On Surgery & Gimmicks: An Open Letter to People Magazine

As it happens every year, this morning I was standing in line at the grocery store and happened upon this:

It’s People magazine’s annual (I believe) issue highlighting dramatic weight loss stories. As per usual, there are before pictures of overweight people and then after pictures, usually of women in bikinis or men in swim trunks sporting muscles and curves they did not have before. At the bottom, always the language, “No surgery! No gimmicks!”When I see this cover every year I feel three very distinct things:

1. I feel happy for the people featured. No matter how they did or did not lose weight, taking control of one’s health is a triumph.
2. I feel slightly irritated. I am a weight-loss surgery patient and I feel like the words on the cover, along with the images featured,
3. are designed to invalidate my experience and affirm people who simply made a different choice than I made.
   I feel profoundly grateful that somewhere in my cluttered mind the resolve persists never to buy People magazine.

This year I decided to do this open letter because there are a lot of mixed emotions within the weight loss surgery community about this particular issue and the words on the cover. I polled my 5,500+ readers about it and got a variety of responses ranging from “that cover is bullsh*t!” to “I’d love to see them without Photoshop!” to “I don’t care and I don’t compare.” But still, this cover — and what it implies — bothers me. And I’d like to tell you why.

First, let’s talk about what this is not about. This is not about defensiveness. In reality, the individuals highlighted look great and their successes do not take anything away from mine. I’m not jealous that they lost weight with diet and exercise alone nor do I wish them anything but continued success and health. When I polled my readers on this cover, most of them felt the same way.

This is not about trying to get People to feature weight-loss surgery patients in future issues like this. Although it would be nice to have such a feature (if only to present weight loss surgery as a valid option), frankly, I don’t think I trust People to report on it fairly and accurately.

And this is not about comparing the validity of one weight loss surgery method to another. The human body is designed to work against weight loss, especially fat loss. Therefore, any method of losing weight is going to be difficult. There’s going to be stalls and plateaus. Any method requires shifts in thinking and behavior. That being the case, I don’t think one method of losing weight is any “easier” or “harder” than any other.

So let’s talk about what this is about. It’s about perception versus reality.

The perception is that weight loss surgery is purely elective, that it is an easier way of losing weight and that people who have had weight loss surgery have somehow not worked as hard as people utilized a traditional diet and exercise method.

The reality is that weight loss surgery is becoming widely accepted in the medical community as a valid and effective resolution to obesity. While it can be argued that weight loss surgery is more invasive than other methods of weight loss, my contention is that weight loss surgery is an
equal valid method of weight loss and deserves the same amount of awareness and objectivity as any other method. That is not to say that we celebrate it and deem it a cure all, but that we keep as open a mind to people whose weight loss has resulted from weight loss surgery as those who went the traditional route.

There’s also a perception that obesity is strictly behavioral. I’ve heard it said many times that if people could “control themselves, eat better and move their bodies” obesity would not be such a problem. That theory would work except for this: I know many people of a normal BMI who don’t control themselves, don’t eat healthy food and certainly don’t move their bodies! So the epidemic of obesity has to be a bit more dynamic than that. But with magazine covers that laud weight loss methods that utilize “No surgery! No gimmicks!” we reinforce the idea that obesity is a character defect more than it is a serious medical problem.

The reality is that this method of thinking is not working. Childhood obesity is on the rise. Type 2 Diabetes is on the rise. Heart disease and many other co-morbidities that are outright caused or exacerbated by obesity are all on the rise in the U.S. And deeming obesity a behavioral issue (and addressing it as such) has not slowed the swell of obesity rates in the U.S. Nor has shaming the obese. Yet, here we are in 2013, again with this People magazine cover. The most stark reality that I see behind all the noise is this: the current rate of childhood obesity is so great that scientists are now predicting that the current generation of children will be the first to not outlive its parents.

Simply put: we can no longer afford to stroke our egos about obesity. It’s time to look at this problem — and all its proposed solutions — with a more critical and objective eye.

Which is exactly what this magazine cover is working against. True, magazines need to sell themselves. I don’t argue with that. But I find it reprehensible when they do so at the expense of an already marginalized population. The placement of the words “No surgery!” next to “No gimmicks!” was not accidental. I can guarantee there were conversations about it in the ranks of People and tha
the placement was a very conscious decision on their part. But it’s also a dangerous one.

Why? Because to perpetuate the myth that traditional diet and exercise plans are superior to weight loss surgery reinforces some negative, even toxic, stereotypes that draw people away from reality and buy into perception.

Like Obama so loves to say, “let’s be clear.” According to the Centers for Disease Control (CDS), a third of the adults in America are obese. In total more than 68 percent of adults are at least overweight. This means that most people in America need to find some solution to lose weight. Studies have shown that while it is not impossible to maintain weight loss, statistically it’s very rare that any group — weight loss surgery patients or otherwise — maintains total weight loss for the long-term.

What does that mean? That means that weight loss surgery patients and traditional dieters/exercisers are about on par with the long-term challenges of maintaining a healthy weight. And for them, to see a mainstream magazine like People hail people with a relatively short amount of maintenance time under their belts is disheartening. Because they often don’t see the “big picture” (in part, because People does not show it to them) of where these people are a year, two years, five years down the road. All they see is a person in a bikini looking happy when they feel hopeless.

Those words (“No Surgery!” “No Gimmicks!”) also perpetuates an inaccurate mode of thinking across all of society — in the obese and non-obese
of our population. Merriam-Webster defines gimmick as, “a trick or device used to attract business or attention.” I write to you as a weight-loss surgery patient, and a peer leader within the weight loss surgery world with a pretty decent following, and I am telling you this is absolutely not true of our population.

In fact, most weight-loss surgery patients try to deflect attention away from their surgeries. Why? In large part because of the social stigma erpetuated by magazines like People but also because it seems futile to explain exactly how labor-intensive this process is. Imagine having to relearn to eat (much in the way an infant has to learn to eat), take on exercise, learn to follow a rigorous vitamin schedule and, perhaps most challenging, learn to cope with emotions that you’ve always placated with food. Imagine doing all that then having some magazine invalidate it by implication that your hard work was about on par with a gimmick.

I don’t want to make People sound like the devil. It is not. It’s just a misguided magazine with an unfortunate name. But its exclusion of people who have had weight loss surgery (and I’m talking about a fair reporting of the good, bad and ugly here) is indicative of the belief of larger society that obese people just need to “buck up.” In reality, obesity is a dynamic, public health problem. Every solution does not work for every person because every person did not come to be obese by the same avenue.

That being the case, we would do well — if we are truly concerned about overcoming the obesity epidemic — to look at all methods of weight loss fairly. We should consider the long-term challenges and success rates. We should recognize that it all boils down to the human body, which operates under the same instincts whether a person has been surgically altered or not. We should celebrate when a person has managed to attain a healthy weight (by whatever means of medical or psychological intervention brought them there). We should look at the struggles of people who are obese or those who regain without a bias for how they can or should lose weight.

And in reality, People doesn’t even have to feature weight loss surgery patients to do that. They could simply exclude those four little words (“No Surgery! No Gimmicks!”), opening the door to a conversation about how truly hard it is to be obese in the U.S. and how it is even harder to
overcome obesity and maintain a healthy weight.

It seems to me, for a magazine that is called People, it sure does not seem to respect them. And it certainly doesn’t understand them, or at least not in a way that would make the magazine anything but a fluff read in a supermarket aisle as I’m waiting to pay for my (very healthy) food. Which is what it will continue to be until they overcome their biases and People begins to reflect the experiences of…people.