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The Obese Are Victims Not Perpetrators

George S.M. Cowan, Jr., M.D., Professor of Surgery, University of Tennessee, Memphis, TN.; President, International Federation for the Surgery of Obesity; Co-Editor-in-Chief, Obesity Surgery Journal
The lean are not "better" or superior persons because their weight appears "under control." Their thinness is a biological gift. They are the lucky ones who have won the "Weight Sweepstakes." Somehow, by a Monte Carlo roll of the dice, they received a biology which has kept their bodies within a range of weight our society regards as "normal."

The human body controls the weight of the lean with the same basic mechanisms as it does that of the obese. They, therefore, do not deserve any more praise or blame than the obese for being driven by their own biology.

What is deserved, however, is our society coming to finally accept that the obese (as well as the lean) are powerlessness in voluntarily controlling their own weight. We all are truly powerless because we do not know the exact details, the "secrets," of how our biology controls our weight. Someday, we will fully understand those "secrets" so that we may help develop medical treatments to keep or make everyone thin, at least if they want to be. Someday, we'll know--not for a good while I expect, despite the hype about "cures" in animals and new treatments we frequently see, hear and read in the media.

But, for now, without possessing those "secrets" about how the body's biology keeps a person thin or fat, and having little else practical to offer most morbidly obese persons for their greatly excess weight and associated co-morbidities, surgery is the appropriate weight control option to consider for those who meet the bariatric surgical standards.

If surgery is not acceptable or available for some reason, we should at least treat the obese with respect. We should regard them as victims of their disease which they are, because, once we see them as victims, not culprits, they have our sympathy, our hearts go out to them, we understand that their condition is something fundamentally beyond their control. We can at least help them to cope better with their disease and its co-morbidities instead of allowing them to be mocked, derided and scorned on a daily basis.

The fat cells of the obese progressively overgrow their bodies, gathering more and more fat like a huge enveloping overcoat, a gigantic tumor which, at the same time, is invading every body organ. These obese victims have greatly increased chances of a shorter life, heart disease, hypertension, diabetes, sleep apnea, cancer and many other conditions known to be associated with obesity, particularly morbid obesity.

Morbid obesity thus has a malignant nature which is often unremitting, punishing and lethal. To "politely" ignore it is as ludicrous as the courtiers in the children's story saying the naked Emperor was well-clothed. In an analogous case, saying that the morbidly obese Emperor "has a little weight problem which he needs to control" totally denies the truth and enormity of the subject. Our society, likewise, remains largely in denial about the truly serious, basically involuntary, malignant nature of obesity.

This malignancy makes the obese victims of their own biology, the helpless products of chance associations between their genetics and their environment. How can they, in all honesty, be more "guilty" than the lung cancer victim who smokes heavily, the heart attack victim who chronically consumes a high fat diet or others who acquire sexually transmitted diseases? How can our society dare to deny the obese a share in this victimhood? All of these other victims may likewise possess genes which promote a specifically compulsive lifestyle which our exceptionally bountiful, permissive environment promotes. Yet, medical insurors and their ilk almost always support treatment for these other diseases but deny it to obesity. They draw the line, an unfair, stereotypical, highly visible one.

And, obesity is nothing if not highly visible. Superficially at least, you can hide your addiction if you are an alcoholic or drug addict or have somewhat different approaches to sex.  But, unlike certain movie plots, the obese cannot magically shrink. Obesity is obvious; it is there for all to see, even at a glance. Their outsize skin and all of its contents make the obese walking billboards, highly visible targets. If you have a hang-up or need to "take it out" on someone, or even to help improve your medical insurance company's bottom line, they are there, targets for abuse without penalty.

And, they are there almost all alone, most obese persons passively accepting the scorn and their "guilt" as well-founded. Their gross mistreatment is further supported by "political correctness" which freely punishes the obese since they have become the "last bastions of prejudice." They are truly the undeserved victims of a cultural, as well as medical, disease, the modern medical-moral equivalent of lepers.

Our Society must come to understand that the obese deserve the same compassion and understanding as do other disease victims, regardless of how they came to be victims. A disease is a disease is a disease is obesity.

As a first step towards making amends for past damage, let us resolve to not add to the already tragic malignancy of their condition by heaping more abuse upon the obese victims. Rather, let's resolve to treat others, and ourselves where indicated, better, to love and care for people regardless of their weight. And, as part of this respect for all people, we must deny weight harassment and fat-ism any place within the boundaries of our society. It should be made as illegal as sexual harassment and with at least as many penalties.

Bibliography

Cowan GSM Jr, MD Smalley, N Defibaugh, KB Cowan, ML Hiler, W Sehnert, S James. Obesity Stereotypes Among Physicians, Medical and College Students, Bariatric Surgery Patients and Families. Obesity Surgery 1(2):171-176, 1991.

Cowan GSM Jr. Bariatric Surgeons, Stereotypes and Paradigms. Obesity Surgery. 2(1):7-12, 1991. [Delivered as Presidential Address to American Society for Bariatric Surgery, June, 1991]

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