I'm not really all that mysterious

fatness and the tragedy of efficiency

Being a Person of Greater Mass™ myself, I understand the discrimination against fat people. (I think the epidemic of anorexia nervosa and body dysmorphic disorder among women is another thing entirely, and very bizarre and disturbing, but that is another tale in the telling. Seriously, though, there are way too many women who are either healthy or dangerously underweight who continue to claim that they’re too fat, and sometimes I have to repress the urge to send them all to the inpatient psych ward on the grounds that they are a danger to themselves.)

On the other hand, being a health care professional, I can’t deny the reality that being overweight or obese puts you at higher risk for deadly diseases such as diabetes mellitus type II and coronary artery disease. Too many studies show time and time again the definite association.

Part of the problem is the crap that is cheaply available in the U.S. Starting with the bizarre farm subsidies from the USDA where the government actually pays farmers not to grow food, the food pyramid is completely inverted in this country. Whereas in most of the world, red meat is sold at a premium and is not frequently indulged in, we eat entire cows for breakfast. It is the unfortunate truth that the poorer you are, the crappier you eat. In developing and undeveloped countries, if you aren’t starving or malnourished, you’re typically eating basic staple foods: unprocessed grains, vegetables, maybe fish or even chicken if you’re lucky. In the U.S., you’re eating hamburger meat, McDonalds or Burger King, and it’s still cheaper for me to buy a big slab of beef that to buy decent vegetables.

The big problem with obesity is that, genetically, many of us are cursed with metabolic efficiency. Meaning, some of us tend to store calories more efficiently than others. In prehistoric times, before the Agricultural Revolution, this made a lot of sense. You would eat meat rarely, but when it was available, it was important to eat up as much as you could and store it up as fat, and try to subsist on grains and roots and whatever fat you managed to buildup until the next major kill came along. The less efficient metabolizers would tend to die off during long, hard winters. But in the age of fast food and being able to order pizzas without leaving your computer, this will kill you.

The group of people where this seems to be the most evident are the Pima Indians in the American Southwest. Straddling the U.S-Mexican border, there have been studies that have demonstrated that, despite sharing the same genetic predisposition to obesity and diabetes mellitus type II, Pima Indians in the U.S. are fatter than Pima Indians in Mexico and it seems that the more sedentary lifestyle and unhealthy diet available in the U.S. is what literally kills them.

Efficient metabolizers. What can I say.

Now the discrimination thing sucks, because it’s about the disease, not the person. (There’s that damned Calvinistic thing going on again—this disturbing propensity for teleology and relating it to spiritual salvation that is what is completely wrong and un-Christian about religious fundamentalists in the U.S.—blaming the victim for their suffering, essentially, but I digress.) But the thing that’s different about obesity than, say, being dark-skinned, or being female, is that you can actually change the fact that you’re obese. (OK, sure, you can change the color of your skin or switch genders, but those are honestly quite extraordinary cases.) Sure, it’s not easy to lose weight, exercise, and eat healthy—far from it, and who am I to talk—but, come on, there are people out there who have given up smoking crack, people out there who have given up shooting heroin, hell, people who have given up cigarettes (nicotine being the most addictive substance of all these drugs.) It can be done. You just can’t have an all-or-nothing attitude. There’s no need to lose 30 pounds in a week (unless we’re talking about morbid obesity here, but honestly, that’s not that common.) Seriously, just losing 5 lbs in a year decreases your risk for stroke and heart attack by an impressive margin.

Interestingly, this comes on the heels of reading about why motivation by external rewards does not work. And negative feedback—motivation by threatening consequences—certainly does not work. The example of how the threat of death rarely motivates patients with terrible cardiac disease to change their lifestyles is invoked as well. It is impossible to motivate someone. Motivation comes from within, end of story.

So for all those fucked-up people who think that fat people need to be told repeatedly to lose weight and who deserve dirty looks for being large, give it up. Live and let live. Or mind your own damn business. You’re just lucky you have a wasteful metabolism that manages to burn up all that extra fat and sugar you’re eating, but, guess what, unless you actually eat healthy all that shit will still clog up your arteries, and you can still get Mad Cow disease, so there.

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