On Obesity

“Monday Musings” for Monday June 20, 2016
Volume VI. No. 25/285

General practitioner measuring waist of obese patient

General practitioner measuring waist of obese patient


The Moral Dimensions of Obesity, A Form of Severe Self-Abuse

by Assad Meymandi, MD, PhD, ScD (Hon), DLFAPA*

(Editors’ Note: Today’s ‘MM’ is a letter to an imaginary man of cloth or religious leader, giving us an opportunity to explore a very important social, religious, and health issue, namely obesity).

Dearest friend, man of cloth:

I consider you a combination of pastor, theologian, scholar-teacher-artist with the intellectual gift of balance and reason. So, from time to time, when I am exercised about some issue (the latest was the unacknowledged repeated errors of translation in the 1611 King James Bible) I bring it to you.

As a practicing physician and teacher with added interests in the arts, Christology/Christendom and theology, I have been thinking especially in the past couple of years “How Christian love influences and relates to our health?”.

I know that Christian love clearly teaches us not to be abusive to one’s self, to one’s fellow humans, and not allow others to be abusive to us. Yet we have this ominous epidemic of obesity that is rapidly deteriorating into a pandemic. We abuse ourselves by eating too much and not exercising. The cost of medical care is approaching 20% of America’s gross domestic product (GDP) most of which is spent on preventable disease stemming from obesity.

We go through excuses blaming obesity on various “glandular,” “metabolic,” “ovarian cyst,” as causes. And as of late, the biggest fraud perpetrated by my own medical profession is “genetics” is blamed to make us fat. Of course, genetics does have a place in illness, but it does not excuse gluttony. And we, the doctors and the medical profession, are not sanguine either. We have coined a new disorder, “Metabolic Syndrome” that seems to provide fat people with more excuses for laziness and lack of discipline. Blaming genes is an additional way of making excuses. Admittedly, science shows that genetics plays a role in obesity. Genes can directly cause obesity in disorders such as Bardet-Biedl syndrome and Prader-Willi syndrome. However, they are so rare that they do not register in epidemiologic radar screen. In some rare cases, multiple genes may increase one’s susceptibility to obesity but require outside factors; such as abundant food supply or little physical activity. Another emerging source of blame that I often hear in my practice is finger pointing a member or members of the family, sons, daughters, spouse, or parents. As the late comedian Flip Wilson used to say ”the devil made me do it…” There is no denying that people suffering from obesity need compassionate treatment, understanding, and love. But a serious national conversation should address the deadly epidemic of obesity. And perhaps it should be initiated in our religious institutions by our religious leaders. All said and done, the bottom line is very simple: taking in more calories than are expended accumulates fat. Keeping trim is a personal responsibility.

Traveling through Africa, Rwanda, Somalia, Ethiopia, Eretria, Ghana, Uganda and Sub-Saharan countries, one seldom sees a fat person except for the rulers and government officials, the members of the oligarchies. The new figures published by the US Health and Human Services are frightening. In the US, 80 million are pre-diabetic, with borderline elevated blood sugar and high basal metabolic rate (Basal Metabolic Rate—BMR–of 28 or above.) This figure is substantially more than previously estimated. Add this to the 51 million already diagnosed diabetics and you see that the population is floating in a sea of unused sugar. In the same report, HHS points to the alarming prediction of increase in future incidence of diabetes type II. The rate of increase is not linear, it is not logarithmic. It is exponential.

Type II diabetes has three causes 1) push button easy and sedentary life style. 2) abundance of food and 3) seductive ads on TV and other media. But the over-arching cause is lack of discipline.

The sad part of this life threatening, abominable and expensive illness that often leads to complications of hypertension, cardiovascular disease, blindness, kidney failure and early death, is that it is altogether preventable (except for Juvenile or type I diabetes, which constitutes a very small percentage of the cases.)

Diabetes is a behavioral disease. It may be prevented by controlling one’s weight and by daily rigorous exercise. Patients with type II diabetes are typically morbidly (twice normal weight) obese and have a scripted set of problems in common: bad back and musculoskeletal pain, irritability, slowness and depression, bad heart, high blood pressure and high incidence of addiction to either tobacco and/or alcohol. And they walk around with shopping bags full of medications given by their well-meaning physicians, a pill for each symptom.

Now, my question: what are the church or organized religion’s responsibility, duty and obligation to eliminate this epidemic? And what are the Diocese, the State, the National Council of Churches and other religious organizations are doing to ensure that the clergy is not fat? Is it not un-Christian, unloving and blasphemous for the clergy, the role models for congregations and the moral and ethical leaders in our midst not to have the discipline of trimming down and staying slim? I am glad to report that organized medicine and the doctors have taken impressive strides in this area. You see very few fat physicians walking around!

I would really appreciate your reply.

Assad Meymandi


*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association; Life Member, American Medical Association; Life Member, Southern Medical Association; and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He is a Raleigh, North Carolina writer and dramaturge.



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