Rethinking Weight
Hey, maybe it's not a weakness. Just maybe. . .it's a disease
Maria Pfisterer has never in her life been skinny. The Arlington, Texas, mother of three was at her slimmest at age 18, when she married Fred, an Air Force sergeant. But she was plump, not seriously fat. She first became seriously overweight at age 21, when she gained about 70 pounds during her first pregnancy. By the time she delivered her daughter Jordan, now 14, she was carrying over 200 pounds on her 5-foot, 2-inch frame.
Over the past 14 years, Pfisterer has tried every weight-loss strategy imaginable: She has taken the (now banned) appetite-suppressing drug combo fen-phen (she lost 60 pounds only to regain it during her second pregnancy). She went on a doctor-prescribed and -supervised low-calorie diet (she lost 10 pounds but regained it). She has been enrolled in Jenny Craig, Weight Watchers, Curves, and a variety of quick-weight-loss fads. All resulted in a little lost and more regained. She has taken antidepressants, reputed to have weight loss as a side effect. They didn't for her. She would love to get into one of those intensive medical weight-loss programs, but she can't afford the $4,000-plus price tag. So she does what she can. "If I lose weight, it seems like I always go back up to that same 197 to 202 range," she says. "I just don't know how to keep it off."
Pfisterer isn't alone. A majority of Americans--now 64 percent--are overweight or obese and struggling to conquer their expanding waistlines before their fat overtakes their health and makes them sick or kills them. At the heart of this obesity epidemic is a debate over whether obesity is a biological "disease" and should be treated like any other life-threatening illness--cancer, heart disease--or whether it is simply a risk factor for those killers. The stakes are high because the answer may determine who gets treated for obesity, what treatments are available, who pays for treatment, and, ultimately, who stays healthy.
New understandings of the biology of obesity are driving the debate. "I think there's enough data now relating to mechanisms of food intake regulation that suggest obesity is a biologically determined process," says Xavier Pi-Sunyer, director of the Obesity Research Center at St. Luke's-Roosevelt Hospital in New York City. And many national and international health organizations--from the National Institutes of Health (NIH) to the World Health Organization--agree. The WHO has listed obesity as a disease in its International Classification of Diseases since 1979. In fact, the organization recently called on member states to adopt programs to encourage a reduction of fat and sugar in the global diet. The recommendation did not sit well with the U.S. food industry or with some within the Bush administration, who still maintain the obesity epidemic can be reversed by individuals taking more personal responsibility and making better lifestyle choices. Many health insurers agree. "For a wide number of people in this country the question is: How do you motivate people to make changes in diet and increase physical activity?" says Susan Pisano of the Health Insurance Association of America.
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