Are you gaining weight? Hoping to fill a void? Seeking pleasure? Are you going to eat it?

Look at the magazines when you are at the check out line at the supermarket this week. All the ones with the word "Woman" or "Women's" in their name. The highlighted story will be one about losing weight. But also on the cover will be a picture and story about the newest idea in making cupcakes. The magazines are having it both ways.

What is all the ambivalence about losing weight? Can you really counsel people to lose weight? People seem to be getting fatter and fatter. Have you ever told someone you think they would be healthier if they lose weight? Why haven't you? Does it seem futile to try to get your friend to think about consequences? Are you afraid you will make the person feel crappier about himself than he already does? Obviously, you do not wish to humiliate or shame your friend. Why is talking about food so difficult? What is easier, talking to a friend about not smoking, or about not eating too many calories?

Do you fantasize that overeating has no consequences?

Karen Hitchcock is a doctor who works in an obesity clinic in Australia. She writes,

Today when we look at those who are thin, part of what we see is a triumph of will over gluttony, so the beauty is a moral beauty; it has little to do with health.

So, what about the health of the fat person? Dr. Hitchcock writes,

Questions of aesthetics aside, obesity is bad because it causes disease by, for instance, raising blood pressure and cholesterol levels, stuffing your liver full of fat, blocking your throat so you can’t breathe at night, crushing your joints. Fat people are more likely to get blood clots, gallstones, gout and some cancers – as well as type 2 diabetes, which leads to all manner of medical mayhem. Fat men and women make less money, marry less often and are less educated than the lean. They are more often depressed. In the Framingham Heart Study, which has examined the causes of cardiovascular disease across generations, the very fat lived on average six to seven years less than the lean. The moderately fat lived three years less. If you quit smoking and get fat, you may as well have kept on smoking.

Governor Chris Christie of New Jersey is getting lots of publicity about his effort to lose weight. Will he lose enough to become a presidential candidate? Who would vote for him the way he looks now? He has undergone some kind of surgical procedure, but he will still have to learn to be satisfied by eating less calories.

Hitchcock continues,

Drugs can help you stay healthy when you are fat, but drugs and doctors cost money. If you are overweight, you cost 25% more per year to keep healthy than a slim person. If you are obese, you cost 45% more. And no drug can fix the functional impairment of being obese. Strap two fully loaded suitcases to the back of someone of normal weight and make them walk up stairs. That only gets them to around 120 kg, which isn’t even close to the weight of many patients I see breaking into a sweat on the walk from the waiting room to my office, their knee joints slowly disintegrating. But so what? Motorized scooters are not so expensive. They too could be covered by Medicare.

The pain of abstinence, of unmet desire, is something quite separate from the pain of an empty stomach. The pleasures of eating are complex and multifaceted. In our society, consumption is a form of entertainment and pleasure. Eating is part of this: from the theatre of a meal at a fine-dining establishment to a bag of chips augmenting the television-viewing experience. Most people do not overeat because of a feeling of hunger emanating from the stomach; they are giving in to a desire to consume – they are seeking pleasure or relief, or hoping to fill a void.

In thousands of labs across the planet, medical researchers are trying to find the cause of, and cure for, obesity. They examine genes, chemical exposures and metabolic pathways. They experiment with amphetamines, anticonvulsants, probiotics. Some of this research is funded by the companies that make and sell the food that makes us fat. In thousands of other labs across the planet, food scientists and marketers are working on ways to make you eat more. They employ highly sophisticated psychological and physiological research to this end; they examine the effects of colour, unit size, price, texture, packaging and advertising on human desire. Look around you: who is winning?

Any public-health campaign to curb obesity would need to be graphic, to make real the unpleasant consequences of pleasurable excess eating. A drug to treat overeating would need to do the same; not just make people feel full, but render them violently ill if they take an extra bite. But who would take this Kantian drug voluntarily?

Is the choice for your friend to eat this food or experience no pleasure in his life?

Do you demand that medicines shoulder the responsibility for your health?

Corporations make it easier for us to eat than to abstain. They loudly promote and supply cheap, taste-intense, non-sating food that is bad for our bodies. They know us better than medicine does. When a fast-food chain dropped its television ads for a weekend, its revenue that week fell by more than 25%. There are more shelves in some supermarkets selling highly processed, nutrient-free combinations of starch, fat, sugar and colouring than there are bearing fresh fruit, vegetables, meat and grains combined. Very few people get obese and none get morbidly obese through the consumption of home-cooked whole foods. To get that fat, for most people, takes piles of highly refined, ready-to-chow junk food and drink. Try googling “what I ate when I was fat”.

Where are we headed? Hitchcock writes,

Let’s just eat and eat, get fatter and fatter, and work out how best to live with it. This is where we are heading now: fatness, outside of morality, as an accepted consequence of the world as we have made it.

We can decide as a country, as a world, that we are going to consume what we have until we’re done, eating as much as we wish and treating all the concomitant diseases by diverting substantial amounts of government revenue into medicine and pharmaceuticals. If we do choose this path – and we are most of the way there already – we must be honest about what we are choosing to do: to spend our country’s money on the consequences of indiscriminate consumption.

If you come to me, your doctor, and you ask me to make you thin, for now I will have to cut you or drug you, as these are the only weapons I have to ward off the sirens. There will come a time when patients stop asking their doctors to make them thin. It will either be because fatness is rare again, or because it has become entirely accepted. The choice is in your hands. Are you going to eat it?