As the war on obesity rages, fuelled by Federal and State Government-sponsored strategies, spare a thought for the thousands who are genetically destined to be overweight.
Obesity experts didn’t want to go on the record officially with statistics because specific large-scale studies haven’t been done, but they gave a range from 21,000 Australians to 200,000 who are meant to be big.
As part of natural diversity, about one to two per cent of the worldwide population have a Body Mass Index (BMI) that’s greater than 40. In addition, there are those who have develop medical conditions or are taking medications that cause weight gain.
It can be difficult living in a society where large people are generally viewed as unattractive, weak-willed, lazy, unfit, and gluttonous, and costing a fortune in health care.
Some overweight people accept their size and reject terms such as “morbid obesity” and “overweight”. They reclaim the word “fat”, but didn’t want their real names used because of the stigma.
Anne, 32, turned up to a show at the Sydney Opera House only to find that the chair was too small. “I had to sit on the steps next to my seat, as it was too narrow for my hips. The staff did not have a problem with it but I felt self-conscious and embarrassed.”
Anne describes the negativity she’s experienced as mostly “interpersonal”. “People feel entitled to shout abuse at me for being fat and strangers approach me with suggestions on diet and exercise.
“Parents use me as a cautionary tale, pointing and loudly telling their children that if they eat too many lollies they’ll end up like me.
“I try to eat a fairly balanced diet, but I’m not obsessive. I have quite an active life and no car, so I walk a lot every day out of necessity.
“I’ve spent probably the best part of 10 years learning to accept myself as I am and to see myself as beautiful. I found out about the `Health At Every Size’ concept. I recognise that my body is strong, it works, it does everything I need it to do… the rest is aesthetics and there’s no right or wrong for that.”
Laura, 42, has a hormonal medical condition, and doesn’t own a set of scales. “People make derogatory jokes and it’s not considered anything other than funny. One of the ladies I work with regularly calls overweight people ‘fat f—ers’ and everyone laughs. Who am I to say, ‘Sorry that’s offensive to me’ when there’s a room of people laughing? I learnt to just laugh along.”
Hanging out with slimmer friends is discouraging. “My friends go pubbing and clubbing and don’t invite me. I know it’s because they are all size 10 to 12s and I’m not. I look at their Facebook accounts and there are pictures of events I’ve been at but there are no photos of me. I also had my photo taken with friends only to see on Facebook that I’ve been cut out of the picture and that really hurts. It’s as if they don’t like being associated with a fat chick and it’s not easy to deal with.”
Lara says that when she goes to the gym: “Everyone steals glances and gives me that face which says: ‘Oh my God, a fat person is finally getting off their arse and doing something.’ Then the staff train me way too hard because they think that’ll encourage me, but it only reminds me of what I can’t do and how stupid I look trying.”
She says The Biggest Loser reality show, where large contestants compete to lose weight, is “terrible”. “It’s a reminder of how unacceptable it is to be overweight. It humiliates contestants. It gives friends and colleagues another opportunity to laugh at how dreadful fat people look and how funny it is to watch them try and exercise. I’ve heard those conversations in the tea room. And no one ever seems to mind that I’m standing right there next to them.”
At work, Laura was told during a casual conversation with her superior that she couldn’t advance within the corporation until she’d lost weight. “She said it was so my discipline and self control wouldn’t be questioned. I was so shocked I said nothing. All I could think of was “Oh my god is that what people think of me?” I never went for any jobs there after that.”
But her main peeve is when she loses some weight and everyone says: “Wow, you look so fabulous now.” “They mean well, but they have no idea they have just invalidated me as a person for all the time they have known me before I lost the weight.”
Jenny, in her 50s, was refused income protection insurance for illnesses because her BMI is over 40. On her behalf, an insurance broker contacted many insurance companies and all knocked her back.
“I want insurance because I have mortgages and kids,” Jenny says.
“This insurance thing has floored me because they seem to assume that fatness is a terminal illness. There has been no medical assessment and no option to have one.
“I am a happy and healthy fat person. I have a great professional job earning around $100,000 a year, three post graduate qualifications, a family and lots of friends. I eat healthily and exercise.
“Weightloss surgery is risky but I would get insurance if I took that risk.”
An Investment and Financial Services Association spokesman said there wasn’t a set industry benchmark, though some insurance companies have loadings for people with a BMI above 30. He said a financial planner could “negotiate something but not a lot of companies offer it”.
Meanwhile, Jenny says fat people are “the new social pariahs, but we can’t hide like smokers do”. “I hate wording like the ‘war against obesity’, because it’s a war against me, and other people like me. People shout abuse and stare all the time.
“I know a young woman who was so ashamed of her size that she lost her Centrelink cheque because she would not leave the house to look for work.
“I have done a lot of work to love myself as I am, and was lucky enough to find the US email group Fatdykes which has been a lifesaver.”
She said people are often told to lose large amounts of weight before doctors will bother trying to find a cause for their health problems.
“Poor medical treatment is a very common story. Every time I change doctors they want to measure my blood pressure and blood sugar, even if I just want to get treatment for a cold.”
Jake, 42, regularly does a 25-kilometre walk around the city on the weekends, or six to eight hours of “solid dancing at a party”.
He found being a long-time member of the social club, Harbour City Bears, has been helpful. The group is for large, gay men and their admirers, and meets weekly in Sydney.
“Harbour City Bears is accepting of all body types and sizes. I found that I, and a lot of my friends, have grown happier, and healthier, in this environment.
“The greatest treasure of the human race is its diversity. We are not Barbie and Ken dolls, unfeeling plastic extracted from one mould. We are all people, and deserve to be treated with respect and acceptance.
“I won’t call you a mindless gym junkie if you don’t call me a lazy fat ass.”
Some of the activities that overweight people can’t do includes amusement park rides, bungee jumping and jet skiing. On the health front, they’re usually denied access to invitro fertilisation and the right to adopt for failing the medical test. While there is no BMI benchmark, a spokeswoman for the NSW Department of Community Services, which arranges adoptions, said applicants must have “appropriate age and fitness to have a reasonable expectation of retaining health and vigour to raise a child until adulthood”.
Obesity is blamed for causing an increased risk or contributing to asthma, arthritis, dementia, kidney disease, type 2 diabetes, heart disease, strokes, hypertension, colon and breast cancer, gall bladder and respiratory diseases.
Insurance company studies estimate obesity can wipe up to eight years off life expectancy. Some academics want to label obesity itself as a “disease” though this is an ongoing worldwide debate.
Some hospitals won’t allow operations on obese people because it can be more expensive due to complications, and new hips and knees can wear out sooner.
Dr John Quinn, the executive director of surgical affairs for the Royal Australasian College of Surgeons, says morbid obesity “greatly increases” the risks of surgery.
He said weight-loss gastric band surgery has different risks and these are offset by the prospect of a safer outcome for other, more major, surgery.
“The need for joint replacements is often caused by obesity,” Dr Quinn says. “If there are no other changes in the person’s lifestyle, then the surgery doesn’t work.” He said it’s “more difficult and complicated” to perform surgery on obese patients by getting access to organs, there’s more chance of wound infections, delayed healing, respiratory complications and an “astronomically increased” chance of Deep Vein Thrombosis before and after surgery, cardio problems and anaesthesia problems.
Lawyer Mirko Bagaric, who writes about moral and political philosophy, said private institutions trying to make a profit are entitled to “make different judgments” to the public sector which has to treat everyone as they are.
“Health care is about minimising pain and distress. Hospitals don’t exist to only treat healthy people,” he says.
“We could say that some people drive too much instead of taking public transport. Should we refuse to spend money on motorists who get into accidents? It’s absurd.
“Is there anything really wrong with being overweight? No one has a pristine life.”
As for surgery being more risky, Bagaric said: “It might be, but the risk and expense is worth it if there will be a better health outcome.
“So what if it’s more expensive? Fat people pay taxes too. It’s repugnant to not alleviate preventable suffering. Everyone’s entitled to health care.”
He said there was no reason to prevent fat people from adopting. “The point of adopting is to advance the needs of the child. There is no proof that fat people are less equipped to be good parents or worse than others – they should have the same rights.”
He says it’s the “height of arrogance” to judge the whole person on one criterion.
“We all want to be the ideal weight but for some people their wiring is different. They’re not moral or social retards. Being overweight can’t be comfortable. Try putting yourself in another person’s shoes. The time for judgments is over.”
Health promotion advocate Lily O’Hara, an academic on the Sunshine Coast, is a board member for the international Association for Size Diversity and Health.
“There’s no local formal group in Australia that advocates for the Health at Every Size paradigm and there’s a need for one,'” Ms O’Hara says.
“The Government’s propaganda is very negative and derogatory – people are marginalised and oppressed. Losing weight is made so important by the dieting industry, television and governments.
“You can’t use terms such as epidemic, war, battle and timebomb to frighten people to change their body shape. As the ‘war on obesity’ rhetoric increases, so does the fat-hating community and there’s an increase in the rates of fat people vomiting, starving and smoking.
“Telling people to ‘just try harder’ doesn’t work or lead to sustainable changes.”
Professor Paul Zimmet, the director of the International Diabetes Institute, and an expert in obesity and type 2 diabetes prevention, says the terms, “war on obesity” and “obesity epidemic” could make individuals feel persecuted, but this is outweighed by raising political awareness. “Because of these terms, six years ago, it became a Federal election issue for Howard and Latham. There was increased funding and lots of national action.
“Epidemic is not a loose term. National surveys in 2000 show 60 per cent of Australians are obese or overweight. This has a huge economic cost to the nation.”
Professor Ian Caterson, the director of the Institute of Obesity, Nutrition and Exercise at the University of Sydney, agreed: “Epidemic is a good term because it makes people and politicians aware of the extent of the problem. In a lot of ways, obesity is damaging to health.”
He said different terms should be used for various audiences. “For example, we don’t say to children that we’re having a war on them – we talk to the parents. For adults, yes, war is a good term.”
While some obese people can live to a ripe old age, Professor Caterson says “it’s still not as good as if they were of healthy weight”. “As well as metabolic disease they get mechanical problems – arthritis, difficulty moving, sleep apnoea. They also have a better quality of life when they lose weight – even to such a small thing as buying normal sized clothes.”
In April last year, the Department of Health and Ageing established a taskforce to develop a National Preventative Health Strategy. Its main aims, to be achieved by 2020, are to reverse obesity and reduce smoking and drinking.
Ms O’Hara says a major failing of the strategy is that “two of the focus areas are behaviours and one is a physiological characteristic”.
“The paradigm is all wrong. They’re comparing apples with oranges. Physical activity and food consumption are not the only things synonymous with body size.”
But Professor Paul Zimmet, who is also a member of the Taskforce, says obesity, alcohol and smoking could “all have behavioural and physiological elements”. He said the Preventative Health Taskforce’s report’s title is “Australia the Healthiest Nation”. “The philosophy is to look at the range of issues that lead to a healthy lifestyle.
“People are blaming diet and lack of physical activity but that can’t explain the rising level of obesity in the US,” Professor Zimmet says.
He said other causes could include a mother’s diet during pregnancy, fat-causing viruses or the effects of plastics. “Things to examine are the environment, toxins, bacteria in the gut, urban planning and even the dangers of being mugged when people want to go outside and exercise.
“We need to continue research – there is no simplistic explanation.”
He said the general scientific view is there are people who are “destined to be morbidly obese, through a genetic or hormonal cause, but it’s relatively rare”. “Most natural characteristics have a bell-shaped curve distribution. There are people at both extremes.”
In NSW, the president of the Anti-Discrimination Board, Stepan Kerkyasharian, said the board looks at whether the data being used to treat people differently is reliable. He said that the main cases of size discrimination usually involved employers “needing to buy a bigger chair” for larger staff.
“People are very welcome to ring us anonymously and inquire about their situation – we can discuss it in confidence,”‘ Mr Kerkyasharian said. Phone 9268 5544 or 1800 670 812.
If you’re denied health care, contact the Health Care Complaints Commission on 1800 043 159.
WHAT’S HAPPENING OVERSEAS
*In Canada, the Supreme Court ruled in November that Canadian airlines must provide two seats for the price of one to people who are “functionally obese”.
*In the US, Peggy Howell, public relations director of the National Association to Advance Fat Acceptance, which has 11,000 members, says anti-discrimination laws were changed in several US jurisdictions by individual citizens, grassroots groups and a large union.
Ms Howell cited a successful size-based discrimination case in San Francisco in 2002 where a plus-size fitness instructor, Jennifer Portnick, reached a settlement with Jazzercise Inc. Jazzercise changed its requirement that its instructors must look trim.
“Discrimination against people based on their body size is wrong,” Howell says. “We believe that one’s health cannot be determined by looking at the size of their body. We believe that by eating healthy foods and adding enjoyable movement to our lives, we can live long, productive, healthy lives: these are principles known as Health At Every Size.”
*In Britain, Jo Morley founded Big People UK in 1997,which has more than 700 registered members.
“There are no laws that I am aware of that is against size discrimination in Britain,” Ms Morley says. “Big People UK does not say being fat is good, nor bad. We say that just because you’re fat does not mean you have to face a life of ridicule and unhappiness.”