1 out of 2

Is all obesity the same? No, but it’s treated in this policy as if it’s all about “stop shoving Big Macs in your mouth.”

And beyond that, who will be the final arbiter of what actually constitutes ‘obesity’ in each and every individual? The same person charged with making a final determination as to which side of the ‘sex’ line Caster Semenya gets tossed?
As for the smoking, however, I think that’s an easy one.

Tobacco users get placed in a more expensive insurance plan starting in July and, for those who qualify as obese, in July 2011.

I’d go further and say no insurance coverage for any treatment that in any way relates to anything that might be related to having smoked.
Or…
Make the death industry tobacco companies pay for all such medical care.

Marlboros and Big Macs Smoking is a very serious habit with grave health implications.
The list of lung diseases that are caused from smoking are too many to list here.
But smoking is deleterious to more than just the lungs. The heart is also impacted by smoking.
I am lucky — I don’t smoke, never have smoked and had no interest in smoking. But I know a number of people who are former smokers and they said “kicking the habit” was the single hardest thing they’ve ever accomplished. But it can be done.
Better 10lbs. overweight than dead from lung cancer.

Cheaper to be fatDon’t know if anyone mentioned this, Pam, but it is also far cheaper to eat unhealthy foods, thereby resulting in likely weight gain. Eleanor Holmes Norton, along with a couple of other DC leaders, did an experiment where they tried to live on the equivalent of food stamps for one month. Norton was able to, but only by not purchasing any fresh fruits or vegetables – they were just too expensive. When people have financial problems, unhealthy foods simply provide a better cost/calorie ratio. I am assuming state employees are not on food stamps, but I am also sure that many of them don’t have high incomes.
What about people who travel? I am on the road about 50% of the time, and I can tell you it is nearly impossible to eat healthy while traveling – the need simply to buy all prepared food adds salt and calories that cooking at home would not. And don’t even get me started on the crap food available at airports or the size of most restaurant portions.
Our entire culture needs to change to really fight the obesity problem.  

One issue I don’t see addressed…is that healthy foods cost more than their junky counterparts.  Other health issues can make it harder to lose weight, granted.  However, even if you reduce this complex issue to “eat right and exercise”, A single parent or other person on a tight budget (especially in this economy) has to stretch every food dollar (s)he can spend.  A loaf of plain old store brand white bread (which is about as nutritionally effective as eating styrofoam) is approx $0.75 at Wally-World.  A comparable loaf of whole wheat bread is approx $1.85, more than twice the price.  Programs like WIC and foodstamps help but not much, as there’s only so much to go around.
My partner is diabetic and is dealing with cholesterol issues, and I have similar issues that I am at risk for because of my family history.  When I go to the store, I can easily spend $100/week for 2 people, and that’s buying items like skim milk, fresh veggies (not organic necessarily, which is simply a budget decison in our case) lean meat, low-fat this, non-fat that, sugar free whatnot, etc. If I were to buy the cheapest foods I would be eating a lot of processed starches, and be nutritionally deficient besides.  It’s all fine and dandy to reform healthcare, but when it comes to nutrition: garbage in, garbage out.  If they are going to mandate healthy eating as part of the way to prevent various health issues, then they should provide a way for lower income people to do so.
Perhaps obese people did make poor life choices, but when all you have is Hobson’s choice… What are you going to do?

I’m the thin one from a family of tanksyou can not tell me obesity is not genetic. I eat more than many in my family and they still gain and keep weight well out of proportion to most of the species.
This is right up there with the con’s telling me if I only put on a dress and grow my hair out I could fit in. It’s a choice. Tripe.
Oh btw what are they going to say is a causative for lung cancer when tobacco is banned? Will you address the internal combustion issue then? It is so obvious. who.gov has lung cancer stats for most countries. Last time I looked, admittedly eons ago, there is a clear demarcation of lung cancer rates stratified by industrial development. I originally looked it up to evaluate the damage from cooking over fire. It was enlightening.

10/01/09 $1,681.65 ANTHEM ANTHEM That’s my MONTHLY premium!  In the 90′s I won a lot of gay “beauty” pageants (i.e. Mr. Leather Michigan, Mr Drummer Toledo, Detroit’s Best Daddy, etc.).  Around 1998 one of my doctors put me on medication with one side effect of massive weight gain.  Well, I sure gained the weight and the increased health insurance costs.  My only alternative is stopping the medication, which I’m doing now.  Why is it that people feel they have to constantly offer weight loss advice when they have no idea for the excessive weight (my mother is the worst)?
Now about smoking – it’s bad.  After losing all my friends to A.I.D.S., I smoked like a chimney and drank like a fish.  In 1989 I gave up smoking and LOST over 100 lbs.  Stopping smoking was the hardest thing I ever did, but one of my proudest achievements.  

BMII just wanted to add another problem with the BMI as an indicator.  After years of problems with my weight and multiple diets, etc, I finally got a gastric bypass.  In order for me to not regain the weight, besides being very careful about my diet, I have taken to going to the gym 6 days a week for aerobics and core exercizes and three days a week for weight training.  (I am fortunate that I am retired and can spend that amount of time in the gym – I couldn’t when I was working.  And, of course, I am fortunate in that I can afford a gym.)  Despite a waist size that is well below the 40″ that doctors warn indicates potential problems, I still have a BMI that puts me in the obese category because of the amount of muscle that I have developed.  The BMI is not really a good indicator of health or of potential illness.  There are better and more accurate ways but they cost more.  I would hope that this would be fought and defeated.

Um, noMy father quit smoking at least 35 years before he developed the lung cancer that killed him.  I don’t think my mother should have been bankrupted to pay for his care.

Uh….

Detroit’s Best Daddy

Damn, where have you been in this native Detroiter’s life? lol.
I know, I know, you’re spoken for but still…

I was surprised at Matt’s vehemenceuntil he started talking about his mother and her health issues.  It sounds like he’s basing his opinion on his personal experience (“I know one fat person who ate all the time and never exercised, so all fat people must be the same”) instead of reality.  It’s been my personal experience that people who are so adamant about blaming usually do it out of fear.  If Matt can figure out how (insert problem here) is that other person’s fault, he can make sure it never happens to him.  At least in his mind.  That eases his anxiety.
If NC can produce reliable evidence that simply being “obese” (and wow do these pictures make one wonder about how BMI is used as the standard for “obesity”) causes health problems, then there may be a case for increased rates.  But the decreasing standard reminds me a little too much of No Child Left Behind, where schools nearing 100% on the standards still have to improve every year or face sanctions.  Hasn’t BMI pretty much been discredited as an individual measure of healthy weight?

When I had my gastric bypass… Well.
As many know, my VA recognized disabilities include mental and emotional health issues. I have a bipolar type II condition and a propensity for depression that is controlled by managing my stress to extremely low levels, talk therapy — and by taking psychotrophic drugs.
As Pam indicated, many psychotrophic drugs have the secondary effect of causing weight gain.
The weight gain caused by the psychotrophic drugs were the impetus behind a significant weight gain that caused me to have high blood pressure and high cholesterol. The pills for treating those conditions also had the secondary effect of causing weight gain.
Then I became pre-diabetic. The pill for that…well, if you guessed the secondary effect for that pill also was to cause weight gain, you’d be accurate.
That’s the mechanism for how, in four years, I gained about 100 pounds. One to four pounds gained every month over four years adds up.
I had a gastric bypass. It was a health issue for me — the health effects for the weight gain were literally killing me. Having that surgery probably added ten-years to my life.
I should state right here than I ate a healthy diet of mostly whole, mostly unprocessed foods. My portion control was poor due to my increased appetite — my increased appetite due to the pills I took for my multiple health conditions.
In my mind, instead of taxing the obese, the better tact would be to tax those processed, fatty and sugary snack foods and drinks that just aren’t healthful — just as how we tax cigarettes. If the government is going to get involved, then the government should be attacking those processed sugary and fatty foods that are a major contributor to how those who don’t have underlying health conditions get overweight.
For example, I just posted in yesterday’s This & That post about the Krispy Kreme donut burger — Fifteen-hundred calories per sandwich. In my diet, that one fifteen-hundred calorie sandwich would comprise about 3/4′s of the calories I’m supposed intake in a day. This heavily processed sandwich is a sugar, carbohydrate, and fat bomb, and its healthy nutrient value is far outweighed by its unhealthy sugar, carbohydrate, and fat levels.
Why government isn’t heavily taxing foods like this — if only to discourage the eating these extremely unhealthful, processed foods that corporate interests are serving us — is just beyond me. Better to attack the unhealthful, heavily processed foods that are being proffered by corporate interests than taxing overweight people. Let’s attack a source of the problem, and not attack those of us who have health issues for which whose treatment secondarily causes morbid obesity.

So, will the state be paying forlap bands, bariatric surgery, and liposuction now?

here is the policy documentHere is the documentation of the plan from its web site:
http://www.shpnc.org/pdf/membe…

Ya, Um noWhen successful lawsuits started to get filed against the tobacco companies, they settled for BILLIONS with individual states.  The reasoning behind the deals were that the states would then take care of people suffering from ailments resulting from tobacco use.
However, the states took this money and used it to cover their budget deficits.  On top of that, they added mega taxes to tobacco sales.  I don’t smoke anymore, but I cringe when I think of how smokers are getting screwed.  It is even worse;  people who buy tobacco products are overly represented in the lower economic groups.  This is an excellent example of the poor being unfairly taxed.

BMI is junk sciencce.The focus on BMI among the medical community, is typical of the medical community’s complete and utter inability to view diet, nutrition, exercise, in a scientific manner.
The fundamental problem with BMI is that it does not distinguish between what the bodyweight is composed of, whether muscle, fat, or bone.
Anyone who is reasonably serious about a physical activity, especially high intensity sports or high intensity physical activities such as dance, that result in muscular development would register as overweight or even obese using BMI.
I am a serious weightlifter. Have been so for many years, have competed in weightlifting and the other various iron sports, bodyfat in the single digits. According to BMI, I am overweight.
Pretty much all the professional and competitive athletes in the world, except in the endurance sports, are overweight or obese according to BMI.
In reference to bodyfat, it actually is very inexpensive to measure bodyfat, using hand held calipers to do skin fold measurements. Calipers are very low tech, they are also actually the most accurate method. All the other high tech measures of bodyfat are problematic.

Pam,the only way to lose weight is to cause a calorie deficit, whether you do so via burning more calories via exercise, a calorie reduced diet, a combination of burning more calories via exercise and a calorie reduced diet, or other more esoteric measures such as a gastric bypass, use of various legal or illegal chemical substances such as diet pills (which typically don’t work, and are based on junk science), anabolic steroids (illegal), ephedrine, clenbuterol (illegal).
To lose weight a calorie deficit is necessary. To gain weight, a calorie surplus is necessary. That is an unpleasant truth that really cannot be gotten around.
If you keep your calories the same, but do more physical activity, you are putting yourself into a state of calorie deficit. If you keep your physical activity levels the same, but go on a calorie reduced diet, you are also putting yourself into a state of calorie deficit.
If you use a diet pill, one that works, such as ephedrine, to increase your metabolism, you are also causing a calorie deficit.
If you get a gastric bypass that prevents the absorption of some calories, you are also causing a calorie deficit.
To say that calorie reduced diets don’t work isn’t true. They work. They are less effective than increasing physical activity, or a combination of increasing physical activity and dieting, for various reasons, among them that increasing physical activity will help to prevent muscle loss when you go into calorie deficit.

Why isn’t government taxing “unhealthy” foods?Because it won’t work.
What is a “healthy” food is relative to the person eating the food.
Different people, depending on their activity levels have different caloric needs. Someone who works in an office all day, sitting in front of a computer has vastly different needs from someone who works as a construction worker. Someone who is (very) physically active, very into sports, dance, is goign to have vastly different caloric needs than someone who isn’t.
Not to mention that even for people with the same caloric needs, the same food can be unhealthy, or not.
If someone chooses to eat nothing the whole day, and then treats her / himself with one of those Krispy Kreme donuts, that won’t be a problem, caloric wise. OTOH, if someone chooses to eat their usual diet, and then top that off with a couple of those Krispy Kreme donuts, that is likely to be a problem.
I agree that the source of the problem needs to be addressed. I disagree that the source of the problem is “unhealthy” foods, and that the solution is to simply to slap taxes on those “unhealthy” foods.
The fundamental problem isn’t “unhealthy” foods. The fundamental problem in obesity is total number of calories a person eats, and the total number of calories a person expends. If you put more calories into your body than you expend, you WILL gain weight. Whether that weight gain is more muscle, or fat, depends on your physical activity levels. If you put less calories into your body than you expend, you will LOSE weight. Whether that weight loss is more muscle, or fat, depends on your physical activity levels. There is no way around this.
If you need 3000 calories a day, and you are eating 4000 calories a day, it doesn’t matter if those 4000 calories come entirely from Krispy Kremes, or entirely from oatmeal, or whatever healthy food you prefer, or whatever food that is perceived to be healthy, you WILL gain weight.
I do favour requiring that all foods be labeled.
People need to be educated about how to balance diet, exercise, and pleasure from food.  

Far far better measures of healthare bodyfat percentage, HDL and LDL levels, blood triglyceride levels, blood sugar levels.

rfloh, you may be rightthat someone who eats nothing all day except for one Krispy Kreme donut will be less likely to gain weight than someone who adds a couple of Krispy Kremes to their regular food intake — if this is routine behavior for both.  But the first person in your scenario will not be healthier; in fact, s/he will be malnourished.
It’s still problematic when we try to define the foods that would be taxed under Autumn’s scenario — we get Catch-22 if we say that, for instance, Kraft macaroni & cheese or hot dogs or chips should be taxed when they’re cheap, filling, and all some families can afford.  We’re just placing a greater burden on the poor unless we also find ways to make healthy food more affordable and accessible to everyone.

I didn’t say calorie reduced diets didn’t work in any wayI stated specifically that they do allow one to lose weight. The problem is maintaining the weight loss, and that’s where the whole setpoint theory comes from. To decrease your weight’s setpoint, that’s where the exercise comes in.
But gaining it back, which happens in most cases, proves that diet alone is not the answer.  

See what I mean……about all the weight loss advice.  Well meaning, but we’ve probably already tried that.

I am not saying that a person only eating one Krispy Kreme burger a dayand nothing else as a routine will be perfectly fine. Obviously Krispy Kremes don’t have many necessary nutrients. I am saying that it won’t be a problem caloric wise, in terms of weight gain. Conversely, the person who is eating a few Krispy Kreme burgers a day ontop of their regular diet might have a problem caloric wise, in terms of weight control, but is likely to be fine, in terms of nutrients, unless the other elements of the diet is stuff such as candy bars, soda, etc.
Defining precisely what foods to be taxed, say Krispy Kremes, is just as problematic as just taxing generally possibly unhealthy foods, say any food high in sugar / high fructose corn syrup.
If you tax Krispy Kremes specifically to get people to stop eating Krispy Kremes, what do you do when they switch to muffins? Or candy bars?
And the problem as to what is unhealthy for whom still arises.
Yeah, poverty is the big problem that people who propose taxes on food often don’t address. Most cheap foods are calorie dense and easy to prepare / consume, but generally, nutrient poor, and also don’t really taste good, compared to real food. They might certainly be unhealthy, but if those foods are what poor people can only afford, it is grossly unfair to tax those foods, just because you think that the lives of those people would be improved if they don’t eat those foods.
Furthermore food is not viewed in any way, in any culture, as similar to cigarettes. For very very many people, food is a source of pleasure and happiness. Any attempt to prevent people from deriving pleasure from food via taxes, is going to be a disastrous failure.
Comparing the taxation of food to the taxation of cigarettes  is an incorrect comparison because food isn’t in any way similar to cigarettes.
Any politician looking to tax food because it might be unhealthy, is IMO, looking at well-deserved career suicide.

My point is that they do work, even with the problem of possibly gaining it back.
They just don’t work as well as exercise, or better yet, a combination of sane dieting combined with a sane exercise regime.
One big reason many calorie reduction diets result in a horrendous rebound is that those diets require insane reductions in calories on the part of the dieter, they cause too severe a state of calorie deficit.  

but they don’t work given the dataMore people gain it back or gain plus more. If keeping it off was that easy we’d all be thin. I think part of the problem is too many doctors, even knowing this, still pressure people to do arduous dieting for some reason.
And clearly no real diet/exercise solution works long-term for most. Look at Oprah, all the money in the world, personal trainers and chefs and access to any and all exercise equipment and time, still can’t keep it off.
If she can’t do it, someone living in the projects working two jobs with kids certainly can’t.
That’s why this policy sucks — it is punishing people without offering a solid solution.

I have to agree with rfloh in some regardsAdmittedly, I’m what a lot of people here would apparently call a “blame the fatty” person.  I entirely understand that there are extenuating circumstances, and I don’t believe one should have restricted access to health care because they’re a bit heavier.  
That said, extenuating circumstances aside, as a close friend that has M.D. after his name told me once, diet and exercise work 100 percent of the time, 12 percent of the time.  What he meant was that when someone sticks to a healthy diet and some bit of an exercise program, they will maintain or lose weight.  
In 2004, I lost 60 pounds via a potent combination of cutting pop, chips, and alcohol from my diet, buying a mountain bike, and (at least for some of it), having a suicidal run of depression that basically killed my appetite.  That said, once I resumed eating healthily and found a balance point, I kept that weight off with no problem until this year.  I was (and will be again) an avid cyclist, but I’ve been laid up since January after getting my leg smashed when I was hit by a car.  Since then, I’ve gained about 40 pounds, and am presently within about 15 pounds of my old high weight.  
Let me tell you something.  It’s NOT because I’ve been injured.  It’s because I’ve continued to shove groceries down my maw as though I wasn’t injured, like I was still riding 150 miles per week instead of being basically unable to walk.  I’ve started counting my calories, cutting my portions, and I’ve cut out the pop and chips and fast food that had crept back into my diet, and thus far, I’ve managed to not only stabilze the weight gain, but I’m starting to see a bit of weight loss.  As I’m able to walk more and more (I’m back up to over a mile without stopping!), that will increase.  
My point?  I get that there are extenuating circumstances, but outside of that, saying that diet and exercise don’t work because people don’t do what they’re supposed to do and stick with it is not valid.  If you lose weight, then stop eating well, you’ll gain weight back, plain and simple.
To be quite frank, there’s a whole epidemic of making excuses and dodging personal responsibility in this country (yep, those words again), and the whole rash of making excuses for why it’s ok to be fat is part of it.  Once can spend $4 on either one meal at Taco Bell or a pound of lean ground beef that can make at least two meals.  Chips, pop, cigarettes, and fast food are NOT essential parts of any diet.  Saying that because a person’s poor they have to eat garbage doesn’t entirely wash, either, since buying real meat and making your own meals with it is cheaper and healthier than is buying pre-packaged processed meat product in a tub.  
Like I said, I get that some medications and a myriad of other circumstances can come into play.  But, for the average person, it really is all about personal responsibility.  

When I was a child, it was rare to see an obese person.I don’t remember going to school with any fat children, much less any who were morbidly obese. Now this is commonplace.
What happened?

Actually no… I’ve seen plently of old smokers, but I’ve never met an old fat person…

Just because it worked for youdoesn’t mean it will work for everyone.
Some people would have to put 4 to 5 times the amount of exercise in, and cut calories to the point of malnutrition to get results. In that case, they can not live keeping that diet. There are genetic factors that are common that make huge differences.
I am genetically blessed. One week in the gym gives me the same results that it takes most people one to two months to get. Even when I am completely sedentary and eating lots of junk food I barely gain any fat. In fact, I can lose weight easily sitting and doing nothing.
Some people just are not that lucky. I worked with a friend who put in at least twice the work as I did, pushing herself harder than I have seen anyone do, eating healthy, and still gained fat.
People can not keep reduced calorie diets once they have reached a lower weight. Period. It causes death. So when they add more calories than the very restricted and dangerous diets allow them, they gain weight.
You can’t expect people to spend 3-4 hours a day of exercise every single day to be “fit”. They will die.
Shaming them does nothing except make it harder for them to do what they want.
People can be clinically obese, and even look very obese, and be perfectly healthy. People can also look like the model of perfect health, and be extremely unhealthy. In fact, unhealthy levels of fat (meaning lower than what they need for regular body functions) for most people is what they strive to attain.
To be quite frank, your ignorance of the horrors of shaming and “blaming the fatties” is saddening. Going to Taco Bell versus buying meat is not valid either. That assumes 1) You are only eating the meat, with nothing else. 2) You have time to make the meals. A single mother working two job trying to keep a roof over her two kids head probably doesn’t always have that luxury.  

All sorts of stuffFood has gotten much more loaded with junk. Portions have grown exponentially in the past 20 years. Instead of sending kids outside to play, parents park them in front of a tv and video game, then the parents dope those same kids up with a medicine cabinet’s worth of antidepressants and behavior meds like ridalyn when those same kids are hyper because they haven’t done anything to burn off any energy.
And then people sit and blame everyone else instead of themselves for why they’re fat and their fat kids are fat too.  The real rub of it is that exercise is shown to improve mood. Instead of doping the kids up, boot their asses out the door and have them do something active.
Maybe you’re a bot overweight because you have a condition or a med you need is impacting you. But maybe it’s because you stuff groceries in your face and then bitch that everything else is making you fat.
 

There are a lot of reasons for America’s increasing waistline. Cost is a big reason.With a head of lettuce costing $1.89 and carrots at $1.40 a pound, tomatoes running upwards of $2.99 a pound and chicken breasts a whopping $5.99 a pound, it costs me $5 to $7 to put together a healthy meal. For the same price, I can get a double Whopper with cheese, large fries and a half-gallon of soda. With being cheaper and much more convenient (when you have to work 60 hours a week to keep out of debt, who has time to cook?), bad-for-you food has become standard fare.

I know that problem wellIn college, I signed up for a PE class that combined aerobics and weight training. By the end of the semester, I had lost three inches on my waist… and gained almost 20 pounds.
For some people, there is no such thing as a win situation.

The problem is…The fact of hyperconditioned overeating. With the development of highly palatable foods and never-ending advertising, many Americans have been turned into Pavlov’s drooling dogs at a hand-bell concert. You might find the book “The End of Overeating” by David Kessler.
I am not saying this as an excuse, nor am I disputing the calorie deficit. I am just pointing out that, for most people, it is a far bigger issue than just “eat less and excercise more.”

This plan treats being overweight and smoking as simple lifestyle choices. They are notThere is growing evidence that humans (along with pretty much every other mammal) are evolved to find certain combination of fat, salt and sugar to be “highly palatable,” meaning that most people will consume them beyond satiation of hunger and actively seek more. The food industry has taken advantage of this to create addictive foods; with 24/7 advertising, we are being conditioned to eat all the time whether we are hungry or not. Then there is the proven fact that tobacco is at least as addictive as cocaine.
Schemes like this are based on the incorrect idea that people overeat or smoke because they are lazy, weak-willed or just don’t care about their health. That may be true for some, but it definitely is not true for most. That is why this is unfair.

Don’t tell my mom

“Then there is the proven fact that tobacco is at least as addictive as cocaine.”

I’ve done both and tobacco was MUCH harder to quit.

Insensitive bastard alert!An average person can maintain weight at somewhere around 2,000 calories per day.  My genetics aren’t exactly kind in terms of weight, as I gained almost 40 pounds in a matter of less than six months (it wasn’t until I was off of crutches that I started gaining weight).  Like I said, it wasn’t until a few weeks ago I could walk at all without pain, and even now, it takes me 30 minutes to walk a mile (but happily, I was able to do it without stopping!).  
Before my accident, I was riding my bicycle 100-150 miles per week.
I’ve started to lose weight because I’ve cut my calorie intake, plain and simple, down to 1,500-1,700 calories per day from the 2,200-2,500 it had been.  I cut chips, fast food, pop, and most other junk food, and I’ve cut my portion size back, too.  I’m not going to die of starvation or malnutrition, but I’ve already started to lose weight.  
What does 1,500 calories look like?  Compared to what most Americans think is a standard portion of food, it’s not a lot, but it’s plenty enough for the body to keep going for a long long time, and I even still make it through the 3:00 point when I’m normally ready to start killing things at work.  Consider this-a 20 oz. bottle of pop is worth 250-300 calories, and for what?  A cup (defined as 8 ounces) of juice drink (Cranberry-Raspberry anyone?) is 120 calories.  Pour a big glass of juice, drink a meal, at least in terms of calories.  1,500 calories won’t even cover one meal of pretty much any restaurant food.  
As a question, how many CALORIES was your friend eating per day?  I’ll bet it was still a pretty sizable number.
Yes, it’s harder for some people, but still doable.  I highly doubt anyone needs to ride a bike 600 miles per week to maintain a healthy weight (four times what I used to do as a very athletic person).  I highly doubt that an average non-athlete person working a desk job (like I do) will die, or even suffer ill effects from eating 1,500 calories per day.  
Using that aforementioned pound of beef, a $1.19 loaf of bread, ketchup, mustard, and brown sugar, one can make 2-4 servings of sloppy joes.  That calculates out to maybe a dime’s worth of bread, a few cents’s worth of ketchup and mustard, and the few cents of brown sugar.  For around $2.50, one can make several servings of food that’s much better for you than is meat product in a tub or cheap fast food.  For a few dollars (2.50, but in season), one can buy a three-pound bag of apples.  Romaine Lettuce (which actually has nutritional value) by the head (not pre-packaged)-$1.79 per pound.  Admittedly, I have the advantage of living in a metro area where food prices are lower than one would find in rural areas, but the point is still the same.  One can buy healthy food and prepare meals at home that are healthier than pre-packaged foodstuffs or restaurant food for cheaper than those alternatives cost.  
Now, don’t take my commentary as a sign of ignorance of the plight of others.  To the contrary, I perfectly understand that it’s hard for people to lose weight.  I’m just an insensitive bastard that doesn’t care and is completely willing to call things as they are.  To be blunt, when I hear someone going on that it’s hard to lose weight, I hear, “Wahhhh!! Woe is me!  I have kids and I don’t want to pay attention to what I eat, and reading labels is hard!  Waaahh!  Those other people just have good genes and are so lucky!  Waaah!”  You know what?  Tough shit!  It’s NOT my fault that you’re fat, (generic you, btw), so stop blaming me and others and take some responsibility for your own life and your own actions.  
No, a lot of the time, those other people actually have to work hard in order to keep a healthy weight.  I know from experience that one day, you realize that you’re out of breath as you’re putting on your shoes because your gut’s in the way and you can’t breathe, and it suddenly dawns on you that, you know, maybe you could stand to get in shape.  

.She had to get down to about 500 calories a day before she was able to see a result. 1500 calories made her still gain weight, and she was working her ass off. She had to stop that because she would get light headed and pass out. Even at 1000 calories a day she was slightly gaining weight. She was an extreme case. She pushed herself that hard because of constant harassment by peers who said it was all her fault. She ended up in the hospital and gained 5 pounds more than she was before she started.
You really have no idea to what extent some people have to work themselves into the ground to make even minimal gains.
Everyone’s body is different. Some people are meant to have more fat. The fact that people like you think they are lazy, and could lose it all if they just worked hard and kept it up is a serious issue. Attitudes like that contribute to cases of bulimia and anorexia. Which is what kills people.  

Extenuating circumstanceIt sounds a lot like your friend was one of those extenuating circumstances that have been mentioned previously.  She needed (and sounds like she got) medical attention.
But honestly, her case and those like it are very much in the minority, and I think it’s far more irresponsible to ignore the fact that the majority of those who are overweight are so because of their own doing.  Making excuses and blaming others instead of dealing with the issue is counterproductive.

Like I saidone big reason many calorie reduction diets result in a horrendous rebound is that those diets require insane reductions in calories on the part of the dieter, they cause too severe a state of calorie deficit.  
Another problem is that most of these diets don’t make any serious attempt to teach the dieter to think about diet, exercise, and pleasure from food. All they do is tell the dieter from on high to cut calories severely, and to avoid this (delicious) food, and that (delicious) food, and that (delicious) food, and that (delicious) one too. That is a recipe for a severe rebound disaster for most people.
Lumping all diets together, whether poorly designed or well designed, and then using that to conclude that they don’t work given the data, isn’t scientific.

I think part of the problem is too many doctors, even knowing this, still pressure people to do arduous dieting for some reason.

The “arduous” dieting is the problem. Any diet / exercise regime that causes a severe calorie deficit, severe being more than 25% of your maintenance caloric level, or more than 500 calories, whichever is larger, is likely to result in a severe rebound, for physiological and psychological reasons, for many people. Yeah, there are some people who can succeed on a severe calorie deficit diet, but that takes enormous willpower, and isn’t healthy anyway.
The other problem is that most doctors are really not qualified to give diet advice. Diet advice isn’t simply telling people what food is “healthy”, eat it, what food is “unhealthy”, do not eat it, tax it to prevent people from eating it. That’s not what they are trained to do, especially given that doctors themselves are often overweight.

And clearly no real diet/exercise solution works long-term for most. Look at Oprah, all the money in the world, personal trainers and chefs and access to any and all exercise equipment and time, still can’t keep it off.

I don’t know Oprah’s personal circumstances, so I would rather not comment specifically on her. What I’ve seen though is that some of the trainers who go on her show advocate some really insane diet / exercise regimes. The kind of diet / exercise regimes that most people will NOT be able to sustain as a lifestyle.
The thing I believe some people don’t realise is that losing the fat, and keeping it off, is a lifestyle thing. Meaning it is something you need to do for the REST OF YOUR LIFE. If you want to keep the fat off, you will need to learn to balance diet, exercise, pleasure from food, for the REST OF YOUR LIFE. Not a couple months, not a year.
This is the problem with many of these diets that promise miracle results. They don’t tell you that to sustain the fat loss, you need to learn to balance diet, exercise, pleasure from food for the rest of your life.
Note, I’m not saying it is easy. I definitely am NOT blaming the “fatties”. I’m blaming the doctors, I’m blaming the people who market those diets, I’m blaming (some of) the trainers.
One note with Oprah and exercise equipment: the best exercises are free weight, 3 dimensional exercises, or real world sport or dance or martial arts, not exercises done on some expensive high tech machine.  

You won.Forget bodyweight. Bodyweight is meaningless.
The first thing people need to learn is to drastically reduce the focus on bodyweight.
You became fitter, stronger, healthier. The bodyweight doesn’t matter in your case.
Muscle and bone weight is not the same as fat weight. Physical activity results in more muscle, and denser bones.

The first mistake your friend did was focusing too much on losing weight. Muscle weight is NOT the same as fat weight. Especially for someone has for the most part lived a sedentary lifestyle, gaining (muscular) weight on commencement of physical activity is common.
500 calories is insane. Any diet that requires a person to survive on 500 calories a day should be ignored out of hand.
Even 1000 calories, unless she is tiny, is dangerously close to being insane.
Most people really should not be focusing much on bodyweight. If you need a measurement of progress, take pictures of yourself regularly, and set goals on how you want to look.

Also, even when focusing on fat lossanything more than around 1 pound of loss a week isn’t generally sustainable. People often are deceived into expecting miracles.

A big problem is thedo what they’re supposed to do and stick with it attitude.
Too many diets / exercise regimes are simply prescriptive, and make no attempt at education.
Do this, do that, don’t eat this, don’t eat that, and don’t eat that too.
Teaching people HOW to stick to the diet / exercise regime should be a requirement, instead of just accusing people of making excuses and dodging personal responsibility.

Once can spend $4 on either one meal at Taco Bell or a pound of lean ground beef that can make at least two meals.  Chips, pop, cigarettes, and fast food are NOT essential parts of any diet.  Saying that because a person’s poor they have to eat garbage doesn’t entirely wash, either, since buying real meat and making your own meals with it is cheaper and healthier than is buying pre-packaged processed meat product in a tub.  

Which takes more time? Taking the time to buy real meat, real meat that is preferably grass fed, and then cooking it deliciously takes time and effort. If someone has just spent 12 hours working in a Walmart, that is time and effort that is sometimes difficult to put in.

I agree that there are many many issuesthat are in play.
The fundamental issue is “eat less, exercise more”, or eat more, depending on your goals; some people do want to gain weight .
The problem is that there are many reasons why “eat less, exercise more” isn’t easy, one of which is the reason you have pointed out.  

Or maybe there are many other reasons other than the 2 manichean onesyou listed.
Maybe most people are human.
They do want to eat and live healthier. At the same time they also derive a lot of pleasure from food. They have willpower, but not enormous amounts of it.
Nor are they serious athletes, or serious dancers, or martial artists, with the motivation of being in love with their sport, to push them to eat healthily. There are other things in their lives that are important to them than losing fat, including deriving pleasure from food.
They don’t know how to lose the fat and keep it off. They are confused by all the diets that are propagated, diets that are often completely unreasonable, diets that certainly work in an ideal world, but do not take into account human circumstances, including diets from doctors.

Who is blaming youfor their being fat? Who is saying that it is your fault?

I agree completelyI actually have a large frame, and having been heavy (and an avid walker) for most of my life, my skeleton is pretty dense. To get to my “ideal” weight (169, BMI 25) I would have to either lose a lot of muscle or go down to a body fat index of about 10%.
Unfortunately, body weight and height (the essential components for the BMI) are very easy to measure, so they have become the standard metric of fitness.

She is not the minorityIn my experience she is the majority.
Prove to me that most of these people are lazy and don’t want to change lifestyle and diet. Show me the studies and evidence that says otherwise. If you can’t, then blaming those people is counterproductive. If you can’t, then why do you have that stance?

She wasn’t gaining muscleit was mostly cardio work, and she was working the muscles too hard, so they weren’t gaining.  

Cardio work can result in muscle gain tooespecially for beginners. Pretty much any physical activity is likely to result in muscle gain, for someone who used to be sedentary.
If she was getting better at the cardio, being able to do more in the same amount of time for example, and geting stronger in whatever strength work she did, she WAS seeing a result.

Howeverexcessive cardio work does too much damage to muscles to get any real gains.