by Jeneen Interlandi

Months after taking his anti-obesity crusade national, Cleveland Clinic CEO Delos M. Cosgrove has e-mailed an apology to clinic employees for any offense taken by remarks he has made about overweight people.

Since President Obama visited the Cleveland Clinic in July, Cosgrove has seized the national spotlight to infuse a message of personal responsibility into the health-care debate. Cosgrove has argued that the biggest cause of exorbitant health-care costs is not our deeply flawed insurance industry but the nation's high disease burden, caused largely by obesity, which he attributes almost exclusively to lifestyle choices. In The New York Times, The Wall Street Journal, NEWSWEEK, and elsewhere, he has likened obesity to smoking and said, repeatedly, that if it were legally permissible, he would not hire fat people at the clinic. When asked by NEWSWEEK and New York Times reporters earlier this summer if some obesity triggers were beyond the individual's control, he responded, "Not unless you prove the law of conservation of matter doesn't hold."

His comments have touched off a fresh round of debate about the extent to which individuals can control, and should be held responsible for, their own health. But at the Cleveland Clinic's own Obesity Summit last week, critics took Cosgrove to task for his remarks, calling them "unfortunate and misguided," and saying that they unfairly demonize overweight people. After that, Cosgrove issued a memo of contrition.

"My objective was to spark discussion about premature causes of death," Cosgrove said in a memo sent to staff earlier this week. "But some of my comments were hurtful to our community. That was certainly not my intent, and for that I apologize." The CEO was quick to describe his crusade as one against obesity, not obese people, and to cast it as just one in an array of personal choices that negatively affect health. "Smoking, poor nutrition and lack of physical activity are key contributors to the development of chronic diseases such as heart disease, diabetes and cancer," his memo read. "I feel strongly that we can lower this by working together and helping . . . people to lead healthier lives."

As critics point out, those key contributors don't always result in obesity. That makes body-mass index a somewhat arbitrary measure of health. For example, other factors being equal, a heavy person who eats right, exercises, and doesn't smoke is likely healthier than a lean person who substitutes diet pills and Marlboro Lights for a gym membership, as we discussed in last month's Fat Wars series. And while diabetes (the illness most commonly linked to obesity) certainly costs us─it affects 10 percent of the U.S. population and gobbles up $147 billion annually─it's just one of several diseases that can be attributed to lifestyle choices.

There are also reams of biological evidence suggesting that one's body size is not entirely within a person's control. As my colleague Sharon Begley wrote in this week's magazine, many of the chemicals we encounter in everyday life may influence our metabolism in ways that predispose us to being overweight. Other research has shown that intestinal microbes (a.k.a. our microbiomes) also play a role. On top of those are a host of genetic factors that scientists are only beginning to untangle. Add to those contributors a litany of cultural, economic, and political factors, and it becomes far less clear where the blame for our nation's growing waistline rests. As The New York Times recently pointed out, the real price of soda is 33 percent lower than it was in 1979, and the real price of fruit and vegetables is 40 percent higher. Put simply, McDonald's is a lot cheaper than Whole Foods. It's also far more ubiquitous. As my colleague Karen Springen wrote last year, families living in rural areas are often hard-pressed to find healthy food in the first place.

Still, there's merit to discussing how to reduce the nation's high and costly burden of disease. Cosgrove's remarks, unfortunately, were not the best way to start the conversation, and for obese people who have weighed in on the debate, his remorse has rung hollow. "His apology does not acknowledge the very real and pervasive weight-based workplace discrimination that he was perfectly happy to foment," one self-described "fat person" commented in response to the news of his apology. "This man has now encouraged employers everywhere to think twice before hiring a fat person," wrote another. "Hatred and bigotry does no good for anyone."

Happy, healthy, and heavy? You're not alone. Check out our fit and fat gallery of user-generated photos.

A few weeks ago we ran a series called "The Fat Wars" that looked at the way we talk about obesity in this country, and whether our current methods of fighting the war on fat were working. Within the course of the articles, we made a few unsubstantiated remarks about fat people being just as able to run or bike as thin people. (Unsubstantiated because we wrote them as fact, without citing backup evidence.) In doing so,  the article generated lots of comments from people basically calling it bull. This was expected: a point we researched but didn't articulate in the article about why America is so darned angry with fat people is that the anonymity granted by the Internet tends to bring out the worst in people; the points we did articulate argued that fat people are easy targets for rage, which people like expressing, and projected self-loathing, since we all worry about weight. Still, it seemed like what President Obama refers to as "a teachable moment," an excuse to solicit reader participation, and also a chance to do a photo gallery, which are fun and pretty and get lots of clicks. 

With that in mind, we solicited photos of healthy, heavy readers─an exercise that was not without its own controversies. Some fat people were energized by the chance to disprove stereotypes, while others felt like they shouldn't have to prove anything to anyone, nor should they have to strap on climbing gear or a bike helmet to "earn" a little human kindness and respect. (I believe "dancing monkey" was the term one reader of Shapely Prose used when discussing our request). 

Nevertheless, we received a lot of great submissions, and picked some of the best images (and by best, we mostly mean "best photographic quality") for our Happy, Healthy, and Heavy gallery.

By Michelle Allison

Let’s start with this: I identify as fat because, well, I’m fat, and also because I don’t think being fat is necessarily a bad thing─it’s just a thing.

But calling myself a nutritionist feels like a fantastic act of audacity. I’m still technically a student, though I’ve completed the work core to my nutrition degree and am now taking a psychology minor.

I initially got interested in nutrition by going on a diet to lose weight when I was 21. I did it to feel better about myself, because I hated my body, hated being fat. What I told everyone, naturally, was that I was losing weight for the good of my health.

Except I didn’t get healthy. I was constantly injured from overexercising, and I came down with a virus that developed into really nasty pneumonia that I couldn’t seem to shake.

What kept me on the diet was the intoxicating sense that, for the first time in my life, I was following the rules. I was doing it right. I was compliant. I was a model eater and exerciser. My habits were above reproach.

In the end, I lost 30 pounds and gained a bunch of disorder behaviors. And I hated my body more intensely than before.

I knew that wasn’t how it was supposed to work─you were supposed to lose weight and feel great about yourself and be healthy.

But when I asked all of my dieting friends, no one could give me an answer. We were all so focused on eating the right number of calories and getting the right amount of exercise that no one had managed to figure this part out yet─how to actually be healthy? How to stop hating yourself?

Around this time, I stumbled onto fat acceptance and Health at Every Size.

In a nutshell, fat acceptance is the idea that human bodies naturally come in a range shapes and sizes, and that being fat is not necessarily pathological. It recognizes that there is a strong prejudice in our culture against fat people, resulting in yet another form of appearance-based discrimination─which is morally wrong, and requires a political response.

Health at Every Size is complementary to fat acceptance─it’s the belief that people can do positive things for their health (like eat well and exercise) in a positive, compassionate, nonpunishing way, without pursuing weight loss, and that even fat people can be healthy by all other objective measures. It’s the belief that self-acceptance, whatever your size, is good for you─especially when combined with other health-promoting behaviors.
 
After discovering these things, I decided to make nutrition my profession, and no one has ever questioned my credibility or competence based on my body size.

Even when I worked in one of the more traditional areas of nutrition practice, diabetes, my superiors never seemed bothered by my weight. I was hired even after competing against thin applicants, after all. And I believe my presence in the diabetes clinic as a nice-looking, intelligent fat lady, often with doughnut in hand, was perhaps comforting to patients, and deeply subversive to the notion of “nutrition equals weight control.”

I think people assume nutritionists all eat “perfectly.” Well, I don’t, and I don’t know any dietitians, even thin ones, who do. I’ve been lucky to work with dietitians who have all loved food and would never turn down a homemade brownie.

As for myself, I’m genuinely positive about food and my body. I’m no longer at war with either one.

When I stopped dieting, it was extremely difficult to relearn “normal” eating. I read a lot of books and struggled on my own for five years. In the end, it was a dietitian who practiced Health at Every Size who taught me how. I learned to eat lovely, nourishing food without worry and stress, and my weight finally settled into a stable, happy place.

Four years after being her client, I’m still doing well, and I want to help other people the way she helped me, now that I have the education and experience to do so.

I’ve done some hard thinking about what it means to be healthy. First, I learned to separate a person’s state of health from their value as a human being. Second, I stopped seeing healthiness as an end in itself, or as a reward for good behavior.

Instead, I now define health as a combination of the cards you’ve been dealt, and the way you choose to play them. Even if you’re dealt a s--tty hand that can’t be changed, you can still play your cards well enough to enjoy a meaningful life.

Acceptance─that is, learning to accept the things you cannot change─is key to health. This philosophy is embodied by the Serenity Prayer, by Jean-Paul Sartre’s concepts of facticity and transcendence, by mindfulness theories, and, lastly, by fat acceptance and Health at Every Size.


─Allison blogs at The Fat Nutritionist.

Tyler before and after, courtesy of 344pounds.com

Last week was not a good week for Tyler.

Tyler, a 24-year old from South Carolina, writes the blog 344pounds.com,which documents his progress as he tries to lose weight. Sincebeginning the site in January, he’s lost 109.8 pounds, thanks to anintense exercise regime. (As part of a blog promotion, for instance, heperformed over three hours of cardio one Friday night).But last week—his birthday week—he gained weight for the first timesince beginning his blog, a fact he chalked up to lowered standards:watching TV, indulging on his birthday, and skipping the gym in favorof surfing the web. “This week should show to you that if you don’t putin the work, you won’t lose the weight.  It’s not rocket science.  I’velost weight 26 weeks in a row without fail—the first week I give just alittle bit of slack I gain half a pound,”

The author, and her shapeless ankles (Courtesy Kathleen Flynn)

 

by Kathleen Flynn

I have cankles.

There, I said it.

Disparage me as you will—it’s currently all the rage to poke fun at cankles. That's the term, of course, for the strange disorder of the lower body where one's calf descends into one's foot without narrowing. (The effect is that of giving it the appearance of a doughy peg leg.

Last week, Gold’s Gym announced that July is National Cankles Awareness Month. “By the year 2012 Cankles will surpass Love Handles as the number one aesthetic affliction in the world,” Gold's states on its new Web site, Saynotocankles.com. The Wall Street Journal followed up with a front-page story, fully exposing the phenomenon of cankle-bashing. Good Morning America even ran a story about it, coyly titled “The New Muffin-Top?” It’s the worst thing that’s happened to big-ankled women like me since Hollywood debuted the silly, hybrid word “cankle” (calf-plus-ankle) in the 2001 movie Shallow Hall. (Before that, my fat ankles were my own secret shame.)

Now ankleless women everywhere are being told that we either have to get in shape or hide our mutated stumps under loose jeans and long skirts.

Along with Gold’s Gym, personal trainers throughout the blogoshpere are currently writing posts on “cankle-busting moves!” such as squats, calf raises, and walking.

I’m all for exercising, and I work out regularly. But I want to set the record straight: I'm a size zero. Cankles are not necessarily the result of eating too many snickers. For many women, they are a genetic mishap and criticizing them is akin to kicking a little person in the shin.

More on Kathleen's life with cankles, after the jump...

Kevin Summers/Getty Images

Could the plummeting economy be contributing to expanding waistlines? Something is: new data released exclusively to NEWSWEEK from Gallup-Healthways shows that in the past year, the number of Americans considered obese has jumped by 1.7 percent—or almost 5.5 million people—and that the obese report a much lower quality of life than those who are at healthier weights.

As part of their larger Well-Being Index, Gallup pollsters began surveying 1,000 Americans a day in an attempt to create a comprehensive index able to track the daily, monthly and yearly shifts in American life. As a result, they now have more than 460,000 completed surveys offering a unique perspective on trends in the health and happiness of America. Several of the questions on the poll have to do with weight and the data from Gallup indicates that the number of individuals who have a Body Mass Index over 30 and are thereby classified as "obese," has risen from 25.1 percent of the population surveyed to 26.8 percent between the first quarter of this year and last. (BMI is the ratio of height to weight.)

Photo: afiler

What is it about diet soda that seems so naughty? Maybe it’s because enjoying something without any calories leads people to feel like they’re going to have to pay one way or another-if not with their waistline now, then with ambiguous bad health later (a tumor? osteoporosis?). Maybe it’s because it takes an already unnatural beverage-there’s no such thing as a soda tree-and fills it with even more foreign substances. Either way, people often have a complex, love-hate relationship with diet soda, especially when you throw some caffeine into the mix.

But it’s not good to fear your food. And while as adults we can eat whatever we want, it’s also nice to know what it is we’re eating. With that in mind, we set out to find the truth behind the biggest diet-soda myths.

Another Reason to Hate Cigarettes. They're kind of racist. The darker your coloring, the more likely you succeptible to smoking addiction. That's what Penn State researchers found when they studied the connection between melanin, responsible for skin and hair pigmentation, and nicotine dependency in African Americans. Scientists already knew that nicotine liked to bind with melanin on a cellular level; this study shows that darker skin color is also related to the amount of cigarettes smoked and the level of carcinogens absorbed from those cigarettes.  (Science Daily)

Flat Tax?  The Senate is considering a tax on soda and other sugary drinks to help fund President Barack Obama's health care plans. If approved as-is, the tax could generate 24 billion dollars in 4 years. At three cents a can - an extra 36 cents per FridgePak - the tax won't likely dissuade soda consumption (and the weight gain it may cause) so much as capitalize on the popularity of sugary drinks. Still, while full-calorie soda and other sugary drinks would be subject to the tax, diet sodas would be tax-free. (Consumer Affairs) 

Medicare on Life Support: Medicare could be broke by 2017, two years earlier than previously predicted. The 8.6 percent unemployment rate means fewer American workers are contributing to the system; the aging boomer population means more Americans than ever are in need of Medicare. Let's all take a break to eat a banana an pop a multivitamin. (NY Times)

The Last Biggest Loser Post For A While, I Promse:  The over-40 crowd ruled at last night's live finale of the NBC reality show. The teeny, tiny, thirsty-looking Helen, 47, bested her 24- and 18-year old competitors, while 64-year old Jerry won the At Home prize, losing almost half of his body fat and the six medications he had been taking previously. Maybe the Senate should consider producing reality health shows with remaining Medicare funds?   (MSNBC)

Photo:Trae Patton/NBC

Break out the Kleenex and the cookie dough. Tonight is NBC’s  weight loss reality show mega-hit The Biggest Loser’s seventh season finale, which means three hours of jaw-dropping transformations, tear-inducing montages, and Jenny-O turkey product placement (plus about 90 minutes of filler).

To commemorate the occasion, NEWSWEEK’s Kate Dailey sat down with Bob Harper, one of the trainers charged with getting Biggest Loser contestants in shape—at least for the duration of the season. He answered critics who say the show is too rigorous for its overweight contestants, explained why so many “losers” gain the weight back after the show wraps, and updated us on the fate of Max Morelli, the overweight teenager who rose to sudden national attention on the show—even though he wasn’t one of the contestants. Max’s father Ron, and brother, Mike, have made it to the final four – and the reunion scenes where Max struggled with being the last of the overweight Morelli men were some of the most emotional of the series. (Expect to see Max – as well as all slimmer versions of the season’s entire cast -- at the finale.) 

Excerpts after the jump.