Obesity’s Price Tag

These items relate to a subject often mentioned here: the societal cost of obesity. Every so often, along comes a news story that points out another example of how the system does not work as well as our society actually needs for it to work.

For instance, within the past year, India has been mentioned as a place where bariatric surgery has really caught on in a big way. Leaving all other factors aside for the sake of discussion, it is possible to question the benefit to society as a whole. It can’t be considered good for a society to have a large proportion of its members absorbed by the overwhelmingly intense preparation agenda for this sort of operation.

However much of a blessing it may be in a particular case, and in the long run, bariatric surgery is a very life-consuming project in terms of burning up time, energy, goodwill, money, and other resources.

But wait, there is more

Then, after the actual procedure, there is a similarly unproductive spell, as the patient is, to a greater or lesser degree, disabled for a considerable period of time. Even barring any unexpected side effects, there are new routines to learn and new norms to become accustomed to, on every side.

There will be medical self-care chores, and record-keeping, and check-up visits. Maybe time will be set aside for meditation. The patient actively participating in their recovery is unable to do very much else, at least for a while, if the newly required lifestyle is to “stick.”

To complete their usual work, or family caregiving, or volunteer activities in the community — effective participation in even one of those categories could prove to be too much to expect, and for quite some time. Somewhere along the line, a price is extracted from — and paid by — society as a whole.

A bit of history

By 2018, 60% of Americans — in other words, more than half of us, over 180 million people — were overweight or obese. That statistic was responsible for “$480.7 billion in direct health care costs in the U.S., with an additional $1.24 trillion in indirect costs due to lost economic productivity.”

The total amount of around $1.72 trillion was equivalent to almost one-tenth of the total Gross Domestic Product. As a risk factor, obesity accounted for close to half of the accumulated cost of chronic diseases in the USA. It should be, and is, possible to acknowledge this reality in a tactful, frank, non-judgmental way, not involving cruelty or injustice.

These words are worth repeating:

Whether or not it is their fault, and whether or not others spitefully blame them, and regardless of whether it is fair — in one way or another, obese people constitute an expense to society.

We also discussed whether poverty causes obesity, or obesity causes poverty, and concluded that both propositions are sadly and eternally true.

And another sad-but-true thing

If fat-shaming and fat-blaming have not been able to revolutionize the situation in all these years, those techniques are unlikely to bring about change in the future.

Your responses and feedback are welcome!

Source: “America’s Obesity Crisis: The Health and Economic Costs of Excess Weight,” MilkenInstitute.org,” 10/26/18
Image by bergy59/Pixabay

Drugs and Surgery — Reevaluation Is Inevitable

A person who lives for several decades is bound to notice something interesting, as time goes on — namely, that one generation’s scandal is the next generation’s yawn. Around the turn of the century in the USA, for instance, a decent man didn’t appear in public without a head covering; and not just any hat, but one with a hatband, a dent in the top, and a brim.

In 1900, women who initiated divorces were as rare as hen’s teeth. By the year 2000, it was quite ordinary to meet a woman who had divorced three or four husbands.

In some times and places, people are implacably set in their ways, while in others, they can’t stand to do things the same way from one week to the next. Philosophers have spoken millions of words about the human tendency to resist change, especially in instances where some members of the population are attempting to force others to act normally.

In that discussion, of course, one issue is all-important. Who is privileged to decide what is considered normal in society, as opposed to what is regarded as unacceptably deviant?

Today and us

“Who died and made you king?” is a sarcastic question that many people have good cause, several times a day, to telepathically ask a passerby some version of. More specifically, they cannot help wondering why they have to go through life hindered by the judgment of others regarding the size and condition of their bodies.

In a way, to be grossly obese is like having two heads — you just know that everybody is staring, and even if they don’t judge with hostility, they probably feel pity. So then, you spend the rest of the day mulling over the question of which is worse, hatred or contempt?

There may be nothing basically wrong, in an abstract sense, with the educational and medical establishments of society having concern about people’s health. In a general way, it is comforting to know that some of the people who run things are in charge of seeing that you don’t catch the plague or smallpox.

That is managed, in a civilized society, by having public health authorities in charge of identifying and sequestering people with a contagious disease, and convincing the healthy ones to get a shot or something, so they don’t catch the illness or spread it around. Even the most ideologically strict proponents of freedom can usually see the sense in that.

What authorities?

But when it comes to obesity, even the most convincing arguments about public responsibility for public health tend to break down. Many people feel that it is no one’s business, especially that of a government bureaucracy, to know how many pounds the scale registers when you step on it. Perhaps a valid civic-minded argument can be made for weighing a newborn baby, because at that age, weight is the most obvious characteristic that can be non-invasively measured.

But ought the authorities to care quite so much about a kindergartener’s poundage? Does the System really need to know the circumference of each 13-year-old’s waistline? Should the authorities embarrass your children at school by weighing them?

An overview

A while back, Childhood Obesity News quoted Southern California health official Jonathan Fielding:

Public health works by successive redefinition of the unacceptable.

Consider the saying, “First they ignore you, then they laugh at you, then they fight you, then you win.” Nobody is sure who first said those exact words. It is certain, however, that trade union activist Nicholas Klein expressed the same concept in different words, and many other people have, too. There was a time when nobody had ever heard of a five-day work week or a paid vacation.

But thanks to the efforts of millions of staunch labor supporters, the unacceptable was successively redefined and became the norm. A similar process occurred back when former First Lady Michelle Obama worked to warn against and prevent childhood obesity. Voices were raised against the tyranny of governmental interference in kids’ eating habits and of families’ responsibility in that area.

Still, after two presidential terms, fewer Americans were either ignoring or laughing at the concept that childhood obesity should be taken seriously. Now it appears that the same kind of gradual change might be taking place in regard to both weight-loss drugs and bariatric surgery for teens and maybe even children.

Your responses and feedback are welcome!

Image by Pat Hartman

Goodbye to 2025, and Try This

The facetious advice in the picture on this page has been seen millions of times online and is impossible to trace back to its source. But let’s lift a glass of sugar-free fizzy soda and drink to the health of its author. Yes, going forward into the new year, humans will continue to fight against our own best interests. Sooner or later (perhaps in 2026!) more of us will come to see the truth of another anonymous quotation:

You can fool some of the people all of the time, and fool all of the people some of the time, but — ultimately, eventually, inevitably — you can’t fool yourself.

This blog has pointed out many of the societal costs of obesity, so for the end of December, it gathers a little bouquet of talking points from the past year and the past few years, and some things to look out for in the coming months.

There are problems we don’t want to see our kids, or any kids, have to face in the upcoming year or any year subsequent to this one. In other words, let’s poke and prod ourselves to do something about looming obstacles and stop putting off the unpleasant tasks. To stall is to invite consequences that quickly outgrow the unpleasant stage and morph into real-life nightmares.

Interview with an expert

“Watchful Waiting Not Recommended For Childhood Obesity” is the title of a very recent piece by Tim Ditman, and let’s have a peek at what the expert he interviews has to say about the subject.

The American Academy of Pediatrics (AAP) has been taking a second look at some of its guidelines and softening its attitude toward surgery and medication. Some parents became nervous about venturing beyond the traditional guardrails of diet and exercise, and this is understandable.

Too often in life, the urge to “Do something!” becomes diverted or misapplied. The only thing worse than neglecting a problem is approaching it with the wrong tool. Maybe the error even lies in the mental construct of attack. Maybe “address” or “examine” is a better approach. So we do not want to start out with a misstep. When aiming for a compass bearing, even a single degree of error can lead to far, far from the intended destination.

One thing is for sure:

The AAP says waiting and hoping things get better is not a good choice.

Up until about age 12, sure, stick with the traditional methods, but beyond that age, “diet plus exercise” is not a sufficient prescription. The AAP is talking about, among other remedies, “in-person, family-based behavioral health treatment” for three months to a year. After passing that 12-year mark, the organization says, let’s start thinking about a pharmaceutical approach; and after the 13th birthday, in many cases surgery should not be arbitrarily ruled out.

Registered dietitian-nutritionist Carly Zimmer feels empathy for the difficulties that children face. Their lives are saturated with “activity” that involves mainly sitting on their ever-enlarging behinds, watching screens that glorify and strenuously recommend eating all the wrong stuff, and plenty of it. Yet and still, very often the food is not the enemy — the mind is.

Zimmer says,

Often our eating habits stem from events in our past, trauma or emotions. A mental health professional can dive into those topics and help establish a healthy relationship with food.

This is what needs to happen, not an eternal relationship with weight-loss meds acting as a band-aid, because a band-aid is glued to a person only to be replaced. That is why they are sold by the package. Commitment to a lifetime of regular injections of a very expensive drug is not a solution; not a win or a cure, or any other positive description of an outcome. It is a very poor alternative to what is ultimately possible, and many professionals are deeply committed to never settling for less.

Zimmer offers suggestions which, yes, have been heard before. That isn’t the point. If a concept has value, it is worth hearing a thousand times — until someone whose health hangs in the balance actually absorbs it. For parents, Zimmer suggests a technique that begins by adding, not subtracting. Go ahead and give the kid the same old cereal for breakfast, but offer fresh fruit, too. Maybe at some point, this particular individual will become more interested in the fruit and abandon the cereal.

Be the grownups

Get used to the idea that sometimes a child will be hungrier than other times, and don’t make a big thing out of it if they occasionally consume what you think is too much or too little. And forget that tired old “Join the clean plate club!” nonsense. Please do not set a heap of food in front of a kid. Let them start with a small serving of the fattening stuff, and maybe they will surprise you by scarfing down all the green beans.

Don’t let yourself be discouraged. You can place the same food in front of a child 20 times, only to see it scorned; and then, one day, they will eat it. When the child eventually caves and admits the stuff isn’t so bad after all, refrain from sarcasm. And now, Zimmer gives advice worth gold: “Don’t make exercise a chore.”

Parents, if there is some physical, active, calorie-burning activity your child enjoys, embrace it. Please. Find where the kid can go skateboarding or swimming, or learn gymnastics or Jiu-Jitsu, or whatever sort of exercise they can get behind. Please give them a chance to try an activity before committing to it. Make the time, find the money (it will probably not cost as much, ultimately, as weight-loss drugs or surgery), and figure out how to retain this as a major part of life, for as long as the child is into it. The rewards will be vast.

Your responses and feedback are welcome!

Source: “Watchful Waiting Not Recommended For Childhood Obesity,” RiverBender.com, 10/13/25
Image by JillWellington/Pixabay

Some Complicated Angles of Weight

Although styles of therapy differ, it is widely accepted that the root of all psychological malfunction is pain. In the animal kingdom, the amoeba is about as simple a creature as can be. And yet, even the humble amoeba knows to avoid pain, and somehow recognizes the appropriate moment to flee from a molecule of poison.

In that respect, people are very much like amoebae, but have more freedom of choice in their reactions. Amoebae probably can’t even fight. Their choice of displacement activity is quite limited.

Now, what about the entities that facilitate the healing of pain? Psychologists, for instance — do they absolutely need to be human?

As we have discussed, one aspect of psychological therapy has developed quite rapidly and noticeably into an overwhelming issue. Can excellent results be achieved with less, or even zero, human interaction? Can human connection be adapted and reconceptualized into something equally curative, by perfecting the ability of Artificial Intellligence to imitate high-quality connection?

It’s not that surprising

One might ask, why shouldn’t this be the case? Look, for instance, at books. They are made from common materials, and from symbols that are very different from human speech or breath. Furthermore, vast numbers of humans have been and still are unable to read books — and yet the influence that books have exerted on many of us (for better or worse) throughout the ages is a true marvel.

An important aspect of convincing relatability is in the bag already. Thanks to technology, AI can be engineered to swindle people out of their life savings by speaking in a voice so relatable that a perfectly sane adult will think it’s their grandkid, in desperate need of bail money. Compared to such an accomplishment, the ability to sound like the world’s most empathic therapist is no big deal.

One thought leads inevitably to another

So, why shouldn’t an equally convincing fake entity succeed in helping a person feel worthy and capable of making enormous life changes and losing 100 pounds? Or, if the human in need of therapy is a child wouldn’t it be theoretically possible to dispose of breath and heartbeat entirely, and let AI help the kids adopt, painlessly, a lifestyle through which they would never become overweight in the first place?

How much actual personal contact between patient and therapist is actually optimal? Can a group of other people with similar problems serve the personal-connection need just as well?

Maybe so. Millions of group therapy participants will attest that to go through the self-discovery experience with a cohort of similarly affected others can be incredibly helpful. For many, it has been vital to associate with others who are on the same basic journey, but a little bit ahead.

As Alcoholics Anonymous and similar groups have demonstrated, we also benefit from hanging out with people who travel a little way behind us so we can take our well-deserved turn as experienced encouragers of others on the same path.

(To be continued…)

Image by dbutlerdidit/Pixabay

So, relax. Eat cake.

Not long ago, we mentioned the experience of Kris, who totally recognized how much her emotional health depended on feeling so massively immovable that she could not be knocked down and rendered helplessly vulnerable. (To state it more theatrically, and sadly, she could absolutely never be “swept off her feet,” either, which was all according to plan).

As we have seen, Richard C. Schwartz and (unrelated) Mark Schwartz spent a decade refining the philosophies and practices of Internal Family Systems, stressing “the importance of working with the eating disordered part of self that encapsulates the trauma of the past.” The materials written for the public explained that, in contrast to other existing treatment facilities, Castlewood helped clients to heal the pain beneath their eating disorders “rather than just manage the symptoms.” They got in touch with their “parts” — the various inner beings known as Exiles, Managers, Firefighters, and other types.

When worlds collide

It seems unfair that even people who grow enough to accept and follow advice will still mess up so badly in choosing which advice to adopt. When taking action, it is also important to do the least possible harm. Listening to the wrong person and/or the lousy advice can be a problem at home, in group therapy, and basically whenever someone sets out to claim agency.

We could say that Kris had an inner advisor who advocated staying massively overweight for the sake of safety. And to all intents and purposes, it worked. But here is the problem. A “part,” be it manager, exile, firefighter, or whatever, could be mistaken in its opinion, and might be a wrong-headed advisor, just like a regular human. Real people and “parts” can all be mistaken, and so might people with degrees and headlines. And so might AI.

Important note: When a counselor helps a patient to identify the decent protective impulses that drive the parts called “firefighter” or “manager,” this is for identification purposes only, and does not imply endorsement or recommendation. To provide meaningful service, the professional really needs to have a handle on what’s what.

Today’s illustration features a slogan that has been seen, with creative variations, many times over the years, but to track and credit the original author would probably be impossible. Our most recent post asked if it is possible to facilitate the healing process without the participation of any actual second human.

And why not?

Well, why shouldn’t this be the case? It has already happened. Look, for instance, at books. They are made from common materials and from symbols that are very different from human speech or breath. Furthermore, vast numbers of humans have been and still are unable to read books — and yet the influence that books have exerted on humanity (for better or worse) is a true marvel.

Now, the real world connection, in-the-flesh, in the same space-time — how much of that is the minimum amount needed; the “necessary but not sufficient condition” that would be required to cause an effect? Is it the same in every case, and if not, then how do we tell the difference and decide how to proceed?

Okay, how about not very much?

One aspect of that psychological challenge has developed quite rapidly and noticeably into an overwhelming issue. Can excellent results be achieved with minimal human interaction, or even none at all? If the ability of AI to imitate high-quality connections could be perfected, then what? Well, first of all, forget all that, because it doesn’t meet the criterion of being human.

But what if AI works anyway? What if it learns to function incredibly well? Then, could human connectivity catch up and be similarly effective? Could human connection be adapted and re-conceptualized into something equally therapeutic?

Some people will always insist that AI is not human: end of story. Likely, there will always be others who insist that, of course, AI is drenched in humanity because people conceived and created it, and trained it on the works of thousands of unpaid creators, and so forth. Most likely, it is too soon to know.

Your responses and feedback are welcome!

Source: “The Therapy That Can Break You,” TheCut.com, 10/30/25
Image by Iffany/Pixabay

How Much Connection?

How often does it happen that a perfectly valid therapeutic approach fails, although there may be nothing wrong with that approach whatsoever? Maybe, for example, an outside force exerts a negative influence on the relationship between a therapist and the person being counseled. Among adults, an insecure partner, especially one who lives with the patient, can sabotage weight-loss efforts with ease.

In a far different setting, on the conceptual level, there may be difficulties, like those that can occur in the implementation of Internal Family Systems (IFS) theory. This modality is said to be designed for patients 18 and older, and may seem to have only a slight connection with childhood obesity — at the moment.

But if our current offspring emerge from their teens still carrying extra weight, the popularity of IFS guarantees that they will run into it sooner or later. It claims to be very successful in dealing with weight-control issues centering around either substance addiction (to food itself), or behavioral addiction (to the process of eating). IFS raises questions that may seem to stray far afield, but which provide glimpses into areas of human psychology that are quite different from jogging for miles, juggling calories, or judging portion sizes.

Human frailty never ends

In the Sixties, group therapy became popular and helped scads of people with various problems. There was a lot less obesity in those days, but for some folks, it was their main difficulty. For them, and many other types of help-seekers, there were side effects.

What if, during every group therapy session, a patient was fantasizing… “I’ll lose so much weight, and at our anniversary parties, I’ll tell the story of how we met because I couldn’t fit into my jeans, but my doctor fell in love with me. And he/she will playfully pinch my bottom, and all our friends will laugh and laugh…”

This is a tempting road to explore, because in the hearts and minds of most psychological counseling participants, to win the approbation of the therapist is golden. It is a powerful drive, and the possibility exists for a patient of any age or sexual orientation to develop very strong, situationally inappropriate feelings toward their therapist.

Another question

How heavy an effect does this need for approval, validation, and love exert in already-established obesity prevention programs? Everyone who enters therapy might not visualize an engagement ring, but plenty of us like to believe that we are the favorite patient, the one whose astonishing improvement makes it all worthwhile, not like those ordinary schlubs our therapist merely tolerates.

How does it tend to work out, for instance, in IFS, where the therapist has a chance to become acquainted with not just one aspect of the help-seeker, but with an entire cast of interior characters, each one of them whispering into the patient’s ear whenever they feel like it?

The future is now

All of this brings up a much bigger and potentially more dreadful problem that gains ground daily. Never mind being the favorite patient. Do we really, really need our psychological maladies to be addressed by a human intelligence or consciousness, at all? Or, for therapy to succeed, can a mere simulacrum do the trick? If we truly require a certain amount of human attachment in this context, how can the most useful amount of it, along with the correct amount of intellectual and emotional content, be achieved and maintained?

A human connection, whether through office visits or online counseling sessions, can affect a patient at any age, though with varying manifestations. In the case of weight-related problems, the relationship involves ideas and emotions about the body, and this additional dimension can be tricky.

What happens when human practitioners are replaced by chat robots and artificial intelligence? How has that method succeeded so far? In light of recent news reports about teenagers persuaded to commit suicide by human-imitating AI programs, the very existence of such an abomination is terrifying. (On the other hand, the issue becomes more complicated when, for instance, we learn that AI counseling may be of great help in preventing suicide among military veterans.)

Two views

Getting back to Internal Family Systems, here are two pertinent quotations from an article by Rachel Corbett, who conveys some of Richard Schwartz’s ideas about how the method that he originated (and developed at Castlewood Treatment Center) “is really the opposite of fragmenting people.” Corbett writes,

Clients come into treatment with their parts already intact — like a bulb of garlic, rather than the layers of an onion, he has said — “It’s not like I’m creating them.” Instead, IFS therapists work on “rounding up all those outlying parts and bringing them back home.”

Corbett views it all from another angle (and more about that is coming up next time). She cautions:

Most of Castlewood’s methods, starting with its use of IFS and the focus on trauma, contradict the prevailing playbook for treating eating disorders. Dredging up harrowing memories can overwhelm already fragile psyches and may lead to self-harm, substance abuse, or other unhealthy coping behaviors.

Your responses and feedback are welcome!

Source: “The Therapy That Can Break You,” The Cut, 10/30/25
Image by ThomasWolter/Pixabay

Listening to Internal Advice

It is worth mentioning here that many people, even in the healing professions, tend to discount emotional pain, as if it were a mere inconvenience or even a whim that someone can simply choose to shrug off. There seems to be a “Just say no to emotional pain” school of thought that tends not to work out well in everyday life. Really, the only people who “get” how crippling emotional pain can be are those whose lives are impoverished by it.

This might be why some practitioners obviously see great value in a basic Internal Family Systems concept, which is:

[D]isordered eating behaviors are not the problem themselves but rather attempts by protective parts to manage deeper emotional pain.

The internal beings called “parts” are also sometimes known as sub-personalities, thoughts, ideas, internal dialogue, feelings, sensations, symptoms, behaviors, defense mechanisms, maladaptive coping strategies, or even spirits.

The crowd

Among the inner multitude, one category of respondent, known as a “manager,” wants to protect the host and might be interested in setting up some rules. Also, those might be counterproductive rules that will wind up creating even more pain in the end. A manager sees a problem and proposes a solution, and strives to make something happen, even if it isn’t the optimal thing. Still, the managerial parts probably tend to have more common sense than those even more proactive parts that leap into the fray — known as “firefighters.”

Firefighters operate under a different set of criteria. They suit up, grab high-pressure hoses, mount ladders, and rush in to try and save the day. Their mission is to stop the immediate threat of psychic violence and destruction, even if it entails physical violence and destruction. Their priority is to end the inner pain, right now. The impulsive firefighters can be like enthusiastic amateurs who mean well, but do a sloppy job. If the only way forward is to tear down the museum-quality ancestral drapes to smother the fire with, a reactive guardian will do it.

Or that over-amped protector might pull some stunt like a spending spree, an unwise date, self-harm, violence, or even suicide. More likely, to terminate the current discomfort, this misguided volunteer might send the person on an eating binge. Sure, that is a variety of self-harm, but it smothers the present, in-your-face pain.

Thanks a lot

A binge is harmful enough, but there are, in fact, other shades and nuances of damage that must be written off as the inevitable consequence of avoiding immediate pain. Conversely, but for the same purpose of escaping today’s pain, tomorrow’s opportunity to heal might be put at risk by purging. If things continue badly, the firefighter’s next suggestion might be to exercise compulsively, or to try some nice numbing opiate.

Of course, all of this activity, however misguided or futile, takes place to protect the Exiles, the “parts” who are like ossified copies of the person at crucial stages when shattering life events took place. They broke off and live like hungry ghosts, unable to reconcile the horrible experiences they went through with a desire to keep on living, and yet unable to give up life as long as the tough old meat body is still hanging in there.

So, why not punish that animated corpse in some way, like the way that is so easily available in almost every society on Earth these days — by piling on the bulk until life becomes undesirable, and is sustainable only at a very high cost in daily pain?

Your responses and feedback are welcome!

Source: “Internal Family Systems and Eating Disorders: A Compassionate Approach to Recovery,” BalancedAwakening.com, undated
Source: “The IFS Model With Eating Disorders: ED is Just a Part of You,” EatingDisorderHope.com, undated
Image by cottonbro studio/Pexels