By Camilo Smith
By Craig Malisow
By Jeff Balke
By Angelica Leicht
By Jeff Balke
By Sean Pendergast
By Sean Pendergast
By Jeff Balke
Beth Haraway is eyeing the two slices of raisin toast on the plate in front of her. When she ordered them 15 minutes ago, the waitress cocked her head to the side, as if to say, Is that all you're going to eat, honey?
Still, Haraway feels guilty. "I'm supposed to weigh 160 pounds," she admits. "This morning, I weighed 166." She sighs, looking at the toast. "That shouldn't be sitting there."
At five feet ten, Haraway fits precisely in the government's range of normal weight, with or without those extra six pounds. She exudes soccer-mom sunniness: big blue eyes, stylish short hair, a wide smile. At first glance, she's not a woman who can cringe over such a small breakfast without sounding self-absorbed, even vaguely anorexic.
But she wasn't always this size, and that's what makes Haraway so careful -- and so different from the average skinny woman complaining about her weight.
Four years ago, Haraway weighed 314 pounds. She's lost half of herself.
The ignorant might say she's one of the lucky ones: She's made it. She's thinner, healthier and happier.
But luck played only a small part. Weight loss meant two surgeries, exercise, a major lifestyle overhaul and constant vigilance. She can no longer eat what the average American would consider a full meal, much less add dessert.
She knows what it's like to be fat. She knows she could be there again.
"I think about it every day," she says. "I think about it, and it scares the hell out of me."
Now that smoking has been thoroughly vilified and Big Tobacco properly squeezed, obesity has become the consensus choice for the country's next major public health crisis.
The topic has generated the sort of media hype usually reserved for miracle drugs or beautiful white murder victims: cover stories in Time, Newsweek and U.S. News & World Report. Reports on a dramatic increase in child obesity. Breathless accounts of the cost of medical care ($117 billion a year now, they say, and rising). Again and again, a recitation of the statistics: 300,000 deaths a year due to obesity. The number of obese Americans has increased by more than 50 percent in the last decade. The percentage of overweight kids has doubled.
Men's Fitness even pegged Houston as the epicenter of the "obesity epidemic." Houston topped the magazine's Fattest Cities list from 2001 to 2003, the first three-peat in survey history.
CNN, ABC News and two dozen major newspapers reported on the award. The attention spawned the documentary Fat City, which gave viewers of cable's Trio endless shots of Houstonians waddling through strip malls and chowing down at taquerias. The film reported that two-thirds of Texans are overweight, while one-third are obese. "Wide-eyed, slack-jawed visitors are often awed by the presence of so much weight," noted narrator Larry Hagman, but Houstonians "just don't care."
The crisis has sent all the usual suspects scrambling for a solution. Surgeon General Richard Carmona made obesity the focus of a "Call to Action" in 2001, warning that it could soon surpass smoking as a leading cause of preventable death. The National Institutes of Health announced a "strategic plan" for obesity research.
In Houston, then-mayor Lee Brown appointed a fitness czar. Even City Council got into the spirit: Members dropped a collective 102 pounds in a six-week shape-up.
In some quarters, concern turned to hysteria.
Kelly Brownell, a psychologist who runs the Yale Center for Eating and Weight Disorders, has called for a "sin tax" on junk food, with the proceeds subsidizing healthy foods. The Public Health Advocacy Institute hosted conferences to discuss "legal approaches to the obesity epidemic" -- mainly, how to sue the food industry for making people fat.
The ideas may seem laughable. But the idea that this country is in the throes of an obesity epidemic now seems widely accepted, despite the fact that there are problems with both the epidemic and its proposed cures.
The diagnosis is based partly on junk science pushed by the diet industry, which has an obvious financial stake in hyping it.
Supermarkets are full of magazines promising quick fixes, diet shakes, low-fat foods, low-carb everything. Everyone has a plan to hawk: Hit the gym. Try these pills. Eat no fat. Eat only fat.
Nothing seems to work in the long run.
And so the people who are the focus of the "obesity epidemic" remain mostly untouched by its frenzy. They've always known that they're fat. They just don't know how to change it.
When they discuss their battle, they don't talk about what the surgeon general is doing or even what they read in U.S. News. They know firsthand how silly most of the hype is.
Instead, they talk about the diets they've tried. Every day is a struggle for them. Not against the food industry, but against themselves.
And each day comes with a choice: What price will they pay to be thin?
Beth Haraway was a fat kid who grew up to be a fat adult. She was acutely aware of it. "People on the street would drive by and yell things. 'Fat pig,' or 'You're disgusting' or 'You cow,' " she says. "Those were mostly teenagers or men in their twenties." With women it was more subdued, she says, imitating a catty whisper: "Would you look at her?"
"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.
Overall, the diet market is growing by 6 percent every year, says MarketData president John LaRosa. "The IRS guidelines definitely gave the industry a boost," he says. "We've had a lot more media stories and an emphasis from the surgeon general to get our hands around the crisis."
In retrospect, Joel Davis admits, buying a deli soon after getting his stomach stapled was not his brightest idea. He had the surgery in 1982, and after a long and difficult recovery, he lost 100 pounds. He thought he was in the clear.
But, he says, "I'd eat a potato chip here and a potato chip there." Within a few years, Davis was back up to 300 pounds. He lost the weight again in the early '90s in a program at The Methodist Hospital, but soon regained it.
He'd been hovering around 350 pounds when his wife dangled a carrot: ice cream at the Marble Slab Creamery if he'd go to Weight Watchers with her first.
Davis, now a 55-year-old retiree, was skeptical of the meetings initially. "I was the only guy in there," he recalls.
It didn't take long for him to get hooked: hooked on the meetings, hooked on Weight Watchers' system.
Davis had planned to drop the pounds in a year; instead, it took three years and three months. He spent nearly $2,000 going to Weight Watchers sessions. (Meetings cost $11 a pop.) "The hardest was the plateaus," he says. "You'd know you'd be doing everything right, but the weight just didn't come off. That's where you'd see people drop off."
Sitting in the kitchen of his Sugar Land home recently, Davis looks positively thin. He shows off a picture from New Year's Day in 2000; the beefy guy in the white shirt looks nothing like him. His 60-inch waist is now 38 inches. His weight is 192.
Davis still goes to Weight Watchers. He works out five days a week. And he still weighs everything before he eats it; if a cut of meat is even one ounce over what's allotted, he'll trim it.
He's convinced that this time will be different. "It's something you never get over," he says, speaking from experience. "I have to worry about this every day."
As Campos explains in The Obesity Myth, weight loss is rarely permanent. Almost everyone gains it back, he writes, and "a significant percentage gain back more than they lost."
Paul Ernsberger, a professor of nutrition at Case Western Reserve University in Cleveland, Ohio, has done studies that show lab rats face more health problems from yo-yo dieting than if they'd just stayed chunky. "As they lose weight, their blood pressure and other risk factors go down, but as they gain weight back, it actually becomes worse," he says.
Critics believe an intense antifat push may hurt more people than it helps. "It's this big wave of hysteria: Do something, do anything -- surgery, dangerous drugs, things that don't work -- do anything to be thin," Ernsberger says. Instead of pushing for weight loss, he asks, why don't doctors treat the problems within their reach, like high blood pressure?
Indeed, for every path to losing weight, experts can produce a study showing it doesn't work. Erik Wilson, who performs weight-loss surgeries at the University of Texas's Minimally Invasive Surgery Center in Houston, admits that national statistics show one patient in 50 dies within a month of surgery. And the successful rarely end up slender. Most patients lose 50 to 75 percent of their excess weight. They remain overweight by government standards.
Wilson believes it's still the best solution. He starts sessions for prospective patients by explaining that less than 5 percent of people who've lost weight through diet and exercise alone manage to keep it off. The room is packed, the audience rapt.
"How many of you have lost over 200 pounds through the course of your life?" Wilson asks.
Almost everyone raises a hand.
Dianne Roscoe is the poster girl for Fat Houston. She appeared in a PBS documentary on obesity, then made an encore in Fat City, displaying a picture of herself wearing a black lace leotard and talking about how good she looked. She weighs 625 pounds.
Her family wasn't thrilled with the media blitz, she admits, or with her attitude. "It is their belief that I am going to die soon and I need to lose a whole lot of weight," Roscoe says. She resists that, saying, "I am who I am."
Roscoe went to Weight Watchers when she was eight. It took her a year to lose 33 pounds -- and two weeks' vacation to gain it back. She eventually tried appetite suppressants, NutriSlim, the grapefruit diet and then Weight Watchers five more times. In 1987, she had weight-loss surgery, but she says the doctor screwed it up. It took four more surgeries to fix. Today she weighs 300 pounds more than when she first went under the knife.
Her health is a mess. She's only 42, but she has severe arthritis in her knees, an overactive bladder, diabetes and sleep apnea. She uses an extrawide wheelchair to get around. She's on disability because she must keep her legs elevated, which rules out work. She needs a home health aide five days a week.
At Senorita's, the Mexican restaurant on her street, the manager greets her warmly. "I get takeout here all the time," Roscoe says. "I was so happy when they opened this place." Some people look at Roscoe and then look away, embarrassed. Others openly stare; one man in a tie elbows his friend.
If Roscoe notices, she doesn't let on. She explains her philosophy over tacos: "I had weight-loss surgery once so everyone could leave me alone. I almost died over that. I'm not willing to do it again. If you push me into that, I'm going to say, 'Bite me.' I'm not going to die to be skinny."
Roscoe puts her fork down. "I've gotta move," she says suddenly. She wants to slide her legs down. It's a difficult shift, and the manager comes over to ask if she's okay. "I've got to put my feet down," she explains. "There."
Properly adjusted, she starts again. "I don't care," she says. "If I'm at the community center, I'll say, 'Fat girl coming through!' People say you shouldn't talk about yourself that way, but why? It's just a word. Like 'tall,' or 'green,' if society was just more accepting of everybody."
Roscoe can come off as abrasive, a crusader just as intent as fighting for her cause as the antifat crowd. But the more she talks, the more her resignation displaces any bravado.
"I was tired of dieting and being disappointed," she explains as the waitress takes away her beans and rice, uneaten. "The hard part is making people understand this doesn't mean I'm giving up on life. I'm going to live a life, and food is not going to be my be-all, end-all concern."
She feels like she's already beaten the odds: "When I was a kid, they said I'd be dead by the time I was 18."
Study after study has linked obesity with serious health problems. But not everyone agrees that the big picture is as deadly as the media coverage insists.
The 300,000 deaths each year that obesity causes? The New England Journal of Medicine editors wrote in 1998 that it was "derived from weak and incomplete data." They also questioned it because of the difficulties in determining "which of many factors contribute to premature death." Scientists also admit they don't have a good estimate on how many kids are overweight, mainly because there aren't widely accepted criteria for what distinguishes baby fat from something more troubling.
Even adult obesity can be hard to define. Researchers use a height-and-weight grid called the body mass index to determine who's fat; under its criteria, more than 30 percent of Americans are obese. Critics note that by applying its standards, George Clooney is obese. So is former mayor Brown's fitness czar, Lee Labrada, who sports a 29-inch waist and a flawless physique.
The index doesn't support some of the more dramatic risks ascribed to fat, either. Wilson, the Houston surgeon, notes that adults in the "overweight" category average longer life spans than those in the "thin" category.
"The threshold might be set a little too low in this country," he says. "Being a little overweight, by our standards, might not be such a terrible thing."
Vera Perry is not just walking down the runway. She's strutting, or maybe sashaying. The sway to her hips suggests modeling experience; with her high, chiseled cheekbones and long neck, she could be Iman's sister.
Four years ago, Perry was shopping for a Christmas outfit when she realized she no longer fit into a size 26. She weighed 358 pounds.
Today she's a taut 185, a success so inspiring that Weight Watchers picked her to model in its Super Meeting at the Greenway Renaissance hotel in September.
The room is packed with nearly 600 Houstonians in various stages of weight loss. The sheepish ones fill their chairs; the slender ones have the pinched look of hungry women who are trying to think about other things.
When Perry strides down the stage in her bright yellow pantsuit, at least half of the audience stands up and cranes for a better look.
As an African-American woman, she never felt much pressure to lose weight. Some experts say as many as 78 percent of African-American women are overweight; more than half of those are obese.
"It's a culture thing," Perry explains a few days before the fashion show. "I always had men friends. But I wasn't happy with me."
At first it was just the way she looked. Then health became a concern: "Every time I went to the doctor, he'd tell me something else. I had diabetes, lupus, high blood pressure. I thought, 'I can't keep doing this. I'm slowly killing myself!' "
Her part-time job offered Weight Watchers free to employees, so Perry signed up. She took to it with a vengeance. At first, she was so strict about eliminating fat, her hair started falling out and her skin began to peel. It took an instructor to remind her that she needed to eat more than apples and oranges.
Even now, Perry arrives at the gym every morning at six and works out for two hours. She strictly observes Weight Watchers' plan.
Still, it was up to her boyfriend to persuade her not to drop any more, to stay at a size eight and like it.
"I want to get a little smaller," she says wistfully, "but my man said, 'No more.' He said, 'I want a little meat on your bones.' "
If the case for a national obesity epidemic is a bit of a stretch, Houston's Fattest City title was a virtual long jump.
Men's Fitness, which shares a publisher with the National Enquirer, relied on no city-by-city weight comparisons, because those don't exist. Instead, it did things like count fast-food restaurants in the yellow pages and penalize areas with a high ratio of eateries per resident. Cities with lakes and mountains got extra points. Those with air pollution were docked.
The connection between those factors and fat is tenuous, at best. And in January, when Detroit was named Fattest City, Houston's fall to second place was dubious, even by Men Fitness's standards.
For example, Houston had improved in the categories of alcohol consumption and nutrition, but those were based mostly on statewide data, some of it not updated since 2002. The magazine claimed Houston's higher ranking for exercise and sports participation resulted from surveys of cities by American Sports Data, which says it never conducted such a survey.
Labrada, the fitness czar under Brown, credits his personal lobbying effort with the magazine's editor as Houston's real achievement. He flew to New York to explain the city's fitness program, "and that was factored in as well."
Peter Sikowitz, Men's Fitnesseditor in chief, says the Fattest Cities list was originally planned as a sidebar to a list of Fittest Cities. But the magazine quickly discovered where the zeitgeist was headed. "There's been an awful lot of attention to the obesity epidemic," he says.
That attention has helped Men's Fitness to increase its circulation. Sikowitz claims the magazine's ranking helps spur the listed cities to focus on fitness. "This is really something that works for the greater good of communities," he says.
Like fad dieters everywhere, however, Houston appears to have lost interest in its municipal shape-up plan.
In the first nine months of Mayor Bill White's administration, Labrada says, he wasn't able to get a straight answer on whether the city wants to keep the fitness program.
Councilwoman Carol Alvarado says the mayor hopes to appoint a new fitness czar soon. The city has had more pressing concerns this year. "There was a list of priorities," she says, "and this was not at the top."
There was a time when Darlene Cates wouldn't leave her house. For five years, she sat at home, and on the rare occasions she went somewhere, she would sit in the car and wait for the errand to be over.
While she'd always been fat, being a few hundred pounds overweight was something new.
"When you're fat," she says, "you find the oddest things to validate who you are and how you are. I was always proud of the fact that I never waddled when I walked. I took pride in that when I didn't have much to be proud of."
But then her knees started to give out, and she found she could hardly even walk. "And that really depressed me," she says, explaining that she started staying at home. "I thought, if people made fun of me before, they'd really do it now."
"I can't get from my bedroom to the car without sitting down a few times, and you want me to come to New York?" she asked. But they pleaded, so Cates consulted her family.
"You've been praying for help," her son-in-law pointed out. "What if this is it -- and you don't go?"
So she went, and a few months later, she went again. And when casting agents were looking for someone to play the overweight mother of Johnny Depp and Leonardo DiCaprio in What's Eating Gilbert Grape?, they thought of her. Cates suddenly had a major role in a movie that still has a cult following 11 years after its premiere.
Cates, too, has a following. A fan has posted her story on the Internet, and every few days she hears from another person whose life she's touched. Someone who saw the movie, or read her story and wants to say thanks.
She talks to them. She answers their e-mails. She tries to remind them that they deserve to be treated well, that they don't have to take abuse just because they're heavy. It's become her ministry.
Cates has learned to accept that she's 542 pounds. "Look, don't assume we're just fat and happy and satisfied. Some of us are, some aren't. But I'm going to be as happy as I can in my circumstances. That's all I can say."
Any person would love to have a safe answer to their weight problems, she says. "I've heard people say, 'I wouldn't lose weight even if I could. I'm perfectly happy.' " Cates pauses. "As we in Texas say, 'That's bullshit.' That's not true."
However, she adds, "The outer stuff isn't as important to me as the stuff on the inside. And I have fought and struggled to get where I am on the inside. I don't have all the answers. I'm still struggling to be the person God wants me to be.
"But I've come a long way."
Beth Haraway had warned her psychologist on her first day of therapy: "I know I'm morbidly obese, but that's not why I'm here. Talking about my weight is not going to fix it."
And sure enough, they didn't discuss it through years of therapy. Didn't discuss it until this September, when Haraway knew, finally, that she looked great.
She had a second surgery, two and a half years after her first, to remove pounds of extra skin. "I was fortunate," she says. "I could grab and hold it, but it didn't hang to my knees." Another procedure tightened her stomach muscles.
She's now where she wanted to be -- or at least close. After all, she's at 166 and she'd planned to stay at 160.
However, she worries over the possibility of losing control completely. "I would be all right being six pounds over if I could promise myself that's all it would ever be. If I knew I could stop. Or even if I got to 175. I'd be okay if I could stop it there."
She looks down at her toast. "But I know that it would keep moving.
"I remember how hard it was in the beginning to go without food," she says. "I cried a lot because I wanted to eat. And I find myself thinking, I'm not sure I could do that again."
It's a battle, every day. And Haraway knows she can never fully win. "We're never going to be normal people," she says.
She has a mantra about lost weight: "It's not gone forever. It's looking for you. You left it, but it's looking. And there's a part of you that's looking for it, too."