Thursday, April 27, 2017

[Second Opinion] Obesity: from self to society

by Gideon Lasco
Philippine Daily Inquirer

Some time ago, my 19-year-old cousin Roi Mammuad posted something on Facebook that touches on an important social and medical issue of our time: obesity.

Wrote Roi: “I’ve struggled with my weight all my life. I went from being a chubby kid, to an overweight teenager, to an obese young adult.”

His post was deeply personal: “During elementary and high school, I was always the ‘Big guy’ in class. Always the one who had a hard time climbing stairs, always the one who had a hard time fitting into the armchair… I’ve heard every possible insult about my weight from ‘Tabachoy’ to ‘Hindi kasya si Roi sa tricycle!’ Even if it came from my family and friends, it hurt a lot. It hurt so much that I experienced depression. I felt unloved and unwanted.”

He proceeded to describe a turning point in his life: He started jogging, exercising and dieting. He concluded thus: “To make this story short, after almost a year of working out, the hard work paid off. I started with a weight of 255 lbs and came down to 160 lbs… I hope I can be an inspiration to all of you especially those who are struggling with their weight.”

How do we respond to young people like Roi who struggle with obesity?

For one, his narrative points to social stigma as an everyday reality for many obese individuals. What we might dismiss as “mere jokes” in the classroom setting—and even beyond—cause emotional harm to young people. Some studies also suggest that obese individuals are less successful in the job market.

Further aggravating the social burden of obesity is the fact that many people perceive it to be caused by the person him/herself, through overeating and lack of exercise. Thus, the obese person attracts not sympathy but judgment.

What’s more, what prevents many obese individuals from doing physical activities is not laziness but how others treat them. Shunned, obese kids avoid sports—thus losing the chance to engage in an activity that can make them lose weight. Stressed because of bullying and negative emotions, many of them turn to food for comfort, further exacerbating their weight problem, and aggravating their feeling of being “not normal.”

But exactly what does it mean to be “normal”? Bodies that we would consider “fat” are seen as normal and even attractive in many parts of the world, from South Africa to Samoa. Our society, however, celebrates bodies that are increasingly leaner: James Reid with his “six-pack abs,” Pia Wurtzbach with her “hourglass figure.” For youths like Roi, the impetus to “improve” one’s body is not just medical but social.

At the level of individuals, it is clear that losing weight offers some form of redemption, or a mental and physical triumph. Thus, people find “before and after” stories like Roi’s and those of celebrities like Erwan Heussaff, who calls himself “The Fat Kid Inside,” inspiring.

But we also have to look more broadly at our society and ask why people are getting obese, in the first place. Most scholars agree that obesity is a “modern epidemic” ushered in by the unprecedented, unregulated, abundance of food, most of which are rich in flavor but poor in nutrition. All socioeconomic classes are thus at risk for obesity, and the poor are doubly burdened with under- and overnutrition, both of which have dire health consequences. Tellingly, the Food Nutrition Research Institute warns that 5 percent of Filipino children below five years are now overweight (from just 1 percent two decades ago), even as 20 percent are underweight.

It’s not just our food choices and circumstances. The social landscape, too, has drastically changed, especially in urban areas: Adults and children today engage in far less physical activity. While some have the resources and mindset to exercise and get their kids to play sports, the same cannot be said of many Filipinos. Alas, our cities don’t have parks where people can walk or exercise, even if they want to.

What does this tell us? When it comes to obesity, we cannot just look at individuals alone. Not when an unhealthy lifestyle is, as a Lancet editorial pointed out, “a normal response by a normal person to an abnormal environment.”

Originally published in the Philippine Daily Inquirer on April 27, 2017:

Thursday, April 20, 2017

[Second Opinion] End of the road for regular cabs?

by Gideon Lasco
Philippine Daily Inquirer

When President Duterte warned taxi drivers last year that not giving exact change to passengers amounted to estafa, he touched on one among a litany of grievances Filipinos have had about taxis. From getting turned down after flagging it down to having to fend off getting ripped off, just the thought of taking a cab can be stressful.

Of course, this is not to generalize; we are also occasionally regaled with tales of honest taxi drivers: In January, for example, Reggie Cabutotan of Baguio City returned a bag containing around P1 million to a very grateful Australian passenger. In this vein, I must commend the taxi drivers of Davao City, some of whom continue to give change down to the last peso.

Even so, many Filipinos have had negative experiences with taxis, which is why when Grab and Uber entered the market a few years ago, they had instant appeal. Simply put, these transport network companies (TNCs) took away the hailing and the haggling—that is, the hassle of getting a taxi.

What’s more, TNC drivers routinely use smartphone apps to come up with the fastest route to your exact destination, and having a nice car with good air-conditioning is a great bonus. Others also find their drivers more personable and professional—and narratives of these interactions can be found on Facebook. Finally, the more recent carpooling services (i.e., UberPool) make for more budget- and environment-friendly options.

But taxi operators weren’t amused, and formally protested their loss of income. They alleged that TNCs don’t pay taxes (a charge that the two companies vigorously denied), and blamed them for exacerbating the traffic in Metro Manila.

What taxi operators don’t realize, however, is they are losing business because of the aspects of quality transport in which they have failed, or which they have failed to offer. The thought of paying more than what one is supposed to, for instance, is generally annoying, no matter how cheap the actual and asking prices are. Competition (i.e., who provides the better services), and not the government, decides who wins.


As mobile internet access becomes more widespread, so will the popularity of Uber and Grab. For regular taxis to survive, they have to professionalize their workforce. The innovation of TNCs, after all, is not rethinking the role of the passengers, but that of the drivers, too: They generally earn more and have more control over their time—but they are also given a set of standards to follow, for which they are subject to passengers’ evaluation. Meanwhile, while taxi drivers are on the receiving end of our complaints, they are under psychological and financial pressure due to long working hours (some go for 24-hour runs) and the need to earn enough to make the “boundary.”

Regular taxis can also compete in areas where TNCs have weaknesses. For one, the waiting time is often understated: Two minutes can easily become 20—an excruciating wait if you’re running late. Because of their (over)dependence on technology, their services can go crazy when the internet connection goes awry. And there are times when they are too expensive, as when they do “surge pricing” during peak hours. If only taxis can offer a no-frills service with metered rates and good customer service, surely they will win (back) more passengers.

Ultimately, however, transport services—whether by regular taxis or TNCs—are only as good as the traffic situation, and while it’s better to be stuck in traffic in a nice car, you’re still stuck—and the predicament of how you can move from one place to another more efficiently remains. As urban planner Benjamin dela Peña has repeatedly pointed out, we have to think of transport not in terms of cars but of people; the long-term solution is not just better services or more roads, but mass transit and streets for walking and biking—all of which can complement one another.

And so while I will keep the ride-sharing apps in my smartphone, I will also hold out the hope that someday, there will be a faster, cheaper, and no less convenient alternative: public transport.

Originally published in the Philippine Daily Inquirer on April 20, 2017:

Thursday, April 13, 2017

[Second Opinion] Holy Week's pilgrimage of tourists

by Gideon Lasco
Philippine Daily Inquirer

This week is significant not just for Christianity, but also for tourism; it is the peak season of travel for many Filipinos. This shouldn’t be a surprise: Unlike Europeans who get five or six full weeks of annual vacation, most employees in our part of the world have very limited leave benefits. For many, Holy Week is a once-in-a-year opportunity to see a part of the country—or the world.

Holy Week, moreover, takes place during the dry season—the perfect time to visit beaches, climb mountains, or even just do a road trip without the risk of storms that come later in the year. For the religious, a trip to the Ilocos can have Manaoag as a side trip; a visit to Sorsogon and Mayon can include a stop for Peñafrancia.

The Lenten pilgrimage of tourists has been around for a long time, but it has swelled in recent years, spurred by cheap flights, better roads, and unprecedented access to information online.

All these developments have opened up various destinations around the country, beyond the traditional attractions like Baguio, Bohol and Boracay. In fact, some folks are aiming to reach all of our country’s 81 provinces.

And ecotourism is growing: Climbing Mount Pulag, canyoneering in Cebu, and swimming in the Enchanted River in Hinatuan have become part of many people’s ever-lengthening “bucket list”—and so has the trek in Buscalan to see Whang-Od.

Overall, I think this is a good development. Ecotourism can form part of a “green economy” that can provide alternatives to more impactful activities like mining and logging. (Donsol and Oslob are good examples: Locals have realized that they can earn more by letting the whale sharks live, instead of hunting them.) Additionally, by having many destinations to choose from, we can “spread the impact” of tourism and therefore lessen the burden on each destination, while distributing the benefits to many.

But the growth of tourism also poses numerous challenges. More and more destinations—old ones like Sagada and Boracay and new ones like the mountains of Rizal—are getting overwhelmed by the sheer number of visitors. Carrying capacity and sustainability—the “eco” before “tourism”—are often left out of the equation.

Then there’s also the question of accountability. Mount Apo’s reopening this week has raised eyebrows not just because of its timing (just a year after the devastating forest fires), but also because of the imposition of a P2,000 fee per visitor—which translates to millions of pesos every year. How will this money be spent? Tourism is good, but we should also be critical of how it is executed and regulated—and vigilant lest it harm the local communities and the environment.


Filipinos are traveling abroad, too, and Japan has emerged as a crowd favorite, especially at this time of the year—the season of cherry blossoms. Our intrepid kabayan are also hiking in the Himalayas, diving in the Indian Ocean, and going to far corners of Europe and South America. Wherever they go, I hope they can show our country in a better light.

But what of foreign visitors to the Philippines? According to Tourism Secretary Wanda Teo, reportage on the EJKs has made it difficult to “sell” the country (I think it’s the killings more than the reportage).

But while it will turn off some people, I think tourists will come as long as there’s good infrastructure and facilities—including decent airports. For better or for worse—as a recent Inquirer editorial pointed out—most tourists don’t really care about the politics of the country they’re visiting. And the places they visit rarely reflect the country’s social realities: When you are strolling along the beaches of Palawan, or hiking through the mossy forests of Bukidnon, it’s hard to imagine the Philippines other than as a blissful paradise.

In a way, this is understandable. Traveling, after all, is as much an escape as it is a pursuit. For the vacationer, politics can wait, especially when the mere thought of it has become wearisome.
Which is probably why, for many Filipinos jittery about our nation’s future, this week comes as a most welcome break—a respite before the storm.

Originally published in the Philippine Daily Inquirer:

Thursday, April 6, 2017

[Second Opinion] When plastic surgery goes wrong

by Gideon Lasco
Philippine Daily Inquirer

On March 26, Shiryl Saturnino, 29, described as a “businesswoman engaged in the selling of beauty products,” died after undergoing three surgical procedures: breast augmentation, liposuction, and buttocks enhancement. The Metro Manila clinic where the operation was done has since been ordered shut, and the case is now under investigation.

Previous “cosmetic procedures gone wrong” have gripped the public in the past. In 2008, Mary Jane Arciaga-Pereira, 29, a vacationing overseas Filipino worker, died while undergoing liposuction in Quezon City; in that same year, Louem Martinez, 34, filed a P26-million suit against the Makati clinic where he had a “penis enlargement operation,” claiming that his organ had been deformed by the procedure
More recently, the face of Ellowe Alviso, 24, was reported to have been disfigured as a result of a solution injected into his nose and chin, which turned out to be “wax, petroleum jelly and sealant.” From a local model with big dreams, Alviso had turned into a balut vendor by the time the TV crews got to him.

These cases have particular valence in a country where many are obsessed with not just beauty pageants but also the pageantry of everyday life. And the people’s reactions to them say a lot about our shared values, expectations, and ideals of health and beauty.

In Shiryl’s case, many described her as a beautiful woman who “should have been contented with what God gave her.” As for Ellowe, many lamented his naivete, wondering why he believed that a P500-procedure could be real, safe and effective.

But some have also pushed back against this “victim blaming,” calling for sympathy for people who have suffered the consequences of their actions, and whose beauty aspirations are actually shared by many. As one netizen remarked: “Aren’t we all trying to make ourselves more attractive? Ironic how those people who are bashing her as ‘discontented’ are wearing makeup in their profile pictures.”

Shiryl’s case, just as the ones that came before her, should not end as a blame game; neither she nor the health professionals should be prejudged. As Dr. Jose Joven Cruz, a longtime plastic surgeon in the Philippine General Hospital, reminded me, there are four factors that could have gone wrong: the patient, the healthcare providers, the facilities, and the procedure itself. Was the performance of three procedures warranted? A thorough investigation should consider all these before we jump to conclusions.

But beyond the case, it should lead to a broader look at how various aesthetic procedures and products go unregulated—from glutathione injections to nose jobs—and how many unlicensed individuals and clinics are able to engage in this lucrative industry. Alas, as Dr. Cruz says, we don’t even have data about how many cosmetic procedures go wrong precisely because of this lack of regulation.

Moreover, it should also lead to a consideration of why people undergo plastic surgery in the first place; we cannot dismiss it as mere vanity. The fact that Shiryl sold beauty products—and that Ellowe aspired to be a model—meant that for these individuals, a more attractive appearance can lead to economic advancement. In our service economy where “pleasing personality” is a euphemism for attractiveness, beauty can indeed be “body capital” that leads to various opportunities.

Then there’s the psychological dimension: mental health issues that surround the decision to pursue plastic surgery, and on the other hand, a seemingly legitimate pursuit of self-esteem and confidence. Or even just “normality,” as a patient once told me: “I don’t want to look beautiful. I just want to look normal.”

Finally, lest we forget, our preference for foreign—mostly Western—beauty standards deserves further unpacking.

These contexts, however, should not detract from the responsibility on the part of the providers of beauty products and services in managing clients’ expectations, informing them of all possible risks, and upholding the highest standards of safety. Regardless of their reasons, everyone deserves a chance to wake up from plastic surgery and be able to look at themselves in a mirror.

Originally published in the Philippine Daily Inquirer on April 6, 2017: