Musings on Obesity

For the past week I've been in Hendersonville, NC, doing a "Mommy visit". She's 86, still vibrant, beautiful, and in great shape. She's been married again for two years to a younger guy who lives for her. He and I played golf today - he thinks of my visits as one long lesson for a fixed fee! They live in a senior living center where they, and almost everyone else in their 80's and 90's are pretty trim as far as their body shape goes. However, their condition is in marked contrast to what we always see on the drive down from Rochester - rampant obesity.

Our drive takes us through West Virginia, southern Virginia, east Tennessee, and western North Carolina, all of which are largely rural and relatively poor. Stopping to eat in these areas brings us face to face with the obesity epidemic. The parade of young and middle aged severely overweight persons never stops. You see young children whose parents limp from the incredible strain their weight puts on their knees, entire families of people who are 50-100 pounds overweight munching down platefuls of greasy food at buffets. These people don't look well off, but they are certainly more than well-fed. It's a sad, sad sight.

USA Today had an article this week that stated 6.8 million Americans, 3% of us, are "morbidly obese", and another 25% are just obese. These statistics have increased significantly in just the past five years. From my experience as an EMT, I have seen firsthand the ravages of obesity. Diabetes and all its horrible complications, usually leading to an early death. Immobility, resulting in people living in the same chair day after day, barely having the strength to get to the bathroom. Heart attacks and life-threatening respiratory illnesses caused by overstressed and inadequate cardiovascular systems. A primary reason why the oldsters in my mother's senior center are "trim" is that almost all the heavy people are dead before they reach the age of 80.

Although these obese people pay a high personal price for being overweight, society also pays a huge price in Medicaid and Social Security Disability costs. Many young obese people cannot work because their joints have deteriorated to the degree they cannot get around, and therefore cannot work any longer - they are "disabled", and they get a monthly check from the government. Their medical costs are enormous, since they require numerous medications, often get surgeries (including amputations), and have frequent hospital visits for heart and respiratory issues. The trend for these costs is up, up, up.

So, should we be angry at those obese people who live restricted lives and cost us a fortune? I don't think so. The truth is that they are usually (but not always) a product of their environment, which is often a place where education, incentive, challenges, and jobs are all substandard. Their lives are dull, their role models are obese, their society shows little in the way of upward mobility. But one thing they can afford is food, and they have plenty of time on their hands to eat it. Another "proof" of this proposition is that many depressed people become obese as they sit listlessly at home. Fixing the obesity problem is going to require more than anger and more than bariatric surgery - it's going to require addressing the social problems in areas where obesity is rampant, and it's going to take a long time.

People who don't understand the issue often want to blame those who provide the food. "Just close the fast food restaurants", they say, or, "Healthy meals at schools". This is the same silly logic as the War on Drugs, which attempts to complete the hopeless task of cutting supply to addicts who will do anything to get their fix. What next? Close Dunkin' Donuts?

There are only two answers to the obesity problem. We could get totalitarian and pull everyone in for body mass measurements, with those over a certain percentage of body fat being sent immediately to a government "fat farm" somewhere in South Dakota. If that solution isn't to our democratic taste, then we need to provide enough education and incentives to modify the decisions of the potentially obese. I could direct some pretty good horror movies for fourth graders, which might scare some of them into skinnyness, but we'd still have to make sure those skinny high school graduates have something useful to do with their lives. A better solution would be to provide kids with enough interesting challenges, physical and mental, that will lead them to live naturally healthy lives. That's the life my kids got - why shouldn't kids in Appalachia and our inner cities have the same chance?