What can stop obesity?
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Karen Hitchcock, The Monthly


© Karen Kasmauski / National Geographic Stock

Why obesity is not your doctor’s problem.

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I have heard people say thinness is beautiful and coveted because it is difficult to achieve and rare now, the way curves apparently appeal in times of famine. There are activists who have set out to challenge the fat-is-ugly paradigm, to curb all this body hatred. I am sympathetic to many of their aims. However, their attempts to manipulate what we find beautiful have been crashingly unsuccessful. The Adipositivity Project – which uses artful photographs of morbidly obese half-naked models to reframe fatness as a thing of beauty – remains separatist and marginalised. And the occasional cover shot featuring a so-called plus-sized model is hardly cause for jubilation. These models – often thinner than the nation’s average – are freakishly well-proportioned Amazons with flawless faces. The pro-fat bloggers are smart, sassy and pissed off. I’d hang out with them. Yet, if they could click their fingers and be thin, would they? Would Lena Dunham? “I don’t want to be skinny like a model,” I’ve had more than one patient tell me, “I’d just like to look like Kate Winslet.”

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his year I started work as the physician in an obesity clinic with a group of bariatric surgeons. No one else really wanted to do it. The attempt to help people lose weight is generally seen as one of the most futile acts we as doctors of internal medicine can perform: pretty much all we can do is make you feel crappier about yourself than you already do.

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If you are overweight, you cost 25% more per year to keep healthy than a slim person. If you are obese, you cost 45% more. And no drug can fix the functional impairment of being obese. Strap two fully loaded suitcases to the back of someone of normal weight and make them walk up stairs. That only gets them to around 120 kg, which isn’t even close to the weight of many patients I see breaking into a sweat on the walk from the waiting room to my office, their knee joints slowly disintegrating. But so what? Motorised scooters are not so expensive. They too could be covered by Medicare.

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In some ways, scientific research has taken obesity outside the realm where it is a consequence of choices made by a more or less free-willed individual in a more or less free society, which nonetheless disapproves of excess. In current medical research obesity is often conceptualised as an unavoidable disease. It’s your genes, your metabolism, the chemicals in your environment, what your mother ate when she was pregnant, whether she fed you at her breast. It is everything but what you choose to put in your mouth.

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Very few people get obese and none get morbidly obese through the consumption of home-cooked whole foods. To get that fat, for most people, takes piles of highly refined, ready-to-chow junk food and drink. Try googling “what I ate when I was fat”.