The skinny on Christie's surgery

In an ideal world, New Jersey Gov. Chris Christie would have had to address publicly his body size in one context and one context only: Does it present or complicate any health issues that would reduce his ability to handle the stresses of the presidency? Though obesity's medical characteristics can be treated, the cluster of symptoms put him at a much higher risk for a cardiac event or a stroke; it also doesn't help the body process extraordinary stresses well. He's acknowledged that he was living on borrowed time. His weight was an issue, and he owned it.

Unfortunately, aside from his personal life, the real other reason why Christie had to address his weight problem is because Americans would undoubtedly have seen it as a "weight problem," a marker of something else, in much broader terms.

He knows that his weight would be a huge and potentially disqualifying issue if he were to run for president without addressing it. It's unfair, but being fat marks people as "lazy" or undignified, unable to take care of yourself. In the stigma we apply to fat people, their fat bodies are imperfect bodies, indicative of a lack of a self-control. The sense is, well if he can't handle his own problem, how can he take care of the rest of us?

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Now, Christie is the poster boy for personal responsibility. He's dieted many times. Nothing worked. Personal responsibility is not a useful way to think about obesity after you've become obese. Before, perhaps. After? You're stuck for life, unless you can work out for two hours a day or you get some kind of surgery.

We unfairly implicitly associate fat people with a whole range of negative things. (Jon Corzine, Christie's opponent in the last election, used the fat=corrupt shorthand in a commercial.) He would have been judged along that axis. Particularly, it's something that he's made an issue of before, so the sense that he's been unable to deal with it would have been a knock against him. These perceptions aren't based on reason or science, but they are based on the reality of what people think.

Christie can now say: I know it was a problem, and I dealt with it.

Personally, he will find it easier to do a whole range of things. And the main reason he did this, I suppose, is the same reason I got my surgery — it prolongs life AND it increases the chance that we will live happier and healthier. Surgery doesn't guarantee it, but it's a tremendous shot in the arm.

I hope that Christie's decision helps open the debate about the effects and side effects of bariatric surgery. There are different types; mine was the Roux-en-y gastric bypass, where the surgeon detached my stomach from my digestive pipe and rewired my food and water pipe to join my small intestine. The gastric sleeve removes most of the stomach itself; the lap band shrinks the stomach. Your weight-regulation mechanisms are reset and your body tends to settle at a much lower set point.

Because these surgeries are becoming popular, a lot of general surgeons with no specific training in gastric bypass want to get in on the money. They'll charge a few thousand dollars less than a surgeon who has been certified by the American Society of Metabolic and Bariatric Surgery. The gold standard are clinics that have been deemed a Center of Excellence. If you're taken care of there, you can bet on a comprehensive and in some cases lifelong approach to your weight, body image, psychological adjustment and any post-surgical complications.

I hope he'll talk about stigma. It's great that Christie doesn't fit the "fat" stereotypes: he's not lazy, he's very energetic, not corrupt. Through his experience, perhaps we can all come to understand better why we treat fat people so poorly, and why obesity seems so irreversible.