The Skinny on Medicalized Obesity

On Tuesday, June 18, 2013, I learned I have another disease —obesity. The American Medical Association (A.M.A.) at their annual meeting in Chicago recognized obesity as a disease in hopes that the medical community could treat this issue that affects one in three adult Americans, nearly 75 million, and about 12 million (16.9%) U.S. children ages 2 to 19 with education, prevention and intervention. Advocates hope this declaration will help improve reimbursement for obesity drugs, counseling, and surgery.

“RESOLVED, That our American Medical Association recognize obesity as a disease state with multiple pathophysiological aspects requiring a range of interventions to advance obesity treatment and prevention.”

Fat activists responded immediately posting #IAmNotADisease hashtag on Twitter. A petition was drafted and signed by 1,200 by Friday demanding that the AMA reverse its position. Peggy Howell, spokeswoman for the National Association to Advance Fat Acceptance, a 44-year-old nonprofit that works to improve the quality of life for people of large size, stated, “We don’t see ourselves as diseased. To label a whole segment of society as diseased without any knowledge of their health is unacceptable. It directly fuels discrimination. This is a step backward.”

I can add this condition —no wait, it’s not a condition, it’s a disease ­— to my laundry list of things I’m being treated for including Type 2 diabetes and cardio-vascular disease, mostly with pharmaceuticals, twice yearly lab work and check-ups with my primary care physician. I have another disease, alcoholism, which has been treated differently for the past twenty-eight years, through out-patient treatment, counseling, peer support (thank you 12-step groups) and by making conscious choices one day at a time to live my life differently, making healthy choices whenever I’m able with the help and support of others. Family members, friends and significant others, have also been treated similarly for mental illness and depression, yet stigmas still exist. Most medical professionals agree that a combination of drugs, counseling, and ongoing support yield the most successful therapeutic outcomes.

For years since I was a child first attending school, like many others who were bullied, I was called names: fatty, fatso, piggy, porky pig, chubby, whale, blimp and etc. and euphemisms by family and loved ones like, “It’s just a little baby fat, she’ll grow of it,” or, “She’s big-boned.”

As I became a teenager I was described as pleasingly plump, full-figured or curvaceous. I was praised by some members of my family for “having a healthy appetite” and criticized by others, “She needs to learn when to push herself away from the table.”

Some of the one third of the population that represents healthy and fit Americans considers obesity a character defect, a lack of willpower or an inability to make good decisions, and sometimes even a measure of intelligence (yes more fat, less smarts).

Other traits are often associated with those of us who are fat: laziness, gluttony, and lacking in self-discipline. We’re less likely to be hired for high-paying positions and more likely to be discriminated against.

I’ll be the first to admit that I do bear some responsibility for my obesity. Simply stated, I need to eat less and exercise more, get off the couch and on to my bike and eat more fruit and vegetables, and fewer servings of carbohydrates, fat and sugar. Lastly, I need to lose weight and gain respect and esteem. Yes, I’m often considered “less than” for being “more than.”

Like alcoholism, I was born with a genetic predisposition to be fat. Like my maternal grandmother and mother I have diabetes and heart disease. I make many of the same unhealthy food choices that are part of my ethnic and family heritage. There’s never any bacon or baked goods left on the table after a meal in my family.

I hail from generations of food-servers, farmers, hunters and fisherman, where food was always a part of every family gathering, recreational activity, and conversation. We grew it, caught it, killed it, butchered it, canned it, cooked it, served it, and yes, ate it!

Danish Kringle

Danish Kringle

When visiting or hosting company you either brought or served a Kringle (a Danish pastry from my hometown of Racine, Wisconsin) whether it was a family visit, funeral, or birthday celebration at work. Family conversations into the night were called “cracker-barrels” fueled by beer, cheese and crackers. My grandmother would begin each phone call to my mother with a summary of all the food she ate that day. Once she was diagnosed, in her words, with “sugar diabetes” she became even more obsessed with food. I’m admittedly an emotional eater and a compulsive overeater. Food has been a comfort and a friend when lonely, afraid or depressed.

Now some of you may ask given my family history and my health conditions (sorry, diseases), and the big number that appears when I step on the scale, why haven’t I done something about my weight (fat, obesity, or fill-in the blank)?  The answer is I have, sometimes with temporary success, often like many others who struggle with obesity, yo-yoing and raising my weight set point.

This is where I “weigh in” as a proponent of the recent A.M.A. declaration. The medical community has historically failed obese patients, beginning with the lack of nutrition education for doctors. Because most insurance policies do not cover or reimburse for counseling, prescriptions or procedures related to weight control and/or obesity, we are left to our own devices often with little effective support, education and preventative care.

Metrecal Diet Drink

Metrecal Diet Drink

As someone who grew up in the 1950s, I’ve experimented with the best and the worst of self-directed weight control.  I watched my mother and her friends consume Metrecal, a diet food supplement introduced in the 1960s, available first in powdered form and later pre-mixed flavored drinks, cookies and other foods. The name for the product was generated by an automated IBM computer system as a blend of the words “meter” and “calories,” referring to the measured caloric intake of the Metrecal diet. Metrecal was later replaced by Slim-Fast and other diet aids.

 

Ayds Appetite Suppressant

Ayds Appetite Suppressant

 

 

Speaking of diet aids, Metrecal was followed by an appetite suppressant candy in the 1970s ironically called Ayds.  The active ingredient was originally benzocaine presumably to reduce the sense of taste to reduce eating, replaced later with phenylpropanolamine.  By the mid-1980s, public awareness of the disease AIDS caused problems for the brand due to the phonetic similarity of names. While initially sales were not affected, by 1988 the chair of Dep Corporation announced that the company was seeking a new name because sales had dropped as much as 50% due to publicity about the disease.

In 1966, at the age of sixteen, my mother and I were both treated for our weight by our family doctor. She had just given birth to my sister Kelly and was having trouble losing the “baby weight.” I gained a large amount of weight as I struggled with hormones and my teenage years. The doctor prescribed Dexedrine and my mother and I became whirling dervishes, cleaning the house, zestfully ironing and doing daily laundry and cooking food we didn’t eat. The rest of the family couldn’t keep up with us.

Slowly I gained the weight back and after I was newly married and working, I began another diet regimen. My job was physical and I enjoyed walking, so I walked everywhere I went, adding miles each day while drastically reducing my caloric intake. In the matter a few months I dropped almost 60 pounds. Soon my family who was accustomed to me having “a little meat on my bones” (yes, another euphemism) began telling me to start eating more, that I was looking anorexic.

Once again, after a few years, my weight set point increased again and I became heavier. My primary care doctor who was monitoring my weight and borderline high blood pressure referred me to the nutritionist, the only option available covered by health insurance for weight control. I had my first in a series over the years of educational sessions with the nutritionist, being introduced to the food pyramid and portion control by playing with plastic food.

Nutritionist Plastic Food

Nutritionist Plastic Food

I achieved short term success until I quit drinking followed by quitting smoking a year later. By this point I had gained my weight back, plus some, and started taking medication for hypertension.

Both my after-care counselor for alcohol treatment and smoking-cessation coach reassured me that weight gain was a natural and not necessarily negative outcome from my quitting drinking and smoking. I was adding years to my life, or so they claimed, as I was adding pounds.

For awhile I tried Overeaters Anonymous (OA). I had a lot of success with 12-step programs when I completely gave up the addictive substance. Not so much in this program. I still needed to eat, and I failed at learning the basic premise of abstinence in OA. Weight Watchers followed, plus a fitness and health regime. Both worked for awhile until I hit middle-age, as I slowly gained weight and increased my set point again. My body was fully entrapped in the yo-yo phenomenon.

Now I added cholesterol and diabetes medication to my daily regimen when I was diagnosed with Type 2 diabetes. I attended educational and preventive care seminars and visited the plastic food lady again. For the past few years my weight has stabilized as an obese, pharmaceutical-consuming, woman who can now add obesity to my list of diseases. I’m unclear today how I weigh in (pun intended) on the issue of medicalized obesity.

Let’s see if I view myself differently when I look into a mirror and whether others see me through a different lens when they encounter me on the streets, the check-out counter at the grocery store, or the Plus-Size clothing department, when the waitress takes my order at a restaurant, or the doctor my blood pressure in the clinic. Will I get the job I seek or the date that I want? Will I be seen as simply fat, or sick?

I feel heavier today.

Updated 3/24/15

Here’s the latest skinny on obesity and weight loss. You might be surprised by the recent findings on dieting and health. The Weight of the Evidence.

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