Heavy Words

The post that forever doomed the world to have my writing forced onto them was one called Shame, in which I describe my frustration with how society stigmatizes people who are obese.  It was picked up by the NY TImes Health Blog and got a good conversation about the subject going on the blog-o-sphere.
A recent article in EverythingHealth (via Better Health) got me thinking again about the subject of society\’s response to the \”obesity epidemic.\”  The article discusses a recent study that showed…well, read it for yourself:

Talk about a cruel trick of nature!  A study funded by the National Institutes of Health (NIH) and published in JAMA shows that physical activity prevents weight gain in middle-aged and older women ONLY IF THEY ARE ALREADY AT IDEAL WEIGHT. Did you read that?  It means that the recommended guidelines advocating 150 minutes of exercise a week isn\’t sufficient to prevent weight gain in most middle age women.

The author, Dr. Toni Brayer, ends the post by saying:

So what are we to think about this study?  First, caloric restriction is the only way to maintain or lose weight.  The health benefits of exercise have been proven over and over in thousands of studies and that is not in dispute.  But weight control demands caloric restriction, period.

I am sorry about these results. Truly I am.

Hearing the frustration from my patients (male and female), and struggling with weight myself, I have to say that this is not really that surprising.  Losing weight is not easy.  Let me say that again: losing weight is not easy.  There are lots of reasons it is difficult to lose weight, from the food-oriented culture to a person\’s own metabolism.  There are emotional and addictive aspects to obesity as well.  This study puts scientific evidence behind the hardness of weight loss.

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From A Cartoon Guide to Becoming a Doctor

So how should we handle the major public health issue obesity has become (and I believe it has)?  Saying \”well, they just can\’t help it\” denies the fact that some people do lose weight, and that studies do show that obese people who lose weight are usually healthier because they do so.  Are we being unjustly judgmental by criticizing people who are obese?  Is it prejudice?  Or is it society\’s job to look at its own faults and bring them to the light?  It\’s far easier to find lower-calorie food now than it was ten years ago – thanks mainly to the public awareness of this problem.

Here is my take on it: we need to address it as a problem, not as a moral shortcoming.  My post on shame talked about the worthless feeling and inferiority many obese people feel in our culture.  I had a pastor recently tell me that he was ashamed of his weight and felt like a hypocrite being an obese preacher.  My response to him was, \”Yeah, it\’s a horrible thing to have a preacher who is also a sinner!\”  He smiled, understanding that one of the central doctrines in Christianity is the fact that everyone is a sinner.

But I didn\’t deny that in his case, his problem of overeating was due to his own weakness.  I know this because of my own struggle with weight, which stems from an addictive cycle of eating:

  • I feel bad, sad, or depressed.
  • I eat to make myself feel better.
  • I eat more to make myself feel more better.
  • I don\’t feel better; I feel worse.
  • I feel more bad, sad or depressed.
  • I am tempted to eat more.
  • etc.

This is a cycle repeated with drugs, alcohol, cigarettes, compulsive spending, compulsively viewing pornography, and probably even compulsive blogging.  I deny that completely.  Anyone who has dealt with an addiction, either with themself or through a family member can say that addictions are very tough things to beat.  The fix to the solution is simple: don\’t drink or smoke, and don\’t eat or spend so much.  Simple, but incredibly difficult.

But it is a problem, and it is possible to overcome any of these compulsions.

One of the major ironies of our day is that a culture that has largely rejected absolute truth has not stepped back from moral condemnation at all.  Obese people are worse than those who are not.  Smokers are not smart.  Alcoholics and drug addicts are \”diseased\” or \”defective.\”  Compulsive spenders are fools, pornography addicts are perverts, and compulsive bloggers are…the bottom of the barrel.  There seems to be a need in our society to morally stratify, calling various groups of people morally worse than others.

Where am I going with this?  I think that we are missing the point on obesity, and any other compulsive behavior.  The root of addiction is the need to escape, and the need to escape is caused by stress and anxiety.  If we fix the obesity \”epidemic\” by a mass surgical campaign or a wonder drug, other problems would take their place.  This doesn\’t mean that we should give up trying to treat obesity as the medical problem it is, it means that treating it only as a medical problem will change things on the surface, not at the heart.

Anxiety is the real epidemic in our society.  We no longer have the community we once had.  We are becoming increasingly isolated, increasingly self-absorbed, and increasingly insecure.  When the individual is at the center of the universe, the faults of that individual are of huge importance – and everyone has tons of faults.  But when community is at the center, when the individual is a part of a whole, then their shortcomings are compensated for by other community members.  The other community members help the person with their problem instead of belittling them.

This is, by the way, one of the reasons 12-step groups are successful.

I am not sure how this problem can be fixed, but like all of the other societal problems, it needs to be talked about.  It needs to be seen for what it is.  We are insecure because we wonder if we really matter.  We wonder what our mark on the earth will be, and if anyone would notice if we weren\’t there.  Even people (like me) who have jobs that \”matter\” are always struggling with this – just check out the alcoholism rate in doctors, if you wonder.

I used to think this was not fixable, but I wonder if the Internet can be a source of community.  My Internet friends have become my \”real life\” friends, to a great extent.  I don\’t think it replaces getting to know your neighbors or finding a group you can hang out with, but it has helped me.

Please join hands with me now, and start singing:  \”Kum-by-yah my Lord….\”

14 thoughts on “Heavy Words”

  1. brilliant, seriously. you dug a little deeper and got rid of the crap on the surface – a good way to begin to fix any problem.

  2. I am in public health, specifically around obesity prevention. Being obese, my career choice is a bit ironic. That being said, I think it is extremely important to look at obesity not as a personal or moral shortcoming, but as a part of the current environment that we live in. Yes, we should all make better choices about what we consume, myself included. But we should also look at the environment that we live in. Depending on the neighborhood, do people have access to healthy fruits and vegetables? By access, I mean, are they affordable and available? I've lived in some neighborhoods where I couldn't shop locally and get even frozen vegetables at my local market. We should also look closely at the policies of our Department of Agriculture, which leads to a glut of corn production that can be used to cheaply sweeten everything, due to the lovely ingredient otherwise known as high fructose corn syrup. We need to look at obesity as a larger public health system issue and how we can systemically change the way people think about food.

  3. Samreygoggles

    A suggested reading that may bring SOME light to the problem of addiction. Our Health Care System is an addiction and we are all in it as a nation. A political party insist on status quo… nothing wrong with the present system so let it be… the other party insist on the present health care reform with amendments to follow…. but direction wise not addressing the root of the problem …that is each items use to treat illnesses are so expensive and going to bancrupt our entire economic structure…..let alone the main economic fiasco by the big banks and big corps.

  4. Samreygoggles

    addendum…suggested reading for this blog…THE ROAD LESS TRAVELED BY DR PECK.

  5. I do agree that our indulgent behavior as a nation that is self-harming via the healthcare system is akin to addiction; I am a little leery of calling it such. Addiction is more than just description of behavior, it is a real powerful force in people's lives that is incredibly destructive. AA folks call it “insanity” and having been around addiction myself, I have to agree with this description.

    You are right, however, that our compulsive spending on expensive tests, etc. is quite pathological.

  6. Yeah, the latest news on middle aged women and exercise made me think, great, just take me out behind the barn and shoot me now, but your larger point about how obesity is not a moral shortcoming should be shouted from the rooftops. The real moral failing is the people who think it gives them license to be cruel. My little brother was overweight and put through hell for it by other kids. He was lucky and grew out of it in high school and he's never been back. You also made me remember a business trip of awhile back. I ended up next to a very large young man and was selfishly grumpy, until I heard the jerk in front of me make very loud fat jokes to the flight attendant. I wanted to pop him, and I was also ashamed of myself for being annoyed at my seatmate. When it was time to leave, I looked at him and smiled. Then I wondered how many people smile at him on planes, or do they all just hate him for taking up space?
    Thank you, thank you, THANK YOU for talking about this.
    P.S. I think the internet community helps immensely. And I just read about a study that says social media releases oxytocin! Not sure that can help any of us lose weight, but it sure shows how good it feels to reach out to each other— http://bit.ly/awqNno

  7. As a overweight person who regularly asks myself “why” I have to disagree with your “addictive cycle of eating”, or at least extend it. My extension is “consequences are not immediate” and this applies in both the gaining and losing phases. In fact I think this is the real crux of the problem. If you're feeling unhappy and eat more, you don't wake up the next morning 5 lbs heavier and with clothes that don't fit. So you don't learn the lesson of “don't do that”. It's only when you repeat the cycle for a few weeks or months that noticeable weight piles on, at which point you're unhappy and may self-medicate with more food. But the lesson never sinks in at a visceral level that food is causing this. Same with weight loss. You may act virtuous all week, choosing the lo-cal salad dressing, passing on the yummy desert, etc. But at the end of it the scale has probably not budged! In order to lose weight you need to deprive yourself for weeks and weeks on end to get the results you want. Somehow those of us who got college degrees managed to do that for months at a stretch in order to pass our classes, but doing the opposite was not as immediately rewarding as a steak and rich desert.

    And let me give a counter-example of an activity that is immediately rewarding but punishing if done in excess — drinking. While there are of course those who drink at the cost of health, for most of us there was a period of experimenting. At a party 1 drink was good, 2 was better, each one promised to add more and more. But we quickly learn the consequences of too many, and after a few episodes of watching the room spin or worse mos of us learn to pace ourselves. After a few even though a part of us is saying “this is good – have another!' a different part remembers the immediate consequences and says don't do it because we know the consequences that quickly follow. This is what distinguishes drinking too much from eating too much, and IMHO is why the latter is much more common than the former.

  8. I see no flaws in your logic. The other difference, of course, is that an alcoholic person when they are not drinking is not wearing a huge “I am an alcoholic” sign over his head. The obese person, on the other hand, cannot hide their problem. The public nature of the problem is what increases the shame. In a way, the alcoholic has an easier time “getting away with it.”

    I still see it as escapism behavior, and hence following the addictive cycle (albeit by a different route).

  9. Sorry that you have addiction issues around eating, but that is not “the” answer. You just can't look at somebody – fat,thin or whatever – and tell if they eat emotionally, or addictively, or for “control”, or whatever. I really appreciate what you are trying to do, and sense your compassion, but holding up your “addiction” to food as part of the way to the answer, is probably a continuation of the problem.

  10. According to the movie, “King Corn,” the government in 1970 began subsidizing farmers, $28.00 per acre, to plant corn, and another $28.00 per acre to harvest that corn. With all that corn, they needed something to do with it. So, they began putting it in processed foods, and also feeding it to beef cattle. That is when the high fructose corn syrup hit the market, with disastrous obesity impact….perhaps. Because cattle are made to burn hay, not corn, the beef growers then needed to give the cattle antibiotics so they would not die before slaughter time, because of the corn diet. Hence, antibiotic-laden cattle. So that could be one component of the obesity problem. Like monkeys, we love sweets……and corn syrup is surely that.

    About the community (or lack thereof) and anxiety: So much of this goes back to how we birth children. When we can return to traditions more grounded in nature (sorry, Dr. Rob), I believe the anxiety level will go down. Pre- and perinatal psychology is finally gaining more exposure, more women are breastfeeding and wearing their babies, so that's a start. I sense that we are all part of the “looking good” society, doing our best to get through life in spite of inner workings that hearken from infancy. Every person is so amazing. When you hear their story, you can see what good hearts they have. Too bad in this culture, we feed our self critic gourmet meals and starve the good, the true and the beautiful……so we've developed plenty of ways to numb out and not feel so keenly.

    I wonder often about solutions. I think a daily session of kum-by-yah around the campfire would go far to restoring connections for many. Unfortunately, I live in Arizona, and we have a fire restriction right now….and other problems. But maybe next year……

  11. I want so bad to let people know that they don't have to follow fad diets. I tried many of them over the years and finally lost weight in a common sense way. (After 35 years of failing)

    I read a bunch of nutrition books. Then figured out if I ate only low calorie food that was also low in fat, cholesterol and sodium that I should lose weight. I did! I lost 79 pounds in 5 months. All you need to do is monitor calorie intake on a free calorie counter website.

    I never exercised either. It's a shame that most people throw themselves into starvation mode through excessive exercise and severe calorie elimination. I'd love to see your thoughts. Thanks

  12. Exercise has its own benefit, so I do think that's good to do. You need to balance things. I agree that “starvation mode” is unhealthy, and fad diets are people just wanting to do things without having to do them the hard way.

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