Lessons on causality from clinical encounters with severely obese patients

Abstract

In this chapter, general practitioner and senior consultant Kai Brynjar Hagen calls for a more personal approach to the care of severely obese individuals. These patients are frequently dismissed, miscategorised and consequently mis-treated in the healthcare system. Two key insights should be highlighted. First, that the tendency to see obesity as a primarily physiological ailment stems not from scientific evidence (of which there is much to the contrary), but rather from the denial that emotional pain can have strong effects on one’s health, even when it does not fit neatly into a psychological diagnostic category. Such denial is in frame with the biomedical model of health and illness. Second, that taking the time to value clinical dialogue reveals much about the nature of that patient’s condition. Such dialogue gives context, elucidates values, and importantly, in combination with the published evidence, it suggests causal explanations that affect the options for successful treatment. Hagen translates into clinical practice the dispositionalist view of causal singularism, presented in Part I of this book: that since causation happens in the single case, it is from the single case that we need to start causal investigation. He gives details about how he operationalises a whole-person view of each patient, encourages joint insights through dialogue, and uses the patients’ narratives in a mutual decision making process about their future. Further, he explores how the results he has observed in his own practice, and the difficulties he has faced, reveal deep-seated issues with the way we tend to treat obesity medically, namely by focusing mainly on its symptoms and little or not at all on core causes.