The high cost of fat

For the first time in my life, losing weight was not about unrealistic aesthetics

WILLIAMSVILLE — I've probably “lost” hundreds of pounds in my lifetime, but I've really only misplaced them, because I've always found them again.

Every time I've lost weight, I've been motivated by vanity. Since childhood, I'd been told I was “heavy” - and I quickly learned that “heavy” was not the feminine ideal. Even if I failed to grow to runway height, I always believed that I could and should achieve runway thin.

Only now do I appreciate what a fabulous body I had at 16 - and every year since.

Only now do I realize that what matters about my body isn't about aesthetics but about health.

In recent years, I told myself that my widening waist was just an inevitable part of middle age. I told myself to get used to it and to wear elastic.

What mattered was that I was healthy and fit; it didn't matter what I weighed, so I stopped weighing myself - until I went to the doctor.

* * *

It wasn't the scale that was over the top; it was my blood pressure. My physician told me that sometimes just a small weight loss of 5 pounds can remedy hypertension.

I tried to lose weight, and I failed (while beating myself up for all kinds of moral failings), so I started taking medication.

My husband, a physician, consoled me, saying high blood pressure was a common occurrence in middle age. Just like our muscles, our blood vessels lose flexibility as we age.

Coronary heart disease runs in my family. My dad, a business executive, smoked for 30 years and had bypass surgery when he was 70. Despite diligent weight control, all three of my brothers have increased cardiac risk simply on account of being male.

For once, I felt smug about my difference, until my low-density lipids rose as my estrogen ebbed. I'm now unequivocally at risk for cardiac disease.

* * *

When I was in college, I'd taken a course in human biology, where part of our lab work included measuring our pulse, blood pressure, vital capacity, and the distance around a track which we could cover in six minutes.

After engaging in aerobic exercise for the semester (a requirement of the course), we took our vitals again. Even as a healthy 20-year-old, I'd improved.

I'd learned back then what I still knew to be true: the garden-variety cardiac risks I have are largely preventable. I could make myself better.

But I'd have to lose weight.

If I didn't, I wouldn't just be putting my health at risk, I'd be spending more time at the doctor's office instead of getting my work done and playing outdoors. I'd be enriching the pharmaceutical companies who profit from every medication prescribed. And I'd be using my health insurance benefits, driving up costs for a preventable condition.

I didn't want to do that.

I didn't want to be another one of those many Americans who don't take responsibility for their own health, irrespective of their access to heath care. For the first time in my life, losing weight was not about unrealistic aesthetics. It was a moral imperative.

So I ate less and exercised more, and I've seen all my numbers go down: not just my weight and my waistline, but my blood pressure and my lipids as well. I became dizzy with success - and I had to stop taking the blood pressure meds.

* * *

I know I'm privileged to have access to good health care and the kind of insurance coverage that everyone should have. Everyone should have access to care for health maintenance, chronic illness, and acute injury and illness. Of course, such universal health care comes with a cost, but so does being overweight.

A person is classified as overweight when their BMI (body mass index, a calculation based on one's weight and height) is between 25 and 30. A person with a BMI over 30 is considered obese.

About two thirds of the American population is overweight. (That group included me until a few weeks ago.) At current rates of growth (pun intended), it is estimated that 86 percent of the American population will be overweight by 2030; 42 percent will be obese.

It's already costing us big bucks, and not just in health care.

In the past 10 years, policy wonks figure Americans have had to buy 938 million gallons of extra gasoline at a cost of about $4 billion, because car engines have to work harder to carry heavier loads.

America's weight problem costs more in jet fuel, just to get us off the ground, and mass transit venues have started installing wider seats to accommodate our larger selves, meaning they can move fewer people at a time.

So in addition to saving money, Americans could help reduce fossil-fuel use and the resulting greenhouse gassesif we all just slimmed down.

* * *

There's a direct link between being overweight and diseases such as coronary heart disease, type 2 diabetes, cancers (endometrial, breast, and colon), hypertension, high blood cholesterol levels (dyslipidemia), stroke, liver and gallbladder disease, sleep apnea and respiratory problems, osteoarthritis and gynecological problems (including infertility).

But beyond the human cost, America's weight problem has cost hospitals extra money for wider wheelchairs, cranes to lift overweight patients from gurney to bed, and oversized diagnostic machines - such as MRIs - large enough for the extra large. According to the Centers for Disease Control, in 2008 the medical care costs of obesity in the United States totaled about $147 billion.

In addition, we see the indirect costs of lost income from decreased productivity, restricted activity, and absenteeism.

Overweight and obesity are bad for business, and premature death is bad for everyone, especially dependents of the deceased. With a sick workforce, profits languish, payroll taxes decine, and workers have less money to spend.

At the same time that tax revenues decrease, the government must pick up the tab for Social Security payments to those disabled by obesity and to the dependent survivors of a head of household who has died prematurely.

Much has been said about the high cost of American health care and how expensive extending health insurance coverage to all Americans will be. Much has been said about health care as a right.

Not much has been said about the responsibilities that come with those rights.

But just as we have a responsibility to vote, to pay taxes, and to serve on a jury, so we also have a responsibility to take care of ourselves.

Achieving a BMI of 25 isn't just good for one person's health: it's cost-saving, it's greener, and it's patriotic as well.

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