July 02, 2014

Obesity and Life Satisfaction: Surprise!

postcard at kellydessaint.com 

Guest Post By Dr. J (with Additional Contrarian Input by Crabby McSlacker)

Many of you are already acquainted with the knowledgeable and amusing Dr. J, who blogs over at Calorie Lab. He's a maxillofacial surgeon, as well as a dedicated runner and a pilot. Dr. J kindly sent me a very interesting article he wrote and let me share it here.

And in return for his generosity?  I'm gonna jump in afterwards and wrassle with him a little, offering a slightly different take.

Obnoxious? Sure! Stupid? Possibly! Because Dr. J is an actual physician plus he has a black belt in karate.

But Dr. J is also an old blog pal who knows I agree with him on about 98% of health and fitness matters and I suspect I'd have to work pretty hard to get him riled.   He's just more of a Tough Love kinda guy than I am when it comes to certain questions of lifestyle and health.

So what's the tussle about?

study of obesity and life satisfaction that Dr. J dug up suggests: in communities where obesity is common, being obese has little negative effect on life satisfaction.

Wow, right? This I did not know. 

Going by everything I've read, I thought it was kinda tough to be obese, and that a lot of things just sucked more, and that people were generally more satisfied with their lives after they'd lost weight.

So, if you're curious to see what the Doctor and the Crab think about all this...

Obesity Loves Company
By Dr. J

With the numbers of overweight and obese individuals now over 2/3 of our population and continuing to rise, rather than feeling out of place with this unhealthy condition, people are more and more seeing this as the norm. When it comes to feeling satisfied with our lives, it is apparent that obesity loves company.

A study "Obesity (Sometimes) Matters: The Importance of Context in the Relationship between Obesity and Life Satisfaction," in the Journal of Health and Social Behavior, looked at more than 1.3 million people from across the United States and evaluated their life satisfaction within the county in which they lived and then compared these findings with other counties that had differing levels of obesity.

[Crabby again: note this says "County", not "Country," something I misread at first. Just means we're talking more about prevalence at the community level rather than the national level.]

"Where obesity is more common, there is less difference among obese, severely obese, and non-obese individuals' life satisfaction, but where obesity is less common, the difference in life satisfaction between the obese (including the severely obese) and non-obese is greater," said Philip M. Pendergast, a doctoral student in sociology at the University of Colorado-Boulder and co-author of the study. "In that light, obesity in and of itself, does not appear to be the main reason obese individuals tend to be less satisfied with their lives than their non-obese peers. Instead, it appears to be society's response to or stigmatization of those that are different from what is seen as 'normal' that drives this relationship."

If the researchers did not factor in where people live, almost thirty percent of severely obese men and nearly forty-five percent of severely obese women reported that they are very satisfied with their lives. However, in counties where obesity is common this satisfaction level is increased dramatically, albeit with women less than men. Prendergast suggests that this difference in women is due to the media and advertising with the constant use of images of “ideal” thin women.

"The most interesting finding for us was that, in U.S. counties where obesity is particularly prevalent, being obese has very little negative effect on one's life satisfaction," said Pendergast. "In addition, we found that being normal weight has little benefit in counties where obesity is especially common. This illustrates the importance of looking like the people around you when it comes to satisfaction with life."

He also feels that his study adds more evidence to a primary cause of our on-going obesity epidemic.

"Our findings demonstrate that where obesity is most prevalent, the difference in life satisfaction between the obese and non-obese is smaller for women and almost non-existent for men, The same relationship is likely to exist over time and, as such, the emotional cost and advantage of obesity and non-obesity, respectively, may be decreasing as the prevalence of obesity increases. If this is the case, then some of the motivation for remaining thin is lessening over time, perhaps offering further insight into why obesity prevalence has increased so dramatically in recent years."

If obesity becomes our normal state, we best be prepared for a continuing increase in all the severe medical problems associated with it, and likely a shorter lifespan and decrease in our quality of life, because even if obesity does love company, our state of health does not care!

--Thanks so much Dr. J!

Crabby's take:

Am I just weird? This seems like good news, not bad!

So if you take away the stigma factor, you can be just as satisfied with life if you are obese, even with all the health problems that come with obesity?  

Of course there are all kinds of awesome health benefits that come from moving down from obesity into a lower weight range. I highly recommend weight loss for those who are obese and can manage it with reasonable lifestyle changes. You're going to have more energy, less pain and disease, better sleep, you'll live longer, etc. From what I understand, MAJOR benefits come from a 10% loss.

But what if you've been trying all your life to lose weight and can't? And it turns out it's only an illusion that you'll be more happy and satisfied with life if you ever actually succeeded?  I would think keeping your diet and activity as healthy as you can, but finding a supportive community rather than focusing on the scale numbers would perhaps be easier?

(Plus you'll need to retrain your brain and dump all the negative crap society's been shoveling at you to mess with your self-esteem all your life. Admittedly, easier said than done.)

OK, I realize my take may sound crazy, and this is just one study so I wouldn't base huge decisions on it. Plus, I think people lie like crazy about things like life satisfaction, and it could be obese people feel more defensive about it.  

But I thought the study was intriguing and will be very curious what you all have to say! 

Does the notion that obesity doesn't have to affect life satisfaction if it's common seem surprising? Does that seem like good or bad news?

33 comments:

  1. People tend to judge their appearances against those around them even more than against media images, which is one of the reasons that eating or exercise disorders are "infectious." If everybody around you weighs more or less what you weigh, you're going to feel normal and healthy.

    Going a bit more into demographics, being overweight is strongly correlated with poverty, for a tremendous number of reasons, and this is fairly new in human history. Our images of beauty are very much driven by images of health and our images of fashion are driven by perceptions of wealth. Demographic groups that have lived in poverty for generations often have an unconscious correlation between being overweight and having the luxury of extra food or the time to be sedentary with both health and wealth. The stereotype of the immigrant mama urging more food, "Eat, eat, you're too skinny, eat!" underlies that. Or in China, there's an explosion of childhood obesity because parents and grandparents consciously or unconsciously remember the famines under Mao or the stories of the famines, and so feed their kids as much as they can eat, because there's a kind of cultural memory of when having a few extra pounds of weight could mean the difference between life and death.

    Agree totally that it's both good and bad news. Good news that it's not causing psychological distress and sense of futility or helplessness, bad news that there's not just enough dissatisfaction to motivate folks to take up a healthier lifestyle and get a sense of accomplishment when they do.

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    1. Crabby McSlackerJuly 2, 2014 at 9:01 AM

      What a thoughtful and informative comment Ann!! Had no idea, for example, of the childhood obesity in China.

      It's an interesting philosophical question for me: if you are as satisfied with life being unhealthy as healthy, and are fully aware you may not live as long... is it wrong not to be motivated to change? I know I personally wouldn't be as satisfied with my life if I were an unhealthy weight, but... well, how do even know that??

      and thanks so much for stopping by!

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  2. It's always a treat to be here at Cranky Fitness!

    First and foremost, I totally agree that I also had a hard time not reading county as country!

    Now to get to the rest...well, actually I don't think this is going to be fight of the night because I mostly agree with the curmudgeonly crab :-) If someone really can't have their weight at a medically approved healthy weight for whatever the reason, there is no gain in a lifelong beating oneself up over it, nor should people who care about this person be doing the same. Accept your loved ones for what they are and what they can be in their life and yours.

    I do feel however, that if you look (http://www.asanet.org/journals/JHSB/Jun14JHSBFeature.pdf)
    at the medium age of the subjects being around 44-46, that with advancing age and increasing debilitating disease, the levels of sadness and dissatisfaction with one's life will dramatically increase.

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  3. Thanks so much Dr. J, and shoot, you mean we don't get to mud wrassle over the implications of the study after all? :)

    And I love hearing the "acceptance" message, even though I think we both would have a tough time doing that if it were our own health or our loved ones at risk. But you're right, beating oneself up doesn't help!

    Thanks again so much for a great post and a lot to think about!

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  4. Good grief I can pretty much tell you from firsthand experience that this is completely true. Before our recent move, we spent over 30 years in Madison County, Florida, just under the Georgia border. I discovered at one time, years ago, that Madison County is (or was at that time) the most obese county in Florida. I would say that easily 24 out of 25 women you will encounter there are huge. The grocery stores don't sell much healthy food since its use-by date comes and goes while it sits on the shelf. Good luck finding a salad on the restaurant menus as an entree--nobody orders them so they stopped making them except in small versions as side dishes, which probably get ignored. On the other hand, every (almost always fried) entree comes with biscuits and gravy. They had the most beautiful tennis courts that my husband and I used back when my knee worked a little better. For years, we were always the only ones on the courts. We quit playing, the pavement cracked and grass grew up around the net, and eventually they tore them down and now that is a grassy field. They put in a great paved bike path--men used it, but I don't recall our ever seeing another woman on it when we took our bikes there. As a result of all this, the women all, with a few exceptions (including me), were the same large round shape. They could all share clothing. There was no judgement at all between co-workers or acquaintances--how could there be? I truly believe that they all felt a sense of belonging there when it came to their size, and I seriously doubt that any of them felt any stigma about their size. The only time you could see several average-sized women together in one place was in the local Curves.

    I agree that this is both good and bad, but I think minimally more good than bad since their self-esteem is not as eroded as it might be if they lived somewhere else.

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    1. Peggy, great comment, and yeah, what a complicated issue when the community obesity is fueled by really unhealthy food choices and activity avoidance--and the impact that then has on people who WANT to make healthy choices!

      When we go on road trips cross-country we are sometimes appalled at the available choices some places, but then we can just keep driving. Those living there aren't so luck!

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  5. I have to agree with Crabby that people lie (to themselves as well as survey-ers) about life satisfaction, so I can't really take the results as very meaningful. But it does sort of make sense.

    Mary Anne in Kentucky

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    1. Crabby McSlackerJuly 2, 2014 at 1:44 PM

      Even giving the fudge factor for people lying, I still found it surprising Mary Anne!

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  6. OK, I'm obese so I have a little experience here. For whatever weird reason I don't beat myself up like I see many of my slimmer friends do. That means I am also more likely to indulge in treats. On the other hand I do get a fair amount of family pressure that can spin me into a binge. As far as happy. I don't know. I am kind of miserable in the summer as I am walking around with basically 2 fur coats on in the heat. If I was small enough to be able to do what I want to do comfortably I think my world would be pretty ideal and I would still be obese.

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    1. Crabby McSlackerJuly 2, 2014 at 1:49 PM

      THANK YOU Cindy for bringing your perspective! It does feel weird (and a little presumptuous) to be talking about life satisfaction of any population when looking from an outsider perspective.

      And thanks for your honest take! Hope you can create that ideal world where you are doing everything you want comfortabley, whatever weight that happens to be.

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  7. This is not surprising to me at all. For me, the pain points of being overweight (I never landed into the obese BMI range, but was on the high end of overweight, so maybe close enough?) had nothing to do with my health. Absolutely yes I feel better in my skin now that I am lighter and engaging in healthy habits. But what was terrible was the name calling. The mockery. The feeling of being "other." The feeling of looking different. Feeling like I had to fit in.

    If everyone I knew had been 30 pounds overweight, it probably would not have bothered me as much.

    And yeah, losing that extra weight didn't magically make me happier. I still had (have) to deal with idiots, pay the bills, go to a job that isn't always dandy. I actually ended the marriage I had gotten into when I was heavy shortly after I finished losing weight. Life went on, with all the troubles that go a long with it.

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    1. Crabby McSlackerJuly 2, 2014 at 1:52 PM

      OtF, my heart just breaks about the name calling and mockery. And yeah, makes sense that your weight loss got you healthy but didn't necessarily solve every problem your life!

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  8. Hmm...now I sort of want to do more research because this is intriguing!! But, it totally makes sense. I see it in families as well - if the mom and kids are all obese, then everyone seems happy and content.

    And, because of several things that have happened to people I know lately (none of whom were obese), I say - if they are happy and enjoying life then more power to them!!!

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    1. Crabby McSlackerJuly 2, 2014 at 1:52 PM

      More power to everyone! Thanks Kim!!

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  9. I am morbidly obese (350 pounds at 5' 8"), and have been to some degree for a good part of fifteen years; before that I was generally overweight. At times when I was of a "normal" weight, I was very unhealthy – I had starved myself and took laxatives as a teenager, for example. But I was finally skinny!

    I got up to over 370 pounds recently, and I was feeling pretty lousy physically, plus I tend to feel pretty crappy about myself when I am so big. I hate being limited to what I can do, and for me, that's what the fat was doing. I try to be very fat-posi and I think it is very important that everyone reserve any sort of judgement on anyone's appearance. It's easy to judge, isn't it? But you almost never know that person's story. (Not that it should really matter, actually.)

    Anyway. I have been focusing being a healthy person because I want to feel better. For me that means losing some weight so that I can move better, and it means not developing obesity-related conditions like diabetes and high blood pressure (though these things happen to non-obese folks, too, don't they?!?). I don't like what is happening to our food system and so my focus has been on eating as many whole, organic, less-processed foods as possible, not ingesting gross chemical stuff like artificial sweeteners, and gradually working on avoiding all those white-based foods (flour, sugar, rice, potatoes). The latter has been probably the hardest thing, and I am not beating myself up about it. We are engulfed in it!

    I have started seeing my doctor regularly again, have had bloodwork and gotten a pretty darned good bill of health. I get at least 30 minutes of exercise at least 4 days a week now, which I worked up to and enjoy. I feel more capable and stronger, even though I've only lost just under 20 pounds for now.

    I feel like I would be fine at 250 pounds, if that is all I ever lost. I have set my ultimate goal to 175, but I'm also going to play it by ear and see how things feel as I go along. It is hard to be very big when so much many people are not, and when things are set up for people who are not. Part of it for me is vanity, I'll admit it – I want to look a certain way and I want to be able to wear whatever clothes I want. Ultimately, though, what is propelling me is retaining the good health I have, and being as comfortable and mobile as I want/need to be.

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    1. And, I should say that in general, I am indeed pretty happy. Most of my life is darned good. The one thing that kind of gets me down is how I was feeling at my heaviest weight – but I also think that feeling was coming out of not treating my body like a temple. If you feel cruddy physically, it's hard to feel good mentally, especially if that is the main egg in your basket. Fortunately, that's not the case for me. I have a great professional life, I am in a long-term, loving relationship, and have a slew of awesome family and friends.

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    2. Crabby McSlackerJuly 3, 2014 at 6:34 AM

      Amy, thank you SO much for these insights! You seem to be coming from such a healthy place with all this. Love your approach and hope you continue to find greater health and strength and it's so cool that this weight and health stuff is only a small piece of a rich fulfilling life!

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  10. Wow - this is all so intricate! This mix of consideration of happiness and fitness and weight. Are they inextricably intertwined or not? Closely related? Directly correlated? I can't even imagine really coming down strongly on this one way or the other because I have found myself nodding to everyone's comments.
    I don't believe anyone knows the answer/s for sure because I also think everyone's dealing with different variables (life circumstances - including social connections, geography, family stuff, economics, access to food, exercise, etc.... the list just goes on and on and on.)
    For me - health IS directly correlated to happiness. But health, while VERY closely related to weight, is not the same. i.e. - too 'skinny' is not good, healthy or attractive or self-esteem inducing for me. Neither is too fat.
    What I have found to be true for lots of folks, though is the whole notion of turning this thing upside down: greater happiness often leads to greater health. Start with happy and go from there :)

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    1. Crabby McSlackerJuly 3, 2014 at 6:36 AM

      UltraKaz, you make such a good point about turning it upside down and looking first to happiness then to other goals like health; the mental game is so much more important than the physical actions we take in the long haul!

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  11. This doesn't surprise me, since people who live among other overweight people just don't think of themselves as overweight, they think they look like everyone else.

    The problem is going to come in when we all hit the years where the health problems crop up. My feeling is that when all of the overweight and obese people see declining health their satisfaction with life is going to take a dive.

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    1. Crabby McSlackerJuly 3, 2014 at 6:37 AM

      It will be interesting to see Messymimi! Though I suspect some of us who are not overweight are going to have to deal with some adjustments around health as well, but it's probably going to be harder for the obese.

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  12. I was obese. I didn't think of myself that way so it never bothered me. The downside was really the health aspects as I found I couldn't do the things I used to do. That irritated me more than how I looked, after all blokes tend to care less about appearance (in general) than the girls do.
    I never had any concerns about how I felt in the group. I had plenty of examples of middle-aged overweight blokes around me. I'm now with a group of younger guys who are all fairly lean. It hasn't consciously made me feel out-of-place; but it has inspired me to continue losing weight.
    People move around from place to place or even job to job. I'm sure the article is right but it will affect people to a greater or lesser extent depending on their own feeling of self worth and perhaps who their current crowd is. Just try being overweight in a surf club or as a gym manager.

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    1. Crabby McSlackerJuly 3, 2014 at 6:46 AM

      Thanks so much Greg, and wow, I think you're right on how even when you take into account who you're hanging out with, it really seems to be easier for men not to let it affect self esteem--the judgements are just not as harsh I guess and guys seem to be better able to not give so much of a crap what others might think about their appearance. But glad you are getting healthy and feeling inspired!

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  13. Wow, this is so fraught with psychological, philosophical and physiological ideals and realities...not sure I want to take this one on. But obviously, I will! I suppose a fundamental question I might ask is: define life satisfaction? Not because I do or do not think overweight or obese individuals can be happy or satisfied with their lives...I am even unsure most Americans no matter their size can be satisfied with their lives. I know many, many normal weight individuals who are fundamentally unhappy or dissatisfied with their lives. In fact, most people I know are fundamentally dissatisfied with their lives. I am talking at the core here...deep and honest. Perhaps this is a reflection on me and the company I keep!

    It all depends on the tool used to measure this, right? Isn't life full of times we are satisfied and times we aren't? Age, gender, socioeconomic status, relationship status, life status...all play a role in our perception (key word there) of our life satisfaction. Of course we will feel better if we are more similar than dissimilar to those around us in a multitude of ways, because no matter what...we all want to fit in somehow and somewhere. Everything is relative.

    Now, to the longer term question. Health ramifications. I think the argument is not very sound because the truth is, we all die. You can argue quality of life, but really...we all die and statistically, thin or not, we will die of some kind of chronic disease. Thin people get cancer, thin people have heart disease, thin people might live longer and perhaps have a better "quality" of life (again, it depends on how that is measured and how honest we all are) but being thin does not make an individual immune to chronic diseases or death. Now, you can argue this from a health care cost perspective which is how most of us approach this. Statistically, individuals who are overweight or obese will be stricken sooner in their lives with one of those chronic diseases, and it will costs more, but in the very big picture, does it matter? This is what is most interesting to me about our society. Those of us who chose or have the opportunity to eat a healthy diet and exercise (often) feel superior to those that don't or can't due to costs, choice, etc....We think we have found the answer to a long life and happiness. We have found an answer, but not the only one. Hubris....probably.

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    1. Crabby McSlackerJuly 3, 2014 at 1:37 PM

      Wow, another great thoughtful comment!

      And it's interesting Tiffany, but I found myself coming around to the same notion about the "does it matter" question--a few years ago I would have totally said "OF COURSE IT MATTERS!" but now I am not so sure. And I agree about our healthy-lifestyle hubris, even as I totally indulge in it myself every time I inwardly "tsk tsk" someone's shopping cart full of junky crap at the grocery store. :)

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    2. We all do that right? It's part of human nature. We want so badly to "fit in" but we also want feel superior to those around us. And what better way than by judging those who are overweight or obese because it is so external and easily judged and it is not accepted from a societal perspective. The media has pushed an ideal image on us that for most of us is unattainable. How someone looks has absolutely nothing to do with who they are as an individual and it is not a reflection on their personality, motivation, etc...but society makes it about that, them as a person because we want to feel better about ourselves. Now really, who is not satisfied with their lives here if we are so eager to pass judgement on those around us for their choices (and probably crappy genes too). When we judge others to make ourselves feel better, I would argue we are the dissatisfied ones and are not emotionally healthy, speaking from a holistic health outcomes perspective!

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  14. Death Ride GrandmaJuly 3, 2014 at 2:31 PM

    Darn. I had a quote in mind and and I was sure it was Jonathan Swift, but I can't find it by googling him. Anyway, what I remember reading somewhere was the suggestion that if everyone always had a toothache, we wouldn't consider a toothache a painful, unhappy thing. So the weight thing makes perfect sense. There are at least two components to our quality of life: fixed and variable. Some are pretty much built in. If we have just been stabbed & are bleeding to death, our quality of life is pretty low. But once we get beyond that actual life threatening emergency, our perception of what we have compared to what we could have is a huge factor. I think we just have to look at history a bit to confirm that. As recently as 100 years ago, the average life expectancy was far lower than it is now, so people accepted easily that they would be really old when they were 50. Speaking as a 62 year old with a major bicycle addiction, I'd say that's changed quite a bit. Or today, in societies where hunger is a problem, any solid meal brings huge satisfaction. Here - well, where's the menu with the stuff I really like on it???

    I guess the point I am struggling to make is that I don't think quality of life measurement has very many essential, unarguable factors. I think a huge part of it is governed by our expectations, which are derived from our time and our place - and our own choices of how we respond to our environments.

    Is it a good thing that people can simply be big and not worry about it? Yeah, actually, it's ok with me. People aren't really unaware of the risks - they're not stupid. For whatever reason, they accept that particular risk. Do I wish our society could make it easier for more people to be smaller/healthier? Sure. I know how much better I feel now that I am back at a lower weight. But I do not think we are doing anyone any favors by making overweight people think less of themselves or their life quality. I can't think of anything that is changed for the better by that approach.

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  15. Crabby McSlackerJuly 3, 2014 at 2:50 PM

    LOVE this DRG! You guys are articulating my thoughts so much better than I could!

    I think too that there is such power in that point you make about the fact that the things that make us happy or unhappy are not absolutes--they're comparisons. Which are just generated by our analytical brains trying to make sense of whether we've gotten whatever good things we're "supposed to" get (food, love, status, whatever), or more or less than that. But then once we realize how much our thoughts control our satisfaction, we can work to change that regardless of our size or circumstances.

    Thanks so much DRG, and I hope the Death Ride training is going well and is not too excruciating? I SO admire your determination and grit!

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  16. From my experience as someone who was morbidly obese in one of America's Fittest Cities (San Diego), I'm not sure I have ever been surrounded by others of my size and that certainly impacted my life satisfaction since I was frequently comparing myself - unfavorably - to the fit, active folks all around me. I wonder now, though, how things would have been different inside my head if I'd ever summoned up the gumption to just go out and do the active sort of things I do now when I was carrying 100 extra pounds around - would I have been just as happy/satisfied as I am now, or would the weight still have been, well, weighing on me?

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  17. This was a real thought provoking post. I have thoroughly enjoyed reading all the comments.

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