river-stone

They gathered around the figure who was lying with face toward the ground.  Holding stones, they demanded justice - that the sin of this person be exposed for what it is: inferiority.  Her sin had been exposed for all to see and the righteous rage of those who were pointing fingers and holding stones was pounding at her on the inside, just as the stones would soon pound her on the outside.

"Her BMI is over 30!  It may even be over 40!" one of them cried out.  The others responded to this with a howl.

"How can she be fit for leading the country's health if she can't even fit into her pants?!" another asked, causing raucous laughter to echo from the crowd.

Nearby, a news reporter spoke into a camera: "People are questioning her fitness for surgeon general, as she obviously is overweight.  The president had initially hoped the popular TV doctor would take the job, but fell back on Dr. Benjamin as a substitute.  Clearly a president, who himself is a closet cigarette smoker, doesn't see the fact that she is overweight as a disqualifying factor.  These people, and many others around the country, disagree with that assessment."

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Forty years ago, people would also have cried out about this nomination.  They would have said that a woman shouldn't be in charge of the nation's health, or that a black person doesn't have the wherewithal to manage such a big task.  Times have changed, as her nomination shows - nobody is talking about these facts that have nothing to do with her ability to do this job.    We have truly progressed.

Sort of.

This objection, of course, is that her weight shows that either she doesn't understand what is causing her obesity, or that she doesn't have the moral fortitude to successfully fight it.  Either way, she's disqualified for the job.  Right?  It's a sign of weakness to be overweight, and we certainly don't need someone with a personal weakness to be in a leadership position!

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It is clear that some view the overweight (which, by the way, constitute 2/3 of our adult population) as being emotionally weak and somehow inferior to everyone else.  After all, study after study has shown that the way to beat obesity is simple: eat less and exercise more.  It's simple; and those who don't do it are weak, lazy, dumb, or just plain pathetic.

It angers me to hear these suggestions.  Racist and sexist people put down others because of the fact that they are different than themselves.  But the moral judgment against the overweight and obese is not meant to be a judgment against something inherent in the other person; it is a judgment against their character, their choices, and their weaknesses.  The implication is that they are somehow either smarter, stronger, or just plain better than the overweight.  The implication is that the other is weak and they are not.

There is a word for this attitude: hypocrisy.  A bigot is a person who hates those who are different; a hypocrite is one that hates others for something they themself have, but choose to ignore.  Both mistakenly act as if they have the moral high-ground.  Both disqualify themself from any argument based on morality.

Healthcare exists because of human weakness.  We all are weak in various ways, and we all will eventually die when one of our weaknesses overcomes us.  Obesity exists because of human weakness - either the genetic or biological miscalibration of the person's metabolism, or the inability of that person to act in ways that are in their own best interest.

I have to say that I probably fall in the latter category, as my lack of desire to exercise and my exuberant desire to eat rich foods make it so I have struggled with my weight for years.  Somehow the prescription: eat less and exercise more, is not very helpful for me.  Yes, it is simple; but it is not easy.  Having others explain it to me at this point is not only unhelpful, it is insulting.  Of course I know that my weight is a problem!  Of course I know I should exercise more and avoid that cookie dough in the refrigerator!

To successfully fight the battle against obesity in our country, we have to stop the condescending finger-pointing and instead ask the question: why is it that we humans don't always act in our self-interest?  Why do smokers smoke?  Why do alcoholics drink?  Why don't people take their medications, eat enough vegetables, or go for walks instead of watching The Biggest Loser on TV?  This seeming self-destruct switch is, to some degree or another, present (in my opinion) in everyone.  It is the same drama with different actors and props.  We all sell our birthright for some soup at times.  We all go the route of easy self-indulgence rather than personal discipline.

Does that mean we are all weak?  Yes, in fact, it does.  My admission of my weakness has actually made it easier to have frank discussions with patients about their own personal struggles - be they weight, smoking, or other self-destructive behaviors.  They listen to me because I don't insult them with statements of the obvious.  If it was easy to lose weight, don't you think we'd have a little less than 2/3 of the population being obese?  Does 2/3 of the people remain overweight because they want to be that way?  No, the problem is not that simple; and suggesting otherwise won't do much to deal with our national problem.

Dr. Benjamin has impressive credentials.  She is a practicing primary care physician who cares for the poor.  She's not some subspecialist TV personality; she's a doctor who has spent a lot of time face to face with the neediest people in our system.  She doesn't just know about the poor and needy, she knows them.  She's one of us; and her weight does nothing to lessen that - for me it actually makes her more relevant, not less.

So put down your stones, people.  We are all weak.  Having someone who understands the real struggle of the overweight may actually give us a better chance to successfully fight it.  And if some of you still hold stones, let me rephrase a famous statement: The person without personal weakness can throw the first stone.

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