Fat City

Photo © Karen Kasmauski

Photo © Karen Kasmauski

I recently read probably the best editorial about obesity that I have ever come across. It was a difficult read: uncomfortable, honest, brutal, no-holds-barred, and yet still, somehow, sensitive. The author, an Australian physician who works at a bariatric clinic, has seen it all. I posted the article on Facebook, but not without much deliberation. I don’t want to engage in what is known as fat-shaming. I don’t want to alienate anyone who struggles with their weight – and I understand that it can be a struggle. In the end, I decided that this article was simply too important not to post. I wish that everyone who is at all interested in health, medicine, obesity, nutrition, policy, law (etc., etc.), would read it.

Here are a few of what I think are the most thought-provoking selections from the article:

  • “I have heard people say thinness is beautiful and coveted because it is difficult to achieve and rare now, the way curves apparently appeal in times of famine…. Today when we look at those who are thin, part of what we see is a triumph of will over gluttony, so the beauty is a moral beauty; it has little to do with health.”
  • “I listened recently to a neurosurgical registrar describing the difficulty of finding a spinal fracture under 10 centimetres of adipose (fatty) tissue. Neurosurgeons love precision; one false move on the inside and you won’t remember your mum. The registrar’s voice was filled with a kind of shocked horror. She had to send the car-crash victim to the scanner mid operation, with a metal screw embedded in his neck so the surgeons could find their bearings beneath the mattress of fat. Post-op, none of the neck braces were big enough to fit. To immobilise the man’s spine the team used sandbags.”
  • “I had a friend who had been anorexic and spent her teenage years in and out of hospital, being fed through a nasogastric tube. She recovered in her 20s and managed to channel all of her intrusive obsessional thinking about food into athletics. One day she said to me that she didn’t understand why she could be hospitalised against her will for not eating enough, and yet there was no limitation on how fat you could get. It was completely unfair, she said, that you could be refused alcohol if intoxicated but roll into your local fish-and-chip shop 100 kg overweight and be served the equivalent of a week’s worth of calories for lunch.”

I also love the section on how our emotional state plays into eating, because it is so true and obvious, and yet so routinely overlooked. Give the article a read and then let me know what you think in the comments section.

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3 thoughts on “Fat City

  1. I appreciated the honesty in the article. I spent a few years dating a man who was morbidly obese. He is a lovely person in many ways, but we were not a good fit. The obesity was one of things that put a strain on our relationship. It affected every aspect of our dating life- from where we could do, things we could do, our love life (physically impossible), his attitude and mostly his poor health was a constant worry. He couldn’t walk far because his weight was putting a strain on his knees and his feet were completely messed up. He often had painful rashes. I can’t even imagine what it would have been like if he had needed surgery. It was hard to watch him struggle, mostly not even trying to eat healthy and to know that there was nothing I could do until he decided to make the change.

  2. The thing that the author sort-of-but-not-really gets is that obesity isn’t the disease for everyone; her patient who said he is addicted to eating is correct. For the compulsive overeater, there really are certain foods that trigger the compulsion to keep eating past the point of comfort (let alone satiety). As she recognizes, the obese know their risks, they know the consequences, they know they have a fatal condition. But for them abstinence is easier than moderation. Just like alcoholism or heroin addiction, they cannot eat “just one bite” of certain foods. Kelly Brownell’s research at Yale is making advances in this area. I liked the author’s compassion and I hear her despair, but I think she missed a point.

    • I agree that she misses the point for compulsive overeaters. I like that she points out how much mental state plays into overeating, which is more than we’ve gotten from mainstream medicine so far. I think that, for a lot of obese patients, it’s not truly compulsive overeating but depression or another underlying issue. For those who truly do have a food addiction, though, you’re right – she doesn’t address this.

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