adds.
‘Being trim equals being fit’ is a cultural idea that has been repeated so many times and has spread so swiftly that it has become part of our belief system. We are led to belief so strongly that being fat is killing us that we lose our open-mindedness and we see everything only through this lens.
The fact is, there are plenty of thin people who are making very bad health choices and don’t gain weight, as their bodies are genetically predisposed another way.
It is simply not true that everyone who is overweight has poor lifestyle habits.
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Picture courtesy of Georgia Obesity
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This just proved that even doctors have conceived bias that is unscientific.
People who are overweight often tell you they have no time to exercise, or they do not eat a lot. Then have dessert after a large & oily meal in front of you. They do not think it’s a lot, when it’s actually more than enough to an average-sized person.
There is one way to slim down. Stop eating so much! People who claims that it’s their fat genes making ‘em fat are giving themselves an excuse to continue being fat. Chances are, if they were to dig up pictures of their ancestors, they wouldn’t find any fat person. ‘cos most people in the past simply can’t afford so much food. If you don’t eat so much, you simply won’t be fat!
Slim people subconsciously dislike fat people ‘cos they’re actually eating food that’s not meant for ‘em. Millions of people in 3rd world countries starve to death every year. & their share of food goes to every fat person out there who doesn’t deserve it. In a way, fat people are gettin’ more than their fair share & this makes people unhappy. Subconsciously anyway. For some.
Fat people, eat less, lose some weight. Not only will you feel better & be much healthier & have much lower risk of contacting obesity-related diseases, you’ll also look much better & gain confidence.
Next time your tummy rumbles, do not think “I want some food but I can’t have some. I’m being deprived ‘cos I’m on a diet.” Think “Great! With every rumble, my stomach’s gettin’ smaller. Soon, my stomach will get back to its normal size & I won’t suffer this rumbling caused by the stretched stomach caused by the previous big meal or snack that I indulged in. Another plus side is that I’m going to have a much flatter tummy in no time & I’m going to look much better!”
Overweight nurses should try and reduce their fats !!
they are blocking the narrow alleys
and also bad tempered..!
EAT LESS, WORK MORE
Being fat has nothing to do with how much you eat more than what you eat. If the CEO wants his staffs to be trim and fit looking, then he has to make sure that his hospital does not sell fried and oily food, processed food like sausages and luncheon meat, fatty meats, doughnuts & fries.
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He must also ensure that the drinks they sell in his hospital are not excessively sweetened by sugar like sodas & colas, no cookies and chocolates and candies.
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Is this possible? I wonder?
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If I am not wrong, the CEO of AH probably believes that obesity is the contributing factor towards poor health conditions like diabetes, cardiovascular diseases and cancer. It is perhaps why he concluded that in order for the hospital to nurse its patients back to health, the people nursing the patients back to health must be healthy as well, or at least to look healthy. Obese staffs do not fit into this perception mould.
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Then again, for a CEO to revamp its appraisal standards around such a perception is totally wrong and discriminatory. Samo Hung is much healthier and fitter than most of us, even though he is now in his fifties, and still as fat as he was twenty years ago.
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The Dim Sum Dollies are just as healthy. Look at the colour on their faces, rosy red, fair and smooth – signs of healthy bodies.
eat what u like,eat what u can,life is short.
There are many very fit people who just collapsed and die suddenly
Some of them are big boned! I know of a few people who looked fat, but they are just built that way.
But anyway, isn’t there Tripartite Alliance for Fair Employment Practices (TAFEP)? Are fat people not people or is TAFEP just for show — so that they can say “we have an agency, so discrimination does not exist in Singapore…”
What rubbish is he talking about? How can one judge the quality of one’s work by how much he/she weighs? I think this is a case of discimmination at its ugliest. I cannot disagree more with this idiot & I can say that I know of many healthy people that arent thin. What’s the use of having a washboard tummy when you couldnt do your job probably. Yes, keeping fit is keeping yourself healthy & let me tell you something, I smoke 20 sticks a day, drink a few glasses a week but I have no problem passing my IPPT. I have known of people that are fit-looking & yet they clean their 14 days annual MC within 6 months & can fall ill almost once every few weeks!! It’s another one of these stupid ideas that these scholars came out & think it’s the next great thing next to the invention of the airplane!! !!
Thank God lesser mortals does not require their Health Minister to be healty else…..
ask anyone from former alexandra hospital, they will have a lot of stories to tell.
Ajax29 June 2010
This just proved that even doctors have conceived bias that is unscientific.
which doctors?
I have an idea, a wonderful idea for the AH CEO. Why don’t you assign duties based on the weight of your staff – the more a staff weighs, the more work he/she has to do; weigh less, work. less. You can incentivize the reduction of weight this way. I guarantee the fat ones will lose their weights in no time. No need to fire any of them. No need to worry about who you hire. All will fall in line in no time at all. Guaranteed success.
Gemani
The article is being disingenuous and misleading. There is a world of difference between railing and arguing against discrimination on the grounds of obesity and finding an obscure article or association or group that Challenges main stream medical opinion that Obesity is bad. This is frankly distasteful and irresponsible.
I recall research funded by cigarette companies which tried to prove that you could smoke cigarettes and live till a hundred and there was no link between cigarette smoking and greater incidences of ill health cancer etc etc.
The author is arguing obesity is good harmless and staff and obese people should not be discriminated against. That is a world apart from saying that Obesity is bad harmful but obese people should be treated fairly.
Locke
Can interview that Singapore fella on the first prog on losing weight…whatever on tevee. He said he was sacked because he was fat. I thought that was discrimination by Singapore but no one question mah.. The other participants from Asia had no similar complaint.
nurse has a point. how can a person with acne be in the beauty industry or a fatty be a personal trainer? let’s not be hypocrites about it
Frens, this happens in the SAF. You’re given three years. First a warning letter, which basically is the death kneel. You loose all promotions, bonuses etc.Ravi, maybe you should research here too, and make this very open. Thank you for all the hard work you do for us and for justice.
Well, just don’t work there if your BMI is above normal… there’s plenty of other hospitals in Singapore. Funnily enough, AH has a good reputation amongst patients and staff.
Isn’t it a requirement for professional soldiers to be fit? If you call that discrimination, you might as well call SIA’s non hiring of not so good looking people as flight attendants a form of discrimination. Any idea how many rounds of selections they have to go through, including the look out for scars, tattoos that might be visible even in the kebaya?
Wow, fat is not because of the amount you eat..
Fellow TOCians, please stop misleading the public. Please ask yourself are there fat starving pple in africa? If yes, there is no correlation between things u stuff in ur mouth and ur size
You beat me to those comments.
Writer only quoted from a vested interest on the issue of health. I’m sure that is lots of literature saying otherwise out there.
Is the writer overweight, and if so slightly or a lot?
FYI, I’m overweight by 5 kg.
The CEO has suggested that the quality of one’s work is affected by one’s weight. Being fat also makes one prone to sickness. We need him to qualify these remarks.
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It is not about an acne-faced beautician attending to her clients, or a soldier being trim and fit (btw, is there such a thing as a professional soldier?), or a fatty personal trainer, or the selection criteria of certain industries.
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This is a statement crafted to insult the ones who are fat, that they are not fit to work for an industry whose main objective, ironically, is to nurse sick and unfit patients back to health. If the healthcare institution cannot find itself able to take care of its fat workers, then how can a patient have any confidence in such an institution to nurse him back to health, especially when the patient is fat himself and therefore classified unfit?
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The hospital is saying very loudly and clearly that it does not have the ability to manage and care for fat people.
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I believe the CEO’s comment was a boast gone wrong. He wanted the world to know the regimental exercise regime he has set for himself and he truly believes that being as fit as he is, and being in the position that he is in, he has the right to dictate and lord himself over his subordinates.
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A restructured hospital like AH cannot compare itself with any commercial or professional businesses whose main aim is profit driven. A hospital, co-funded by the government, must remember its higher objective to provide employment to Singaporeans as well as to care for sick Singaporeans.
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Unfortunately, all our hospitals are now run like private enterprises, where the sole and primary objective is to make money out of sick people.
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It therefore cannot use such excuses like those being used by commercial businesses where they have to attract their own customers and in so doing have to find the most suitable candidates for themselves based on pre-set criteria drawn up for such purposes. It is up to those seeking employment to fit into those criteria and not the other way around.
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Know the difference and you will know why the comments by the AH CEO is unqualified and discriminatory.
@SAF
Which is incredibly, pointlessly discriminatory in itself, not to mention their vicious ageism. I’ve been served perfectly well on flights by homely attendants in their forties. SIA is just catering to the yellow fever of wealthy business travellers – talk about a colonial hangover.
@gemami
Sort of true, but not entirely. Instead of simply vilifying ‘sinful’ foods, the health conscious should take an overall approach in assessing food, in order to maintain proper portion control and serve food with a sensible glycaemic index, which keep you full longer, which discourages snacking.
Protein keeps you full. Fat keeps you full. Fibre keeps you full. Processed grains send your blood sugar levels all over the place, and don’t keep you full. I, for one, eat plenty of meat and veg, and not very much rice. I don’t faint at the sight of fried food – I just take care not to have too much. End result? I’m practically underweight.
@Sgporean: by your definition, all thin people are ‘starving…
Gd reason to make sure wimmin not obese and I’m not talking abt modelling or air hostess.
http://news.bbc.co.uk/2/hi/health/10434138.stm
“Big-boned” people being fat is an urban legend. Some people claims they’re heavy ‘cos they got big & heavy bones. C’mon. You are not Wolverine. Your bones are not made of adamantine. It’s just an excuse to continue being fat, similar to claiming to have “fat genes”, when one’s ancestors are likely not to be fat as people don’t have enough to eat in the past.
Overeating is a direct cause of obesity. Fat people almost always deny that they eat too much, ‘cos they didn’t know what a healthy food portion looks like. They think they’ve been eating “a little food” all along when they’ve been eating way too much.
Yes, a professional military should ensure its soldiers are at their peak physical conditions at all times. Why don’t we see it here? ‘cos it ain’t professional anymore when there’s conscripts involved. You are not a real, professional & FIRST WORLD defense force if you still conscript unwilling folks into the military for your own selfish desires.
Wow pugdragon,
Are you some sort of nutrition expert? Have you done any sort of research to back up your claims? Have you examined the amount and type of food fat people eat, and compared them to what a “normal” person eats? Have you yourself been fat before and shrunk to a “normal” or “acceptable” weight after reviewing your diet, or have you personally known people who have done that, and maintained that weight for life?
You think overeating is a direct cause of obesity. Haven’t you met anyone who can eat pretty much anything they want and still remain board-thin? Or someone who resorts to food restriction yet find it a struggle to keep their weight down?
You really don’t believe in the presence of “fat genes” and think it’s a myth?
You think people are fatter than their ancestors because of their dietary habits and not because of any other factors like environmental toxins, pollution, use of chemicals, lifestyle, etc?
10 Reasons Why The BMI Is Bogus: http://www.npr.org/templates/story/story.php?storyId=106268439&sc=fb&cc=fp
The BMI theory is actually meant for the europeans. It has never been accurate for them, let alone, we asians, who are smaller in build. It does not measure the amount of fats in our body. It’s a general rule with fats and muscles all in. Therefore, anyone can overshoot his BMI because he has more muscles not fat. It’s better to watch those waistlines and use the BMI as a guide.
Society should not ascribe obesity to poor or inferior work performance, although it may have an implication on image. Consider this: Is there anything wrong with a dietician, who is grossly overweight, but provides good advice and is able to draw up a good programme for his diabetic patient?
It can be an uphill battle for people who are struggling with weight problems, worse for those, whose age is catching up, with a decreased metabolic rate. The mind might be willing but the joints are weak. Some people are just plain lucky, they can eat luxuriously and voraciously without putting on weight. Many factors are involved when it comes to obesity; genes, hormones, gluttony, etc.
Yes skipper, I was a fat ass & I conducted that experiment on myself. By simply eating less at meal times & eliminating snacks from my diet, after a few weeks, the size of my tummy went down (flat in the morning, quite obvious) & my weight reduced too. I asked obese friends if they eat a lot that contributed to their obesity. They said no. & then I observed them a little more closely. Yup, they tend to buy snacks in between mealtimes & are likely to eat more at mealtimes too.
I had failed attempts to cut down weight. Back then, I was convincing myself that I have reduced my food intake. I snacked less & tried to eat smaller portions at mealtimes. But I was chugging beer (lotsa calories) 2 to 3 times a week & having supper after those times. Needless to say, that attempt failed.
My body size fluctuated a lot over the years, up & down. I was scrawny when I was 17 & thought no matter what I eat, I’d stay thin. That seemed to be the case back then. Had chicken chop every school day at Ngee Ann Poly from canteen 2 & I looked like I was of acceptable weight halfway to year 2. Come year 3, I got chubby. & I looked back to year 1 & wondered how come I was scrawny then. (Impossible not to see the link between chicken chop meals & growing fat, maybe I was in denial)
Those people who claims to eat a lot & yet stay thin, probably doesn’t eat at home, or is on the way to becoming fat in a couple of years if they keep up their eating habits.
It’s a really simple equation. Eat more = grow fat. Eat less = stay thin.
IMHO, there are 2 separate issues here.
1. Is obesity directly caused by overeating?
2. Is Alexandra Hospital and Khoo Teck Puat Hospital HR policy of linking overweigh to KPI discriminatory?
1st issue. Is obesity directly caused by overeating? E.g. A university hostel-mate had to consistently eat way less than me (I’m underweight all my life to-date) to maintain a normal weight range. I couldn’t understand her obsession with food until she showed me her secondary school photos showing an overweight girl. It seems that at some point in time, once a person became overweight, somehow it becomes hard to return back to the normal weight range and maintain it. Wish there are more research in the area. My “once-fat” theory seems to hold for the average fat persons that I’ve met. However, there are others who are fat due health problems (e.g. hypothyroidism). Thus, I would avoid assuming that fat people are so because they overeat.
2. Is Alexandra Hospital and Khoo Teck Puat Hospital HR policy of linking being overweight to KPI discriminatory? If the hospital’s intent is to assist patients to change their diet effectively, then why not use the success rate of patients’ dietary changes as KPI instead of an indirect measure such as nurse’s weight? IMHO, without scientific data comparing the success rate of the patients advised by fat nurses versus those advised by the slim nurses, the hospital’s policy is discriminatory. Unfortunately, such discriminatory words are regularly uttered by staff with authority in the public healthcare centres and in polytechnics (where nurses are trained).
pugdragon made an interesting point, “people who claims to eat a lot & yet stay thin, probably doesn’t eat at home”. Some (ex-)colleagues think that I eat a lot and yet stay thin, but they don’t believe that I would balance out by eating less for the next few meals after an overindulgence. That, plus I was never overweight before, helps me to stay slim.
Overweight people get fat in the 1st place usually from overeating or eating the wrong kinds of food, eg. lots of mayonaise on the side, oily chicken chops, fried chicken, ice-cream for dessert, soft drinks to accompany meals, etc. They’ve gotten used to snacking or overeating. It’s imbued in their brains. They reach for food the 1st sign of tummy rumble. The rumble is caused by the overexpanded stomach not gettin’ food when it feels like it should. By ignoring the rumbling & eating less, the stomach will go down in size in time.
They usually wouldn’t know if they’re eating too much. Reaching for snacks or overeating are performed subconsciously, as they’ve been doing this for quite some time. To eat less, they have to be conscious that they’re on a diet, & consciously make sure that they’re not snacking or overeating or making poor food choices.
I was fat, I know it’s hard when my tummy rumbles & I’m not supposed to eat as I am on a diet. I wasn’t supposed to eat as that was night time & I already had 3 meals for the day, thus I have had enough food. But I was so used to snacking at night. It’s hard to get used to in the beginning, but the rewards are far greater than the mild discomforts caused by not being able to eat as much as before initially.
Hahaha, you have the answer to “why thin people stay thin despite eating so much” in your final paragraph. Thin people stays thin because they control their diet consciously.
On your 2nd point, hell, it’s unfair to link KPI to obesity! Being obese is not good for health & doesn’t make you look as good as you should, but it’s no ground to be punished further at work. It should work on a reward system, not a punishment system. If staff can stay acceptable weight, they get a small bonus or perk, so to speak. Perhaps a small cash bonus every month? I’m not talking about a big amount. Probably, say, $20 as acceptable weight bonus every month? That’d be better motivation to stay in shape than imposing the punishment system which stresses out overweight people even more & make ‘em depressed & probably eat more in an attempt to fight the stress & depression. The punishment system is prevalent in the local military & I must say, it can control people, but it can’t earn loyalty or respect this way.
Pugdragon,
I wish the explanation for obesity is as simple as you have depicted. Sadly, it is not so. I believe the problem of obesity is mostly one of genes and hormonal imbalance.
The question is: does overeating make you fat, or does being fat make you overeat? Certain hormonal conditions cause the body to slow down its metabolism and try and conserve energy. This energy is stored as fat. The body, in its attempt to preserve this stored fat, demands for more food. This becomes a vicious cycle. Women with a condition known as Polycystic Ovary Syndrome (PCOS) are afflicted with this problem.
You mentioned your personal experience of having been skinny in your early years and then having become obese. And you try to blame it on those fat laden chicken chop meals. I would say your weight gain was probably due to hormonal changes.
I have lived with and am living with obese people and I have first hand knowledge of their dietary habits. I can assure you that these obese individuals do not consume more than an average person would, yet they keep on gaining fat. You must realise that obesity has a whole plethora of causes, and overeating is just one tiny bit of it.
You make a bold claim that thin people stay thin because they control their diet consciously. That is an extremely broad brush to paint the scenario with. Many thin people stay that way not because of what they eat, but in spite of what they eat. And I know of people who are like that.
I could point you to literature supporting my statements, but I’d rather you do your own homework before making ill-informed claims not entirely grounded in fact.
some years back, there was something similar about obesity in changi hospital as well. back then there wasn’t any complaint so i think it didn’t get noticed.
Skipper, I’ve done research online too about the link between overeating & obesity. Many articles support my claim. Or rather, I support their claim. However, there are also many articles that go against this claim. I can point you to literature too that establishes the link between overeating & obesity. But the thing is, there’s so much information online, you can’t be 100% sure which is the right info.
1 bodybuilding site claims that you should eat lotsa proteins in the form of meat & protein shakes to build up muscles. That’s the only way to build up muscles. Seems quite true. However, another site points out that it’s not what you eat, it’s what you do. Prisoners (subjected to physical labor in the past) eat slop, & yet are lean & fit from the physical labor they do. It’s what they do that makes them lean & fit, not what they eat.
No one can be sure what’s right. As Kevin Butler said, you can’t believe everything you read on the internet.
I mean no offense, skipper, but I think everyone, obese or not, would stand to gain from healthy eating habits & exercise. It’s hard to visualize someone who has healthy eating habits & exercise regularly staying fat & unhealthy, fat genes or not.
skipper, seems that we are both right.
http://www.nhlbi.nih.gov/health/dci/Diseases/obe/obe_causes.html
The earlier paragraphs mention lack of exercise & overeating as cause of obesity. More calories in than out. The later paragraphs mention genes. We’re both right! Peace!
it seems, the emphasis on keeping fit in the workplace according to the requirement for the job is not a new concept.
the nepalese police have also taken a firm stand on similar issues, even from as far back as 2003!
http://www.ekantipur.com/2010/04/03/top-story/raw-deal-on-cards-for-obese-police-officers/311620/
Jesus! Why should you ask AWARE when they have no idea what is really BOTHERING Singaporeans (or the real root of the problem)?
Learn from vegans like Dr. Khaw Boon Wan. Sure way to beat obesity!
Pugdragon,
Thanks for the balanced view. We both agree that obesity is a complex condition with multiple causes. Even the medical profession hasn’t fully understood the mechanism of weight gain.
Going back to the original topic, obesity does lead to health risks. However, in many cases, obese people can and do lead healthy lives, with no ill-effects caused by their excess weight. So to summarily dismiss all overweight people as unhealthy may be unfair.
What Khoo Teck Puat hospital is practising is no less than discrimination. The role of hospitals and especially nurses in the modern context is to nurse the sick, not provide them with advice on living a healthy lifestyle. We have nutritionists and fitness trainers for that.
This may be a bit cynical but why would the hospital wish to teach patients a healthy lifestyle? More healthy people means fewer patients.
Toc Writer,
This is better source to support thesis that to be fat is OK.
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PULLMAN, Wash. (AP) — How do grizzly bears stay healthy, when they love pastries, have up to 50 percent body fat and spend nearly half the year sleeping? That’s what researchers at the Washington State University bear research center hope to find out. They’re studying grizzlies to learn how they keep their hearts, arteries and muscles in good shape, and if there are any lessons there for humans.
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I believe that avoiding refined foods would be the first step to help lose weight. They might taste great, but packaged foods have very little vitamins and minerals, making you feed on more only to have enough vitality to get throughout the day. For anyone who is constantly taking in these foods, converting to cereals and other complex carbohydrates will help you to have more energy while feeding on less. Great blog post.
I beleive that eat more does not mean fat. It is eat unhealthy then fat. Don’t eat less don’t go on full on diets. Change your diet. Excersize. Skipping meals and eating less might affect one’s health too!