Germs that make you fat? An idea that would have seemed nuts not long ago has suddenly become respectable. Although by no means proven, it is no longer in the same outlandish class as the dog that ate homework and other butt-covering fictions.
The possible connection between a pathogen and obesity is just one more example of a startling revisionist hypothesis that is, well, infecting biomedical research: the notion that germs cause, or at least contribute to, an increasingly long list of chronic diseases, many of them exceedingly common. With the help of new molecular techniques, scientists can now easily zero in on disease organisms in human patients and, using statistical methods, link them with particular maladies. Infection is suspected of being at least partly responsible not only for metabolic disorders like diabetes and mental disorders like schizophrenia, but also for the two ailments that will eventually kill most of us: cancer and heart disease.
“In my medical school I was taught that gastric ulcer is due to hurry, worry and curry,” says Nikhil Dhurandhar, Ph.D., who was educated in Bombay and is now an assistant professor at Wayne State University in Detroit. He is talking about the disease that is everybody’s favorite example of biomedicine’s new infectious paradigm. For decades the medical party line was that ulcers were stress-induced and incurable, the archetypal ailment of the Age of Anxiety — except that almost all ulcers are caused by a bacterium, Helicobacter pylori, and can be easily, permanently and inexpensively cured in less than a month with antibiotics. Researchers first described the relation between H. pylori infection and ulcers in 1983, but their findings were scoffed at for years and incorporated into the medical canon only recently.
Dhurandhar is on a similar mission, but meeting less resistance. Backed by a powerful mentor, obesity researcher Richard Atkinson of the University of Wisconsin, Dhurandhar is slowly amassing evidence that some proportion of obesity — at this point his work suggests, scarily, that it may be a very large proportion — is the consequence of infection by a virus.
Most of this research has been done in animals, but some small human studies, so far mostly unpublished, back it up. The latest published contribution appeared last month in the International Journal of Obesity and Related Metabolic Disorders. The paper reported on experiments in which Dhurandhar and his colleagues inoculated chickens and mice with a human virus they suspect of promoting fat gain. It did: The infected animals gained two-thirds more fat than uninfected control animals.
The virus, designated Ad-36, is one of 50 adenoviruses known to infect people. In an electron microscope, adenoviruses look a bit like the World War II mines used to block shipping channels — spherical and studded with spikes that help them attach to host cells. Despite that ominous configuration, most appear to be benign. A few cause respiratory infections, pinkeye and diarrhea.
As for Ad-36, it doesn’t seem to give diarrhea or colds to Dhurandhar’s birds and rodents, at least. “They are quiet for a day or so, and then they bounce back,” he says.
A handful of viruses are known to make animals fat, which is how Dhurandhar — who operated obesity treatment centers in India before he came to the U.S. nearly a decade ago — got interested in them. An unexpected characteristic of these infections is that when the animals get fat the levels of cholesterol and triglycerides in their blood plummet. Increased body fat is generally accompanied by increased cholesterol and triglycerides, which ferry fats around in the blood.
In a study published in 1997, Dhurandhar examined blood from patients in Bombay looking for antibodies against an adenovirus that was epidemic among Indian chickens — and which killed them after making them fat. He found viral antibodies in 10 of his 52 human patients, evidence that they had been exposed to the virus at some time in their lives. The 10 tended to be fatter than the other patients, and also tended to have lower cholesterol and triglycerides.
Dhurandhar says he has strengthened the case in a U.S. study. In findings presented at conferences and in a paper Dhurandhar says has been submitted for publication, Ad-36 antibodies turned up in 100 of 313 obese subjects, but in just four of 92 lean controls. In short, nearly one in three fat Americans in Dhurandhar’s study showed evidence of prior infection with the virus, compared with only one in 20 slim ones. Moreover, the infected subjects also had lower-than-usual cholesterol levels.
Dhurandhar’s provocative results, especially the human studies, must, of course, be replicated before they can be fully accepted. But the reactions of other obesity researchers, at first skeptical, have become cautiously friendly, at least in public. One measure of Dhurandhar’s increasing credibility is that top obesity researchers have joined the advisory board of the Rochester Center for Obesity Research, the nonprofit center he has set up to do human studies in collaboration with the weight management center at Crittenton Hospital in Rochester, Mich. These scientists include Atkinson, who is president of the American Obesity Association, and John P. Foreyt, a professor at the Baylor College of Medicine in Houston. The National Institutes of Health has given Dhurandhar money to screen other human adenoviruses for fat-promoting effects.
But as Dhurandhar points out, even if the results of his studies hold up, many questions remain. “We don’t know what role the virus plays. Is it that you need a viral infection and a high-fat diet? If you have just the infection but not a high-fat diet, maybe you won’t gain weight. Or is it some other factor that has to go together with viral infection for obesity to be expressed? We don’t know.”
To add, um, weight to his thesis, Dhurandhar and his colleagues have also studied twins, a traditional means for ferreting out genetic and environmental causes of disease. They screened a group of 90 pairs of identical twins for Ad-36 antibodies, throwing out the pairs in which both twins tested the same — positive or negative — for the virus. In the remaining 26 twin pairs, where one twin possessed the antibodies and the other did not, the positive subjects had significantly higher body weight and body fat than the antibody-negative twins, says Dhurandhar, who is seeking funding to expand the twin study. “I believe that’s the closest one can come to showing the role of this virus in humans,” he says.
This sort of indirect evidence of a relation between viral infection and obesity in humans is probably the best we can expect. One of the Australian researchers who finally established that ulcers are caused by a bacterial infection got so fed up with being hooted at by his colleagues that he put his mouth where his convictions were. He swallowed some H. pylori — and promptly got ulcers. But he also had faith that his stomach pain could quickly be vanquished with antibiotics. There is no such magic bullet for infectious adiposity, if it exists. And even if regulatory agencies would permit direct human tests, it’s hard to imagine thin people volunteering to swallow Ad-36 and then sit around — perhaps for years — waiting to get fat.
“In humans we say we have a strong association, not a causation,” says Dhurandhar. “So we have to collect circumstantial evidence, something like smoking and cancer.” The circumstantial evidence includes continuing searches for viral antibodies and traces of the virus itself. The virus has been detected in infected animals but, so far, not in people.
Dhurandhar is also doing laboratory investigations of how a virus might make people fat. In these studies, Ad-36 seems to speed up the conversion of a kind of pre-fat cell into full-fledged fat cells, known as adipocytes. His hypothesis is that the virus is doing what viruses do, commandeering human DNA and getting it to make viral proteins, in the process ratcheting up the adipocyte production rate.
Dhurandhar has been inundated with beseeching e-mails from hundreds of distended and desperate people. Sadly, he has nothing to offer them — for now, at least — except the conventional, notoriously unsuccessful advice: diet and exercise.
But some day, if the infection theory of fatness holds, Dhurandhar thinks it would not be too difficult to develop an Ad-36 vaccine that could be administered to everybody early in life, like polio vaccine. “But right now we are far from that,” he cautions.
Another possibility is antiviral drugs. But before developing a pill, scientists would want to know how long the virus remains in the bodies of the fat. “Does this virus just turn genes on or off, and go away, but the body goes on to become obese? That’s one scenario,” says Dhurandhar. “The other is that the virus stays in your body and continues to make you fat. In that case one could add an antiviral to other therapies.”
If researchers continue to fail to find traces of the virus itself in the antibody-positive obese, that could mean that the infection itself is long gone, rendering antiviral drugs useless. On the bright side, it could also mean that virally induced obesity isn’t contagious.
“At this point we don’t know whether it’s an acute or a chronic infection,” Dhurandhar says. “It may be that a virus makes a person fat, but once they’re obese, then what they’ve got to do is eat less and exercise more.”
In a slightly cheering bit of news, he says, a small pilot study of people undergoing drug treatment for obesity has shown that those with the Ad-36 antibodies lost weight faster than those who were antibody-free. Dhurandhar thinks that might mean that someone who gets fat as a result of a viral infection may not be predisposed to gain weight — unlike those of us who chose our ancestors unwisely and are therefore genetically more resistant to weight loss.
Which might mean that fat germs are less fateful than fat genes.
“Maybe,” says Dhurandhar, “but we don’t know right now.”
If Benjamin Franklin was writing his famous letter to Jean-Baptiste Leroy today, his famous aphorism might read: “In this world nothing can be said to be certain, except death, taxes and the obesity crisis.” It seems no matter the year or the season, that crisis inexorably continues, with experts now saying 42 percent of Americans will be obese by 2030. And whether you are one of the 42 percent or not, that trend is going to affect you, because it is expected to cost the country roughly half a trillion (yes, trillion) in additional healthcare costs.
And yet, as relentless as the obesity crisis appears to be, its expansion doesn’t have to be a foregone conclusion. That’s because, unlike a naturally occurring epidemic, it’s almost completely human created — a reality that allows for the possibility of a human-directed reversal.
What does such a reversal require in practice? First and foremost, awareness, and thanks to everything from Michelle Obama’s fitness campaign to HBO’s new documentary “The Weight of a Nation,” that prerequisite is finally starting to be met. But then what? As GI Joe said, “knowing is half the battle” — but it’s only half. Once more of us are aware of the emergency at hand, what will be the most reliable way to address the problem?
In an instant gratification culture obsessed with extreme makeovers and get-thin-quick diet schemes, it’s easy to feel confused about a path forward. But a tranche of new science, data and public policy proposals that cut through the fog of misinformation suggests that path is there — if we’re willing to take it. Here are five of the most promising ways forward.
1. Tax Junk Food
Over the last four decades, we went from spending $3 billion a year on fast food to $110 billion a year on fast food. At the same time, there’s been an explosion in the amount of chemically enhanced, calorie-packed processed foods Americans eat at home, at work and in the school cafeteria. Not surprisingly, in predictable cause-and-effect fashion, this has all happened as obesity became a public health epidemic.
The response from some policymakers has been to champion junk-food taxes, initiatives whose supreme press-release-worthiness can make them seem a bit gimmicky, but whose merits are nonetheless rooted in substance. Indeed, a bevy of new studies show that such levies, when structured properly, can disincentivize junk food consumption on a large scale.
In one University of North Carolina study, ABC News reports that “Patients got significantly less of their calories from soda or pizza when there was a 10 percent increase in the price of either.” In another study of college-age adults, “researchers found that the students generally bought fewer lunchtime calories when sugary, high-fat fare came with a tax of 25 percent or more.” In yet another study, this one from the University of Buffalo, it was much the same result: Higher taxes meant more healthy consumer choices.
New York Times food columnist Mark Bittman has noted that while taxes alone won’t solve the obesity crisis, they are an important part of a multifaceted attack on the problem — and they will also raise much-needed public revenues at a time of crushing deficits:
A study by Y. Claire Wang, an assistant professor at Columbia’s Mailman School of Public Health, predicted that a penny tax per ounce on sugar-sweetened beverages in New York State would save $3 billion in health care costs over the course of a decade, prevent something like 37,000 cases of diabetes and bring in $1 billion annually. Another study shows that a two-cent tax per ounce in Illinois would reduce obesity in youth by 18 percent, save nearly $350 million and bring in over $800 million taxes annually. Scaled nationally, as it should be, the projected benefits are even more impressive; one study suggests that a national penny-per-ounce tax on sugar-sweetened beverages would generate at least $13 billion a year in income while cutting consumption by 24 percent…A 20 percent increase in the price of sugary drinks nationally could result in about a 20 percent decrease in consumption, which in the next decade could prevent 1.5 million Americans from becoming obese and 400,000 cases of diabetes, saving about $30 billion.
Put it all together, and junk food taxes should be about as close to a no-brainer as you’ll find in the public policy arena.
2. Stop Subsidizing Junk Food
There’s no scientific reason junk food should cost less than whole grains, fruits and vegetables. After all, the former are the product of a mechanized process relying on an entire industrial system, while the later can be grown directly out of the ground by almost anyone.
Yet, junk food consistently beats natural foods in the price competition. Why? It’s all about the subsidies.
As a the U.S. Public Interest Research Group’s “Apples to Twinkies” report shows, your taxpayer dollars subsidize junk food and artificially deflate the cost of that junk food so that it undersells everything else. “Between 1995 and 2010, $16.9 billion in tax dollars subsidized four common food additives—corn syrup, high fructose corn syrup, corn starch, and soy oils.” At the same time, PIRG points out that “taxpayers spent only $262 million subsidizing apples, which is the only significant federal subsidy of fresh fruits or vegetables.” To put those numbers into real-world terms, “if these agricultural subsidies went directly to consumers to allow them to purchase food, each of America’s 144 million taxpayers would be given $7.36 to spend on junk food and 11 cents with which to buy apples each year — enough to buy 19 Twinkies but less than a quarter of one Red Delicious apple apiece.”
While studies show that changing this subsidy structure would be no cure-all for obesity, there’s no evidence to suggest that keeping it in place does anything but make the obesity crisis worse — and there is evidence that changing the subsidies would make things better. This isn’t surprising; it’s basic economics.
Think about it: If subsidies for commodity crops that create junk food were redirected into subsidies for natural foods, it would radically change the market incentives for healthful eating. Sans the subsidies, industrial food corporations would no longer be able to price processed foods at artificially lower prices than their natural competitors. Instead, healthful foods would have the price advantage — and, quite likely, bigger market share.
3. Ban Junk Food in Schools
The Obama administration has been trying to reduce the amount of obesogenic foods in school cafeterias, under the theory that stopping obesity-inducing eating habits at an early age might stop the obesity crisis in its tracks. It’s been an uphill fight. According to the Associated Press in February, “Junk food remains plentiful at the nation’s elementary schools,” with “nearly half of public and private schools surveyed sold sweet or salty snack foods in vending machines or other places.”
Nonetheless, new data proves the administration’s efforts, in conjunction with local school districts, are indeed worthwhile. As the New York Times recently reported:
Five years after California started cracking down on junk food in school cafeterias, a new report shows that high school students there consume fewer calories and less fat and sugar at school than students in other states…The study found that California high school students consumed on average nearly 160 calories fewer per day than students in other states, the equivalent of cutting out a small bag of potato chips. That difference came largely from reduced calorie consumption at school, and there was no evidence that students were compensating for their limited access to junk food at school by eating more at home…
To study the effect of this policy, the researchers examined data from the Centers for Disease Control and Prevention on the eating habits of high school students in California, comparing it with data on students from 14 states that did not have nutrition standards for vending machine snacks and other foods sold outside of school lunches and other meal plans…California students had the lowest daily intake of calories, fat and, especially, added sugars.
In light of this, it’s hard to imagine anyone still defending the American school system’s role as glorified junk food machines.
4. Stop Glorifying Unhealthy Eating Habits
In his endorsement of the campaign to legalize gay marriage, Vice President Joe Biden said that “when things really began to change is when the social culture changes … I think Will & Grace probably did more to educate the American public than almost anybody’s ever done so far.” It was an acknowledgment that televisual images often play as big a role in our society as ironclad policies — and the same truism relates to the obesity crisis.
Today, our political culture regularly equates unhealthy eating habits to Americanness and authenticity. As evidence, recall that the party nomination fights have become a kind of televised eating contest, with candidates trying to one-up their competitors with photo ops stuffing corn dogs and cheesesteaks.
The committee now has a White House petition calling on the president to stop undermining his wife’s crusade against obesity and end such photo ops. It’s the least the administration can do.
5. Start Broadening Our Understanding of Obesity
Conventional wisdom holds that a calorie is a calorie, and that if Americans simply take in fewer calories and use more via exercise, obesity can be stopped. But journalist Gary Taubes reports that science now suggests that this formula may be fundamentally flawed — that obesity is a product of specific kinds of calories from sucrose and fructose:
There is an alternative theory, one that has also been around for decades but that the establishment has largely ignored. This theory implicates specific foods—refined sugars and grains—because of their effect on the hormone insulin, which regulates fat accumulation. If this hormonal-defect hypothesis is true, not all calories are created equal…
Sucrose and high-fructose corn syrup have a unique chemical composition, a near 50-50 combination of two different carbohydrates: glucose and fructose. And while glucose is metabolized by virtually every cell in the body, the fructose is metabolized mostly by liver cells. From there, the chain of metabolic events has been worked out by biochemists over 50 years: some of the fructose is converted into fat, the fat accumulates in the liver cells, which become resistant to the action of insulin, and so more insulin is secreted to compensate. The end results are elevated levels of insulin, which is the hallmark of type 2 diabetes, and the steady accumulation of fat in our fat tissue—a few tens of calories worth per day, leading to pounds per year, and obesity over the course of a few decades.
He goes on to note that “back in the 1980s, the FDA gave sugar a free pass based on the idea that the evidence wasn’t conclusive” — but that now, the evidence can’t be ignored.
This isn’t to say that the theories about sugar are 100 percent correct; it is only to point out that if we are going to reduce our consumption of junk food in order to stop the obesity epidemic, we need a better understanding of exactly what junk food is. That means broadening our understanding of obesity’s roots and rejecting the reductionism that says simply that “a calorie is a calorie.”
With the economy still struggling and the debates over how to fix the problem more intense than ever, one word still evokes bipartisan consensus: exports. “I want us to sell stuff,” said President Obama, summing up the bipartisan sentiment.
That nebulous word “stuff” is significant. It asks us to see all exports as the same and to refrain from making nuanced value judgments about what exactly we’re shipping overseas. In this coldblooded view, a job-creating export is a job-creating export, and that’s as far as any conversation should go.
At first glance, such reductionism seems logical, rational, even boringly uncontroversial. But two recent news items highlight how in a globalized economy, there are troubling consequences that come from the particular kind of export economy we’re building.
The first bit of news came from the Washington Post, which this week reported that “the Obama administration is crafting a proposal that could make it easier to export firearms and other weapons.” Though the Homeland Security and Justice Departments say the new rules could make it easier for terrorist and drug cartels to further arm themselves, the White House is nonetheless citing the “stuff” theory of exports to ignore the objections.
This is part of a larger pattern since President Obama took office. During Obama’s first year in the White House, he began to gut the Pentagon’s approval process for arms exports, weakening controls on what could and could not be sold. Later, diplomatic cables uncovered by WikiLeaks showed, as Fortune magazine put it, “American officials act(ing) as de facto pitchmen for U.S.-made weapons.”
The result is that America has become the true “Lord of War,” as the arms dealer motto goes. We are the leading arms supplier to the developing world and we are responsible for the majority of all weapons sales across the globe. Yes, we are so committed to selling instruments of death to the rest of the planet that military industries have almost tripled their share of the U.S. economy in just a decade.
The second bit of news came from the Institute for Agriculture and Trade Policy, whose new study shows that America is exporting our obesity crisis to Mexico. Coupling health statistics with U.S. export data since the North American Free Trade Agreement tore down Mexico’s agriculture trade barriers, researchers found that the Mexican market was flooded by American agribusinesses’ taxpayer subsidized commodities (corn, soybeans) and their processed derivatives. According to the report, that quickly wiped out Mexico’s local food economy, leaving its food system exactly “like the industrialized food system of the United States — characterized by the overabundance of obesogenic foods.” Not surprisingly, Mexican obesity rates have consequently skyrocketed.
Taken together, these export booms represent what could be called America’s new Guns and Butter economy. We are so desperate to export any “stuff” we can, we are now fattening up the world and arming it for permanent bloodshed.
Seeking to short-circuit any objections to this trend, President Obama has said simply that “we’re at a moment where necessity has tempered the old debates” over exports and economic policy. In terms of history, he’s not wrong — during the previous century, America witnessed fevered fights over what constitutes a moral farm policy, and in the 1930s the U.S. Senate’s Nye Committee held almost 100 hearings into “greedy munitions interests” that were unduly influencing public policy. Sadly, Obama is correct – those debates have been silenced.
But should they be? Should we simply say that any exports — no matter their moral, ethical, environmental or health implications — are inherently good? Does “necessity” really mean that “stuff” for stuff’s sake must be the basis of our export economy?
Washington and profit-at-all-cost industries certainly say yes — but that doesn’t mean it’s the right answer.
January sucks. Every magazine cover is festooned with the image of a celebrity in a bikini, promising you the secrets of a BETTER BODY for the new year. Your friends are all going on juice fasts. And the answer to “Feel like going for a bike ride today?” is “Maybe sometime when it’s not 11 degrees out.”
So here’s a crazy idea. This time, let’s not use the beginning of the year as an excuse to hate on our bodies. Let’s not swear to get a tinier butt by Memorial Day, or even Labor Day. No 21-day “action plans.” No master cleanse. Nothing, in fact, that sounds like an enema from a dominatrix. Instead, let’s do something radical. Let’s do something small.
In just the time it takes to realize that “Work It” is the worst thing that ever happened to television, you could change your life. Thirty minutes a day. That’s the minimum amount of physical activity the CDC recommends to stay fit. Yet approximately 30 percent of Americans get no weekly activity at all. Zero. Not even candy-ass pastimes like gardening. And many more of us aren’t exactly wearing out the gym membership cards. Right now, the only thing moving at a fast pace in our country is the obesity rate – 30 percent and climbing.
In an already over-saturated life full of work and family and errands and commuting, it’s often grueling to find 30 minutes to do anything at all. There are days when carving out a window of opportunity to grab a shower feels like a big deal. But I promise, a half-hour is not a lot of time. Treated seriously and honored consistently, it’ll do a lot more for your health and well-being than that spinning class across town you go to once a month. And don’t you deserve as much loving attention as you’d give your car or your iPad?
Here’s what you need. Sneakers. A mix of cardio and strength training. An understanding that you can’t fool your body by not making an effort. A casual saunter on the treadmill while tweeting isn’t going to do jack. You know that lady in the Apple Siri ad, the one who wants to be reminded to call Chris while she’s going for a run? Yeah, don’t be her. No talking on the phone. No checking the weather. And no excuses. Thirty minutes to put in real work, whatever work feels like for your fitness level. (Here’s the inevitable reminder that this isn’t medical advice, and you should talk to your doctor about a plan that’s realistic for you.) Here’s the payoff. Research says that you can build bone density and ease the symptoms of arthritis, high blood pressure and even depression. If this stuff came in a pill, it’d be hotter than Viagra and Effexor put together.
Like a lot of people, I spend most of my days on my butt. Yet I have a beautiful heartbeat. When I see my doctor for my weekly health monitoring, he smiles appreciatively as he presses the stethoscope to my sternum, praising my “slow, steady, runner’s rate.” And last summer, shortly before my lung surgery, the respiratory technician was similarly complimentary. “Look at that pulmonary function,” he said encouragingly as I puffed into a tube. “I can always spot the yoga people.”
Now here’s what you need to know about me. I was always chosen last in gym class. I can’t open a jar of pickles without assistance. I don’t train for marathons. I will never be on the cover of a magazine, Valerie Bertinelli-style, flaunting my abs. I have a body that’s over 40 and has birthed two children, and looks it. And many days, I don’t want to get out of bed. But I put in three and a half hours of exercise a week – mostly running, mixed with the use of a pair of five-pound dumbbells and a yoga app on my phone. I breathe hard. I stretch muscles. I resist gravity. Then I’m back on my butt, possibly holding a beer. That’s it.
Good health should not be reserved for the perky sporty types. Screw the jocks. Almost everybody, of every age and fitness level, can afford a half-hour a day. You can. Why am I telling you this? Because when the surgeon had to cut some cancer out of my lung last August, I was pretty happy I could breathe unassisted afterward. And because I hope that if you’re ever in a similar situation, you are likewise prepared.
This year, it’s not about fitting into those jeans that linger accusatorily in the back of the closet. It’s not about the scale. It’s about getting in touch with what we humans were meant to do – move around. It’s about taking the stairs. It’s about being able to play with your kids. It’s about those sweet, sweet endorphins. And it’s about knowing that though we’re all different, we’re all capable of greater wellness. Is it hard sometimes? Does it get boring at times, day in and day out? Sure. Is it achievable, and is it worth it? Always. But don’t listen to me. Listen to my beautiful heartbeat. Now get out there and thump along. And tell me about your progress — I’ll be right alongside, cheering you on.
Is childhood obesity child abuse? Child services officials in Cleveland seem to think so. They recently removed an 8-year-old boy from his mother and placed him in foster care — because the child tips the scales at over 200 pounds. Department of Children and Family Services spokeswoman Mary Louise Madigan told the Cleveland Plain Dealer that the boy’s condition constituted “a form of medical neglect.”
“This child’s problem was so severe that we had to take custody,” Madigan said, adding that her office had worked with the boy’s mother for over a year before removing him. The boy first caught the attention of child services when his mother brought him to the hospital last year with breathing issues. He was diagnosed with sleep apnea, and now uses a machine to assist his breathing while he sleeps.
Was the boy’s mother, in fact, neglectful? That’s something the state still appears to be determining. The boy’s mother told the Plain Dealer that “They are trying to make it seem like I am unfit, like I don’t love my child. Of course I love him. Of course I want him to lose weight. It’s a lifestyle change, and they are trying to make it seem like I am not embracing that. It is very hard, but I am trying.”
But how do you undo deeply ingrained patterns, combined with a damming family history? Both of the boy’s parents are overweight. (His teenage brother is not.) For her part, the mother says she enrolled the boy in a local Healthy Kids, Healthy Weight program at a local hospital. She got him a bike. She says she tried to talk to him about what foods to eat. And for a while, he lost weight. Then he gained it back — and then the county intervened. He was taken from his school last month, and now his mother sees him once a week for two hours. Reps for the county say he has, in the past few weeks, lost “a few pounds.”
Was his removal an overreaction or a necessary intervention? In a July piece for JAMA, the Journal of the American Medical Association, Lindsey Murtagh of the Harvard School of Public Health and David S. Ludwig of the Children’s Hospital in Boston recommended “State Intervention in Life-Threatening Childhood Obesity.” In the article, they noted, “Improper feeding practices, causing undernourishment and failure to thrive, have long been addressed through the child abuse and neglect framework.” If we consider it a social responsibility to step in when a child is being starved, should the same imperative apply if he’s overfed? Aren’t both forms of malnourishment?
Deprivation, however, has a very different connotation. The notion of being harmed by having too much has generally been too unusual to consider seriously. Now, however, 20 percent of American children between the ages of 6 and 11 are obese — and approximately 2 million of them are extremely obese.
Public defender Sam Amata said Monday the removal of the Cleveland boy would be challenged on the grounds that he was never “in imminent danger.” It should, however, be uncontroversial to say that a 200-pound child – well over triple the average third-grader’s weight — is a child whose health is severely at risk. He needs help, and so does his family. Not diets, not restrictions, but help. Help shopping. Help cooking. Help embracing physical activity.
Yes, parents are responsible for their children. And extreme obesity may be a sign of deeper, more severe issues at home. But it is nonetheless seriously disgusting to see children wrenched from their parents when, at the highest levels, we are represented by a government that has made it abundantly clear it would prefer to pander to the interests of the frozen food industry than reform childhood nutrition. One in which presidential candidates mock children’s health initiatives as “nannying.” Even the authors of that provocative JAMA story recommended governmental “investments in the social infrastructure and policies to improve diet and promote physical activity among children.” It takes a village to raise a child without a body-mass index number in the danger level.
Imagine if you were a little boy, perhaps without the best body image, and you knew that seeing your mom was contingent upon losing weight. Now imagine the over 12 percent of third-graders in Ohio who are severely obese and may now be facing a similar fate. Whatever you think of parental accountability for childhood obesity, ask yourself this: If one child can be removed, what happens to the rest? Who’s going to decide which parents of obese kids are neglectful? And who will take care of their health when neither their government nor their families seem to know how?
I was channel surfing mindlessly, avoiding some household chore, when I landed on a cable talk show discussing child abuse. The guests were talking about horrible things: parents who starve children, beat them or sexually abuse them. Parents who let their children get fat. This last one, one woman leveled, was the same as any other form of abuse and deserved the same unequivocal response: Remove the kids from the parents.
I had happened upon yet another media debate in response to the controversial JAMA article that came out a few weeks ago. This study looked at whether intervention was ever warranted when parents allow their children to become dangerously obese. The study itself was balanced in its approach, but the talking-head response was anything but. This particular pundit — shoulder-shrugging with a clear look of disgust on her face — talked about taking fat kids away from their parents as if it were nothing more than trading in a car. I had to turn the TV off, my stomach in knots.
I wondered what this woman would say if she met my own parents. Would she blame them for the way I turned out? For that matter: Should I?
Let me back up a bit. I’m fat and have been since I was a toddler. Not “trapped in my trailer” fat, or “have to use an extra-wide electric wheelchair at the grocery store” fat, but medically, technically, morbidly obese. I confess that whenever I hear that term — morbidly obese — I giggle, because I picture chubby Goths with back nail polish and dog collars. That is not to say I do not take it seriously, because I do. It is the first thing I think about when I wake up in the morning, the last thing on my mind when I go to bed at night. And I will never be a member of the “fat acceptance movement,” because I don’t accept it. I have been fighting my weight for over 35 years.
But I don’t believe I deserve to be hated, and hate is what I feel every single day as a fat woman. I feel it in the stares from strangers’ children, and when someone screams “fat ass” as I walk my dogs. I feel it when I get a flawless performance review, but my boss asks if I have considered weight loss surgery — as if that has something to do with my professional skills. I feel it in the constant stream of media images about what women should look like, in the tired fat jokes from comedians (come on, stop phoning it in — get creative!), and in the constant articles about the doom that is The Obesity Epidemic. Fat people are taxing the healthcare system, they make other people uncomfortable on planes and trains, they use more fossil fuels because it takes more gas to haul their big butts around thus causing global warming, and they suck up the world’s food resources while others starve.
And yet, I understand: These arguments aren’t without merit, and it is after all human nature that some people express their points with meanness and derision. I don’t take it personally.
But even at my most open-minded, I could not bear the debate that erupted in response to the JAMA article (and the derisive online comments). While the study, by Dr. David Ludwig and Lindsey Murtagh, did suggest that obese children — in some extreme circumstances — should be taken away from their parents, coverage of the article focused on the most sensational elements of the argument. It resulted in a cascade of hate on cable news and morning shows that was packaged as concern for children, like that disgusted-looking pundit who made me sick to my stomach.
Did my parents make me fat? Probably. They fed my siblings and me meals of bologna on white bread, hot dogs and potato chips. They let us have four of those Oreo-knock-off cookies-that-don’t-quite-taste-right in a sitting, rather than one or two. They used fast food as a reward and eating in general as a form of entertainment. If I was upset, I might be offered a tasty snack as a pick-me-up. Even if nothing got done all day, not the dishes, not the vacuuming, not mowing the lawn, by god dinner would get done and there wouldn’t be any leftovers to pack up and put away. I suppose to some people it is a portrait of failed parenting.
But my parents are also a success story. They were teen parents. They had me — the eldest — at age 16. It was not a mistake but a planned pregnancy. My mother grew up in a household where she faced daily abuse at the hands of people she trusted. There were challenging finances and in a family with eight children, food could sometimes be scarce. My father grew up in a slightly more stable financial situation, but where violence was the primary outlet for anger, or disappointment, as well as for discipline of children. When these two wounded, but hopeful souls met they made a forever pact in heart-shaped doodles on their class notebooks. They crafted an escape plan: Create their own family where they would make different rules. That is just what they did.
And they did it all on their own. My dad worked two jobs while finishing high school. My mom went back to night school after I was born. Dad worked double night shifts and Mom cut coupons and raised the kids while balancing work at McDonald’s. They never got welfare. They never received food stamps. They modeled hard work and commitment and most of all, love. They are still married — still go out on date nights and still laugh and look longingly in each other’s eyes — almost 40 years later.
Doctors did warn them about the children’s weight, and these problems were not ignored. My mom worried. She ached for me when I came home crying after schoolmates teased me all day long. She was my biggest cheerleader when, in the fifth grade, I became the youngest member of the local Weight Watchers group to reach the 50-pound weight loss mark. She saved money we didn’t have to buy weight-loss shakes and exercise equipment. She went without sleep sewing cute clothes that actually fit well, unlike the pricey crap in the husky department. Dad did his best when he wasn’t working.
But once the fat is on, it is hard to get it off. When you get it off, it comes back with a vengeance. My parents could never quite bridge the gap between what was recommended and what we could afford, between what they went without and what they would never allow us to miss. And who’s to say what part their parenting played in all this, really — which part was simple genetics and which part of was the learned behavior of emotional eating; which part overindulgence and which part the negative side effects of yo-yo dieting; which part was uncooperative children and which part plain lack of knowledge and time. To think of that pundit giving such a disgusted look to my parents, crushes me. They tried so hard. They, in fact, did way more than so many. From troubled beginnings, they created a family where the cycle of violence was broken, where their children had access to more education and opportunity than they had. Did they make mistakes with food? Yes. But there was nobody better to raise my siblings and me than the two people who sacrificed so much to make sure we grew up happier and healthier than they had.
That’s the real point here: We are healthier for their efforts. No matter our size.
Stacey R. Hall lives and works in southwest Ohio, where she regularly walks her dogs, despite the rude yelling, and works with her siblings to educate the next generation on healthy eating, exercise and the importance of family.
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