Heather Michon

Heather Michon
June 25
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JANUARY 7, 2009 2:47PM

Surgeon General Gupta, Feminism and Fat-Phobia

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The news that the Obama Administration is considering CNN health report Sanjay Gupta for the post of Surgeon
General has not been met with undiluted joy on some of the more prominent feminist and fat-acceptence blogs.

"I heard this on NPR this morning and was screaming, "NOOOOO!!!!!" at the top of my lungs in the car. Gupta
is a BAD choice period. He's an extraordinarily bad choice if you are a fat person in the United States. Increased marginalization and vilification here we
come," says a commenter on BigFatBlog.com.

"I want to say "Sounds Good!" just to keep the S.G. theme going, but, unfortunately, this selection doesn't sound that good, at least for some of us, because Dr. Gupta is an "obesity epidemic" guy who occasionally likes to mingle his fat-hating with misogyny," says Melissa McEwan at Shakesville.

Various bloggers have criticized Gupta's reporting on the role working mothers may play in the increasing rates of childhood obesity, his concerns that doctors are too reluctant to tell patients they are overweight or obese
and his management of CNN's various programs to educate viewers on exercise, diet and weight managment.

This criticism illustrates just how complicated and confusing the national discussion on weight has become. The medical issues have become entangled with the social issues, to the point where the ultimate goal -- optimal health for each individual -- has become lost.

We are completely schizophrenic when it comes to food and weight. Our world is saturated by food, much of it high-fat, high-sugar, cheap crap that fills without nourishing, while the increased pace and stress of daily life makes eating something we do anytime, all the time, without having the time to reflect on that which we are shoving down our gullets.

At the same time, we're still Puritan enough to equate fat with lack of discipline and sloppiness, and still carnal enough to bombard women with the message that if they aren't thin, they aren't sexually desirable, and will likely die childless and alone.     

(Some claim that fat-bashing is the last acceptable prejudice in America, but this is patently false: think how we collectively look down on the elderly, the toothless, the working poor, and just about anyone from Appalacia, for starters.)
Like all prejudices, fat-phobia is unproductive. It serves only to make people feel bad about their bodies, to brand them with "a Scarlet O" as one blogger says. Women, in particular, should be able to see the beauty in their bodies even if they can't see their bones; nobody should feel like they need to starve or otherwise abuse themselves in the service of some unattainable image of physical perfection.

On the other hand, it's absurd to criticize Gupta and other doctors for warning patients on the risks of excess body fat.
Sedentary people carrying extra weight are at a higher risk of heart disease, Type 2 diabetes, strokes and sleep apnea, among other things. These diseases are showing up in younger and younger segments of the population. And health observers are seeing increased prevalence on these diseases not just in the United States, but everywhere in the world where obesity rates are on the rise. 

Others say that it is possible to be fat and fit and cite studies that indicate that people who are active but still obese seem to have no more -- and perhaps slightly less -- of a risk of developing health problems than their skinny counterparts.

So what should the government's policy be?  With the science still out, it seems better to err on the side of the lower end of the Body Mass Index, to encourage people to, as author  Michael Pollan puts it "Eat food. Not too much. Mostly plants," and to move around as much as possible during any given day.

We need to somehow break the back of the food lobby, and re-educate people on the low cost of healthy whole grains and produce. (According the the USDA, the average cost per serving for fresh fruits was $0.12, and the average cost for a serving of fresh vegetables was $0.18.) We need to get these fresh foods into the inner cities and the rural regions where obesity levels have climbed the fastest.

We need to educate doctors and other health professionals on talking to people about the role of weight without shaming or hectoring. People need to be encouraged to make the decisions that are best for them. That can't happen if they don't have all the facts and can consider them in at least a somewhat dispassionate fashion. 

The live-and-let-live crowd isn't likely to find comfort in our incoming Beanpole-in-Chief. Barack Obama exercises more in a day than most of us manage to do in a week (....or a month....), and seems to exist primarily on salads, broiled salmon, and the occasional waffle. Beside his personal abstemiousness, he's also on record as saying that we could save millions in health care costs if we could get obesity rates down to their 1980 levels.

One thing is certain: if he isn't already, Dr. Gupta better start eating his Wheaties.

Recently, we looked at the false comparions we make between women in politics, the sad case of Dymond Milburn, and the history of appointed female senators before taking an overly-long break for the holidays.   

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Ever try to lose weight? Who hasn't.

What with advertising, office parties, house parties, vending machines, office cafeterias and grocery store offerings, we are facing a tsunami of cheap, abundant shit food that is constantly being offered to us.

Someone needs to sound the alarm and stop the epidemic. I'm all for Dr. Gupta and those like him that clarify the problem. If some feelings get hurt in the process?

Oh well.
I do think doctors are too reluctant to talk about weight. My observation from living internationally is that the French diet is just as full of buttery breakfast treats (it takes a lot of butter to make a croissant) and luscious desserts.

But every French doctor I've ever been to has thought 10-20 excess pounds is an issue to bring up with patient or parent. No American doctor ever has. I've had some 'don't worry about your kid's weight' advice from American doctors and never a comment about the fact that my daughters weight is steadily increasing faster than her height.
There is a town in the San Joaquin Valley, where I live, that is named Lard. Honest! A town named for pig fat!

This county has a lot of very overweight people. Very.

Lots of fat children. Dangerously fat, already in diabetes children.

The extra large size clothing for both men and women sells out first!

I know this, as that is what I buy for both my husband and myself. Only now he needs XXlarge.


Our mild mannered, kind, gentle and non-confrontive MD SAYS NOTHING! He orders the obviously needed blood tests BUT SAYS NOTHING...even though he, in his fifties, is slim and trim, gaunt by this Valley's standards, and KNOWS BETTER!

Dr. Gupta and my doctor are both of Indian descent ; I hope my lovely man of a doctor will take a few pages from lovely Dr. Gupta.


Oh, I should say that the town is indeed named Lard but as it was given the Spanish word for Lard when founded (by hog farmers? pig fat renderers?) everyone knows it as and calls it MANTECA.
Dr. Gupta would have used CNN to oppose universal coverage. Now he can't - he might even support it. Sounds like a good appointment to me.

"Our world is saturated by food, much of it high-fat, high-sugar, cheap crap that fills without nourishing"

This is the problem. Shaming the hell out of obese people, while perhaps satisfying, doesn't address the fact that our food is - by policy and design - too cheap and plentiful to maintain a healthy population. Overproduction is subsidized, and our agricultural policy sees to it that corn- and soy-based calories are inexpensive feedstock for value-added processed foods. The cheapest foods are those with the highest proportions of corn and soy-derived calories, with the result that obesity and suboptimal nutrition is largely a problem of the poor and blue-collar.

Until all that changes - until food is sold for its real price, and until the American food industry no longer profiteers on cheap subsidized calories - obesity will be with us no matter how much we chide and nag the overweight.
Good post. I think Gupta's appointment is OK - because only when we can start talking about obesity openly and rationally can we hope to dispel fat-bashing.
I would like for all states to abolish the food tax.
And, less you live in an urban desert where poverty deprives you of reasonable access to fresh fruits and vegetables there is little excuse.
And I hope physicians are telling parents they are raising obese children. My goodness.
I certainly can't condone misogyny or fat-hating (weightism?) and I don't have cable so I don't know this guy from Quincy MD, but I do hope that a frank conversation about food and exercise can take place at the national level. Additionally, I'd love to see some coordination with the DOT, the FDA, the FCC, HHS and a few other letters to encourage a healthier population.

I think the current mess actually allows an opportunity to improve our overall health that might not otherwise exist. I expect we'll be applauding some and booing some.
"By the way I haven't eaten solid food since 12/31/08 and have dropped 4 pounds. I'm fasting for 14 days on juice and water only."

Unsurprising; your body's in starvation/survival mode. Watch it all come rushing back the moment you eat anything solid. Your body's metabolic survival mechanisms will prevent rapid weight loss from becoming permanent - because while your brain might feel great, down in the engine room the klaxons are blaring and the lights are flashing.
"At the same time, we're still Puritan enough to equate fat with lack of discipline and sloppiness, and still carnal enough to bombard women with the message that if they aren't thin, they aren't sexually desirable, and will likely die childless and alone. "

It is my experience - from observing the world, observing people close and not so close to me and, not least, observing myself - that being overweight certainly can be a result of laziness and is often seen in conjunction with sloppiness. Additionally, I will not be maligned for finding a thin, fit body more sexually alluring. Sex can indeed, without need for apology, be carnal. It can also be mental, spiritual.....or all of the above. But it is not pathological or mentally ill to be sexually attracted to thin and young and beautiful.

And while the sexual attraction issue is frivolous and, thus, debatable ad nauseum, the weight issue is not. Whether insured privately or publicly, we are in this together and sharing health care resources.

At some point, excess body fat leads to health problems. Data will tell us where "some point" is and we will have to encourage and incentivise the people who are able (which is almost everyone) to stay below that point for the sake of a health care program that works for all of us....even those who occasionally turn down the cookie we want and drag our asses to the gym when we don't want.

McDonald's commercials, vending machines, cheap food and media bombardment don't make us fat. Mostly, we make ourselves fat.
@Yoga Fix - Wow, a two-week fast! You're made out of tougher stuff than me.

As to the font change, I do all that in a seperate program, then copy and paste the HTML into Open Salon. It's kind of a cumbersome process, but it's nice to tweak things a little bit here and there from time to time.
I thought this blog was well-written and even-handed, but I have trouble processing the idea that being fat or obese is anything other than a serious health and social issue. That is because I am obese, and have first-hand experience with the self-righteous strangers who say the most outrageous things right to my face while I go about my daily business. Some of them act like they're doing a public service. Hatred of fat people may well be borne out of fear, but that makes it no less stinging when experienced in person. It is difficult to make friends, impossible to find a mate (unless you want an obese partner, and why would I want to see in my bed what I now have to look at in the mirror every morning?). So I've decided to do something about it.

Last month I started a dietary plan that is as follows: Banana, apple or V8 for breakfast; the Rob Variation of Jerrod's Plan for lunch - 6" turkey on wheat with no mayo/cheese and all the produce with no oil or salt, club salad minus the meat and cheese, apple wedges, water; dinner is egg whites cooked in a smidge of extra virgin olive oil, fresh garlic and gourmet mustard. No soda, beer, wine or juice. Just water and organic cranberry juice with no added sugar or preservatives (Knudsen has a great one). No desserts, no candy, no bread (until I can find a decent whole grain brand). A mile of walking per day to start, with graduated increases on the way. Thus far I've lost 50 pounds (though I started at 430). I'm doing this because I want to be healthy and fit, not because I want to be accepted and get laid (the worst two reasons, by the way, for taking on this challenge).

Body image is a very tough subject, because the simple truth is that extremely fat or obese bodies are uniformly repulsive. There's just no way around it. Now it is true that people (especially women) with a little extra often-times look great. Beyond that it's just hard to look at them, male or female. And I have not met a single "odd-ball" couple where the thin one was not a fat fetishist. That's not love, it's obsession, and who the hell wants that? Nobody should feel that they are a "bad" person because they are fat or obese, but they should be ashamed for hurting themselves and being irresponsible.

Many of the respondents to this blog have bemoaned the bombardment of crap food and drink we all have to deal with every day in this society, and I agree; but there's an simple solution: DON'T EAT OR DRINK ANY OF IT! Not easy, I know, but simple.

We must all try to stop the endless lying about this subject. I read the "Time" magazine article linked above, and had to chuckle many times. Too much of the medical information fed to the reporters was impossible to confirm because of privacy laws. A 5'2" woman who weighs 200 pounds putting her toe to her forehead? Sure...if 100 of those pounds are confined to her buttocks. Otherwise I don't believe it. I also don't believe that she has "normal" cholesterol levels and blood pressure, unless she is willing to let a reporter look at her medical records. I've seen this before, some of it a long time ago. Back in '85 Phil Donahue had a segment on obesity - then a relatively rare thing - and when a Weight Watchers advocate mentioned that she had only had two eggs, toast and a grapefruit for breakfast one of the NAAFA representatives blurted out "So did I!" in what was an obvious falsehood. Fat and obese people get that way the same way I did: By eating too much and not exercising. Glandular conditions create an overabundance of fat *cells*, which then have to be filled with lipids from overconsumed and unused calories...or not, as the case may be. I have seen documentaries about people with hyperthyroidism and other glandular conditions who eat right, excercise vigorously and, sadly, still look a bit chubby. But only a *bit.* The rest of the people with glandular conditions who weigh 500 pounds or more are lying. There is no other logical or reasonable explanation.

When we all stop lying, and start facing the harsh truths about obesity, we will be in a position to start solving the problem.
"McDonald's commercials, vending machines, cheap food and media bombardment don't make us fat."

I disagree. Ever visited an all you can eat buffet? Yes, we make the choices, but those choices are informed by a mind and body that are programmed by 5 billion years of evolution to get while the getting's good.
"still carnal enough to bombard women with the message that if they aren't thin, they aren't sexually desirable"

Sorry, I'm not going to apologize. Overweight isn't attractive to me. Not everybody gets a star for participating. Is that unfair? Sure. Do I have to be fair? No. I'm also not typically attracted to girls with dreadlocks, tattoos, or boob implants, so why does another variety of voluntary body choice have to get a pass under pain of guilt trip?

Wow. Thanks for your input to this thread. Very informative, informed and well written.
Seconded. That was one hell of a honest post, Rob, and a breath of fresh air.
i have lots of overweight friends and i have lots of overweight relatives. i dont judge them. but i do worry about them. i feel like they are all ticking bombs. because it is a health issue. and it does need to be addressed, and it is possible to address it in non-judgmental language.

i dont trust the food industry to make the right changes as long as the status quo is keeping them rich. it is up to individuals to change their diets, and like most change, people need to have a good reason to want to change. education is key. and the tone of the argument, of the language, of the rhetoric used will make or break the lesson.
Not every person who is attracted to larger people is a fetishist. Those whom you have met, Rob, are not the sum total of attraction expressed in the world. There are many variations.

Best of luck to you on your quest.
Bravo, Rob. Your honesty is refreshing and I wish you the best in changing your life. I'll just bet you'll succeed.
Everyone is bringing up some great points. Thanks!

I would add that I don't think anyone needs to apologize for finding thinner women (or heavy women for that matter) attractive. Sexual attraction is varied, and different cultures have different ideals of beauty.

I do think it's wrong to ridicule or dismiss those who are overweight or obese, particularly in this era where it is so easy to gain weight, and so hard to lose it.
My weight has gone up and down my whole life. Scorn, shame, and criticism inflicted on me by other people because of my size has had no benefit whatsoever. For me, healthy behavior is inspired by the good things I want to attract, not by the bad things I want to avoid.

I’d rather see the new surgeon general address matters that might actually help, such as improved work/life balance. If keeping your job requires very long hours or if you have to work two jobs to make ends meet, you’ll have a tough time keeping a regular workout schedule and healthy, home-cooked meals on the table. I know my fitness level went up and my weight went down when the company I work for got serious about telecommuting. Sure, the days are still long. But it’s easier to find time to exercise when the office is 10 steps from my kitchen and I can chair a 6 am conference call in my pajamas.
Thank you for that.

I always find it odd when the word fetishist is applied to people who are attracted to fat people. Sure, there are fat fetishists....people who are COMPLETELY about the fat, and who cares about the person.

But there are plenty of people that simply..well.."can't get it up" for a thin person...they are exclusively attracted to a larger person.

People that "can't get it up" for a fat person...and are exclusively attracted to thin people, are not fetishists....so why is the minority?

Intersting post and comments, Heather.

Gary Taubes’ recent book Good Calories, Bad Calories is a 600 page tome in which he reviews the current and past science on nutrition, obesity, and related diseases. One of the most interesting thing in his book is his review of a number of studies of putting obese people on extremely calorie restricted diets and how remarkably ineffective these diets are. Obese people may not necessary over eat and the cause of their obesity may be more related to their metabolism and the types of food that they eat. Overall, Taubes’ comes out on the side of carbohydrate restricted diets because of the way carbohydrates interact with insulin and result in increased production of fat in the body.

I have read the last three of Michael Pollan’s books, most recently In Defense of Food, and his books, while good, don’t have nearly the depth of Taubes’ book concerning the metabolism of various food types. Interestingly enough, though, both authors damn the ubiquitous use of high fructose corn syrup in all types of food as a key suspect in the rising incidence of obesity.

The world wide obesity epidemic is not simply a case of people over eating. It has complex causes and I have to agree with Pollan’s contention that it is strongly related to the types of food we eat, especially the move away from naturally produced food to foods that are highly refined. Both Pollan and Taubes are certainly worth reading if one wishes to gain a better understanding of this complex phenomenon.
I don't watch CNN and although I know who Gupta is, I don't know enough about him to make any sort of comment one way or the other. But regarding the topic of obesity and how it should be treated, I personally feel the same way about it as I do smoking, and it's an opinion that shifts based on circumstances (universal healthcare or what we have right now). In our current healthcare environment, I think that people really have the right to eff themselves up as much as they please--it's their body, they can do whatever they want to it.

It's no secret that smoking causes cancer, heart disease, and all sorts of other problems, nor is it any sort of eternal mystery that overeating, sedentary lifestyles, and eating the wrong foods will lead to health consequences--obesity being chief among them. I tend to judge smokers and obese people with the same sort of indifferent confusion: “You know that it’s bad for you—how can you still be doing that to yourself, you idiot?” And I ask this question as an ex-smoker and former heavyweight (I was never considered clinically obese, but I did get pretty large at one time).

Really, I know it’s not affecting me personally one way or the other if you’re a smoker or an over-eater, but I’m human and thus I judge. The obese and smokers are in the same league of what I like to call the “common stupid”. It doesn’t necessarily mean that all smokers and obese people are actually Stupid via IQ, no, but it does mean that these people are acting and thus being stupid by perpetuating these habits, regardless of the known consequences.

If/when we get Universal Healthcare, my attitude will change toward both smokers and obese people, as they will be impacting me directly in some way at that point, and then, yes, we will have a collective right to be truly upset at these lifestyles.

I think one of the largest problems, though, is the fact that the weight loss industry has, well, become an industry that is dependant upon a supply of unhealthy people. The “secret” to weight loss isn’t really a secret, but the last decade of diet fads shoved down our throats has put a sort of barrier up in people’s minds against logical thinking when it comes to weight loss and adopting an active lifestyle. But still, only so much of this can be blamed on society, and even then the individual has to take responsibility for his or her own actions when conducted in spite of known consequences.

The argument of “our culture/society is so inflated with saturated fats, sugars etc.” is a scapegoat argument, IMO. It is true that there’s a lot of cheap and easy-to-get crap out there, but the same is true of fresh foods that not only taste good, but are nutritious. My brother and I grew up with a single father on Welfare, and we both managed to stay healthy, so it’s not a question of money, either. You don’t have to shop at Trader Joe’s to get healthy foods. Any super market carries fruits, vegetables, and even frozen foods that are tasty, good for you, and reasonably priced.
"The argument of “our culture/society is so inflated with saturated fats, sugars etc.” is a scapegoat argument, IMO."

I disagree - because if it were truly a baseless argument, then obesity would occur regardless of income level or social status. Yes, it's possible to eat well for cheap; I'm a grad student and I manage. But I'm also highly educated and come from the middle class, and I have the education and desire to eat healthily and stay active. If your family lives on fast food, doesn't have much education, and if health isn't a huge priority with your family and friends, you bet the fact that the cheapest, easiest, tastiest food you can obtain is gonna be terrible for you.
"I'm thinking about sticking with a liqued only diet from now on because honestly I don't like to poop."

Sorry, but I'm going to be honest here: that sounds like orthorexic food neurosis. We've been taking dumps for the past few billion years; if it harmed us, we'd have figured out another way to eliminate our waste.

"Food may have toxins in it that are affecting me is what I think about it. "

Then go about it systematically, and eliminate ingredients and food groups experimentally until you find the one that you might be having a reaction of some kind to. As with shitting, solid food is nothing to be afraid of.
As for feeling great when you're not eating, that's probably a combination of low blood sugar giddiness and the endorphins that are released as part of your body's transition to starvation mode. It's not a healthy thing, it's your body trying to manage the stress that most people would feel in a situation where they weren't receiving sufficient food.
Some compelling posts! When I was living in Europe I hauled around an extra 60 pounds between my belly button and my knees. I can still remember the stinging shame, the constant fatigue, and the self consciousness. When I look at the size charts I would have been considered obese. In my work now as a health coach I partner with my patients and set realistic goals. Most want to lose about twice as much weight as they need to. It's not a black and white world where you are either fat or thin. There is a nice middle range in weight that is an appropriate amount for your bones to carry. For many of my people I get them down in to the overweight zone. Never, never underestimate the significance of even a 10 lb weight loss.
I believe Dr. Gupta is correct in identifying obesity as a national health issue. Dr Gupta as a "fat basher?' Absolutely not
I was on a medical site recently and there was a discussion amongst the physicians about how to address obesity with their patients. There were so many stories of being told off, having things thrown at them, and other really unpleasant behaviors that went along with trying to broach the issue of weight with both adult and pediatric patients. The fat acceptance group does not want to hear about their weight. They do not believe that it is a problem.

When I practiced with adolescents, discussing weight was such a difficult issue. First I had to assure my patients of color that I was not trying to inculcate them into the Eurocentric beauty standards. I just wanted them to attain health: less fat intake, avoid sugared beverages, and gain cardiovascular fitness. And not being svelte myself (I'm size 12-14), I assure them that I'm not trying to get anyone down to a size 00. I just think that at 16, they should be able to outwalk/outrun their old ass doctor...though they cannot.

One of my very obese inpatients almost got stuck in the MRI machine when we had to evaluate her knee. She was the outpatient of one of my colleagues and I don't know what he had discussed with her about her weight, but I thought that getting stuck in the MR was a good opportunity to broach the subject as an inpatient.

In our discussion, I happened to say one thing that ended up really having an impact on her.

I asked, "Do you know what happens to people who need an MRI but can't fit into the scanner?"

"No," she replied.

"Well, we end up having to take them to the zoo."

Both she and her mom looked at me with their mouths' hanging open.

"With the animals?!" she finally said, aghast.

"Yes, unfortunately," I replied.

Next thing I know she had gone to the patient center and had called to join the Y. Of course, when I recounted this story on my blog, one of my fat acceptance friends said that she would have reported me to the hospital administrator.

"For what?" I asked her. "I said nothing about the patient herself. I didn't say that if she got any more fat she'd have to have her MRI at the zoo. What I did tell her was the truth about what happens to patients who don't fit into the scanner."

My colleague was also a bit miffed at me. "That's not even true," he retorted. "They don't go to the zoo. They go to the vet school!"

Oh that is so much better...

And in DC they do go to the National Zoo. I didn't realize that in Philly they go to the vet school.
"Survivalists and spiritual/health fasters tell us the human body can go very long periods of time without food."

That doesn't mean it's healthy.

"You make it out like I am harming my body by doing this."

You are. You're burning muscle tissue because you refuse to consume anything with protein in it. That's not healthy. I'm not going to blow sunshine up your ass and tell you it does.

"You come across like every other traditionalist who tries to knock down someone who has found a better natural way than going to the damn psych office for the pills."

That's fine. I don't really care. You come off as a rube who'll follow any dipshit fad if it squares with your half-assed appropriated pseudo-Asian spirituality. I'm sure we're both more complex than that.

"And turds? Turds and dumps just suck. I hate it and I won't do it anymore! You can't make me!!"

I have not the slightest interest in standing in the way of your neuroses. I just don't respect them. You're welcome to starve yourself any way you see fit. Just know that you're probably going to end up undernourished, and you'll probably shit anyway because you're still taking in suspended solids.
Actually I blame the transportation system as much as the junk food in this country. If you go to Paris or Tokyo or any of those large cities where people travel by mass transit instead of cars- you'll notice they are a lot slimmer. That's because they are walking a lot more than us. We are used to driving right to our destination and walking less than 50ft at a time.
I have to question the average cost of a serving of fresh fruits and vegetables. The average cost at my grocery in Memphis would seem to be nearer to a dollar a serving (defined not by weight by as one actual serving a person might eat - a small apple, a single small banana) for fruits bought in bulk and two dollars for fruits bought individually, and maybe 50 cents per serving of fresh veggies. The only fresh vegetable that costs anywhere near 18 cents a pound is a yellow onion, and the only fruit that costs anywhere near 12 cents a pound is discount bananas that are going to be thrown away so they pack them for quick sale.

Incidentally, Memphis won the "fattest city in the country" award a few years back (I think we're third now, but don't quote me on that) so our grocery prices may not reflect prices in the rest of the nation.
I like Sanjay Gupta for the post. Obesity is unheathly. My parents have varied in their weights all my life and they have always made sure my brother and I maintained an active and heathly lifestyle as children. Though my Mother may be dealing with Thyroid issues (the medicine makes her sick so she doesn't take it) she works out to keep working on her weight and my Father works out as well.

Obseity is dangerous and the diseases associated with has well known effects in the African American community. Being concerned for the health of children is never the wrong choice.

Though people may accept their size and be happy they should also be healthy. My ex-boyfriend is 6'4 and 290 pounds...during the four months we were together he dropped 25 pounds simply because I didn't cook and bring home food that was unhealthy and made him work out. He wasn't overweight, or even chubby, in appearence, due to muscle and his size, but he was unhealthy.

When we broke up a year ago he went back up in size since I wasn't there to streamline his diet but has since taken control and is working on getting better.

Obesity is an issue. There is not doubt of it. I am in the military and we actively pursue fitness regiments for those who can't meet standards or pass a PT test...but I am in the military so perhaps my view is slanted.
Food addiction plays a significant role in America's obesity battle. Unless the root causes of food addiction are examined, breaking a "weight on, weight off" cycle like Oprah's is hard to overcome. Not only must one adapt physically to consuming less, but changing eating habits requires a change in mindset also for long-term success.

In the work environment, the societal double standard where overweight women are ridiculed but their male counterparts are rewarded continues today. In fact, when was the last time you saw an overweight female media personality? Changing perceptions, however, is a tall order indeed.
"In fact, when was the last time you saw an overweight female media personality?"

Well, I don't watch Oprah, and certainly not Rosie O'Donnell, but....
I forgot to mention that Dr. Gupta can be an arse but...I rather a have a good doctor with no bedside manner than one who is a feel good and doesn't confront my issues (two extreme examples as the middle ground does exist).

On another note this prevents him from fighting against Universal Healthcare via CNN...he leans toward the drug companies.
Smug is also a problem..and anyone who chalks it all up to "hurt feelings"....hasn't a fecking clue.
M. Chariot swears by The Caviar Diet!
As hard as it is to be overweight, and endure the scorn of those who haven't had to fight their weight all their lives, it harder to endure the diabetes, cardiac and other diseases that come with obesity, as well as earlier death. SG says this out loud and often, and it will be refreshing to have a Surgeon General who will act on what is (at least one of) the primary public health problems in the country.

It's about time that someone at HHS and the Public Health Service takes a look at what is making America so fat. It is not just access to food, it is our sedentary lifestyle, kids having no PE in school, fried foods and pizzas for lunch, almost no vegetables offered in school, and the access to fat-laden fast food instead of healthy home-made meals that are the factors I perceive. Remember when ketchup was considered a vegetable in public schools?

The Surgeon General serves as an Assistant Secretary of HHS (at least that used to be the case) and reports directly to the Secretary. His programs get funded. Start with influencing schools to re-introduce PE on a daily basis. Get funding for coaches at all levels of school. Get real veggies into school lunches, and get the fat out of lunch trays. Then, work on us old fogies. The best place to start the country getting healthy is with our young people.

It would be a great idea to look into 50millionpounds.com too, for all of you who are thinking about losing weight. And good luck. (Me included.)

Oh, one more thing - Does anyone else feel that the comments about overweight females being unattractive have been somewhat one-sided? I didn't read every comment, so maybe it's in here somewhere, but I personally find overweight men unattractive too. Maybe just as much so.
I just realized that Sanjay Gupta (SG) will be Surgeon General (SG.) Nice symmetry there.
Hello Heather,

Generally speaking, French women are thinner than American women. Why? They walk more. They eat less. They eat better. Unfortunately, this trend is changing as the French become Americanized. I am an American living in France who returns to the States once or twice a year.

In the Paris region, people walk a lot, so they naturally exercise without even realizing it. When we were in New York City, people seemed thinner than in Florida. Could there be a correlation?

Another thing that is different is the portion size. They are smaller in France, especially in the good restaurants. A few years ago, a girlfriend asked me for a suggestion for loosing weight. I suggested eating anything she wanted only half of the normal portion. She told me that she lost weight but got some dirty looks from a waitress when she left half of her filet mignon on her plate. When you have been taught to clean your plate and not to waste food, it is understandably difficult to leave it, especially if it is good.

One of the differences that I notice between American food and French food is what you buy at the grocery store. In France, the fruits and vegetables seem more natural than in the States; also, I am often doubtful when I see the fish in the American grocery stores. The last few times I ordered a salad in the States, the nuts in the salad were coated with sugar or honey or something. Why?

Personally, I think that addressing obesity is an excellent plan. Of course there are some health reasons for being overweight which are beyond personal control, but generally speaking, a reduction in the American waistline makes good sense. Medical expenditures would decrease, people would feel better, in my opinion, they would be sexier, and in a world where far too many are starving, Americans just might have a better image.
@Jane Smithie "oh come - who doesnt know that shit food is bad for us? who thinks a bag of cheetos is as good as an apple?"

Most people KNOW that apples are healthier than Cheetoes -- so why do they choose the Cheetoes? What happens when so much of the food that surrounds us isn't really food anymore, but something that was cooked up in a lab or designed to be SUPER sweet, SUPER salty, SUPER fatty, and served up in super portions?

That prim, fiberous, mildly sweet little apple doesn't dazzle the palate, doesn't give the body what it thinks it needs (even thought it's exactly what it needs).

Even at fast food places, apples have become a chemical-soaked, packaged treat to be dunked in a cup of fake caramel sauce. It's not as easy to make good decisions as one might think.

@Allie....Memphis! I probably shouldn't admit this after all this food talk, but I could really go for a plate of BBQ spaghetti right now. ;-)

The USDA figures are an average of cost per serving, not per pound -- so you're absolutely right, you can't even buy bananas or onions for under $.25 a pound. I'm also not sure how they factored regional differences.

The serving-size thing could drive you nutty. The gov't says to eat at least 5 servings of fruit and veg every day, and that just sounds insurmountable -- until you figure out what they mean by a serving size. For leafy greens, a serving is about 1 cup, for most other veg it's 1/2 cup chopped, and same for fruit, or one small, whole fruit like an apple or a banana. .
A couple points:

1.) I was once morbidly obese. I had trouble breathing, chest pains, sleep apnea and was pre-diabetic. I nearly broke the toilet in my apartment - and quite a few chairs - with my excess weight?

Is this the type of life that you "fat-positives" celebrate?

Am I fat-phobic & misogynistic (!) for wanting and proceeding to become less heavy, more fit and *gasp* thinner? To, in essence, save my life?

2.) It took a lot of hard work, struggling & determination to get in better shape. But I did it. No weight-loss pills, no magic solutions. I simply said no to bad food, and yes to exercise and healthier choices...which brings me to point 3:

3.) NO ONE ever held a gun to my head and demanded I eat at a buffet. Or Mc Donald's. No one ever held a knife to my throat at a supermarket, and made me buy Cheetos instead of celery, or Cocoa Puffs instead of whole grain Kashi.

Every fat person in the USA has BOTH free will AND a wide variety of healthy eating options accessible to them. So quit blaming ads and whining about high fructose...it's your own fault for ACTIVELY CHOOSING bad food! Lose the denial, make better choices and your life will be better for it.

4.) Finally, I'm a libertarian....

If you wanna smoke yourself to death, fine. Just don't saddle me as a taxpayer with the burden of paying your healthcare costs when your lungs give in.

Similarly, if you fat-positives wanna eat yourself to an early grave, fine. I have no intention or desire to shame you or change you. You have the right to destroy yourself...

But please: don't ask me to pay YOUR healthcare costs when diabetes, heart failure, high cholesterol and blood pressure, metabolic X syndrome and other obesity-related illnesses strike you.

You have the right to be fat...but you should have the SOLE responsibility of dealing with the consequences. Fair, no?
Great post Heather. I agree that guilt-tripping doesn't work, and I'm by no means a Gupta lover, but I think what he's really trying to emphasize is the central role nutrition plays in a child's development. I live in the city, and see teenagers eating pizza and fries during their lunch breaks. Forget the fat for a second -- this sort of diet affects your ability to perform in school, and leads to behavioral problems. I can't cite it off the top of my head, but someone studied prisoner nutrition, and documented a dramatic betterment of inmate behavior when prison nutrition was improved.

If Gupta becomes obsessed with food as surgeon general, I couldn't be happier. Vast, unimaginable quantities of lives and money could be saved if our medical care focused on prevention rather than treatment of disease. Thus far, food lobbies and pharmaceuticals have more or less driven our health policy. Focusing on the basics -- what we eat, the air we breath, the amount of exercise we get -- really is the only solution to our health woes.
Though it feels like futility to even post in the face of the usual discrimination and "fat hating", I still think it is worth my time here to mention that, no matter how "bad" being fat is for you or how it is linked to diseases like diabetes....ALMOST NOTHING WHATSOEVER CAN BE DONE TO CHANGE A FAT PERSON INTO A THIN PERSON. Yes, despite what you see in reality TV programming, diet ads or on magazine covers. The vast majority of people who lose weight at all regain it with in a few months or years, and most people never lose any weight at all. The greatest likelihood from going on a diet is that you will temporarily take off some water weight, then get very very hungry, go into a state of "refeeding" and regain all the lost weight plus about 15% extra. THAT IS A FACT AND THE TRUTH, substantiated by literally thousands of studies and tests by medical professionals.

Gary Taubes book is very good and highly recommended, but even more so is Gina Kolata's "Rethinking Thin", which sites the exact studies and results. BTW, neither author is themselves obese, so their work is not an attempt to defend their own weight problems.

Please realize that most fat people have tried many, many times to lose weight. Perhaps the worst myth about the obese is that they are in a state of denial where they just "eat everything in sight", i.e., they engage in unrestricted eating. Almost nobody really does this, for any length of time. Unrestricted eating is mostly a fantasy of the normal-sized bigot, who would love to be able to eat that way but fears becoming obese himself....a fear that is unrealistic. If you are normal-sized by nature, you can never become seriously obese (300+), your natural metabolism will prevent it. Just as the very obese person can almost never become very slim (sans gastric bypass surgery, problematic in itself).

Despising fat people for a problem that cannot be controlled (or even explained) by medical scientists is as ridiculous as blaming -- or refusing to pay for medical treatment for -- black people with sickle cell anemia, or Jewish people with Tay Sachs disease. Many people have diseases or injuries that are at least in part their own fault. Do you seriously suggest that as a society we refuse to pay for knee surgery for a runner who has worn out his joints pursuing his hobby? Attempting to make those judgments, trying to assign life-saving care based on whether you meet "criteria of worthiness", is a futile end game that in the long run hurts us all.

And it won't make anyone thin. NOTHING exists that will make the majority of very fat people thin, and that includes (especially includes) conventional dieting and/or exercise.

Please eat healthy foods, and please be active. These are good and worthy things by themselves. But they will never make you permanently thin.
I am going to be a contrarian here and say that I think being fat is mostly genetic and that there isn't much that can be done about it absent extreme measures like gastric bypass surgery (and even that sometimes doesn't work). People respond that they see fat people eating fast food so it must be their lifestyle that causes obesity. What they're forgetting is that skinny and normal-size people eat fast-food too. They just don't get so fat.

I hold this opinion because (1) that's what the actual studies say -- that weight is at least 50% genetic and that the odds of a fat person losing weight permanently are minuscule; and (2) because I am naturally skinny so I know that weight is heavily influenced by genetics and is NOT just a matter of "calories in, calories out." I have horrible eating patterns, my lifestyle is entirely sedentary, and I am almost 5'10" and I weigh 122 pounds, which is very thin (also, I am 32, not some teenager). I easily eat 4,000 calories a day but I don't get fat because everyone in my family is skinny and so am I.

I think that average weight people don't like to believe this because it gives them a false sense of control to believe that we have a choice about these things. And it certainly helps to sell millions of diet books and work-out equipment. But most people can't significantly change their weight over the long term any more than they can change their height. Think about it: the social pressure to be thin is ENORMOUS. If it was really possible to stay thin by will-power, most people would be thin. I know people who would gladly give up 20 years of life to be skinny.

Also, every mammal has a strong evolutionary drive to eat as much as possible while expending the smallest amount of energy. Given the opportunity, almost every adult mammal will gorge itself and become lazy. This is an extremely strong evolutionary drive that is virtually uncontrollable when abundant food is around. Our current culture, with it's cheap, high-calorie, tasty food, is the sexual equivalent of a society full of naked supermodels who want to have sex with every person that passes by. How many people would stay faithful in that kind of environment? Not many. And most people won't resist the urge to eat when they're hungry either, because it goes against every evolutionary impulse.

Last, this trope that smokers and obese people are the cause of our skyrocketing healthcare costs is a load of B.S. The single largest healthcare cost we carry is keeping very old people alive for years on end. Smokers and fat people actually cost our system LESS because they die early. It's those people who live til age 98 but use 10 years of intensive medical care at the end of their life who cost us so much money.
P.S. To anyone who doubts my last assertion: http://content.nejm.org/cgi/content/abstract/337/15/1052
Everyone has responsibility for their own genetic failings. I don't believe weight is exclusively genetic. 1) some people (probably me) are designed for heavy work. In the current world, this means I have to do a lot of exercise to keep from getting too fat. 2) there is so much interplay between lessons learned in childhood. Clean your plate. Sweets as treats. My husband (not obese, but not slender either) has parents who spent a lot of their childhood being hungry. They drilled into him NEVER waste food. (eat it instead). They made sure there was plenty on the table and that it didn't get wasted (that it got eaten). They gave out candy because it was such an unobtainable treat when they were kids, they didn't see it wasn't that way for their well-off American kids. I can see some of these values being passed on to my kids through their father.
And lastly, serving sizes have grown. When I was a kid, a Quarter-pounder with Cheese was the huge option, with the sense it was for football players. Last time I was at Wendy's, QPs were the normal serving and you could get half pound or 3/4 pound burgers. A regular sized coke was enough for 2-3 people. You have to be paying attention to realize that what's sold as a normal serving is plain old too much for most people.