Recently I read a post by a person on the internet that I usually respect. Their post was about people trying to have obesity declared a disease. While there were some decent points made, the person could not help but come across as either ignorant of the subject or disliking overweight people. The main points that were made was that being obese was a choice and not a disease. The impression I got from those points seemed to be “Obesity is a choice, so just choose not to be obese and be done”. I got a little angry at the post. I then remembered that I am obese and maybe I was just being sensitive. I have decided that I have a few things to say on the subject.
First, do I think obesity is a “disease”? Not really. Imagine you are in a doctor’s office. Here are two scenarios: 1) “I am sorry, you have celiac sprue disease.” 2) “I am sorry, you have obesity/alcoholism/drug addiction”. The second scenario gives examples of things that aren’t diseases, but are major problems (yes, I know the AMA declared alcoholism a disease) but are not genetic abnormalities or from some sort of contagion. I will touch back on this point later.
I have been fat for my whole adult life. I am used to people treating fat people poorly. Being fat with a bad attitude does not seem to help matters. Here are some actual scenarios I have experienced: A) A man on a plane was sitting in the window seat, I was in the aisle seat. There was an empty seat between us. The man stood up before the flight and said, “I hate fat people. Just so you know, if you fall asleep in the flight, I am going to punch you in the face.” B) A bouncer in a nightclub told me that I could not go on the dance floor because it would not hold my weight. The dance floor was like every other ground level dance floor in the world. C) The manufacturer of the work uniforms I wear told me that they did not have my size, and was I really certain that I couldn’t fit into their largest size, a mere 10 inches of waist smaller. I did not set out to be fat. I am fat. It is a changeable feature (like hair) but it doesn’t change very quickly.
So how did I get so fat? Well, there are a few reasons. Despite the typical mouth-breather’s response “Hurr hurr hurr you just don’t get your fat butt off the couch”, there are more reasons for weight gain than meet the eye, or belt. Most people who say such things to me have never struggled with weight and think all fat people are lazy. Let’s start with basic nutritional science: if you eat more calories than you burn, you will gain weight. If you eat the same number, you will remain steady. If you eat less, you will lose weight. The science works for almost all scenarios, barring a gland or hormonal issue. Well, that doesn’t explain why so many people are overweight.
Reason #1 (not necessarily the #1 reason, just the first one that came to mind)- Food that is bad for you is cheaper. Last night I bought spinach and spring greens mix, some bell peppers, some chicken, some low fat yogurt, some high fiber tortillas and some ground turkey at the grocery store. This wasn’t an organic store or a specialty store. This was the standard grocery store. I spent almost $35 on basically two to three meals worth of food (that does not include the price of cooking the food from the electric company or the gas to get to the store and back). That same $35 dollars can buy 15 bags of potato chips or many loaves of bread, peanut butter and jelly, etc. Bad food is much cheaper. It is possible to find decent deals on healthy food, but you are never going to be able to match the unhealthy food low price.
Reason #2- People are not exercising as much. This is partially based on the amount of television people are watching and partly based on other statistics. It can be tough to exercise without going to some type of gym, but not impossible.
Reason #3 (the biggest, in my opinion)-People are not dealing with emotional issues in the same way that they were. Food is a known comfort. People overeat due to emotional issues.
In all those scenarios, the overweight person is still making a choice. Sometimes it is the choice between eating unhealthy food and starving. Sometimes, it is the choice between spending too much time on the couch or (more likely) at work. Sometimes, it is the choice of not dealing with an emotional issue.
I get really annoyed when people act like “since you had a choice, and now you are this way, you must just not want to be in shape”. I did not start out trying to get fat. I will go back about 10 years, since that is when the really big problems started. Sure, I could go back to teen years when I didn’t train myself to eat properly, but I want to start later.
In 2004, I separated my shoulder. For about six months, it was difficult to do almost anything. It was easy to sit on the couch.
I moved to Denver in 2005 where I took a high stress job that spent 300 days a year traveling. Eating healthy on the road is tough. The typical hotel gym is either made up of all broken equipment or so small that it often gets mistaken for a closet. After working 80 plus hours a week, working out is not a high priority. I say things like this and people say “well you sill have almost half the hours of the week left”. That is true, but here is a scenario: Get up at 5:45 am-shower, dress and eat breakfast, at 6:30 head off to work, at 7pm leave work, at 7:30pm sit down and order dinner (you are in a hotel so you can’t cook) at 8:30pm you finish dinner, at 8:45pm you have to choose between working out for an hour and getting your heart rate up so you can’t sleep or getting ready for bed. Do that every day. It is true that I could have worked out more. My job was (and is still sometimes) physically and mentally exhausting, so that made it more difficult to workout.
Between 2008 and 2009, a series of things happened and I went into a deep depression. I found, through trial and error, that anti-depressants make me physically ill, psychotic, suicidal, or homicidal. Ice cream, however, didn’t. For almost a year, I only left the house for work or to get food. I had zero social interaction for most of the year. I don’t know if I could have made it to a gym but I probably should have. At the end of the year I weighed about 390 pounds. I eventually gained another forty pounds and was suicidally depressed. Imagine the effort of getting out of that dark pit to go to the gym. That doesn’t even include the social anxiety of being around people, even friendly ones. Social anxiety when encountering unfriendly people would surely go away in a gym, right? I mean, pick any gym in the world. Nothing but the friendliest, non-douchy people there, right? It was still my choice to overeat, in the same way that it is a heroin addict’s choice to shoot up. It absolutely is a choice, but it doesn’t feel that way. [Some of the science comparing overeating and other addictions: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2910406/ ]
I tried therapy. My health insurance would not cover therapy, but would partially cover “stomach stapling” (not the real name or concept of the procedure). Therapy is about $120-$150 per hour. Ice cream is $4 a pint. I eventually made it to a 12-step recovery program that is starting to work. I have a sponsor and I go to meetings. I am not a “foodaholic” because “foodahol” is not a thing.
After a couple months, I decided to buy a gym membership. Understand, I still panicked about going to my recovery meeting where everyone actually was friendly. Going to a gym was horrible. I was (and still am for some) too fat to use the equipment. Walking for 10 minutes winded me. It took three months to get to a point where I could walk for 30 minutes straight. Heaven help me if I tried to talk to anyone or accidentally sweated on some equipment. As an aside, ears don’t get fat. I could still hear the comments.
After a few months of that fun, I got together with a personal trainer and it has been an ongoing battle since.
Why is it still hard for me to get to the gym? Well, that is easy. The gym smells, is unfriendly, and is booooooring. People talk about getting a “runner’s high” or an endorphin rush after a workout. I work out between four and five times a week, I always do about 45 minutes of cardio and 2 or 3 times a week I do a light “full body set” where I do dumbbell squats, dumbbell rows, dumbbell chest press, dumbbell curls, triceps push downs, and a core exercise as one set (no rest between exercises,12 reps each) and repeat 3 times. I am working hard. I am not one of those people holding a conversation during my cardio or reading. I am not stopping for more than 90 seconds between my weight sets (I would like to make the rest less, but I am busy asking the women on the floor if they have their tickets to the gun show. Also…laziness). After the weights and cardio workouts do you, Christian Radio DJ Choice A lot, know how many times I have had a “runner’s high”. Let’s go back to 1999. Since 1999 (when I got out of the Navy), do you know how many “runner’s high” experiences I have had? I will give you a hint. It is the same number of women that have initiated a romantic relationship, the same number of people I have helped become a Christian, and the same number of pieces of wicker furniture rated for my weight. Zero (yes, there is debate on zero just being a place holder, but for tonight it is a number). I have never ended a workout and thought “Wow, what a rush”. Four to five times a week fairly steady workouts for a year and a half. Zero endorphin rushes. Would you like to know how I feel after a workout? Hungry. Not the “Rocky movie” hungry like I want to achieve a goal. I feel tired, sore, gross and sweaty, hungry, and pathetic (usually because I feel tired & sore and the workout wasn’t that hard). Want to know how I felt almost every time I overate? Exactly the same except less sweaty. By contrast, I almost always get a nice endorphin rush after a good tasting meal. The only other activities where I ever got an endorphin rush like I get with food were a)getting a tattoo and b)sex. This isn’t a “Oh woe is me” tale. I am just mentioning that some people have different chemical reactions to things.
This brings us back to disease and choices. Why did the AMA decide that alcoholism is a disease? Obviously doctors know the causes and vectors of diseases, and alcoholism doesn’t really fit the model. It is simple. Alcoholism treatment plans were not being approved by insurance companies. If it is a disease, insurance companies have no choice in treatment. Should obesity be a disease? I still don’t think it should as long as some of the thousands I pay each year in costs to my insurance could go toward my therapy. My insurance will cover some of the surgery (80% of people lose weigh and then gain 15-25% of it back in 5 years) but not the emotional causes of obesity.
Choice. As Neo said, “The problem is choice”. Just because someone made a choice to improve their health, does not mean that results will happen soon. Many people treat obesity as a “once you choose to be not fat, it happens” type of thing. There are billions of examples where an early choice harmed somebody’s life for years. Let me use some biblical examples. Jonah had permanent scars on his body because he tried to run from God for a few days. David chose to commit adultery and had a variety of family problems (like being pursued by his own sons). Moses chose to kill a man and went into exile for 60 years.
I chose to overeat and succumb to depression and i gained 150 pounds. I have been working out and seen few results. I stumbled off my diet plan and almost immediately gained all my weight back. I also chose to listen to myself when I asked, in a depressive stupor, “Why bother working out? It is not like it is going to change things. You are just going to be skinnier at the end of your life”. I don’t blame anyone for my weight but myself. I don’t expect anyone to cheer me on when I go to the gym as I don’t have 10,000 fans who will cheer me on. I don’t think that losing weight will change my life all that much, and I would love to be wrong about that one. Try to remember when talking to people that have different problems than you have, they are still difficult problems. Some of us can work out for a year and a half and only take two inches off our waist. Now I want some ice cream. One advantage of food addiction over others is that I don’t have to call some shady guy to meet me in a parking lot. Heck, girl scouts will bring it right to your door.