After six years living and working in New Zealand, a South African chef has had his annual work permit declined for the first time due to his weight. Albert Buitenhuis and his wife Marthie moved to Christchurch in 2007. At the time, Mr Buitenhuis weighed 160kg, yet passed the medical exam needed to obtain his visa. Since then, he has lost 30kg, a not-insignificant amount, but has now been deemed too unhealthy to remain in the country. Both he and his wife have had to stop working, despite no apparent problems with her work permit, and they both face expulsion from the country.
The official reason given for rejecting the permit application was that Mr Buitenhuis "did not have an acceptable standard of health." According to an immigration spokesperson, New Zealand requires migrants to have an acceptable standard of health to minimise costs and demands on the country's health services, and that Mr Buitenhuis' obesity put him at "significant risk" of potentially costly medical conditions such as diabetes, high blood pressure and heart disease.
While any country is entitled to operate an immigration policy that maximises benefits to itself, this decision is problematic for a number of reasons. First, the policy seems to be inconsistent. For five years, Mr Buitenhuis has been awarded his work permit with no difficulty, despite starting at 160kg and gradually becoming less heavy. Now, at 130kg, the permit has been refused. This lack of consistency raises the question of how this 'policy' is being applied. Is it possible that permission to work in the country depends of the extent of anti-fat attitudes of the immigration official on whose desk your application happens to land. If this is the case, there is clearly scope for unfairness and discrimination.
Second, is this 'policy' applied equally to migrants who engage in behaviours that are known to increase risk of other health conditions? Are you refused entry for smoking, for not exercising sufficiently, for not getting enough sleep at night? These behaviours are all strongly correlated with increased risks of very expensive health conditions such as cancer and heart disease. If you take up smoking, for example, after moving to New Zealand, will you be asked to leave? If not, this policy would appear to be discriminatory against individuals on the basis of size, rather than health. Weight stigma is a problem in many areas of society, including healthcare, education, and employment, and has been shown to cause both direct and indirect harms.
Weight stigma appears to be the last socially acceptable form of prejudice and discrimination, and many people engage in behaviours towards fat people that most societies and individuals would deem abhorrent if directed towards other groups, for example, people of colour or certain sexual orientation. No doubt, some would argue that obesity is an outcome a person has brought upon themselves by their own poor choices, and thus, they are undeserving of basic human considerations. Quite apart from the fact that almost all people working in the field of endocrinology will tell you that there is nothing simple about obesity - that genes play an enormous part in how people partition energy - that dieting and self-loathing both result in increased health problems and, often, weight gain, and that stigma itself may lead to further weight gain, it is also worth noting that few would suggest that a disabled young man who finds himself in a wheelchair after driving his motorbike too fast with a gut full of booze should be treated more poorly and denied basic human dignities because he 'brought it on himself'.
And, perhaps most importantly, there is no suggestion that Mr Buitenhuis is indeed in poor health. There is no suggestion that he is unable to engage in his profession or be a contributing member of society. There is no suggestion that while doing so he has been a drain on the state, has received benefits of any kind, or has failed to pay his taxes. This 'policy', such as it is, suggest that a person should not be allowed to live in New Zealand because he may one day become ill. It conflates weight with health. The two are not the same things. Many thin people get heart disease, diabetes and hypertension. And while this may come as a shock to some, many fat people don't. There is even a name for this - metabolically health obese - and large studies suggest it applies to around 40% of fat individuals. What protects these people from the diseases sometimes attributed to obesity is not known, but a wealth of scientific evidence is showing that maintaining a healthy lifestyle - exercising, not smoking, drinking in moderation and eating a range of fruits and vegetables - confers similar advantages regardless of weight. Healthy living fat people have the same long-term outcomes as healthy living thin people. Both do much better than thin people who do not engage in these healthy habits. Contrary to common belief, exercising a few times a week and improving your diet will not necessarily make a fat person thin. Once you become fat, the degree of restriction needed to achieve and maintain thinness is extreme, and would not generally be considered healthy in any body. This is what happens when the number on the scale becomes more important than health itself: maintaining that number at the expense of your health is actually considered the better choice. But even if these healthy behaviours will not necessarily, or often, make a fat person thin, they will make you healthier - improving blood sugar, cholesterol and blood pressure, even without weight loss. Weight cannot be used as a proxy for health. This is a lesson that many, including the New Zealand immigration authorities, would do well to learn.