“The Weight of the Nation” Part 2

Posted By elissa on May 19, 2012 | 1 comment

Sorry I didn’t get this up yesterday, but I wanted to think about Part 2 – which I watched last night – a little more.

Like Part 1, Part 2, subtitled “Choices,” was pretty well done. Unlike Part 1, which gave more of an overview of the obesity crisis, Part 2 focused largely on what individuals can do to improve their health. And like Part 1, Part 2 featured interviewees viewers could empathize with, good presentations from various experts, and solid – even inspiring – advice on how individuals can take control.

Nonetheless, it bugged me. Something was a little “off” about the whole thing, and I couldn’t quite put my finger on what it was. But after sleeping on it and reviewing my notes, I think I’ve got it. Or rather, I’ve got them, since more than one issue struck me. Here they are (in no particular order…):

1. In Part 1, excess body fat was clearly THE problem. Yet – without actually admitting it – Part 2 tacked in a somewhat different direction. To the writers’/producers’ credit, they firmly rejected fad/popular diets in favor of making lifestyle changes in small steps; and made it clear that significant health gains could be realized if only modest, realistic goals were achieved.

A pair of identical twin brothers with the same risk profile served as an example. Bro #1 enrolled in a diabetes prevention study after learning his blood sugar was high. As part of the study, he lost 7% of his original body weight and added an additional 150 mintues/week of moderate physical activity. By taking these modest steps, he normalized his blood sugar and is currently free from diabetes. Bro #2, on the other hand, developed the disease after ignoring the warning signs.

Ok, here’s the deal: Bro #1 actually didn’t lose much weight – it takes a lot more than losing 7% of your body weight to go from being obese to a “healthy” weight. Relatively painless diet/exercise modifications were all it took to keep the disease Bro #2 developed at bay.

If the “logic” in Part 1 held, then Bro #1 would still be at risk, until his BMI dropped into the “healthy” range. Yet the gist of Part 2 was that – with lifestyle mods and comparatively little weight loss – one could be both fat AND metabolically healthy.

In other words, adopting healthy behaviors trumps achieving a “healthy” BMI – and a good thing too, since the documentary pretty much ruled dramatic weight loss out for most obese people (and yes, I loved the shot Dr. Samuel Klein took at “The Biggest Loser”). This conclusion certainly tracks with the data (and the experiences of the interviewees), but IMHO, it contradicted the ominous, “all-excess-body-fat-equals-death-fat” tone of Part 1.

2. Part 1 discussed the relationship between poverty and obesity to some extent, but this consideration was nowhere to be seen in Part 2, where the affordability/availability of healthy food, medical care and safe spaces to exercise were simply assumed.

3. And speaking of assumptions, I couldn’t help but notice how certain social/institutional issues that contribute to obesity were generally waved aside. Basically, Part 2 was all about “personal responsibility.” Obviously, I’m very much in favor of personal responsibility: people should make time to exercise, reduce their stress levels, endeavor to eat more veggies/fruits, create support groups, engage in mindful eating, etc. But – if obesity is a societal issue – then certain other segments of our society ought to step up to the plate too, right?

Especially if they’re actively contributing to the problem…

This hit me while I was pondering the vignette about the call center employees who organized an office wellness group. For these women, 40 hours/week was the minimum time worked (the one who organized the group said she worked 60 hours/week). As they all lined up in their custom t-shirts and left the office for a group walk, I caught myself thinking “gee, it’s nice of their employer to allow them to do this.”

“Nice,” indeed… and that’s a problem for some.  Not every business likes the idea of organized employees – even if it has nada to do with their job performances. For example, a group of law firm employees in Florida were summarily – and  legally – fired from their jobs for wearing orange t-shirts on Fridays, to celebrate payday and to be recognizable as a group for post-work “happy hour.” To some companies, employees are basically chattel: as author/political science professor Corey Robin reminds us in this article, it was only in 1998 that US workers were granted a federal right to take bathroom breaks on the job.

Why did the feds need to step in?

In their 1998 book ”Void Where Prohibited: Rest Breaks and the Right to Urinate on Company Time,” Marc Linder and Ingrid Nygaard of the University of Iowa – he’s a law professor, she’s a urogynecologist – trace the long and ignoble history of the struggle for the right to pee on the job. In 1995, for instance, female employees at a Nabisco plant in Oxnard, Calif., maker of A-1 steak sauce and the world’s supplier of Grey Poupon mustard, complained in a lawsuit that line supervisors had consistently prevented them from going to the bathroom. Instructed to urinate into their clothes or face three days’ suspension for unauthorized expeditions to the toilet, the workers opted for adult diapers.

Point being, there are a few great workplaces out there, where companies take an active role in encouraging employee fitness. And there are a range of decent ones – like the one those women work in – that don’t interfere with their employees’ efforts. But as the above examples suggest, there are also some really crappy companies out there, including one that happily cheats its employees out of breaks and forces them to work off the clock. As a society, we could do a lot to help people get in better shape by incentivizing employers to be part of the solution, rather than part of the problem.

4. As noted above, I’m all for personal discipline and recognize that a certain amount of vigilance is appropriate to maintain weight loss. But the two women used to illustrate the the conclusions of the National Weight Control Registry made me do a double take. To these eyes, their obsessive record keeping (one of the women displayed a binder containing 4 years worth of data!), chronic low calorie intake, and dedication to rituals (like continuing to weigh food items they’ve already learned to accurately estimate) smacks of disordered eating. Yet the documentary appeared to approve of their behavior. 

Yikes! If I were overweight or obese, watching these two would be enough to drive me into the “fat acceptance” camp.

5. Speaking of fat acceptance, my heart went out to an earlier interviewee, Vivia. Her personal testimony was sad to watch. She was reduced to tears as she described her relationship to food: 

“…food can be my best friend… food can be my boyfriend at the moment. Food can be a vacation to the beach that I can’t afford to go. If I were not obese, I would have no hesitation in doing the things I want to do, going to places I want to go, trying for things I want to accomplish. I could go on a roller-coaster. I would sky dive if I wasn’t obese. I would be able to roller skate. I would probably pursue dating, if I were not obese. And… I would have a little Vivia.”

Yet, she could, realistically, pursue many of her dreams right now (other than the skydiving, perhaps).  At 341 pounds, she may have (or will have) health issues that need addressing, but she’s a person of worth just as she is, who has a right to go to places she wants to go. She can go on a roller coaster. She can roller skate. She can love and be loved… if she loves herself first.

Yet no one made this point: the documentary seemed to agree with her self-assessment. According to the frame presented in Part 2, obesity itself is to blame.  Yet it’s not obesity alone that’s dragging people like Vivia down, it’s also the teasing, mockery and social disapproval they routinely receive. No one evidently intervened when – as a child – she was poked with pencils and otherwise singled out because of her weight. But fixing victims isn’t the answer to bullying… fixing bullies, is.

At any rate, I liked the factual info discussed in Part 2: there was a lot of no-nonsense, reality-based information that many viewers could apply to their own lives. What I really would have liked to see, however, is some discussion of policy – what communities and states can do to facilitate personal efforts. Not every town has a Linda Fondren, with the resources, passion and energy to make a difference, and – at least so far – stressing personal responsibility hasn’t been very effective as a public health strategy.

Well, there’s still Parts 3 and 4 – maybe we’ll get there.