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Ms. Fat-so

Heidi McDonald, who by new federal standards is obese, asks: What's the big deal?

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I wake up and try to avoid mirrors. But when I pass one on my way to the closet, she's there in my peripheral vision: a 5'6" 200-pound woman, a woman considered obese by federal standards. My closet contains outfits in six sizes -- over the last 20 years, I have worn every women's size from 12 to 26, and my body frequently fluctuates between them, changing as much as 15 pounds in a single month. Sighing, I rummage through my closet for something to wear, because I don't know which of my four typical sizes I am today. (The decision is complicated by the fact that I've removed the tags from my clothing, to spare myself from seeing the numbers on them.)

While getting dressed, I focus on clothes instead of the puckered, silvery stretch marks that appeared with my children. I hold up my clothes to briefly marvel at how large they are. I often have to try on my outfits two or three times before something fits correctly. I don't want to relinquish the smaller clothes just yet, because then I'd be resigning myself to eternal largeness; I don't want to get rid of the large clothes or even the middle-sized outfits, because I need them and shopping for clothes is usually torturous. I stand in front of my closet thinking these thoughts for the millionth time. This is how every day begins.

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In determining that obesity is a serious national problem, the federal government lowered its guidelines for obesity last year, so that more people are classified as obese. The federal Centers for Disease Control and Prevention use a height-to-weight ratio to categorize people as overweight, obese, or morbidly obese. But the Surgeon General lowered the thresholds in 2002, so while I wasn't obese in 2001, this year I am -- even though my weight hasn't deviated more than 15 pounds. While eating disorders, a more sedentary lifestyle and bad nutrition are important factors in many cases, scientists have isolated 250 genetic causes of obesity, a figure cited by the University of Pennsylvania Medical School's Weight and Eating Disorders Program. The CDC estimates that 50 percent of Americans are overweight, with 27 percent of that figure (roughly 14 percent of the total population) being obese. More recently, the Harvard School of Medicine released numbers showing that as many as 60 percent of Americans are overweight and 30 percent are obese -- data that suggest being overweight is becoming the rule rather than the exception. Pennsylvania is our nation's third fattest state (tied with North Dakota and Kentucky), with 59 percent of residents qualifying as at least overweight if not obese, according to the Kaiser Family Foundation.

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For my 14th birthday, my mother bought me a book called Flatten Your Stomach. When I was 16 and already wearing a size 36D bra, I was mocked and repeatedly told by boys at Swissvale High School that I had "a great personality" but was only "liked as a friend." Out of nowhere, a well-meaning high school English teacher gave me a girdle one day after class; she suggested it could help me. At 18, when complaining of stomach cramps, I went to a Wilkinsburg gastroenetrologist who took one look at me and curtly explained that once I lost weight, my pains would go away. (One week later, in the emergency room, I was diagnosed with mononucleosis.) While top-heavy since the age of 11, I never wore a size larger than 14 in high school. I now see photos of myself as a teenager, and don't necessarily look at that girl and think, "Wow, she's a big girl," but apparently that's what others saw. I remember how I suffered and wonder why.

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It seems that people like me are so big, we're invisible. Wal-Mart's employee benefits booklet (1999) lists the following charges as "not payable for treatment or services": medications and diet supplements related to diet programs; appetite and weight control; and treatment of obesity or morbid obesity, including gastric bypasses and stapling procedures -- even if the participant has other health conditions which might be helped by the reduction of weight. The American Obesity Association (AOA) estimates on its Web site, "Sweetie," I answer, "you never have to apologize for saying you love me. I love you just the way you are, too."

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