Land of the free, home of the fat and unhappy

It sneaked up on the nation the way it often creeps up on individuals. Its arrival was a surprise, even though it had been a long time coming. We were used to looking in the mirror and seeing a tough, lean country of do-it- yourselfers. Then, seemingly overnight, our image changed. We looked in the mirror and saw that we had become fat. And we've been upset about it ever since.

Of course, people in other countries have been calling us fat for years. In 1990, France's Le Monde published articles about "les Americains obeses" and referred to our kids as "les enfants du Coca-hamburger." The Coke-hamburger kids.

It's easy to ignore a message from the other side of the Atlantic, but when Southwest Airlines told us this summer it would charge those of us whose derrieres don't fit on one 18.75-inch wide seat for two 18.75-inch seats, we finally woke up.

I assume the royal we means the media. Physicians have known this for years. Generally, we do not know how to manage and treat weight problems. This frustrates us, and our patients.

But we haven't gotten where we are today through eating habits alone. We also don't exercise. In fact, we hardly move at all. Less than 20 percent of American adults exercise the federal government's recommended minimum amount -- just 30 minutes a day, five days a week.

Our kids aren't moving any more than we are. Physical Education has been cut so severely in public schools that many youths get no P.E. at all, or it's offered only as an elective. Playtime after school is spent watching television or exercising one digit -- the thumb -- on the GameBoy or PlayStation.

I type the same message constantly. Weight control requires 2 things, eat less and exercise more. The rare patient makes that committment. Our society gives us too many excuses to eat more and exercise less. Few of us resist the easy path.

The American Obesity Association reports that 89 percent of Americans believe that overweight individuals -- not their environment or genetic makeup -- are to blame for their size. Heavy people feel this condemnation at work, in public and in the doctor's office. A study conducted by Rice University's Department of Psychology found that Texas physicians spent less time with heavier patients than with average-weight patients, and "a significant number indicated that it was a greater waste of time to see patients who were heavier. "

For HMOs and health insurers, it's not a question of a waste of time, but of money. Individuals who fall into the obese category have discovered they cannot get independent health insurance, even if they have no other health problems.

When asked if Blue Cross Blue Shield of Florida denied a 26-year-old woman insurance solely because of her weight, spokesperson Rick Curran said yes, that might have happened. "Obesity," he explained, "is considered a health risk factor that can lead to debilitating and chronic diseases." If a person's weight "significantly exceeds recommended guidelines," he said, "that person might receive a rejection letter that states that their weight would need to become more stable and more closely aligned to what is considered healthy."

It's a cruel policy that won't help anyone but the stockholders of Blue Cross Blue Shield, but Curran is right. Obese people often develop such serious health problems as heart disease and Type 2 diabetes. The research institution Rand reported that "obese individuals spend 77 percent more on medications" than non-obese people. Armed with such statistics, health insurers have decided that doing business with fat people is not cost- effective.

Physicians do spend less time with obese patients. I would guess that we respond to our learned futility by giving up on these patiens. We want to help patients, but we rarely fix problems, we just give patients the tools to help themselves! After you try to help obese patients for several years, you rarely if ever have any successes. This learned behavior affects how we treat the obese.

I suspect that obesity will provide this blogger ammunition for a long time. Oh but that were not so! Would that I could influence patients to change their lifestyle. I know that it can be done, I live the proof. But I do work it every day, choosing my diet, even my cheat meals! I exercise 6 days a week on average, and plan that exercise on a weekly basis. Can we get most Americans to do that? And if you read the British press, they have the same problem!