A New York Times blog post this week started a discussion about "fatism." It is widely accepted that obese people endure professional and social bias in America. The data point to slower advancement in the workplace, decreased appeal as a mate and social isolation. The shame of being fat in this day and age feels like a scarlet "F" emblazoned on your forehead. Obese people frequently describe feeling invisible in their daily life, any attention quickly turning into scorn.
Although this is a sad commentary on the current trend to emphasize thinness above all else, the blog post aligns the bias against obesity with the gay rights, civil rights and women's rights movements. Being born a homosexual, African American or woman is an inescapable fact. Prejudice against people based on basic elements of their personhood is a strike against human rights. Not to minimize the impact of the bias against overweight people, obesity is a not a similar genetic trait. Although people may be born with a genetic predisposition to being overweight, that is a very different story. Unfortunately, jumping on the political process that has been highly effective recently in the gay rights movement oversimplifies the growing bias against the obese and obscures the real, underlying problem for this population.
It is critical to remember that obesity has been rising precipitously for the last 40 years. The significant advances in the food industry has created a land of plenty with more than enough food to feed our entire population, a remarkable feat of production and engineering. The drive behind providing the country with adequate nutrition is the profit-seeking, under-regulated food production business. Accordingly, the food widely available is what will appeal most to our sensibility and thus sell best: highly processed food laden with fat, sugar and salt and, based on increasing amount of hard data, deleterious to human health. There is no reason a profit-driven company should factor public health into its business plan unless a regulatory agency insists on it to protect the population's health. Although the exact medical reasons behind the rise in obesity remain unclear, the increasing availability of highly caloric, unhealthy foods is one obvious cause.
The clash between government just starting to recognize its collusion in this vast public health problem and industry hellbent on profit above all else has just begun. In the meanwhile, the social problem of millions of citizens lugging around dozens of extra pounds continues to grow. The empty promises of the diet and weight loss industries just cement the overall frustration. The medical establishment tries vainly to keep up with the increasing medical problems associated with a vastly overweight population. But, as the Times blog post suggests, individuals need to learn how to live with the reality of being overweight.
The eating disorder community has coined the term pathological obesity to describe this phenomenon. In addition to the practical component of both weight loss and weight maintenance meal plans, the most important psychological step in obesity therapy is to separate the physical and psychological effects of being overweight. The physical symptoms range from metabolic illness to orthopedic problems to long-term cardiac effects. Psychologically, the overwhelming shame of obesity combined with the prevalent social bias creates a mental state of absolute obsession with food restriction and weight loss. Repeated severe dieting triggers an overwhelming sense of starvation, as explained in the last post, which only exacerbates the ruminative state of pathological obesity. The result is that a functional, driven and psychologically healthy person puts life on hold until the weight comes off. Years can elapse while someone spends more and more energy focusing on the latest diet or exercise plan, holding off all goals for the future, only to be devastated when one magic cure after another fails to deliver. The wasted years and energy of this process is so demoralizing as to render life truly hopeless.
The treatment of pathological obesity is twofold. First, establishing realistic goals of weight loss and, more importantly, weight maintenance creates an environment of success and a promising direction for the future. The hopelessness is replaced by an advocate clearly able to put the obesity and powerlessness around food and weight into perspective. Second, the weight maintenance phase focuses not on change but on stability, a state of mind and body never experienced by an obese person obsessed with weight loss. The relative calm of just eating to maintain weight enables the therapy to re-establish life goals, separate from food and weight and remind obese people of their true passions and goals. The therapy can reconnect the person with true self-worth and label the weight issue as a solely medical issue. Although this process cannot eliminate the fatism rampant in today's society, treating pathological obesity gives an overweight person the personal freedom and power to overcome this bias day by day. Freeing the patient's mind from food and weight obsession opens up the possibility of seeing options in life and goals for the present and future once again.
The perceived powerlessness of the obese reinforces society to continue to overvalue thinness, but the resurgent voice of the obese population can allow those struggling with weight to feel empowered again. While obesity therapy helps an individual separate self-image from weight and then re-engage fully in life, the steps towards generalizing the experience are less clear. The next post will address how to broaden the message about pathological obesity and help society share the responsibility for the clash between thinness and obesity in our culture today.