Slim society's tolerance is wearing thin.
As more people over the last decade have tipped the scales toward obesity, normal weight folks have signed up for employee wellness programs that offer them lower premiums and other financial perks as a reward for their healthy weight -- and that indirectly penalize heavier workers. They've crafted policies, most unsuccessful, to compel individuals to lose weight. They've become vocal, sometimes vehemently so, in their support for "sin taxes" on junk food and soda. And they've increasingly attacked, with words or actions, the overweight and obese.
All the while, public service campaigns offer a steady drumbeat of vague lose-weight, get-healthy messages.
"Americans as a society are getting fed up with the matter of obesity. No doubt about it," said Douglas Metz, chief of health services for American Specialty Health, a San Diego-based company that offers wellness programs to employers. "Some pockets of society are taking positive action, and unfortunately others are taking negative action. That's what happens when a society hasn't figured out what the fix is."
Among those actions:
* A recent and ultimately unsuccessful plan at Lincoln University in Pennsylvania sought to take the body mass index of every enrolling student and require the obese to lose weight or take a fitness class before they could graduate.
* In Mississippi, legislators tried to pass a bill to let restaurants prohibit obese people from dining.
* In an interview with the New York Times last August, Toby Cosgrove, chief executive of the Cleveland Clinic, one of the nation's largest medical centers, provoked national outrage when he said that, if it were up to him, he would stop hiring the obese. He later apologized for his remarks.
* Last summer in Florida, animal rights activists at People for the Ethical Treatment of Animals (PETA) took aim at heavy women in a "Save the whales" billboard campaign that featured an overweight, bikini-clad woman. It read: "Lose the blubber. Go vegetarian." Angry reactions caused the organization to remove the signs.
Most efforts have ultimately met a quick demise or retraction, but not before leaving an impact. Employers and legislators are now getting in on the force-others-to-change bandwagon. And the 31-year-old National Assn. to Advance Fat Acceptance has seen its membership increase 20% each year for the last five years, according to co-chairman Jason Docherty.
Michael Kellner, a trim, 37-year-old public relations professional who lives in San Francisco, is among the disgusted: "I am completely and utterly frustrated with rising healthcare costs due to the deluge of fat Americans taxing the healthcare system. I'm in shape and have been all my life because I don't soothe myself with food all day." He's not alone in his opinion.
Los Angeles actor Jim Dailakis feels most frustrated with the fat issue when he travels. "I understand some people have issues that are uncontrollable. However, why is it that if I say anything about being stuck between two huge people on an airplane, I'm being politically incorrect? I work out religiously, watch what I eat and am very healthy. Yes, I'm fed up with it."
Frequent media reports of the toll obesity is taking on our nation's health fan the fury. A report by Emory University researchers projected last November that by 2018 the United States could expect to spend $344 billion on healthcare costs attributable to obesity. Obesity-related costs would account for 21% of healthcare spending, up from 9.1% today, said the report, sponsored in part by the United Health Foundation and the American Public Health Assn.
"If we as a nation don't get any fatter, then excess weight would cost the nation $198 billion in 2018," said Kenneth Thorpe, professor of health policy at Emory and the report's lead author. "Obesity is a leading driver in rising healthcare costs. Between 1990 and today, obesity rates have doubled, and obesity now accounts for one-third of the increase in our nation's healthcare costs."
The forecast is frightening, agreed Dr. Reed Tuckson, chief of medical affairs for the UnitedHealth Group.
"It portends a tsunami of preventable chronic illness, and it's overwhelming from an economic point of view." Obesity is linked to heart disease, stroke, cancer, respiratory disease, diabetes, hypertension, asthma, sleep apnea, arthritis, degenerative joint disease, gastric reflux and depression.
But sociologists believe more lies behind the anger than concern over healthcare costs.
"In our society, being heavy has become more of a stigma lately because we're struggling with other issues of consumption," says Abigail Saguy, associate professor of sociology at UCLA.
The economic climate, a recent history of people buying more than they can afford as well as environmental issues, including the depletion of our planet's resources, are making people feel more angry about society's overconsumption, she says. Obviously overweight people are an easy target.
"They're almost a caricature of greed, overconsumption, overspending, over-leveraging and overusing resources," says Saguy. "Though it's not entirely rational, it's an understandable reaction, especially in a country founded on the Puritan ethics of self-reliance, sacrifice and individual responsibility. If people feel they're sacrificing, then see someone spilling over an airplane seat, they feel angry that that person is not making the same sacrifices they are."
Rebecca Puhl, a researcher at Yale University's Rudd Center for Food Policy and Obesity, has quantified the rise in fat bias. In two papers published last January -- one in the journal Obesity, the other in the International Journal of Obesity -- Puhl reported that weight discrimination in the United States increased 66% over the prior decade.
The study compared two national random surveys of adults ages 35 to 74, the first of 1,826 adults taken from 1995 to 1996, and the second of 1,136 adults taken from 2004 to 2006. The survey asked participants to report occurrences of discrimination they'd experienced and what they perceived as the cause of the discrimination, including age, gender, race, sexual orientation, religion, disability, height or weight.
"Weight discrimination is highly prevalent in American society and increasing," said Puhl, who cites several possible reasons. Among them are a lack of legislation to prohibit weight discrimination and an increase in media coverage of obesity (up fivefold from 1992 to 2003). Most media framed the problem of obesity as one of personal responsibility, she reported.
The constant nudges might be having an effect, albeit a small one. Data released in January from the Centers for Disease Control and Prevention showed that the percentage of Americans who are overweight or obese has leveled off. But a sea change is unlikely; 68% of Americans remain overweight, and 33.8% are actually obese.
Bill Clayton of San Bernardino is one who responded to workplace pressure. Though no one at work said anything to him directly, the formerly 320-pound manager felt he'd hit what he called the fat ceiling. "I knew I was being passed over for jobs because of my weight. I wasn't going to get promoted looking the way I looked. I got the clear impression that it wasn't acceptable to be overweight anymore."
In March 2007, Clayton, then age 55, learned from his doctor that he was going to need blood pressure medicine unless he lost weight. He'd had some prior success with Weight Watchers, so he went back on the program and lost 35 pounds. Then he hit a plateau.
"I was still 100 pounds over my target weight of 185, and I was stuck," said Clayton, a safety manager for the Southern California Schools Employee Benefits Assn. In September 2007, he saw a poster at work promoting Healthy Roads, a new offering in the company's health and benefits program. "I figured, what could it hurt?"
He signed on and got a health coach, who checked in with him regularly and held him to a diet and exercise regimen. Over the next two years he lost 90 pounds. Today he weighs 195, runs five miles three days a week, does strength training and encourages others to lose weight. "I have a before picture of me in my office, and people can't believe it's the same person. I tell my co-workers all the time, 'Look, it's in your benefits. It's free for you. Why wouldn't you use it?' "
If public health officials, employers and still-slim Americans channel their concerns properly, it will have a positive effect, health experts say. "There's no better example of what happens when public health takes on an issue than what we've seen happen with tobacco over the past 10 years," Tuckson said.
Metz has a similar view. "Not long ago, the thought of not allowing people in a building to smoke wasn't realistic; now it's common," he said. "Similarly, in some schools the thought of banning sugary drinks and junk food seems completely unrealistic, but that will change too. The changes will meet resistance, but over time, healthy ideas will gain acceptance."