Is it a person's "fault" if they're fat? What does that question really mean?

I'm writing in response to various comments in another thread a few days ago where people were getting all steamed up about "fat shaming" and "taking personal responsibility" and the like.

Just to get this out of the way, I'm currently 178 lbs at 6'0", having lost 85 lbs since last April, along with 10" from my waist, taking me down to 30" waist jeans that I had to mail order since 30x34 is a hard size to find locally. (I guess it says something about the average American male that 34x30, not 30x34, is in plentiful supply.) My last physical (when I'd only lost about 50 of the 85 lbs.) showed I was very healthy in terms of cholesterol, blood sugar, and plenty of other measures. (My blood pressure, oddly enough, went up for a while, just crossing into Stage 1 hypertension, but it's back to a healthy value again. I blame the then on-going election! )

I say this not to fish for compliments (well, OK, maybe a little!) but because some people don't seem to take you seriously about diet and exercise unless you're in good shape, even if same information and opinions you might convey are shared by both fit and fat people. I would have said much the same things I'm going to say now back when I was 263 lbs.

Was it my fault I'd gotten so fat? Is it to my credit that I've become fit and trim? Does what applies to me apply very much to anyone else?

I grew up an out-of-shape geek, the kid picked last for teams in high school gym. I didn't get fit until my 30s, I let myself go during my 40s, and in just the past year I've gotten myself back on track at 50. Clearly I can make up my mind to eat better and exercise, and I get good results when I do. Just as clearly, I can also fail when a situation that makes it a lot easier for me to take the time for exercise (a work-at-home job I held for seven years) gets replaced with a less conducive situation (losing 1.5-2 hours a day to commuting, feeling more worn out from working and driving).

I don't think "fault" is always such a clear concept, even though people get very impassioned about what is and isn't a person's fault. It's more useful to consider of how easy or hard some personal choices might be. Does a choice require trivial or heroic effort, or something in between? Can 8 out of 10 people resist an extra cookie in one situation, but change circumstances a bit, and only 3 out of 10 can resist?

As a thought experiment, imagine an overweight prisoner locked in a cell. The only food he can get is what a jailer provides him through a narrow slot. Imagine further than the calories burned by the prisoner are closely monitored -- not just calories burned via exercise and general motion, but calories burned by all metabolic activity.

Human bodies follow the laws of physics. I can guarantee you (minor issues such as water retention aside) that if the jailer puts fewer calories through the slot than the prisoner burns, the prisoner will lose weight over time. He might be very unhappy about it, he might suffer from frequent and distressing hunger pangs, and if the jailer makes poor nutritional choices the prisoner might become ill or malnourished -- but he will lose weight.

I know that the phrase "calories in, calories out" infuriates some people, but when you fully account for every bit of the "in" and the "out" (which can be complicated and nuanced) you can't help but lose weight when your body is burning more calories than it is taking in. The energy your body uses has to come from somewhere, and if that energy is not in your food, your body has to start breaking down fat and/or other body tissues to provide that energy. People who struggle with weight loss, whatever their real you-don't-want-to-blame-them-for-it problems might be, do not have a magical ability to suck energy out of the aether. A "low metabolism" can only go so low if you're still alive.

If you aren't locked in a cell, if you aren't being fed by a calorie-counting jailer, it's a difficult question how much calorie-counting knowledge and discipline (or adherence to good non-calorie-counting habits which yield equivalent results) is a reasonable expectation for any given person, especially when we're not just talking about food calories ("in&quot , but knowledge of your own metabolism and activity in terms of caloric values ("out&quot .

Some people stay at a healthy weight with little effort at all. They aren't especially disciplined or conscientious, they aren't counting calories, they eat what they want, they don't go out of their way to exercise -- they're just lucky. Others have to work hard at reaching and maintaining a healthy weight, but they succeed. Some work hard and fail. Some, for good or bad reasons, don't make much effort at all.

When you look at the American population as a whole, clearly something is going wrong with our high and growing rates of obesity. A large portion of the population didn't simply transform from good, hard-working responsible people into bad, lazy, irresponsible louts. Many things about our food supply, eating habits, and physical activity have changed. You can, of course, blame the Evil Capitalists and Evil Corporations for that, and they certainly bear some of the blame, but they can't do all that they do without the public cooperating to some extent. They won't sell it if we won't buy it.

It is simultaneously dastardly yet eminently understandable that a snack food maker, given resources like focus groups and food laboratories, will be driven to figure out how to make you want to keep eating their tasty treats until your hand reaches the bottom of the supposedly six-serving bag.

Would you outlaw this kind of irresistibility in food? Would you tax it? Warning-label it? How much responsibility do you place on the consumer to resist temptation and exercise self-control?

Some people say, for example, diet soda makes you gain weight. Let's suppose this is true (might be real cause and effect, might be more a matter of mistaking correlation for causation), and the reason it's true is that diet soda increases your appetite for foods that contain the calories that the soda doesn't contain. If so, you still have to give into those cravings before the unwanted weight gain occurs. If you drink diet soda, feel those cravings, yet still manage to restrict your calorie intake, you will still be able to lose weight. It might be a more stressful, unpleasant task, more prone to eventual failure, but in the bigger picture the diet soda can only be an indirect cause of weight gain. It's an unclear value judgment whether a person's susceptibility to induced cravings and ability to battle those cravings when they occur constitute a blame-worthy failing.

I've been able to change my eating habits and even my food cravings themselves so healthier eating comes more naturally. Can I expect that will work for everyone? No. Do I think people who are eating poorly should at least give it a try? Yes.

I now do lots of exercise, several hours worth every week, cardio and weight training. But I've now got a blissfully short commute to work, and a free gym at the office. I'm quite sympathetic to people not being able to find the time to exercise as much as I do now. On the other hand, I think people should reconsider their priorities if they aren't doing what they can do to make at least some time for some exercise.

There are good medical reasons why the potential for exercise is limited for some people. On the other hand, I've seen people like my own father use every excuse he could for inactivity, not fighting to do as much as was still possible for him to do, until he essentially crippled himself for the last 10-15 years of his life.

I have no clear conclusion to present, just a mixed bag of feelings and a sense of many gray areas. I know that many individual people could improve their health if only they decide to do it. I know that's easier said than done. I know good excuses for poor health exist, I certainly don't want to go as far as the mindless "motivational" rhetoric of people who smugly shout "NO excuses!", but that many of those excuses aren't as good as many people think. I'm pretty sure that most people who claim to "eat like a bird" but can't lose weight are simply in denial about how much they eat and/or suffer badly from "portion distortion". I believe that real metabolic disorders exist, but that they aren't as common as claims to suffer from them are. I believe we've created a food environment that makes it harder to find healthy food, harder to resist overeating, but that with some effort we can all eat better. I believe a lot of improvement in diet can be made without getting fanatical about all-natural, all-organic, non-GMO, gluten-free, etc. -- you shouldn't give up on eating better just because the whole package deal of "clean eating" fanatics seems horribly restrictive and overwhelming (and perhaps, in some areas, absurdly and needlessly puritanical).