Chapter 4
Living with Obesity

Obesity has a major impact on many aspects of an individual's life, including psychological, social, overall health, and lifestyle issues. Social and emotional effects, of course, vary in different cultures, but in the United States, where thinness is perceived as attractiveness, obese people are usually seen as unattractive. This makes them the brunt of jokes and derision concerning their condition. One study found that on television, where 90 percent of female stars are underweight, overweight characters are often objects of ridicule and are perceived as lazy and lacking in self-control. Another study that is a classic in the field of social psychology originally appeared in the Journal of Personality and Social Psychology in 1967 and is still cited by many experts in the field. It showed that children as young as six years describe silhouettes of obese children as lazy, stupid, dirty, ugly, liars, and cheaters. This indicates that kids learn stereotypes associated with obese people early in life.

For an obese person who is the object of such ridicule and derision, the emotional effects can be devastating. One obese woman commented, "Life is so lonely when you are obese. People mock obesity and think it isn't a real disease, but they are wrong! I have seen its effects for so long and I have felt them!"¹⁴

One woman who gained sixty-five pounds after having a baby was amazed at how isolated and picked on she felt just because of her weight. She said:

Since my weight gain, my life has changed so much. I used to be "quite pretty" or so my family keeps saying, but now I am just an embarrassment to them. Most of the overt discrimination that I have felt has come from my own family members. They often refuse to invite me to public places, and have even been known to take food right out of my hands during family gatherings.¹⁵

This woman's mother told her that as long as she was fat, her achievements would mean nothing because no one cared about fat people. Her husband refused to take her to an office party because he was afraid his coworkers would no longer respect him if he was seen with her.

This sort of attitude shows that although many professionals and organizations for the obese now regard obesity as a disease, many people still do not see it that way. Even many doctors reportedly see obese people as lazy and lacking in self-control, and a good number of doctors prefer not to treat the obese because they do not think they will get results. Says one obese woman, "The doctors, most of them seem really uncaring toward our condition, like if we really wanted to be thin we would do something about it. That's just not the case. No one wishes to be obese."¹⁶

Obesity and Young People

For children and teens who are obese, the teasing and isolation from their peers can be especially difficult to endure. One seventeen-year-old girl who weighed 440 pounds dropped out of school because she could not tolerate the nasty comments from other students. She was depressed, hated her body, and wished she could lose weight, but instead sat around doing nothing but eating. She wrote:

I missed my whole teenage-hood because of my obesity. I wish I could go to a store and buy sexy clothing and bell bottoms and tank tops and a bikini, but I can't because they don't make clothing in my size. I know I'm not the only obese person in the world but me being a teenager and watching all these other skinny teenage girls, it makes me feel like I am the only one and I feel like such a freak. I wish I could change, but it's so hard. I really need some support right now. I wish all these pretty skinny, inshape people could just respect me, but that will never happen because of the way I look.¹⁷

This experience is fairly typical for many obese kids from elementary school on up. Studies have shown that children and teens identify obese kids as individuals they do not want as friends. One study of obese adolescent girls found that 96 percent experienced ostracism, teasing, and rejection on a continuous basis, which led to low self-esteem. Self-esteem was found to be lowest in those who believed they were responsible for being overweight.

One study at the University of California, San Diego, compared obese children to those with normal body weights and to children with cancer and found that obesity had a physical, social, and emotional impact similar to cancer. "The quality of life for severely obese children and adolescents is roughly equivalent to that of pediatric cancer patients undergoing chemotherapy,"¹⁸ said the authors of the study. The obese kids were socially isolated, missed school more often than other kids, and had many more physical afflictions than normal.

Discrimination and Obesity

Besides the ostracism and rejection that many obese people feel, a large percentage also find they are routinely discriminated against in employment and other situations. Obese people are often not hired or—if they are—are not promoted, and do not receive comparable salaries to those who are not obese. According to the American Obesity Association, this discrimination seems to affect women more than men, at least where wages are concerned. One study found that the wages of mildly obese women were 5.9 percent lower than for women of normal weight. Wages for morbidly obese women were 24.1 percent lower. Men only received lower wages at the very highest weight levels.

Explains one obese woman:

People are extremely prejudiced towards fat people. I was passed over for employment positions because of my size. For example, I was eighteen years old and weighed in at 211 pounds. I had an interview with a large corporation in Manhattan. The personnel agent told me I was not suited for the position and that before I interview again in the city that I should lose some serious weight. She told me appearance was everything, if you look sloppy they base your working habits on your appearance. Being overweight is not businesslike.¹⁹

In another case, John, who weighed about four hundred pounds, was fired from his job. The reason given was poor performance, but John had always done a good job and his coworkers and customers at the store where he worked said his performance was excellent. John sued his employer and was awarded over $1 million for lost compensation and emotional distress. The jury made this award because they concluded that John was being penalized for his weight, a condition that was mostly beyond his control.

Advocates for the obese have hailed this decision as a major step forward for the rights of overweight and obese people. Although the laws of one state, Michigan, expressly prohibit employment discrimination on the basis of weight, such discrimination is not usually considered to be strictly illegal in most of the nation. The Civil Rights Act of 1964, which prohibits discrimination in employment, does not specifically list weight or obesity as a protected characteristic. The Americans with Disabilities Act, passed in 1990, prohibits employment discrimination for people who are disabled, but also does not list obesity per se as a disability. Some complications of obesity qualify as disabilities, but obesity itself does not. As more people file discrimination lawsuits, the courts will have to more clearly define whether or not obesity qualifies as a disability in some or all cases.

Despite the high incidence of discrimination and serious medical problems associated with obesity, recent research finds that most Americans do not believe that obesity itself should be treated as a disability that requires protection by the government. Many people who support legislation giving special accommodations to other serious medical conditions do not believe the obese merit such support. J. Eric Oliver and Taeku Lee, authors of a 2002 study on obesity-related legislation, write: "Most Americans continue to understand obesity as a case of individual moral failure rather than see it as the result of the food environment or genetics."²⁰

Physical Limitations

Besides emotional, social, and job-related hardships, living with obesity is difficult because of the many physical problems and limitations it imposes. Not only is it difficult for the severely obese to move around; it is virtually impossible for many to exercise at all, including walking. Because of the breathing problems, foot pain, and back pain experienced by many obese people, walking even short distances may be very painful. Betty, for example, who weighed three hundred pounds, had special shoes made to try to alleviate the pain in her feet, but still was unable to walk more than a few steps because of the discomfort.

Doris, who had two small children, lamented the fact that her 390 pounds kept her from being able to do anything with the kids like a normal mom. Her high blood pressure, diabetes, pain in her legs, feet, and back, and rashes and infections kept her practically bedridden and prevented her from leading any kind of productive life.

Physical problems can also result in the obese person having to take many medications and make frequent doctor visits. As well as being extremely expensive, all these medications can have dangerous interactions and create further health problems. Jeff, for example, took medication for high blood pressure, high cholesterol, asthma, arthritis, and gastrointestinal reflux disease. He was constantly light-headed and exhausted from the medications as well as from his health problems.

Access to Medical Care

Along with experiencing the everyday physical problems and limitations, the obese often face difficulties in obtaining all types of medical care. Something as simple as getting certain diagnostic medical tests can be impossible. One obese man died of cancer because his doctors could not perform the proper diagnostic tests, such as MRI, because he could not fit into machine Then, while he was in the hospital before his death, he was seriously injured when he tried to get out of bed, could not do so on his own, and fell when the nurses were unable to help him because of his bulk.

A recent study at Johns Hopkins University School of Medicine showed that obese people are less likely to seek preventive health care because of their weight. Obese women in particular tend to avoid tests like mammograms, which are used to detect breast cancer, and therefore put themselves at increased risk of not having such a condition diagnosed and treated.

When an obese person becomes ill and requires surgical treatment, the difficulties associated with excess weight are further exacerbated. For example, someone who weighs four hundred pounds will not fit on a hospital bed or gurney, so special arrangements have to be made. One woman who needed back surgery had to be weighed on a truck scale because no standard patient scale could accommodate her bulk, and her doctor needed an accurate reading so he could find an operating table that could handle her weight. Also, administering intravenous anesthesia and other medications is problematic, since it is difficult to insert an IV needle with layers of fat burying the blood vessels. Cutting through and keeping so much body fat out of the way during an operation is also a concern for surgeons.

Access to Insurance

Another problem associated with medical care concerns difficulties obese people have getting medical and life insurance. Many insurance companies will not insure anyone who is over a certain weight for their height. And even those who do obtain medical insurance often find that the policy will not cover treatment for obesity because it is considered cosmetic rather than medically necessary. Advocacy groups have been trying to educate insurers about the medical risks of obesity. They have also asked the government to pass laws requiring coverage for obesity treatments. In February 2003 the estate of a deceased, morbidly obese Washington, D.C., man sued a health care insurance provider for not covering the costs of a surgical treatment for obesity that could have saved his life. The court ruled that discrimination against the man occurred on the basis of personal appearance and disability. Advocates for the rights of the obese are hailing this decision as a huge step forward in fighting such discrimination.

However, even government-funded insurance plans like Medicare and Medicaid still do not consider obesity to be a disease and will not pay for treatments related to it unless the diagnosis given is other health problems, such as heart disease or arthritis. Organizations like the American Obesity Association are trying to change this by getting the government to classify obesity as a disease. One argument they use is that obesity causes numerous medical conditions and hundreds of thousands of premature deaths each year in addition to consuming billions of dollars in related costs that could be saved by dealing with obesity itself. Another is that many other conditions, such as type 2 diabetes, cancer, and heart disease, can be affected by personal behavior other than overeating and are covered by these types of insurance, so it is discriminatory not to cover obesity on the basis that it is dependent on personal behavior rather than being a specific disease.

Although many public and private insurers will not yet cover treatments for obesity, since the year 2000, the Internal Revenue Service has allowed taxpayers to deduct the cost of weight-loss programs as a medical expense if the program is recommended by a physician to treat an existing disease such as heart disease.

Frustrations Related to Weight-Loss Failure

In addition to the financial stresses involved in trying to treat obesity by losing weight, especially frustrating for many obese people is the failure of these attempts to actually succeed. One woman, for example, joined a weight-loss program and lost thirty pounds, then gained fifty, lost the fifty pounds and gained one hundred. She became overwhelmed by depression and anxiety.

Experts say that there are many reasons for this up and down weight loss and gain. One primary reason is that the diet plan the person is following is not a good one to retain long-term healthy eating habits. Another is that some people eat for comfort and abandon their program if they become stressed. One woman learned as a child that eating was a way of dealing with whatever came along. "My childhood was filled with 'eat something, you'll feel better,'"²¹ she explains. She continued this behavior into adulthood, eating every time she felt anxious or angry or sad. This made it extremely difficult for her to stick with a prescribed diet plan.

Other times an obese individual is not really aware of how much he or she is eating. This is why it is important for the person to keep a food diary or count calories to better succeed in weight-loss efforts. Roger, for example, who weighed 340 pounds, told his doctor he was eating a modest amount of food for each meal. He did not mention that he was actually consuming a gallon of whole milk with breakfast alone. The milk did not seem important to him, nor did the tremendous amounts of food he took in seem anything but "modest" in his mind.

Whatever the reasons for an obese person having difficulty losing weight, this tendency can make them vulnerable to advertisers' proclaiming quick or miraculous weight-loss schemes. According to the American Obesity Association, many obese people are so desperate for any solution to their problem that they buy into fraudulent products and services. Such fraud often keeps them from seeking legitimate help from a physician or a worthwhile weight-loss program. Fraudulent schemes also eat up large sums of money even though they provide no benefit, and this adds to the obese person's sense of failure.

The Federal Trade Commission has filed numerous charges against providers of diet pills, potions, and devices, and warns that consumers should be careful about investing in questionable schemes. The main thing that government authorities say to keep in mind is that there are no quick and easy weight-loss solutions, so claims of that nature should be viewed with skepticism. "Any claims that you can lose weight effortlessly are false. The only proven way to lose weight is either to reduce the number of calories you eat or to increase the number of calories you burn off through exercise,"²² points out the Food and Drug Administration.

When Weight Loss Happens

For those who find a legitimate way to lose significant amounts of weight and succeed in the endeavor, the emotional, social, and physical rewards are immense. Many people find their self-esteem improves, along with their social life and general lifestyle. No longer do they have to put up with nasty comments about their fatness. One teenaged girl who lost fifty pounds was thrilled to be able to go to the beach and wear a bathing suit without embarrassment for the first time in years. A woman who lost one hundred pounds was excited about not having to buy two seats on an airplane, because she could now fit into one. A man who went from 440 to 220 pounds said:

My self image greatly improved. I could buy clothes in my new size almost anywhere, in a great variety of styles and colors. I could wear blue jeans and find them to fit. I went from a size 22–23 shirt, 66 inch waist pants to a man's 16–16½ shirt and 40–42 pants. I could fit comfortably in even small-size cars. I purchased a Toyota Celica, which would not have been possible earlier.²³

Along with the social and practical improvements, weight loss also has a big impact on overall health. Blood pressure, and cholesterol and other blood fats that are often elevated in obese persons, are lowered, and many people with type 2 diabetes no longer have to take medication. Improvements in breathing and lung function are seen, and those with arthritis and other joint problems often see big improvements. Walking up a flight of stairs becomes easier; taking a hike or riding a bicycle becomes possible. Essentially, say most individuals who achieve the goal of adequate weight loss, every aspect of life from physical health to emotional well-being benefits.