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Stop judging - obesity is about more than gluttony

A ruling made last month by the Canadian Transportation Agency, ordering airlines to provide the same fares to disabled passengers, has elicited much discussion about the implications with respect to the clinically obese. Let's face it - looking at such people is not fun; their oversized bodies betray years of overindulgence and lack of self-control. Obese people are the victims of their own poor lifestyle choices. Society, and certainly the already struggling airline industry, should not be forced to pay for their unchecked gluttony.

If you find yourself agreeing with these assertions, you are likely a member of a not-so-silent majority. You are also a significant part of the problem that obese people face every day.

At the simplest level, obesity is about the balance of caloric intake and expenditure. It is tempting for us to simply conclude that its cause is lack of control, or gluttony. The fact is that such a conviction, while perhaps providing us with some level of self-satisfaction, is quite wrong. We know there are many factors that go well beyond individual levels of self-control. Obesity researcher George Bray said it best when he asserted that "genes load the gun and the environment pulls the trigger."

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But even if we assume that at least a substantial part of the obesity epidemic does lie in individual lifestyle choices, this is by no means unique to obesity. My dear mother, may she rest in peace, died of cancer. When she was diagnosed, her cancer was littered throughout her body - in virtually every vital organ. Her doctors, caregivers, friends, neighbours and even people she barely knew were supportive and genuinely concerned about her suffering - even though my mother had been a lifelong heavy smoker. We tend not to blame lung-cancer victims for their problems, even when we're fairly certain their illnesses stem from poor individual decision-making.

So why are we so hard on the obese? The most obvious answer is that the obese aren't "sexy" to most people. It's extremely difficult to get past the visual representation of their illness and its source. It was relatively easy for people to forget that my mother smoked. She quit after her diagnosis and people were able to forget. But the obese cannot hide their weight from us, and we don't like it.

But I believe there's more. I think obesity scares us. It forces us all to examine our own weaknesses and proclivities. Who among us has not overindulged or felt a loss of control? In the obese, we see just how close we are to our own personal vulnerabilities.

It's also a complex issue, and we crave simplicity. Obesity is about much more than food and individual willpower. It is about the way we organize society, the way we build our cities, produce food, eat, shop and work. Grappling with obesity in a serious way requires us to look at ourselves and how we organize as citizens of a prosperous Western industrialized country. The obese don't need our scorn - they need our understanding, support and protection. Obesity is about food, which we all require to live. The alcoholic can swear off alcohol, the diabetic can avoid refined sugar and the celiac can eliminate wheat. But the obese don't have the luxury of swearing off food. Every meal presents a challenge.

The weight-loss industry in Canada is entirely unregulated. The obese are left to their own devices to find treatment options that are legitimate amidst a flurry of sales pitches of dubious credibility.

Injections, fad diets and unrealistic exercise regimes compete with reasonable weight-loss programs and bariatric surgery on the same level playing field despite the fact that some do little more than generate profits for their vendors. More than 5.5 million Canadian adults and 500,000 children are obese. That's one in five Canadians at increased risk for early disability and death, decreased quality of life and a diminished capacity to contribute to our economy. These factors translate into more than $1.8-billion in direct health costs to the national health-care system, and things are only getting worse.

We need to get off our high horses and stop judging. We need to solve this problem.

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Irving Gold is chairman of the Canadian Obesity Network, a Networks of Centres of Excellence New Initiative.

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