“Aren’t you happy for me?” asks the patient smiling from the exam chair in my office. I say yes, but that’s not entirely true.

Happiness isn’t the right word. Conflicted might be it. How do I reconcile my feelings when this patient, who I am not sure is deserving, reports that he was awarded Social Security disability?

Sure, he has severe arthritis, wildly uncontrolled diabetes, and a massive skin breakdown of his legs. But I’m convinced these ailments are byproducts of a body mass index (BMI) of 43. And as I squat down to help him slip on his shoes overtop the fresh leg wraps (since he cannot reach his own feet), I cannot stop my first thought: This man gorged himself to free money.

Joyfully, he reported finding over $10,000 of back disability pay deposited in his bank account, with more to come each month. He credits God for the lump-sum payment that rescued him from a financial avalanche. But with some of the money, he purchased a new car — one he admits he probably didn’t need.

I’m glad his financial situation has stabilized. But something in me tightens when I consider the possibility that our government, at least for the next five years, will be rewarding him for decades of admitted undisciplined and excessive food consumption.

I’m not sure which is worse: Seeing another display of the repeatedly-enabling, haphazardly-managed, wildly-abused disability system, or dealing with the hyperglycemic-inducing, joint-crushing, leg-weeping results of obesity.

Since I can’t do anything about broken government programs, I decided it was the latter.

I know, I know. My first thought was shallow and naive, maybe worthy of shouts of “fatism.”

Sorry. Sometimes my frustration that things aren’t the way they should be boils over and finds its voice. I fully realize the path that leads a person to becoming 10 pounds short of twice my size involves many factors. Genetics, emotions, maladaptive behaviors, boredom, television, modern food habits, and variations in what’s considered excessive all contribute to this epidemic. I get it.

But I remember leafing through a medical magazine some time ago when I noticed a heated letter to the editor regarding a recent article about obesity.

The author of the letter found the article to be offensive and erroneous. She bristled at the idea that obese individuals are not only condemned for their appearance but blamed for it as well. She went further to say that blaming a victim for obesity is archaic and should be obsolete by now (the author’s words).

The World Health Organization (WHO) states on their website: “The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended.” And while expanded and enlightened views on the cause of obesity have been proposed, at a base level, obesity involves choice.

The victim mentality (which is so pervasive in our society) would rightfully call out the condemnation but also would appear to excuse poor food choices made over and over again.

On the other hand, I view obesity as a deep pit that a person digs with his choices but then manages to fall in. This analogy is not perfect but provides some perspective. And though well aware of the decisions made to create such a predicament, you wouldn’t go to the edge of the dark void and yell down to the victim, “C’mon, just climb out!” Yet we callously tell the obese person to simply stop eating so much. Compassion and a long rope are what’s needed instead.

I also recognize similar but distinct forces, both internal and environmental, at work in my life, like a tractor beam, dragging me toward my own addictive potentials. Perfectionism and others’ opinions of me can be just as deep pits as overeating. Realizing it could easily be me staring helplessly at the dirt walls, grace is a better response.

And while this man may rejoice in his financial windfall, I know he would trade places with me in a heartbeat. Disability pay stinks. Money will still be tight. His new car (probably his last new car) will collect its share of dents over time. He could make a lot more money (and preserve his male ego) with paychecks from an employer rather than the Social Security office. Whether or not his physical ailments or his pull on gravity truly warrant disability, he must still deal with being obese, diabetic, arthritic, and leg-leaky.

Here’s the conclusion I came up with as I manufactured a smile in front of my patient. What’s done is done. He is obese. And in the next 15 minutes (apart from a catabolic miracle), he will continue to be obese, so I must deal with it. I can choose not to judge and vilify him in my mind, instead choosing to treat him with grace, respect, and golden-rule humaneness.

Yet he can choose to accept that he is not a completely helpless victim or a totally innocent casualty of a conniving food industry, but an intelligent life form capable of rational forethought. He can choose to address his obesity, one choice at a time (with my help). And even if he doesn’t hold up his end of the bargain, I can hold up mine.

The author is an anonymous physician.

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