A friend of mine emailed me last night, suggesting I watch the latest episode of BBC 2's 'Horizon', because it dealt with the issue of Gastric Bypass. But when I started watching it this evening, I realized that really, it deals mostly with obesity – how and why it exists, and what we should do about it – and Gastric Bypass plays a large part in the last third of the program.
In all honesty, as I started watching, my immediate reaction was rage and righteous indignation. Gabriel Weston, the thin, blond, female surgeon who hosts the show announces at the very beginning that for her entire life (including the ten years in which she's been practicing medicine) she has operated under the 'assumption [...] that I am the size I am because of my character'. Now, not only is that a particularly smug way of putting it, there is a serious problem with the underlying message: that fat people are fat simply because they are lazy and eat too much. They don't have the strength of character to change their bodies.
Of course, the program isn't just about this one extremely irritating person spewing her views about fat slobs – it's also about finding out why fat people are fat, and investigating the causes of and possible solutions to this 'epidemic' that's sweeping the western world. And on that front, the show (and maybe Wilson, if she wasn't just there as a figure-bobblehead) does a very good job.
One of the first people Wilson talks to is a doctor whose own personal experience with attempting to control his weight led him to study the reasons that our bodies seem so stubborn when it comes to weight. Interestingly, this doctor is a former athlete, who was trying and failing to gain weight, despite being, as he said, very motivated and a very driven person. He is now studying the ways in which hormones affect our weight and, specifically, our appetites – Wilson is, of course, skeptical of the idea that hormones are the reason she's not fat (easy to be skeptical when you're thin).
The hormone studies are really interesting. I don't want this post to be a super-long summary of the show (if you're in the UK you should watch it on iPlayer), but the gist of it is that every body contains a 'hunger' hormone and a 'fullness' hormone. In normal people, these peak and trough as you'd expect: hunger is very high when you're hungry, and fullness is high when you've just eaten. In obese people, though, the hunger hormone never really peaks, but it also never goes away completely. It just stays dimly present all the time, like a lightbulb that's on very low. This means that, unless they're truly starved for a long period of time, obese people never really get hungry, but they also never really aren't hungry – they could always eat (this is particularly interesting to me because it's totally how I feel post-GB, and I suspect it's how I felt when I was heavier as well, although of course I don't remember).
The other studies Wilson learns about involve genes – specifically, a study involving twins with different body types and another that tracks genes from when the patient is a fetus in the womb into childhood, to determine whether or not a pregnant mother's diet has anything to do with her child becoming obese later in life. Both studies were really interesting, and both came up with yet more reasons for people getting fat. The twins study found that both twins had the 'fat gene', but only one of them had a life experience that 'switched it on' (this was usually stress-related). The other study found an astounding 25% chance that poor diet during pregnancy (specifically deprivation but also poor food choices) would lead to the child being obese later in life.
The last thing Wilson examined was a potential solution to the problem: Gastric Bypass. Interestingly, though, she examined the surgery from a different angle than I'm used to: how it changes the patient's brain, through changing his stomach. Wilson spoke with a psychologist who is studying the ways the unconscious mind reacts to photos of rich vs healthy foods, and she has found that patients whose brains essentially drooled over photos of fatty, sweet foods before surgery have a much more muted reaction after the GB. The surgery is presented as a way to change appetite, not just lose weight.
I wasn't sure I agreed with the premise at first – I still love me some sweets – but as I examined my own habits more closely I had to admit that even though, ten years after the GB, I do eat sweets, the kinds of sweets I'm drawn to now are much less rich and sticky-sweet than what I would have chosen before. And I can barely look at greasy, creamy, rich foods without feeling like I might throw up. And that's a huge deal. As the surgeon who performs the GB on camera says: 'they want something to change their lives, and that's what it does' – I agree 100% Nonetheless, it was presented a bit more black-and-white than it is; interviewed 6 weeks after surgery, the patient says she dislikes fat and sweet immensely. In fairness, she's still swollen inside and throwing up regularly – I'm not sure she'll feel quite so strongly once she's healed.
Overall, though, the program is well-researched and presents multiple interesting angles on a very complex problem. They examine the different kinds of fat our bodies store, pointing out that visceral fat, the internal kind, is what causes things like diabetes and other diseases; they investigate different causes for why people get fat; and they even take a new and different look at why one solution is better than others because it changes not only the body but also the brain.
And, to her credit, Weston does eventually change her mind about fat people through her investigations, even admitting that 'it is all too easy to take the moral high ground'. Still, it's depressing to think about just how much it took to get her to open her mind. As the BBC's own program description puts it: "Gabriel is shocked to find out that when it comes to being overweight, it is not always your fault you are fat." This is extremely troubling; not only is she kind of an asshole for thinking this way, she's also a bad doctor – for ten years, she has been willfully misunderstanding her patients as a result of her own sense of superiority.
To me, an attitude like hers shows how closed-minded and judgmental doctors are trained to be when it comes to fat. This is a problem on a basic human decency level, of course, but more importantly it's a problem because it keeps doctors from viewing the issue of obesity as a medical puzzle to which there may be multiple, different, ever-changing answers, which I'm pretty sure is how they're trained to view the rest of the body's afflictions. As far as I'm concerned, doctors should always be open to new ideas and new information, because that's how we cure diseases; really all scientists (in my opinion all people) should be open-minded, otherwise they not only risk being assholes, but they also risk being straight-up bad at their jobs. Which, in a doctor's case, can mean really dangerous consequences for her patients.
Despite Weston's newly opened mind and the show's interesting and balanced look at the problem of obesity, I came away from watching it feeling a bit sick. How many doctors out there in the UK and America – and how many laypeople, who don't even have a good reason to know better – feel the same way about obesity that she did before investigating further? I can tell you simply from my own experience that there are plenty. And I find that depressing, and exhausting. While it's great that this one doctor changed her mind (after months of BBC-sponsored education), I can't help feeling sorry for all those patients who had to endure her useless, judgmental attitude for ten years, and it's hard not to wonder when the rest of the world will stop wallowing happily in the filth of their society-accepted fattism and sit up and start paying attention to the reality of this problem.
It seems obvious to me, based entirely on observation and a curious mind rather than personally conducted scientific studies, that fat people are fat for different reasons: emotional, hormonal, genetic, situational, and a hundred others. I can only hope that programs like this one start the long, slow process of getting the rest of the world to realize that as well, and to figure out that we won't solve anything until we stop judging and start trying to understand.
In all honesty, as I started watching, my immediate reaction was rage and righteous indignation. Gabriel Weston, the thin, blond, female surgeon who hosts the show announces at the very beginning that for her entire life (including the ten years in which she's been practicing medicine) she has operated under the 'assumption [...] that I am the size I am because of my character'. Now, not only is that a particularly smug way of putting it, there is a serious problem with the underlying message: that fat people are fat simply because they are lazy and eat too much. They don't have the strength of character to change their bodies.
Of course, the program isn't just about this one extremely irritating person spewing her views about fat slobs – it's also about finding out why fat people are fat, and investigating the causes of and possible solutions to this 'epidemic' that's sweeping the western world. And on that front, the show (and maybe Wilson, if she wasn't just there as a figure-bobblehead) does a very good job.
One of the first people Wilson talks to is a doctor whose own personal experience with attempting to control his weight led him to study the reasons that our bodies seem so stubborn when it comes to weight. Interestingly, this doctor is a former athlete, who was trying and failing to gain weight, despite being, as he said, very motivated and a very driven person. He is now studying the ways in which hormones affect our weight and, specifically, our appetites – Wilson is, of course, skeptical of the idea that hormones are the reason she's not fat (easy to be skeptical when you're thin).
The hormone studies are really interesting. I don't want this post to be a super-long summary of the show (if you're in the UK you should watch it on iPlayer), but the gist of it is that every body contains a 'hunger' hormone and a 'fullness' hormone. In normal people, these peak and trough as you'd expect: hunger is very high when you're hungry, and fullness is high when you've just eaten. In obese people, though, the hunger hormone never really peaks, but it also never goes away completely. It just stays dimly present all the time, like a lightbulb that's on very low. This means that, unless they're truly starved for a long period of time, obese people never really get hungry, but they also never really aren't hungry – they could always eat (this is particularly interesting to me because it's totally how I feel post-GB, and I suspect it's how I felt when I was heavier as well, although of course I don't remember).
The other studies Wilson learns about involve genes – specifically, a study involving twins with different body types and another that tracks genes from when the patient is a fetus in the womb into childhood, to determine whether or not a pregnant mother's diet has anything to do with her child becoming obese later in life. Both studies were really interesting, and both came up with yet more reasons for people getting fat. The twins study found that both twins had the 'fat gene', but only one of them had a life experience that 'switched it on' (this was usually stress-related). The other study found an astounding 25% chance that poor diet during pregnancy (specifically deprivation but also poor food choices) would lead to the child being obese later in life.
The last thing Wilson examined was a potential solution to the problem: Gastric Bypass. Interestingly, though, she examined the surgery from a different angle than I'm used to: how it changes the patient's brain, through changing his stomach. Wilson spoke with a psychologist who is studying the ways the unconscious mind reacts to photos of rich vs healthy foods, and she has found that patients whose brains essentially drooled over photos of fatty, sweet foods before surgery have a much more muted reaction after the GB. The surgery is presented as a way to change appetite, not just lose weight.
I wasn't sure I agreed with the premise at first – I still love me some sweets – but as I examined my own habits more closely I had to admit that even though, ten years after the GB, I do eat sweets, the kinds of sweets I'm drawn to now are much less rich and sticky-sweet than what I would have chosen before. And I can barely look at greasy, creamy, rich foods without feeling like I might throw up. And that's a huge deal. As the surgeon who performs the GB on camera says: 'they want something to change their lives, and that's what it does' – I agree 100% Nonetheless, it was presented a bit more black-and-white than it is; interviewed 6 weeks after surgery, the patient says she dislikes fat and sweet immensely. In fairness, she's still swollen inside and throwing up regularly – I'm not sure she'll feel quite so strongly once she's healed.
Overall, though, the program is well-researched and presents multiple interesting angles on a very complex problem. They examine the different kinds of fat our bodies store, pointing out that visceral fat, the internal kind, is what causes things like diabetes and other diseases; they investigate different causes for why people get fat; and they even take a new and different look at why one solution is better than others because it changes not only the body but also the brain.
And, to her credit, Weston does eventually change her mind about fat people through her investigations, even admitting that 'it is all too easy to take the moral high ground'. Still, it's depressing to think about just how much it took to get her to open her mind. As the BBC's own program description puts it: "Gabriel is shocked to find out that when it comes to being overweight, it is not always your fault you are fat." This is extremely troubling; not only is she kind of an asshole for thinking this way, she's also a bad doctor – for ten years, she has been willfully misunderstanding her patients as a result of her own sense of superiority.
To me, an attitude like hers shows how closed-minded and judgmental doctors are trained to be when it comes to fat. This is a problem on a basic human decency level, of course, but more importantly it's a problem because it keeps doctors from viewing the issue of obesity as a medical puzzle to which there may be multiple, different, ever-changing answers, which I'm pretty sure is how they're trained to view the rest of the body's afflictions. As far as I'm concerned, doctors should always be open to new ideas and new information, because that's how we cure diseases; really all scientists (in my opinion all people) should be open-minded, otherwise they not only risk being assholes, but they also risk being straight-up bad at their jobs. Which, in a doctor's case, can mean really dangerous consequences for her patients.
Despite Weston's newly opened mind and the show's interesting and balanced look at the problem of obesity, I came away from watching it feeling a bit sick. How many doctors out there in the UK and America – and how many laypeople, who don't even have a good reason to know better – feel the same way about obesity that she did before investigating further? I can tell you simply from my own experience that there are plenty. And I find that depressing, and exhausting. While it's great that this one doctor changed her mind (after months of BBC-sponsored education), I can't help feeling sorry for all those patients who had to endure her useless, judgmental attitude for ten years, and it's hard not to wonder when the rest of the world will stop wallowing happily in the filth of their society-accepted fattism and sit up and start paying attention to the reality of this problem.
It seems obvious to me, based entirely on observation and a curious mind rather than personally conducted scientific studies, that fat people are fat for different reasons: emotional, hormonal, genetic, situational, and a hundred others. I can only hope that programs like this one start the long, slow process of getting the rest of the world to realize that as well, and to figure out that we won't solve anything until we stop judging and start trying to understand.
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