Seven years later, the
overweight women were less educated (0.3 fewer years of school), less likely
to be married (10%), had lower household incomes ($6,710 less), and had 10%
higher rates of household poverty than women who had not been overweight,
independent of baseline socioeconomic status and aptitude test scores. Interestingly, the investigators found no evidence of an effect of
overweight on self- esteem. Similar trends (although weaker) were found
among the men. It has been said that obesity is due to low socioeconomic
status, yet the results of this study indicate that the inverse is also
true: low socioeconomic status is influenced by obesity.

It has been said that obesity causes chronic health problems that influence
job status, yet subjects with chronic health problems who were not obese did
not suffer from the same low attainments. The final hypothesis -- that
obesity is a stigma that results in discrimination -- is a likely
explanation for the social disability. It is the public nature of obesity
that invites discrimination. The US Equal Opportunity Commission, responding
to complaints of widespread discrimination against obese persons, has now
declared obesity a protected category under the federal Americans With
Disabilities Act. (Gortmaker SL et al. N Engl J Med. 1993: 329: 1008-1012.)

In a recent letter in JAMA, Robert Yaes wrote, "Certainly, at a time when it
is fashionable to claim that alcoholism and drug abuse are illnesses whose
treatment should be covered by health insurance, it is inconsistent to blame
fat people for their own condition." While it's possible to lose weight by
decreasing food intake and increasing exercise, "consciously overriding
one's homeostatic control mechanisms requires constant attention and
vigilance, which takes time and energy away from other duties. As soon as
that vigilance is relaxed, the natural control mechanism will once again
take over." Yaes, a physician who is himself obese, concluded, "In our
culture, obesity is perceived as more of a cosmetic problem than a medical
problem. The majority of patients who enter weight-control programs do so
because of concerns about their physical attractiveness, notÉtheir health. This perception could partially explain why so few physicians and so many
charlatans are involved in the treatment of obesity." (Yaes RJ. JAMA. 1993;
270: 1423.)

Combination Drug Therapy for Obesity
Obesity is a chronic disease that requires lifelong management. Drug
treatment can play an important role in any management strategy, and
combination therapy with two anorectic drugs may be the best approach. Combining two anorectics permits reducing the dose of both agents, which
reduces adverse effects.