Obesity: what’s the solution?

I was buckled in already when I saw this guy squeezing down the aisle. I froze. I had seen him earlier, waddling towards the boarding gate, his T-shirt not quite long enough to cover the apron folds of his belly, rings of effort-sweat under his arms. I felt alarmed for him: how do people that size fit into dainty little three-in-row economy class seats on airlines? How, if he needs a "comfort break" will he manage to squeeze into the toilet cubicle?

But when a guy like that seems to have his eyes fixed on the seat next to yours, suddenly it's not his comfort you think about as much as your own.

The Universe was on my side, and he collapsed into the seat behind me. He was wheezing and exclaiming: the walk from boarding gate to seat had been a marathon. It was a good 10 minutes and several hits of his ventilator before he quietened.

In the aftermath of the decision by the pharmaceutical group Abbott Laboratories to take Reductil off the market in South Africa, I'm finding myself wrestling mental alligators around obesity.

It was in 1997 that Abbott launched Reductil, a scheduled drug whose active ingredient, sibutramine, works at a serotonin level to manage satiety levels in patients. Though other weight-loss products exist in doctors' armoury, none is in Reductil's league. It has given health back to hundreds of thousands of patients over the 13 years of its existence. Click here for an overview of why the drug was withdrawn.

More than 60% of South African adults and a good percentage of children are, medically speaking, overweight or obese. I don't think we really understand obesity. We understand some of the mechanisms that drive it. For instance, we know that empty kilojoules and a sedentary lifestyle are part of the picture, particularly when a person formerly of healthy weight starts to pick up weight. We know that other environmental, psychological and genetic factors are also at play. We also know that you don't need to be carrying too much surplus weight before the side-effects of obesity start to have a life of their own, compounding your propensity to gain weight, and your difficulty in losing it.

Yet despite all that we know, we are irrational. We are irrational in the way we stigmatise certain conditions and diseases. HIV/Aids is one of them; also certain cancers, if the victim is a smoker. Obesity is a third. We see these as the consequence of poor lifestyle decisions, and somehow therefore deserved. Probably, some poor lifestyle decisions have been made. But I have made some pretty poor lifestyle decision in my life and, so far, appear to have got off scot-free. That makes me lucky, not morally superior.

I don't know, in the post-sibutramine era, what the solutions are for obesity. But I know that self-discipline and denial aren't solutions. And I know that society's fastidious condemnation of fat people is neither helpful nor intelligent.

This, surely, must be one the medical science's top priorities.

(Heather Parker, Health24, October 2010)

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