Overweight and Underpaid

Oh, yeah, these things are related

I’d lost about 40 pounds when we took this picture in my kitchen, but couldn’t find a 40-pound bag of anything to illustrate that. It’s hard to believe I was carrying around the equivalent of two of those bags! (Photo by Harrie Teheux)

The cheapest foods out there aren’t usually the healthiest ones.

That’s one reason it’s more likely for poor people (especially poor women) to carry extra weight, but it’s not the only one. It’s also true that poor people are less likely to live in safe, walkable neighborhoods, to be able to afford gym memberships or to have time to devote to sports and exercise if they’re cobbling together multiple jobs and side gigs to keep up with their ever-rising rent.

The time loss that comes from irregular work schedules is real. The times in my life when I’ve been most successful at sticking to a strict workout schedule have correlated precisely to the times when I’ve had a regular work schedule.

But also? Stress, poor sleep and weight gain go hand-in-hand. And any person living in poverty or near-poverty knows very well how stressful it is when you’re not sure you’ll be able to cover all your bills for the month.

So yes, there’s a correlation between obesity and poverty. Add it all up, and you wonder how any poor person ever manages to keep their weight at a healthy level.

If only there were a magic drug!

Well, there is.

We now have something everyone has always dreamed of – a medication that is incredibly effective at helping people lose extra pounds.

Of course, we decided not to make it available to the people who most need it. The new injectable GLP-1 analogs, like semaglutide, and a related drug, called tirzepatide, help people with Type 2 diabetes and/or obesity take off weight and normalize their blood sugar.

There’s often a fine line or no line at all between those two groups, by the way. While there are some people with Type 2 diabetes who aren’t overweight, the two conditions are usually closely related.

I’m not diabetic, but I know I’m at risk

One of my babies was 10 pounds at birth. That’s a danger sign.

My A1C hemoglobin test last summer had me just a cupcake away from prediabetes. I have been checking my morning blood sugar once in a while for years, using a cheap home blood sugar test kit, because I have always known I’m at risk. My morning blood sugar tended to hover right around 100 each morning, even if I cut all refined carbs and performed heavy exercise.

If only I had diabetes!

My insurance provided coverage for a while and it was great. I lost significant weight without changing anything I was doing – because I was already eating an appropriate diet. I cook most of our food from scratch. There’s seldom much processed food here.

But then my insurance company changed the formulary and decided it would only cover my injections if I could produce a diagnosis of diabetes.

Was I tempted to go on a sugar binge for a month to push my body into diabetes so I could get coverage? Yes, frankly, I did consider that. Instead, I went on Reddit and found some work-arounds. (The FDA is about to remove the affordable option of compounded drugs, which will force many people of poor or moderate means to discontinue these drugs.)

Normally, Americans have to pay around a thousand bucks a month for these medications, although the drugs are quite affordable in other countries.

Obesity was considered an urgent medical issue caused by people too stupid and lazy to eat and move appropriately before these drugs came along. Doctors felt free to berate their overweight and obese patients at every appointment.

But then a miracle occurred!

Obesity is no longer harmful, you see. It is merely a cosmetic issue now. And cosmetic issues are not generally covered by insurance.

Glory hallelujah! If you are obese, you may now rejoice to know the only downsides to carrying extra weight are aesthetic ones.

Therefore, wealthy people carrying an extra 10 or 15 pounds can pay full price for these injections and return to the svelte weight of their younger years. Poor people carrying an extra 100 pounds will be told they are out of luck because their weight is just a cosmetic issue. Oh, and have they thought about swapping out the pound of candy they undoubtedly eat every day for some lettuce?

Most naturally thin people have trouble understanding this issue

It’s a little bit like alcohol. I have a friend who cannot have even a sip of wine. He must completely abstain.

But he could cheerfully walk past a plate of cookies all day long and never feel the slightest inclination to indulge. At most, he might have one cookie.

For me, it’s the opposite. I have a well-stocked liquor cabinet that I seldom open. I just hardly ever think about it, and if I do, one drink is usually all I want.

But if there’s a plate of cookies in the house, I am hyper-aware of those cookies and will think about them nearly constantly for as long as they’re in the house. It’s a terrible feeling, so I usually avoid having any dessert in the house because the temptation is overwhelming.

I should say I used to have that problem. With these injections, that’s no longer the case. I got through Valentine’s Day and my birthday last month without a single sweet treat. I didn’t even want a box of chocolates or a birthday cake.

A “normal” person can have a treat now and then without worrying about it. I really can’t do that, just as an alcoholic cannot have a beer once in a while. (You can cut out all alcohol, of course, but you cannot abstain from all food).

Many people on these drugs report it cuts their desire for alcohol and even things like recreational shopping, gambling or other behavioral addictions. There’s a lot about these drugs and the human brain we don’t understand, clearly.

Will we be able to come up with a similar drug that eliminates drug and alcohol addictions? It seems possible – but even if we do, we probably won’t make it available for poor people. The purpose of medicine in America, as you know, is not good health for the masses. It is profit for the few.

I’ve lost about 50 pounds

The loss did not result from changing my diet. I’m mostly eating the same foods as ever, but in very slightly smaller portions.

Here’s a fun experiment: Bring up an online calorie counter and compare the difference in calories needed for a given person. Let’s pretend you’re a 25-year-old woman who is 5 feet tall and weighs 100 pounds, which is about what such a person’s ideal weight would be. (I’m deliberately not choosing a woman of my age and height for this example). She can supposedly maintain her weight with about 1,540 calories per day.

What if that same woman were to eat 1,852 pounds per day? She’d weigh about 150 pounds! The difference between her weighing 100 pounds and 150 pounds is only 312 calories a day. That’s about a cup of cottage cheese, one peanut butter and jelly sandwich or half of most Panera salads.

It could easily be the difference between a small portion of a casserole and an imperceptibly larger portion of a casserole. My point is, there usually isn’t much difference at all in food intake between a thin and fat person. If you are eating just enough to satisfy your hunger and are sticking to a reasonably healthy diet, you can still get pretty damn fat.

With these drugs, we don’t experience the “food noise” that urges us to eat. Even more importantly, we can eat less without experiencing overwhelming hunger, lightheadedness and nausea. Almost anyone can white-knuckle their way through ignoring their hunger cues for a while. But almost nobody can carry on doing that forever, which is why close to 100 percent of dieters regain lost weight eventually.

We love to blame people for situations society puts them in

This applies to poor people, who are assumed to be lazy and stupid, even when they’re working more than one job and finding ingenious ways to survive. It also applies to fat people, who are also assumed to be lazy, even if they are hitting the gym several times per week and living on so little food they often feel unwell.

And when you combine poverty and obesity, now we have a synergistic effect. Surely that fat, poor person deserves her fate! Let’s all judge her! We may do it silently or we may make a snide remark, but either way, she’s perfectly aware you’re doing it.

Should she figure out how to find a way to get her hands on these drugs, the judgment is still not over, because now she is perceived as cheating. Fortunately, for people who enjoy judging fat people, there’s a socially acceptable way to do that: You can warn her she is putting her health at risk.

These are new drugs! They might be bad for your liver. Or your kidneys! Or your heart! You’re probably going to die, but first you’ll probably go blind. I’ve read all these warnings over and over and over by “concerned” people online. It has always been OK to shame fat people if you do it by pretending you care about their health. Weirdly, I do not see people going out of their way to warn others about the dangers of antibiotics or aspirin or beta blockers or Botox. Just weight loss drugs.

That’s why most people who are using these drugs say they’re keeping it on the down low.

“I’ve been making better food choices and working out more,” some say. I support their choice to tell a little lie to avoid being attacked and judged by awful people.

But do you know who else is quietly taking these oh-so-dangerous drugs? Doctors.

A New York Times story notes how popular the drugs are with physicians: The Physicians Really Are Healing Themselves, With Ozempic: At cardiology conferences and diabetes meetings, doctors can’t help noticing that thin seems to be very in. (That’s a gift article, by the way, so feel free to share it with your judgy colleague.)

No drug is risk-free

But neither is obesity.

I appreciate body positivity as much as anyone, but all the body positivity in the world will not protect obese people from possible complications like high blood pressure, high cholesterol, high blood sugar, Type 2 diabetes, knee and hip replacements, etc. Younger overweight people may escape these issues, but they usually creep up over the years.

I’m here to tell you frankly I have lost 50 pounds. Along the way, I have improved all my blood work. My blood pressure is excellent. By every common metric, these drugs have been great for me. My doctor is pleased.

I do not give a damn if others are not. Keep your faux concern about my health to yourself. If you’re having trouble keeping your mouth shut, I suggest you stuff a cookie in there.

About Michelle Teheux

I’m a writer in central Illinois. If you like my work, subscribe to me here or on Medium. My latest novel is The Trailer Park Rules. Tips accepted at Ko-fi.

All wealthy families are alike; each poor family is poor in its own way.
— Leo Tolstoy, if he had written about a trailer park

For residents of the Loire Mobile Home Park, surviving means understanding which rules to follow and which to break. Each has landed in the trailer park for wildly different reasons.

Jonesy is a failed journalist with one dream left. Angel is the kind of irresponsible single mother society just shakes its head about, and her daughter Maya is the kid everybody overlooks. Jimmy and Janiece Jackson wanted to be the first in their families to achieve the American dream, but all the positive attitude in the world can’t solve their predicament. Darren is a disabled man trying to enjoy his life despite a dark past. Kaitlin is a former stripper with a sugar daddy, while Shirley is an older lady who has come down in the world and lives in denial. Nancy runs the park like a tyrant but finds out when a larger corporation takes over that she’s not different from the residents.

When the new owners jack up the lot rent, the lives of everyone in the park shift dramatically and in some cases tragically.

Welcome to the Loire Mobile Home Park! Please observe all rules.