Sunday, June 2, 2013

Questions Of Obesity From The Perspective Of A Frustrated Doctor

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."

I don’t know if there is any force that could purposefully change a culture’s definition of beauty. Is fat inherently ugly? Ask Aristotle, Susie Orbach, Naomi Wolf. Their answers are different, their arguments from different places. It is not an empirical question although it reads as one. Today when we look at those who are thin, part of what we see is a triumph of will over gluttony, so the beauty is a moral beauty; it has little to do with health.

Questions of aesthetics aside, obesity is bad because it causes disease by, for instance, raising blood pressure and cholesterol levels, stuffing your liver full of fat, blocking your throat so you can’t breathe at night, crushing your joints. Fat people are more likely to get blood clots, gallstones, gout and some cancers – as well as type 2 diabetes, which leads to all manner of medical mayhem. Fat men and women make less money, marry less often and are less educated than the lean. They are more often depressed. In the Framingham Heart Study, which has examined the causes of cardiovascular disease across generations, the very fat lived on average six to seven years less than the lean. The moderately fat lived three years less. If you quit smoking and get fat, you may as well have kept on smoking. These dire facts are not my opinion. They are based on empirical data extracted from large international trials and studies. I wish it were not so. I wish you could get really fat and stay healthy. I wish you could get morbidly obese and be considered beautiful. Maybe it will change with time, as we all become enormous, and we’ll look back on the skinny-is-beautiful era with distaste, regarding high cheekbones, defined jaws and long sculptured thighs as skeletal and ugly. I cannot imagine this, but neither could I have imagined that we’d end up in a world so fat.

I listened recently to a neurosurgical registrar describing the difficulty of finding a spinal fracture under 10 centimetres of adipose (fatty) tissue. Neurosurgeons love precision; one false move on the inside and you won’t remember your mum. The registrar’s voice was filled with a kind of shocked horror. She had to send the car-crash victim to the scanner mid operation, with a metal screw embedded in his neck so the surgeons could find their bearings beneath the mattress of fat. Post-op, none of the neck braces were big enough to fit. To immobilise the man’s spine the team used sandbags.

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