It’s not like McGraw stuffed her face with super-size-me burgers and fries. She’s sick. In 2000, she was diagnosed with a rare condition called Cushing’s disease, caused by a benign pituitary tumor. One of the hallmarks of Cushing’s is massive weight gain, particularly in the trunk, face and back.

Though surgery to remove the tumor was successful, McGraw still suffers with severe hormonal imbalances, making weight loss and weight maintenance difficult. And it’s those extra pounds — or more accurately, people’s perception of those extra pounds, she says — that can be as tough to deal with as any disease or treatment that causes weight gain.

McGraw knows all about indignities. She got dumped by a personal trainer after she couldn’t shed pounds fast enough. A doctor told her she could lose weight if she was locked in a closet for a week with only water to drink. Even well-meaning friends could be annoying as they told her about the latest-greatest diet.

‘Fat is fat’

“I know how people look at me now, and how people looked  at me when I was fit,” says McGraw, who runs a pituitary and brain tumor patient support group in Santa Monica, Calif. “The bias out there against heavy people is incredible. Having an illness doesn’t matter. In people’s eyes, fat is fat.”

In a society that value’s thinness, McGraw’s dilemma isn’t unusual. Weight bias is rampant, although women seem to experience it at lower weights. Though folks who have gained weight due to medical conditions or by taking prescribed medications like steroids that can cause weight gain are only a small fraction of the overweight and obese, they too feel the anti-fat scorn.

“You would think that illness would be somewhat protective (against bias),” says obesity researcher Marlene Schwartz, deputy director of The Rudd Center for Food Policy and Obesity at Yale University. “But (as a society) we like to assign fault. We think it’s so easy to be healthy, and therefore, not fat.”

Because obesity and all of its co-morbidities like heart disease, stroke, diabetes, some cancers, and asthma, to name a few, rack up big health care bills (according to a 2009 CDC study, America now spends as much as $147 billion annually on the direct and indirect costs of obesity) some researchers fear this bias might get worse as health care reform plays out.

“There is some evidence that shows that for whatever reason weight bias is increasing,” says obesity researcher Robert Carels of Bowling Green University in Ohio. His own research published in the journal Eating and Weight Disorders shows a “strong level of contempt” for the obese, especially among people who believe the weight is highly controllable. “There’s a feeling of why should I have to pay for them (the obese), if they can do something about their weight,” says Carels. “As a society we have a strong, pull-yourself-up-by-the-bootstrap mentality, and the overweight are the targets.”

You don’t have to tell that to Nellie Sabin, 56, of Cape Cod, Mass. About 15 years ago, Sabin developed severe migraines, which her doctor treated with a long-term course of steroids. Unfortunately, the steroids produced a massive weight gain of 100 pounds and rebound headaches that lasted about five days.

“I was a complete mess,” says Sabin, a book editor and writer. “I thought I was going to die.” The long-term steroid treatment caused Sabin to develop a hormone disturbance and she also developed severe arthritis in her back, making it difficult to exercise. “Unless you have experienced it, you can’t imagine the prejudice and shame associated with being fat, even if it isn’t your fault,” says the 5-foot, 10-inch Sabin, who once weighed 155 pounds but now weighs more than 300 pounds.

The good news is that Sabin has the full support of her husband and children. The bad news is that it’s tough to get respect from other people. “Everyone assumes I’m fat because I eat Snickers bars for breakfast. They also assume I’m stupid and have no willpower,” says Sabin. “At this point I would rather not have to meet people than have to explain I’m not a moron and I’m fat for medical reasons.”

Ashamed of own prejudice

Liz Gabor of Cleveland, Ohio, used to be one of those people that thought the obese were an easy target for loathing. That is until she became a self-described “fat girl,” after gaining 60 pounds in about 18 months despite eating well and exercising. The diagnosis: insulin resistance.

“I thought that was a disease that couch potatoes got, so I was embarrassed about everything, and it didn’t help that people looked at me and thought I was bingeing on chips and ice cream all night,” says Gabor, whose weight jumped from 125 pounds to 185 pounds.

She is now taking medication to better help her body respond to insulin and to help her lose weight.

Gabor believes her “time of fatness,” is payback for her years of judging the obese. “I think weight gain, no matter what the cause, can be really complex for some people. But I think I’m even more embarrassed about the way I thought about obesity. It’s very shameful.”

That’s not to say that Gabor, McGraw and Sabin are at peace with their bodies. They want the pounds gone. And the sooner, the better. In the interim though, they are just trying to get through the day.

“I think society makes it tough for everyone to accept the way they look,” says McGraw. “When I was a size 2, I probably thought I could have had a better  body. My gosh, that’s really kind of funny now.”

Joan Raymond is a freelance journalist whose work has appeared in Newsweek, the New York Times, MORE and Woman’s Day.

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The results show 71 percent of participating parents with overweight or obese toddlers misperceived their child’s weight, identifying it as either a healthy weight or lighter than healthy weight.

The parents were more likely to underestimate their child’s weight if a pediatrician had never discussed the issue with them. In fact, fewer than 8 percent of parents reported hearing from a pediatrician that their child was overweight or gaining weight too fast.

“Pediatricians have to really embrace this idea that talking to families about toddlers’ weight is important,” said study researcher Dr. Raquel Hernandez, assistant professor of pediatrics at the University of South Florida. Although doctors might find it difficult to bring up toddlers’ weight issues , “it does pay off, because families who have the provider talk about it are much less likely to misperceive their child, and therefore much more likely to make healthy behavioral changes,” she said.

While making a fuss over baby fat might seem a little extreme, obesity at a young age does matter, Hernandez said.

“We shouldn’t neglect the very young kids just because they’re cute and chubby and no one wants to do anything,” Hernandez said, adding that toddler-hood is a critical time when good habits can be set so kids have a better chance of being healthy throughout life.

Predictor of later obesity

A number of studies have found that being overweight at a young age, even as young as 2, can increase a child’s risk for obesity in school age and adolescence up to five-fold, Hernandez said.

“The concept that kids outgrow their weight at some point or another, may have been true maybe 10 or 15 years ago, but more and more we’re seeing that once the kid falls into that category, it really tends to be predictive long term,” she said. Modern-day tendencies toward less exercise and an overabundance of food might be the culprit behind this shift, she said.

The American Academy of Pediatrics recommends that doctors start screening for overweight and obesity at age 2. Body mass index, or BMI, (an indicator of body fatness calculated from height and weight) is used to assess each individual. Children are considered overweight if they fall in the 85th to 94th percentiles of the BMI growth charts and obese if they are in the 95th percentile or higher.

Currently, about 33 percent of preschoolers in the United States are overweight, and 12 to 15 percent are obese, Hernandez said.

Parents’ misperceptions

Hernandez and her colleagues interviewed 150 parents with children between the ages of 2 and 5. The parents were asked “Do you feel your child is…”(very underweight, a little underweight, about the right weight, a little overweight or very overweight).

They were also ask asked to view sketches of children with various body sizes and circle the image that most closely matched their own child’s size. Such sketches are considered a better way to gauge parents’ perceptions of their child’s weight because parents are often hesitant to identify their child in a negative way.

“It’s much easier for a parent to circle a bigger picture than to actually say that their child is overweight or obese,” Hernandez said.

Among the findings:

About a third of preschoolers in the study were overweight or obese. 83 percent of all parents reported their children as “about the right weight,” and 55 percent of parents with obese children said their child was “about the right weight.” Using the sketches, parents of overweight preschoolers were much more likely to underestimate their children’s weight than parents of obese children (89.6 percent vs. 45.5 percent). 20 percent of parents with overweight or obese kids actually chose an image that was smaller than the healthy weight image to indicate their own child’s size.

Hernandez finds the last result particularly disturbing.

“Imagine the risk that those kids are at, where their parents think that they’re too thin and they’re already overweight or obese,” she said. “Those are the kids that are going to get more portions; they’re going to get more high-calorie, dense foods. And then you’re really tipping the scales at that point with those kids.”

Big toddler isn’t always a healthy toddler

It’s understandable that parents would not realize their young child has a weight issue, Hernandez said. They can’t be expected to calculate BMI at home, and there tends to be a perception in society that a big toddler is a healthy toddler, she said.

Pediatricians might be reluctant to measure BMI and discuss weight issues both because they are afraid of offending the parents and because there are relatively few guidelines for how to go about modifying a young child’s diet and exercise habits, Hernandez said.

Nevertheless, such discussions are important if parents are to take action early on, she said.

“With no one commenting, then certainly parents aren’t going to have any idea if they’re not hearing anything from the person who would theoretically know the most about the child’s weight,” she said.

The results were published this month in the journal Clinical Pediatrics.

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The rate of obese adults remained consistent in the state in the past year. Adult obesity rates increased in 23 states and did not decrease in a single state in the past year, according to the F as in Fat: How Obesity Policies Are Failing in America 2009. In addition, the percentage of obese and overweight children is at or above 30 percent in 30 states.

“Our health care costs have grown along with our waist lines,” said Jeff Levi, Ph.D., executive director of TFAH. “The obesity epidemic is a big contributor to the skyrocketing health care costs in the United States. How are we going to compete with the rest of the world if our economy and workforce are weighed down by bad health?”

Mississippi had the highest rate of adult obesity at 32.5 percent, making it the fifth year in a row that the state topped the list. Four states now have rates above 30 percent, including Mississippi, Alabama (31.2 percent), West Virginia (31.1 percent) and Tennessee (30.2 percent). Eight of the 10 states with the highest percentage of obese adults are in the South. Colorado continued to have the lowest percentage of obese adults at 18.9 percent.

Adult obesity rates now exceed 25 percent in 31 states and exceed 20 percent in 49 states and Washington, D.C. Two-thirds of American adults are either obese or overweight. In 1991, no state had an obesity rate above 20 percent. In 1980, the national average for adult obesity was 15 percent. Sixteen states experienced an increase for the second year in a row, and 11 states experienced an increase for the third straight year.

Mississippi also had the highest rate of obese and overweight children (ages 10 to 17) at 44.4 percent. Minnesota and Utah had the lowest rate at 23.1 percent. Eight of the 10 states with the highest rates of obese and overweight children are in the South. Childhood obesity rates have more than tripled since 1980.

“Reversing the childhood obesity epidemic is a critical ingredient for delivering a healthier population and making health reform work,” said Risa Lavizzo-Mourey, M.D., M.B.A., RWJF president and CEO. “If we can prevent the current generation of young people from developing the serious and costly chronic conditions related to obesity, we can not only improve health and quality of life, but we can also save billions of dollars and make our health care systems more efficient and sustainable.”

The F as in Fat report contains rankings of state obesity rates and a review of federal and state government policies aimed at reducing or preventing obesity. Some additional key findings from F as in Fat 2009 include:

• The current economic crisis could exacerbate the obesity epidemic. Food prices, particularly for more nutritious foods, are expected to rise, making it more difficult for families to eat healthy foods. At the same time, safety-net programs and services are becoming increasingly overextended as the numbers of unemployed, uninsured and underinsured continue to grow. In addition, due to the strain of the recession, rates of depression, anxiety and stress, which are linked to obesity for many individuals, also are increasing.
• Nineteen states now have nutritional standards for school lunches, breakfasts and snacks that are stricter than current USDA requirements. Illinois is one of the states that does not have these standards. Five years ago, only four states had legislation requiring stricter standards.
• Twenty-seven states have nutritional standards for competitive foods sold a la carte, in vending machines, in school stores or in school bake sales. Illinois is one of the states that does have these standards. Five years ago, only six states had nutritional standards for competitive foods.
• Twenty states have passed requirements for body mass index (BMI) screenings of children and adolescents or have passed legislation requiring other forms of weight-related assessments in schools. Illinois is one of the states that does have one of these screening programs. Five years ago, only four states had passed screening requirements.
• A recent analysis commissioned by TFAH found that the Baby Boomer generation has a higher rate of obesity compared with previous generations. As the Baby Boomer generation ages, obesity-related costs to Medicare and Medicaid are likely to grow significantly because of the large number of people in this population and its high rate of obesity. And, as Baby Boomers become Medicare-eligible, the percentage of obese adults age 65 and older could increase significantly. Estimates of the increase in percentage of obese adults range from 5.2 percent in New York to 16.3 percent in Alabama.

Key report recommendations for addressing obesity within health reform include:

• Ensuring every adult and child has access to coverage for preventive medical services, including nutrition and obesity counseling and screening for obesity-related diseases, such as type 2 diabetes;
• Increasing the number of programs available in communities, schools, and childcare settings that help make nutritious foods more affordable and accessible and provide safe and healthy places for people to engage in physical activity; and
• Reducing Medicare expenditures by promoting proven programs that improve nutrition and increase physical activity among adults ages 55 to 64.

The report also calls for a National Strategy to Combat Obesity that would define roles and responsibilities for federal, state and local governments and promote collaboration among businesses, communities, schools and families. It would seek to advance policies that

• Provide healthy foods and beverages to students at schools;
• Increase the availability of affordable healthy foods in all communities;
• Increase the frequency, intensity, and duration of physical activity at school;
• Improve access to safe and healthy places to live, work, learn, and play;
• Limit screen time; and
• Encourage employers to provide workplace wellness programs.

The report was supported by a grant from RWJF.

MEDIA CONTACT:

Liz Richardson, 202-223-9870 x 21
lrichardson@tfah.org

Laura Segal, 202-223-9870 x 27
lsegal@tfah.org

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