Is our attitude on obesity more dangerous than obesity itself

Great Debates
61

I hesitate to post since I’ve put up such a number in this thread of late, but picunurse’s post deserves comment.

The straightforward first. Bariatric surgery is an invasive step that can work, but it is only indicated for extremely morbid obesity or nearly so with medical complications, because it is so invasive. It is also only indicated if other approaches fail. Many plans will only cover it if there is documention of a year of supervised attempts at weight loss.

Even a 5% weight loss coupled with exercise can be very effective at improving various health measures and lowering mortality rate. Doing it slow is fine. Are you swimming again? Rather than Optifasting it, are you making lifestyle changes in what you eat and how, changes that you can stick with?

But here is where you hit a key issue-

We cannot and should not pretend that obesity is a nonproblem, but stigmatizing the obese is counterproductive. It is more of a public health issue than one of individual will and I fear that some of the tactics employed by some in this war can indeed make things worse. You’ve been to subjected to some of what I (and most policy makers) would see as poor tactics. Stigmatization. Stereotyping and assumption making. Limited time diets and psychobabble. We can do better, and it has to start young. Parents battling with their kids over food and obsessing over the scale will make things worse. It teaches kids to not pay attention to whether or not they are full but to react to external forces, either in compliance or in rebellion. Parents only having healthy food choices available, having them include a variety of tasty choices, and encouraging kids to listen to their bodies, eating more if after a break they are still hungry and stopping when full, will help. Parents limiting electronic entertainment and getting out on the bikes with their kids will help. Society needs to recognize that the poor nutrition advertised to, and readily available to children is as harmful to their long-term health as tobacco and hard booze ads would be. School programs need to refocus from those on the teams to getting everyone enjoying doing something that gets them breathing heavy for half an hour a day. City planning should include less parking on sites and foster more reliance on public transporrt that requires a little walking to and from the pick-up and drop-off sites.

The war will not be won by blaming individual soldiers, but by correcting the problems in our system design.

62

DSeid Thank you for your response. Of course, since I am a healthcare professional, I already knew that.
The Lap Band although, as you stated, is an invasive procedure, however, not as invasive as gastric by-pass. It is also totally reversible, making it safer in the long term.
I find the rule of having to have a year in a supervised weight loss program that has failed, spurious. Why should one have to endure yet another year of failure? I believe that rule is simply to keep insurances from having to pay for the procedure. Their letter stated that if I wanted to pay for it out of pocket, they’d be happy to do it. Concern for my well being isn’t part of the mix.

Exactly. That’s why I made the comment about it being a “dirty little secret.” Because it stirs emotion in the non-obese, and people don’t talk about it. They peek out the corner of their eye, as though I have an extra eye or something.
Do people think I haven’t noticed? :dubious:
It seems the average person can’t help their bias. Is it learned, or is it part of our survival instinct?
I don’t know the answer.

63

Relevant article in The Times today comparing the health benefits of overweight vs obese people losing weight:

64

Costs.

65

With all due respect to all the research people have gathered and all the supported arguments people have made, I have just one:

*Nothing tastes as good as thin/fit feels. *

I’ve struggled with weight problems from childhood. It was passed on to me genetically and conditionally growing up. My mother was prone to weight gain. My dad went hungry quite often as a child and though he was never fat, he does enjoy the comfort of food and a full fridge.

At my worst, I was over 60 pounds heavier than I am today. At 5’8" and 168 pounds, I’m very athletic and wear a 31" waist pants and 40-42 jacket. But it didn’t happen over night and it wasn’t easy. I understand the challenges of family life, working for a living, raising kids and being a husband (though I’m between wives at the moment :wink: ).

That said, I exercise 2-3 hours a day, 5-6 days a week. It’s rewarding but very difficult to maintain as a discipline. I constantly watch what I eat and how much. I’m almost always hungry. More so when I’m down or a bit depressed. I’m always craving something that I know I don’t really need. Every once in a while, I treat myself. But not on schedule like a Sunday eating fest. I treat myself occasionally just to remind myself that no matter how good something tastes (greasy burger or rich dessert) it’s rarely that good when it hits the stomach. It’s certainly never good enough for me to be embarassed to take off my shirt on the beach or be unable to run along the side of my children’s bicycle as I’m teaching them to ride a two wheeler.

In a way I think I have come to appreciate what an alcoholic, smoker or drug abuser feels when they talk about their addiction. Unfortunately, I can’t give up eating. Though I’d really consider it if there was a practical and healthy alternative. It may sound fucked up. Maybe it is. All I know is that if feels better to be fit and healthy than living with the alternative as I have in the past.

66

I don’t see how $36 billion is 11% of a healthcare budget of about 1.6 trillion, or how they got to that conclusion. Did they mention how much money was spent helping the people who have eating disorders, psychological disorders from dieting, or health problems from yo you dieting? Nope. What about the costs of smoking?

http://cms.psychologytoday.com/articles/pto-19970201-000023.html

A rather drastic measure of weight control is cigarette smoking. Statistics reveal that smoking is on the rise among young women. Robert Klesges, Ph.D., and colleagues at the University of Memphis have repeatedly shown that smoking is used by many women for weight control. While we didn’t specifically ask whether you smoke, we did ask whether you smoke to control your weight. About 50 percent of women and 30 percent of men say they puff away to control the pounds.
http://abclocal.go.com/wls/health/033105_hs_cancer_prevention.html

Two thirds of cancer deaths are due to poor diet, lack of exercise, bad screening, and smoking. Was there outcry when it was discovered that cancer deaths were due to a large degree to ‘laziness’ on the part of the sufferers (most diseases, including obesity, are due to laziness. Hell most problems in life are due to laziness)? If people got screened, ate better, exercised and didn’t smoke they wouldn’t die. But they don’t. Cancer costs alot more than $36 billion a year.

Assume you did those four things to avoid cancer, and you tried other preventative measures (taking baby aspirins, taking statins, taking vitamins, etc). These measures to avoid cancer are potentially dangerous and not completely proven to promote health, but neither is dieting. It wouldn’t be suprising to assume 80% of cancer deaths could be avoided if people weren’t so lazy. Outcry? None. We don’t loathe cancer victims the way we loathe fat people.
Lets call a spade a spade here people. We live in a culture that loathes fat (and by proxy, fat people). In and of itself, I guess that is expected (all cultures have heirarchies and preferable traits). However, to claim that this war on fat is about health or money is a myth and can’t we just admit that our social prejudices and hatred for fat play a role in our decisions as a society when it comes to obesity treatment? Doctors and the public will latch onto anything they can to encourage fat people stop being fat. Whether its is unreliable scientific studies, treatments with a 90% failure rate, treatments with a 2-5% death rate (bariatric surgery), or sweeping critical studies under the rug we are a culture that loathes fat people so badly that we will stop at nothing to get rid of them by encouraging them to stop being fat. The reality is no one cares if obesity leads to smoking, mental disorders, or if dieting is dangerous and doesn’t work 90% of the time. We loathe fat people so much that none of that even registers on the radar as reasons why we shouldn’t ‘encourage fat people to stop being fat’. Our loathing runs so deep we will stop at almost nothing, to the point where levels of malpractice that would lead to multimillion dollar lawsuits in any other field of medicine are the status quo in obesity treatment. There are two forces, the force of medicine and the social force that says fat is bad. The social force taht says fat is bad will always win in this society. Health risks and double standards be damned, our social dislike of fat people runs far too deep and is far too powerful and important to us for those things to really register for most people.

As far as the idea that healthy eating will lead to weight loss

The study found that 40% of women who ate meat, poultry, fish, eggs and dairy products (as well as plant-based foods) were overweight or obese, as defined by having a body mass index of 25 or more. That’s equal to a person 5 feet 6 weighing 155 pounds or more.

Compare that with 29% of vegans and semi-vegetarians (who in this study were defined as those who skipped meat, poultry and eggs but who ate dairy products and fish). The leanest women were lactovegetarians, who ate dairy products but who avoided meat, poultry, fish and eggs. Twenty-five percent were overweight or obese.
Essentially, eating a healthy diet makes you thinner, but people are still overweight (29% vs 40%). As I said, there is no guarantee of thinness from healthy eating. You will become thinner, but due to genetic variance there is no telling how much thinner.
I would write more but the power keeps going out here due to a thunderstorm. I’ll be back to reply to the other posts.

67

That 5% weight loss you refer to is almost proof that fat alone doesn’t matter. If a person has a BMI of 37 and loses 5% of their bodyweight, their BMI is now 36. They are still grossly obese but they are much healthier.

I’m all for healthy nutrition and exercise, but I think the war on obesity prevents these things for a number of reasons. This is based on the fact that eating healthy and exercising are largely seen as methods of weight management in this society.

  1. It tells the 35% of americans and 80% of american kids with a BMI in the acceptable range that they don’t need to eat healthy and exercise since they aren’t fat. In other developed countries the number of people who aren’t overweight/obese is closer to 40-60%. In the developing world its closer to 80%.

  2. when working cures for obesity start coming out people won’t eat as healthy or exercise anymore. The study I listed above shows

“More than 60 percent of women and 40 percent of men indicate that at least half of their workout time is spent exercising to control their weight. And for a significant proportion of both sexes – 18 percent of women, 12 percent of men – all exercise is aimed at weight control.”

However, this is probably an endorsement for the war on obesity since it shows the war encourages exercise. At the same time the HAES study shows people who exercise for health benefits quadruple their exercise levels and those who do it for weight loss go back to baseline.

  1. It creates an all or nothing mindset about healthy eating and exercise that decreases motivation (ie, the HAES study I listed above showed those who ate healthy to lose weight quit and dropped out in droves). Eating four slices of high fiber bread (in conjunction with a person’s everyday diet) and walking two hours a week will provide many health benefits. However most people think of eating healthy and living healthy like what QuickSilver is doing, exercising 18 hours a week and maybe living off steamed vegetables.
68

If you’re happy that is what is important. I don’t think I have the motivation for that kidn of lifestyle though, I don’t know how you fit that much exercise into your schedule unless you get up at 5am.

Nonetheless, the level of dedication you will resort to to lose weight (and you are a man, you are not treated nearly as bad for beign overweight as a woman would be) is proof of how deeply our loathing of fat as a culture runs. This is what I keep saying in this thread, no matter how dangerous, inefficient, destructive or counterproducitve our desire to make fat people thin is, no matter how many problems it causes, none of it is more powerful than the social force that causes a man who has kids to raise (Ie someone from a demographic with much less motivation to become thin than, say, a 21 year old woman) people to devote 15+ hours a week of their lives to exercise they may not want to do.

69

Incidentally, Dseid, I wasn’t directing those comments at you. I was just referring to our culture’s value system as a whole. I am pretty sure you care more about healthy eating and exercise. That is laudable, so do I and I practice them both.

http://www.ti.org/vaupdate25.html

Household Average Percent
Income BMI Obese
<10000 27.3 27.5%
10000-14999 27.2 25.7%
15000-19999 26.8 24.0%
20000-24999 26.7 23.1%
25000-34999 26.5 21.1%
35000-49999 26.5 20.8%
50000-74999 26.3 18.6%
75000+ 25.7 15.1%

              Average     Percent

Education BMI Obese
None 27.4 25.2%
Grade 1-8 27.6 28.3%
Grade 9-11 27.2 26.2%
Grade 12 26.7 22.3%
College 1-3 26.4 20.6%
College grad 25.7 15.4%

Race BMI Obese
Black 28.2 31.6%
Native American 27.8 29.1%
Hispanic 26.9 22.7%
Other 26.8 22.6%
Non-Hispanic White 26.2 19.2%
Asian-Pacific 24.3 8.3%

Don’t you think the fact that uneducated, poor people are more likely to be obese means that its not the obesity per se that is the problem, but poverty and being uneducated? And I don’t see how lifestyle alone explains the obesity rates of non whites. Asian Pacifics in the US have an 8% obesity rate, whites have a 19%, and blacks have a 31%. I doubt lifestyles vary drastically to explain this, its genetics. Hispanics, blacks and indians (to my knowledge) are also more prone to diabetes and hypertension. So again, encouraging fat people to lose weight may mean nothing. A person with an 8th grade education, an income of 12k a year, no health insurance, chronic stress, chronic sleep deprivation, poor diet and no exercise will be about 500% more likely to be fat than a white person who makes 80k a year, has low stress, gets ample sleep, exercises, eats healthy and has a good education, but the fat is not what is killing them.

70

Assume a 27 year old woman goes to her doctor for a sinus infection. While at the doctor he takes her weight and blood measurements. He doesn’t really address her sinus infection and her blood tests are normal in regards to cholesterol, blood pressure, homocystene & glucose. Nonetheless the doctor recommends she lose weight since her BMI is 28.
The reason this is a bad idea (and potentially malpractice) is

  1. She didn’t come in for that, her real reason for seeing the doctor was ignored
  2. There isn’t much evidence that having a BMI of 28 is dangerous
  3. There is evidence showing a BMI of 28 is more healthy than a BMI of 25 (the norway study, the latest CDC study, etc)
  4. There is evidence that losing weight is unhealthy and increases mortality (a recent study was released on this)
  5. She doesn’t have any signs or symptoms of the illnesses associated with obesity (cardiovascular disease, cancer or diabetes)

So you have a situation where a doctor ignores a patients complaints, encourages them to engage in unhealthy behavior to cure a disease that isn’t harming them when more competent treatments exist anyway (even though she doesn’t have any symptoms of cancer, diabetes or cardiovascular disease).
Pretend she went in for a checkup or for something like a runny nose, had a clean bill of health but the doctor recommended an experimental cancer treatment anyway even though she had no symptoms of cancer. Assume she is a 27 year old woman, and it was a treatment for a cancer like postmenopausal breast cancer (aka a cancer that doesn’t strike until someone is in their 50s at the earliest). This treatment fails 90% of the time, and in the 10% of the time it works is no proof the experimental treatment works to improve health anyway. There is building evidence that the treatment is unhealthy to 90-100% of the people who use it. Even if she did have cancer, safer treatments with fewer physical or psychological side effects that have a success rate higher than 10% exist to improve her health, but those aren’t used as the primary treatment, the experimental treatment is used as the main treatment and the other treatments are just considered ‘crutches’ until the experimental treatment ‘kicks in and works’. The doctor doesn’t inform her that there is a 90% failure rate or that this treatment has been shown to make health worse for 90-100% of the people who use it. He also hasn’t told her there isn’t much evidence showing even in the 10% of the time it works that it actually makes her health any better. When treatment fails, he insults her.
Would a doctor who recommends that treatment be guilty of malpractice? When you remove our intense loathing for fat (and the fact that we, as a society, will resort to hook and crook to encourage fat people to stop being fat since we loathe fat so much) that is pretty much the medical and scientific reasoning behind a good deal of the obesity war. The point of the ‘post menopausal breast cancer’ reference was to the fact that the health effects of obesity do not strike until the 50s (obesity, cardiovascular disease, cancer). Assuming obesity itself causes these diseases.

You ahve to remember this is a society where a poll in (I think esquire) asked women if they’d rather be hit by a truck or gain 100 lbs, half the women said they’d rather be hit by a truck. This loathing seeps into our science and medicine, you can’t divorce the social aspect from the scientific and medical aspect.

71

I disagree. It’s not a bad idea. It’s the truth. It might not fit in with the mollycoddling that some obese people would prefer, but it’s the truth, nonetheless.

Further, you didn’t show it’s a bad idea “for several reasons”. Not in my book. However, to be fair, you DID show that there are a number of ways of avoiding the truth so as to sabotage what needs to be done.

So what do you have to say to the many, many people who absolutely LOVE exercising over 15 hours per week? Are you quite happy to paint them too with your broad brushstroke that people who exercise that much are all self loathing people? Thank you, but as an active sportsperson, I couldn’t let that one slide. Your assertion that people who exercise heaps do so because they have self loathing issues is ridiculous. And don’t go and post-qualify that now by stating that it’s only formerly obese people you were talking about. You stuck your head on the chopping block with that one, now cop the blade.

Exercise is great. It’s great for your self-esteem, it’s great for your quality of lifestyle, and it’s great for your sense of innate happiness. Anyone who exercises for more than 15 hours a week and doesn’t like what they’re doing is doing the wrong sport - period. When you’re doing that much exercise, it should part of a lifestyle which introduces other similarly motivated and joyous people to hang around. As my Dad used to say… “The family that surfs together PARTIES together!”

And this last one is just plain “denial” in action. It has as much basis in reality as arguiing that tomorrow morning, the sun’s gonna come up in the west.

Obesity. Morbid Obesity. Chronic Overweightness. Call it what you want, but the bottom line is that body fat percentages throughout the Western World are rising inexorably upwards, and have been for the past 35 years. It has nothing to do with social ostracising. It has nothing to do with thin people giving fat people a hard time. It has everything to do with an explosion of cheap, shit food combined with a society which sits on their ass more than any time in history.

I’m happy to help anyone whatsoever who wishes to help themselves. I’ll never say anything unkind, nor will I ever offer anything other than support. But I draw the line at trying to rescue someone who’s determined to sabotage themselves.

72

You’ve totally lost me at this point. The thread you’ve started has been hijacked by yourself, no less, and in doing so, has evolved from being a debate to merely being a soapbox for your perceived injustices.

It’s none of my business if you loath yourself. I care not. But I resent the notion that you’ve automatically assumed that I am guilty of loathing you merely because I’m a part of the society which you’ve decided is guilty until proven innocent.

73

Sabotage how? You have proven absolutely nothing as far as I can tell. My proof may not be foolproof, but I’m certain its far more in depth and trustworthy than your non existant proof. You have proven nothing, and your statement about ‘avoiding the truth’ when you didn’t reply to a single one of my scientific or sociological stats shows who is really avoiding the truth.

Do you think people prone to cancer don’t deserve ‘mollycoddling’. Shall we subtly insult them when they get sick and die for not trying hard enough to avoid their fate (cancer deaths are largely avoidable). Shall we insult the poor for spending too much and earning too little? Shall we insult the victims of violent crime for not moving out of the ghetto?

I said ‘may not’. Nice try though. Also, thanks for addressing the numerous science and sociological points in my posts.

Feel free to prove me wrong. How do you explain that vegetarians in Sweden are still obese and overweight? Yeah, people in the third world tend to not be obese, but I wouldn’t call that healthy eating or a healthy lifestyle, considering that about half the people in the developing world suffer from various forms of malnutrition and vitamin/mineral deficiencies. Nor would I call it realistic to import third world lifestyles to the west. Nor would I say it is worth the health benefits it supposedly provides to run the risk of malnutrition and stunting.

I can’t find the article but 80 years ago people were about 3-4" shorter than they are now. I am not too keen on the idea of encouraging people to be thin by providing them with a diet that malnourishes them and makes them shorter (the technical term is stunting). Given the choice between a malnourishing diet that causes stunting and massive vitamin/mineral deficiency, but where people are more physically attractive (lets not kid ourselves, thats what this is really about) and a diet where people are nourished but fatter, I would pick the fatter society.

QUOTE=Boo Boo Foo]
Obesity. Morbid Obesity. Chronic Overweightness. Call it what you want, but the bottom line is that body fat percentages throughout the Western World are rising inexorably upwards, and have been for the past 35 years. It has nothing to do with social ostracising. It has nothing to do with thin people giving fat people a hard time. It has everything to do with an explosion of cheap, shit food combined with a society which sits on their ass more than any time in history.

[/QUOTE]

Yeah, true. The mexican Pima are far less obese than the Arizona Pima. The Arizona Pima are a race of Indians who are prone to diabetes and obesity. The Mexican Pima are genetically similiar and have obesity and diabetes rates of 13% and 6% respectively while the Arizona Pima have rates of 50ish% and 50%. However, who cares, we should encourage people to eat healthy and exercise not lose weight for the reasons I’ve listed above. The mexican Pima may be thinner, but they are also stunted (from malnutrition I assume) and about 2-3" shorter than the Arizona Pima. They also have a life expectancy of 40, which is lower than the life expectancy in sub sahara africa. Don’t encourage people to smoke, hate themselves, hate others, rely on junk science and practice poor medicine. Those aren’t the same thing as encouraging healthy eating and exercise. You can encourage healthy eating and exercise w/o encouraging weight loss and all the negatives it provides. Also, just because healthy eating and exercise do not lead to thinness as it does in the developing world (the developing world also has massive malnutrition, nutritional deficiencies and stunting) doesn’t mean it isn’t healthy per se.

74

I don’t loathe myself. What I posted was more of a rant and an observation than anything else.

75

Since we really don’t know how to make large numbers of the population lose large amounts of weight and keep it off I don’t see how it is relevant though.

I am willing to concede that being overweight could be dangerous. However I don’t know to what degree it is the excess weight itself that causes the danger (in this instance, I am sure that income and access to healthcare is the same for all groups), and I still don’t think as a society that we know how to make fat people lose weight and keep it off. So even if it is a risk, we don’t know how to cure it in any way that works for more than 5-15% of the population.

You may say that in the third world there are no fat people and that diet and exercise work to lose weight and keep it off as evidenced by the third world. But as I said above, the third world is also chock full of stunting, malnutrition and several vitamin and mineral deficiencies.

I’m all for a healthy lifestyle, but the level of ‘healthy lifestyle’ necessary to lose large amounts of weight and keep it off may be too extreme and unhealthy to be worth it. People would be better off focusing on one of the other 246ish risk factors for cardiovascular disease if they are afraid of dying from the disease.

76

FTR to clear up miscommunications:

I agree with Dseid that poor diet and lack of physical activity are dangerous and very important, and that they encourage obesity. I just feel that our social dislike (and by proxy, our medical dislike) for obesity does alot more harm than good for our health and discourages healthy eating and exercise. I feel we should just accept bodysize for what it is and promote healthy eating and exercise in everyone, irrelevant of their BMI and irrelevant of whether it leads to weight loss. Even if weight is an independent risk factor all by itself and I admit it may be, we understand so little about the issue of appetite, metabolism and fat storage that we’d be better off focusing on other interventions aside from weight loss for diseases like cancer, cardiovascular disease and type II diabetes.

One of my posts above was a rant, feel free to ignore it.

77

At a societal level, we do know what will cause large numbers of the population to lose weight - they need to eat less, and exercise more. This message is basically shouted from the rooftops - so it’s not like society is hiding this secret information while laughing at all the fat people.

What you choose to do with this information is up to you. The actual weight loss of a person is their own responsibility. The fact that you don’t want to live this lifestyle is up to you:

But as Quicksilver has said (and from my own personal weight loss experience) if it is important to you, and you put a priority on it, you can make time and motivation to do the exercise and cut down on what you eat.

I have a natural tendancy to put on weight - I bemoaned the unfairness of this for the first 25 years of my life, then finally realised that I needed to take responsibility for it - OK, if I don’t exercise and eat too much, I will put on weight. So I keep an eye on this and act sensibly, and have maintained a 40lb weight loss. I can’t eat what my naturally thin friends eat, and maybe that’s ‘unfair’, maybe I don’t always want to go out for a run or refuse the chips, but that’s life, and I feel better for being realistic about the situation.

And as my previous post mentioned, there are major health benefits for obese people in losing weight:

And nothing says this has to be mutually exclusive; eating more fibre and vegetables, reducing saturated fat intake, increasing exercise - these will all reduce your risk of cardiovascular disease while aiding in weight loss.

78

Let us break down this discussion into component parts.

First is obesity unhealthy?

The evidence for this statement is overwhelmingly yes. And obesity coupled with inactivity is even more unhealthy. And obesity makes it less likely that someone will be physically active. The more obese the worse the risk, so even a moderate weight loss while staying in the obese class can still help significantly, especially if coupled with excercise. But of note, weight loss induced by surgery has significant positive effects as seen in this study. And the long term f/u of the 116,000 women is very significant. These were all nurses, none poor, and it showed that exercise helps but that avoiding obesity helps more.

Is it a significant probelm?

Yes. A third are obese and have much greater mortality than those just a little less heavy. Healthcare associated with both overweight and obesity is driving up healthcare costs in this country significantly. Debate the exact amount but it is significant.

Does “society” stigmatize the obese?

Yes. There are negative stereotypes that are unfair and unhelpful. An excessive focus on the scale and on weight per se is not useful. Media images are derogatory. Prejudice abounds.

Does attending to the health risks of obesity for individuals and society mean using poor tactics?

No. And it doesn’t mean increasing smoking rates. Or causing negative self-images. But for the individual it does mean an honest appraisal of lifestyle choices and a willingness to address behavioral choices. And for society it means looking at primary prevention: how do we arrange things so as to make obesity less likely to occur in the future? It is this discussion that the so-called liberterian crowd wants us to avoid.

Are the healthy lifestyle choices associated with avoiding and treating obesity all that difficult?

No. A healthy diet does not need to leave you hungry or unsatisfied. Exercise can be moderate and fun and still have significant benefits. Most people feel better when exercising regularly and eating healthily.

BTW, your hypothetical? No doctor would ignore a sinus infection because they noticed someone was overweight. Only an exceptionally good doctor would bother to notice it in addition to the sinus infection and try to address it at all.

79

Before I continue, let me state that stigmatising someone because of their weight is a loathsome act. Just as it is to stigmatise a woman because she chooses to wear a Muslim veil. Or to stigmatise someone because they’re deformed and live their life in a wheel chair. It’s all bad, and I do none of it.

That being said, fixing the “obesity epidemic” (it seems to me) is analoguously similar to another problem we have down here in Australia - namely, the “skin cancer epidemic”. It’s an epidemic that most of us Aussie fair-skinned caucasions suffer from living in a climate which naturally breeds dark skinned peoples. In short, by the time you’re showing visible signs of skin cancer, the damage was done long, looooooong ago. Years ago, decades ago - in your youth. Basically, you can’t undo the damage, all you can do is try and minimise the symptoms and cut out all those skin cancers on your forearms and ears etc.

From where I’m sitting, obesity is the end game scenario. The damage was done years ago. By the time you’re obese, the stats would indicate you’ve got probably less than a 10% chance of ever making a lasting comeback into thinsville from what I’m reading. Hence, I don’t really care about people who are obese. I don’t have a negative judgement to make, nor do I have a remotely negative thought. Live, and let live I say. Have fun, do whatever rocks your boat. Go for it. Go nuts. Your appearance doesn’t bother me in the slightest. I might speak up if you’ve got stinking body odour, but that’s about it.

What I DO care about however, is my little 2 and a half year old daughter. I care about children in general. And I care about what they eat, and how much exercise they get, and basically making sure they fall into all the “good lifestyle habits” necessary to stay on the straight and narrow.

If my daughter ever gains weight, I’ll love her regardless. But I’ll also do my damndest to the day I die to set the right example for her to follow by working hard at my sport, staying focused and not hittin’ the booze, and staying disciplined. I won’t ever pass judgement, I won’t say anything to harm my daughter’s self-esteem, but I’ll damn well set the right example, no matter how hard it gets. If that makes me a “fat bigot”, tell someone who cares.

80

PURPOSE: To determine the relationship between measures of body size and the risk of hip fracture in elderly women.

Women with smaller body size had a higher risk of subsequent hip fracture compared with those with larger body size, while women with average and larger body sizes shared similarly lower risks of subsequent hip fracture. For example, the incidence rate of hip fracture was 9.35 per 1000 woman-years in women in the lowest quartile of total weight compared with 4.63 per 1000 woman-years in women in the highest quartile of total weight (age-adjusted relative risk 1.93, 95% confidence interval (CI) 1.34 to 2.80), while rates of hip fracture among women in the second and third quartiles of total weight (5.22 and 4.32 per 1000 woman-years, respectively) were not significantly different from the rate among women in the highest quartile (P > 0.64).

Essentially those in the heaviest 75% of the population had half the hip fracture rates of those in the lightest 25% of the population. Considering that about 65% of americans are overweight or obese, that means that the vast majority of those in the overweight/obese category have a better prognosis than those in the ‘ideal’ weight category for hip fractures.