Last week two reports crossed my desk. The first was a survey from the Grocery Manufacturers Association. It reported that 89% of Americans believe that individuals are to blame for being overweight. Only 5% thought that obesity was due to the environment or genetics.

The second report was that three homeless persons died in Washington last week during a cold spell in an otherwise unusually warm winter. The Mayor of Washington, D.C., Anthony Williams, was all over the news lamenting about the tragedy of the deaths of these homeless persons who escaped the District of Columbia's safety net.

It does not take long in talking with politicians or health care policy persons to hear the refrain, "It's their fault." It is not surprising that 89% of the population, including, it must be assumed, many individuals who are overweight or obese, think their weight, is their own fault. But it is simplistic to leave the discussion there. Important questions remain:

• Is obesity among children their "fault"?
• Is our health care system based on "fault" in other areas?
• Does a fault-based approach help or hurt efforts to solve the problem?

The scientists tell us that obesity is due to three primary factors (excluding specific diseases that cause obesity). They are (a) genetics (a predisposition to overweight), (b) environmental exposure to an energy-rich food supply and a tendency to reduction in physical activity and (c) personal behavior.

But most of the world, it seems, sees only personal behavior.

Compare this to skin cancer or melanoma. For skin cancer (like obesity) three factors must be present. First, your genes give you fair skin. Second, you must have an environmental exposure to sunlight. Third, you must not take personal protective strategies, such as sunblockers, clothing, etc.

Now, if a person gets skin cancer no one says, "Don't treat them. They did it to themselves." No one says, "Melanoma is not a disease. They did it to themselves."

How many of us have had a parent or grandparent mistake the gas pedal for the break pedal. Their car races across a few lanes in a mall and hits a light pole. They may have a broken wrist, maybe a head injury. People flock over to help. No one says, "Don't call 911. They did it to themselves."

How about sexually transmitted diseases, including HIV/AiIDs? Does anyone say, "Let's not research this disease and let's not have prevention programs and let's not have insurance pay for treatment. They did it to themselves?" (Actually some people did say this about persons with HIV/AIDs but they lost the public debate.)

How about lung cancer and emphysema? Does anyone say,
"Don't pay for lung cancer treatment. They did it to themselves." Of course not.

How about liver disease? Anyone say, "You drank too much. You did it to yourself. Insurance won't pay."

The fact is that many, many health care conditions are mediated by personal behavior. One third of all cancers are attributed to diet and lack of exercise. Does anyone say cancer is not a disease?

Our society responds by taking personal behavior into account and dealing with it through education. Except for obesity. For obesity it - personal behavior - is the end of the discussion. More money for research? Forgetaboutit. Insurance coverage for treatment? Inyourdreams! Prevention? Getoffyourbutt!

Surgeon General David Satcher said it well in his Call to Action, "Many people believe that dealing with overweight and obesity is a personal responsibility. To some degree they are right, but it is also a community responsibility. When there are no safe, accessible places for children to play or adults to walk, jog, or ride a bike, that is a community responsibility. When school lunchrooms or office cafeterias do not provide health and appealing food choices, that is a community responsibility."

For homeless persons who choose not to come to publicly supported shelter, for smokers who get lung cancer, for the sexually promiscuous who do not use protection, for sun worshippers who don't put on sunscreen, for all these persons our society in general and many of us personally we have compassion for these individuals in spite of the contribution personal behavior played in their disease. At least we acknowledge that there is a difference between their behavior and their disease. Except in obesity. Obesity is different. The moral judgement of laziness, lack of self-control, weakness even extend to denying obesity is a disease. Thus, obesity is not so different from other diseases which are modifiable by personal behavior. But our reaction to it is. Its principal feature may be that we suspend the compassion we normally feel. It is above all marked by this - the Suspension of Compassion.

Morgan Downey
AOA Executive Director