Obesity patients are not victims

Call it the McVictim syndrome. Too many pundits, public health experts and politicians are working overtime to find scapegoats for America’s obesity epidemic.

In his latest book, former FDA Commissioner David A. Kessler argues that modern food is addictive. In it, he recounts how he was once helpless to stop himself from eating a cookie. In a paper in this month’s Journal of Health Economics, University of Illinois researchers join a long list of analysts who blame urban sprawl for obesity. In November, former Carter administration advisor Amitai Etzioni argued that it’s so hard for Americans to keep weight off that adults should simply give up and focus attention on the young instead.

The peak of the trend: A recently released Ohio study, using mice, suggests “fine-particulate air pollution” could be causing a rise in obesity rates.

How long before we’re told that the devil made us eat it?

The McVictim syndrome spins a convenient — and unhealthy — narrative on America’s emerging preventable disease crisis. McVictimization teaches Americans to think that obesity is someone else’s fault — and therefore, someone else’s problem to solve.

The truth: In the vast majority of cases, obesity is a preventable condition. So those of us in the medical community must be candid with overweight patients about the risks they face and the rewards of better health choices. But it’s also time for American policymakers to show the same level of candor.

All things being equal, the simplest explanation is often the right one. And the simplest explanation for the dramatic rise in obesity rates — roughly doubling as a percentage of the total population in just a quarter-century — is the surge in our daily caloric intake. Excess food now, excess weight later. And Americans won’t make better choices if the McVictim syndrome provides a convenient excuse to carry on as before.

Obesity is preventable, but its consequences seem difficult to avoid. Consider that the cost of treating resulting conditions such as diabetes is about 7% of all U.S. healthcare spending — and a significant drain on federal and state budgets. Obesity is a national security threat because it severely limits the pool of military recruits; in 2009, the Pentagon indicated that since 2005, 48,000 potential troops had flunked their basic physical exams because they weighed too much. Most important, obesity is a human threat, destroying otherwise healthy lives and increasing personal health costs, all for the sake of a few daily moments of instant gratification.

For these reasons, there is a role for government to play in attacking obesity. Public policy can help. School lunch programs shouldn’t push our children toward obesity at taxpayers’ expense. We should stop subsidizing agribusinesses; many are using taxpayer dollars to produce and market unhealthful foods. We should promote insurance reforms that support preventive medicine.

But we must also launch a direct attack on the philosophy behind the McVictim syndrome. Policymakers must accept the fact that a poor diet is almost always a poor personal choice.

Yes, it’s fair to say that many Americans try to choose better — and fail because they’ve chosen quack drugs or crash diets as the solution. Yes, it’s fair to say that losing weight solely for appearance’s sake isn’t a healthful choice. Yes, it’s fair to say we shouldn’t crush the self-esteem of those who’ve tried, and failed, to keep off excess weight. In other words, our society makes healthful choices tougher.

But even so, encouraging Americans to cut their dietary health risks is a responsible act of citizenship. And it’s absurd to pretend that Americans are helpless to make that choice — or that it’s too late for them to reap the benefits. Contrary to claims like Etzioni’s, even a modest, voluntary improvement in the average American diet could pay huge dividends.

Just as a little more weight causes more damage over time (to joints, to cardiovascular systems, to organs), a little less weight can produce dramatic health benefits. To take one example, a study cited in the Journal of the American College of Cardiology found that obese patients on a program of mild weight loss and modest exercise cut their odds of getting diabetes by as much as 60%. Imagine the benefits that would flow from keeping millions of future Medicare recipients from ever needing an insulin prescription.

The McVictim syndrome is far too prevalent, which promotes the notion that regulations and laws are the primary solution to the problem. But governments can’t micromanage your waistline for you. Even if governments could magically walk you to work, ban food advertising, regulate sugar out of food and suck those fat particles out of the air, in a free society you would still have the power to drive to the nearest restaurant, shake your salt shaker and order a second piece of pie.

That’s why understanding — and rejecting — the McVictim culture is crucial to obesity reduction policy. And the first step in that process is to reject the temptation to find an easy scapegoat.

David Gratzer is a physician and senior fellow at the Manhattan Institute. He is author of The Cure: How Capitalism Can Save American Health Care.

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  • Jan

    Did you see the recent research that showed that even lab animals are fatter today than 25 years ago, being fed the same food as always? So there may be issues of what is in the food because of the use of various hormones, antibiotics, and chemicals that have affected the way these foods are metabolized or by alterations of the flora of the gut leading to enhanced caloric absorption. Things may not be as simple as we would like them to be.

  • Susannah Merrill-Bernath

    Let’s put aside for the moment the idea of obese people as victims, or as active agents of their own destruction, and focus on what it takes to lose weight and keep it off. Surely you know that most dieters don’t keep the weight off, but let’s look at what that takes anyway. The plain fact of it is that contrary to “taking a walk after dinner and eating less”, sustained weight loss requires 45-60 minutes of exercise a day and what they call the “edge of hunger”- and, to be frank, dedicating large amounts of your time and brainpower to what becomes more than a hobby: weight loss is like running a home business. And I’m not going to say it can’t be done, but I am here to say that although every fat American has ample knowledge AND motivation to lose weight, most can’t put that kind of priority on weight loss without severely affecting their jobs, their family life and their well-being.

  • Get real, something has changed and its not calories in.

    I am a very slender person and have been always. As a kid, I and all my friends ate bad food along with the good and lots of it. Fritos, entire boxes of cookies, little Debbie cakes, Ice cream, chocolate… funyuns, you name it. We guzzled whole milk and HiC pretend fruit drink and koolaid laden with sugar, and as much soda pop as we could get our hands on.

    I went outsided and played, to be sure, went for walks in the woods and so forth, but spent the larger part of my free hours sprawled on the floor or sofa watching reruns of star trek and petticoat junction and after homework, sonny and cher or whatever lame Cannon episode might be on. My lifestyle might have been called…sedentary, especially when school hours stuck seated in one spot for hours on end.

    I was a rail, if of good height and solid bone. I had one plumpish friend (would not stand out today) whose family just liked a lot of butter on absolutely everything, but she was an outlier.

    What has changed? Something.
    I have a child who began gaining too much weight around age 10, and he has a weight problem today. If illness requiring him to be sedentary has contributed, it came after the weight gain began though. He doesn’t actually eat that much. I make his meals, he eats what his father eats, and his father, if he has not the figure of his youth, is not a fat guy.

    My husband and I have speculated on how this could be – my son is not an uncommon size, if rather overweight.
    We have wondered if the fact that we grew up on processed foods made with cane and beet sugar instead of high fructose corn syrup has anything to do with it.
    I’m almost convinced it has mattered.

    He’s not less active than I was, he eats better and less than I did, and excercised just as I did – long walks and so forth.

    Is it a virus? Gut flora? HFCS? Fat genes that came out of nowhere? I don’t know, but it’s something.

    I think obesity trends are not necessarily related to discipline. Lord knows I and my husband never had to even think about that.

  • Muddy Waters

    Agreed. Unfortunately, there is a massive shift to the ideology of “not my fault” for many issues in this country today. “You didn’t tell me the coffee was hot” seemed to be turning point. Society must have failed you if you can’t go to college. Accutane is the reason my teenager is misbehaving. Frivolous lawsuits. Abuse of welfare and disability. The list goes on and on. There is a general lack of personal responsibility and decreasing concern for the good of society. The old saying “what can you do for your country” has truly flipped to “what can my country do for me.” It’s only going to get worse as long as the government allows and somewhat encourages selfish behavior.

  • Justin

    Interesting topic. It seems like the bottom line is we need to eat more healthily and exercise more if we want to stay thin, until they discover which type of alien radiation is causing us to gain weight so we can block it from entering our brains with tinfoil hats.

  • Bobbo

    Bravo. Finally someone who understands that people need to take responsibility for their own actions.

    First let me say that i understand that other factors than choice influence weight.
    -some people have faster metabolisms than others
    -increased use of HFCs or antibiotics or whatever may increase weight gain, both directly (increased food caloric content) and indirectly (feeling less full, etc.)
    -Some people have sedentary jobs

    That being said, take some freaking responsibility for your actions. My metabolism is much slower than it was 5 years ago, and as a med student I sit in lecture halls or libraries for the majority of my day. I compensate for this by eating a bit less, eating much healthier, and going to the gym and playing sports when possible. Just because it may be harder to stay thin now than 50 years ago doesn’t make it OK to just let yourself go. Obese individuals should pay much health higher premiums due to their increased use of health services, without cries of “discrimination.” Newsflash.

  • http://www.yourneurodoc.com Pete

    I think I am missing the point of the article. So if fat people just had more self control and made better choices they wouldn’t be so fat and cost us so much money and so much harm to themselves. That seems a little short sited and not very well supported in the medical literature. Isn’t that akin to say that if depressed people just wouldn’t lie around so much and get up and do stuff and not be so depressed, then they wouldn’t be so depressed. The obesity epidemic is much more complicated than calories in equals poor self control.

  • Bill

    While the proposals outlined in the article–improving school lunch programs, eliminating agribusiness subsidies, promoting preventive medicine–are nice, the end result of this is likely to be that fat people will be asked to pay more for treating their illnesses and, more likely, insurers will treat fat insurance applicants like HIV-positive or cancer survivors…they’ll run as far from them as possible. I’m not saying that we should completely excuse those who lead a life of gluttony, but all fat people are not gluttons. I think there is something to be said for HFCS’s effect on our bodies as no producer eliminates all corn adulterants from the final product. There are certainly environmental issues–pharmaceutical-laced drinking water, air pollutants, etc–as well as the simple fact that most people now work incredibly long hours and commute to distant jobs, meaning you’re left to choose only two from the following three items: sleep, family(or social ties), exercise. How many of you would elminate sleep and risk the diseases associated with that? There’s a risk in eliminating your social contacts or family bonds, and studies have shown antisocial and single individuals to also be predisposed to their own unique illnesses. So what do most overweight people cut? Exercise. If we want healthy people who have time to exercise, even in the coldest days of winter, we need to thoroughly change American society. But, in the end, we’ll just all say fat people deserve to be sick and we as a society shouldn’t subsidize their care…that’s the cold truth.

    • Anonymous

      The end of agribusiness subsidies = the end of HFCS

  • Finn

    There’s the problem right there: no one wants to admit that calories in > calories out = weight gain.

    • Killroy71

      Finn — that is the nutritional equivalent of a “flat earth” world view. 1200 calories of processed carbs has an entirely different effect on the metabolism than 1200 calories of lean protein and vegetables. One signals fat storage, one signals fat-burning.

  • everyman

    there are some issues that relatable to the way food is prepared, but by far the main thing is that people don’t hold themselves accountable, and they don’t do it for years on end so that by the time they get so fat, their brain is hardwired a certain way and there is no way for them to ever go back, this is why most fat people over 40 will continue to stay that way, it’s hard to change people, it needs to start early, you can talk about antibiotics and processed food all you want, americans don’t hold themselves accountable , they are fed misinformation, and now these advocacy groups will make the situation worse, which i guess in the end is good for the medical business as smoking continues to decrease it will be quickly replaced with the obesity epidemic which will be harder to treat.

  • Kristin

    I must say I agree with most of the article. I nearly found it laughable a few weeks ago when the news said that insurance companies would be covering lapband surgery to treat obesity on people who weigh much less than the current standard calls for. Before rushing into the “cure all” surgery, why wouldn’t insurance pay for a dietician consult weekly and gym membership for a year before paying for a $$$$$ life risking surgery? And I find it total BS to blame the food you are eating and not the amounts. Do people even realize a small DD coffee is what a large used to be in the ’70′s? And who ever drinks a 12 oz. soda anymore? All the machines carry 20 oz bottles now…etc….

    • Natalie Sera

      Well, there is more to obesity than sodas. There is a lot of research on metabolic abnormalities in obese people, and they are finding that it is a very complex issue. Obesity is more than just the over-simplified calories in = calories out. There have always been obese people throughout human history, and there have always been cases of Type 2 diabetes.
      And dietitians advocate low-fat, high-carbohydrate diets that are almost bound to make people fatter.
      I have cut out bread, pasta, rice, potatoes, corn, cereal and fruit, and am eating more protein and fat, and guess what, I lost 16 lb. Only 12 more to go before I achieve BMI 24.9, officially “normal” weight. Of course, I am eating more low-carb vegetables to make sure I get good nutrition.
      And I certainly did not get this advice from doctors or dietitians!
      Until the medical and dietary professions get THEIR acts together, I don’t expect to see any progress in this so-called War on Obesity — I think it is full of sound and fury, signifying nothing! (to quote Shakespeare).

      • pcp

        “I have cut out bread, pasta, rice, potatoes, corn, cereal and fruit, and am eating more protein and fat, and guess what, I lost 16 lb.”

        You reduced your caloric intake and you lost weight. Isn’t that the point?

        • Natalie Sera

          I don’t think I reduced my caloric intake. Before, I was eating very little meat, and the fat in meat is high-caloric.
          But that’s not the point I was making. The point is that so little is known about obesity, and people who argue that fat people should just eat less (and blaming it on junk food) and exercise more are ignoring the complexity of the issue. I can’t remember who said it, but someone said that sure, diet and exercise work for the merely overweight (like me), but for the truly obese, whose pictures are shown with every article in the media, it’s more complicated than that. I know too many fat people and Type 2 diabetics who DO try to eat well and exercise within their physical limitations, and who do not lose weight. A starvation diet would work, but who could maintain that in the face of the plenty that is apparent in American grocery stores?
          I think it’s time to stop pointing the finger of blame and start finding and treating the abnormal metabolism that causes true obesity.

        • Killroy71

          No, she reduced the high-glycemic foods — she could replace it with avocado and still lose weight this way.

          • Natalie Sera

            Yeah, and I have lost another 2 lb. (only 10 lb. to go for BMI 24.9). Low-carbing really reduces hunger, and I only eat when I’m hungry.
            Even so, I don’t believe most obese people could low-carb — it’s expensive, and may be unavailable to those without cars in poor urban communities. And it does take some willpower to avoid those high-carb treats like sandwiches, spaghetti, Asian food, etc. And I’m not talking about soda and doughnuts here!
            Time to stop pointing the finger of blame at obese people, and start helping them!

  • Paul Watson

    ‘Policymakers must accept the fact that a poor diet is almost always a poor personal choice.’

    No – it is often a choice of necessity by the poor, who are more obese per head than well off people. When you’re struggling to put any food on the table, high calorie ‘bang for buck’ foods often come first. This is well known. The best strategy is to address the enormous income and health inequalities in the US, alongside health promotion initiatives such as, as you say, improving school lunches.

    • Vox Rusticus

      Well, if today’s news is true, it seems your statement only applies to women and not to men. In fact, higher income is associated with greater excess weight in men.

  • http://skepticalscalpel.blogspot.com/ Skeptical Scalpel

    I agree that lap band surgery for everyone is not the solution. The band can be defeated by drinking milkshakes. Dr. Gratzer is correct but I’m afraid the McVictims will not listen. There is no such thing as personal responsibility anymore. Everyone is an “addict.” Food, alcohol, drugs, sex, you name it.

    • Killroy71

      wow, this totally ignores the fact that at least two generations were doomed at the start by being given baby formula instead of breastmilk – have you looked at the ingredients? Sugar! How are baby endocrine systems supposed to process that. Just give them heroin and see who turns out to be an addict and who doesn’t. That’s the social experiment we’re seeing the results of.

      Plus, “fast” or “convenience” foods are engineered to deliver massive doses of what we are hard-wired to crave and store: fats and sugars. The same DNA that makes medicines act differently in individuals also affects how they process macronutrients.

      I’m not saying there’s no personal responsibility, but I am saying there are biochemical reasons for what we’re seeing over and above the many behavioral/emotional reasons that people eat or do other activities compulsively.

      Enough with the righteousness already.

  • Sandy

    Insurances covering bariatric surgery as a substitute for self-control is ridiculous. I will also say that it isn’t correct to put every obese person in the same category, though – it isn’t an issue of lack of self-control for all of us. I’ve struggled with my weight for most of my life. I eat very sensibly, and at my house we don’t drink soda or eat junk food, we do a lot of brisk walking almost daily – on paper it looks like I’m doing everything right, and I should be reed thin like my kids are. Nope. I weigh as much as my dad (about 260) , who cares not a whit about his health. He drinks a huge amount of soda, will down a pack of cookies at a sitting, eats fast food and other junk regularly, and doesn’t exercise at all. The only difference is he is diabetic while I am not (so far) and I can run up flights of stairs with no problem while he gets winded very easily. I think it’s the obese people who have no self control and make themselves that way that make it so hard for the rest of us who really struggle to get any serious help with our weight.

  • mcvain

    With all this talk of goverment intervention in the form of more policies, perhaps a person should stop and think about why the goverment paid a massive sum of bailout money (our money) to McDonalds. Yes, the billion-dollar McDonalds enterprise received your tax dollars.

  • PAULMD

    you want fries with that? They have sea salt on ‘em?

  • Erica

    Obesity is obviously a complex multifactorial disease that manifests differently in different people, but I do agree with the “McVictimization” sentiment.

    As a researcher for Endocrinology and Weight Management, I am unable to reduce obesity to overeating and under-exercising. It is a sweeping generalization that is blatantly false in many cases. People are obese for a myriad of reasons, and as “Sandy” and “Get Real” pointed out, obesity is not always cured by diet and exercise. In fact, I would disagree with Sandy on insurance coverage for bariatric surgery. Its one of the few options that is clinically proven to not only assist with weight loss but also to save lives. For people who are morbidly obese, it might be their only chance to live a full life that is free of weight-related comorbidities.

    That being said, obesity has reached a near-taboo level in this country. People are afraid to call others fat, or to even think of themselves as fat. We have gone so far as to make it “OK” to be overweight, desirable in some instances. Phrases like “big is beautiful” literally make my toes curl. There is nothing beautiful about Cardiovascular Disease, Hypertension, Hyperlipidemia, Diabetes, weight-related Cancers, and early death. Dr. Ratzer hit the nail on the head with “those of us in the medical community must be candid with overweight patients.” Those of us who recognize obesity as the epidemic that it is should be candid as well.

    Maybe the appropriate word would not be “victimization,” but rather “acceptance” of obese persons. In some cases, obese people are victims, but their obesity should never be accepted or accommodated. And although diet and exercise may not be the only answer it will always be part of the answer. And maybe the government could be doing more to stop the epidemic, but at heart I do agree, people need to be encouraged to make better choices – even when their obesity is not entirely their fault.

    • Killroy71

      ” I am unable to reduce obesity to overeating and under-exercising” —
      THANK you for acknowledging it is not “calories in, calories out” — foods have hormonal influences and it depends too on who’s eating what. The thin people who eat anything have very INefficient metabolisms and have to eat every few hours.

  • pcp

    “People are obese for a myriad of reasons”

    Please tell us what those are.

    “bariatric surgery. It’s one of the few options that is clinically proven”

    Bariatric surgery works (sometimes) because it reduces caloric intake.

    I saw a patient today who requested a script for phentermine to help loose the 75 lbs she has put on since her bariatric surgery. I declined. Prior to her surgery, she had intentionally gained 50 pounds so that her insurance would pay for the surgery. I documented in her medical record on multiple occasions that she told me that she had eaten every meal for the previous two years in fast food restaurants. They paid for the surgery.

    • Erica

      PCP,

      Many of the obese clients that I’ve interacted with are obese because they suffer from Thyroid dysfunction. In many cases, the weight loss starts once the thyroid treatment starts. I’ve also worked with clients with various pituitary disorders that contribute to either obesity or to them being severely underweight. Just a few examples of how it’s not always about food intake and exercise. Obviously that can and will contribute, but it’s not the only variable.

      And I do agree with what you’re saying about bariatric surgery. It’s unfortunate that it can happen that way. But I’ve also seen it change people’s lives and actually motivate them to live a healthier lifestyle.

  • Finn

    @Erica, I take issue with one point: We should ALWAYS “accept” obese persons. It’s OBESITY, not the people afflicted by it (even if they’ve done it to themselves), that shouldn’t be acceptable.

    • Erica

      I agree, sorry if I phrased that poorly.

  • http://obesefromtheheart.com Sara Stein MD

    It’s disheartening, and frankly, embarrassing, to those of us who treat obesity when physician colleagues remain (purposely?) underinformed about the science of obesity, despite treating patients with this condition.

    As a society, we are overfed and undernourished. The reason we are overfeeding is BECAUSE of the lack of nutrients in most of our food. We are underexercising because as a society, we have taken movement OUT of the workplace, substituting sedentary physiology instead. Hungrier, fatter, weaker, sicker. Depressed and exhausted. Even good character people fail under these conditions.

    The science of neurotransmitters is very clear that abnormal dopamine reactions to food-like substances can cause addiction equal to that of cocaine. It’s no surprise the tobacco companies were busted putting glucose in cigarettes to make them more addicting. And the nutrigenomics of food-like substances can be devastating. In one study, palmitic acid, a commonly found ingredient in ice cream, altered leptin and insulin metabolism for 72 hours in mice given one little mouse dish serving. A 100 kcal serving of high fructose corn syrup leads to more weight gain than 100 kcal of plain ol’ table sugar. Yet hfcs is ubiquitous in the food supply.

    Overweight is a lifestyle issue – simple thermodynamic imbalance – too many calories in, not enough calories burned. Eat Less Move More works perfectly.

    Obesity, on the other hand, is a medical condition of serious inflammation, chronic pain, disordered genetic signalling and metabolism, altered brain chemistry, food sensitivities, and serious vitamin and mineral deficiencies. Adipocytes are wildly metabolically active, changing genetic signals and creating inflammation. Applying severe restrictive diet and exercise to an ailing body may worsen, not improve, the obese person’s health.

    To the PCP who saw a bariatric patient who regained – did you draw ALL of the bariatric labs? Do you know for sure the patient does not have vitamin, mineral, trace element and protein and fatty acid deficiencies? Is she iron deficient and exhausted? How long is her blind loop? Does she have short bowel syndrome? What about her depression? Are you treating it with medication, and in so doing, have you WORSENED her carbohydrate cravings?

    Bariatric surgery exists because no one else could think of anything to do that worked. So the surgeons tried to help. It’s a tool that is successful 2/3 of the time. Not all the time. The addition of pharmacotherapy is another tool that works some of the time.

    And please, you are scientists. Do not generalize your own body experience to a medical condition. At the very least, be cognizant of genomic variation.

    Lastly, if you know how to eat healthy, I challenge you to do so on $180 a month, like many of my patients. You will quickly see how good ramen noodles taste, and how fast you give up daily protein, and how easily you substitute fruit punch for fruit.

    Sara Stein, MD

    • pcp

      Yes. Yes. No. Appropriate length. No. Not depressed. No and no.

      She’s in the top 5% of income earners. She loves fast food shakes (i.e., pureed burgers and fries).

      But, obviously, I’m obviously purposefully underinformed.

      • http://obesefromtheheart.com Sara Stein MD

        You might want to check her essential fatty acid levels. She’s craving greasy food at any cost. Easy fix.
        Also, highly unlikely she’s not depressed. She’s got full cognitive dissonance about wanting to lose weight and not being able to keep it off. At the very least, she should see a therapist familiar with bariatrics.

  • http://www.drjoe.net.au Dr Joe

    Obesity has more to do with physics than medicine.Energy can be neither created or destroyed.It can only change form.Energy taken in (for whatever reason) ,if not utilized will be converted to fat by the body.All the hand wringing in the world will not change the laws of physics.

    • Natalie Sera

      But skinny people poop the energy out, while fat people hold on to every last calorie!

  • gzuckier

    I’m always skeptical of a hypothesis which boils down to “the majority of people are substandard”. Given the prevalance of obesity in America these days, i’d have to lump the “poor diet is almost always a poor personal choice” hypothesis in there.

  • http://www.movingforwellness.com Bobby Fernandez

    Physicians must take responsibility for their part in this epidemic. Food should be an intuitive daily practice. The medical establishment of last century took the reigns on what we should put on our tables and before we knew it, we switched our natural butter for partially hydrogenated veg oil and whole milk for soy milk. We have hundreds of thousands of years of “data” on what a human should eat and because some study comes around sponsored, by God knows who, it all gets thrown out.

    • Killroy71

      It would help if physicians actually studied nutrition as part of their education, but then much of what’s been written in the past 50 years we’re finding out is bunk anyway. Read Omnivore’s Dilemma — eat what your grandparents ate, or great-grandparents. Not the processed “foodstuff” of today.

      For too many decades, “mainstream medicine” acted as if what we put in our mouths was divorced from health, while they bashed “alternative” medicine for promoting nutrition. Sheesh.

  • AZT

    @sara stein, well said and agree with all your points; not sure about @pcp’s point.

    This is a typical individual vs society debate, which is as we know always combination of the two. What is missing from this discussion is the factor of human nature. As taught in accounting classes, to keep people honest, the work place needs to take all the precautions to remove temptations (yes, intervention – surprise!) because by years of experience, we know this:
    - 10% of the population will not be tempted to cheat, cut-corners or embezzle under any circumstances,
    - 10% will do whatever they like no matter what extreme methods of controls are instated, and
    - the remaining 80% of the population might commit wrong-doing given the right combination of opportunity, pressure, and rationalization.

    I believe these principles apply to every aspects of our lives; hence, I would be beneficial to direct our health outcome goals to the 80% of the population by controlling the opportunity, pressure and rationalization side of the equation as well as the physiologic and systemic. As mentioned before, this is a complicated issue and I do not believe will be solved as simply as accusing people as being weak-willed and scapegoat-prone.

  • pcp

    AZT:

    I completely agree with the fact that there are enormous societal conditions (many paid for by our tax dollars) that support overconsumption. But, the bottom line is that the vast majority of weight problems are a result of taking in too many calories (thyroid and pituitary problems are the rare exception), and they are cured by reducing caloric intake. To try and minimize that basic fact is doing no one any good.

    • AZT

      My point is not denying it; just pointing out that by fixing one side of the equation will not make our problems go away. I am a BMI 21, healthy 50 year old, but I can tell you it is not that easy to keep your calorie intake at check when there is so much tempting food material around and no time to think the consequences of indulging in a bit of this and a taste of that. Our life styles have completely changed from my parents’ generation and denying the impact of this change is also doing no good to any one.

      • Killroy71

        PCP – you must be one of those people who thinks 100 calorie cookie = 100 calorie apple.

  • ruthde mitroff

    Is this a rant about non-compliant patients, patients who expect you to prescribe meds you don’t think fit their health needs, patients lifestyles you find offensive or an opinion piece against funding for bariatric surgery?
    As a person, you can have any opinion you want.
    As a clinician, it would be safer to use evidence-based medicine. Kinda tricky because the morbidly obese aren’t included in the majority of pharmaceutical trials or clinical studies. Health care for the obese lacks science because many in the medical community get really spiritual when obese patients need treatment for anything and think gluttony and sloth – deadly sins – yucky and gross – wish they were someone else’s patients.

    • pcp

      I was attempting to point out that, as a physician, there is very little effective treatment for obesity, evidence-based or not. As long as we continue to fund HFCS and build cities that are unwalkable and design workspaces to minimize physical activity (EMRs, anyone?) and take PE out of schools, and on and on, there’s really almost nothing I can do.

  • http://www.weightlosscoachingmd.com Melanie Lane MD

    Right on, Dr Gratzer! An attitude of victimization is something Americans cannot afford. If your predicament is the fault of your genes, bad parenting, the media, or whatever, you’re screwed. You can’t change any of these things.
    By focusing on empowering patients, reminding them that they are responsible for everything they put in their mouths, we remind them that they are always at choice and do have the power to positively impact their own health.

    • Natalie Sera

      YOU haven’t dealt with being hungry ALL the time, even when your stomach is distended, have you? It’s very easy to point the finger, when you haven’t experienced the problem. With me, it turned out that my hunger was being caused by diabetes, and when I went on insulin, it quieted down. Now, with a low-carb eating plan, I can go hours and hours without feeling hungry. And have lost 18 lb. in the bargain — only 10 lb. to go for BMI 24.9.
      You need to figure out a better approach than “Just don’t eat”!

  • ruthdemitroff

    Obese patients really have no expectation that you can magically solve their problems. Say you have a day where everything goes wrong and you want to quit. You blurt out to your receptionist, “I don’t need this stress. Don’t you think I’d make a great travel photographer?” And she’s supposed to do what? Listen, give a little indication that your life is demanding and say something like you’re too valuable to go that route. That’s it. Takes about a minute. Makes you feel heard, acknowledged and valued. Obese people are experts on obesity but do need lab work because they often develop deficiency diseases trying to avoid further gains. Neither you nor them expect the world to understand the toll your day takes on you. You’ve studied anatomy, psychophysiology, a bit of psychiatry – you can envision the effect of obesity on every body part and function and the quality of interactions. You actually are their best bet at finding someone who truly gets why obese patients sometimes long to do something drastic to just have the experience for one day of life in a body that functions effortlessly and draws an admiring eye.

  • ruthdemitroff

    Could you change my comment to say pathophysiology instead of psychophysiology. I was thinking about stuff like metabolic syndrome while also thinking about the toll on self esteem that goes with obesity – although I’m sure the mind also plays a part in hormone release and how we position our body, etc.

  • http://www.movingforwellness.com Bobby Fernandez

    This may be too esoteric for this forum but if you allow your mind to wander a bit, it seems to me that there is some creedence to the Ayurvedic concept that as adipose tissue proliferates, it affects the mind and the being in a way that not only perpetuates the weight gain but accelerates obesity by injecting the “heavieness” quality in to every aspect of the being. A bit of a chicken of the egg scenario but I am more of the opinion that we as a society have been poisoned with low quality foodstuffs that has in turn psychoactively created the level of inactivity from which we now suffer.

    Anecdotally, as a normally fit, athletic and energetic individual, the minute I gain double digit lbs I feel my mind change in not only my food choices but also by desire to move. Fat is not our fault but it is our fault to deny both the degree to which our harmfull food supply affects the physiology and the possiblity that poor nutirion can affect the mind and behavior of the individual. I reccomend reading the works of Dr. Weston A. Price. His work is unique in that he was able to experiment with good samples of industiralized people and non-industrialized people from the same tribes.

  • Lisa

    I’m overwieght, by BMI, thought I used to be obese at one point. I gained 110 lbs while taking Xyprexa for a year. Prior to that I was always a thin and active (running) and never had to watch my weight. So far, I’ve lost 65 lbs….45 lbs to go. I’ve found that losing weight is not rocket science, however, it requires consistency.
    I picked activities that I love to do: running and swimming. Since I like my chosen activities, I look forward to doing them, so it’s not a chore and I rarely skip. I think that’s really important and makes it more likely that I’ll complete my goal. I think people makes the mistake of not picking things they really like, so they aren’t passionate about doing their selected activity.

  • Natalie Sera

    So, Lisa, what about the people who really don’t like ANY physical activity? For them, anything will be a chore, and hard to maintain. And activity doesn’t solve the hunger problem.
    I think I said before, I’m lucky because I’ve never been obese, just overweight, and by low-carbing, I’m coming close to meeting my BMI goal. I have diabetes, and am on insulin, so that’s even more important for me. But I agree with Dr. Stein (earlier message) who said that there is more to obesity than calories in = calories out — they do have a serious metabolic condition, and they need help, not finger pointing.