This week, Health Affairs published a new study showing that--quel surprise!--obesity accounts for an ever growing share of our health care costs. They put the number at about 10%. So I decided to ask Paul Campos, the author of The Obesity Myth, what he thought. The book, which everyone should read, argues that the health benefits of losing weight are largely imaginary; that we are using "health" to advance our class bias in favor of thin people, particularly thin women.
Megan: The CDC is sponsoring a conference on obesity this week. In conjunction with this, the journal "Health Affairs" just published a study showing that almost 10% of US medical costs may be due to obesity. As we're debating the costs of a public health care plan, controlling obesity is moving even further to the forefront of the American public health agenda. What should we think of this?
Paul: It's a terrible idea on all sorts of levels. There are three big problems with attempting to control health care costs by reducing so-called "obesity." First, it's a fake problem. Second, the solutions for the problem are non-existent, even assuming the problem existed. Third, focusing on making Americans thinner diverts resources from real public health issues.
Megan: Let's start with the first. If there's one thing that everyone in America knows, it's that being fat is really unhealthy. Why do you call it a fake problem?
Paul: The correlations between higher weight and greater health risk are weak except at statistical extremes. The extent to which those correlations are causal is poorly established. There is literally not a shred of evidence that turning fat people into thin people improves their health. And the reason there's no evidence is that there's no way to do it.
So saying "let's improve health by turning fat people into thin people" is every bit as irrational as saying "let's improve health by turning men into women or old people into young people". Actually it's a lot crazier, because there actually are significant health differences between men and women and the old and the young -- much more so than between the fat and the thin.
Megan: So why is the public health community so set on this issue as the major driver of our health care costs?
Paul: Because we're in the midst of a moral panic over fat, which has transformed the heavier than average into folk devils, to whom all sorts of social ills are ascribed.
Megan: Aside from rising health care costs?
Paul: Well according to the obesity mafia our kids are all going to die sooner than their parents, which sounds like a moral problem as well as one of health care costs. It's all complete nonsense.
Megan: Do you think being overweight is a proxy for things that DO make a difference, like fitness?
Paul: It's a weak proxy, but yes it has some marginal significance. It's good to encourage people of all sizes to be active and avoiding eating disordered behavior (like dieting), but this isn't because lifestyle changes will make fat people thin people. They won't. I'd like to talk a little about the statistics if I may.
Megan: Please! We're all about statistics here.
Paul: OK, the CDC honchos and the authors of this study you referenced are in hysterics because the obesity rate, so-called, has roughly doubled in the last 30 years. But let's consider what that actually means.
Obesity is defined completely arbitrarily as a body mass index of 30 or higher (175 pounds for an average height woman). Now body mass follows more or less a normal distribution, whiich means if the the mean body weight is in the mid to high 20s, which it has been for many decades now, then tens of millions of people will have BMIs just below and just above the magic 30 line. So if the average weight of the population goes up by ten pounds, tens of millions of people who were just under the line will now be just over it.
This might be meaningful if there was any evidence that people who have BMIs in the low 30s have different average health than people with BMIs in the high 20s, but they don't. At all. So the "obesity epidemic" is 100% a product of tens of millions of people having their BMIs creep over an arbitrary line. It's exactly as sensible as declaring that people who are 5'11 are healthy but people who are 6'1" are sick.
Adding to the absurdity of all this, people with BMIs in the mid to high 20s actually have the best overall health and longest life expectancy -- ,more so than those in the so-called "normal" BMI range.
Megan: So we can't save billions of dollars by making people thinner?
Paul: Consider the methodology of this study. It tried to calculate changes in health costs if everybody with a BMI over 30 had a BMI under 25. But leaving aside the preposterous assumption that all increased health risks associated with a level of body mass are caused by that level of body mass, the idea that somehow we could make fat people into thin people is bizarre.
A study like this isn't talking about turning 180 pound women into 165 pound women, which at least in theory might actually be possible. It's talking about turning 200 pound women into 130 pound women, on statistical average. The success rate for such attempts is about .1% Even stomach amputation does not turn fat people into thin people.
So even if it were true that we knew it would be beneficial to turn fat people into thin people (which we don't) it's not something we have any idea how to do. The statements in the study indicating that there are known methods for doing this are simply lies of the most egregious sort.
Now lets talk about excess health care costs. if you look at the study, nearly half of the excess health care costs associated with being fat are from higher rates of drug prescription. But why are fat people being prescribed more drugs than thin ones? Largely, because they have the "disease" of being fat, which is then treated directly and indirectly by prescription drugs!
For instance, statins. Statins are a multi-billion dollar business, but there's very little statistical evidence that they benefit the vast majority of people to whom they're prescribed. Basically the only people who have lower CVD [cardiovascular disease] mortality after taking statins are middle-aged men with a history of CVD.
But the heavier than average are prescribed statins at higher rates simply because they're heavier than average, even though there's no evidence this is beneficial for them. And of course this doesn't touch on the costs of all the treatments for "obesity" itself, which are uniformly ineffective.
Megan: You're saying that increased risks from being heavy come from--what? Having gained weight in the first place? Bad genetics? Or dieting?
Paul: As for where the increased risks associated with being heavy come from (such as they are), many of them come from weight cycling, which is clearly bad for people, and which is the outcome of 98% of diets. Others come from the stress and social discrimination generated by having what's considered an inapproprirate body in this culture. Others come from diet drugs, eating disordered behavior, poverty -- all things strongly associated with higher than avberage weight.
Megan: What about gastric bypass? The quoted figures for gastric bypass seem pretty impressive when doctors talk about them on television.
Paul: Gastric bypass is surgically induced bulimia. People starve for the first few months so of course their blood sugar levels go down. At five and ten year followup the average weight loss from these procedures is about 10% to 15% of body mass (it's actually less than that since lots of people drop out of the studies) which means most of these people end up still "morbidly obese." And they can never eat normally again.Why do you think you never see the actual stats for weight loss from stomach stapling? If they were good they'd be on billboards 50 feet high.
Megan: Those shows on TLC that basically invite the audience to gawk at fat people usually say they'll lose fifty percent of their excess body weight
Paul: If you put people on starvation diets, which is what these methods do, of course you'll get huge amounts of weight loss. Then most or all of it will be gained back, which among other things is a recipe for congestive heart failure. I'd love to do a "reality" show on the contestants on shows like The Biggest Loser three years down the road. But that would probably be a little too much reality.
Gastric bypass is the most radical method available for weight loss, and it basically doesn't work. Everything else is even less successful, though usually not quite as dangerous.
Megan: Over the last five years or so, I've noticed that public health efforts about obesity are not just amping up the volume, but exploring increasingly coercive methods to induce weight loss: taxes on junk food, lawsuits against fast food companies (which are basically a tax on junk food), and so forth. Does that match your analysis?
Paul: It's the classic pattern of moral panics. As public concern about the damage being done to the fabric of society by the folk devils increases, increasingly intense demands are made on public officials to "do something" about the crisis, usually by eliminating the folk devils.
That of course is the strategy for this crisis. If fat people are the problem, then the solution is to get rid of them, by making them thin people. The most amazing aspect of this whole thing, for me, has always been the imperviouusness of policy makers, and even more so people who consider themselves serious academics and scientists, to the overwhelming evidence that there's no way to do this.
I mean, there's no better established empirical proposition in medical science that we don't know how to make people thinner. But apparently this proposition is too disturbing to consider, even though it's about as well established as that cigarettes cause lung cancer. So all these proposals about improving public health by making people thinner are completely crazy. They are as non-sensical as anything being proposed by public officials in our culture right now, which is saying something.
It's conceivable that through some massive policy interventions you might be able to reduce the population's average BMI from 27 to 25 or something like that. But what would be the point? There aren't any health differences to speak of for people between BMIs of about 20 and 35, so undertaking the public health equivalent of the Apollo program to reduce the populace's average BMI by a unit or two (and again I will emphasize that we don't actually know if we could do even that) is an incredible waste of public health resources
Megan: The idea I'm hearing now is that we need to change the environment, but of course, if losing a great deal of weight actually makes you unhealthier, that might not save us any money. The other idea I'm hearing a lot more these days is that we have to Save the Kids: intervene when they're young so they don't get fat in the first place
Paul: So the strategies that have failed so spectacularly with adults -- tell them to exercise more, and eat less, and shame them about their weight -- will work with children. Because if there's one thing fat kids need, it's to be made to feel bad about feeling fat.
The current stigmitization of fat kids is essentially child abuse as government policy, and the people behind it are, as far as I'm concerned, either incredibly stupid or very evil or in some cases both.
Here's an idea: Stop harrassing people about their weight. Because it appears that focusing on the idea that being fat actually makes people fatter. At least there's an extremely strong correlation there. I bet if we stopped demonizing fatness people would actually be a bit thinner. They'd certainly be happier and healthier
Megan: What should we do instead if we want to reduce health care costs? Here are some proposed ideas I've heard:
- Taxes on soda
- New urbanism (make people walk more)
- Bring back physical education in schools
- Make gym memberships tax deductible
- Menu labelling.
Paul: Some of those ideas may have merit independent of whether they'll make people thinner (they won't). It's good to encourage physical activity, but NOT if the purpose of encouraging it is to try to make people thinner. Then it's counter-productive. People will be healthier if they're more active and don't smoke and if they avoid eating disordered behavior (like dieting in particular.
But Americans are actually very healthy and getting healthier all the time, despite the massive inefficiencies and dysfunctions of our health care system.
Megan: The problem is, almost no one actually does "healthy" activities to be healthy. If burgers made you thin, but clogged your arteries, I think 95% of the "healthy" eaters I know would consume one every day.
Especially since those people are generally young people with poor grasp of their own mortality. Eating "healthy" and then taking up free climbing doesn't make much sense.
Paul: Oh that's certainly true. The idea that people pursue thinness primarily for health reasons is laughable.
Megan: They often actually claim they don't care about being thin. It's just a happy side effect of their drive for health. Indeed, I'm sure I've made that claim myself more than once while on the quasi-permanent diet of the Upper West Side woman.
Paul: It's pretty much the opposite though. I know for a fact (because they've told me) that some public health officials engage in what they think of as a noble lie about the effects of physical activity on weight, because they know people won't become more active just to be healthier.
Megan: Is there any evidence this works? Don't people just stop going to the gym when they notice they haven't lost any weight?
Paul: Of course. People aren't dumb. They do the experiment, the experiment doesn't work in the vast majority of cases, so they quit until they get desperate again. Or (llke the upper West Side women) they stay on a permanent restricted lifestyle that the vast majority of people don't have the combination of willpower and social privilege to maintain. There's an important class angle here. Thinness is a sign of social status, and is to some extent a product of it, which is one reason -- probably the main reason -- why it's so prized, especially among women.
Megan: An economist recently pointed out that we don't encourage people to move to the country, even though rural people live more than three years longer than urban people, and the diffefence in their healthy life expectancy is even more outsized. Nor do we encourage people to find Jesus or get married. We target "unhealthy" behaviors that are already stigmatized.
Paul: Right, as Mary Douglas the anthropologist has pointed out, we focus on risks not on the basis of "rational" cost-benefit analysis, but because of the symbolic work focusing on those risks does -- most particularly signalling disapproval of certain groups and behaviors.In this culture fatness is a metaphor for poverty, lack of self-control, and other stuff that freaks out the new Puritans all across the ideological spectrum, which is why the war on fat is so ferocious -- it appeals very strongly to both the right and the left, for related if different reasons.
Megan: And now a convenient scapegoat for our health care costs: if we can just eliminate the folk devils, we can have a new national health care program, and more room on the bus, for free!
Paul: Yes it's a low-calorie free lunch.
Megan: If you were put in charge of reducing the costs of the new plan that we may or may not get, is there anything you would do? Preferably instead of lecturing people about their avoirdupois?
Paul: One thing I've learned over the past 20 years of studying about four issues in great detail is that it takes an enormous amount of work to have a meaningful opinion on any complicated issue. I don't have anything useful to say about what sort of health care policy we ought to have, because I don't know enough about the subject. So I don't know what we should do in general. I do know what we should do about fat, which is to stop talking about it. If I were emperor I would ban scales from all homes (just kidding -- sort of)
Megan: Probably have a hard time getting that past Obama's proposed health commission.
Paul: Or anybody else's. I do want to mention that I think a huge factor in all this stuff is the desire to get the next generation of diet drugs through the regulatory pipeline. That's the goose that will lay the golden eggs for so many interested parties.
Megan: Well, here on the east coast, it's lunch time, so I'll let you go. Thanks for talking with us.
Isn't it interesting that the rate of obesity doubled in the last 30 years. In case you don't know, that coincides perfectly with the government's decision to tell us how to eat - the "food pyramid".
Carbohydrates lead the list on that - all sugars. Eat lots of pasta (carbs). Make sure you eat all that fruit - loaded with sugar, which is why it tastes good. Give your kids lots of fruit juice (lots of sugar), but watch that poison known as milk. All that "fat" in milk might give them a heart attach at age 11.
Whatever you do, stay away from protein, like meat and eggs, it's pure poison according to the government bureaucrats.
By the way, the huge jump in diabetes also coincides with the government's food edicts on eating carbs and little protein. Meanwhile, heart disease stays the same as it was - despite all the "healthy" eating.
Could it be possible that, for only about the 40 millionth time, the government bureaucrats totally f--ked up?
The food pyramid clearly isn't the ideal nutritional guide. But look at portion sizes at McDonald's and such now compared to 30 years ago. Or any restaurant. The number of calories consumed on average has skyrocketed, and that definitely isn't due to everyone closely following that goofy food pyramid we saw in elementary school. It's just due to people constantly overeating, and eating unhealthy foods, because that's part of our modern culture. Not *everything* is the fault of liberal bureaucrats, try as you might to spin it that way.
ed
Are you implying that 2/3s of Americans follow the Food Pyramid? The pyramid states that one should consume meat sparingly per week. Instead people eat it daily and often several times. Do you know how much calories the average american consumes from dairy? Almost 40%. Butter? Cheese? Cream?
And sugars? I think you are confusing carbs with sugars. Pasta does not equal corn syrup at all. Sugar can does not equal a mango at all. Please show us how many dangerous sugar calories Americans consume via fruits.
Then please also explain to us why the government subsidizes the most unhealthy foods of the "government pyramid" with our tax dollars and via the bureaucracies that you fear. Why don't Southern Republican states try to refuse those subsidies like they tried with some of the stimulus money? What is going on here? Maybe you can help.
Do you know how much calories the average american consumes from dairy? Almost 40%.
I don't know where you got that, but I call BS. Here's USDA data on food availability, which is essentially an upper limit on how much the average American eats.
It shows 284 calories daily from dairy products, or just over 10% of available calories. If we assume that the average American eats only 2,000 calories and that wastage skews away from dairy products, that still won't get you to 15%. 40% should be implausible to any reasonably numerate person.
For comparison, the other categories:
Meat: 387 calories
Eggs and nuts: 89
Fruit: 91
Vegetables: 130
Grains: 626
Added fats: 710
Added sugars: 459
Again, these are availability figures, not consumption figures, but they do provide an upper bound for consumption, and I think that average actual consumption is probably not much less than this.
Meat and dairy consumption do appear to be more or less in line with the recommendations of the food pyramid, at around 2-3 servings each. The real deviations are in added sugars and fats.
Mr Berg,
Thank you for helping me prove my point.
Following your link - it becomes clear that butter, cream and cream cheese etc are EXCLUDED from dairy in this calculation. They show up under Added fats! How can you conveniently miss that Mr Brandon Berg? Especially if you have shown interest in this topic for long?
Please do your calculation again and before calling out BS. Why so emotional and vulgar anyway? "BS, fuck,..." Are you guys, yourself,... never mind.
ed writes:
The data posted by you shows that we human apes get only 4% from fruits. Much less than from Added Fats (mostly saturated) and Sugars (simple). Is ed merely projecting?
What is going on here?
PS: To be fair - in my "almost" 40% from dairy sources statement I have included lard and eggnog etc which is obviously saturated fats animal fats but not from dairy.
But my obvious point, which I feel has been confirmed by your data, is that we do not follow the Food Pyramid. Not by far. As most people know anyway - we eat to much fat, the saturated ones being the worst, and simple sugars.
The other point is that the government is subsidizing exactly those foods that we eat too much of when compared to the "government" pyramid. As a libertarian I find this absurd and it is hard to take any ideological "sick care" discussions seriously unless you tackle this hypocrisy first?
But all this is still not as absurd as ed's implication that we should eat less fruits and more meat and milk?
Mr. Pottisch:
You're right; I did miss that, and I apologize for the error. However, your 40% figure is still way off, "almost" or no. According to the breakdown for added fats and oils, butter accounts for 37 calories per day and dairy fats from other sources account for 28 calories. That gets you up to 350 calories per day from dairy products.
Throw in lard, tallow, and egg nog, and you get another 30 calories or so. The added fats are overwhelmingly plant oils and shortening.
So you still overstated the role dairy products play in the average American's diet by a factor of at least two.
You are correct about fruit not being a major source of calories for most Americans, which is why I didn't dispute that point. I would argue, however, that most domesticated fruits, having been bred for much higher sugar content than their wild ancestors, are not particularly healthful.
I appreciate people with well-supported insights that run coutner to conventional wisdom, but there are a lot of unsupported and/or weasely assertions here. Paul Campos looks to be trying to do for fat people what Elizabeth Warren tried to do for the middle class: sell books that make them feel better by arguing that they aren't responsible for their own plight and we should all be more supportive of them.
Campos claims that it's "nonsense" to link weight and health and that losing weight is "basically" impossible. But he also admits that weight does have "marginal significance" as a health indicator and that it "might actually" be possible for someone to loose 15 pounds. He then throws in a lot of hyperbolic rhetoric like "surgically induced bulimia" and hopes we won't notice the contradictions.
Yes, there are overblown claims tinged with moralistic rhetoric about obesity out there, and Campos appears to be doing his part to make sure there are overblown counter-claims tinged with moralistic rhetoric about obesity out there, too.
Well put
No.
If you loose 15 pounds from exercising over an extended period of time (I did this after my children were born; over a period of about four years,) you don't put the weight back as easily as if you drop 15 pounds in a couple of months starving yourself.
Both are losing weight; but they're not the same thing.
The first is good for you.
The second is horrible for you.
What he's saying--and from what I've read, he's right--what he's saying is that the amount of weight it has proven possible for people to lose long term--about 10-15 pounds--does not have any measurable effect on health. The people who are really significantly impacted are people who are hundreds of pounds overweight. Those people are not going to get thin because we put calorie labels on McDonalds menus. Those people have spent most of their lives dieting like crazy, and 90+ percent of them could probably cite the calories in every item on the McD's menu by heart. Study after study shows that those people don't lose any significant amount of weight long term--not with Atkins, not with Sugarbusters, not with Dean Ornish (sorry, Taubes fans), and not with any other diet. Campos is not the only one saying this; read Gina Kolata's Rethinking Thin. Even if obesity is a problem, it's not one we have any idea at all how to fix.
The issue is that middle class people who manage to stay 10-30 pounds lighter than their body would like to be confuse what they are doing--which does not in any way increase your measurable life expectancy, btw--with what a morbidly obese person would have to do to stay thin. And even then, Campos argues there's no evidence that if they could do it, they'd actually be much healthier.
The health benefits from losing that 15 pounds I described come from the exercise, not the weight loss.
Dieting that 15 pounds off; particularly when the diet is fad instead of a life-time change toward sensible eating, is a much larger health issue.
The real conundrum comes when we get to the "healthy diet" description.
There, I would agree with Michael Pollen, we've let nutritionism overtake good nutrition; paying too much attention to the supposed value of the parts and forgetting the value of the whole. And forgetting the joy of the table, shared with people we love. I highly recommend his book, "In Defense of Food." It's one of the best books on food I've read.
The studies are incredibly poorly done. At the least, they ignore the obvious evidence shown by very fit people (who do not exercise hours a day as a norm, nor do they starvation diet to maintain their weight) that long term weight loss and maintenance are not only possible, but relatively straightforward processes to achieve.
Several of these studies have things like study participants giving up on exercise and only doing it when they felt like it, but then that is recorded as 'see, exercise is useless!'. Also, the level of activity in these studies is just too low to actually do anything. Ten minutes per day lifting weights will result in long term fat loss without any other changes (not very much, but a little), but these studies usually involve slow walking, no weight training at all, and participants do the same exercise at the same pace for the entire study (when again there is extensive documented evidence that exercises must be regularly changed around so the body doesn't get too efficient at the form and thus reduce the exercise's calorie benefits).
The dirty little secret of studies 'proving' that diet and exercise are useless to lose weight is that they wildly underestimate intensity of physical activity and they also ignore what very fit people know-- you have to eat enough to lose weight or maintain a certain weight level long-term.
1200 calories a day is horrible for most people, but even diet studies calorie restrict at fixed levels like that for all the participants, and don't even bother to give each person a calorie reduction that is tailored to their current body weights, which is essential to long term weight loss.
A six foot tall man weighing 300 pounds who wants to be 220 can probably eat about 3000 calories a day, increase his activity level and lose pretty much all of that weight in a calendar year and it will stay off so long as he keeps up the same activity level, even after he moves up to more calories to maintain his lower weight.
In one of these studies, this guy would be told to do light jogs or very slow walks, put on a 1500 calorie per day diet, and then everyone would stand around baffled that he didn't ultimately lose weight.
There is just a ridiculous amount of misinformation floating around as justification for being overweight and out of shape. Paul Campos is used by 5'3" women weighing 400 pounds as an authority on why their body is 'designed' to be that way. Which is complete BS.
http://www.msnbc.msn.com/id/4580934
http://www.telegraph.co.uk/science/science-news/5787445/Secret-to-a-long-life-is-ultra-low-calorie-diet-claim-scientists.html
http://en.wikipedia.org/wiki/Calorie_restriction
This is technically about very low calorie intake, not actual body size. Still, body size, to my knowledge, correlates reasonably well with calorie intake, particularly in childhood.
This is hardly knock-down evidence against the argument that we're overly concerned about thinness. Still, there is substantial evidence that very low calorie consumption prolongs life considerably. It seems quite possible that calorie consumption is thus relevant in the development of numerous ailments that low calorie consumption avoids. It's unclear what the exact shape of the relationship it - it's probably not quite linear.
There also do appear to be some meaningful links between diet and health outcomes - it seems unlikely that diabetes has shot up for completely non-dietary reasons. If the way to get people to eat healthfully is to have them want to be thin, the whole lie makes sense. Of course, this doesn't actually work; most people who diet do so temporarily, not as a change to a healthier lifestyle, which probably explains why most of them fail in the long run.
Right on, David. There is a measure of moral panic out that about obesity but Paul Campos seems no better than those he critiques.
Why doesn't he mention the correlation between rising BMIs and the incidence of Type II diabetes?
Well said David...
Paul's comments throughout this interview are in direct conflict with my own personal experience. Some feel as though he is directly insulting me and so many people I know. For example, "the idea that people pursue thinness primarily for health reasons is laughable". Thank you Mr. Paul Campos for calling my lifestyle "laughable".
I find his claims that "there is literally not a shred of evidence that turning fat people into thin people improves their health" hard to digest. I am consistently reading about the benefits of diet and exercise. Here is one, an article on stress and health by John Medina, Director of SPU’s Brain Center for Applied Learning Research and author of Brain Rules(http://www.spu.edu/depts/uc/response/summer2k9/features/cope-with-stress.asp).
I wish he would quit calling weight loss strategies as diet's too. A diet is one's style of eating. A typical Japanese diet may consist of particular foods and eating times. A diet is not something people suddenly do to change their appearance. Comments like "As for where the increased risks associated with being heavy come from (such as they are), many of them come from weight cycling, which is clearly bad for people, and which is the outcome of 98% of diets" sound asinine. Maybe 98% of consumers commiting to short term radical eating strategies may be bad, but lets not blame the diet.
There are probably a lot of reasons people make up stories about weight and health. One of them may be that it's not that much fun to demonize smokers any more, now that they've pretty much been run out of town, so we have to find a new group to bully. Back in the day, it was common to argue that smokers drove up "our" medical bills, although smokers' lifetime medical bills are lower than non-smokers' because smokers tend to die before getting the really expensive stuff. Now we are starting to bully fat people and those who sell them food.
I think it was Hayek who pointed out that the kind of person who seeks political power will depend on the sort of government we have. If the government controls the details of people's behavior, government "service" will be attractive to those who like to push others around.
Let me preface this by saying that I lost 100+ pounds the old-fashioned way a few years ago and have kept it off since that time.
I agree with Mr. Campos that the government should get out of the fat-fighting business, but what's his point other than that? Does he believe that fat people should not try to lose wieght because they probably can't? Or because it won't imporve their health?
If I hadn't lost weight, I almost certainly wouldn't have attracted my wife (I mean, no one consciously says "I won't date fat people", but hardly any non-fat people do). I might not have gotten the job I have now. And just looking at yourself in the mirror and seeing a "normal" person rather than a fat person can change your ife everyday.
Has Mr. Campos ever had to squeeze a 350-lb butt into an airline seat? Or been refused entry into a roller-coaster because the bar wouldn't go down over his belly? Or gone shopping only to find that he has to dress as a retired golfer or a lumberjack? Being fat sucks, regardless of health.
So if watching calories is the only way to not be fat, why on earth wouldn't I do it? How can he possibly object to "The Biggest Loser"? Good grief, the show takes massively fat people and makes them feel good about theselves for the first time in years. Talk about missing the point. I totally agree that the "ideal" of thinness in our society is screwed up, but there are better targets than a show that consistently helps people change their lives for the better.
Finally, Ms. McArdle, this interview showed far too much skepticism from you. You believe in markets, don't you? If obesity is such a bad predictor of health or early death, why do life insurance companies use it in pricing insurance? They have an economic incentive to price risk of death correctly. I'm not saying there's not a good answer to that question, but you didn't seem to press Mr. Campos on any of his claims. I am a big fan of yours, but this was a disappointing effort.
Good points.
Does Campos's book touch on the diabetes issue at all? Without actually looking at recent research, my impression is that type II diabetes and obesity are at least somewhat well-correlated, even if diet (as ed notes above) is a more fundamental factor. There's no question, I think, that diabetes costs are huge and long-lasting, even more so than CVD. I'd be interested to hear his counter-argument on the issue.
Yes, obesity and type II diabetes are correlated, but we don't know the direction of that causality, even though docs, nurses, and dieticians nearly all assume that somehow diabetes is the result, not the cause.
I find this worth poking on because of my anecdotal experience with diabetes. I posted this on Althouse recently, too, but it fits here.
I've recently had two pregnancies,and in both cases, had gestational diabetes, which is when your baby and your placenta basically put additional load on your body, either on the blood sugar itself or on the pancreas, and your insulin/glycogen can't maintain the old balance. What happens is you're hungry and tired so you eat, but your body can't convert the sugars to energy, so they just loll around in your system, and eventually get converted into fat. nothing burns the fat, and nothing burns the sugar, so you keep needing to eat more because you're still starving, and all you do is put on weight.
I was starving all of the time. and by starving, i mean desperately hungry. Fall-down-and-cry if not able to get to eat hungry. emotional basketcase hungry. And nothing I ate made me any less hungry. an hour after a meal I was starving again. fruits, nuts, veggies: starving while eating. a pork chop: not hungry for an hour. a pork chop, milk shake, order of mac and cheese: maybe TWO HOURS max before starving again.
I went from 110 pounds (at 5'4") at 12 weeks gestation the first time to 195 at 40 weeks: 85 pound gain, at least, and the second time from 115 to 180, 65 pounds gained by week 39. The second time the diabetes police had me on a strict diet--basically the opening stage of Atkins. And that diet restriction? Made me insane. I was in the foulest blackest mood ever. It was as if I'd been a pack a day smoker and gone 2 days without a cigarette. I was habitually angry, anxious, and otherwise feeling like I was going to lose it at any second. It was outrageously worse than whatever weight gain would have been. And the meds they give to control it? EVEN WORSE! THEY INCREASED HUNGER!!!
So, what if something triggers type II diabetes in people, and they become obese because they are starving all of the time and nothing makes them satiated? What if most people, having NEVER felt that hungry in their lives, haven't taken their patients really seriously, and think "those fattys need to diet and exercise" having never legitimately investigated why that might not be a possible solution? What if dieting made you suicidally depressed because you can't regulate your blood sugar that way, and the way the docs tell you to regulate it makes your mood one of black despair?
I don't think it's farfetched anymore. I wonder how often overweight people aren't really taken seriously in the first place, so their concerns are dismissed.
Allison -
Thanks for discussing your experience. It brings up something I've wondered - even if there's a correlation between obesity and health, how can we determine causality? When I was in graduate school in economics, we spent a lot of time on how difficult it is to establish causality, but for politicians, any casual correlation seems to be considered sufficient. Maybe sun spots and/or skirt lengths really do drive the stock market!
What's obvious is that there's an awful lot of metabolic diversity in the population. I've never heard a story exactly like yours before (wow, that's a horrible experience, and I'm amazed you were willing to go through it a second time), but I've heard enough other accurately reported and differing stories to make it clear that there isn't a one size (heh) fits all solution to obesity. And there's also a lot of variation in ideal weights, body fat percentages, etc.; whether losing weight would lengthen your expected lifespan varies from person to person!
In light of this, moralistic crusading is disgusting. We're all honestly trying to figure out our own bodies. So many people are afflicted with the illusion that if a particular diet and exercise regimen works for them, it'll work for almost everyone.
Allison --
Thanks so much for such an excellent description of the experience of diabetes. I was diagnosed with Type II diabetes several years ago and that's exactly what I've been living through. I went on Wellbutrin while enduring Atkins. Atkins worked for awhile but eventually stopped helping me, so I'm on insulin now. Prior to developing diabetes I was following the low-fat diet that I was told was healthy -- loaded with refined carbohydrates and sugar, and almost devoid of protein. I would get the lap band surgery but my insurance won't cover it -- instead they'd rather shell out thousands for insulin, other medications, doctors' appointments, lab tests, and operations. I get a heart stent at the end of the month.
There's so much slimy doubletalk in his interview I don't know where to start. But I'll just go with his most notable claim that underpins most of his argument: that people with an overweight BMI have the longest lifespans overall. And this is true! I think 27 is the best number on the graph. But he conveniently leaves out one major reason why this is true: because smoking is an appetite suppressant and a lot of smokers are therefore fairly thin but with tons of health problems. I'd love to see the same chart that I know he's referring to with smokers excluded and see him make the same argument.
The implication of what he's saying is that if someone with a normal BMI would have better long-term health if he gained 20-30 pounds of fat. This is, to put it mildly, completely insane. And the obesity problem is not about people with a 30.2 BMI. Which, by the way, is what mine is, at 6'3 242, and I feel horribly large and am trying my hardest to lose weight before the likely onset of diabetes. But it's not about people like me, it's about the people who have a much higher BMI. 6'3 300 is 37.5. 5'8 270 is 41. Over half the people in my company and quite a large percentage of the people in the South where I am have figures like this. Go into any Wal-Mart and see for yourself. And even the chart he cites as evidence is clear that over 35 BMI your health problems go dramatically up.
Megan, you could do a lot better than this guy. You'd absolutely tear him apart if he were using logic like that to support liberal views.
According to his book--and I haven't read the studies--there are too local minima on either side of the "normal" weight being promoted. But he also points out that the revulsion towards fat people, which is promoted by the public health establishment among many other outlets, is a common reason that people keep smoking. If you simply compare fit active people to "overweight" and "obese" active people, there's no difference in life expectancy.
I can agree with him that stigmatizing fat people, or making a moral campaign to shame fat people, is unlikely to help much. But I'll admit that his answers in this interview jumped up and down on my slippery reasoning/snake oil salesman buttons.
1) Paul Campos is a law professor, so anything he says about medicine should be read with that in mind. (Not that we lawyers cannot be educated about science but I do question his qualifications to dispute the mounds and mounds of evidence that contradict his theory.)
2) As Adam notes, Campos sets up a strawman in saying that people with BMI of 30 or so are not unhealthy. It's those in the 35+ category that have the clear health risks, and he does not address that population at all.
3) I, like Matt F. , wondered about the diabetes question. Lo and behold, Campos admits there is a link between diabetes and weight. (See Salon interview with Rebecca Traister). But he downplays its role in mortality. I don't know enough to take on that assertion but since the point of his conversation with Megan was to discuss the role of obesity in healthcare expenses, it is preposterous to ignore diabetes, which is a huge cause of medical expenses. All I need to do is look at the costs of my husband's glucophage, mother-in-law's and sister-in-law's insulin, etc., to see just a few examples. (And then we can add my mother-in-law's endless medical bills for the diabetic wounds, and it goes on and on from there....)
It's not a strawman, because it's people in the 30 range who account for the "obesity epidemic".
"Paul Campos is a law professor"
This explains a lot. It's pretty clear from the interview that neither of them knows much of anything about food, nutrition, or fitness.
Smoking is not the reason why people with lower BMIs die younger. The studies control for smoking (as well as many other pre-existing conditions and behaviors). People in the "overweight" range were less likely to die from infections and accidents. Those in the "obese" range, shared those advantages. However, obese people had overall increased mortality, due to diabetes, stroke, MI, etc. However, where Paul gets it wrong is his dismissal of bariatric surgery. I am a surgery skeptic, in the sense that it seems like a very invasive procedure, just to get rid of some fat. However, randomized trials have shown that people with pre-diabetic symptoms, were significantly less likely to develop diabetes, and overall lower mortality rates than those who were "treated" with diet and exercise counselling alone. I agree with Paul's overall skepticism about the anti-fat movement. However, it is not always necessary, to maintain a strong position, to insist that every last argument or scientific result is on our side.
"We're all about statistics here." And weddings.
But too much statistics - as in prattle about correlations - is a bad thing. Although matters of diet can't be tested in the best way - the double blind, randomised, controlled experiment - they can surely be tested in a better way than mere observation and correlation.
Whatever the perfect shape to be is, BMI is a lousy way to measure it
Phhiu. Lucky me that I read till the end because I initially had the impression that this guy knows exactly what is wrong and ergo does know to a degree what is right. Something out of the rest. What strikes me as a libertarian most about this whole debate is that nobody really discusses an end to subsidies of those things that make us sick when consumed in too large quantities over time.
Question: what do independent scientists and nutritionists say about too much saturated fats and simple sugars? Given that - what would a libertarian policy look like to improve on that? Do nothing? That would mean - stopping the bad things that we are doing as much as not adding to the pile? Or does "doing nothing" these days, when uttered by libertarians, mean "doing nothing starting from today's status quo"?
It almost seems as if we are still at the stage where we were with man-caused environmental destruction more than a decade ago? Is there a real problem at all? Let's assume, for argument sake, that there is a real problem beyond the elitist socialists and capitalist pharma threat.
What would a preventive libertarian policy look like that attempts to lower our consumption of certain nutrients? In contrast to the reactive treatment centric policies discussed right now?
Campos' claim about diet drugs runs counter to one of your (our) heroes, Derek Lowe. Go through all of his posts on obesity drugs and you'll see one thing: no one is having a lot of success, and companies are dropping out of the clinic.
Maybe the magic diet drug is out there, but most in the industry don't see any success anytime soon.
Bravo, Megan. Excellent interview. (And I'm proud of you for doing the Q&A format, it's not easy.)
And great myth busting.
We have this fixation on fat, and on dieting, that's astonishingly unhealthy. When my father was living with prostate cancer, and my brother living with AIDS, both were encouraged to put on as much weight as they could; reserves against the days they wouldn't be able to eat. (They both complied happily, and both still died very thin.)
And I love what he stresses as the real health danger: yo-yo weights and diets. Not fat. Diets.
Excellent point about your family members being medically advised to get fat. This is exactly why Magic Johnson has survived AIDS unlike so many others, and is thriving. In my own family, my grandfather in his youth survived a serious bout of tuberculosis because of his solid build and extra fat reserves. He's edging on 93, and he is a bossy, happy fat old man in full possession of his senses.
And yes - down with yo-yo weights and dieting. What really matters is maintaining some damn consistency and healthfulness in the simplest lifestyle activities - eating and sleeping. You can have a healthy equilibrium within a very wide range of body types. One of the unspoken side effects of this "fat" obsession I think is the way fairly healthy people who are average or slightly overweight get sucked into yo-yo-ing and weight abuse because of damaged self-image. Extreme examples are held up as a house of horrors... and constant overexposure to both ends keeps the inner demons loud and strong.
But...but...there are no old fat man! Every internet commenter tells me so!
And dieting works because there were no fat people in Auschwitz!
Sorry, I'm bitter. I should stop reading comment threads.
There are simply very very very very very few fat people over about age 70. This is handwaved aside by the 'obesity will make you live longer!' brigade.
When people get really old, like into the 80s and 90s, it is surpassingly rare to see anyone 100,200,300 pounds overweight, and not terribly common at all to see anyone 30-50 pounds overweight.
A lot of people (overwhelmingly women) are using the fact that being a little heavy and physically fit are not mutually exclusive as justification for not actually being physically fit or eating a nutritionally optimal diet or trying to do either/both.
I should clarify about my grandfather the fat old man. I think much evil is comprehended in the term "fat," little of which is applicable to his case. He is pudgy, and solid. He LOVES sweets, and cashews, and was a damn good cook throughout his life. But he exercises self-control in his eating habits, and rations everything he enjoys - he has his pantry and drawers of goodies, and works through them methodically. He maintains a clockwork schedule of eating and sleeping, and reading the newspaper and watching tv.
He is also blessed with more than the usual amount of human cussedness, so I think he will tenaciously hold on to life for quite a few years more. I think some people just love life more, and that helps.
and @ wibbles:
I wish these stupid studies and theories would include people from around the world, because I have seen, and continue to see, a lot of pudgy old people. They're not overweight in your stated ranges (morbidly obese and obese) but they are probably all 20 pounds or less overweight. I think there is a happy medium there... and of course they are unafflicted with our cultural obsessions with youth. being old was awesome, once...
PS: Why do I sometimes get the impression that esthetics is brought into the discussion when it comes to obesity? When my sister and I were younger - we asked our mother to quit smoking for us. She had a wired habit - she smoked only in Fridays and Saturdays - but a whole pack each of those days. We asked her for obvious reasons - we wanted to have her around for as long as possible. Now she drinks rotten grape juice instead, we all do, and seems to enjoy life. Wine in moderation does not seem to be as unhealthy as smoking. But in case somebody of us started started drinking too much rotten grape juice - we would probably start all over...
The American Heart Disease Association reports that one of the worst things about heart diseases is that they can occur very quickly and unexpectedly. This leaves many families shattered and the pain and costs go beyond the sick care involved. When I see an obese person - I see somebody who looks somewhat sick. I am not thinking why does he not look like Johnny Depp or why does she not look like Jennifer Anniston. That would be an absurd, egoistical self-reflection of my private insecurities that has nothing to do with the real threats to families and communities at hand.
There are no elitist running around - wanting for all of us to be skinny and beautiful. Those who struggle to be thin for mainly esthetic reasons do not want the rest of us to look thin and healthy.
Sorry - I meant to write: "one of the worst things about premature deaths due to heart diseases is that they can occur very quickly and unexpectedly."
Those who struggle to be thin for mainly esthetic reasons do not want the rest of us to look thin and healthy.
Well, they may want half of the rest of us to.
I agree with most of the comments here about what a silly interview this was. The arguments from this guy who fail Critical Thinking 101 at most community colleges.
And as a fat man (although soon to be a not-fat man), I think it's good that society looks down on obesity. It does not make a man, obviously, but is not a positive trait. It's a sign of lack of control, gluttony, and self-destructive behavior. It's most likely unhealthy (probably very unhealthy) and terribly inconvenient. I suppose it is theoretically possible to be physically healthy and obese, but how often is that the case?
Again, a person's weight does not define them. I think despite my weight, I'm a good person with mostly positive traits, but my obesity is not one of them. And I do agree that some of the pressure to be thin goes far in the case of women, but I disagree that society should just accept any behavior as normal and neutral.
"We have this fixation on fat, and on dieting, that's astonishingly unhealthy. [...]
And I love what he stresses as the real health danger: yo-yo weights and diets. Not fat. Diets."
I don't see why all of these can't be unhealthy.
I definitely agree that constant weight gain and weight loss is bad and most diets are terrible ideas that prey on the insecurity and lack of knowledge of the public. If you care enough, losing weight and keeping it off isn't very hard once you understand proper nutrition and how the body works. The problem is that most diets are sold as quick fixes and require only very short term sacrifice.
However, a proper weight loss program--full of exercise and healthy foods (lean meats, veggies, fruit, beans, nuts, etc.) throughout the day in smaller portions--is absolutely a huge health improvement. And once you hit your health weight, you still keep the same principles in place, but you can simply eat a little bit more. If you view weight loss as a lifestyle change as opposed to magic plan, then it's certainly much better than accepting being obese.
If you view weight loss as a lifestyle change as opposed to magic plan, then it's certainly much better than accepting being obese.
The problem is that this often translates as "You can't eat stuff that tastes good, and you have to spend much of your free time doing exhausting and often painful activities. For the rest of your life." It's easy to see why many people prefer to try quick fixes or just accept obesity.
You can be more physically active without doing explicit 'exercise'. Plus, since fats and proteins are your friends, you very much should not give them up for long-term weight maintenance.
This is the problem-- fad diets have people believing that all physical activity involves the gym and only certain machines on the gym, and that if you can't somehow lose 30 pounds in a month, a diet is worthless. Oh, and you can't eat anything tasty, because tasty things have calories, or something.
Again, the problem is misinformation, and not bothering to be physically active and eat only what your body requires to stay healthy and maintain physical activity. Or really, not understanding that this can be done.
Well, obviously it's more enjoyable to eat a cheeseburger and play videogames. Work sucks too, as does raising kids, brushing your teeth, taking a shower, etc.
As for never eating anything that taste good and doing painful activities? Simply cutting down portion size, being more aware of the caloric content of foods relative to you daily requirement (It's one thing to know a cheeseburger is a 1000 calories, it's another thing to know a cheeseburger is 1000 calories and you only have 2000 in a day to maintain your weight), and finding some sort of enjoyable activity would go a long way for a lot of people.
I'm not suggesting losing weight and keeping it off is easy. I'm simply saying that there are methods available that would make it easy if more people were aware of them. The problem is that these methods aren't easily captured in any neat way and aren't marketed like magic diets. All the commercial diets out there have high failure rates because they really just suck.
Well either you choose living and all the work, or go to an early grave. Poor oral hygiene has been shown to lead to heart disease and early death, so there. There is no EASY living. Living is its own reward.
I'm no expert, but I believe that most diets have high failure rates.
No disrespect Brian but could you be any more obvious?
And yes - playing tennis, ball with your kids or dogs or taking a hike in nature is oh so boring. The endorphins running through your body when you sweat for other reasons than too much body mass mean nothing in terms of enjoyment and natural high? Sex? Dancing?
Nobody can change their taste habits either - right? You can not possibly imagine enjoying healthy foods? Or at least learning to - since most do not even know them.
What a dull dull life a healthy life would be. I follow your insights any day!
PS: On second thought. There is a chance that Brain was sarcastic and just trying to make obvious jokes here and there. In which case I say "sorry".
No disrespect Brian but could you be any more obvious?
I'm just offering an explanation as to why not everybody is enthusiastic about altering their lifestyles by giving up things they enjoy and doing things they don't (or at least think they won't), for uncertain future payoffs. I'm not sure what secret agenda you're attributing to me.
The sun is raising is not an explanation. It is something obvious that everybody knows. I do not attribute any secret agenda to you at the moment. For that you would need to make some kind of point.
The sun is raising is not an explanation. It is something obvious that everybody knows.
Gotcha. Yes, it is obvious, but still I think it's underappreciated. To take a similar example from my field, most people who have problems with computers wouldn't if they would read instructions and avoid doing foolish things like installing software that claims to let them watch porn. But trying to educate users has for the most part failed, because they're just not willing to take the time. We need to design systems for the way we actually behave, not how we "should".
For that you would need to make some kind of point.
My point is that the statement "anyone can lose weight if they just eat right and exercise" is mostly true and mostly useless.
If anyone here is interested in losing weight, may I recommend yoga. As Victoria Moran writes in an essay about how she came to care about factory farming, "'Don't change your diet,' my first yoga teacher had told me, 'yoga will change your diet.' And it did..." Part of the way it changes you is that you really don't ever have to worry about dieting ever again. My yoga studio keeps a plate of cookies available by the water and tea at all times to make sure people can keep their blood sugar up, and that plate of cookies gets eaten by the end of every class. And I've never seen a fat person there, even though there are some forty to sixty people there every hour.
Thin people don't eat stuff that tastes good? How fat are the shoppers at farmers' markets, or the people eating at fine restaurants? How many marathoners are running marathons against their will? This BS must get spread through talk radio like the BS about Obama's birth certificate.
The stupendous rise in obesity in America in the past generation is not natural, even if it is not as unhealthy as often depicted. We have bought into the system that says that fast food tastes good but home-cooked meals don't, that exercise is exhausting but car commutes that result from "drive till you qualify" isn't, and that if you cut back on your sleep and cutting out your exercise because you are spending so much time at the job and in the car, that shows that you are a glutton with poor self-control.
I don't think we should stop talking about fat. I just think we should be telling the truth about it, because someone out there is spreading misinformation.
The stupendous rise in obesity in America in the past generation is not natural
Agreed. My libertarian instinct is to blame corn subsidies, but I don't know for sure. Clearly there's been a substantial change somewhere and it shouldn't be an insurmountable task to find out what.
Thin people don't eat stuff that tastes good?
Some people are naturally thin, and some naturally enjoy healthy foods and exercising. Many aren't and don't, so it takes much more willpower for them to stay in decent shape.
that exercise is exhausting but car commutes that result from "drive till you qualify" isn't
I do wish more people understood how horrible commuting is in terms of happiness. I'm not sure that explains the increase in obesity; aren't we working the same or fewer hours than 30 or 50 years ago?
Brian,
Thank you for at least mentioning subsidies while claiming to be a libertarian. I do not trust libertarians who fight subsidies for the sake of it but apparently not in this context. It should be the first step - if you are a libertarian that is?
Having said that - although I have myself pointed to an end of saturated fat and simple sugar subsidies - this would not be a magic bullet solution. Ending saturated fat and sugar subsidies (via livestock feed subsidies) would only be part of a solution. But it would be the low hanging fruits with the largest immediate ROI.
Can the real libertarians please stand up?
What about all the other benefits of being thin/athletic? People treat you better and your place in the mating game is drastically improved? Coming from NYC, if you're fat here people don't even see you - you're bruce willis in sixth sense. Who wants that?
And sure, exercise is painful, but it's good pain - I feel good during, and amazing afterwards. Plus, when did laziness become admirable?
Do you say all this as a fat Republican lesbian?
Don't encourage marriage to promote health.
You see, divorce is worse than never getting married.
All this seems like excuse-making by Campos & McArdle. Everyone knows how you lose weight, eating right and daily exercise. There is no rocket science to it. Yeah, it even works for obese people. Stop making excuses for fatty mcFatty America.
I agree that the fat/skinny dichotomy is overdone and overly simplistic. I also agree that skinny doesn't equal healthy, just like fat doesn't equal unhealthy. However, this guy is over the top. I'm always leery of people who can't discuss those that disagree with them without using vilifying language. I've always thought of it as a hallmark of a person who is either insecure about his argument or trying to sell you something.
Overall health is a combination of lipid profile + body fat percentage. Not weight or "looking like Cameron Diaz". You'd be shocked at how unhealthy an average thin Hollywood actress really is on the inside.
There are also other measures of health, like VO2 Max, skin elasticity, bone density, and neural connections. Too many sheeple think of health in too simple terms.
Resting heart rate and cholesterol level are also good indicators.
The point of encouraging a sensible diet and regular exercise should be to become healthier, not skinnier. If a person has a strong heart, good lung capacity, low stress, low cholesterol etc., then their weight will most likely be whatever it SHOULD BE for that person, which may be skinny or somewhat rounder.
In other words, my opinion is that weight should be considered a lagging indicator, not a primary goal.
I'm not buying the idea about low cholesterol. There is not hard evidence that cholesterol determines level of heart health. The key factor instead is the level of inflammation in the arteries. But I realize that is controversial view.
OK, whatever. I'm not a doctor, so I not going to argue the point about cholesterol.
My point was really that there seem to be various and better ways of measuring health than weight, and that a obsessive focus on body size more often than not makes things more difficult.
Shelly:
You should get your husband to buy the generic, metformin. It's $4.00 a month at Target.
He does, but takes a host of other meds too -- buys them thru the discount mail-order service. His heart by-pass at age 40 was likely due to being borderline diabetic (but not realizing it) plus family risk. (Cholesterol was not high so no warning there.) We will never know exactly what caused all of this but his obesity in his early 20s was likely a factor.
One of GNXP's contributers says that the disapproval is class-based. http://lowcarbartandscience.blogspot.com/2009/07/class-bias-in-perception-of-whats.html
Compare the sugar and calorie contents of the stuff most people buy at Starbucks versus what they buy at 7-11.
From a NY Post article about a NYC DOE study linking academic performance and fitness:
In particular, the kids who rated among the top 5 percent for fitness -- on measures that included strength and aerobic capacity -- scored an average of 36 percentage points higher on state reading and math tests in 2007-08 than did the least-fit 5 percent.
http://www.nypost.com/seven/07142009/news/regionalnews/a_heavy_burden_179176.htm
Obviously you are not the type to take a study at face value, and I will assent that socioeconomic factors very often correlate with childhood obesity, but I don't think that negates the fact that youth obesity is a factor that can undermine future success in a variety of life's facets (and not just because of society's predilection towards thin).
As you tell it, however, working to decrease obesity levels - in any manner - is the work of the New Puritans and, given the failures up to this point - something that it is complete waste of time:
"Making information, or fresh vegetables, available, hasn't worked--every intervention you can imagine on the voluntary front, and several involuntary ones, has already been tried either in supermarkets or public schools. Americans are getting fat because they're eating fattening foods, and not exercising. How far are we willing to go beyond calorie labelling on menus to get people to slim down?"
If we're just banging our heads against a wall, then why not embrace obesity? Why not set up gravy fountains at elementary schools? If our society were truly free, then we should be advocating binge eating at early ages- the smart kids will figure out that it will kill them while the dumb ones will just kill themselves. Ta-dah! Society is now truly survival of the fittest.
And as far as Paul Campos' concern about the diet pill industry, two points:
1) You have stated before that you are against a public health option because it will kill pharmaceutical innovation. But aren't you here, as a strong opponent against, eh, The Obesity Battle of Ought-Nine, coming out as an opponent against a free market? Consumers drive the free market, and if consumers are demanding more diet pills, then why deny them what they want? I can think of myriad reasons, but then I'm not usually a proponent of libertarian market ideals.
2) What about the American fast-food industry? Am I to understand that while pharmaceutical companies making diet pills do not have society's best interests in mind, McDonalds and BK do?
Megan, given your views on the difficulty of individuals changing their weights, I wonder how you account for the change in obesity rates over the latter half of this century? Doesn't that change suggest that a combination of social conditions, public policy and individual choice can move individuals' weights away from the set-point you're supposing they have? This seems like an extremely severe test of your view, and therefore one worth addressing. I've never really seen this point addressed very well, but maybe I haven't looked hard enough.
I have a faint recollection of reading a study that claimed a substantial fraction (a third? a half?) of the change was a result of reduced smoking, and that's obviously a good shift. Not even the most extremist commentators would say you're better of smoking than being somewhat overweight. But that leaves a substantial proportion of the change unexplained.
Food, especially "junk food," is a very, very cheap pleasure.
Nothing can touch it on the $$/pleasure measure.
Whether its a giant Snickers or a cheeseburger, some part of our animal brains get tickled when we eat those big calories. It feels good. All that for 99 cents!
We are so rich in US that even our poorest citizens have enough food to be obese. It is a remarkable achievement compared to 99% of human history (and, what, maybe 2/3 of the world today?).
You take the bottom quintile from 1750 and give them the wealth of calories available to our bottom quintile, and they'd be fat, too.
Yeah, this seems like an obvious objection to Megan/Campos' thesis that nothing can be done about obesity. Since there was much less of it 40 years ago, it's clearly not beyond human ability to have less of it than we have now. (What's that quote Jerry Pournelle likes so much? "What men have done, men can aspire to.")
It may be that it's politically too hard to do anything about. (Given how dysfunctional our political decisionmaking is about stuff that's got to be done politically, I am terrified by the idea of trying to use it to solve any problems that can't be dealt with by writing a really big check or dropping a really big bomb on someone.) But it's not impossible.
As an aside, does anyone have a link for overweight/obesity statistics, particularly by how overweight people are? My impression is that morbidly obese people are much more common now than 40 years ago (from stuff like a booming business in medical equipment for horribly obese people), but I don't know that for a fact. It would be interesting to see whether this is true, and whether it can be explained by a 15-20 lb "drift" upward in weight.
It also might be that it's morally wrong to do anything about it. Poor people used to be thin because they were malnourished. The way you keep people from eating too much is price rationing or government rationing of calories.
Longitudinally, there's no way you can argue that the main problem is simply lack of access to vegetables and healthy food by the poor. Urban supermarkets are getting better, not worse. The poor are eating the way they eat because that's how they choose to eat, not because they're in need of some non-coercive tweak to their environment.
Is that the case? It seems like there's a substantial rise in obesity in the United States that continues well after you'd expect malnourishment to be a major issue. Not that I want to be dogmatic about it--maybe people really were that much poorer in 1960. Obviously if your comparison goes far enough back, people were short and skinny because they couldn't afford food. The question is when that stopped being the important factor.
This is just absurd. Take a look at when we started to heavily subsidize commodity crops like corn and then compare that to the rise in obesity.
I think you miss my point.
Unless you want to move us back to the pre-Industrial era--when calories were very expensive--we're going to have fat folks.
"it's clearly not beyond human ability to have less of it than we have now."
So what do you propose: huge Pigovian taxes or simply firebombing farms around the globe?
(I'm assuming that coercive limits to food consumption, such as looking people up at the 3,000 calorie mark, if "off the table").
Was there widespread starvation in the US 40 years ago, when there was less obesity? Did we firebomb all our farms, back then? If not, it's not impossible to get back to 1969 levels of obesity, adjusted for the older population and somewhat different ethnic mix. (I believe we have more Mestizos (or whatever you call the racial group that makes up most of our immigrants from Mexico, El Salvador, Guatemala, etc.) now than in 1969, so maybe we're partly heavier because the population has different genes.)
It may not be politically possible. It may not be possible short of unacceptably coercive or nasty policies. I don't know. But something we could do in 1969 is almost certainly not beyond our abilities today, in the broadest sense.
Personally, I'm not interested in a government solution to this problem--as I said before, they don't seem up to the job. I'm interested in solutions we can do ourselves. Part of that might involve looking into the differences between 1969 or 1959 and now. Obviously, if the explanation is that more people were on the ragged edge of starvation, or that more people smoked 3 packs a day, then this isn't too useful. But if there are other lessons--say, the rising amount of eating out or junk food in our diets, or the different mix of carbs--then it would be useful to try to apply that in my own life.
From a government standpoint, the most direct route to curbing obesity via the law would be to outlaw hydrogenated oils, which are correlated with obesity. At the very least they should be, by the FDA's own standards, regulated as an additive rather than a foodstuff.
There are a number of controllable lifestyle choices associated with weight loss; calcium consumption and hours of sleep per night are high on the list, not to mention aerobic exercise, of course.
Why do so many people 'diet' by starving themselves and eating puffed rice instead of eating nutrient rich low calorie foods like cucumbers, vegetable juice, etc.
When I lived in China people ate oil rich food and most were thinner than in the states. So I don't believe the excuses this guy throws up.
Also, D-Chiro-Inositol is starting to look interesting for people with PCOS (or the male variant equivalent.) About ~5% of the population has PCOS and which is a risk factor for diabetes and which can make weight very difficult to lose.
What I don't understand, though, is why everyone and their mother suddenly has a thyroid condition. I've heard a suggestion that a Yersinia species could possibly trigger Hashimoto's. It'd be interesting if we managed to find and treat the cause of these thyroid conditions rather than just medicating them.
I'm still confused. If:
1. it's impossible to get obese people to lose weight, and
2. non-obese overweight people aren't less healthy and are thus not more costly to insure, and thus
3. programs that attempt to get people to lose weight will not save money on health care costs
then
4. why do you think that cost pressures on government will lead the government to institute aggressive programs to make people lose weight? Wouldn't cost pressures on government lead the government to scrap such programs, as a waste of money?
If, on the other hand, cost pressures on government lead the government to encourage fitness (rather than lose weight), which Campos says does improve health, then...what's the problem with that?
Cost pressures don't really affect the government. They are not a for-profit enterprise.
Is there a doctor in the house? This interview reads like a conversation between an economist and a lawyer about what is essentially a medical question (is being obese detrimental to your health?).
You don't need a doctor, or a lawyer, or an economist, to tell you what is the optimum way to lead your life. That's what so damn obtuse about this.
This bothers me so much, the way people keep chasing and panting after people on podiums and soapboxes. If people quit paying attention to all the excessive, certificated and licensed noise in the world, and practiced constant self-observation, they'd learn their circadian rhythms. They'd learn their general metabolic rates and the times at which they're strongest and weakest. Each would learn the amount of daily physical exertion needed to maintain a sound mind. Some people require more physical exertion to be happy/healthy, others less. Each would learn the range of calories and types of food to enjoy and those to avoid. And women would learn their hormonal flux and cyclical changes. These things DO EXIST, and this is why no one size will ever fit all. You have to find your own size.
You DON'T NEED an office full of medical equipment and a bookshelf full of studies to know the basics about your body. There is no substitute for knowing yourself. And knowing yourself is a helpful filter to all that the world throws at you - calories, images, ideas, studies, addictions, whatever!
As Sid pointed out, the only really issue here is whether or not being obese is bad for your health. If being obese isn't bad for you, then discussion over, fill the cart with Doritos and soda and party on. If being obese actually is bad for you, then it is a very bad idea to encourage people to give up on losing weight and accept being obese.
On the only real issue of whether or not being obese is bad for your health I see a lot of bald assertions that obese people are just as healthy as anyone else, but no discussions of any details about any studies to support that assertion. There is nothing I love more than seeing conventional wisdom debunked in detail with facts, but that doesn't happen in this piece at all. Given the prevalence of the belief that obesity is scientifically proven to be unhealthy, I think any pro-fat piece should spend most of its time explaining the scientific evidence showing that being obese isn't bad for you. For example, I thought the link between weight and Type 2 Diabetes was pretty well established, so debunking that would be a good place to start if you want to convince someone like me.
Finally, the whole bit about how its impossible for overweight people to lose significant weight is ridiculous. Everyone who eats fewer calories than they burn loses weight. Period. And all people who fail to lose significant weight simply failed to significantly change their eating and exercise habits. Period. Really. Sure its a challenge to change your eating and exercise habits, just like its hard to change any habit, but its changing habits that is hard, not losing weight.
Of course I am biased because of my personal experience. Three times in my life, spread over 20 years, I started to gain weight over my personal target zone (195 for 6'2" which I believe is BMI 25). Each time I made relatively minor changes to my eating and exercise habits before the gain exceeded 15 lbs, got back down to my target zone, and then stayed there for a long time. It was really hard changing my eating and exercise habits. Changing habits always feels wrong and scary. But I decided it was worth it to me and I chose to do it.
All that being said, if people are more comfortable with being obese than they are with the discomfort of changing their eating and exercise habits, then I have no basis for second guessing that person's personal choice. And I really don't care that much if the additional health care costs of the obese put some burden on society. We all pay a lot of costs for a lot of habits and choices of other people that we personally wouldn't choose; that is part of living in society.
But Andy, you're completely ignoring the body's tendency to become more efficient at using calories when one diets and exercises. Yes, you can change your eating and activity levels and initially you will lose weight, but that weight loss will eventually level off and stop, even if you keep up those behaviors.
Also, your experience as a man who was at most 15 pounds overweight is simply not the same as, say, a hypothetical woman who has 100 pounds or more to lose before she becomes average-sized. For one thing, it is a proven fact that it is easier for men to shed fat than it is for women. For another, losing 15 pounds is a much quicker and easier goal (mentally, emotionally, and physically) to reach than losing 100 pounds. Finally, as an average-sized man, you don't have to worry about any of the stigma, shaming, and stress that our hypothetical woman is bombarded with every day just by being fat in the world.
In short, everyone's experience of weight loss is not the same. You can't apply your history with weight and body manipulation to every single other person in the world and expect that to be enough to make your point.
Next you can interview the guy who thinks AIDS is a "moral panic". I'm starting to wonder if we're going to have a moral panic about "moral panic".
There's a tendency among people with somewhat atypical political views to identify with those who make outlandish claims that most experts do not agree with. These people do have value, but it's a mistaken bias to assume they are more likely to be right. Usually it's simpler than that, and the experts really do know better.
I have no trouble believing that being mildly overweight is the healthiest place to be, especially for people past their 20s. That's where I feel most energetic and have the most endurance, both for work and for exercise. That's where my body seems to want to get back to if I go over or under that weight. Why is it so hard to believe that our bodies actually want to be "normal plus a bit of famine reserve/winter insulation?" It makes evolutionary sense to me.
That said, being very fat doesn't seem like a good idea, any more than anorexia does. I can't see how it wouldn't cause health problems. Forget hearts for a minute -- think ankles and knees.
As for society and obsesity, whatever happened to rollerblading? Or tennis? Up through the 90s, day-to-day American life had a lot of physical activity in it. A lot of that was social and recreational, not undertaken for health as such. And people cleaned their own houses and mowed their own lawns. I haven't seen as much of that in the past ten years. Social life has been more caught up in eating and drinking, and frankly the food and drink available has gotten a lot better. And then there are cleaning and yard work services. Is it any wonder that everyone gained 15 pounds?
I found this discussion very interesting, if not for the fact that it is profusely one-sided and overly skeptical. I have a couple major problems with the overall thesis:
1) Campos' primary issue is with Body Mass Index (BMI) as an accurate metric for a) "obesity" and b) obesity-health associations. His beef with BMI is neither innovative nor illuminating - it's been a point of debate since its inception. I'd argue that most people who work in the fields of diabetes, obesity, nutrition, epidemiology, etc... also have an issue with BMI as a metric and as a marker of obesity. Most everyone (in my oppinion) would agree that Body Fat % is a superior indicator of obesity; however, this metric is much harder to produce per individual, making large epidemiological and observational studies (the exact kind the CDC and policy analysts love) much harder to conduct. BMI is used because the data for height and weight is universally captured for the population, making it easy to use in analysis. I think Campos goes too far in discounting the possible correlations between obesity and health outcomes, because his first point is how much BMI sucks as a metric. Garbage in, garbage out.
2) There is far too little discussion about Type II diabetes in this post (I will assume it's in his book, which of course I haven't read.) Most epidemilogical data - yes, with BMI - at least points to the relationship of obesity and Type II diabetes. States in the US with high obesity rates per CDC BMI data also have high Type II diabetes rates. As a poster mentioned above, we do no know yet if diabetes at a cellular level drives obestiy or vice-versa, but there is certainly plenty of observational data to say that they are partners in crime in driving up health care costs, specifically in the Medicare population. I've heard some 10% of Medicare beneficiaries have a diagnosis of diabetes, whereas ~40% of Medicare outlays go to these same beneficiaries. (don't quote me on this, I heard it a talk some time ago)
3) Campos is right that we have weak scientific and clinical data on how to make obese individuals non-obese. However, I think he is missing the point. The idea of policies aimed at obesity epidemiology is not necessarily to reduce the # of obese people currently, but to slow the trend in obesity prevalence. In other words, it's not making fat people thin that we think might be good, but preventing thin/average weight individuals from becoming fat. Whether this is possible or not is up to debate (Campos says no), as is whether or not this would lead to any measurable amount of improved health outcomes for the population (Campos says no).
In general, I think he is right that the adopted stigma of obesity does more harm than good, and that obesity itself is a poor predictor of health outcomes: there are healthy fat people and unhealthy fat people, just like there are unhealthy thin people and healthy thin people. There are many other indicators and metrics (Fat%, HbA1c, BP, ejection fraction) that are more accurate in depiticing actual health states of the individual. However, there are few population-sized databases with these metrics, but there is one for BMI. Thus the crappy evidence he cites.
He should be a bit more deferential to the physiological and medical rationale behind obesity prevention, however.
So, it would appear that the the position that is being advocated here is that there is a war against obesity taking place, that obesity is not really as large a problem as is generally believed, that private industry is hyping the health dangers of obesity in order to fast track lucrative (and yet, quite unnecessary) drugs through the regulatory pipeline and promote costly dangerous and also unnecessary procedures - all in order to generate profit.
For all his railing against the other side, "obesity mafia", and etc., his own rhetoric comes across just as pompous and heavy handed. It's a real turnoff, no matter what thoughts he may have to share.
Interesting discussion and a good interview. But....
My old swim club has a team picture of every year from 1960 through 2009 on its wall. There are about a hundred kids or so in each picture, ages 5-17. Everyone always comments on how thin the kids were in the 60's and 70's and how chubby they are all in the 90's through to today. (And these are kids that are putting two hours in at the pool every day.)
This is a valuable discussion, and I'm opposed to any sort of gov't weight management program. However, if society can make kids considerably fatter, why can't it go the other direction?
A few points:
1. I'm somewhat surprised that Campos is still citing the BMI studies, given that he's surely aware that BMI isn't a good measure of bodyfat. See http://stuartbuck.blogspot.com/2008/07/paul-campos-obesity-myth.html People can be thin under the BMI measure, but because they exercise so little, they're actually carrying substantial bodyfat. Not good. People who exercise regularly will often (if not always) be heavier under the BMI measure, but that's because they have more muscle (which is heavier than fat, and which is good for you).
2. Campos continues to ignore the huge medical literature that has been uncovering the specific biological mechanisms on how extra bodyfat is bad for you See http://stuartbuck.blogspot.com/2008/08/more-on-paul-campos.html for about 13 citations.
3. That said, Campos has a perfectly good point: Focusing on bodyweight is silly, for the reasons mentioned in 1. There are a huge number of people, thin and "fat" alike, who need to 1) exercise more, 2) eat better, and 3) gain muscle and lose bodyfat. For thin people, this will usually mean gaining weight. For many "fat" people, this will mean staying at the same weight or possibly gaining weight.
4. I've known lots of people who started out thin but who gradually gained a large amount of bodyfat over a 10- or 15-year period as they aged. The reason this happens is patently obvious: they become more sedentary in office jobs after college, even while continuing to eat and drink as they used to.
But I have never seen a scientific reason that such weight gain would be permanent and irreversible. The weight could (and often does) come off the same way it went on: by a gradual process involving changed patterns of exercise and caloric intake.
5. The notion that eating healthily doesn't "work" involves looking at people who went back to their old ways of eating. There's no reason to think that people who eat a moderate amount of calories of fish, nuts, vegetables, and fruit, will first lose weight and then gain it back even while eating the same diet. And there's no reason to expect that a diet will produce permanent health benefits even after you go back to eating entire pizzas and drinking sugary Coke. This is like saying that "training for a marathon doesn't work, because years later, after people have quit running, they're out of shape again." Well, sure. Nothing gives you a permanent health benefit.
Stuart,
Thanks for the links, and I am pretty much on the same page with you. A whole book citing BMI studies and the U-shaped curve of mortality vs. BMI as reason for hypothesizing that obesity does not affect health is more an indictment on BMI, than it is an indictment on obesity studies.
Eh, the number of people so muscular as to tip the BMI scales is very unlikely to be statistically significant. It's not so good at my height, either, but since I'm four standard deviations from the mean, that's not a huge problem. If BMI doesn't apply to you, you already know who you are.
It's not so hard or rare, actually. Having body fat % in the
It may be hard to be muscular enough to be "obese" by BMI standards (Tom Cruise and Arnold Schwarzenegger fall into this category), but it's relatively easy to be low in body fat enough to be "overweight".
No, this isn't just about muscular athletes. As the study I cited points out, BMI simply doesn't distinguish between lean body mass and bodyfat for the entire "overweight" range. As I read it, that means that pretty much anyone in the BMI category of "overweight" is at risk of being misclassified, not just a few athletes.
The BMI weight ranges are narrow enough that it's actually pretty easy for muscle to confound the issue at the margins. Say I weigh 135, but I'm carrying 10 lbs more muscle and lean mass than a more delicately built woman of my height. I gain 15 lbs of fat, while she gains 20, but I'm "overweight" and she's not.
I think what's most significant about your post is how some of the points Mr. Campos makes (the unreliability of BMI) undermine other evidence that he cites (the large amount of "noise" in studies relating BMI to mortality). Seeing this sort of thing is a usually a sure sign that someone either doesn't really understand the topic they're addressing, or that they're looking for the evidence that seems to best support their position, rather than looking for the position that is best supported by the evidence.
anyone see Roger Cohen's NYT column today?
Classic example of the bias against overweight people.
People are also forgetting that very atheletic people who tend to have a higher percentage of their body mass as muscle tend to have higher BMIs. These people look thin, but have BMIs that put them in the "overweight" category.
I'd say the real issue here is with how poor of an indicator BMI is.
If you need BMI to tell you if you're overweight or not, you're not a very athletic person. Seriously, nobody is saying that BMI is a perfect indicator but if you are 6'0" 240 with a 6-pack chances are you're not overweight. This strawman argument is brought out in every discussion about BMI. For the average person, BMI is a rough guide of what your weight should be. It's easy to self-administer as well, which makes it ideal for home use.
That has nothing to do with what we're talking about here. Regardless of whether use of BMI on an individual basis makes that person athletic, the index IS used as a key statistic in the arguments in the post. Its lack of accuracy is confounding the issue and giving people a lot of room to fudge their arguments.
Agreed,
I lost a lot of weight after college, getting down to 195 lbs at my lowest which is a BMI of 26.4. I kept working out and even though my pant and shirt sizes went DOWN, I ended up at 215 lbs because I started gaining muscle faster than I was losing fat. BMI standards said I was approaching obesity at a BMI of ~29, but that clearly wasn't the case.
My weight has gone up and down since then, and as an athlete who regularly plays sports I've certainly noticed the effect it has on my health. The effect on my "general health" is small. My vital stats are all good, but wear and tear on my lower back, knees, joints is obvious. Complications with these things will be attributed to the sports I played later on in life, not the extra 20-30 lbs I dragged around the whole time I was playing them, even though I can tell you it was a factor.
Campos wants to make a name for himself and sell books. Campos is smart enough to know that this "theory" will find many, many eager adherents, regardless of its stupidity, because it will justfify said eager adherents' desired behaviors and lifestyle. Therefore, Campos' goal of selling books will be achieved. Perversely, the same MO as the authors of all fad diet books.
Liposuction, BTW, does not help health. Studies where people get it and don't change their habits find they don't get healthier.
(Of course, we could justify it to get adult stem cells if the government didn't drag its heels on adult stem cell treatments.)
Obviously BMI has flaws. It's a very simple formula and it breaks down for athletes, pregnant women, and kids. But I believe it correlates pretty well with Body Fat % for about 90% of the adult population. Of course it will fail at the margins for some people, but it still has a lot of value.
No. As this study showed [ http://www.ncbi.nlm.nih.gov/pubmed/8787936 ], BMI correctly identified only "about 44% of obese men, and 52% of obese women."
BMI reminds me of the joke where the man is looking around under a streetlight. A cop walks by and asks what he's doing. He says that he dropped his watch and he's looking for it. The cop asks where he dropped it. The man points to a pitch black alley. The cop asks why he's not looking over there. The man replies that the light is better over under the streetlight.
Megan,
I can't believe you said the following:
"Urban supermarkets are getting better, not worse. The poor are eating the way they eat because that's how they choose to eat, not because they're in need of some non-coercive tweak to their environment."
Are you really that dense? Can't you admit to grey areas?
Urban supermarkets? Please. Don't compare Fairway on the Upper West Side to the supermarkets in East New york until you have spent a month or two shopping at them and living there, it's rude.
That's how they choose to eat? The poor choose to eat less expensive food because they want to right?
Forget it. Why do I even bother? I started out trying to point out some comments that I thought were naive but by the end of it I am just sick of it.
Get a life Megan. This whole column today is a piece of shit. The interview was awful and the guest was an even bigger fool than you for kissing his ass like you did. I'm going to start calling you Matt Lauer.
Get a life Megan.
Thanks, but I've shopped in the supermarkets frequented by the people in the housing projects on the upper west side, not Fairway, which I couldn't afford. I know what they were like when I was little, and I know what they're like now. There is more produce, more lean meat, more of everything available than there used to be. No one is seriously contesting this; the state of urban supermarkets in the 1970s was disastrous. Forgive me, but I am skeptical that you've spent several decades doing your marketing in East New York.
Alright. I am calmer now. I just get very frustrated and I apologize, I was wrong to go off like that.
However...I still think that there are a lot of assumptions going on and attacking one fringe (Fat people need to taken down) with another fringe (People who are thin are leitist and less healthy) is a diservice to ALL of us. There are huge holes in his argument and I am used to a much more reasoned approach from you, or one that tries to use data to look at both sides.
I never said I lived or did my marketing in East New York although I have had my times of buying crap to eat because I didn't have enough money and or a kitchen or running water (thankfully few times at that) and I wasn't saving my pennies to buy the fresh mozzarella (although I would have rathered eat that given a choice) but was finding the dollar specials that would keep me full for a little while.
I think a valid question would be to compare the state of urban markets in the 30s to those in the 70s to those now and look at things like obesity rates and health outcomes, what food was available, what were people cooking, how have eating habits changed, has mass marketing of food products affected choice and availability, availability of locally grown food, etc...
I just think there are way too many variables in this topic to be distilled down to a sound bite or a pitch to sell a book or a ralling cry for obese people to gather around.
And I haven't even begun to talk about the public health policies behind this all...
I just wanted to stop by and thank you for writing this article and engaging in this discussion about obesity. I'm a big fan of Paul Campos's work (I use it in my own work as a Health At Every Size holistic health counselor). The message that shaming fat people doesn't work and that making fat people into thin people is not only a waste of time but a waste of money, is an important viewpoint to be presented to counterbalance the current "War On Obesity" viewpoint.
I am "overweight" but, except for recurring sleep apnea directly related to smoking cigarettes, I am a healthy late 30-something with normal blood pressure, cholesterol, etc. My sleep specialist recommended losing weight specifically to help the apnea. As for my own self-image: since dropping a few pounds by daily walking/lifting, my penis looks much larger than before. Wouldn't that simple result make a much more effective weight-control campaign??
So your data on the quality of grocery stores patronized by the urban poor are from personal experience of housing projects on the upper west side of New York, compared with the 1970s. Try this: http://www.publichealthadvocacy.org/designedfordisease.html
And here's personal experience: my wife recently returned from time spent with family in South Central Los Angeles, where she grew up, and reports no more grocry stores in the neighborhood than there were decades ago, and you still need a car or long bus rides to reach them. Convenience stores and fast food establishments, however, are everywhere.
As for New York, see http://www.nytimes.com/2009/03/21/opinion/21sat4.html?scp=4&sq=urban%20poor%20grocery%20stores&st=cse
and
http://cityroom.blogs.nytimes.com/2009/05/19/city-promotes-grocery-store-development/?scp=7&sq=urban%20poor%20grocery%20stores&st=cse , which reports that "Across the city, supermarkets and grocery stores have been driven out by slim margins, restrictive zoning requirements and high rents in recent years", which is borne out by http://www.nyc.gov/html/dcp/html/supermarket/presentation.shtml
On the up side, perhaps we could spread the word that "Real Food Can Be Cheaper Than Junk Food", at http://bitten.blogs.nytimes.com/2009/05/29/real-food-can-be-cheaper-than-junk-food/?scp=12&sq=urban%20poor%20grocery%20stores&st=cse
There's another way obesity harms your health: it can impede diagnosis. I'm an X-ray and CT technologist who can tell you that abundant fat produces "scatter" radiation that fogs up the resulting image. A medical X-ray beam is polyenergetic; lower-energy photons neither contribute to a diagnostic image nor get absorbed, but are effectively diverted in all directions by the soft tissue. My MRI-tech colleague assures me that obesity prevents a good MRI too. Manufacturers are also having to build stronger imaging tables to hold the greater numbers of morbidly obese patients we see these days. Older tables can be damaged by someone above 350-400 lbs.
How it gets in the way of medical interventions following diagnosis I'll leave to others.
A question for the libertarian/don't tax soda people here...
Is ok for the government to "force" choice upon farmers and consumers by heavily subsidizing corn (and corn syrup) but not ok for another branch to act against it by placing taxes on the products that are cheap and unhealthy because of government intervention?
I'm fairly certain I am now literally dumber for having read this interview. I guess none if it's really surprising, though, given Megan's ridiculous assertion in her much maligned earlier post that "every intervention you can imagine on the voluntary front, and several involuntary ones, has already been tried either in supermarkets or public schools."
As for supermarkets in low-class urban areas, I think it's certainly possible that they are better than they were 40 years ago, however, they still mostly suck.
The produce in low-class supermarkets is really terrible, so of course healthy foods will taste terrible. What so great about fast food and processed food at grocery stores (I say this as a fan), is that they always taste the same and always good. Cooking with healthy food is definitely more hit-and-miss...it requires technique, some more time, and quality ingredients. All that stuff is in short-supply is bad neighborhoods. It is much, much easier and cheaper to simply go to a Wal-Mart Superstore or Fast Food and buy your food. And what's the ratio of healthy-unhealthy foods there?
I had not even heard of Paul Campos until this interview but his thesis seems in line with what my research into the subject. I will certainly be ordering his book.
I tend to think he takes it a bit far when he suggests that moderate changes in BMI as not a proxy for health. Even at moderate levels there is a fairly robust correlation between obesity and diabetes or metabolic syndrome in general.
This is, of course, not to say that obesity causes metabolic syndrome. It seems more likely to me that it goes the other way, though one can't emphasize enough that we really do not know.
The second thing I would really emphasize is that the increase in obesity over time makes us think that something is changing. However, we shouldn't jump to conclusions about what that is. Here are several culprits that I think have signficiantly more empirical backing then the notion that it is less exercise:
- AD-36, the "obesity virus"
- Decline in nicotine consumption
- Higher levels of stress
- Increased consumption of High glycemic foods
There are also other possible culprits that don't yet have much backing but again, we don't know
- Sexual selection and/or allele concentration
- Environmental pollutants
- Unidentified infection
- Unidentified food additive
- Unidentified nutritional deficiency
- Food addiction
- Dieting itself
- Reduction in related mortality (obese people living longer)
I will end by saying I was particularly heartened that Campos got a confession of what we all know (or I should say all of us keeping up with the obesity research):
I know for a fact (because they've told me) that some public health officials engage in what they think of as a noble lie about the effects of physical activity on weight, because they know people won't become more active just to be healthier.
Don't forget broader usage of antidepressants and hormonal birth control, both of which definitively cause weight gain. (Ironically, birth control is very often prescribed for women with metabolic syndrome to "treat" the menstrual irregularities caused by PCOS.)
"The current stigmitization of fat kids is essentially child abuse as government policy, and the people behind it are, as far as I'm concerned, either incredibly stupid or very evil or in some cases both."
This is an excellent point Paul! This is exactly how I feel about the continued stigmatization of fat kids. I mean, I've been watching Pound Puppies on the Boomerang channel. The most striking thing about 80's cartoons compared to cartoons now, is that they included fat children, with no shaming involved. They were treated just as if they were any other children. I wish we could go back to those days.
I completely agree that antifat hysteria is a moral panic. I did my master's project on this issue in 91, but I called it a deviance scare. Sociologists believe norms hold a society together. When society starts to break down, society rallies around the persecution of a "deviant" to achieve temporary unity. Much like you can be fighting like cats and dogs with your loved one, but if an outsider steps in to criticize them, the outsider becomes the new enemy as you go to defend your loved one. Social breakdown, or anomie as the famous sociologist Emile Durkheim referred to it, is an extremely dangerous phenomena. When we look at many atrocities in history where people turned against each other, it is usually present. Pharma will keep pushing the antifat propaganda because all it cares about are profits. But will the rest of us stand by and let it happen?
Saturated fat is NOT the danger all you "libertarian" thinkers believe it is...Go find Gary Taubes book, "Good Calories, Bad Calories," read it, and then do a little more research into the actions of insulin/glucagon/etc. in controlling hunger/fat mobilization/fat storage.
And if you don't believe we are fatter than ever, watch an old (1970s/1960s) movie and what do you notice compared to what you see on a trip to WalMart or Disney World?
You want to fatten a cow? Feed them corn...
You want to fatten a person? Hmmmmm....oh yeah, corn...
One more thing. While I love how Ms Mccardle handled the interview in general, ampleness is not really the result of "bad" genes. We completely forget that one purpose of fat is survival of the species. It was the calorie efficient people who were able to make it through famines. Not to mention fat on hips and thighs is protective. Pear shaped women have lower risk of heart disease and diabetes, even when "overweight." When they inject hip fat into diabetic mice, it helped the condition. All body types were necessary as the species evolved though. We never know what is coming down the pike or who will be at biological advantage. I almost wish there would be a magic pill for fatness. So greedy pharma could push it and sheeple could take it. And then we have a major famine and have no way to protect ourselves, hold outs like myself would laugh our healthy, beautiful fat derrieres off!
I would generally agree with many of Paul's claims. I think his strongest claim actually just boils down to "Correlation does not imply Causation". It is certainly the case that negative health outcomes are correlated with obesity. But that does not imply that the weight caused the negative outcome, nor does it imply that losing weight will improve outcomes. I'll also agree that this proposition is extremely tricky to test in absence of a reliable and controllable way to generate weight loss in a human experimental population.
Nonetheless, I'm not sure I this fatalism with respect to our genetically predisposed weight is wise or rational. Moreover, the quick swipe at pharmaceutical companies at the end of the interview is counterproductive, at best.
Despite the fact that weight loss medications will be a cash cow for drug developers, they may also free us from our genetically predisposed metabolism, as well as give us a reliable way of testing various causative propositions with respect to weight change and health change.
It seems that Paul fills in the causative gap* in his argument with skepticism, but weight loss medications could give us the opportunity to fill in the gaps with fact.
*The fact that correlation does not equal causation, does not imply that there is absence of causation. In fact, correlation is a necessary condition of causation. Thus, correlation is correlated with causation. ;-)
obesity has no impact on one’s health??? you’ve got to be kidding!! i’ve worked an ambulance on the street over 25 years and have toted more than my share of fat-asses around to dialysis, doctor’s offices, wound care appointments, orthopedic follow-ups, and coronary bypass surgery. it goes like this: obesity > hypertension > vascular disease > organ failure/renal dialysis/respiratory problems/diabetes/joint problems/skin wounds from fat folds etc etc etc. this doesn’t even take into account the tubs that have to go to the emergency room because they’re too fat to walk. ask anyone in the healthcare field and you’ll hear the same stories.
p.s. the reason there’s no way to turn fat people into thin people is because there’s no way to keep them away from that box of twinkies.
While, Mr. Campos has some valid points to make about the dubious moral assumptions that pervade most of the popular articles on obesity, he is so utterly dishonest about the medical evidence on the subject that he completely undermines his credibility.
For example, he states that “There is literally not a shred of evidence that turning fat people into thin people improves their health. And the reason there's no evidence is that there's no way to do it.” Mr. Campos knows perfectly well that it’s quite possible for fat people to lose medically significant amounts of weight and maintain it for long periods of time through weight-loss surgery.
He correctly notes that WLS is a fairly drastic intervention and that most WLS surgery patients do not achieve a “normal” weight in the long-run. Yet even with these drawbacks, WLS surgery has unquestionably been shown to reduce the long-term relative risk of mortality compared to matched controls that did not have the surgery (see, for example, Sjostrom L., et. al. 2007. “Effects of bariatric surgery on mortality in Swedish obese subjects.” New England Journal of Medicine. 357:741-52).
Mr. Campos is most certainly be aware that this “shred” exists, given that he has commented upon the paper in the popular press. The most charitable explanation for this discrepancy is that he simply doesn’t understand the methodology employed, but I suspect that another aspect of his being trained in law rather than medicine is more likely. As an advocate for a particular social/political cause, he doesn’t feel any need to consider the evidence from the “opposing counsel” since his main interest is in making his own case appear as strong as possible. This predilection may help him play a useful role in reducing the stigmatization of obese people in our society, but it also makes him an extremely unreliable source of information on the health consequences of obesity.
People who believe in a calories-in/calories-out account of individual weight fluctuation perhaps also believe in Santa Claus. Ask yourself honestly: Do you know any thin people who eat large quantities of so-called "junk" food and who spend their days sitting (playing video games, computer, etc.?). That person is proof that the Law of Thermodynamics is not the only rule governing what each of us weighs.
As Campos points out, we've been running a population-wide experiment for at least 50 years, trying to prove that eating less and exercising more can produce lasting weight loss. The nearly unanimous finding: It doesn't.
Even the amputation of perfectly health, internal organs fails to turn fat people into thin people. It does leave the people who survive such eviscerations with longterm malnutrition and wretched complications of the sort I would not wish on my worst enemies.
I am a fat person. I am not allowed to purchase health insurance. Not at all. Individual applicants like me are routinely and uniformly denied access to health care. When this first happened to me, I was outraged. I felt that the institutions of my society were basically saying that they'd rather I curl up and die than offer basic medical services to me. Whenever I hear people lamenting the alleged health problems or shortened lifespans of fat people, I know they don't care one whit for my wellbeing...because NONE of these professional (and highly remunerated) handwringers has ever lifted a pinky to make sure fat people have access to basic medical services. Even if you think we're all doomed and diseased, wouldn't it still be the teensiest bit prudent for fat women to get Pap smears and mammograms???
Here's simple proof that professional "obesity" trolls don't care about actual fat people. A few years ago, the government's smartest statistician looked at the most extensive and accurate data set regarding weight and mortality (risk of dying). Flegal found that fat people are not dying in droves. The immediate reaction of "obesity" hysteria-mongers? Anger, denial. When someone genuinely cares about a group of people, and learns that where they had anticipated high death rates that actually people are living long and happy lives, I imagine such people would be........GLAD! Julie Gerberding, head of the CDC, issued a press release telling people to disregard that rogue statistician behind the curtain and instead go on believing that the world is flat. (Er, fat.)
For people who argue that weight discrimination is no serious burden. I can prove that you yourself know that's untrue. Just honestly ask yourself whether you would like to weigh 50 or 100 pounds more than you currently weigh. How would you imagine being treated socially? In the workplace? By your medical care providers? When you seek sex and romance? When you go shopping for food or clothes or cars or airplane rides or insurance? Yeah, not such a fun-sounding prospect??? That's a simple measure of the enormity of fat oppression: your own level of resistance to the possibility of yourself being a fat person.
In a few years (or decades), weight-related prejudice and stereotypes and discrimination will have gone so far out of style that many of the people who posted so vituperatively and self-righteously here will feel some serious chagrin. Instead, I invite people to join in with those of us who are early adopters for celebrating weight diversity and adopting Health At Every Size. You'll be a cool rebel now, and in future days, you'll just be right. Until then, until you do, I will continue to be a monster to you instead of a human being; and you will continue to be just a bigot to me and not a human being.
Weight loss surgery is certainly no walk in the park. However, despite the fact that, as you say, it leaves those "who survive such eviscerations with longterm malnutrition and wretched complications of the sort I would not wish on my worst enemies", it still decreases the relative risk of mortality compared to matched fat people who don't get the surgery. Put two and two together: what do they say about the health status of fat people who don't get the surgery?
Yeah, gut lobotomy sure is FUN! In one study — which was remarkable because it followed ALL of the surgery survivors and not just the ones alive enough or willing to still talk to their original surgeon — the suicide rate for the stomach-free was 8 times higher than that in the general population. And that didn't include the drug overdoses that were not counted as suicides. Who knows? If those were inspired by despair, you'd get a suicide rate 15 times the rate in the general population.) Archives of Surgery, October, 2007.
An example that wasn't counted in that study: A woman of my acquaintance survived intestinal bonsai but found herself unable to absorb vitamin D at all. Not even with the specially formulated absorptive pills given to survivors of gastric guillotine. She got Rickets, a very painful disease that involves softening of the bones. It hurt like hell for her to walk at all. No hope for any way to ease or end the pain. She was an MD, so she prescribed herself an overdose of drugs and died.
You're still not putting two and two together here. Let's assume for the sake of argument that WLS is every bit as terrible as you claim it to be. The fact remains that, despite these horrors, the largest and and by far the best designed study of weight loss surgery to date (which, thanks to the excellent record keeping of the Swedish national health system, followed the long-term outcomes for virtually everyone in both the treatment and the control groups) found that WLS improves longevity (among many other many other measures of health) compared to matched obese people who don't have the surgery. What do those two things together say about the effect of obesity on health? The whole of your argument is considerably weaker than the sum of its parts. Do you not see that, or do you just not care?
PS
I can't find the article that you cite unless you provide the other elements of the citation (title, authors, etc.)
That thin person is illusory. My experience with those people is that they overall didn't eat much on a week to week basis, and/or were very active. a fidgety person will burn more calories than someone non-fidgety.
That is, a thin person can eat a whole pizza, but then they don't eat much the next two days. 'Oh I forgot to eat' is not an unusual thing to hear (both from male and female thin persons who 'live on junk').
And again, a lot of people don't consider a long walk home after work 'exercise'. There are numerous computer nerds who walk all over the place and don't count it as exercise and believe they are 'naturally thin' until they really do stop walking 6-7 miles per day and the weight then shows up.
You don't see any waiters who are severely obese, and you see relatively few who are even moderately so (usually diner waitresses working in a tiny space, so very little walking and carrying compared to other waitstaff).
Researchers have been trying to prove a huge disparity between the way thin people eat and the way fat people eat for decades. The data just doesn't show some big distinction. Likewise, researchers find that people who start to exercise after being sedentary may lose some weight, but moderate exercise just doesn't produce large amounts of weight loss for most people. It does, however, help people to be healthier. Which is why I exercise regularly. And I eat my veggies as part of a balanced and moderate diet because I'm just smart that way.
The point about thin people who are lazy gluttons (and I'm really pretty sure they exist!) is that our bodies each have a natural setpoint range of weights that we will occupy when living in a moderate manner. It takes extreme and damaging behavior to get one's weight either lower or higher than that setpoint range. My natural and healthy weight is not the same as Gwyneth Paltrow's. It wouldn't improve my health or lifespan to try to be her height and weight any more than it would improve her health or lifespan to try to be my height and weight.
First, Paul Campos is a lawyer. He has zero credentials in health care or statistical analysis, so I would take everything he says with a grain of salt. If the director of the Mayo Clinic weighed in with his opinion of the latest Supreme Court decision, how much weight would you give it?
Second, I think both extremes are wrong. On one side you have people claiming everyone can lose weight easily with just diet and exercise. On the other you have people saying long-term weight loss is impossible, and 95% of diets fail (a fictitious statistic that has never been traced to an original source).
It's probably more accurate to say that ease of weight loss lies along a smooth spectrum. For some, it's very easy - cut out the fried chicken and all of sudden you're 40lbs lighter. For others, you can starve yourself for years and not budge, and regain weight very easily. It comes down to how much important it is to you and how much you're willing to sacrifice.
What a bunch of rubbish.
So according to the "expert" Paul, dieting is an unhealthy eating disorder. The point is absurd an requires no rebuttal.
If don't pay attention to what you eat, you'll get fat, and nobody wants that. It is very unhealthy.
Banning scales? Scales are the feedback loop that allows people to control their weight. The first step to controlling a variable is measuring it. I also love the part about how gyms don't work and people "aren't dumb" and "do the experiment". People who actually stay with the program more than maybe 6 months know very well how well how well it works. It just shows how out of touch he is with the very concept of mindful living.
Of course people who go to the gym and use a scale already know this. Of course they are also people who are masters of their weight, instead of slaves to it.
I imagine the number of people who just can't get their eating under control is about the same as the number of people who cant get their spending under control, and for the same reasons.
When it comes to America's weight issue, there are two categories: 1- People who are overweight 2- People on their way to becoming overweight. I agree w/ Paul Campos on one point. There's no benefit to forcing the fat to become thin. Not gonna happen. Instead, the emphasis must be to reduce the risk for chronic disease in those overweight or obese. That means daily exercise; a non-starchy, non-fried, mostly-vegetarian diet; and water instead of soft drinks, sports drinks or juice. All of the above applies to Category 2 as well. But also we must do all that we can to preserve their health and prevent them from becoming overweight in the first place. That means a focus on pre-pregnancy to age 5, when body composition, eating patterns and exercise habits are being established. How can we justify junk food in school and daycare centers? Or marketing these harmful substances to children in any setting? Tax ingest-able entertainment like sweetened soft drinks and earmark that money for education, safe recreation facilities and affordable produce. Launch campaigns to convince parents to hook their kids on water rather than liquid candy. Re-cast our nation as one in pursuit of the long-term pleasures of good health rather than the quick fix high of junk food. Nutshell? Prevention: Prevention from the overweight and obese from becoming heavier and sicker. Prevention from the next generation from becoming sickly and overweight in the first place.
Want to debate whether or not the obese are already sick? Ask an orthopedic specialist. Ask any doctor who understands the effects of obesity-induced, excess estrogen on men, women and children. Ask heart specialists who understand silent inflammation associated with obesity... Obesity is associated with a higher incidence of infertility, pregnancy complications and ultimately, birth defects. So forget what Campos or I think--debate the matter with Darwin.
www.MeMeRoth.com
www.actionagainstobesity.com
That's WONDERFUL, MeMe!!!
You can retire now! There's no need for you to "act against" an entire demographic group any longer.
The alleged evolutionary unfitness of fat people will do your work for you.
I'm so very glad to learn this is the last time I'll have to encounter your vituper.