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T he f act that obesity is f ar less under individual control than generally assumed is f urther evident f rom the f act that f ewer than one in 20 individuals embarking on a weight loss attempt are likely to keep any of the weight of f . T he jury is still out on whether such f ailed attempts at weight loss are detrimental to health they certainly are to the ego. T here could also be a number of unintended consequences of such a pay as you weigh policy, such as people starving themselves and abusing diuretics, laxatives and anorexic agents (including tobacco) to lose weight prior to boarding a f light. Such unhealthy weight-control practices are already widespread amongst competitive athletes who participate in sports that involve weight categories (e.g., boxers and wrestlers). T his could be lif e threatening when it involves patients who are on medications f or blood pressure or diabetes, where even short term attempts at weight loss can result in increase health risks, such as stroke and hypoglycaemic shock, f or example. A single emergency landing because of a diabetic patient skipping breakf ast bef ore weighing in f or a f light would by f ar outweigh any potential savings to the airline (not to mention the inconvenience to other passengers). Ultimately, however, it is a matter of f airness. If airlines wish to treat their passengers like cargo, then a pay-as-you-weigh policy may appear justif iable. But if an airline sees itself as providing a service, namely, transporting human passengers, then the average price of a ticket (and the average size of a seat) should increase. T his is the only f air distribution of costs, and the only f air way to accommodate everyone. Playing a game of blame and shame is not a constructive solution to the obesity problem. Arya M. Sharma, MD, is an expert advisor with EvidenceNetwork.ca, Professor and Chair in Obesity at the University of Alberta and Scientific Director of the Canadian Obesity Network.