In which my commute lengthens.

Cynthia will be at 32 weeks tomorrow and has gained about 15 pounds -- essentially increasing her weight by around 14% throughout the process thus far, if I am doing the math right. This has led to her finding virtually everything difficult to do -- sitting, standing, walking, everything. Our commute has lengthened; we still walk to work each morning, but we walk a lot more slowly up the hills.

Her doctor is thrilled that she walks three miles a day in addition to her gym workouts (which are also increasingly limited). I am entertained by the grunting and gasping noises she makes when she tries to roll over.

On the way into work this morning we overtook several immense people on the sidewalk, parting to pass around them and then linking up again on the other side. These are not people who have an extra 14% of their body weight to worry about, unless their normal weight is 270. These are people who are carrying 200% and more of their recommended weight.

When I started in private practice, I used to handle Social Security Disability Claims. You could draw SSDI for disability. If memory serves, you had to be at 300% of the median weight for your height, age, and gender. (Given that most of us are a little overweight in the US, the "median weight" chart is misleading; median is too heavy.) I handled a few obesity claims. I think they've since changed the rules on that; you now need other medical conditions on top of the obesity.

My point is that Cynthia is struggling with an extra 14%. How do people manage with twice their healthy weight? This coming from someone who gained a lot of weight in law school and ignored it for years -- it didn't look good, but it didn't interfere with my breathing or my ability to walk. I could sit in a single airplane seat (at least to the extent that ANY adult can sit in a single airplane seat) and walking between the seats at a sports stadium. I am, therefore, fully cognizant of the fact that weight gain can sneak up on you when you get older, and that it is a bitch to shed it once it's there.

But at the same time, when you can't walk, sit in a car, or breath while sleeping, you would think at some point a lightbulb would go on and you would resolve to do what needs to be done. Carrying an extra 20% body weight is one thing; carrying an extra 150 pounds is another.

The journal Obesity (got to love the internet!) confirms what is apparent from casual observation: obesity is a socioeconomic indicator. In what is probably a first for the history of humankind, it is the poor and disadvantaged who are most likely to be fat. This is not merely an American phenomenon; the Obesity article looked at studies from Europe, too. One thing that was interesting about the studies was that for women, childhood economic status appeared be an even stronger indicator of obesity than one's adult economic status. Parental education levels were, oddly, the single highest correlative; the less educated one's parents, the more likely one was to be obese.

This has led to me coming up with three half-baked ideas, each seemingly guaranteed to piss of a different group of people.

(1) Junk food is a lot cheaper than healthy food.
I lost most of my excess weight and have managed to keep most of it off for several years now. One thing I learned was that eschewing unhealthy food for healthy food costs a lot more money. It costs more for a good salad than it does for an immense McDonald's meal. Whole grain bread costs a lot more than white bread. Fresh fruit costs more than chips. Now, in the long run, I think it evens out -- even if you don't factor in healthcare costs -- because once you adjust your diet, you eat less, and eventually it takes less food to feel satisfied. Nonetheless, if you want to eat cheap, eat poorly.

(2) What else does education level indicate?
It is not universally true, but it is generally true that education and income levels are indicators of a capacity for deferred gratification and self-discipline. These are, I think, learned behaviors. These are the same traits necessary to keep one's weight under control in a society where, as noted above, junk food is ubiquitous and cheap, while healthy food is relatively scarce and expensive. ("Scarce" as in "harder to find," not "unavailable." Compare the number of produce stands to the number of fast-food joints in most neighborhoods). The same thing that causes someone to say "I am going to work hard for a long time and spend a lot of money getting my Ph.D." would also cause someone to say "I am going to reform my diet and exercise to bring my weight under control." Conversely, the person who is unable to say "I am going to exercise more and eat better" is probably unable to say "I am going to study more and educate myself." By this I do not mean that all fat people are lazy, or that all skinny people are hard workers. We are talking about trends here, not individual cases. But for a variety of reasons, in the developed world, it is simply easier to be fat than it is to be skinny. The question I am wrestling with is not "what makes us fat?" -- that's pretty obvious. Cheap junk food and a car-based society. The question I am trying to understand is "what keeps us fat?" Why would someone who can't sit on the bus or walk up a flight of steps not undertake corrective behavior? Why would someone take diabetes medication and blood pressure medication and back pain medication and undergo arthroscopic surgery on her overstressed knees and suffer from depression and low self-esteem and body-image issues, all on account of her weight, and not simply eat less, eat better, and exercise more? The answer, I think, is that losing weight takes a long time and takes a lot of work, and a lot of people are generally incapable of that sort of sustained effort and discipline. These same traits are linked to educational success and, therefore, to income. And that's the connection.

(3) Normative abnormalities.
The final factor is, I think, the normalization of obesity. A person stays fat because everyone around him stays fat. He fails to lose weight because failure is acceptable. Think of how many people you know who always speak of losing weight, but never accomplish it. Speaking for myself, I ignored being overweight for a long time... but when I decided to do something about it, I did something about it. And when I started to backslide a couple years later, I reversed course pretty quickly. Yes, it's easier for me to lose 20% of my body weight than it is for someone else to lose 50%, but then again, I stopped ignoring it when it got to the 20% mark -- I didn't wait until I was twice as heavy as was healthy.

When I was in private practice, the hardest part of my job was saving people from themselves. One of the most common, and aggravating, things I encountered was this belief that good intentions were sufficient by themselves. Directly tied to this belief was the notion that having a really good excuse for not doing something was the functional equivalent of actually accomplishing something. There is a parallel phenomenon -- the person who is always on the verge of getting her shit together, but always has some really good reason why it hasn't happened yet. I'm going to start my own business as soon as I... I'm going to go back and finish my degree after I... These are the people whose cars get booted because they ignore parking tickets. The waitress who believes that she is way too smart and talented to still be waiting tables. The office worker who bounces his rent check a couple times a year. The people who take eight years to get a B.S. in early childhood education (and continue working as daycare assistants for $8/hour.)

It is perfectly possible that some of the grossly obese people I saw on the street today are smart, well-educated, industrious, hardworking people who have their acts together and who accomplish whatever they put their minds to; they just haven't put their minds to losing weight. As I said, I am talking generalities here, not specific individuals. But my hunch is that the really dangerously overweight people are people who are out of control in many aspects of their lives, and their girth is just the most readily apparent manifestation of this.