Overheard: Whose fault is obesity?

This post is part of the Overheard on CNN.com series, a regular feature that examines interesting comments and thought-provoking conversations posted by the community.

Obesity is a huge problem in the United States, and it’s linked to serious illnesses such as diabetes, stroke, heart disease and certain cancers.

A new report suggests that by 2030 nearly half of all Americans will be obese, and these expanding waistlines will translate into billions of dollars of health care costs. The study authors advocate for nationwide interventions to get children and adults to be more physically active and eat healthier.

More than 400 readers commented on the story. The most popular reader comment came from Joe Skinner, who says:

This is something I've been saying forever, the problem isn't "Romneycare" or "Obamacare," it's fat Americans who are the problem and they are more willing to blame politicians for health care cost problems than to say the 300-pound reading on the scale might have something to do with it.

Bruce Force responded that weight loss alone won’t solve the problem:

I agree that we are responsible for our own health but I think this obsession with losing weight is the wrong way to go about it. When we talk about fitness, we never talk about skills and that's unfortunate because that what being fit is about: developing skills in order to survive.

Chichetr proposed the radical measure of taxing overweight people per pound, a comment that got 59 “likes” :

I'm sick and tired of seeing my fellow Americans waddling around from fast food restaurant to fast food restaurant, their giant bellies swaying and bulging out under their shirts. It's absolutely shameful.

I propose that we start charging health care costs by the pound. How many of these people do you think are going to keel over from 1, 2 or 3 heart attacks, strokes, cardiovascular disorders of every kind? The list goes on and on. How many of these people can actually PAY for the tremendous health care costs associated with their weight? Not many.
I as a taxpayer, I refuse to pay for these people. Tax the overweight and obese NOW!

But pgauthi responded with a more pragmatic approach:

Those of us living in the real world realize we can't just let people "take responsibility," because we have decided that everyone has the right to emergency treatment. So as much as it pains me to pay for the lazy obese I would rather pay for their preventive care than for their emergencies.
I would love it though if medicare tax and/or health premiums were based on BMI and cardiovascular fitness.

Delishus Cake represented the point of view that the high cost of healthy foods compared to fattening foods is part of the problem:

If fresh fruit was affordable year round and a salad didn't cost the same as 4 double cheeseburgers people might not be so fat. Low income people typically choose whichever option looks to be the most bang for your buck. If you've got $4 and you want to eat are you going to buy a salad or 2 double cheeseburgers, a large coke, and a fry?

But halfthestory argues the opposite viewpoint:

So tired of hearing the "it costs too much to eat healthy" argument. Plan your budget and buy healthier foods ... fast food is not much cheaper and is much less healthier. It's a lifestyle change and not a financial issue in most cases. It's just easier to justify when you say "it costs too much".

Chemical BPA linked to children's obesity

Finally, the usage of body mass index as a measure of obesity is imperfect, as readers such as CatMagnet noted. Height and weight are the factors that go into calculating BMI, but for some people that is not an accurate assessment of whether they are healthy.

On Twitter, science writer @miriamgordon responded to the story by citing this New York Times article from Tuesday, which notes that obesity as we know it may not be the whole story: “In study after study, overweight and moderately obese patients with certain chronic diseases often live longer and fare better than normal-weight patients with the same ailments.”

Part of the problem is that if you measure obesity with body mass index, you are ignoring other potentially critical measurements of health, including metabolic abnormalities, lean muscle mass and body fat, the article said.

Another science writer, @daviddespain, responded with an article he had written on his blog suggesting that young Asian-American women may be improperly categorized as healthy using the traditional BMI scale; they may have low BMI but high body fat percentage.

The state-by-state obesity data from the Centers for Disease Control and Prevention do not take these deviations from the traditional BMI picture into account, nor do the 2030 predictions.

Man refuses surgery, drops 270 pounds

Bryan Ganey slowly climbed out of his parents' car. Michael and Martha Ganey had driven their son to work because he wasn't feeling well -- for the past couple of days, simple tasks had left him short of breath and exhausted.

At 577 pounds, being out of shape was normal for Bryan, so he ignored it. But as he headed toward the door of his office on June 20, 2010, the ground suddenly shifted.

The Ganeys were pulling away when Martha's cell phone rang. All she heard on the other end was gasping.

The couple stopped the car and sprinted back to the building, where they found their son lying in the bushes, struggling to breathe. The ride to the hospital took only five minutes, but to Martha, it seemed like hours. Bryan didn't care how long it took -- he knew he was going to die.

"I was absolutely convinced that I was having a heart attack. I had been told by doctors before that at my size, if I ever had heart problems, they weren't going to be able to operate on me. So there was a very good chance that this was the end -- that I would get there and there wouldn't be anything they could do," he said.

Out of control

For years, Bryan worked the night shift at a Verizon call center in Charleston, South Carolina, 20 miles from his home in Moncks Corner.

He skipped breakfast, ate fast food for lunch and dinner, then picked up a pizza or some convenience store snacks on his way home. He often drank more than a gallon of soda a day. By the age of 37, he had a body mass index around 87. A BMI over 30 is considered obese.

"He was very aware that he had a problem," Martha said. "It was out of control."

June 20 was possibly the best thing that could have happened to Bryan, although it certainly didn't seem like it at the time. His "heart attack" was actually a pulmonary embolism, or a blood clot that had traveled to his lungs, blocking his oxygen flow. According to the Centers for Disease Control and Prevention, "sudden death is the first symptom" in about a quarter of patients who have a pulmonary embolism.

For six days, Bryan lay in a hospital bed, covered in bruises caused by the blood thinners being pumped into his body. The blood thinners slowly cleared the blockage in his lungs, giving him plenty of time to think.

"At first, I felt like a victim, like somebody or something had done this to me," Bryan said in a YouTube video about his experience. "But then reality set in and the pain turned to anger. My condition was unacceptable."

Several doctors tried to broach the subject of weight-loss surgery while he was in the hospital, but Bryan refused. Both he and his mother had friends who had gone through the surgery and were suffering from complications.

If I can make it out of here alive, he thought, I'm not coming back.

Small steps

Today, Bryan, 39, tells his story from the driver's seat of a car that he wouldn't have fit in two years ago . He shops for clothes at department stores, buys one seat on an airplane instead of two and sleeps through the night.

"The absolute best thing about all the weight that I've lost is just waking up every day and realizing that I don't weigh 577 pounds anymore," he said with a laugh. "The biggest rewards are the smallest ones."

Small steps are what began Bryan's weight loss journey. After leaving the hospital, he began to move -- at first pushing a shopping cart around the grocery store like a toddler learning to walk. Then he ventured to the mailbox at the end of his driveway. Soon, he was conquering several miles at a time.

He lost 130 pounds in the first six months, then dropped another 140 pounds over the course of the next year. At 5-foot-8, Bryan now weighs just under 300 pounds.

"It turns out it really is true," Bryan wrote in his iReport submission. "If you use more energy than you take in, you will lose weight."

Bryan switched to a day shift at work to conquer his bad eating habits. He's very particular about what he puts in his mouth, refusing to stray from self-prepared lean meats, vegetables and fruits. He eats five to six meals a day, every two to three hours. He measures his portions so that his total calorie count for the day hits 2,500.

"Food is everywhere," he said, reflecting on his struggles to keep on track at work or in social settings. "I just can't eat it anymore. I can't do it ever again. I don't have the ability to have just a little bit. They think I must be miserable because I ... don't allow myself to have certain things. [But] the benefits I have gained, the prize is worth the struggle."

After dropping his first 70 pounds, Bryan decided to hire a personal trainer. This wasn't the first time he had tried to lose weight by exercising, and in the past he had burned himself out pushing too hard, too fast. His trainer, Martha Peake, started slowly. At first, all they did was sit down and stand up. For the 500-pound Bryan, that was enough.

Last year, Bryan limped across the finish line of the 10K race he entered. This year, he plans to run the whole race. He's still losing six to seven pounds a month and hopes to eventually get down to 200 pounds.

Simple prayers

Every morning, Martha wakes up and asks God to give Bryan one more day. She understands the obstacles placed before her son -- most addicts can give up their abusive substance, but he can't just give up food.

"I guess there's always that little shadow of a doubt," Martha said. "But I know also that he's a very strong person ... if it can be done, he can do it."

When Bryan returned to the doctor, the change in his blood work was almost unbelievable. He's off many of the medications he was on before; his blood pressure medication has been cut four times over the last two years. His LDL cholesterol, the bad kind, is 100 -- an optimal number.

Most importantly, at 577 pounds, Bryan was prediabetic. Now, he's looking forward to a bright, diabetes-free future.

"I think what gets lost in the advertisements and everything that's written about weight loss is that if people would keep it simple, that everyone has that power in them. You can change your life."