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Please read the preceding disclaimer first. Read the following at your own risk:
“Outside of gastric bypass surgery, no system has ever produced any significant long-term weight loss. None. “
So says Megan McArdle, channeling Paul Campos and Gina Kolata, in her article “Thining Thin” in The Atlantic Monthly. She adds, “Every single study which has attempted to make overweight people get thin without very risky surgery has failed completely and utterly. Fewer than 1% of patients ever keep the weight off.”
She rebuts the predictable argument of “But I’M thin! Therefore there must be a way to ‘make’ fat people lose weight.” with the hilarious “And I’M tall! So there must be a way to make you shorties grow!” Speaking with chutzpah I can only admire from a non-confrontational distance, she adds,
“I fearlessly predict that more than one person will respond with some variation on ‘there were no fat people in concentration camps/but I told you, I totally lost 20 pounds last year by taking up marathon running!’ Yes, we could solve America’s obesity problem by putting everyone in the country on sawdust bread and cabbage soup. We could also just shoot anyone whose BMI is over 28. Are these good solutions? Because short of that, we don’t have much.”
Read her entire article to get the details of her argument or just accept the parsed version: Despite decades of scientific research into why some people are fat and why some aren’t, we really don’t have any practical answers.
Assuming the validity of her premise, I’m going to ask the obvious question: So why doesn’t every overweight person just get gastric bypass surgery and be done with it? Sure, there’s the “dumping” and the lifelong vitamin deficiencies and the pain of major surgery and, oh yeah, that pesky 2% mortality rate. But I’m willing to bet that people would accept all those risks and more to be guaranteed to be thin for life.
Well, maybe not for life. Gastric bypass surgery, while more successful than other weight-loss interventions, still doesn’t work for everyone. In fact, most patients gain back a significant amount of the weight they initially lose. Even though their stomachs can only 2 tablespoons of food.
Even still, the promise of losing any amount of weight is enough to tantalize more than 205,000 people into going under the knife in 2007. So I’m going to postulate that it isn’t the riskiness of the surgery nor the mixed results that’s holding people back. I’m guessing it’s the $20,000 – $25,000 price tag and only spotty insurance coverage for it. Which is why the government should sponsor gastric bypass surgery. To heck with “a chicken in every pot”! How about “A band on every stomach!”? Think of the publicity coup for any politician who supported that kind of health care reform. Not only are they lowering costs for all Americans by Winning the War on Obesity but they’re prettying up the joint too.
That’s ridiculous (and offensive) you say? Well then the only options left to us are to continue doing what isn’t working (i.e. good hearted but sadly unproductive programs like diet and exercise education, early childhood intervention and reality television shows/celebrity-endorsed diets) or to admit that we don’t know the way to make people lose weight and keep it off.
McArdle sums it up by saying,
“You do not have better willpower than they do. You do not “care about myself” more. You are not more “serious about a healthy lifestyle” because you took off the eight pounds you gained at Christmas. You are no more qualified to lecture the obese on how to lose weight than I am qualified to lecture my short friends on how to become tall. You just have a different environmental and genetic legacy than they do. You’re not superior. You’re just somewhat thinner.”
All of which isn’t to say that obesity isn’t a problem. It is. The negative effects from being obese are well documented. I’m also not saying that we don’t need health care reform. We do. The system is deeply flawed and unstable. What I am saying is that we need a little more compassion and lot more creative thinking. Anyone ever read that short story by Orson Scott Card where aliens discreetly turn suburban malls into fat farms by providing endless buffets of decadent food and then harvesting the resulting pudge for energy? Solves two problems in one! People get to eat what they want, stay thin and it’s green energy to boot! Too bad it ends up killing off the humans in the end. I know what we need: smarter aliens.
The reason Gastric Bypass en mass wont work is that it doesn't deal with the reason people over eat in the first place. No point fixing the broken vase and leaving the kids with the ball playing in the room! People are overweight for a reason be it physical or psychological and even a surgery can't fix that.
I had far different opinons on obesity etc before I met kate harding (first virtually & then hung with her at blogher/she was on the panel I did).
have you read her work?
Im embarrassed to say I kinda got FA by reading the amazing Kim Brittingham and REALLY GOT IT ALL after reading/talking to Kate.
I think Megan's positions are just as extreme as those she's railing against.
I love that she "gets" that we do not all have the same metabolisms and for some, weight loss is a huge struggle. But she seems to ignore the huge impact lifestyle changes can have on those who are obese not just because of body type, but because of overconsumption and lack of exercise.
As a country, our health habits suck and she seems to just throw her hands up and say "there's nothing we can do!"
I think the truth lies somewhere in the middle. I've seen too many people change their lives by adopting healthier habits to believe it is hopeless for anyone who is obese.
Well, we've both written about this in various ways. For many reasons, society has created an obesogenic world. Without addressing that, it will continue. Denial won't help. Surgery is a disappointing answer. I didn't become a surgeon for that!
This is hogwash.
Actually, ctina, it's satire.
I think I'll add a disclaimer though as so many people seem to be missing my point.
Picking on obese people is ridiculous (not you, the country in general…I'm supporting part of your view). The point is that obesity as a whole is not the problem or even a topic we should be discussing. Being skinny can be bad too if you are not HEALTHY, but we can't visibly see that so we pick on "fat" people. Obesity doesn't mean you're not healthy it just means you weigh more. We should encourage everyone to eat better and exercise. Period. (yes, I realize that morbidly obesity is just that, but for the most part it has little to do with the pounds and more to do with lifestyle). You can't predict who is unhealthy by the scale or by looks.
For example:
My SIL is obese but runs and eats healthy. My hubby is thin and eats junk food. Who do you think is more at risk for diabetes? Just because he looks like we expect a healthy person to look doesn't mean that he is healthy (I'm trying…it's a process!).
Sorry, Charlotte. I appreciate the satire of your post. I meant to say, Megan's article is hogwash. I read it and am still reeling.
Ctina – sorry, girl! Misunderstandings abound today, apparently. 🙂
Scary stats about the surgery!
Love this post.
This was hilarious. 🙂
I haven't clicked through to read McArdle's article (wow, say THAt 5 times fast!), but based on what you're quoting here, I'm guessing I'd agree with a lot of it. Many people (stats vary) will gain the weight back and then some, and yo-yo-ing like that is actually worse for your health than just staying fat.
I think a huge part of the problem is that we as a society are so focused on the external that we forget it's not necessarily an indicator of the internal. (Diana's example is a great one.) It does a disservice to both healthy fat people and unhealthy thin people, the former assuming that they need to lose weight (when it might not matter) and the latter assuming that they're healthy just because they're thin. I just think the whole debate focuses on the wrong thing, you know?
what orson scott card story are you talking about?
It is all so much to think about & what to do. What is that saying, "You can lead a horse to water but you can't make him drink". I wish fixing health & obesity were easy. People have got to want to do it & many look for an easier out even if they can do it on their own. I know in some cases, surgery is necessary in a way but not in as many as happen.
What to do…
We live in a culture that encourages unhealthy habits, and sometimes that "encouragement" comes in the form of deviousness.
(I'm reading "The End of Overeating" right now, which is very interesting. Even if you don't agree with everything he writes, it's an eye-opener.)
Hmmm, what does it say about me that I had no idea what the satire disclaimer was talking about? You should ban from this blog anyone who thought that post was advocating what it advocated. And should you ever need a weirder sense of humor to comfort yourself, you know where to find me.
I guess its the usual thing. "cure" the symptom instead. Obesity is a symptom, as much as sneezing is a symptom of a pollen allergy. Obsity is not the problem in of itself, but they will gladly alter a GI tract to change the symptom…the original cause though…will still be there and manifest itself in any number of ways.
Also Diana is correct. It is very common to meet people who are fit but definitely NOT healthy.
The problem is that most doctors actually don't see us as having different metabolic and genetic systems.
Responses I've had from doctors about losing weight over the years:
"I have a book about low self esteem I'd like you to read"
"You're fine"
"Don't worry about it"
"Exercise 3 times per week and eat right" (which I did/do)
clearly, what works for one person doesn't work for others and the canned responses above are typical of a medical culture that wants to put people in little boxes with labels because it simplifies their jobs.
the best doctors alert you of vitamin deficiencies, don't cast judgemental comments around casually and work towards giving you the complete understanding of what YOUR body is particularly good at and what it's weak at…then and only then can you truly accept, fix and move forward.