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.

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...."