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The Tyranny of Size : Weight, Like Height, Is Inherited, but No One Expects a Tall Person to Cut Off His Legs

January 13, 1991|MICHAEL S. WILKES MD and MIRIAM SHUCHMAN MD | Michael S. Wilkes is a physician in the Clinical Scholars Program at UCLA Medical Center. Miriam Shuchman is a physician in the Clinical Scholars Program at UC San Francisco Medical Center

ALL MY LIFE, I have been an embarrassment to those I cared for. I wouldn't even go in to speak with my son's teachers. I insisted on speaking on the phone. I know, from past experience, that if I walked into that school, my son would be teased and harassed for weeks," says a 54-year-old accountant from his hospital bed.

The condition that plagues this man is not a bizarre facial abnormality or an unusual skin disease. This man is obese. And despite the fact that perhaps at least 25 million Americans are obese--defined as exceeding one's ideal weight (which is determined by height and body frame) by 30%--obesity remains a condition surrounded by myth, misinformation and prejudice.

The common notion is that obesity is caused by gluttony. Subsequently, most research conducted on the subject over the years examined what and how much obese people eat, and compared their eating habits with those of normal-weight persons. Surprisingly, in many cases, the two groups consume the same amount and type of food--and often it is the obese who eat less.

The problem for many obese people is genetics. Just as eye color, freckles or height tendencies are inherited, the number of fat cells our bodies contain and how efficiently our cells burn calories are often genetically determined. No amount of dieting or behavior modification can change such inherent traits.

For years, this accountant tried countless diets and exercise programs. None worked for very long. Desperate, he had four major stomach operations and managed to reduce his weight from 400 pounds to 200. But the price he paid, literally and physically, was astronomical. Currently, he is in the hospital, suffering from severe malnutrition. He has a complicated i.v. connected to his heart. When he stabilizes, he will undergo surgery to undo some of the stomach operations. In such a weakened condition, it is possible that he could die.

Yet, he says, "even as I lie here feeling I could die, there is no question that I would go through the operations again. They changed my life in ways that a normal-weight person can never begin to imagine."

His attitude is not surprising. Obesity carries a more crippling social stigma than even having deformed or missing body parts, or a disfiguring skin disease. In a Yale study, psychologists visited three East Coast kindergarten classes, each from different socioeconomic backgrounds, and offered each child a chance to win a doll, which they could choose from among a large group. Each doll was altered to simulate a physical deformity--some were missing a limb, others had disfiguring skin conditions, and some were fat. The fat dolls were regularly the last to be selected. The children said, "they are ugly," "they are lazy," "they eat too much" and even, "I don't like fat things."

Adults can be equally judgmental and prejudiced; studies show that overweight people, regardless of race, age or economic class, face discrimination from schools, employers and peers. They are less likely to be accepted by high-quality colleges than normal-weight people with identical qualifications. They are also less likely to be hired or promoted than normal-weight people who possess the same attributes.

A recent example of this is illustrated in a case that will go before the Supreme Court this year. Sharon Russell was a nursing student who weighed more than 300 pounds. Her school, Salve Regina in Rhode Island, required that she lose weight, and when she could not, she was expelled. A jury agreed with Russell's claim of discrimination and awarded her $44,000 in damages. The U.S. Court of Appeals for the First Circuit upheld the judgment, stating that Russell was dismissed "because she was obese and for no other reason." The school took its appeal to the Supreme Court.

Even medical doctors, who should have the greatest understanding of the various factors that can cause obesity, hold many of these social prejudices. Many doctors stereotype their obese patients as simply being chronic overeaters. In a national study, the majority of the 77 physicians surveyed said they considered the obese "weak-willed, ugly and awkward." Other researchers have found that doctors dislike treating obese people because they categorize them as "self-indulgent . . . hence, at least faintly immoral and inviting retribution."

Yet research has clearly debunked the idea that all fat people overeat. Studies have proven that biological factors beyond our control play a large part in determining whether we are slim, heavy or markedly obese. A number of studies on children adopted during the first year of life show that size can be predicted by birth parents; the weight of the adoptive parents has little effect.

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