访谈录 2010-07-06&07-10 姐就是长的胖，怎么了吧-

I happen to note that one of my colleagues is here, um, Dr. Richard Bether talking about stacking the deck, um, he is a pediatrician by training, he is a former acting 1 head of the CDC, and also an epidemiologist. I would like you to weigh in on the discussion. Can you be healthy and fat?

Yeah, it has been a very interesting discussion for me to watch. I listened to it with two hats, one is the hat as a general pediatrician dealing 2 with children and their bodies and issues of self-esteem, concerned about young children in eating disorders 3 and demonizing food and demonizing any body type. And then I listened to this discussion as well as an epidemiologist and in my role when I was at the CDC and there is not refuting that there are major health consequences on a population basis to being obese 4 and overweight. The issues that have been raised here, diabetes 5, heart diseases, issues of arthritis 6, of sleep apnea, cholesterol 7, and these are all linked to overweight and obese. There is an increasing risk, and when you talk about risk, I hear you; it doesn't translate to the individual that you will necessarily develop these problems. But if you take a hundred people, those who are obese are at great risk of developing those problems and so, I look at these problems as what can we do as a society to reduce them and I'm hearing some agreement in terms of make healthy foods available, make it easy for people to get activity, that on a population basis will reduce the likelihood that so many are overweight or obese. There are also things that you can do to an individual in terms of educating people about proper eating and the importance of exercise. There also are different body types. People have different body types and you want people to embrace their body types. Um, I always ask children when I see them in the office, "Do you think you are overweight, underweight, or just right?" And, you know, regardless of their body type, the girls are much more likely to say that they weigh too much and that's bad. It's very important that we deal with that issue of the extremes. But there is no doubt in my mind that we are not doing enough as a society to help people be healthy and lead healthy lives, and that ties into issues. Now I am hearing both sides here, I didn't hear anyone say that healthy food shouldn't be available in every community and it shouldn't be easy for people to make that choice of the healthy choice, so I mean a question that I have is: Is there an acceptance that at least for the population there are risks to being overweight, even if as an individual, you may be healthy; for if we as an society, don't take on that issue of obesity 8, as a society we will not be as healthy, is there, is there ...  I think that that comes back to the conflation of weight with health. I dieted my way into this body. You know, it's specifically the dieting behaviors that caused my weight increase. I mean, I started out as a kind of chubby 9 kid, and increased through all of these behaviors and a lot of these things are linked to, you know, a lot of the sort of health risks that people talk about are linked to that sort of dieting behavior, yoyo dieting over the years. There is societally this idea that we should be fighting this obesity problem but nobody is talking about actual health like they're framing this very good goals as a battle against something, and I think that that is where the problem lies and that's when it turns it into a sort of moral grey area where people start to think, well, you know, we have a war on obesity, obese people are bad.

I think we have to be very, very careful. I’ve heard you say that you don't want to get shoved on a bus or made fun of on a bus. And on the same breath, you are saying that you should not have to pay two seats on an airplane or shouldn't have higher health care because you are overweight. So the two things are completely different.

I have, I do have a question though: Do you think that people who are overweight or obese should be stigmatized 11?

Uh, coming from a family where the people I love and respect most, and most of them obese, I don't think you wanna stigmatize 10 a person. I do absolutely think we need to harness the power of stigmatization 12 for the products and the practices that make people obese and that is meaning that's chronic 13 over-eating, that's constantly pushing the fourth meal from tackle belt, it's one hundred ounce soft drinks, it's schools with the kids don't get recess 14, the schools with the kids don't get P.E., It's the environmental factors that must be stigmatized. We have to say enough with all that. There shouldn't junk food in the day care center; there shouldn't be junk food in the school, I don't care if you call trans fat in food calling a cup cake, it doesn't need to be in school, kids can celebrate that elsewhere. These are the things that should be stigmatized - never the person.

But what your message does is stigmatizing 15 fat people, like you don't run an organization that attacks school systems for not having resource, like recesses 16, what your internalization does is make people feel bad about themselves, and there are no, there are no powers of stigmatization that can do anything good for a person, you know, shame doesn't work that way.

I think peer pressure is very effective and that's what I'm talking about. Peer pressure, the whole thing, (Peer pressure and stigmatization are very different) well, peer pressure, I think I was pretty explicit 17 in what I explained and I don't think what I said is anything about what you were saying.

The question of, um, risk across the population, I mean when we have risky 18 drivers, we charge them more for a driver insurance, auto 19 insurance. When we have people at risk for diseases related to obesity, should they be charged higher insurance rate?

We charge bad drivers more because they have a history of driving badly. If I don't have a history of costing my insurance company more, why are they charging me more for this chance? If fat people don't go to the doctor, because they are afraid of being treated badly, fat people are treated badly when they go the doctor, you can't have it both way, it's like we can't cost the system huge amounts of money but then not do prevent off care and sort of you know, well woman and well man may learn that we need to do be healthy. I think she has made same anecdote 20 with the data, (I am not. It's amazing.) the data shows that obesity is across-the-board very expensive, so I don't, so clearly, eventually, obese had avoided people go to the doctor because we know categorically the expense that ends, 147 billion CDC, (They are going through pressure after not going to the doctor for) which is a shame and a different tough subject. (40 years, because they had been afraid to go to the doctor.)