Friday, April 1, 2016

One Asshole's Mailbag: A fat, crying shame

From comments on my Facebook page:

"Indeed shocking. But you mentioned the long list--surely exercise and eating right are the solution, the only solution. Perhaps one reason that people don't control themselves is that they are now in the majority and no longer stigmatized. Hence, let the bus seats get bigger...It's all really sad. Think of how much it will cost the health care system to take care of these people."

If diet and exercise were the solutions, surely they would have shown evidence of working by now. They don't, at least not to any significant extent. Yes, we all know friends or family members that have made it work, but they're a tiny minority. In three different family practices, I can point to one obese patient who lost the weight with lifestyle alone and kept it off. One. The ones who tried medication and even surgery didn't fare much better in terms of keeping it off.

My rants about obesity are trying to point out that we've spent 40 years trying to address the problem as one of personal failing, lack of control, or bad behavior, hence these lame-brained ideas like soda taxes and so on. Clearly it's not the right approach.

There is a lot of literature, including the damn report by Canada's Senate, indicating that there are systemic causes of obesity--car-centered urban planning, sedentary employment, agricultural policy--that we don't even pretend to talk about. The proverbial room is packed with elephants we're all ignoring.

The last comment, about health costs, points to another thing we don't talk about. Are we trying to reduce obesity in the interest of the public good or to save money on health care? The two goals are related but not interchangeable. In fact, reducing obesity for its own sake might prove a good deal more expensive in the long run than letting people get fat and die prematurely. That sounds callous, but it's not necessarily untrue.

"Yet the attention is on stopping the fat shaming and not on stopping the fat. Shaming isn't right. Is saying nothing and accepting that people are killing themselves right? This fat epidemic should not be ignored and we should not mind our own business, if we care."

Again, "fat shaming" stems from the notion that obesity is the result of some kind of personal failing. It seems rather absurd that the proportion of humans unable to control themselves at the buffet table has tripled in the last few decades. Likewise, sloth has been considered a sin for most of the last 2000 years. A global explosion of laziness also seems kind of far-fetched. It's long past time to address the systemic causes rather than throwing more brainpower towards individual-minded answers.

One final note: if you think fat shaming is bad in broader society, that's nothing compared to what goes on in the health care system. Obese patients are treated like absolute shit in health care, and I'm as guilty as anyone in that regard. Sadly, I can't imagine it's going to get better anytime soon.

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