Just a quick little blurt today. We took my mum out to dinner at ‘The Blue Dolphin’ in Crofton. It was fine but I’m not in a hurry to get back.
Okay so everyone’s going bananas about this health care reform. I have also heard about how one big thing is that our obesity epidemic needs to be tackled by ‘individual responsibility’ or addressed by a ‘fat tax.’
So let’s look at that.
First off at first blush it would appear that the problem is very simple. One becomes overweight when one creates a caloric surplus – when one takes in more calories than one expends. Therefore, and it’s no secret, that to lose weight, one should create a caloric deficit – one should expend more calories that one takes in. Simple, right?
Except. We know it’s not. Obesity and the behaviors which lead to it are understood as mostly involving something other than a lack of will power. (If it were merely a lack of will power then surely obese people have only themselves to blame and it would be a simple matter of encouraging them to find the will power or dealing with their irrational choices. Pretty cut and dried. But it never seems to work that way.
Rightly or wrongly the medical establishment, and countless speakers and writers on the subject, have analyzed the behaviors which seem to create obesity as a disease. Certainly it’s an irrational self-harming behavior as much as alcoholism or gambling addiction, or drug addiction. But what cures does modern medicine offer? It’s an important question because the only rational basis for assigning blame and responsibility for this condition would be if there were a cure available. You can’t blame somebody for refusing a cure which doesn’t exist, can you?
The most efficacious cure is bariatric surgery. Interestingly this is not automatically covered by insurance, nor have its long-term effects been studied, nor is it without risk (any surgery to an obese person is risky), nor is it a firm cure; a dedicated overeater can defeat it over time. So there’s the best cure.
Okay so we don’t want to rely on that and insurance mostly doesn’t cover it and when it does you have to (get this) demonstrate that all else has failed. Because of course any invasive procedure should be the last resort.
But the first resort, recommending that the person exercise more and eat less is not what you’d call universally effective. Most people who try it (or who say they’re trying it) fail. Not everyone fails. But what most people get – exhortations, dire warnings, little brochures, etc. – doesn’t seem to be enough.
But we may say, well, if overeating is an addiction (which chemically it seems to be) why not treat it like other addictions, like alcoholism or gambling addiction or drug addiction. Here’s the rub though: None of the treatment programs for alcoholism involve the sufferer having three drinks a day. Nobody suggests that the compulsive gambler place bets but only morning, noon, and evening. And I’m not an expert but I doubt people get over heroin by having only three fixes a day. But the overeater still has to eat. The drunkard can stop drinking. The bettor can never wager again. The drug addict can abstain totally. Only the overeater has to revisit his or her compulsion three (or more if you follow fitness experts’ advice) times a day, day in and day out.
It seems to me that the overeater is told the following:
- You have a disease, one which is manifest in chemical reactions in your brain (release of seratonin).
- We don’t know how to treat it conclusively. We may or may not be able to cure it.
- But if you don’t get better, you’re lazy. it’s all your fault and you should pay in higher premiums or a fat tax.
Fair? I guess it’s in the eye of the beholder.
More to come on this topic in my next post.
How about that Phil?
Yes, how about our edible entrepreneur? I’ve found some more pictures of his hotness for your delight:
First he’s with his fiancee, the lovely and accomplished Ilona (a top flight attorney for lesbian civil rights):