Not much on the telly tonight, so I ended up watching "My 600 lb. Life" --- the show where folks go to Houston for bariatric surgery… some successful, some not so much.
After watching a couple episodes, I'm left with some mixed feelings.
Is super morbid obesity:
1) a disease along the same lines as alcoholism and drug addiction?
2) a lifestyle issue (poor food choices, lack of exercise, laziness)?
3) a mental health issue (poor self esteem, depression, etc.)?
What have you seen in your practice re: number of super morbidly obese admissions, bariatric surgeries, disease processes related to super morbid obesity, difficulty caring for super morbidly obese patients.
As in years past, Gallup broke the data down according to the most and least obese states. If you're wondering why some places are fatter than others, look no further than data on poverty from the U.S. Census Bureau. Nationally, the poverty rate is 15.4 percent, but nine of the 10 most obese states have rates above that. When you're living in a low-income community, junk food—not a grocery store full of kale and quinoa—is usually what's nearby.
Nine out of the 10 most obese states have poverty rates above the national average of 15.4 percent. For the second straight year, Mississippi is the fattest state in the nation—35.2 percent of residents are classified as obese—and its 22.7 percent poverty rate is also the highest. Similarly, West Virginia and Louisiana, which have 34.3 and 33.2 percent obesity rates, respectively, are also afflicted with high poverty rates. A full 18.5 percent of West Virginians and 19.8 percent of Louisiana residents live in poverty.
Given that our current political majority leadership is not in the mood to address issues related to poverty and food insecurity preferring, instead, to make this a conversation about "lifestyle choices", it seems unlikely that much is going to change in this country on this topic. When you see a poor person who is obese it may be related to the things the person chooses to eat. It also may be related to the lack of affordable choices for nutrition, not that many citizens apparently want to consider or believe that. When you see a wealthy person who is obese it is more clearly an issue of choice...they can afford and have better access to healthy foods. Poor Americans will by and large continue to become obese and those in power and with money will continue to tell everyone that it is exclusively their own fault while ignoring the evidence that suggests otherwise.
Families poor enough to be on SNAP also automatically qualify for WIC. WIC provides vouchers for fresh fruit and vegetables in addition to cheese, milk, peanut butter, tuna, and healthy breakfast cereals. SNAP provides cash benefits that users can choose to spend either on healthy food or on crap. Since WIC requires attendance at nutrition classes to get your vouchers, they can't say they don't know the difference. I was on WIC twice, and the classes were actually pretty decent. So I call BS on the idea that the poor have no choice but to be fat.
Specializes in OR, Nursing Professional Development.
Families poor enough to be on SNAP also automatically qualify for WIC. WIC provides vouchers for fresh fruit and vegetables in addition to cheese, milk, peanut butter, tuna, and healthy breakfast cereals. SNAP provides cash benefits that users can choose to spend either on healthy food or on crap. Since WIC requires attendance at nutrition classes to get your vouchers, they can't say they don't know the difference. I was on WIC twice, and the classes were actually pretty decent. So I call BS on the idea that the poor have no choice but to be fat.
Just because one has been given the information doesn't mean one understands and is also in a position to apply that information. Many who qualify for SNAP and/or WIC may have spent a life living in poverty, frequently attending schools with lower budgets and unfortunately, the inability to retain good teachers who burn out or look for better salaries and thus experience a poorer quality of education. They may live in cities where grocery stores require a bus ride, which requires money. If they are able to find a job and work, the hours may mean little time to coordinate bus schedules, ability to only carry two to three bags worth on a bus, etc. It's not just about the vouchers they are given but where they are able to use them and the ease of using them. The city I live in doesn't have actual grocery stores in the poorer areas. What they have are convenience stores with convenience food options. It's much easier for people to go there rather than make the effort, take the time, and spend the money to get to a real grocery store.
It's a multifactorial issue and so much more than just providing vouchers and a class.
Specializes in OR, Nursing Professional Development.
I've shared this story before, on another obesity related thread. Please be aware that it may contain triggers related to childhood sexual abuse.
I am morbidly obese. I have been obese since I was a child and have unsuccessfully battled the weight since I moved out into my own home. It all started as a result of sexual abuse I experienced as a child at the hands of two people I should have been able to trust. I didn't speak a word about it to those who would have been able to help me because of threats of being raped for many years. When the truth was finally revealed to my parents after I was sent to the guidance counselor for a comment I made to a friend, my mother's very first words were "Oh my god, we have to move. People know".
The effect on me, my self-esteem, my self-worth, my emotional status was devastating. At the age of 12, I turned to food for comfort. There was no shortage of unhealthy options available- and being a child of 12, of course I went for what tasted best- the unhealthy sugar-laden, processed snacks. It's a habit that has continued into my adulthood and one I have battled, sometimes successfully, sometimes not, ever since.
I currently weigh close to 300 pounds. The lowest weight I've hit as an adult was 265, and that was only briefly. I've had extensive counseling, participate in survivor message boards, belong to a gym where I exercise 3 days a week, but I still struggle. Having experienced what I've experienced, I know that it is much more than just choices, just mental health, or just any of the other reasons tossed out for obesity. It's one thing to completely give up cigarettes or other things that are not essential to living; food is something that just can't be given up 100%. To hear of nurses and other healthcare professionals making some of the comments I've read on this thread is heartbreaking and quite honestly infuriates me. Unless one has experienced it, one cannot understand the difficulty in changing one's entire lifestyle, coping mechanisms, daily habits, etc. when not only making those changes but also dealing with the stigmatization that has many people seeing the obese as making poor choices, being lazy, etc.
Specializes in LTC, assisted living, med-surg, psych.
I've shared this story before, on another obesity related thread. Please be aware that it may contain triggers related to childhood sexual abuse.
I am morbidly obese. I have been obese since I was a child and have unsuccessfully battled the weight since I moved out into my own home. It all started as a result of sexual abuse I experienced as a child at the hands of two people I should have been able to trust. I didn't speak a word about it to those who would have been able to help me because of threats of being raped for many years. When the truth was finally revealed to my parents after I was sent to the guidance counselor for a comment I made to a friend, my mother's very first words were "Oh my god, we have to move. People know".
The effect on me, my self-esteem, my self-worth, my emotional status was devastating. At the age of 12, I turned to food for comfort. There was no shortage of unhealthy options available- and being a child of 12, of course I went for what tasted best- the unhealthy sugar-laden, processed snacks. It's a habit that has continued into my adulthood and one I have battled, sometimes successfully, sometimes not, ever since.
I currently weigh close to 300 pounds. The lowest weight I've hit as an adult was 265, and that was only briefly. I've had extensive counseling, participate in survivor message boards, belong to a gym where I exercise 3 days a week, but I still struggle. Having experienced what I've experienced, I know that it is much more than just choices, just mental health, or just any of the other reasons tossed out for obesity. It's one thing to completely give up cigarettes or other things that are not essential to living; food is something that just can't be given up 100%. To hear of nurses and other healthcare professionals making some of the comments I've read on this thread is heartbreaking and quite honestly infuriates me. Unless one has experienced it, one cannot understand the difficulty in changing one's entire lifestyle, coping mechanisms, daily habits, etc. when not only making those changes but also dealing with the stigmatization that has many people seeing the obese as making poor choices, being lazy, etc.
I made the following on another thread, but it bears repeating.
There are neighborhoods that have no actual grocery stores in walking distance, and in my area many rely on public transportation. One neighborhood was the place I did a big community assessment for public health class. The only food store was a mini-mart type place, like a gas station minus the gas. They had the following fresh items: red delicious apples, bananas, and milk. But wait...they DID take EBT.
Imagine for a moment that you're a single parent with a couple of babies and 2 or 3 jobs. You need to buy food in what limited time you have. How realistic is it to expect you to go the several miles to Whole Foods, and tote your babies and a week's worth of groceries either on foot or on the bus? Can you even imagne trying to board the bus with your arms that full?
That's not even taking safety into account. This area can be dangerous to walk alone in at night (when you probably have to do your errands)? We also have extreme weather where I live--cold that can cause frostbite in minutes, and heat that can top 100°F in the summer. So you have to take that into account.
It's way more complicated than simply knowing what to do.
Specializes in Psych, Addictions, SOL (Student of Life).
I made the following on another thread, but it bears repeating.
There are neighborhoods that have no actual grocery stores in walking distance, and in my area many rely on public transportation. One neighborhood was the place I did a big community assessment for public health class. The only food store was a mini-mart type place, like a gas station minus the gas. They had the following fresh items: red delicious apples, bananas, and milk. But wait...they DID take EBT.
Imagine for a moment that you're a single parent with a couple of babies and 2 or 3 jobs. You need to buy food in what limited time you have. How realistic is it to expect you to go the several miles to Whole Foods, and tote your babies and a week's worth of groceries either on foot or on the bus? Can you even imagne trying to board the bus with your arms that full?
That's not even taking safety into account. This area can be dangerous to walk alone in at night (when you probably have to do your errands)? We also have extreme weather where I live--cold that can cause frostbite in minutes, and heat that can top 100°F in the summer. So you have to take that into account.
It's way more complicated than simply knowing what to do.
It is a misconception that a person cannot get decent healthy food from a convenience/Dollar store. Most have at least some fruits and vegetables - 7/11 in my area sells salads. apples oranges bananas, They all sell dairy, they all sell bottled water. They all sell cereal. This is the 21st century and unless you have been living under a rock you know what's good for you and what's not. People need to quit blaming others or trying to make it a societal problem. This is America which means I am a free person. If I want to go to KFC a buy a bucket of hot salty deep fried chicken parts that's my right , same if I want to feed my kid a happy meal. Still if people want to kill themselves eating junk food that's called natural selection.
Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
It is a misconception that a person cannot get decent healthy food from a convenience/Dollar store. Most have at least some fruits and vegetables - 7/11 in my area sells salads. apples oranges bananas, They all sell dairy, they all sell bottled water. They all sell cereal.
7-11 stores in my area also sell salads, wraps, dairy products, and a limited selection of produce. However, the salads are single-serve and $4.99 each. The wraps are single-serve and $3.99 each. The bananas are $0.69 each. The dairy products are overpriced.
Convenience stores might offer some healthy options, but being forced to use them as one's grocery store is not a viable option if you are a lower income person looking to stretch whatever limited food budget you have.
Specializes in Psych, Addictions, SOL (Student of Life).
7-11 stores in my area also sell salads, wraps, dairy products, and a limited selection of produce. However, the salads are single-serve and $4.99 each. The wraps are single-serve and $3.99 each. The bananas are $0.69 each. The dairy products are overpriced.
Convenience stores might offer some healthy options, but being forced to use them as one's grocery store is not a viable option if you are a lower income person looking to stretch whatever limited food budget you have.
Back in the day when I was poor and didn't have a care and lived with my crack addicted 1st husband - I got one of those collapsible grocery carts and took the bus to the grocery store once a week in the daytime. I could get enough groceries for the two of us to last a week. Then I trundled it home and up three flights of stairs to our apartment. If people continue to make excuses for why they can't do something they'll never do it. With SNAP and WIC people can buy food at Walmart, Target, dollar stores, etc... The fact remains that even when large chain grocery stores are available people who eat junk still eat junk. Just yesterday I was in Stater Bros (a moderately priced grocery in so Cal) to buy my week's food for a family of three on my grocery budget of $100 and filled my cart. The people in line ahead of me where paying with snap and had a basket full of High carb convenience food, sugary snacks and soda. Not a vegetable in the basket unless you counted the potato chips. It was a mother daughter team with a toddler in the seat and guess what all were Fat. Now in spite of regular exercise and an exceedingly healthy diet. I am still overweight. I did not win the metabolism lottery. However my labs are great. So go figure. What I am saying is that if people want to do something (really want to) they will do it. They will not sit on the couch with a big gulp in one hand and a bag of Doritos ( I do so love the cool ranch flavor) and complain that they have no options.
And yes I do snack on Doritos from time to time. I don't keep soda in the house at all - Though I allow my son to have it when we go out for a meal.
Specializes in NICU, PICU, Transport, L&D, Hospice.
Back in the day when I was poor and didn't have a care and lived with my crack addicted 1st husband - I got one of those collapsible grocery carts and took the bus to the grocery store once a week in the daytime. I could get enough groceries for the two of us to last a week. Then I trundled it home and up three flights of stairs to our apartment. If people continue to make excuses for why they can't do something they'll never do it. With SNAP and WIC people can buy food at Walmart, Target, dollar stores, etc... The fact remains that even when large chain grocery stores are available people who eat junk still eat junk. Just yesterday I was in Stater Bros (a moderately priced grocery in so Cal) to buy my week's food for a family of three on my grocery budget of $100 and filled my cart. The people in line ahead of me where paying with snap and had a basket full of High carb convenience food, sugary snacks and soda. Not a vegetable in the basket unless you counted the potato chips. It was a mother daughter team with a toddler in the seat and guess what all were Fat. Now in spite of regular exercise and an exceedingly healthy diet. I am still overweight. I did not win the metabolism lottery. However my labs are great. So go figure. What I am saying is that if people want to do something (really want to) they will do it. They will not sit on the couch with a big gulp in one hand and a bag of Doritos ( I do so love the cool ranch flavor) and complain that they have no options.
And yes I do snack on Doritos from time to time. I don't keep soda in the house at all - Though I allow my son to have it when we go out for a meal.
Hppygr8ful
Just like you, most poor people must work very much harder than someone like myself to put food on the table. Unfortunately, Ronnie Reagon gave us the notion of the "welfare queen" and now poor people are denigraded as a matter of routine. Millions of Americans just assume that the poor are lazy, druggies, unmotivated, second or third class citizens. In part that is because they are hearing that or reading that in their media choices, not because it is true.
toomuchbaloney
16,109 Posts
America's Most Obese States Tend to Have One Thing in Common - Yahoo News
The obesity rate in America is rising.
Given that our current political majority leadership is not in the mood to address issues related to poverty and food insecurity preferring, instead, to make this a conversation about "lifestyle choices", it seems unlikely that much is going to change in this country on this topic. When you see a poor person who is obese it may be related to the things the person chooses to eat. It also may be related to the lack of affordable choices for nutrition, not that many citizens apparently want to consider or believe that. When you see a wealthy person who is obese it is more clearly an issue of choice...they can afford and have better access to healthy foods. Poor Americans will by and large continue to become obese and those in power and with money will continue to tell everyone that it is exclusively their own fault while ignoring the evidence that suggests otherwise.