In my public speaking, I routinely note that obesity remains the last bastion of socially acceptable prejudice in our society. I keep waiting for the statement to become obsolete, but it hasn't happened yet.
The very definition of "obesity" in children -- a body mass index at or above the 95th percentile, adjusted for age and sex -- is willfully exclusive, rather than inclusive because we prefer to leave many overweight children out for fear of stigmatization
The official definition places the national prevalence of childhood obesity at around 20 percent. Look around, and ask yourself if you believe it. I don't. I believe it is much higher.
None have done a better job of cultivating awareness of fat bias than my friends and colleagues at Yale University's Rudd Center for Food Policy and Obesity. This is important work, for we have long placed blamed on victims of epidemic obesity themselves, attacking people with the problem as assiduously, if not more so, than we have attacked the problem itself.
Some of you are doubtless already starting to get dubious about where this column is going, thinking that fatness is a tale of laziness and sloth, that staying lean is simply a matter of personal responsibility. Lest I lose your interest, let's address that now.
If you are among those who think this is all a tale of will power, self control, or personal responsibility, consider that we have rampant obesity among children under age 10, and ask yourself this: is there any evidence to indicate that the current generation of children-under-10 has somehow been endowed with less 'will power' or 'personal responsibility' than every prior generation of under-10-year-olds? Is it even plausible? Are we manufacturing seven-year-olds from some new mold?
If not, simply extend the thinking to adults who are, as well, much the same as Homo sapiens ever were. It is the modern environment that is as it never was before. It is powerfully obesigenic. Throughout most of human history, calories were relatively scarce and hard to get, and physical activity unavoidable. We have devised a modern environment in which physical activity is scarce and hard to get, and calories are unavoidable.
That assessment, by the way, does not exonerate us of personal responsibility. At the end of the day, how we use our feet and our forks is up to each of us -- and it is up to us to guide our children to salutary use of these master levers of both weight and health as well. But the environment that dictates our options for their use, and that lays before us the paths of least and greater resistance is not of our own devising. To take responsibility, we must be empowered, and the modern environment is mightily disempowering where weight control is concerned.
In most modern buildings, elevators are far more attractive and easier to find than stairs. The message that sends about societal norms and expectations is unmistakable. My wife and I once went for a walk in Houston (one of America's fatter cities, by the way; Houston, indeed, we have a problem!) and got looks from drivers as if we were extraterrestrials. No one walks in Houston! Even our neighborhood in suburban Connecticut lacks sidewalks.
The food supply is even more disempowering. A dizzying array of claims, often misleading at best, undermine the best intentions of even the most health conscious shoppers. Fat reduced, salt reduced, sugar reduced products are not necessarily better for you, because as that one nutrient is adjusted favorably, several others may be adjusted unfavorably. This is common practice, but the package is mum on the topic. Will power cannot help with this; it requires skill power most people don't have.
All of this can, and will, be fixed. It is what I and many others have devoted our careers to. But, don't hold your breath.
In the interim, our attitudes about fatness -- our "fattitudes," if a neologism will do -- are not just problematic. They are between the proverbial rock and hard place.
While I rail routinely against fat bias, I cannot sign up with the "OK at any size" crowd. The anti-bias goals of organizations like the National Association to Advance Fat Acceptance are laudable, but the connotations in their entirety are not. Because we cannot and should not simply "accept" fat.
This is not a sudden about-face on my part. It's not hypocrisy. We must stop attacking people burdened by the problem of obesity. But we must NOT stop attacking the problem of obesity. Or, to use gentler terminology, we must not stop acknowledging obesity is a problem, even as we strive to stop blaming people for having the problem.
Why so adamant? Because obesity is, among other things, the reason why what I learned in medical school to call "adult onset" diabetes is now called "type 2." What was, less than a generation ago, a chronic disease of mid-life, is now a pediatric scourge. Epidemic obesity is the reason why a 17-year-old boy in Missouri had a triple coronary bypass. It is the reason we will see more of the same, and worse should current trends persist. And that, simply, is unacceptable; current trends cannot persist.
Fat bias is wrong. So is complacency about a societal plague that is propelling our children toward the chronic diseases of mid-life before ever they reach puberty. Between this rock and that hard place, we must find our way forward.
Dr. David L. Katz; www.davidkatzmd.com
Follow David Katz, M.D. on Twitter: www.twitter.com/DrDavidKatz
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We wouldn't feed our pets or houseplants the fast food, processed foods and soft drinks that we "normally" give our bodies everyday. It is the "normal" diet that is the problem. We simply need to get back to eating the foods indicative to our specie--the human being wasn't designed to consume big macs, Coke, fries, twinkies and chips (longer list of course but the worst culprits!) We weren't designed to spend hours a day sitting on our butts.
An overweight woman told me she eats a pound of nuts per day--so does a squirrel-what's the difference between her and a squirrel? "A Squirrel runs and jumps all day!" We are meant to move!
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It is not about obese people, it is about the problem of obesity. And the first step should be health education. If we don't know how to read labels and why most of foods in the grocery stores can cause different illnesses, how we can raise healthy children. If we think that magic pills can solve all our problems, how we can stay healthy.
Most of people don't think or use common sense any more- it is easier that way. Well, maybe it is time to start thinking, because prevention is much better and cheaper than cure.
Breathe, smile and be happy. NaturalCounselor.com
The main problem is that good food is expensive. Few people can afford to eat absolutely organic. I'm fortunate in that I have the room and the knowledge to garden; I know where to look to prioritize which foods should top the list of what organics I buy; I now stay away from canned vegetables; and I know how to cook and make do with basic ingredients. Many people can't do that these days. These people also tend to be lower income. Highly processed, boxed foods are cheaper than fresh. These are the foods that are high in fat and sugar, low in nutrients and are largely consumed by those in the lower income brackets.
We all know about the correlation between income and obesity. I would be willing to bet that the "fattitudes" we have in this country would not be nearly as prevalent if this were more a problem of the rich.
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"Hopefully one day the bias about obesity will be seen as hateful rather than acceptable."
So you can do what? Draft legislation to go after the hatemongers? Penalize people for noticing that we got Jurassic Park fatties roaming the earth?
I happen to be thin, and consider fat-hatred to be an instant turn-off in dates, a sign of massive insecurity and general meanness. Here's a thought: you don't like fat people, IGNORE THEM. It's not that freaking hard.
Having been fat, I am speaking from experience when I say that not-fat is a lot better than fat --- being able to move, tie one's shoes without breaking a sweat, etc. are only the small (but important) comforts that pale in comparison to not needing a CPAP machine to breathe at night, have normal blood pressure, and less fear to go diabetic soon. There are few redeeming features to being fat, and a lot of reasons not to be.
With many other diseases, we manage to separate the opposition to the condition from opposition to the one having it, even if bad life choices increase the risk for the condition --- we would not, I hope, stigmatize someone with lung cancer, for instance. But on the flip side, a cancer patient would probably not identify themselves with their condition to the extent that our "fight against cancer" was taken as a personal attack against him, even if it might be critical of life choices (such as smoking) that could have contributed to the condition.
So why is this so difficult with obesity? When I was fat, I had no doubt in my mind that I would rather be thinner, given the choice. I suspect that is the case for the vast majority of fat people.
I'm sure that it won't be long before eating that extra french fry results in your paying a mandatory financial penalty...or being shot.
The school cafeteria was just a small shop that sold non-fatty foods. We had no sandwiches and nothing that involved bread, rice, potatoes. While candy was popular, milk chocolate was the only available choice and not like the over 40 choices of candy we have here. Drinks were mainly tea, milk or water. Obviously, parents were not given to obesity since they were exposed to the same influences in their school.
The result: Less than 3% of the school kids were considered overweight, not OBESE. Since we did not have health care because doctors did not consort with attorneys to form insurance companies, most practitioners would scoff at overweight patients who chose a sedentary lifestyle.
Not surprisingly, although I am nudging 50, I still lift weights, jog about 12 miles a week and eat healthy. I have not seen a doctor for anything by a medical check-up which my sister, a doctor, does for me whenever I fly home.
How do we get our kids to get addicted to that endorphin rush because I know I am addicted to it?
We had two recesses each day plus a gym class where we had to do calisthenics, run a lap around the entire school, play dodgeball or kickball or football...
It's a no-brainer but kids need that today, more physical activity and more healthful food at lunch - and only at lunch.
If we don't voluntarily set limits on medical care an economic collapse will. Remember that Medicare has about 40 trillion of unfunded future liabilities. It's a great program that has lifted the elderly out of poverty (and made them the most affluent segment of society). IMHO we should extend Medicare to all citizens, means test it, and work towards an agreement on what care society should guarantee and what should be paid out of pocket (or with supplementary private insurance).
Or perhaps we'll let personal prejudices dictate public policy, a'la Bloomberg wanting to regulate salt intake, regardless of what the science tells us.
I have read those who are mildly - again MILDLY - overweight do have higher survival rates in certain instances such as heart attack because those who are thin may have contracted the disease due to more complicated reasons than obesity and it's harder to treat, but overall those who are of normal weight are healthier and live longer.