December 2, 2013

"This is where the obesity-as-disease concept leads us – to a situation in which people demand that medicine shoulder the responsibility."

Karen Hitchcock, an Australian doctor who works in a bariatric surgery clinic, writes about the medicalization of the obesity problem.
I ask a young 200-kilo [440-pound] patient what he snacks on. “Nothing,” he says. I look him in the eye. Nothing? He nods. I ask him about his chronic skin infections, his diabetes. He tears up: “I eat hot chips and fried dim sims and drink three bottles of Coke every afternoon. The truth is I’m addicted to eating. I’m addicted.” He punches his thigh.

Addicted. The word is useless in my clinic, a mere barrier to any hope of self-determined change. My patient is not addicted; he’s a very lonely, unemployed young man who has gradually become socially isolated to the extent that the only thing available to him for comfort and entertainment is food. He has no friends, no money to buy other consumables, little education, no partner, no job. Some days he doesn’t leave his bed. The choice for him is to eat this food or experience no pleasure. The surgeon and I discuss his situation, concerned that he may overeat after the band has been fitted. We tell him that surgery may not be appropriate for him, given his situation. The patient is perturbed. “Well, what are you going to do for me if you won’t do the operation? Don’t you have some kind of ethical responsibility to help me lose weight?”...

For whatever reason, the majority of human beings respond to advertisements inviting them to enter a pleasure state by eating a day’s worth of calories in one sitting, again and again. In the face of this, we are stuffed. We could say, “You are free agents, totally free, so pay for your own consequences.” We could make people pay at the point of choice, via a food tax, or we could limit choice. The other option, always unspoken, is: let us have our cake. Let’s just eat and eat, get fatter and fatter, and work out how best to live with it. This is where we are heading now: fatness, outside of morality, as an accepted consequence of the world as we have made it.
Much more to consume at the link. 


tim maguire said...

We're surrounded by sophisticated people using their special expertise to encourage us to destroy ourselves. Whether it's lawyers and accountants at the bank pushing us to over borrow on a house so they can sell the security or advertising agencies encouraging us to eat ourselves into the hospital or spend ourselves into the poor house, our economy is built on the sweat and imagination of people who are willing to make us feel bad about ourselves in order to sell us a pen.

But whattaya gonna do?

EMD said...

advertising agencies encouraging us to eat ourselves into the hospital or spend ourselves into the poor house

Society has grown incredibly weak if advertising has this sort of power.

Oso Negro said...

Lemme see....advertising versus modern willpower.....I'll take advertising and the points!

TML said...

I've been a creative director for over 20 years now and let me tell you, the merest thought that what WE do makes people do what THEY oughtn't is laughable. Meaning we laugh all the time about it. Like I'm some Svengali with powers of persuasion that most cannot overcome. Please. I work on big brands like IBM, Lexus, HP, BP, Exxon AT&T and others. No one's running out to buy a $6,000,000 enterprise server because of what I wrote. Now they'll seriously consider it, but no one's being manipulated. Did I really even have to write this?

Paddy O said...

Food is the new sex. Complete with the same characters. The Puritans, the moralists, the perverted, the casual gluttons.

Carol said...

it's like the disease model for alcoholism. it confuses cause and effect but makes the insurance claims easier.

EDH said...

Not sure the answer is treat the obese as bunch of lightweights.

PB Reader said...

People should be able to do as they please as long as it doesn't infringe on others. The trouble with this guy is that the feedback on his actions was largely severed until the situation became untenable. The prescription for this guy is to be locked up from food on demand, be given 3 necessary meals a day, require 3 exercise periodss a day, and the rest of the time he should be required to read on nutrition.

Illuninati said...

Scientists who study obesity have found that it is very rare for someone to have a long term reduction in weight. The body is very effective in auto-regulating weight. In obese people the body is set to automatically upgrade the food intake and downgrade exercise until the desired weight is achieved. Doctors may feel better about lecturing fat people about their weight but the fat people receive little medical benefit from the lectures. The down side is that doctors who are prejudiced against fat people are often rude and do not give them the appropriate medical care.

Probably the best time to fight obesity is at the beginning. The body contains millions of stem cells which are easily transformed into fat cells which then stay around for many years demanding to be fed. People who diet and lose a great deal of weight are simply depleting existing adipocytes but the number of fat cells remains the same waiting to be refilled.

Robert Cook said...

"'...advertising agencies encouraging us to eat ourselves into the hospital or spend ourselves into the poor house....'

"Society has grown incredibly weak if advertising has this sort of power."

Don't underestimate the power of advertising--propaganda, by another term--to influence the attitudes and behaviors of masses of people. And don't overestimate the capacity of masses of people to resist or reject the influence of perpetual and ubiquitous propaganda. This does not reflect a new "weakness" in society but a basic aspect of the nature of social creatures. If advertising didn't work--if it hadn't always worked--advertising would not be so omnipresent and the vast fortunes spent on it would cease.

Robert Cook said...

TML doth protest too much, I believe, or he/she is incredibly obtuse.

If you work in advertising and do not think the work you and your colleagues do influences the attitudes and behaviors of those your work targets, why do you think you have a job...or that your industry even exists?

SJ said...

Advertising alone is not sufficient to generate an addiction to food consumption.

If such an addiction is possible, there are probably a cluster of events which supported each other, to drive this particular person to self-medicate by putting food in their mouth.

Perhaps there needs to be a Food-Consumption-Addicts Anonymous group to help him.

But it is much easier to blame "The System" of "Advertising" than to address the hard parts of this specific case.

Robert Cook said...

Of course, it's not advertising alone that influences our food consumption habits; it's also what's available and affordable.

So much of the food one finds at hand in stores and restaurants is high fat, high salt, high sugar food that is almost--if not literally--addictive to us, and it is almost impossible to escape these processed is fast, cheap, designed to appeal to our innate desire for fattening foods, and it is ubiquitous.

Moreover, we are largely ignorant of the calories in the foods we eat, and most of us grossly underestimate the calorie content in the foods--and in the portions of food--we eat. Even the labeling that purports to inform us of the nutritional content of the food we buy is obfuscatory, with an intent to deceive: too many read "150 calories" and believe this is for the entire container of food, when it applies only to a specified portion size, of which there are usually several in the container.

One may argue it is our responsibility to read carefully and discern the fat, sugar, salt, and calorie contents of our food--and it is--but if those selling the food did not intentionally play on the carelessness (or willingness to be deceived) of consumers, and instead stated plainly the calorie contents of the entire container of food or beverage, more people would be aware of how many calories they consume, and at least some would reduce their consumption.

Robert Cook said...

"Perhaps there needs to be a Food-Consumption-Addicts Anonymous group to help him."

There is an Overeaters Anonymous organization, if you weren't aware of it.

Ann Althouse said...

We have natural urges that produce disastrous effects when we're not living in the natural setting in which the urges evolved. There's nothing wrong with us when we consume way too much food when food is in abundance. It's just physically damaging, and we don't have the natural capacity to avert this damage. This is the consequence of abundance, unless we can somehow impose control from within or without. But we like our freedom, obviously. Can we at least just use our freedom to look at the world and figure out what is true? Or do you think it's better to use our freedom to invent fantasies and believe what we want to believe? The human mind has evolved a capacity to perceive truth and to embrace fantasy. Seems to me we're having some of both. Gluttonously. Self-indulgently.

Diana said...

Screw the advertising, it's the ubiquity and the affordability. I couldn't get through to the original article but the syndrome is familiar to me and the excerpts that Ann supplied are enough, as someone who once weighed 60 pounds more.

Food is everywhere in "our" society - Australia and the US being one society in this regard.

I speak from experience. I was a fat teenager (before the obesity epidemic) and that just plain sucked. As an adult I lost weight here and there, about 60 pounds in all. OK, I was never as morbidly obese as the poor guy in the article but that I attribute to sheer luck. I was born into a family, a time, and a place that simply didn't allow it. What would have happened to me if I'd been born into a working class family in a semi-rural area? I shudder to think.

At a local CVS chain I just saw cookies for sale for 99 cents a box. Due to rigid discipline and training, I didn't buy any, but I sure wanted to. In the local Duane Reade, they sell candy underneath the pharmacy counter. Both these stores were in Manhattan, supposedly the land of the skinny. (Not, as a cursory glance around will prove.)

I repeat, candy underneath the pharmacy counter.

My theory is that we are about as skinny as we are paid to be in the modern world. If you are a person whose job depends on slenderness, you'll be slender. If not, it's genes and luck. And genes are a form of luck.

Diana said...


I composed my comment before I read yours of 9:16. I agree with everything you are saying but of course, real life is always more complicated than anything we can resolve on a blog comment exchange. I think that your comment is a masterful precis of exactly what is wrong with our obesogenic environment. Two observations, not disagreements but still...

"There's nothing wrong with us when we consume way too much food when food is in abundance."

In fact eating the food that's there is (I believe) programmed into our genes - because we evolved in environments where scarcity was the norm. Take away that variable and you have disaster.

I also think that stripping food of its nutritive properties, and fiber, and water, and offering only the sugar, is somehow deranging. Yes, I believe in sugar addiction.

Further, "our" and "we" is a useful construct as far as adults with control over resources and sometimes their own minds and wills is concerned. When you are a screwed up fat kid, stuffing his face with goodies, it's a different matter altogether.

There's also a lot of sheer misinformation with respect to weight loss out there. As someone who has been through the diet wars, I can say that it's really crazy.

The fact is you cannot lose weight without controlling your caloric intake (yes, some people dispute this), and that's simply a hard thing to do on a consistent basis.

EMD said...

TML - Do you have an email I can contact you at?
I'm poking around for new employment opportunities.
(Assoc. Creative Director with 18 years exp.) Thanks.

MadisonMan said...

So, if fat people have a disease, can I look at them with contempt and say "You're sick!" as I see them eat ice cream? Or should I look at them with pity as I say it?

Fat people, please respond. I want guidance in this!

Levi Starks said...

Everyone is going to die.
The choices you make will have a definite effect on the length of your life.
I don't see any immorality in allowing a person to suffer the consequences of their own action/inaction.
Even if a shorter lifespan is the consequence.

Robert Cook said...

I have never been obese or significantly overweight, but I have been over my preferred weight at times, and I've endeavored to and have successfully lost weight about three times in my life; each time the weight loss was achieved through strict control of my caloric intake. I never try to figure out arcane formulas of proteins versus starches versus fats, and so on and on...I merely constrain my caloric intake, and the weight does drop long as I am disciplined and consistent. I usually try to pair control of caloric intake with regular exercise, but the control of caloric intake is the greater mechanism--in my experience--for weight loss.

(The weight will tend to creep back up if one becomes complacent and less rigorous with one's caloric intake over time.)

Diana said...

People who have never been significantly overweight have no idea what it's like. There are no true analogies but try imagining yourself really short, and the only way that you can be a normal height is by using lifts.

Maintaining a normal weight is a constant struggle for a person who tends to be fat, and sometimes it's very wearying.

n.n said...

The civilization paradox. This was the observation which justified the design of "The Matrix". Oh, well. It was such a cool movie.

William said...

I was always a compulsive jogger. If you knock off five miles on a regular basis, the weight stays off, and the jogging is fairly addictive. My fitness is a symptom of my lack of character.......if brothels were as available and as well stocked as bakeries, we'd all be sex addicts. There's something going on besides advertising or lack of self discipline in the obesity epidemic.. The food is just too damn good and too damn cheap. The country has confronted worse problems.

Illuninati said...

Fat people have become an unhealthy obsession in modern society. The prejudice against fat people is very ugly. The just so story that obesity used to be useful during famines but is no longer helpful is wrong. Like many physical traits obesity has its health benefits.

An example is that obese people are more resistant to some infections; in particular tuberculosis. With the advent of TB which is resistant to a broad spectrum of antibiotics this selective advantage for obesity may become operative again.

Also mildly obese elderly live longer than elderly people who are normal weight. Those who are underweight fare the worst.

Michael K said...

Some of this, not the gross morbid obesity, began with the food pyramid, which is still heavily weighted (pardon the pun) with carbohydrates.

Robert Atkins dissented and proposed a diet based on protein and fat using the theory that hunger is better satisfied by these foods and thus people will eat less.

For that theory,he was vilified and attacked as a quack. We still see emphasis on carbohydrates in planning diets but they do not suppress appetite well.

Type II diabetes is probably caused by insulin insensitivity and chronic hyperinsulinism is seen for years before diabetes appears. Carbohydrates stimulate insulin.

Morbid obesity is probably another matter and genetics is involved.

Ann Althouse said...

"So, if fat people have a disease, can I look at them with contempt and say "You're sick!" as I see them eat ice cream?"

If you're mean like that to sick people — say, someone with the flu or cancer — be consistent.

Ann Althouse said...

"if brothels were as available and as well stocked as bakeries, we'd all be sex addicts."

If only loss of appetite were as common as loss of libido...

Diana said...

The food pyramid is stupid, IMO, but is not the cause of the OE. No one got morbidly obese eating 11 servings of bread a day, which I agree is not necessary, and bad for some. You get morbidly obese by eating huge amounts of carb/fat bombs.

Many traditional societies have been thin and had a carb-based diet. China and Japan, for two examples.

The diet Atkins suggested is just a fattier version of the Stillman diet, which was a pop version of protein-fasting, a solution for the morbidly obese. You eat basically lean protein. This is the diet the doctor recommended in her article.

It works, but it's boring as fuck. Can I say fuck on Althouse? I'm about to find out.

wwww said...

The MD should have referred him to a psychiatrist to be evaluated for major depression.

Staying in bed all day, most days, is a sign of depression, not a sign of moral turpitude. Staying in bed is boring and intolerable for healthy people. Normal brain function urges people to get out of bed.

This sort of depressed behaviour is not self-indulgent so much as a symptom of something gone wrong with biochemical reactions in the body, and most importantly, in the brain.

Major depression can be treated with medicine and therapy, which can correct the brain disfunction.

A man who stays in bed most days is likely to be severely depressed. A person who is suffering from major depression will find it very difficult to get dressed. A person who has a normally functioning brain will find it very easy and natural to get dressed and go outside.

People suffering from depression often have brains that are serotonin deplete. Eating certain foods causes a serotonin boost. Depressed people often self-medicate by eating foods that will give them that boost. Depression also slows down metabolism.

Staying inside increases the Vitamin D depletion and encourages depression which increases sedentary behaviour. The food he is eating lacks the nutrients which is necessary for optimal brain function. His brain needs those nutrients to function normally and lift the depression. His brain needs his body to move about to function normally.

wwww said...

Nothing is easier then laughing at a severely depressed person. Or a mentally ill person. Or a mentally disabled person.

It is easy for those with healthy brains to denigrate those who deal with mental illness.

The physical effects of that mental illness may make you feel superior about yourself.

I look at difficulty levels when I evaluate the courage of individuals.

Mental illness increases the difficulty level for activities that are simple and easy for the healthy population.

The effort it takes that person to get out of bed may be tremendous. That person may have courage that is much greater then yours.

paul a'barge said...


Laissez les bon temps roulez.

Joe said...

The power of advertising is way overestimated. Even when it is effective, it's as cop-out to blame advertising. (Billions are spent on advertising precisely because it is so ineffective--were it not so, counter-advertising would work wonders, but it doesn't. Advertising is most effective once we've decided to make a purchase or do something and are now simply deciding where to make that purchase or what brand to buy.)

The fact is that many people are gluttons because they can afford to be and because quite a bit of food tastes good. I can eat a whole lot more really tasty food now for $10 than I could for $3.50 in 1980. (I limit myself to 1450 calories per day eating a balanced diet.)

Yet, despite all this and the hand wringing, life expectancy is increasing. The average 50-something, of which I am part, is healthier than the average 50-somethings in all of history. Damn us, damn us all to hell.

Loren said...

I lost 120 pounds 4 years ago (still have it off!) I was at my local bike shop, and someone mentioned to someone else about my weight loss. Their comment: "Did you have an operation?" My response, "I didn't need an operation to put it on, I didn't use an operation to take it off."

mccullough said...

People used to smoke more. Substitute food for cigarettes, and you get fatter.

ALP said...

William said:
"If you knock off five miles on a regular basis, the weight stays off, and the jogging is fairly addictive."
I have come across research that shows just covering 5 miles on foot, regardless of the speed, is effective. When you consider that we evolved as hunter gatherers on the move - each meal represents a few miles of ground that was covered on foot. That is why I am a huge fan of any exercise on foot: fast or slow, using our feet to cover survive, is what we evolved to do.

Plus you can't beat it for mild/moderate back problems.

Peter said...

Screw the advertising, it's the ubiquity and the affordability.

The ubiquity, affordability, and desirability of the foods.

Most commercial foods we eat today are engineered. They are designed by food technologists who use science to make these foods more desirable than any natural food could possibly be- as well as easy and convenient to eat, rapidly, and in large quantities.

In the presence of such superstimuli, many eat too much and gain weight. Of course the food designers are not trying to make you fat- they just want to stimulate large, frequently repeated sales of the food products they design.

Which still doesn't mean the obese have a disease. Since when did every maladaptive behavior become a "disease"?

jaed said...

A couple of observations:

- enter a pleasure state by eating a day’s worth of calories in one sitting
Eating an entire day's food in one sitting is not pleasurable. It hurts. It's painful. People with eating disorders who consume huge amounts of food do not, generally speaking, enjoy doing it, any more than anyone else with OCD enjoys performing the compulsion action.

- Anyone who believes the vignette in the first quoted paragraph actually happened, I have some lovely oceanfront property in Kentucky I hope to interest you in. Low, low price.

Craig Howard said...

Scientists who study obesity have found that it is very rare for someone to have a long term reduction in weight. The body is very effective in auto-regulating weight.

Well, scientists may have "found" that, but it's nonsense. We eat a diet of crap primarily centered around wheat and sugar.

Cut those out and the body regulates its weight very well, indeed.

John Lynch said...

The rewards for people with self-control have never been greater. We've never had more freedom to succeed, if only we will do the work.

The consequences for those who can't control their base desires have never been more dire. We've systematically kicked away every societal bulwark that would help the wavering stay on the path to a truly happy life.

The ancients all figured this out- desire is the enemy of happiness. Nothing's changed, except for our material abundance and an unwillingness to set and follow age-old rules of self-restraint.

Materialism has failed, hasn't it?

So we get fat poor people, something that has never happened in human history. And they aren't happy!

Andy Freeman said...

If we're going to tax people for medical care, we can't deny it to obese and so on.

If we're not going to treat them (or smokers), they should be exempt from the taxes….