Remember back in March when I posted about a documentary called “Fat & Fatter”? It’s about two young overweight British women who travel to Smith County, Miss., to spend time with some morbidly obese sisters, and to explore eating and exercise habits, and what goes into making people so fat. As I wrote at the time:

“Why are you putting salt on your fruit?” Bex asked one of her hostesses.

“Because it tastes good,” she replied.

“But don’t you know too much salt is really bad for you? Don’t you feel guilty?”

“I’ll feel guilty tomorrow. Right now, I’m enjoying myself. The food is good.”

The show is playing out like a version of “Scared Straight” for fat people. The program had an interview with Ann’s parents back home in the UK. They are both rather fat. The two said that the reason their daughter is so large is because they fed her lots of convenience food growing up. They knew they were doing wrong, they admitted, but the girl loved that food, and they didn’t want to hurt her feelings.

They just talked to a 52 year old morbidly obese woman who is on dialysis three times per week; her type 2 diabetes caused her kidneys to fail. She was bluntly unsentimental about her situation. She showed the Brits all the wounds on her body from years of dialysis and medical procedures.

“It’s horrible, and it’s very painful. It’s reality,” she said. “It’s my fault. I ate pizza, everything, hamburgers. I was gobbling, gobbling. You ain’t thinkin’ about who to blame. You’re enjoying yourself to death.”

And wow, she was harsh to the younger women. She said flatly to them, ”If you don’t change your lifestyle, you might not be so fortunate to get on this machine. You may die.”

The documentary is now available in three parts online. Part Three is above. Part One is here; Part Two is here. I strongly encourage you to watch the whole thing. What keeps coming out, in all the people they talk to, is that everybody — both the obese people and their enablers — knows perfectly well the terrible effects of eating this way. They have the money to eat differently. But they don’t want to.

All of this matters to the question of healthcare reform in the US, because obesity and related medical conditions raise medical costs substantially. A new study estimates that obesity adds 20 percent to the nation’s overall healthcare bill. One doesn’t learn from this video to what extent the morbidly obese sisters receive healthcare paid for by the government, or by private insurance, but in either case they are driving up healthcare costs for us all. If you watch the video, you can see how much they suffer physically from their condition, and how expensive the treatments must be (e.g., the dialysis woman).

Yet it is very hard to feel sympathy for these women, because they are not trying in the slightest to change their way of eating. In the clip above, one woman who has not walked outside to her own mailbox in 10 years acts offended by the suggestion that she do so. Later in the clip above, the two visiting British women make dinner for the sisters. They go shopping at a local supermarket and buy ordinary fresh vegetables (and by the way, those sisters live in a nicer house than I do, so I don’t believe for one second that they can’t afford better food). The Brits cook an ordinary dinner of skinless chicken breast, green beans, corn on the cob (without butter), and sliced tomato, all in ordinary proportions. From the way the Mississippi women react, you would think they had been served twigs and leaves. Seriously, they freak out over it. The idea that they should have to change anything about the way they choose to live and to eat for the sake of healthier living is utterly foreign and repulsive to them.

It makes me sick to see it. Of course I do not believe these women should be denied medical care, any more than I believe smokers should be, even though they persist in their habit. Still, at some point, something’s got to give. The documentary shows that these women are not helpless victims of a medical or economic condition not of their own choosing. They know better. They can do better for themselves. They simply do not want to. And taxpayers and insurance rate-payers are on the hook for their extreme sloth and gluttony.

If we all have a responsibility to provide for the medical needs of others in the community — and we do — then the beneficiaries of the charity of their neighbors have a responsibility to do their part to carry their own weight. Literally and metaphorically.

I talked the other day to a cousin of mine who teaches culinary arts in the local public school here — this, for a TAC essay I’ve just written. She mentioned that most of the kids she teaches have almost no idea about basic nutrition, and even less idea how to prepare simple healthy meals for themselves. This is striking to me, in part because we live in a place where fresh vegetables are in great abundance this time of the year. It’s a rural parish; many country people have gardens. When I was a kid, my grandmother, who lived in a small cottage and didn’t have much money, spent many a hot summer day processing and canning vegetables from her own garden, from family gardens, and from neighbors’ gardens. That’s just how people did. The tradition has been lost.

Moreover, my cousin talked about the learned helplessness of her students — how many of them have a big mental and cultural block against learning how to do better for themselves regarding eating and cooking. She said she puts little stock in people who complain that they don’t have the money to eat better. Many of these kids eat McDonalds every single day. It’s not cheap, and its a nutritional disaster.

I think there are real obstacles to eating healthy in this country — obstacles put in place by government policies, by economic conditions (did you know that people in the US and the UK, the fattest of the industrialized nations, spend far less of a percentage of income on food than comparable nations?), by social and environmental factors (e.g., more sedentary workplaces, popularity of videogames teaching kids to be less active, etc.). There are also real medical conditions that make it very difficult for people to lose weight. I know this. I can look at my own family, and how the people who physically look more like my paternal grandfather are lean, but those who look more like my paternal grandmother — who was fat and diabetic — struggle with their weight. This includes me, and included my sister; our father took after his mother. I can see it in my own children. My oldest doesn’t eat much, but he’s got something of a gut. My middle kid eats like a horse, easily as much as his father does, but he doesn’t have an ounce of fat on him. My youngest eats like a bird, and is trim and delicate. Guess which one of these children most physically resembles their father?

Genetics are important. So are these other factors. But I remain convinced that the greatest obstacle — not the lone obstacle, but the greatest obstacle — is in our own heads.

I have been there myself. When I graduated from college, I ate the same crap diet many other people eat. I was rounding out my twenties when I finally got serious about eating like a grown-up, because I got tired of feeling so bad. It was hard at first, because French fries taste better than broccoli, and fried chicken tastes better than broiled chicken. Tough. You can’t have it all.

Over time, my tastes changed, and now, even though I like French fries, I’d almost always choose the broccoli, because it tastes better to me, and I know that if I eat it, I’m going to feel fine 20 minutes later, but if I eat the fries I’m going to feel heavy and slightly headachy.