Did you see Governor Chris Christie on the The Late Show with David Letterman? During the show, he pulled a doughnut from his pocket and began to eat while Letterman chuckled. This sparked a comment from a former White House physician, Dr. Connie Mariano, who said that Christie’s weight was no laughing matter and that he was a ticking time bomb. She said that “if elected president, he could die in office.”
While these comments may simply sound like the the honest opinion of a well-known physician to some, for Dr. Mitchell Roslin, the Chief of Bariatric and Metabolic Surgery at Lenox Hill Hospital and Northern Westchester Hospital Center, the comments about Christie’s weight demonstrate how unique obesity is over every other medical condition. Dr. Roslin wrote an article about Governor Christie, and gave a detailed comparison between the Governor’s health and that of former Vice President Richard Cheney. Cheney had numerous treatments for management of coronary artery disease, before, during and after his term as Vice President. Despite this serious health concern, there was very little questioning of his capacity to serve based on his medical condition. “He was never viewed as being incapable because of the severity of his heart disease,” said Roslin. Christie, on the other hand, has never had a health problem and refers to himself as “the healthiest fat person,” but is labeled as unfit for office due to his excess weight. If we extrapolate on this idea that obesity limits his ability to serve, could employers believe that a person of ideal weight many be better able to work in their establishment than an obese person? The door is wide open for this type of prejudice and discrimination, Roslin says. In a society where we have evolved enough to understand and accept diversity in ethnicity, religion, race and sexual preference, obese individuals still face stereotyping and profiling.
Part of the problem is that obesity is such an apparent health condition and that society in general views obesity as something that the individual could fix, if they only had the will-power to do so. Watching popular television shows like The Biggest Loser leads people to think that weight loss is easy. However, most people who lose large amounts of weight go on to regain it later. Many believe that we can simply learn to change our behavior and maintain weight loss, but science contradicts these widely-held beliefs. Rather, the body resists weight loss and works against a person struggling with obesity. “When caloric intake is reduced, our bodies respond by becoming more ‘efficient’ and reducing our metabolic rate”, says Dr. Roslin. Citing the story of Dr. Stuart Berger, Roslin says his tale is typical of the weight loss struggle. “Dr. Berger was perhaps the first famous television diet doctor. While in medical school at Tufts University, he weighed in excess of 400 pounds. He lost a substantial sum of weight and authored The South Hampton Diet. His diet book was widely-publicized and he became a weight-loss guru.” However, as is the case with so many, he was unable to maintain his weight loss. “He died from heart disease at the age of 42. At the time of his death, his weight was again 400 pounds.”
Obesity is a prevalent issue in the United States, with the CDC citing that more than a third of American adults are now obese. These numbers are expected to climb in the coming decades, and with them will come increasing rates of weight-related diseases. While some obese people like Christie seem to be spared from these conditions, many are not. There has been only one medical device and one pharmaceutical product approved by the FDA in the past ten years to treat obesity. Weight loss surgery is an effective treatment option, but admittedly the idea of surgery is frightening for many people and it is often difficult to obtain insurance approval. Roslin advises earlier treatment for obesity, routinely evaluating BMI and referring for treatment at a young age.
Dr Roslin’s essay has received significant appreciation from healthcare professionals and the general public. He told us, “the multiple positive comments that I have received are flattering. They have reinforced my belief that there are substantial misconceptions about morbid obesity even amongst educated individuals. An important aspect of our role as weight loss physicians is to educate the public and erase these myths. Simply stated, Governor Christie is very aware of his weight issues. He is not in denial. However, there are few options. To this point, his frustration has not reached the point to justify surgery. In 2013, surgical remedies are the only long standing effective treatment for morbid and super morbid obesity.” You can access Dr Roslin’s complete essay here.
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