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What Role Should Medicine Play in Fighting Obesity?

The Reed family we’re following on their weight loss journey in Austin, Texas, offers one perspective.

By James McWilliams


(Photo: Spencer Platt/Getty Images)

“This may be too personal,” Becca Reed warned me as she looked at herself in the gym mirror and prepared to lift a couple of barbells. “But the fat on my upper and lower back no longer touch.”

As noted in my last column (which introduced the Reeds), Becca is involved in an experiment. She has vowed alongside her husband James and their son Drew — all of them suffering from obesity — to embrace two potentially life-changing goals: work out three times a week with trainer Mike “Bonebreaker” Crockett, and eat an exclusively plant-based diet of mostly whole foods, roughly following the Engine 2 program. With a study out last week in The Lancet causatively linking body mass index and mortality, the family understands what’s at stake when it comes to the lifestyle changes they have chosen to pursue.

After three weeks on their regimen, the Reeds have seen improvements in mood, mobility (Becca already achieved her goal of walking for five minutes), and weight loss (together the family has dropped over 30 pounds, with James accounting for 18 of them). And now, happily, we can add reduced back fat to the list of results to celebrate.

My initial column on the Reeds noted that their experiment faces a food system conspiring against their success. I even went so far as to call the Reeds victims of the standard American diet (to the ire of some readers, who see the issue as exclusively one of personal responsibility). But there’s another challenge to the Reeds’ diet/exercise approach, one that, ironically, comes from within the medical profession. While there’s not a reputable doctor on Earth who would denigrate diet and exercise as essential to human health, many medical professionals (and pharmaceutical companies) are framing obesity as a problem beyond the reach of behavioral modification. Instead, they’re primarily promoting surgical and drug-based therapies as the best way to address this epidemic.

The wonders of modern medicine — and they are wonderful — could, in their seductive appeal to a quick fix, very well compromise the non-medical efforts that the Reeds are undertaking to fight obesity.

In no way do I want to present these two general approaches — therapeutic versus behavioral — as mutually exclusive. Some combination of drugs, diet, and exercise will surely help many obese patients. But the wonders of modern medicine — and they are wonderful — could, in their seductive appeal to a quick fix, very well compromise the non-medical efforts that the Reeds are undertaking to fight obesity. In so doing, the therapeutic option, in so far as it’s privileged over the behavioral one, could undermine the character-building experience that a medical procedure or pill would never be able to foster in patients determined to conquer obesity for good.

For Vox, Farah Naz Khan, an Atlanta-based doctor, wrote persuasively in support of greater medical intervention into the obesity crisis. “If we want to try to curb any of the future devastating health complications our obese patients will face without weight loss, then we have to try to offer them something other than diet and exercise pep talks,” she wrote. In addition to advocating drug therapies and bariatric surgery, Khan went so far as to push the use of a very recently Food and Drug Administration-approved device, called AspireAssist, a machine that enables eaters to empty their stomachs of excess ingested food (yes, bulimia style) into the toilet (or wherever, I guess). “Our patients,” she said, “may need this kind of assistance.”

I’m dubious. Perhaps if I observed Khan in her clinic, witnessing firsthand the awful extent of the problem, I might be more inclined to agree with her, or at least have more sympathy with her faith in medical machinery and pharmaceutical therapy. But my intuitive sense is that Khan is an outlier on this issue. When I first heard of AspireAssist, in late May, it was in an email blast that included several physicians with whom I routinely correspond. The incredulous doctor who sent it out had to repeatedly convince the others that this really wasn’t a joke.

Either way, it’s hard not to cynically juxtapose the two options on the table — gorge on junk and siphon off the ingested effluvia or, by contrast, bust your ass at the gym, eat well, and take pride in the results. The balance further tilts when you consider the latter option in more detail, making sure to appreciate the discipline and drama underscoring the efforts of those who tackle the problem through behavioral change. Start with the Reeds’ recent weekly meal plan (a list to which they carefully adhered), keeping in mind that their previous diet existed almost exclusively of fast food (E2=Engine 2):


Equally telling is the family’s work at the gym. The first workout was mayhem. Becca, who was walking from one end of the gym to the other, suddenly started crying — wailing, really — because her hip hurt. Drew huffed out a set of leg lifts, stood up, wobbled, and then fell to the floor like a sack of meal. James, who does manual labor during the day, was the only one who seemed not traumatized by the physical exertion, nailing his reps with confidence, but clearly concerned about his ailing clan.

In terms of physical performance, the second workout was a drastic improvement. Every member of the family burned through their reps; the energy in the room practically hummed; and this time there was no crying or falling. Becca, who walked into the gym rather than using her wheelchair (Drew filmed her), immediately got on the floor and started stretching, telling me how, last week, she was able to play with her granddaughter for the first time this way. She then began ripping through barbell reps. “Don’t forget to breathe, mama!,” Bonebreaker yelled. He then turned to me, his eyes wide, and said: “The whole family is in here killing it! Last week she could hardly walk!” James, determined as ever, quietly went through his own routine, recording every finished set in a log book he keeps by his side.


(Photo: James McWilliams)

The only concern was Drew. He arrived with his face set in anger. Drew was in a mood. When I said that he seemed upset he muttered something about having plans that evening but his parents taking forever to leave the house. During the workout he grew more frustrated, perhaps because his parents were outpacing him, even sort of unknowingly showing him up. Drew is a kind young man. Even as his anger grew, he reached out for his dad’s hand to help James off the bench after his reps. The rapport between the two tightened throughout the workout as they shadowed each other around the gym, counting and spotting for each other at every machine. At first, Drew would not accept his dad’s own outstretched hand to help him off the bench. Eventually he did. Still, the discontent only intensified as Drew’s own fatigue further set in. “Vocalize, don’t internalize,” Bonebreaker advised. Drew gave him a helpless look. Bonebreaker took him outside for some core strengthening.

As I noted last time, Drew has already taken the medical route toward fighting his obesity. His gastric bypass surgery — the most common bariatric procedure — led to the loss of 150 pounds. But it also left him atrophied and devoid of core strength, a condition that was making the gym work especially difficult. A couple days after the second workout, I caught up with Drew to see how he was doing. What he told me was interesting:

As for the [gastric bypass] surgery I do regret it, knowing I could have done all this [losing weight, getting in shape] without it. It would have taken longer but I wouldn’t have gone through all the muscle wasting I did go through after the surgery. I do like that I have lost a lot of weight and that I have been able to do things that I hadn’t prior. I liked the quick results. But they don’t feel earned, especially comparing what I’m doing now by just eating right and working out.

None of this is to deny the power of medical approaches to fighting obesity. But the Reeds’ experience highlights something critical (and harder to measure): A behavioral approach that comes with a fuller set of benefits — ones that far exceed physical health.

I suppose you could hook the Reed family up to an AssistAspire machine and drain food from their guts. And I suppose there are many doctors who would advise this route. But in so doing you would also be draining away the emotionally resonant experiences of overcoming adversity, pursuing a shared goal with loved ones, accounting for your own accomplishments, and, as the Reeds continuing are continuing to do, preparing for another week becoming the better people they want to be.