The comments on this piece and on the author’s Twitter have predictably been a total trash fire, and I don’t suggest reading them or the piece if these kinds of things make you crazy, but as someone deeply interested in man-made things we describe as inevitable, this section stuck out at me: 

Still, despite the Task Force’s explicit recommendation of “intensive, multicomponent behavioral counseling” for higher-weight patients, the vast majority of insurance companies and state health care programs define this term to mean just a session or two—exactly the superficial approach that years of research says won’t work. “Health plans refuse to treat this as anything other than a personal problem,” says Chris Gallagher, a policy consultant at the Obesity Action Coalition.

The same scurvy-ish negligence shows up at every level of government. From marketing rules to antitrust regulations to international trade agreements, U.S. policy has created a food system that excels at producing flour, sugar and oil but struggles to deliver nutrients at anywhere near the same scale. The United States spends $1.5 billion on nutrition research every year compared to around $60 billion on drug research. Just 4 percent of agricultural subsidies go to fruits and vegetables. No wonder that the healthiest foods can cost up to eight times more, calorie for calorie, than the unhealthiest—or that the gap gets wider every year.

It’s the same with exercise. The cardiovascular risks of sedentary lifestyles, suburban sprawl and long commutes are well-documented. But rather than help mitigate these risks—and their disproportionate impact on the poor—our institutions have exacerbated them. Only 13 percent of American children walk or bike to school; once they arrive, less than a third of them will take part in a daily gym class. Among adults, the number of workers commuting more than 90 minutes each way grew by more than 15 percent from 2005 to 2016, a predictable outgrowth of America’s underinvestment in public transportation and over-investment in freeways, parking and strip malls. For 40 years, as politicians have told us to eat more vegetables and take the stairs instead of the elevator, they have presided over a country where daily exercise has become a luxury and eating well has become extortionate.

I am, as I’ve mentioned elsewhere, extraordinarily privileged, and I get home at 6 on a good night, put Kick to bed at 8-8:30, and hop on the exercise bike that doubles as a desk because I can either work out or write for an hour and I cannot choose either of those things exclusively.

I work out, after all my back problems, not to get skinny but to keep my muscles and bones from locking up and my nerve pain from reaching debilitating levels. I do yoga while trying to catch an hour of TV with Mr. A or talk in the middle of down-dog about what’s coming up in the week.

My commute is public transport. I take the stairs and can afford to buy salads. I drink a lot of juices and eat bananas and honestly, the only thing that’s gonna lose me 20 pounds at this point is to quit taking my anti-depressants, which will kill me. I mean that quite literally.

So alive with the muffin-top, maintaining a technically “overweight” BMI while eating nowhere near the amount of cake I really want, or dead and a size six, and our culture is so goddamn insane that sometimes I actually wonder.

And some nights, when I get home at 11 p.m. from standing all day at an event or a conference, I cannot face the fucking bike, and I just want some ravioli and a glass of wine and to lay down for a second.

These aren’t all personal choices. This isn’t all “just eat less.” This where we live, what we do, how we get around, and what we grow. This is who gets paid. It’s public goddamn policy and the people screaming in the author’s mentions about “just lose some weight then fatty” are the ones who made fun of Michelle Obama relentlessly for having a White House garden and reminding kids to play outside.

A.