[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: http://opinion.inquirer.net/103512/obesity-self-society

[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
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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: http://opinion.inquirer.net/103012/plastic-surgery-goes-wrong

Do we have the right to modify our bodies?

by Gideon Lasco, MD

Recently, Italian neurosurgeon Dr. Sergio Canevero announced plans to conduct the first “head transplant” on a 30-year old Russian man, Valery Spiridinov, who suffers from a rare muscle wasting disease that has left him severely handicapped. In the planned procedure, Mr. Spininov’s head will be transplanted into a healthy body.

Scheduled for 2017, this plan has reignited a conversation about the limits of medical technologies. “Will it create a new human being?” pundits have asked, with bioethicists, scientists, and religious scholars weighing in on the debate. Spirinidov himself has defended his decision, saying that he is volunteering for the sake of scientific advancement.

The head transplant debate may be dismissed as hypothetical or premature, but it strongly resonates with a broader question that is salient for our time: In this age where individuals are increasingly assertive about their rights and their autonomy in questions of their own identity, do we have the right to modify our bodies? How far can we modify our body parts and bodily features?

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Before doing a survey of body modification in our time, we must recognise that humans have been altering their bodies since ancient times. Lip-stretching in Africa and Central America, skull-moulding in the Middle East and in the Philippines, and footbinding in China, are just a few examples; some - like the wearing of neck rings in Myanmar - continue to be practiced today. Our “shock” over radically-altered bodies should be balanced with the realisation that body modification is as old as humanity.

Contemporary examples of body modification, meanwhile, are at the heart of many current issues and debates. When Olympic champion Bruce Jenner revealed that she is now a woman by the name of Caitlyn Jenner, her announcement was accompanied by a completely-transformed body, made possible by hormones and surgery. Arguably, her transformation - and that of the Philippines’ BB Gandang Hari before her - was as much physical as it was social.

In June 2015, the parents of US civil rights activist Rachel Dolezal claimed that she was a white woman pretending to be black. A majority derided her for her masquerade - it had emerged that she had tanned her skin and curled her hair - but others defended her right to identify with the ethnicity of her choice. Importantly, however, her ability to claim a black identity was made possible by the ways in which she modified her body.

Of course there are more quotidian ways of body modification. Circumcision continues to be a rite of passage for boys in many parts of the world. Teens endure braces for several months or years to straighten their teeth; women and men in many Asian countries are applying all kinds of products to whiten their skin. Men struggle to attain “six-pack abs”, while women undergo regimens of diet and exercise for a slim, curvaceous figure. What emerges from these examples is the body as a source of distinction, aesthetic worth, and personal satisfaction.

Finally there are also instances of body modification for financial gain. In Iran, a person can legally sell his or her kidney for $2000-$4000, and though this is banned elsewhere in the world, the black market for organ trafficking spans many countries and millions of dollars.

The morality of these practices can be very contentious. Even when individuals consent to their kidneys being sold, for instance, critics point out that such a choice - often in circumstances of poverty - violates human dignity. Female circumcision has almost-universally been called a “mutilation” and outlawed in almost all the countries in which it occurs, but some circumcised women have defended the practice as part of their cultural heritage.

These debates are animated by arguments coming from various fields. Some religious scholars assert that the human body is imbued with a natural dignity that must not be tampered with. Medical experts focus on questions of safety and harm. Political economists look at the ways in which body modification practices privilege the rich (i.e. those who can afford to be “surgically beautiful”) while disadvantaging the poor (i.e. those who sell their kidneys). Finally there are transhumanists who assert that humans should embrace being cyborgs as the logical next step in our evolution. The multiplicity of voices speaks of the contentiousness of the body, and its centrality in many of the debates of our time.

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Perhaps the very limits of technology will set boundaries on what we can do to our bodies. If the head transplant in 2017 fails, then it will settle the debate - at least for the time being. On the other hand, we cannot discount technological successes beyond our imagination. Just as the first heart transplant in 1967 captivated the world, a head transplant fifty years later will surely provoke a similar - if not greater - response. There is simply no precedent, save for the world imagined by science fiction, on the ramifications of such futures.

How far can we modify our bodies? The answer is for different societies to decide. But it is safe to say that the frontier is going further and further, pushed by technology and enabled by a moral milieu in which individual rights are increasingly taking precedence over long-held belief systems.

Perhaps there will come a point when people will collectively agree that enough is enough. Or perhaps we will come to realisation that what is truly “natural” for us humans is the urge to modify ourselves.

Manila, Philippines
July 25, 2015