Always the Fat Kid

Always the Fat Kid: The Truth About the Enduring Effects of Childhood Obesity by Jacob C. Warren
My rating: 4 of 5 stars

This is a somewhat strange book that never quite lives up to its title. That being said, the authors still make some valid points that will resonate with anyone interested in obesity and the risks it presents not just to the individual but to society as a whole.

The authors strike an odd tone between the importance of calling out obesity early on for its role in various poor health outcomes (even calling it an epidemic) and avoiding the stigmatization of fat and fat people (especially fat children). Interestingly, this is an ongoing issue many health practitioners face. How do you address the known associated risks of obesity and overweight without minimizing and/or stigmatizing the person who is obese or overweight? As a health care professional, that really is the million dollar question, one that I'm not sure the authors ever address, or at least not adequately so.

I mean how do you separate the behaviors that lead to obesity from the person who is obese?

As a PT, I often see patients whose weight, even if it is not the sole cause, is generally a contributing or aggravating factor for the issue that is being treated. How do you not discuss weight when treating knee pain? Orthopedic MDs will tell you each additional pound you carry is like an extra 4 lbs through the joint. That's pretty significant. There are even docs who will encourage a patient to lose weight before they perform certain surgeries because they are worried about poor outcomes.

In my own practice, I've always tried to be empathetic and diplomatic when bringing up weight. I might offer it as an aside when discussing contributing factors. And I'll never forget the day a patient literally exploded when I mentioned weight.

Apparently, she was tired of being told that she was fat. Not only, fat she said. No, she was obese. Obese. What an ugly word. She wanted to know why was it that every problem she had was blamed on her weight.

I sat and listened as she vented. It was clear her words were not a rebuke directed toward me as much as a general rant about what she perceived as personal criticism. She hurt and she hurt because she was fat. And the underlying implication is she was fat because she chose to be fat. Or at least that is what everbody seemed to think. And she was tired of hearing how her weight was the root of all her problems. After all, wasn't it possible that she could have a medical condition that wasn't a direct result of her weight?

Once she finished, I took a deep breath. I told her I understood her frustration. I agreed that there were thin people who also experience knee pain and that extra weight absolutely wasn't not the sole cause of her condition. However, as a medical professional my job is to determine not only the cause of her pain, but factors that can impact her pain, and her extra pounds were likely a factor whether she liked it or not.

More recently, I've read several books that have challenge the assertion that fat is indeed unhealthy. The authors point to studies on mortality that have shown that it is better to be overweight and fit than thin and unfit. They claim that the death rate for overweight and obese is only significant when you enter the morbidly obese categories. They also argue that the "fat shaming" that is inevitable when you associate weight with a particular medical condition is not helpful. Instead it leads to feelings of worthlessness and self-loathing. It certainly doesn't inspire or facilitate change.

And the truth is there is still some debate about the role overweight and obese play in the development of disease. Some overweight people don't experience the associated conditions like diabetes and heart disease, while others do. On the other hand, there are medical journals filled with research that has established a correlation between too much stored fat and the development of disease, even if there are other factors at play.

Furthermore, the absence of health is not necessarily death but disease. And while disease may or may not contribute to a premature death, it generally affects the quality of life no matter how long that life is.

In the end, it's tough to wage a war on fat without wounding those carrying the extra pounds in the process. Then again, normalizing "fat" is also dangerous because it is a known risk factor for just about every lifestyle disease we have. And it really doesn't matter whether it is the excess fat itself or the behaviors that led to the increased fat stores because the outcome is the same.

To further complicate this issue, we are now dealing with children, too many children according to the authors, children who are often affected psychologically even if they are one of the lucky fat kids that becomes a thin adult. Obviously, it's a sensitive issue. How do you police weight with children? Their bodies are growing. Norms are not only hard to identify but constantly changing. You certainly don't want to contribute to poor self-esteem or negative attitudes about food and eating. Yet the threat is real, one needs only to look at the sobering statics surrounding childhood obesity to recognize it is a far greater risk to our children than many other risks currently on the radar.

At the end of the day, I'm not sure Warren and Smalley tell us anything we don't already know. That said, their book does challenge readers to take notice of the threat and start pursing a course of action. And there are some other bits and pieces of wisdom scattered throughout that are likely to inspire some internal or external dialogue on the topic of fat and the medical, social, cultural, and personal issues that surround it.