Point of View

Fat people aren't the enemy

February 4, 2010 

— As the debate continues to rage about the future of health care reform in the United States, a related skirmish has gone largely unreported - the war on fat people. In 2009, the North Carolina legislature enacted a "Comprehensive Wellness Initiative" in which state employees on the State Health Plan will be subjected to mandatory weight tests beginning July 1, 2011. Unless they have a note from their doctor or enroll in a weight loss program, those who fail the body mass index test or who cover an obese dependent on their policy can have their insurance benefits reduced.

On the surface, the logic behind making overweight people pay more for their health insurance seems to make sense. The obese have higher medical bills because they are more likely to develop diabetes and cardiovascular disorders. In addition, advocates of the "fat tax" argue that these penalties will encourage obese people to lose weight.

In reality, however, the insurance penalties are both unfair and doomed to fail. Americans now spend more than $30 billion every year on weight-loss books, pills and fad diets. This money is largely wasted.

Recently, a team of psychologists from UCLA reviewed the scientific research on the effectiveness of weight-loss regimes. The good news - it is fairly easy for most people to shed up to about10 pounds. The bad news is that nearly all of them will gain the weight back within two years. The even worse news is that between 30 and 60 percent of dieters regain more than they lost.

The reason it is so hard to lose weight is simple - whether you are fat or thin is mostly the result of a throw of the genetic dice. But if weight is controlled by genes, why has the obesity rate in the United States nearly tripled in the last 30 years?

To answer this question, consider two flower gardens - mine and my neighbor Anne's. In both of our gardens, the irises are bigger than the daffodils. That's because the two types of flowers have different genes for height. But Anne's plants are bigger than mine for environmental reasons; her garden gets more sunshine and has better dirt.

Our weight is similarly affected by a confluence of biology and environment. The inborn human proclivity for sweets and fats that served our Stone Age ancestors well is maladaptive in a world in which a burger, fries and Coke cost less than a head of lettuce.

There is every reason to believe that some people are genetically more susceptible to putting on the pounds in our hyper-caloric food environment than their skinny peers that nature bestowed with high basal metabolisms that enable them to chow down with impunity.

Advocates of punishing people for being overweight think that obesity is caused by bad decision-making, that people can shed their excess pounds simply by making "healthy choices." They are wrong.

As Rockefeller University's Jeffery Friedman wrote in the journal Science, "Obesity is not a personal failing. In trying to lose weight, the obese are fighting a difficult battle against biology, a battle that only the intrepid take on and one in which only a few prevail." People like Jared, the guy on TV who lost 240 pounds by eating Subway sandwiches, are exceedingly rare.

The big winners in our culture's obsession with weight are the drug companies. Blue Cross and Blue Shield of N.C., for example, is pushing two weight-loss drugs on obese state employees. They are expensive - $420 a year in insurance co-pays (more than $1,500 for the uninsured). Among their possible side effects are high blood pressure, "soiled" underwear, excessive flatulence and the sudden urge to defecate. And, because you start to regain the weight you lost as soon as you stop popping the pills, you have to take them forever.

Some unhealthy behaviors are, indeed, simply a matter of personal choice - driving while texting, for example. But being fat is not one of them. Your weight reflects a complex interplay between biology and culture that make permanent weight loss nearly impossible for most people. The New York Times' Gina Kolata correctly argued in her book "Rethinking Thin" that the war on fat has become a moral crusade.

And, like some other recent wars, there is little evidence that it is winnable, particularly by penalizing the victims.

Hal Herzog is a biological psychologist at Western Carolina University. He is the author of the forthcoming book "Some We Love, Some We Hate, Some We Eat: Why It Is So Hard To Think Straight About Animals."

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