The Paradox of Obesity

By Michael Popejoy

I am happy to have been appointed the health columnist for the year 2014 for PA Times online. I certainly hope that the information that I provide for our readers is informative, interesting, thoughtful, current and quite possibly, occasionally a bit controversial since rarely we will often strike easy wide agreement on health issues. One thing is that I am not going to focus my entire year of work here to just Obamacare since there are so many other issues that I should offer to our readers. So, I will touch on Obamacare when it seems right while I offer many other points of view to readers. I will even respond to issues you may want to read about if you send letters to the editor requesting more information on different subjects that are of interest to you. As you can see from my degrees, I am cross trained in business administration, public health, public administration and health administration which should provide an interesting mix of topics aimed at the health issues of modern life in a global perspective. So, let’s begin!

The history of medicine is a rich and expanding field of wide interests. Today, we face an epidemic of obesity. We are warned daily about the adverse effects of overconsumption of sugar and fatty foods with the dire consequences of being overweight especially with obesity related diseases such as diabetes and heart disease. Deaths by diabetes are probably the most underrated statistical ranking of obesity related diseases. Many people may die of a disease that is related to diabetes related to obesity—so, at the autopsy, we have to look back to what brought us to the medical examiner’s office for the final diagnosis. A balanced and nutritious diet coupled with exercise remains vital for the future health of all of us. In many cases, this is under our control when we do not think so as we battle a disease that we believe could not have been avoided.

Especially severe today is the raging epidemic of childhood obesity which seems to be the most preventable. Now the legal, moral, and ethical issue of childhood obesity must be considered. Should it be considered child abuse? Anything done to children causing them harm can be classified abuse. Child protection organizations work hard to identify victims of such treatment and get these children forcibly removed from their dangerous environments. This is one of the crosswalks between public administration and public health. We would legally remove a child from being starved but we are reluctant to remove a child from being overfed. Clearly, the environments are equally deadly. Why do we allow children to be dangerously overfed but then act with immediate dispatch when a starving child is identified? I believe this a cultural observation that allows us to believe that a fat child is healthy and a thin child is sickly. This is not necessarily a true relationship but it can set up a great deal of peer pressure on the parents of a thin child to fatten the kid up which they may do to their detriment.

I was a thin child once. I watched my parents take on a great deal of family and community peer pressure to fatten me and my siblings up because we were thin and appeared underfed in the minds of our extended family and neighbors. My parents were afraid that the state would eventually take us away, accusing my parents of denying us food. Of course we weren’t denied food but that is not how it looked to those following a cultural imperative. Thin kids are sickly and abused. My siblings and I wanted to protect our parents and make them happy so we ate—today, we are all obese.

Just three nights ago, at a restaurant, history repeated itself in front of me. Sitting nearby, I observed a mother berate her perfectly height-weight ratio son into eating more than he wanted after he stated repeatedly that he was “full.” She guilt-tripped him into eating more food than he wanted. He was embarrassed and ashamed as he ate and ate until she was satisfied. I hesitate to wonder where this cultural imperative will leave him later in life. I also sit here tonight feeling guilty for not saying something to the mother. As a public health doctor, I should have told her that she was potentially leading her son to a catastrophic weight problem in the future. An ethical dilemma of when do we speak up and when do we just stay out of it as an issue that is none of our business. He is her son, but with this kind of abuse, when should the boy be removed from his family for his own safety?

Michael W. Popejoy, M.B.A., Ph.D., M.P.H., M.S., FRSPH teaches both graduate public administration and graduate public health and is cross trained with his Ph.D. in public administration and the M.P.H. in public health from a CEPH accredited school of public health. He can be reached at [email protected].

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