The following post was one of my most read and commented-on from my old blog. I wrote it in June of 2008 after seeing a patient who was utterly ashamed of his obesity. I was so struck by his self-loathing that I wrote the post within a few hours of seeing him. My most recent post on defectiveness brings back a lot of those emotions, and I thought it would be an appropriate time to re-publish that post. ----
I saw a gentleman in my office for his sciatica. He was having severe pain radiating from his lower back, down to his calf.
I was about to describe my plan to him when he interrupted me saying, "I know, Doc, I am overweight. I know that this would just get better if I lost the weight." He hung his head down as he spoke and fought off tears.
He was clearly morbidly obese, so in one sense he was right on; his health would be much better if he would lose the pounds. On the other hand, I don't know of any studies that say obesity is a risk factor to ruptured vertebral discs. Besides, he was in significant pain, and a lecture about his weight was not in my agenda. I wanted to make sure he did not need surgery, and make him stop hurting.
This whole episode really bothered me. He was so used to being lectured about his obesity that he wanted to get to the guilt trip before I brought it to him. He was living in shame. Everything was due to his obesity, and his obesity was due to his lack of self-control and poor character. After all, losing weight is as simple as exercise and dietary restraint, right?
Perhaps I am too easy on people, but I don't like to lecture people on things they already know. I don't like to say the obvious: "You need to lose weight." Obese people are rarely under the impression that it is perfectly fine that they are overweight. They rarely are surprised to hear a person saying that their weight is at the root of many of their problems. Obese people are the new pariahs in our culture; it used to be smokers, but now it is the overweight.
The fear/disdain of obesity has reached into areas where it should not be. I regularly have to tell mothers of chubby babies that it is perfectly fine for their child to be that way. Children under three generally regulate their eating to what they need. I do not believe a baby can become obese on breast milk or formula. Now, if they are giving the child french fries and burgers, that is a different matter.
Instead of patronizing obese patients with a lecture, I try sympathizing with them. Just because something is simple doesn't make it easy. How do you quit smoking? You just stop smoking. We should just pull out of Iraq. There should be peace in the middle east. People should stop hurting each other and start being nice. All of these are good ideas, but the devil is in the details. Losing weight is a struggle, and it really helps to have people giving you a hand rather than knocking you down.
Don't get me wrong, I don't deny the health risk of obesity. I do my best to work on weight loss with my patients. But the idea that their personal worth lies on their BMI is extremely damaging. There are a lot of screwed-up skinny people out there; just look at super-models. It is a lot easier to lose weight when you actually like yourself and want to do something about your health. Our culture of accusation and shame simply makes obese people hate themselves. If you hate yourself, why should you want to take care of your body?
Is obesity a problem? Sure it is. But we need to get off of our self-righteous pulpits. Obese people should not be made into a group of outcasts. The "them" mentality and the finger-wagging are no more than insecure people trying to feel better by putting down others.
It sounds a lot like Junior High.
If we really want to help with obesity, we need to grow up.