Weight Maven

The May issue of The Atlantic includes a lengthy article by Marc Ambinder, Beating Obesity, that is part policy discussion, part personal story.

The policy discussion is pessimistic; the personal story is perhaps more optimistic. Ambinder had weight loss surgery a year ago, and has lost 85 pounds, becoming what a colleague refers to as “a ghost of my former self.”

But I say perhaps more optimistic for a number of reasons. First, Ambinder notes that his insurance didn’t cover his $30K surgery. I don’t know (he doesn’t say), but I’m guessing it is because he wasn’t heavy enough. Doing a reverse calculation for a BMI of 34 and a weight of 235 puts Ambinder at just under 5′ 10″ tall.

Is 235 too much for that height? Clearly. Is it the kind of excess weight you normally associate with weight loss surgery? I don’t; my understanding is that typically patients need to be morbidly obese with at least 100 pounds to lose.

But that’s one issue. The other is that Ambinder is still in the early glory days of WLS. After time, the weight can come back. And I suspect it’s at a much higher rate than acknowledged; of the people I know who’ve had weight loss surgery, more have plateaued at a higher weight than desired or regained much of their initial loss.

So I think Ambinder’s current success colors his analysis just a tad. It’s not that he doesn’t identify the elements that make fighting obesity such a wicked problem, it’s that it seems that the fact he has beaten obesity means that it apparently can be beaten; we just need to figure out how to scale the solution. But this can be said of any approach to obesity. For every Ambinder, there’s someone else who is convinced that diet and exercise is the key, or prescription drugs, etc.

But Ambinder certainly speaks to the bleak future for addressing our obesity problem:

the debate on how to deal with obesity remains frozen. On one side are the proponents of individual responsibility, who believe that fat people suffer from a surplus of self-indulgence and a shortage of willpower. On the other are people who believe that Americans are getting fatter because of powerful environmental factors like cheap corn, fast food, and unscrupulous advertising. Each side is held in political check by the other, and both have advocated unrealistic solutions: diets and exercise programs and miracle drugs that don’t work versus massive, and in many cases punitive, government interventions that are politically impossible.

Ezra Klein had some interesting commentary on this point. In one blog post, he notes:

Obesity is much more structural than it is personal. That’s why it’s so depressingly predictable. It afflicts certain communities, with certain socioeconomic characteristics, and it has only really emerged across a certain time period. Those communities contain a lot of different individuals, but their environments and their time and money stresses and their transportation and grocery options and their street safety and exercise opportunities are broadly similar. How we live has changed much more quickly than who we are, and no effort to turn back the tide on obesity will succeed without an accurate understanding of what’s made us obese.

I’m always encouraged by anything that gets away from the individual responsibility, “eat less, move more” school of thought. But as Klein points out in a follow-up blog post, Ambinder’s analysis:

lends itself to either punitive, government interventions that are politically impossible or miracle surgical interventions that are expensive and dangerous. In this case, the only answers that even approach the scale of the problem are far more extreme than anyone is comfortable with. But the fact that we’re not comfortable with extreme answers doesn’t mean more moderate interventions will be effective.

What’s particularly scary is Klein’s conclusion:

I think it’s quite possible that a mix of surgeries and pharmaceuticals eventually becomes our society’s answer to obesity. The risk of these treatments will go down, their efficacy will go up and their cost will settle into a more affordable range — particularly compared with the cost of treating the complications of obesity.

Well, yes, obesity IS a wicked problem … one that Klein references professionally rather than personally (he’s one thin columnist!). But the thought of medicating or surgically altering potentially 100 million or so Americans is pretty damn frightening. At the risk of being flippant, is it that we can send a man to the moon, but we cannot address the causes of obesity? Or as Thomas Frieden says (via Ambinder), perhaps it is that just “being an American can naturally lead you to be obese.”

I’ve only recently started reading Stuffed. It’s probably too much to hope that industry can be more of a solution than the problem, but I find the alternative way too depressing.

Update, 4/19: Ah … how’s this for connecting the dots. Ambinder is also Samuel T. Stanley, a “a pseudonymous reporter living in Washington, DC … who received gastric bypass surgery at George Washington University hospital.” I remember thinking at the time that Stanley mustn’t have been very heavy. In one of his posts, he talks about looking “normal” or “ordinary” or some such, just a month of two after his surgery.

I certainly understand the struggle though. Hope that his WLS success endures!