How to Solve the Obesity Crisis, Fix Health Care and Save the Environment (All at the same time!)

DiPlease read the preceding disclaimer first. Read the following at your own risk:

"Outside of gastric bypass surgery, no system has ever produced any significant long-term weight loss. None. "

So says Megan McArdle, channeling Paul Campos and Gina Kolata, in her article "Thining Thin" in The Atlantic Monthly. She adds, "Every single study which has attempted to make overweight people get thin without very risky surgery has failed completely and utterly. Fewer than 1% of patients ever keep the weight off."

She rebuts the predictable argument of "But I'M thin! Therefore there must be a way to 'make' fat people lose weight." with the hilarious "And I'M tall! So there must be a way to make you shorties grow!" Speaking with chutzpah I can only admire from a non-confrontational distance, she adds,

"I fearlessly predict that more than one person will respond with some variation on 'there were no fat people in concentration camps/but I told you, I totally lost 20 pounds last year by taking up marathon running!' Yes, we could solve America's obesity problem by putting everyone in the country on sawdust bread and cabbage soup. We could also just shoot anyone whose BMI is over 28. Are these good solutions? Because short of that, we don't have much."

Read her entire article to get the details of her argument or just accept the parsed version: Despite decades of scientific research into why some people are fat and why some aren't, we really don't have any practical answers.

Assuming the validity of her premise, I'm going to ask the obvious question: So why doesn't every overweight person just get gastric bypass surgery and be done with it? Sure, there's the "dumping" and the lifelong vitamin deficiencies and the pain of major surgery and, oh yeah, that pesky 2% mortality rate. But I'm willing to bet that people would accept all those risks and more to be guaranteed to be thin for life.

Well, maybe not for life. Gastric bypass surgery, while more successful than other weight-loss interventions, still doesn't work for everyone. In fact, most patients gain back a significant amount of the weight they initially lose. Even though their stomachs can only 2 tablespoons of food.

Even still, the promise of losing any amount of weight is enough to tantalize more than 205,000 people into going under the knife in 2007. So I'm going to postulate that it isn't the riskiness of the surgery nor the mixed results that's holding people back. I'm guessing it's the $20,000 - $25,000 price tag and only spotty insurance coverage for it. Which is why the government should sponsor gastric bypass surgery. To heck with "a chicken in every pot"! How about "A band on every stomach!"? Think of the publicity coup for any politician who supported that kind of health care reform. Not only are they lowering costs for all Americans by Winning the War on Obesity but they're prettying up the joint too.

That's ridiculous (and offensive) you say? Well then the only options left to us are to continue doing what isn't working (i.e. good hearted but sadly unproductive programs like diet and exercise education, early childhood intervention and reality television shows/celebrity-endorsed diets) or to admit that we don't know the way to make people lose weight and keep it off.

McArdle sums it up by saying,

"You do not have better willpower than they do. You do not "care about myself" more. You are not more "serious about a healthy lifestyle" because you took off the eight pounds you gained at Christmas. You are no more qualified to lecture the obese on how to lose weight than I am qualified to lecture my short friends on how to become tall. You just have a different environmental and genetic legacy than they do. You're not superior. You're just somewhat thinner."

All of which isn't to say that obesity isn't a problem. It is. The negative effects from being obese are well documented. I'm also not saying that we don't need health care reform. We do. The system is deeply flawed and unstable. What I am saying is that we need a little more compassion and lot more creative thinking. Anyone ever read that short story by Orson Scott Card where aliens discreetly turn suburban malls into fat farms by providing endless buffets of decadent food and then harvesting the resulting pudge for energy? Solves two problems in one! People get to eat what they want, stay thin and it's green energy to boot! Too bad it ends up killing off the humans in the end. I know what we need: smarter aliens.