Customs Traditions in Belize

Belize, Once known as British Honduras is the only English speaking country in Central and South America. Since the early 1800's Belize was part of the British Common Wealth. In the past the country was part of a long standing dispute with the Guatemala who claimed that Belize was part of that country. With the help of Britain and the United Nations Belize became an independent nation on September 21, 1981. Customs traditions in Belize are the result of its many diverse people who live there.

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The true history of Belize of course goes much further back to the Mayan civilization. The customs traditions of Belize are a meld of many influences. Although English is spoken in Belize, the Creole dialect is spoken throughout the nation. The Creoles make up approximately 30 percent of the country and are descendants of slaves and Europeans. Most Creole's live in the largest city San Jose.

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Mayan's are the descendants of the Mayan Civilization that flourished in Central America more than a thousand years ago. It is felt that most of the present Mayan population immigrated to Belize during the 1800. Most of the Mayan population is located in Southern Belize in three distinctly different groups. Mayan's account for about 13 percent of the total population. The customs traditions of Belize are strongly influenced by the Mayan in these areas.

The Mestizos immigrated to Belize from the Yucatan during the Caste Wars of the mid 1800. They make up about 40 percent of the population and live on the Northern Islands of Ambergris Caye and Caye Caulker as well as the Orange walk and Corosal districts. Their common language is Spanish at home but use English on the streets and in Business. Mestizo food is a favorite of visitors and locals alike.

The Garifuna make up another large portion of the population that lives mostly along the Southern Coast. According to the government they make up about 7 percent of the population. They are the descendants of slaves and Indians that immigrated to this area in the early 1800's. They speak their own language and live in distinct communities. On November 19th of each year Garifuna Settlement Day is celebrated across the country. Known for their very distinct cuisine and art they make a special contribution to the customs traditions in Belize.

More recent immigrations to Belize include the Mennonites who came from Mexico in the early 1960's and established their traditional agrarian communities on large blocks of land in the Orange Walk and Cayo districts. Much of Belize's agriculture products come from these closed tight knit communities. They are also famous for their furniture and construction skills. In addition there are distinct Chinese and Arab communities located in San Jose. All of which adds to the spice and variety of customs traditions in Belize.

Belize is a beautiful tropical paradise where many different cultures are flourishing. Many people are immigrating to this country because of the customs traditions in Belize. Retirement communities are growing each year. All attesting to the quality of life in Belize.

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Social Security Disability And Fibromyalgia

Social Security disability benefits are often the ultimate safety net for persons suffering from medical impairments that make it impossible for them to work. For many people, however, struggling through the Social Security Administration's bureaucracy is frustrating, confusing and slow. For people suffering from conditions such as Fibromyalgia and Chronic Fatigue Syndrome, the requirements of the Social Security Act can become overwhelming. This article will explain and simplify in general terms the requirements of the Social Security disability program and describe the application and appeals process.

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Two Different Programs - SSDI and SSI

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There are two programs under the Social Security Act providing benefits for persons who are unable to work. The first is the Social Security Disability Insurance (SSDI) program found in Title II of the Social Security Act. The second is the Supplemental Security Income program contained in Title XVI of the Social Security Act. The medical test for both programs is identical. The differences are in the non-medical eligibility requirements.

Non-Medical Requirements

SSDI benefits are paid to totally disabled individuals who have worked and paid into the Social Security system with the FICA taxes that are deducted from paychecks. These FICA taxes are analogous to insurance premiums paid for automobile, homeowners or other private insurance. The FICA payments, which are matched by employers, buy coverage under the Social Security Retirement, Disability and Medicare programs. For SSDI, there are two requirements: a worker must have worked and paid FICA taxes for at least 40 quarters lifetime (10 years) and, also 20 quarters had to have been paid in during the ten years prior to the date of becoming totally disabled. For example, a 40 year-old Claimant who became disabled in 2003 would have had to have worked and paid FICA taxes for at least 10 years during his lifetime, and for at least 5 years between 1992 and 2002.

If approved for SSDI the Social Security Administration pays a monthly benefit based upon how much was earned and paid into the Social Security system. Benefits are also paid to dependent children who are under 16 years old, or who are under 18 years old and still in high school. Medicare eligibility begins twenty-nine months after the onset date of total disability.

The SSI program requires that an individual be totally disabled and "indigent." "Indigent" basically means that a single Claimant has little or no income and less than ,000.00 in non-exempt assets. A home and furniture are not counted. One car is exempt. Bank accounts, IRAs, profit sharing plans, cash value life insurance and similar assets are all included in determining assets, even if penalties and taxes would be incurred if the asset were converted to cash. In addition, a spouse's assets and income are "deemed" to the disabled Claimant - this deeming rule wreaks havoc on many disabled persons, particularly the stay-at-home parent.

In 2004 SSI will pay a basic monthly benefit of 4.00 which may be supplemented by some states. A disabled person receiving SSI will also be eligible for food stamps and a Medicaid card from the state.
The Social Security disability program is designed to pay benefits to claimants suffering from medical problems causing symptoms so severe that it becomes impossible to sustain function at any type of work. Issues of employability, job existence, insurability and location or desirability of alternative work will not be considered, although age and education are often important factors. The fact that a person cannot do the work performed in the past is usually not determinative. This is a medical program that focuses upon medically proven symptoms and their impact on the ability to perform work activities.

Therefore, the focus in on function, not on diagnosis; SSA often admits that Claimants have medical problems and are "impaired," but denies that they are "totally disabled." The debate is over what the Claimant can "do" despite the medical problems.

The Social Security Administration's Regulations require determination of disability be based upon on "objective proof" of both the medical problem and of the severity of the symptoms. "Objective proof" means the findings contained in medical tests that are not dependent on the patient's subjective responses. A MRI, a cardiac treadmill test, an x-ray and a pulmonary function test are all "objective" tests. Asking a patient if she is in pain is "subjective." In Fibromyalgia and CFS claims, it is often difficult to objectively prove either the existence of the disease, or the severity of the symptoms. This has caused many claims based upon these conditions to be denied - especially at the first two levels of review.

The focus in all disability claims is upon the medical evidence, i.e. the treating physicians' clinical findings, office notes, reports, and medical test results. This evidence is primary and is often more important than the testimony of the Claimant. While a Claimant's description of the impact on daily activities, social functioning and concentration must be considered by SSA, the content of the medical documentation is the most important source of evidence in deciding the claim.

In Fibromyalgia claims the clinical notes and a report of the treating rheumatologist are most important. A 1996 decision by the Seventh Circuit Court of Appeals established that a rheumatologist is the primary source for proof of this disease. Office notes from the rheumatologist should consistently document the positive findings for the tender points which are diagnostic for this disease. In addition, the patient should be complaining at each office visit of the fatigue and pain that are consistent with this condition. A report that establishes that all other causes for the symptoms have been ruled out helps establish the existence of the disease.

Since the extent of fatigue and pain cannot be measured, consistency of complaints in the various medical records will be important. The use of pain medications, even if just for trial periods is an important consideration in evaluating the severity of pain. Use of mild analgesics indicates less severe symptoms; prescription of stronger narcotics indicates that the treating specialist felt the pain problems more severe. Also, documentation by the physicians of concentration impairments, and the inability to perform routine daily activities such as housework, shopping, and social functioning, are also factors considered by Social Security Administration decision makers.

Chronic Fatigue Syndrome claims have been made clearer by the adoption of Social Security Ruling 99-2p. This Ruling finally acknowledges that CFS is a medically determinable impairment and describes the various findings that can establish the diagnosis. This Ruling is quite useful and can be found at the SSA's web site. Generally, the focus is on a longitudinal view of the medical evidence and the extent and nature of the treatment provided by the various physicians. The clinical findings and summaries of the patient's complaints in the office notes are critical in terms of establishing the existence of a medical impairment. As to whether the symptoms are totally disabling, SSA will consider the medical opinions, as well as the statements of the Claimant and third parties, as in any other disability claim.

Claimants who suffer from depression should also seek treatment from a mental health professional. Whether the depression is a symptom of the disease, or results from the significant impact on a Claimant's lifestyle, or is a separate disabling medical condition, the treatment notes and histories often lend credibility to the claim. However, SSA will generally not give significant weight to depression treated by a family doctor or social worker - emphasis will always be given to the records and reports of an M.D. psychiatrist or Ph.D. psychologist. Depression does not usually negate the existence of other underlying impairments but instead confirms the severity of their impact. On occasion, this diagnosis provides an alternative theory for an Administrative Law Judge who wishes to award benefits but will not approve a claim based on CFS or Fibromyalgia.

The Application Process

There are multiple levels of review of an application filed under the Social Security Act. In an effort to increase productivity, and decrease processing time, the Social Security Administration is testing different review models across the country. This article will describe the basic system which is still in place throughout most of the United States.

A claim is initiated by filing an application. This can be done over the telephone, on SSA's web site (for SSDI claims only) or, preferably, in person at the local Social Security Administration District Office. The application will require a list of all of the jobs performed during the last 15 years, a list of all medical providers, a list of current medications, names and dates of all prior marriages and divorces, and a copy of the Claimant's birth certificate. Generally our practice is to recommend as much be done with Social Security face to face at the District Offices - this decreases the chance for errors. At the time of this writing, only SSDI claims can be filed over SSA's web site.

After the application is filed, the Social Security Administration will send the file to a Disability Determination Service (DDS) administered by that State. Each state has a contract with SSA to perform the first two levels of review. At the DDS the file will be assigned to an adjudicator who will be responsible for gathering medical documentation, getting any additional information from the Claimant, arranging for consultative examinations and obtaining medical and vocational opinions from the DDS's internal experts. A written decision is issued in about 90 days on average, although the time frame can vary widely. Historically only about 36% of claims are paid at this level.

If denied, the second step is the filing of a Request for Reconsideration at the SSA District Office. A Claimant is allowed 60 days from the date of the initial denial to file this appeal, although there is usually little to gain by waiting. The Request for Reconsideration is also processed by the state DDS. Historically only about 17% of claims are approved at this level and SSA is testing elimination of this step.

The third level of review, for those claims denied at Reconsideration, is the hearing before the Administrative Law Judge (ALJ). These are informal administrative hearings held before independent judges who hear testimony, review the medical records and issue written decisions. While progress had been made in reducing the backlog in setting hearing dates, the delays have been increasing once more. Time frames vary widely across the nation, many hearing offices now take at least twelve months from the date the Request for Hearing is filed to set a hearing date.

The hearing is critical to the review process because it is the only time that a Claimant has the opportunity to see, and talk to, the decision maker. Up until this time all decisions are based upon paper, i.e. medical reports and written questionnaires. This is the only time in the process where the decision maker gets to see and question the Claimant. That face to face observation is critical and in this author's experience is one of the factors causing ALJs to reverse many reconsideration denials.

While all Social Security cases first focus on medical proof, the testimony at an administrative law judge hearing may tip the scale in favor of a sympathetic and credible Claimant. It is important that a Claimant fully explain the limitations and the effects of the disease on their daily activities. Testimony, which is consistent with the medical evidence and credible, can persuade a Social Security judge to award benefits in a claim based upon Fibromyalgia or CFS.

The final two steps in the review process are the Appeals Council, and if unsuccessful, the United States District Court. These reviews are primarily based upon the medical evidence and testimony from the ALJ hearing. Since there is no additional testimony, and very little additional medical evidence can be supplied, these two levels of review are helpful in only a small percentage of claims. The backlog at the Appeals Council is now almost two years.

NOTE: SSA has begun testing different application processes in different parts of the nation. Some Claimants will not have a reconsideration stage; some will not have Appeals Council review. All Claimants will have an opportunity for an Administrative Law Judge hearing.

Representation

This Social Security disability application and appeals process was designed so that Claimants are not required to obtain representation. However, people with representation have much higher success rates. Familiarity with SSA's Regulations, Rulings, the federal caselaw interpreting the Act, and with SSA's internal guidelines called the POMS and HALLEX, help guide preparation of a claim. Representatives do not have to be licensed attorneys and there are paralegals and other non-attorneys who do provide representation.

This author's strong preference is to become involved in a claim as early in the process as possible. The earlier a Claimant understands the issues in her particular situation, and the earlier the review of the existing available medical proof, the greater the chance the assistance will be granted at some point in the process. In addition, care needs to be exercised in the completion of many of the early questionnaires sent by the DDS adjudicators - many answers on these forms end up being twisted and serving as the basis for denials by adjudicators and ALJs.

Almost all attorneys who focus in this area of the law will agree to representation on a contingency fee basis - that means that fees are only awarded in the event of a favorable outcome. In addition, the Social Security Administration always retains the right to review attorney fees.

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The Personal Costs of Obesity

People who are overweight and obese face many difficulties their normal weight peers do not. Frequent doctor visits are a fact of life for overweight and obese people, due to the development of weight-related disorders such as diabetes and osteoarthritis. Along with the daily difficulties associated with these diseases, the overweight or obese person may be personally affected financially as a result of weight-related expenses and reduced income.

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The personal consequences and costs of obesity are serious, and the personal financial cost great. Multiple studies have shown that obesity significantly negatively affects personal and working relations, wages, and advancement, particularly for females.

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While the health problems as the overweight/obese age may ravage savings, an overweight/obese person may have difficulty accumulating those savings in the first place. One of the earliest sociological studies of the overweight, in 1966, found that the heaviest students had a harder time getting into top colleges. The obese, particularly white women, are paid less. A study by Cornell University found that a weight increase of 64 pounds above the average for white women was associated with 9 percent lower wages.

I can personally attest to the ceiling placed on the obese; the jobs that are available to you based on your talents and abilities are often not received; there can be pattern of coming in second in interviews. This is particularly so when the job involves social context or a large amount of meet and greet.

Overweight people may or may not spend more than normal-size people on food, but their life insurance premiums are two to four times as large. They can expect higher medical expenses, and they tend to make less money and accumulate less wealth in their lifetimes. They can have a harder time being hired, and then a harder time earning promotions. People carrying as little as 30 to 40 pounds extra can be seriously affected.

In 2004, The Obesity Society created a Task Force on weight which found accumulating evidence of clear and consistent bias, stigmatization, and in some cases discrimination, against obese individuals in three areas of living: employment, education, and health care. They also reported that recent studies have documented automatic negative associations with obese people among health professionals and among obese individuals themselves.

In addition to the negative financial impact that excess weight carries, there is also impact on quality of life. People who are severely overweight may have difficulty performing simple daily tasks, such as tying shoes or walking up a flight of stairs. Many obese people have trouble sitting in, or can not trust the weight limit of, standard furniture. It becomes difficult to go to restaurants or theaters, or to utilize public transportation. Many bathroom facilities would be inaccessible to the obese were it not for the availability of the much larger handicap stall. While I was able to use the regular stalls when I weighted a little over 300 pounds, which is certainly obese but not gargantuan, there were many that were on the small size, and getting in and turning around to shut the door was awkward, if not difficult.

Think about all the places you might not go if you had to be worried about fitting in, or not breaking, the chairs; think of all the places that have booths, which have fixed distances from the table. Consider the size of the average subway turnstile. Go window shopping and mentally buy several stylish items; then go to one of the plus size departments or stores and try to replicate the satisfaction you had mock shopping in your size range. Tie a few gallon water jugs to yourself and see what it is like to sit in your own furniture.

If you are really looking to get an inkling of the reality, fill the jugs with water and carry in your groceries. Water weights about eight pounds a gallon, so you can see what it is like at 50 pounds overweight, 100, 150. I doubt many of us could handle carrying around enough jugs to bring our weight up to the 500, 600 or higher that some people live with; the obese put the weight on over time so tend not to realize just how much weight they are asking their backs and knees to support. There is no way to truly feel what it is like physically to be obese: things like raw inner thighs from chaffing and permanent raw indentations from bra straps can not be duplicated.

These problems may seem trivial to some, but they represent serious, multi-layered difficulties that can have both a cumulative and a rippling effect. If you are afraid you might not be able to use facilities, long shopping trips become less inviting. If your size affects your lung capacity, you may have trouble sleeping, which can affect your performance at work, which in turn may worsen the experience of day-to-day financial strains. So might the ability to keep up, literally.

Duke University Medical Center researchers reported in 2004 that obesity significantly impairs the sexual quality of life. Obese people report sexual problems such as lack of desire, lack of enjoyment, avoiding sex, and performance difficulty at a much higher rate than people of normal weight.

Overweight and obese people are frequently stereotyped as emotionally impaired, socially handicapped, and as possessing negative personality traits. Evidence of discrimination is found at virtually every stage of the employment cycle, including selection, placement, compensation, promotion, discipline and discharge, according to research presented by Western Michigan University. In addition, this bias extends to job assessments of overweight individuals in their various work related roles, both as subordinates and co-workers.

According to recent studies, wages of mildly obese white women were 5.9 lower than standard weight counterparts; morbidly obese white women were 24.1 percent lower. In contrast to females, the wages of mildly obese white and black men were higher than their standard weight counterparts. Men only experienced wage penalties at the very highest weight levels.

The potential effect of applicant weight, age, sex and race on ratings of job candidate acceptability in a laboratory setting was examined in 1988. Overweight candidates were rated significantly lower, but none of the other criteria manipulations had a significant effect. Michigan is the only state that prohibits employment discrimination on the basis of weight.

The Americans with Disabilities Act (ADA) is a federal statute that protects qualified individuals with disabilities from discrimination on the basis of disability in the workplace. Since the enactment of the ADA, the Equal Employment Opportunity Commission has taken the position that people who are morbidly obese (body weight more than 100 percent over the norm) are disabled and protected under the ADA. This leaves a huge number of obese, but not morbidly obese, unprotected in forty-nine of fifty states. It also puts those who do qualify under obligation to bring an ADA law suit to rectify a qualifying situation. And you still have to prove it was discrimination due to obesity.

Compared to normal weight people, morbidly obese and massively obese people are more likely to incur instances of institutional and day-to-day interpersonal discrimination. Morbidly obese and massively obese persons report lower levels of self-acceptance than normal weight persons, yet this relationship is fully mitigated by the perception that one has been discriminated against due to body weight or physical appearance: a more palatable reason psychologically than character or personality defect, or a job not well done.

Unflattering portrayals of obese people pervade popular culture, while multiple studies document that children, adults, and even health care professionals who work with obese patients hold negative attitudes toward overweight and obese persons. Twenty-eight percent of teachers in one study said that becoming obese is the worst thing that can happen to a person; twenty-four percent of nurses said that they are repulsed by obese people.

Obese people who believe that their health care providers look down upon them may avoid seeking care; this reaction is potentially dangerous given that obese individuals are at an elevated risk for many health conditions.

Research conducted over the past 40 years shows that obese people are viewed as physically unattractive and undesirable. Obese individuals also are viewed as responsible for their weight due to some character flaw such as laziness, gluttony, or a lack of self-control and self respect. Obese persons may form negative self-evaluations as a reaction to the pervasiveness of negative attitudes toward obese persons and real or perceived discriminatory treatment.

Interpersonal consequences of severe obesity are most acute for members of higher socioeconomic strata. A number of studies suggest that upper-middle class Americans are less likely to be obese, more likely to adopt negative views toward the obese, and more likely to view thinness as an ideal body type; the belief that obesity is a consequence of laziness may be particularly common among those with richer resources and opportunities. Physical appearance and putting forth a positive image of your employer also may be a more critical aspect of job success in professional occupations than in blue-collar or service occupations. In all of our surveys, the only striking difference in obesity statistics was a drop in the obesity percentages in the shopping playgrounds of the wealthy.

The Employment Law Alliance (ELA) released findings from its America at Work Opinion Poll portending a rise in lawsuits alleging employment related obesity discrimination. The survey found 47 percent of obese Americans believe they have suffered discrimination in the workplace, while 32 percent think obese employees less likely to be respected and taken seriously in the workplace. Nearly 40 percent of those who identified themselves either as obese or overweight contend they deserve special government protection against weight-based discrimination in the workplace, though only 26 percent of individuals of normal weight echoed that contention.

Studies show that overweight and obese students, especially girls, are less likely than the non-obese to be accepted by the more competitive colleges. This is true even if their grades, standardized test scores, and other variables are the same as for other boys and girls.

Overweight people are less likely to attend college even though they score high on standardized tests and are academically motivated. Also, overweight women are more likely than other men or women to pay their way through college.

Overweight students are more likely to be refused letters of recommendation from faculty members.

There has been some change in the practices regarding hiring of the obese, as so much more of the employment force has become obese there is not often an option. Look at the number of employees you see in stores and businesses in a day, and you will notice that there are more obese employees than there were when you were a child. But it does not remove the ceiling or reduce the promotion restrictions that shadow the obese.

A study of 1200 doctors revealed that, although physicians recognized the health risks of obesity and perceived many patients as overweight or obese, they did not intervene as much as they thought they should, were ambivalent about how to manage obese clients, and were unlikely to refer them to weight loss programs. Only 18 percent of physicians reported that they would discuss weight management with overweight patients, and only 42 percent of physicians would have this discussion with mildly obese patients. I have lived and worked in five states in my lifetime, and have had jobs in six different counties in California, so I have had many different primary physicians in my adult lifetime, and I can tell you that most never broached the subject of my weight, and the few who did merely remarked that I should lose some.

In a 1969 survey of physicians, obese patients were described as weak-willed, ugly, awkward, and self-indulgent. In a more recent physician survey, one of three doctors said they respond negatively to obesity, behind three other diagnostic/social categories: drug addiction, alcoholism, and mental illness. A survey of severely obese patients found that nearly 80 percent reported being treated disrespectfully by the medical profession.

Physicians are not immune to obesity. Ironically, physicians report fifty percent of their physician colleagues are obese. The Physicians' Health Study reported that 44 percent of male physicians are overweight, and 6 percent are obese. Although there are no published data on obesity in female physicians, the Nurses' Health Study demonstrated that 28 percent of female nurses in the United States are overweight, and 11 percent are obese.

Researchers at the Mayo Clinic recently released the results of a survey of more than 2,500 obese patients who went to their doctor for a regular checkup over the course of a year. They found that only one in five of those people were listed on their charts as obese.

Discussing weight becomes even more complicated with children. According to a 2005 study in the Journal of Pediatrics, doctors diagnosed obesity less than 1 percent of the time among 2 to 18 year olds, a figure far below the one-third of young Americans struggling with overweight and obesity.

Among physicians, 17 percent reported reluctance to provide pelvic exams to very obese women, and 83 percent indicated reluctance to provide a pelvic exam if the patient herself was hesitant. Given that overweight women may hesitate to obtain exams and that physicians are reluctant to perform exams on obese or reluctant women, many overweight women may not receive necessary medical attention or preventive care.

Overweight and obese people get waited on more slowly than normal weight customers. They often encounter more difficulty making returns or exchanges than their thinner counterparts. When I was obese, sales people rarely asked to assist, and I often felt I had to track someone down; I assumed this was a general condition of the loss of the ethics of service of the old days. One thing I noticed when I became a size 4 was that sales people began to come up to me and ask if they could be of help much more frequently.

Results of a study by the North American Association for the Study of Obesity revealed that obese children were liked less and rejected more often by peers. Obese boys encounter more overt victimization (verbalteasing or physical aggression) and obese girls reported more relational victimization (cruelty by friends and cliques) compared with their average-weight peers.

Obese girls were also less likely to date than their peers. Both obese boys and girls reported being more dissatisfied with their dating status compared with average-weight peers. The results suggest that obese adolescents are at greater risk for mistreatment by peers and may have fewer opportunities to develop intimate romantic relationships; this may contribute to the psychological and health difficulties frequently associated with obesity; during adolescence, a time of rapid change in body shape and size as well as dynamic interactions with peers and parents, weight control is a particularly sensitive issue.

Recently school nurses reported being more likely to label obese children as sad and lazy. They overwhelmingly agreed with the statement Childhood obesity is a significant cause of peer rejection. Another recent study found that children who are obese are absent from school more than other children, missing an average of two more days than their non-obese peers. Interestingly, obesity seems to predict absenteeism more than any other factor, including school performance and socioeconomic status, two of the top reasons cited in the past for poor attendance. As a former public school teacher (at both elementary and high school levels, and as an principal and superintendent of schools pre-K-12), I can tell you that the number of days of school missed severely effects a child's learning, and can carry forward in terms of lesser jobs and less pay for the rest of the life of a child. That is a steep personal cost.

Social attitudes towards obesity are negative and usually result in the adolescent becoming withdrawn and isolated. Obese adolescents have feelings of low self-esteem, social isolation, feelings of rejection and depression and a strong sense of failure. Obese children are more likely to engage in high-risk behaviors such as smoking,or consuming alcohol. Obese adolescent girls are more likely to become sexually active at a younger age in an effort to achieve acceptance and attention.

The prejudice associated with obesity is intense. Fat teenagers are often disregarded and subjected to ridicule. Most comments about fatness have negative consequences. Young people are often humiliated and frequently suffer permanent emotional scars. Fat people become tired of being judged by weight first and personality second. Adolescent girls who are dissatisfied with their bodies frequently try to lose weight in unhealthy ways, including skipping meals, fasting, and smoking to ward off hunger. A smaller number of girls are even resorting to more extreme methods such as self-induced vomiting, diet pills, and laxative use. Strict food denial in an effort to lose weight often leads to late afternoon or evening binging episodes. More than one-third of obese individuals in weight-loss treatment programs report difficulties with binge eating. This type of eating behavior contributes to feelings of shame, loneliness, poor self-esteem, and depression, and these feelings in return can spur additional eating as a means of solace.

In a study by the University of California, San Diego, researchers were surprised to find that the scores of obese children on a quality of life survey were as bad as cancer patients in every domain of life.

One obesity study asked severely obese persons to take a forced-choice questionnaire; for each question, they had to make a choice between being at their present weight or having some other given illness. The results were astounding. Although there were some variations on some of the questions, every obese person said that they would rather be blind or have one leg amputated than be at their present heavy weight. Most interestingly, every person who participated in the study would rather be a poor thin person than a morbidly obese millionaire.

Little wonder that depression is commonly linked with obesity, and, having been overweight and obese from age 5 to 50, I can personally attest that this chapter understates the multitude and magnitude of the true personal costs of obesity.

The Personal Costs of Obesity
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