(This is the second installment in a five-part series about fat acceptance.)
Regarding the medical aspects of being overweight or obese, do fat advocates have a case? Overwhelmingly, statistics are not on their side. According to the National Institute of Diabetes and Digestive and Kidney (NIDDK) Diseases of the National Institutes of Health, the Federal Government’s lead agency responsible for biomedical research on nutrition and obesity, excess weight is associated with an increased incidence of type 2 diabetes, heart disease and stroke, diabetes, sleep apnea, osteoarthritis, gallbladder disease, fatty liver disease, and some forms of cancer.
The U.S. Surgeon General’s office – whose Web page on the consequences of obesity is headed by the statement, “The primary concern of overweight and obesity is one of health and not appearance” – attributes some 300,000 deaths a year, a total fat advocates vehemently dispute, to obesity; the organization says that even among people carrying only a moderate amount of excess weight (10 to 20 pounds), the risk of premature death from all causes rises by 50% to 100%. In addition, obesity is associated with high blood pressure, blood-fat abnormalities, depression, reproductive complications, asthma, incontinence, erectile dysfunction, gout, gastroesophageal reflux disease, and increased surgical risk. According to the results of a Mayo Clinic study released last year, obese patients spend four times as much on prescription drugs as normal-weight patients – a difference of $700 a year. While many of these findings are challenged by fat advocates, their sources — see here and here — are not equivocal.
The trend toward heaviness in America spans all age spectra, but perhaps most ominous is its clear effects on the health of the nation’s children. According to the 1999-2002 National Health and Nutrition Examination Survey (NHANES), 16 percent of adolescents aged 12-19 were overweight, over triple the prevalence seen in the 1976-1980 NHANES II and up from 11 percent in the 1988-1994 NHANES III. Younger children have been similarly affected, with the prevalence of overweight in children aged 6-11 rising from 7 percent in the 1976-1980 study to 16 percent in 1999-2002. Type 2, or non-insulin-dependent, diabetes – once a disease seen almost exclusively in adults – has reached alarming levels in American children, the twin culprits being the intertwined woes of inactivity (43% of U.S. adolescents watch at least two hours of television a day) and overweight (nearly 80 percent of people with the disease are obese). 20 years ago, 2 percent of new cases of Type 2 diabetes were diagnosed in kids aged 9-19; today that number is 20 percent and rising. The CDC estimates that one in three U.S. children born in 2000 will eventually develop the disease, with Hispanic girls facing a whopping 53 percent risk.
The most immediate consequence to overweight kids’ well-being, however, is usually a decrease in self-esteem and depression resulting from real and perceived social discrimination. But perhaps more gloomy is what their future is likely to hold: According to the Surgeon General, overweight adolescents have a 70% chance of becoming overweight or obese adults, with the likelihood climbing to 80% if at least one parent is overweight or obese. Not surprisingly, many doctors and researchers believe that teaching children to limit the amount of fat they eat and encouraging them to increase their activity level may prevent the reported 10% to 20% weight gain that occurs during adulthood.
Yet fat advocates’ position – commendable, perhaps from a psychosocial viewpoint but seemingly irresponsible from a health perspective – is that fat children should be taught healthful eating and exercise habits along with strategies for building self-esteem, but should not be urged to lose weight per se. Hence a futile cycle is encouraged: Treat the various symptoms of a disorder while ignoring its fundamental causes. With momentum already favoring a slide toward a progressively fatter nation, such attitudes can only help fuel a train bound to deliver to the world a new generation of sedentary, overweight Americans, along with all of their associated infirmities.
“Not a day goes by without someone asking if they can have their child seen in my clinic,” says Albright, an internist who treats adults exclusively. “The children I see accompanying their parents are often the same body type and, often, quite obese. It’s really starting to scare me with the long-term consequences I see. They are just too darned sedentary and we, as a country, are doing far too little about this. We are going to have some astounding problems to deal with in the very near future. Coronaries at age 25 are going to be common as opposed to anomalies.”
An ever-more-popular option for the “morbidly obese” – i.e., those with a BMI greater than 40 – is bariatric surgery (a type of which is popularly called “stomach-stapling”), which limits food intake and absorption via structural alteration of portions of the gastrointestinal tract. These procedures cost between $20,000 and $35,000, with the level of medical insurance coverage varying from state to state. Most patients report the long-term loss of about 50 to 75 percent of their excess weight, with greater success seen following the gastric-bypass procedure that has largely replaced gastric banding; such dramatic weight loss is usually found in combination with the lessening or abolition of related symptoms and conditions (e.g., diabetes, sleep apnea). However, largely because morbidly obese people are poor candidates for surgery in general, intra-operative bariatric surgery mortality rates reportedly range from 0.5 to 1 percent, depending on the specific procedure performed and the center at which the operation is done. There are also a number of unpleasant side effects associated with weight-loss surgery, such as nutritional deficiencies, nausea and diarrhea.
Bariatric surgery is recommended as a last resort in people at grave risk for obesity-related adverse medical events. Nevertheless, the American Society for Bariatric Surgery (ASBS) estimates that surgeons performed more than 140,000 weight-loss operations in the United States in 2004, up almost 800% from 16,000 in 1994. Even adolescents are going under the knife in increasing numbers; although the ASBS does not break down its surgery figures by age, more and more centers have begun offering bariatric surgery to adolescents – some of them as young as 12 – with many facilities reporting long waiting lists. NAAFA opposes such surgery, not because of the surgical risks but because the organization demonizes purposeful weight loss of any sort.
Another organization spawned by the nation’s burgeoning heft is the American Obesity Association. While the group’s mission is similar to NAAFA’s in that it seeks to improve the lives of obese and overweight people, its premise – and therefore its approach – could not be more different: The AOA maintains that obesity is “a serious, chronic disease” and states that “no human condition – not race, religion, gender, ethnicity or disease state – compares to obesity in prevalence and prejudice, mortality and morbidity, sickness and stigma.” Like NAAFA, the AOA is ever on the watch for examples of discrimination against fat people, but emphasizes first and foremost that obesity is a medical condition and that its sufferers require treatment.