Fat Chances: Weight Loss Surgery for Everyone?

The FDA has approved lap-band surgery for less obese patients. But where will we draw the line?

Weight loss surgery just became an option for 11 million more of us. The Lap-Band device, which helps folks lose weight by cinching their stomachs to limit how much food they can eat, was previously only approved for use in patients with a Body Mass Index (BMI) of 40 or higher. Which meant the average 5’4” woman would have to weigh at least 233 pounds to qualify.

However, the Food and Drug Administration (FDA) announced this week that they are lowering the required BMI to just 30, as long as the patient also has one obesity-related medical condition. Now that a 5’4” woman only needs to weigh 175 pounds, just ten pounds over the national average, I think it’s time to ask: When it comes to the obesity epidemic, have we maybe lost the plot?

I know, I know. America is so fat, it’s making us sick. We hear this all the time. And I’m not denying that there are many overweight people leading unhealthy lifestyles and setting themselves up for major health problems, which may need major medical interventions.

Of course, there are also many normal and underweight people who lead unhealthy lifestyles and are setting themselves up for major health problems. But we don’t see headless B-roll footage of them every night on the news.

And averages are only averages. We come in a whole range of shapes, sizes and health conditions. Does being just 10 pounds above the average weight for women — yes, even if you also have elevated blood pressure or your knees are starting to ache — really warrant a majorly invasive and life-altering surgery?

I think not.

I think it’s pretty clear why Allergan, the makers of Lap-Band, are doing a happy dance over the new FDA ruling. They’ve just gained 11 million potential customers for their 25,000 dollar product. That’s a potential 275 billion dollars in additional sales from people who have been operating under the delusion that maybe they could save their cash and just try to eat less and move more. But as the war on obesity wages on, it seems like we’re finding more ways to profit — and spending less time worrying about the body count. Meanwhile, reports of weight discrimination in employment, education and healthcare doubled between 1996 and 2006, say researchers at the Yale Rudd Center for Food Policy & Obesity. Their studies show that experiencing weight bias makes it much more difficult for overweight people to lose weight — and may take a toll on their health that rivals any damage done by the extra pounds themselves.

Expanding our definition of what makes a person obese enough to qualify for weight loss surgery means narrowing our definition of health to a perhaps unrealistic ideal. Plus, it normalizes the idea that major surgical interventions are a proportionate response to anyone who looks a little different than average. We’ve got thin and health so mixed up together that even most women who weigh that average 165 pounds (or even 155 or 145) torture themselves with guilt trips, fad diets and other quick fixes that promise to make them “healthier”, when what we really mean is “prettier.” And that’s not good for anyone’s health.

Virginia Sole-Smith is a journalist whose work has appeared in Slate and The New York Times.

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