I am morbidly obese, according to the latest guidelines. My BMI is an astounding 48. I am 130-150 lbs overweight, depending on whose chart you use. It’s one of the reasons I didn’t put a picture of myself up on the website for a long time. I know how people judge you if you are obese. So I have been around the Fat Acceptance websites for years. And I believe in Fat Acceptance.
For me, Fat Acceptance has to do with not being discriminated against. In these United States, you can’t discriminate in hiring against a dwarf, or a one-legged person, but you can discriminate against a fat person. To me discrimination against fat people is just as unacceptable as discrimination against a person of color. But, you say, a person of color, or a dwarf, or a one-legged person can’t change, but a fat person just needs to change their eating habits and start exercising. Were it really so easy. Studies have shown that for the most part, people tend to have a set point, and to return to that set point again and again. Thus the stories of the people who have lost the same 50 lbs over and over. This is due to a mechanism that sets your weight higher after every period of low food intake. Originally a mechanism to protect people from famine, and prepare them for more years of lean during years of good crops, one thing that can set it off is dieting. Think about that for a minute. Every time you lower your calorie intake, the next time you go back to eating normally, or even at a higher rate than what you were taking in on the diet, you gain weight. I have seen patients in a nursing home gain weight on 800 calories a day. Which also explains why every time we regain the weight, we gain a little more.
If dieting is a risk factor for obesity, I have my mother to thank for starting
me on that road at the age of 13. She decided I was too fat, and put me on a 1200 calorie diet, about half what I needed at that age. But looking at the pictures from then, I wasn’t fat. I just had boobs and an ass, attributes my mother lacked.
Part of the reason that fat people can be discriminated against is our stupid healthcare system, that puts the burden of providing healthcare coverage on employers. Employers fear, because of all the hype about the health problems of the overweight and obese, that their insurance premiums will rise. And they will, because the insurance industry is not out there to help us get healthy, it’s out there to help Wall Street get healthy.
But how much real evidence is there that obesity really causes or contributes to increased health care costs or premature death or disability? Not much, as it happens. Yesterday’s edition of Junk Food Science looked at the importance of null studies, studies that find no correspondence between supposed risk factors and poor outcomes. The particular factor in play here was the role of belly fat in the supposed increase in rates of diabetes. None was found. Was that reported in the news? Hell no! Why not? Why, we might quit worrying about our belly fat and buying nostrums to get rid of it.
Even that gold standard of treatment for we who are morbidly obese, the gastric bypass, has not really demonstrated that it can improve health outcomes for the morbidly obese. As a matter of fact, because it induces malabsorption syndrome, many of the “survivors” have considerably more hospitalizations and poor health after the surgery. Even then, they usually regain the weight after 6-7 years, if they survive in the first place. Death rates post op are 3% in the first year and 6.4% in the first four years. Compare this to a death rate of 0.44-0.66% among “morbidly obese” adults overall.
If the norm is to regain the weight, even after this drastic surgery, why all the recrimination of fat people here* and here, even by those who have been or are, by their own admission, overweight or obese? Why the “disgust” at someone who has to use a scooter in the grocery store, and whose belly hangs down to their knees? When I see that person, and I think there is one in every town, I think “God, they must have lost a lot of weight to have all that loose skin.” I can’t look at them with disgust, or I would have to look at myself with disgust. And I gave that up a long time ago.
As to sitting next to us in an airline seat, and us encroaching on your space, I can only say that the most miserable trip I ever had was sitting next to a normal weight guy with extremely wide shoulders. I felt I had to bend myself in half vertically to accommodate him. We would all be better off if airline seats weren’t on the average, 17.2 inches wide. Compare this with theater seats that average 2o inches and compact car seats that average 22 inches.
In the mean time, I have been told I have a “beautiful heart” by an echocardiographer, I haven’t developed Type 2 diabetes, despite the dire predictions, and neither did my grandmother who was my height and weight. She lived to be 89, BTW. I take a minimal dose of diuretic to control my blood pressure, which has never been over 140/90. Most of my “health problems” are minor inconveniences, not life-threatening.
The only thing that might be improved by weight loss is my knees, and since they are already bone on bone, even that is doubtful. Of course, if I lost about 75-100 lbs, then they might do the knee replacements they refuse me now. On the other hand, the surgeries would run about $30,000, and for that they could buy me a new power chair every five years until I’m the age my morbidly obese grandmother died at. And I wouldn’t have to have revision surgery for them either. Another example of how the US healthcare system wastes money.
But my knees are bad from my obesity, right? Well, maybe. On the other hand, perhaps I have Ehlers-Danlos syndrome, of which I have many symptoms, and which causes early arthritis in hyperextensive joints. Which my knees have always been hyperextensive. Or maybe it has to do with spending 30 years on my feet, often on concrete floors, 8-16 hours a day as a nurse.
So, yes, I’m trying to lose some weight. Most people who lose weight lose about 10% of their weight before the body’s survival mechanisms kick in. In my case, that would be about 25 lbs. I might be able to get into my skinny jeans. But get down to my normal weight and stay there? According to the studies, not bloody likely. And I accept that.
*BTW, fat people who accept themselves are more fun because they’re not worrying about their weight, and bitchy from being on a diet.