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The One Way to Lose Weight

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In an article in the January 11, 2010, issue of The Mountaineer (Haywood County, NC), Garland Scott addresses concerns about obesity, its effect on health care, and the rising statistics of both adult and childhood obesity. For the record, Scott is president and CEO of UnitedHealthcare of North Carolina. Among the statistics Scott presents are the report that 27% of Americans are obese, the projection that 47.9% of North Carolinians will be obese within a decade, and the observation that childhood obesity rates have doubled in the past three decades. He is promoting education as the means to avert this “epidemic.”

While education is important (ask anyone who’s got one — or anyone who doesn’t), it appears to be a very slow route to achieving the goal of a healthy America. If eating/activity education is a success, it will take generations of it to turn the tide. There are many causes of obesity and overweight, and many of them are not included in curricula.

What is the difference between “overweight” and “obese”? According to the Centers for Disease Control and Prevention (CDC), both terms refer to “ranges of weight that are greater than what is generally considered healthy…also…ranges of weight that have been shown to increase the likelihood of certain diseases and other health problems.” Overweight is defined, for an adult, as a “body mass index” (BMI) between 25 and 29.9; 30.0 or higher indicates obesity. Here is the formula, provided by the National Institutes of Health, to determine your BMI: multiply your weight in pounds by 703; divide that answer by your height in inches; divide that answer by your height in inches again. A 5’5”, 135-pound individual would have a BMI of 22.4 (18.5-24.9 is considered “healthy”), a 5’8”, 270-pound individual would have a BMI of 41.0 (morbidly obese).

According to the World Health Organization (WHO), one billion people are overweight, 300 million of them are clinically obese. WHO declares obesity “a worldwide epidemic.” Epidemic is not the proper term for this problem since an epidemic is a widespread outbreak of an infectious disease; the emphasis here is on infection and contagion. There are many causes of obesity, but so far no one has proven it’s caused by a germ.

One of the major concerns, besides health and mortality, is the skyrocketing cost of medical care. There are a host of diseases and disease conditions that are caused or exacerbated by excess weight, besides the well publicized diabetes and heart disease. Scott, in his article Obesity a statewide concern, cites projections that the cost to the State of North Carolina within ten years will be $11.14 billion dollars ($1473 per every adult). Educating children about healthful eating and the importance of physical activity cannot do much to alleviate that now. And the fix is needed now.

The government has not yet tried to put us all on crash diets; politicians can’t afford to do that to us. So how does America save itself from the obesity beast? Diets, diet plans, diet clubs, diet books, diet pills, and diet gurus are not the answer. The problem with all of these is that once the results are achieved the former fatty wants to return to satisfying, not healthful, food. Satisfaction here is not based on physical needs so much as emotional needs. Although some authors and diet designers address the issue of emotional needs, the solutions offered usually concentrate on a fast fix, because dieters are results-oriented.

The health insurance companies should take a much more active role in defeating the fat monster. It does not have just one cause—lazy people with no self-control—there are many causes (even our DNA is being blamed) and they require more than one solution. Insurers should aggressively promote the most successful weight loss method currently in use, bariatric surgery. Bariatric surgery is not for everyone, but it is for those at least 80-100 pounds overweight. For the uninsured, the cost ranges from $15,000 to $35,000, and there are several types of surgery, including stapling and banding. Insurance companies do not pay providers what an uninsured person pays — $15,000 is a lot of money, but the cost of health care for a morbidly obese individual over a lifetime is considerably more. Consider the cost of diabetic care or heart surgery. As in all weight-loss methods, there is some obesity recidivism; however the rate with bariatric surgery is extremely low. The health insurers have an awful lot to gain, if an awful lot of us lose weight. By promoting weight-loss surgery and making it accessible to those who need it, they will be doing a service not only to America but also to themselves. And isn’t that what health insurance companies are all about?

Bariatric surgery is not elective or cosmetic surgery; it is a life-saving procedure. It is also a quality-of-life-improving procedure. It’s not fun to be fat. There are some morbidly obese people who profess to enjoy being fat, and I am always astounded to hear this. Fat people’s lives are more difficult physically, socially, and emotionally. They are discriminated against and the target of jokes. Climbing stairs is difficult, running can be impossible. Compliments are scarce, “well meaning” advice plentiful, mirrors depressing, and dieting disheartening. I would not promote vanity surgery. If someone is 100 or more pounds overweight, vanity may play a part, but this surgery is necessary.

The terms “fat” and “fatty” may seem harsh in this land of political correctness, but as a “recovered” fatty, I stand by them. Ten years ago, on March 8, 2000, I underwent bariatric surgery. I went from being obese (BMI 37.9) to healthy (BMI 22.4) and have maintained this for ten years, with little effort. I have changed from being a draw on my communities to being a contributor. As an asthmatic who couldn’t roll over in bed without having an attack from the effort, I have experienced through the combination of weight loss and preventive medicine a reduction from my four or five daily attacks to five or six a year. There have been a number of other health and emotional benefits as well. My life has improved to the point where I want to go up to obese people and beg, “Please. You’re killing yourself. Have this surgery.”

I am not disparaging education, but I question its value in a health care crisis. An awful lot of time and money has been expended on tobacco education, but we are still dying from smoking- and chewing-related disease. Sometimes it’s imperative to take more than one approach, and this is one of them. Please, yes, educate our youth on the importance of fitness and healthful choices, but please also eliminate the threat that obesity poses to adults by eliminating it.

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About Miss Bob Etier

  • Miss Bob — After reading your article, as well as your author’s profile and taking a good look at your blog, it’s obvious to me that you’re a very sincere and decent person. And having once been fat yourself, and given some of the things you wrote in your piece about the many causes of being overweight or obese, it’s clear you have an understanding of the issue.

    That said, I — an obese person, age 57 and fat since puberty — must disagree with your wholesale endorsement of bariatric surgery, as well as your furthering the myth that obesity is the bogeyman of high health care costs.

    I, like you, have a blog on Blogspot, and if I knew how to insert a link in a comment, I would (anyone who’s interested can reach it through the link on any of my Blogcritics articles). On said blog, I’ve devoted a great deal of time to writing about the Fat Acceptance Movement (which I’ve come to regard as a lost cause), as well as documented facts about obesity in relation to health care costs.

    Fat people are not a “drain” on their communities because of health care costs, and to imply such an idea is to contribute to the already extensive prejudice, contempt, discrimination and outright hatred already directed against fat people.

    Yes, fat people are more prone to diabetes, heart disease and other serious illnesses. However, fat people, in significant numbers, also die younger. When mortality rates are appropriately figured in, it is NOT fat people who cost society the most, it is aging and old people who are the greatest “culprits.”

    Now that “healthy” people are aspiring to life expectancies in the 90s and even 100, their health costs: long-term care, end-of-life care, and care for expensive diseases like cancer and Alzheimer’s that increase with age, comprise the greatest burden.

    However, as a citizen, that doesn’t disturb me. May people live as long as they like, as long as they can, and if they incur major health costs along the way, so be it. I’m childless and I recognize that problem pregnancies, children with special needs and children in general cost health care $$ big time. I don’t engage in sports and I recognize that amateur athletes who frequently incur injuries or in later life develop serious joint problems cost a lot of money.

    My point is, the diversity of people in our country have a diversity of health problems. We would do well to regard everyone equally and accept their choices and/or conditions as simply the package they bring to the table (as it were) without prejudice and without singling out fat people as the root of all evil in health care costs.

    We would all do well to remember that health care in America is what it is (poor, difficult and extremely expensive) because in the U.S. AND NOWHERE ELSE, health care is a profit-making business instead of a public service. In addition, fraud, mismanagement and overhead combined are the greatest causes of ridiculous health care costs, not sick people in any category.

    Finally, weight loss surgery, while necessary and appropriate for some people, is still an extremely invasive and dangerous procedure with frequent dangerous (and extremely unpleasant) side effects).

    The truth is, ALL diets work if one sticks to them; I’ve lost hundreds of pounds over the years. Maintenance is what’s difficult, nearly impossible (98% of those who lose 100 lbs or more by conventional means gain it back within two years) — and not just because people resume poor eating habits, but more often because a combination of genetic and other physiological factors, such as weight set-points, play an…enormous role.

    I have never claimed to be happy about being fat; it’s socially difficult and physically uncomfortable. But when I hit the age of 40 (by which time I had been dieting almost constantly for 30 years), I decided enough was enough and came to accept myself for who and what I am — whether others approve of it or not.

    I believe you meant well, intended to spread a positive message, with your article. But I believe that it and the countless others like it that appear frequently all over the place, only serve to pump up ugly behavior towards fat people by the thin/normal-weighted population. I would urge you to see beyond your own experience, as well as investigate the wealth of legitimate alternative science and statistics, before continuing to spread your chosen message.

  • Jeanne Brown—Thank you for reading my opinion piece on bariatric surgery; I appreciate your thoughtful response. I agree, obesity is not THE “bogeyman of high health care costs,” just one of many. Others you mention certainly make their contribution, and I wish all were addressed effectively. Some of the reasons I am such a cheerleader for weight loss surgery (WLS) are things you bring up: fat people have shorter life spans, and may face social difficulties and physical discomfort. I realized that I wanted to live to see my grandchildren grow up, and decided that my weight was not going to prevent that from happening (while something out of my control might). I’d like more people to be given this choice.

    I did not mean to imply that fat people are a drain on their communities–I was a drain on my communities due to the fact that I was morbidly overweight. I do not give an omni-endorsement to bariatric surgery (“bariatric surgery is not for everyone”). I am also aware of the fact that many overweight people are profoundly healthier than I am and that some “overweight” people are incorrectly classified as such due to a flaw in the BMI system.

    People who don’t want WLS because they are happy the way they are should not be pressured to have it. Bariatric surgery is definitely not for them. Accepting who you are—skinny, fat, healthy, unhealthy—is the ideal. I am particularly sensitive to contempt and discrimination against the overweight, deploring the fact that for some reason this group is exempt from political correctness (of which I am not a fan), leaving its members an okay target for stereotyping and mean-spirited jokes.

    I believe that it is the responsibility of health insurers to address health care problems and solutions, which is why they should aggressively promote successful “cures.” Yes, all diets work, as long as the diet rules are followed. Diets do not stop or reverse obesity when they are abandoned, as most are. And when I say “promote aggressively” I do not mean force the insured to have WLS but to get the information out to those who need and want it that these procedures are available and covered. Since this is in the interest of the insurers, and they will gain from it, they should provide the coverage. Offering educational programs to our youth may be prophylactic, but other approaches are needed. WLS is just one of them.

    Again, thank you for reading my blog (or as I call it, blahg) and sharing your insights.

  • Wow. I’ve had bariatric surgery — five years ago. The day I went under the knife I weighed about 560 pounds and had been living as an invalid for a decade. I couldn’t walk without canes and toward the end I was pretty much confined to a wheel chair. I cruised Alaska the summer before my surgery enjoying the icebergs, towns and ship all from a wheel chair. How I got to that point doesn’t matter — it was a combination of overeating, steroids used to control other conditions I have and just plain giving up on life.

    Here I am a half decade later. I walk regularly. I drive. My wheelchair sits in the basement – a gentle reminder of a life that was. I keep the pair of jeans I wore to the hospital that day as another reminder. They’re a 74″ waist. I’ve lost over half my weight. I’ve lost 302 pounds and after plateauing for about a year, I’m losing again! Life isn’t perfect – some health issues remain. But, dear God, there is so much hope.

    The surgery isn’t for everyone. It saved my life. I’m no longer diabetic; don’t have blood pressure issues; my heart beats with the strength of a teenager. Every abnormality I had with my heart with the exception of one is all but disappeared. I have an energy that knows no bounds. My love of life and its possibilities is renewed and reinvigorated. But there is a downside…

    Losing weight on such a grand scale causes many an interaction. All that testosterone stored in the fat cells is released so violently that one develops the sex drive of a pubescent boy hiding in the basement perusing Dad’s “girlie books”. I hear in women it’s twice as string.

    The largest downside, however, is how those around you will respond. For me every pound lost was a pound gained in discovery. I found myself questioning many decisions I made along the path of life because I had a new perspective. Those of my loved ones who had a caretaker role in my life were directly impacted. They had difficulty in coping with my new found freedom and in some way their own “need to be needed” was being attacked.

    That being said, the decision itself is individual. It is not for everyone and I’ve done my best to remain quite neutral when others sought my counsel. For me it was the right thing and opened doors to experiences I never would have known. The loss of over half my body is multiplied by the amount of love I have in my life today. I do believe that one can still be “fat” and healthy. I just know now, that I’m not one of them.

    Thanks for this piece.