My Fight against Fat Discrimination
By Francine Russo

McCall's Magazine, March 1999

     Lenay Yorko has always been agonizingly aware of society's biases against obese women-she's 5 feet 6, and her weight has fluctuated between 200 and 420 pounds for most of her adult life. But one incident is seared in her memory. Two years ago, she was sitting in church when her priest told a joke in which a fat person with a beeper is confused with a truck backing up. The Fort Wayne, Ind, wife and mother, who carried a beeper for work, felt she stood out. "I started crying," she says.

     Yorko's weight wasn't just embarrassing. As a nurse, she knew she was at an increased risk for heart disease, diabetes and even sudden death. After years of unsuccessful dieting, Yorko learned of a surgical procedure that she believed would help her shed the pounds for good. But her HMO refused to pay for it, suggesting she try one of the programs that had already failed her. "They were looking at morbid obesity (being overweight by 100 pounds or more as a character flaw rather than a disease," she says. Still, Yorko refused to give up.

                         Overweight and ridiculed: A painfully familiar story                     

     Yorko, like most women in her situation, knows it isn't easy being fat. Numerous studies show that heavy women make less money and are less likely to be hired or promoted than thin women. Studies also reveal that antifat prejudice influences the way many doctors treat their overweight patients. But few laws exist to protect the obese from discrimination.

     Why is it okay to hate fat people? "In this country we have a very strong Puritan and Protestant work ethic," says Obesity specialist Esther Rothblum, a psychologist at the University of Vermont. "We think of the obese as hedonistic and self-indulgent, even though the data show the condition is highly related to genetics and metabolism."

     Many researchers now believe that weight is more affected by genetics, metabolism and brain chemistry than by eating and exercise.

     The 37-year old Yorko has grappled with fat discrimination almost her entire life. At the age of five, she weighed 110 lbs. A young man once said he'd date her if she were thing. "And I was thinking," she says, "If I were thing, I wouldn't date you ."

     Yorko's husband of 14 years, engineer John Yorko, helped soften the blows by telling her he thought she was beautiful-at any size.

     But Yorko kept trying to slim down. She joined Weight Watchers more than 25 times, each time losing 40 to 50 pounds before leveling off. She tried other diet plans and attended a spa-all to no avail.

     "It was a revelation to me," John Yorko recalls. "She'd eat less than I would and still gain weight."

     The repeated failures wore on Yorko. "Your sense of self-worth just keeps dropping," she laments.

     When her fourth and fifth children, twins Matthew and Anna, were born in 1995, Yorko weighed nearly 400 pounds. She'd become a visiting nurse because she couldn't maintain the pace of hospital work. Keeping up with her kids (who included Sean, 13, Joshua, 11, and Aubrey, nine) was also exhausting.

     A radical operation - but the only one that could help

     A few months after the birth, Yorko saw a TV advertisement for the Bariatric Treatment Center in nearby Ann Arbor, Mich. She discovered that the National Institutes of Health endorses two bariatric, or stomach-shrinking, procedures for the severely obese: the Roux-en-Y gastric bypass, which sections off a small stomach pouch with an outlet that bypasses much of the small intestine, and the vertical banded gastroplasty, where a small pouch with a restricted outlet is partitioned from the stomach. In order to quantify for bariatric surgery, you must have a body - mass index (BMI) of 40 or above (roughly equivalent to being 100 pounds or more overweight) or a BMI between 35 and 40 with accompanying diseases such as diabetes or hypertension.. The surgeries work in several ways: They reduce stomach size, making one feel full faster, they shorten the small intestine, reducing food absorption, and they modify behavior by creating nausea when foods high in fat and refined sugar are eaten.

     The procedures are not a quick fix. Although the risk of death is less than 1 percent, complications may include persistent vomiting, gallstones and diarrhea. Patients still need to change their diet and exercise habits to slim down. They typically lose 40 percent of their excess pounds, but few reach the ideal weight for their height. The success rate (keeping 75 percent of the weight off for five years or more) is 89 percent or better, but lifetime medical monitoring is needed to prevent nutritional deficiencies. Still, Yorko believed the operation would give her a fighting chance to lead a normal life.

     She could only have the surgery, though, if her insurance company would pay the $35,000 cost. Because Yorko's HMO, Physicians Health Plan of Northern Indiana (PHP), had no bariatric surgeons, in November 1995 her plan physician referred her to the Bariatric Treatment Center. After a consultation with Yorko, the surgeon there recommended her for the operation because her BMI was 63.9.

     But just two weeks after receiving Yorko's claim, PHP turned down her application, saying the surgery wasn't medically necessary.

     As required by law, Yorko's HMO offered an appeals procedure. After the first denial, she had 60 days to reply. If her claim was again turned down, she could ask that an arbitration committee review her case.

     A setback - and a vow to fight on

     In January 1996, Yorko wrote PHP a detailed letter that chronicled her family's medical history. She explained to the company that her parents, sister and brother were obese, and that three of them suffered serious medical problems: Her father had severe diabetes and kidney and heart disease; her mother had diabetes, high blood pressure and high cholesterol; and her sister had asthma.

     In February 1996, her HMO again said no, and Yorko, coping with an ailing father, didn't have the heart to ask the PHP arbitration committee to review her case. "I lost hope and thought, 'I'll just die.'"

     Yorko's father passed away in March of 1997, at age 66, from heart failure caused by complications of diabetes. Someone Yorko knew, who'd once weighed 370 pounds, appeared at the funeral significantly thinner after bariatric surgery. Yorko felt both jealous and inspired: "I wanted that," she says. "I could just taste it."

     A month later Yorko rededicated herself to getting the operation. Searching the Internet, she discovered attorney Walter Lindstrom's Obesity Law & Advocacy Center in San Diego, Calif. He began specializing in weight discrimination after fighting his own insurance company for bariatric surgery in 1994. Formerly 370 pounds, the 5 feet 10 Lindstrom now weighs 215 pounds.

     "It's clearly discriminatory" to deny the surgery, Lindstrom says. "It's like saying, 'We will not cover cancer unless medically necessary.'"

     Advised by Lindstrom, Yorko made another claim, and it was denied again. Lindstrom sent the HMO a ten-page appeal. Yorko cried when she read it, because "he finally made me feel I had a right to this."

     The insurance company reacted with a series of discouraging moves. First, her plan's doctor called her, saying that PHP was offering to pay for Optifast, a physician-supervised weight-loss program. Was that okay?

     No way, Yorko said. She's tried it in 1993, lost 70 pounds on the liquid part of the diet and regained it as soon as she ate solid food.

     Next, a case manager, during a conference call with Yorko and Lindstrom, said Yorko had been approved for surgery. But the HMO balked at sending her to the Ann Arbor facility, saying it wasn't sure of the center's quality.

     If PHP refused to send her where she wanted, Yorko told them, she'd insist on going to the Mayo Clinic or San Diego's Alvarado Hospital-far more expensive because of travel costs for her and a companion.

"I had approval the next day to go to the Bariatric Surgery Center," Yorko says proudly.

     On August 15, 1997, Yorko had the Roux-en-Y gastric bypass. She had some postsurgical pain, but it wasn't as bad as she expected-she was walking hours after waking from the anestesia. The toughest part, Yorko says, was the four weeks she spent on a liquid diet. She now eats solid foods, though some, such as pasta and rice, give her digestive problems.

     Her weight has dropped from 420 to 241 pounds, more than halfway to her goal. During the first seven months after the surgery, she lost an average of 5 to 7 pounds a week. Her weight loss since slowed to 5 to 8 pounds a month. "Before, I could eat a box of Pop-Tarts and still not be satisfied," she says. "Now I feel full after three graham crackers."

     Yorko now exercises a half hour every day and recently walked six and a half miles in a charity fund-raiser.

     She has a new job as a nurse, sells Mary Kay products and was asked by the manager of a local factory to talk to his workers about taking control of your life.

     Her husband insists he's thrilled because she's healthier. "Now guys are looking at her more," he chuckles. "If you're in love with your wife the way I am, that could really bother you."

     When her latest insurance policy arrived, Yorko was elated to see that it no longer excluded bariatric surgery. A spokesperson for PHP said there hadn't been a meaningful change in coverage, just a clarification of the plan's policy. However that may be, the item in the list of exclusions that read "procedures intended primarily for he treatment of morbid obesity" is now gone.

     "This is the best thing I've ever done for myself and my husband and my kids," Yorko declares, then adds happily, "I'm so proud of myself! I just can't help it."