Yet most of America particularly the America of the Me Generation seems to be in deep denial about the class and age aspects of obesity. Get a group of boomers together and, within minutes, the topic of obesity shifts not to medical issues but, rather, to aesthetic and gender issues, to the notion widely held in the urban upper middle class that "talking too much about obesity just ends up making kids have low self-esteem." Or that it "might lead to anorexia."
Those attitudes also permeate the medical sphere; doctors and other health care providers remain either in ignorance or outright denial about the health danger to the poor and the young. In a rare moment of industry scrutiny a few years ago, the Centers for Disease Control surveyed twelve thousand obese adults to find out what, exactly, their doctors were telling them. The results were arresting. Fewer than half reported being advised to lose weight. A separate study sharpened the indictment: Patients with incomes above $50,000 were more likely to receive such advice than were those with incomes below. As the Journal of the American Medical Association noted, "The lower rates of counseling among respondents with lower education and income levels . . . are particularly worrisome, because members of lower socioeconomic groups have poorer health outcomes." Yes, worrisome. Yet we Americans are inured to such dirges, which daily seem to well up from the pages of our newspapers. Certainly I was. Until, that is, the unexpected intruded.
It happened in the Intensive Care Unit of Los Angeles County/USC Medical Center, one of the nations busiest hospitals. I was there visiting an ailing relative when, suddenly, a gaggle of interns, nurses, and orderlies pushed a gurney through the ward. On it lay a very large young man, perhaps 450 pounds, hooked to the ganglia of modern medicine. He had just undergone an emergency gastroplasty repair, and it did not look good. As I came to learn, first through bits and pieces exchanged by the ward nurses, then through comments by the patients parents, it was not the first emergency for this man. As his mother, a modestly dressed woman in her forties, moaned at one point, "Second time in three months . . . his stomach keeps coming unstapled" (not all forms of gastroplasty actually involve stapling, as did older forms of obesity surgery, but many still refer to it that way). The woman then leaned on the shoulder of her weary husband. "My . . . boy." Her boy was dying from his own fat. Yes, he was dying, and yes, the more I looked, the more I could see: Here was someones boy, one plagued, I imagined, by years of bad health, discomfort, self-loathing, and, of course, countless insults and snickers by passersby and friends alike. But someones little boy nonetheless. Watching him as he gasped for air respiratory function is one of the first things that can go when one gets so big I could not help think: There but for the grace of God go I. And, to hear Jim Hill and Dr. Satcher tell it, a large number of other decent Americans.
Driving home that night, through the barrio of East L.A., then up the chilly black Pasadena Freeway to the town where I live, I wondered just how a boy becomes so disabled. Genes certainly played a role, but as Jim Hill had lucidly pointed out, genes have always played a role in obesity. The question was, why are we seeing so many more people like the one I just saw? How exactly had they been made? And if it is true that, in America, every man is his own author, that every man, as Ivan Illich once wrote, "is responsible for what has been made of him," then what, as a nation, is being made of us by the obese?
I decided to find out: How is it that we better-off Americans, perhaps the most health-conscious of any generation in the history of the world, have come to preside over the deadly fattening of our youth and their future? That is the story you will read on the following pages, and that is why we must now turn to the strange career of one Earl L. Butz . . .
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