“The Talk” and Its Repercussions

This blog has been looking at some of the many sources of grievance that can be found in the ever-increasing existence of obesity in the USA — most of which, if the truth is acknowledged, revolve around money. People who don’t have much of it are upset because they are blamed for the fact that they can’t afford excellent nutritious food for themselves and their children. People who have lots of it are indignant because the tax dollars they begrudgingly part with are used by poor people to buy potato chips instead of broccoli.

Some people are unhappy because they can’t afford treatment for the obesity that others feel is “their own darn fault, so why should we pay for their weight-loss drugs and their gym memberships?” Some are embittered because no matter how they run their own household, once the kids are old enough to go to school, many diverse influences will be working on those little minds contrary to their parents’ beliefs and wishes.

A lot of grownups are quite reasonably and justifiably angry about the advertising that is everywhere, from which they cannot protect their children unless they join a community that forswears electricity and other modern conveniences. Many parents feel helpless against the overwhelming force of ubiquitous and relentless advertising.

Tell me something I don’t know, ha ha

Kids don’t want to be told what to do, and the question of what they eat is not one that arises once a year, when they want something outrageous for Christmas; or once in their high school career when a girl wants a scandalously expensive senior prom dress; or only when the kid starts campaigning for the parents to buy him or her a car; or once a month when they want extra cash to go to a movie.

No. What goes into those young mouths is a question that arises every single day, week after week, month after month, year after year. Even the most conscientious adults cannot control what their children eat outside the home. Even the most caring parents have to give up sometimes, or risk blowing the whole relationship right off the map.

Slow your roll, Mom and Dad

Speaking of dangerous territory, family dynamics can be so unhealthy and unproductive that parental warnings actually cause the very result that the parents dread. A teen girl who is hounded by her parents about the possibility of pregnancy just might (consciously or unconsciously) express her opinion of the nagging by going out and — you guessed it — conceiving an unwelcome grandchild.

An adolescent boy who catches too much flack on the subject of unsuitable companions could very possibly react by seeking out those exact undesirables to hang out with, and incur consequences that wind up in a courtroom or in even more dire surroundings.

Even if such extreme outcomes are avoided, the fact still remains that an obese kid will probably become an obese adult, and face very unwelcome reactions from other adults. How useful is it to warn a child that today’s behavior regarding food could easily turn into tomorrow’s life of miserable rejection?

Answer: not very useful at all. In fact, most likely any such prognostications will be, at least, laughed off and at most, resented to an extent that can lead to no good end.

Public opinion and private behavior

It goes without saying that the surest way to become an obese adult is to be an obese child and/or teenager, and obese adults catch a lot of flack. In the world of work, even if “the company” pays for employees’ weight-reduction drugs, that is money subtracted from what the business might otherwise be paying the non-obese employees in the form of various benefits. And of course, the same goes when “the government” (also known as “our tax dollars”) picks up the tab for obesity treatment.

The reaction becomes even more intense when people get news reports bearing such bad news as the fact that two years after learning that someone else will pay for their GLP-1 meds, three out of four — that’s 75% — of those patients quit taking the drugs or refuse to adhere to the entire weight-loss regimen that includes other factors.

Another important aspect of the entire controversy is uncertainty about the long-term effects of weight-loss meds on the children who are increasingly becoming involved with them. This is perhaps the most unfortunate result of the development of oral medications to replace what used to be available only in injectable form. While we might not want children to be involved with needles (and neither do they), pills are a whole different proposition, making it way too easy to glide along into a “new normal” that could turn into a nightmare.

Your responses and feedback are welcome!

Images by NB_art and MoteOo/Pixabay

Dollars and Cents, Obesity and Sense

Let’s continue to explore the many ways in which our children, if allowed to become obese, could potentially be blamed and shamed by society. Those possibilities are all too likely. However, at least presently, they are not old enough to vote, and cannot yet be blamed for the measures that state and federal governments put into effect. We as adults, however, can be and are blamed by people who believe that the government should take no part in paying for people’s GLP-1 medications or anything of that sort.

Some critics with a specialized viewpoint do not believe that tax dollars should be used for that particular purpose, while others with different priorities would prefer to see those revenues utilized for purposes that they themselves can benefit from and exert control over. Such motivated citizens have strong opinions, like the anonymous social media critic who, early last year, claimed that “fat people are the costliest component of healthcare.”

Adjudicating that particular claim is better left to others. For our purposes today, it is enough to acknowledge that obesity as a national health problem already costs a lot of money and could grow even more. The notion that people who receive government assistance might get anti-obesity meds for free is repugnant to many Americans. They are totally against the idea that just for being overweight, without any life-threatening condition caused by that obesity, someone could qualify for special treatment.

The basic question concerns responsibility, which is just a softer word for the assignment of blame. But really, is obesity always and only the fault of an individual? What about genetics? What about environmental factors like “food deserts”? How about the inability to pay for good, nutritious food, even when it is available?

And what about the fact that parents are the ones who have the car and the money, and sole responsibility for deciding what a young family eats? Can children be assigned any blame at all when Mom and Dad buy, bring home, and prepare the food?

But shouldn’t motive be taken into account? So many parents are impoverished and unable to do anything meaningful for their children if there is a price tag. Can’t they be forgiven for buying cookies instead of carrots? It is huge, complicated, and in many respects an ugly problem.

Check in with experts

About a year and a half ago, Medical Economics published an article by Dr. Harith Rajagopalan, examining a situation that really has not changed much since then. It starts off with a bang:

Few public health issues have more devastating health consequences — or higher economic stakes — than today’s obesity epidemic… Without aggressive intervention, the number of people living with obesity or overweight [in America] is expected to rise to 260 million by 2050.

Already, he notes, almost three out of four adults in the U.S. are obese or overweight. And guess what proportion of the children? Around one in three.

No offense to the good doctor, but what if things are supposed to be this way? Couldn’t we just say, “Times change, populations change, things evolve, the world changes…” After all, the ancestors of humans didn’t used to walk upright, and yet we consider ourselves to be an improvement over them.

Maybe universal obesity is supposed to be where everything is heading, for evolutionary reasons that we do not yet understand. Maybe obese humans will turn out to be better able to withstand extreme climate change and ever-increasing pollution.

Okay, let’s get serious. When the people in Washington first posited, then ditched the idea of having Medicare and Medicaid pay for people’s GLP-1 drugs, plenty of constituents on both sides were angry for opposite reasons. But one of the problems is that two years in, only one out of every four patients still adheres to the weight-loss drug regimen — and not because they don’t need it.

Please consult the article for the fancy math involved, but the bottom line presented here is:

Unfortunately, the reality is that adherence rates are low. Without ongoing treatment, patients are back to square one: all therapeutic benefit and financial investment evaporate.

Dr. Rajagopalan lays out some of the cold, hard facts of the case:

[S]tandard GLP-1 therapy costs about $550 per month, but after two years, only one in four patients remains on the drug. This means for every 100 patients starting therapy, the total cost over two years reaches $845,625. When divided by the 25 patients who are actually adherent and continue treatment, the true cost per long-term user soars to $33,825…

[T]he total cost to prevent just ONE cardiovascular event based on the results of the trial exceeds $2.2 million.

Of course, no price should ever be set on any human life. But there it is, one of the as-yet-insoluble dilemmas of the case.

Your responses and feedback are welcome!

Source: “Obesity’s $250 billion problem,” MedicalEconomics.com, 04/16/25
Image by biker_becca/Pixabay

Chasing Stigma Through the Ages, Part 11

Anyone vulnerable to being stigmatized by the larger society — for instance, an obese person — will probably not feel the same about their condition throughout the course of a lifetime. It can go different ways. She/he/they may start out by feeling very “other,” but then at some point encounter a group of similar individuals and seize the opportunity to spend time amongst them and, to all intents and purposes, feel normal.

Or the person might be in circumstances that include no others who are afflicted by the same drawback, and suffer years of feeling estranged from humanity. Even if the individual finds an affinity group with whom to comfortably meld — he, she, or they might change, causing him or her to want to leave and seek other circumstances.

And yet, even if their prospects for finding plenty of similarly obese people to hang out with are abundant, still it is to be hoped that no parent actually aspires to have an obese child.

This is the last of a series of posts examining the work of Erving Goffman, author of “Stigma: Notes on the Management of Spoiled Identity,” and what really does not need repetition is that the author knew what he was talking about.

Ups and downs, ins and outs

In the course of a lifetime, sometimes a person fits in, and sometimes does not. What causes a good fit is often what Goffman calls the special opportunities for in-group participation. Since the beginning of time, that has often implied a consciousness of being somehow superior to the rest of humanity.

An affinity group of musical geniuses might be quite justified in that conviction; a group of people who never bathe, not so much. A mob that burns down a house is an affinity group. Affinity does not necessarily or automatically imply worthiness or any other virtue.

Human nature is subject to ebbs and flows, about which Goffman says,

There will be “affiliation cycles” through which he comes to accept the special opportunities for in-group participation or comes to reject them after having accepted them before. There will be corresponding oscillations in belief about the nature of his own group and the nature of normals.

Each affiliation cycle implies “shifts of participation and belief.” Each such shift involves a change in relationship between the individual and her or his community, whether that is an informal group of hangout buddies, or an official organization dedicated, for instance, to the concept of fat acceptance.

However, all “acceptance” avenues do not lead to the same place, nor do they start out in the same place. Membership in the NAACP, for instance, includes, of course, anyone of any race whose beliefs line up with the principles of racial justice, civil rights, voting rights, education, economic opportunity, and equality — along with a preponderance of people who were born and will remain Black.

Members of an organization centered on fat acceptance (or even fat encouragement) tend to mainly be actual obese individuals, with a welcoming attitude that could be expressed as, “If you’re one of us already, stigmatized in the same way we are, well, come on in. It’s a big tent.” There is room for all, especially if they lean on a moral principle like the basic human right, possessed by everyone, to remain overweight if such is their desire. Or if they like to pretend that they really are without an option.

But for most people, that choice is very much within the realm of possibility. They have it in their power to remain overweight, or to change. Many members could, in theory anyway, slim down to normal-range weights; yet still decide to remain in the organization that encourages acceptance of those who have not committed to the quest for a smaller body.

Another angle

But what, actually, is wrong with having such a positive attitude? Or with believing that we are in excellent health, and could not possibly be happier? If the others join us, they too will experience health and happiness.

What is the problem? Goffman wrote,

In reviewing his own moral career, the stigmatized individual may single out and retrospectively elaborate experiences which serve for him to account for his coming to the beliefs and practices that he now has regarding his own kind and normals.

Basically, anyone with the motivation to remain obese can also find the justification. Nobody should have to go through this kind of moral dilemma, this nightmare of struggle against the self — and eventually, the tipping point will come. Goffman points out that a turning point may occur in the case of…

[…] an “isolating, incapacitating experience, often a period of hospitalization, which comes later to be seen as the time when the individual was able to think through his problem, learn about himself, sort out his situation, and arrive at a new understanding of what is important and worth seeking in life.

Someone might say, “Wait a minute, I think about my problems all the time. That is in fact one of my problems.” To sum up, as parents, we don’t want, or should not want, our kids to ever have to face this sort of existential crisis. What can prevent such a struggle? Not letting them grow up to be obese adults. And what can, in turn, prevent that eventuality? A firm resolve to not let them become obese children.

Your responses and feedback are welcome!

Source: “Stigma: Notes on the Management of Spoiled Identity,” WordPress.com, 1963
Source: “Social Change and Status Protest,” Phylon, 1949
Source: “Cycles and Turning Points,” essay in “Men and Their Work,” Free Press of Glencoe, 1958
Image by pinterastudio/Pixabay

Chasing Stigma Through the Ages, Part 10

Is it even possible that there could be more to say about how different groups of people have either suffered under, or dealt out to others, the crushing pain of stigma? Relax, there is plenty more malice in the pot, without even needing to scrape the sides yet.

How people cope

Erving Goffman made a distinction between normalization and normification. The difference is real, and sometimes crucial to the point of threatening the person’s survival. To normalize is to actually change, which an obese person can do by losing weight. A gay individual, however, can’t voluntarily change their nature.

To normify, however, denotes “the effort on the part of a stigmatized individual to present himself as an ordinary person, although not necessarily making a secret of his failing.” In the midst of society, gay people can pretend to be straight by adopting the appearance and behavior that is not natural to them.

It is a move that in some eras and places can be a life-saving deception. However, obese people, if they are actually present on the scene, cannot really pretend to be otherwise. These points have a lot to do with what kind of stigmatization a person is expected to put up with, how they deal with it, and a great deal more besides.

Another reason for not wanting our children to become obese

Back when Goffman studied the effects of obesity within society, science held that “obesity is rarely reversed,” and it seemed unlikely that a young obese person would become any less so over time. Today, however, a new phenomenon has arisen, to form a world in which dealing with the consequences of constant and ongoing dependence on weight-loss medications could turn out to be as much a burden as the obesity those substances were designed to prevent.

Yes, the new meds might slow aging and extend the lifespan, but what will take place within those extra years? It will be a long time before our science can really grasp the full implications of such a dependent lifestyle, and financial expense is of course a major factor in that prediction. To continue affording their meds, men might prefer not to marry, and women might choose to forego motherhood.

The new normal?

Maybe a best-of-both-worlds lifestyle will evolve, in which the eventual agreement to marry will imply that both participants have decided to “let themselves go,” and to accept whatever that implies in their partner. But isn’t this pretty much what most of the population have been going with all along, and the premise of 1,001 banal sitcom jokes? The standards might stay higher, for a longer period, but eventually just about everybody gives up. It becomes a case of “Love me? Love my thinning hair, my wrinkles and my 50-inch waistline.”

And if someone decides to stick with the meds until the bitter end? She or he would be a true “anti-hero,” refusing to give up the skinny pills far beyond some arbitrary and generally agreed-upon time limit.

In the slightly younger age bracket, among those who had caved to the inevitable and let obesity take over, some of its members would rant against the refuseniks, although, perhaps, while secretly envying their courage and determination. Contention over the appropriate time to abandon all subterfuge, and surrender to a corpulent old age, could become just one more major divisive issue in a society that already suffers from so much dissension.

Another literary genre is heard from

Among the Slim Forever crowd, some would have worked hard for years to make sure they could continue to afford their prescriptions. What a noble life goal — not! A screenwriter could easily imagine a criminal mastermind who must continuously steal in order to stay with the anti-obesity meds. Even at age One Hundred and Slimmity-five, even on crutches, Howard is slim. Yellowtart isn’t giving up her Lululemons any time soon.

They must constantly generate new ideas about how to get their hands on plenty of money and, ta-da! There is a whole series of cinematic comedies starring geriatric drug dependents who refuse to give up.

Your responses and feedback are welcome!

Source: “Stigma: Notes on the Management of Spoiled Identity,” WordPress.com, 1963
Image by Hellio42/Pixabay