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"You're pretty sure they intend you to hear it," she says.
"I'd pretty much go home and cry and beat myself up. There's a lot of shame."
By 2000, 40-year-old Haraway weighed 314 pounds. Worried about high blood pressure and convinced she was going to die, Haraway had surgery that May, a vertical banded gastroplasty. The procedure is a less common cousin of the gastric bypass: Surgeons use a line of staples to seal off a big piece of the stomach, dramatically limiting how much food it can hold and absorb. Haraway's new stomach held only two fluid ounces -- about one-sixth of a soda can. The typical unstapled stomach holds 48 times that.
Dieters sometimes sniff at weight-loss surgery as the easy way out. For Haraway, the first months were anything but. If she ate more than a few ounces at once, she threw up. Initially, her physician told her to stick to a near-starvation diet of 800 calories daily, roughly equivalent to one chicken breast sandwich, a salad and a soda.
It was almost five months before she could keep even that amount down. She'd eat a few ounces of soup and feel both full and nauseated: "Your stomach is swollen and angry. There's not much room for anything."
Once she got her appetite back, problems continued. Weight-loss-surgery patients often find that it's difficult to get chicken and broccoli through their tiny stomachs, but ice cream and chips slide down just fine.
That terrified Haraway. She became obsessed with the fear that her staples would break down and that she'd eat more and get fat again. "I went through a week where I could eat a lot, and it really scared me," she says. Vomiting can excite her. "It means I can't eat much. It means the staple line is still there."
Adjusting to tiny portions was tough. She'd put dinner out for her husband and son, then go to her room and cry.
She still struggles. If her family goes out to McDonald's, for example, she can eat a side salad and one kid's hamburger, hold the bun. On Thanksgiving, she can eat "a teaspoon of this and a teaspoon of that," but that's all.
She knows that some people, after surgery, become bulimic. It's the only way to experience the joy of eating after losing the ability to keep it down. She compares her feelings about food to those of an alcoholic eyeing the gin bottle.
Her stomach is full, but that doesn't mean she doesn't crave more. Sometimes food is about taste, or the comfort of eating. Haraway can no longer experience that.
She loves being thinner, loves the way sales clerks look her in the eye and men make small talk in elevators. But eating, she admits over her breakfast of raisin toast, is still depressing. "Everyone who has the surgery has this fantasy of 'Give me ten minutes,' " she says. "I want to turn it off for 15 minutes. I want to eat this and have this and eat that."
She looks at the toast critically.
"There's definitely a frustration factor."
A prime catalyst for treating fat as a "public health crisis" has been the American Obesity Association, or AOA. The name sounds innocuous, and its nonprofit status seems to have granted it credibility. Its statistics are quoted by everyone from MSNBC to Newsweek.
Those media outlets rarely, if ever, disclose that the association is actually the lobbying arm of for-profit interests: seven pharmaceutical companies, all in the process of developing or hyping one diet drug or another, plus Jenny Craig and Weight Watchers.
"The profit angle is so transparent," he says.
The group's efforts are already paying off. In 1999, the AOA petitioned the IRS to declare obesity a disease and thereby allow taxpayers to claim deductions for treatments -- for example, diet pills or Jenny Craig products. The IRS agreed in 2002. Last July, Medicare followed suit. It changed its policy stating that obesity wasn't a disease, opening the door for the funding of obesity treatments ruled to be medically effective.
The AOA says it's just helping overweight Americans. But that presumes obesity can be fought much like smoking: by raising awareness and creating a national consensus.
Critics such as Steadham point out that eating is not something you can stop cold turkey. And unlike the smokers of years past, obese people are only too aware of the health risks. As University of Colorado law professor Paul Campos writes in The Obesity Myth, the government's own statistics indicate that 88 to 93 percent of obese Americans are on a diet.
"In other words, almost all fat Americans are already undertaking the 'cure' that obesity researchers and the weight loss industry recommend for their 'disease,' " he writes.
In the last generation, the percentage of dieting Americans has tripled, Campos writes. "And the result? Americans weigh on average 15 pounds more than they did 20 years ago."
Clearly the diets aren't working, but their pushers are making money. MarketData Enterprises, which studies the weight-loss industry, estimates that Americans will spend more than $40 billion in 2004 on pills, plans, meal replacements and gym memberships. Diet drugs alone are a $705 million enterprise, with 15 new drugs about to begin clinical trials.
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