It still remains to figure what the environmental change in America is that has caused this: whether the government is largely responsible, and regardless of that, whether the government can stop it.
As I've said elsewhere, I don't think the government is all that plausible as the primary source of the problem. Obesity is rising everywhere, even in poor countries. It seems to be rising fastest in the anglosphere, but then, most countries outside the anglosphere rely on self-reporting data, which produces lower estimates. Eyeballing it, people in other countries are a lot thinner. But there are also a lot more fat people in Europe than there used to be.
But leaving culpability aside, what can the government reasonably do to make us healthier? We could change our road building and build denser. But of course, as I pointed out elsewhere, while being rural is correlated with being fatter, it's also correlated with being healthier (though that advantage may be eroding). It's impossible to tease out the countervailing effects, so which should we do? Build up dense areas in which people will be thinner, but maybe sicker from the stress hormones of living in a noisier, more crowded area? This might be liking taking up smoking to lose weight.
We can eliminate agricultural subsidies. Great: high fructose corn syrup won't be so cheap! But total corn subsidies in the US are about $10 billion, or about $33 per American. Even poor households spend many multiples of that per capita for food. You're talking about a difference of less than a dollar a week per person in the food budget. Meanwhile, what else happens when we dismantle our ag subsidies? The price of sugar, which is kept high by that same farm policy, falls by about 30-40%. Perhaps you wanted to get rid of the corn subsidies while keeping the sugar price supports? But the politically impossible job of slashing corn subsidies (we've been trying since the Reagan administration) will become even more unlikely if you don't also cut the cost of sugar to keep corn syrup competitive.
We could ban television advertising, a favorite of many public health types, and Marc. But there's something interesting about that. When I wrote this article, seven years ago (yikes!), everyone was very much up in arms about the problem of food advertising on television, particularly to children. So I went looking for all the studies showing that advertising made people eat more junk food. I couldn't find any. Suspecting my google-fu was terrible, I enlisted the support of others. No luck. Ultimately, I called Eric Schlosser, whose book, Fast Food Nation, had argued against fast food companies largely on the grounds that their advertising campaigns turned children into helpless addicts. At the end of the interview, I asked him for the studies he'd relied on. He sounded confused. He didn't have any studies indicating that fast food advertising spending made people eat more of the stuff. But, he argued, it stands to reason that if they advertise, it works.
Well, oddly, I have a little less faith in corporate America than a left-wing journalist. Companies, even entire industries, do all sorts of idiotic things for surprisingly long times . . . investment banking and autos tend to spring immediately to mind right now. And I still haven't found any evidence that advertising actually makes people consume more fast food. It may make them eat more during the commercial, but there's no evidence that it even ups their overall food intake, much less sends them out to McDonalds. Most of the studies of advertising I found show that it does a much better job at creating new product awareness or brand switching than creating new demand.
I mean, there's no evidence it doesn't make people eat more, and I don't think I'd get particularly worried if we banned food advertising on television, though I'm sure the networks would, since I"m not sure they'd be viable without it. But the belief that this will help revolutionize America's eating habits is not very well supported.
We could change what's happening in schools: take vending machines out, make cafeteria meals healthier, and so forth. Fine, but the kids are in school for six hours out of 24. What's happening the rest of the time? Child obesity increases most during summer vacation.
Marc goes into a lengthy paragraph about social capital and obesity:
The idea that anti-obesity activists think the problem will be solved by putting grocery stories in urban areas is kind of a myth. A grocery store is fine. Farmers markets are great. But food in them tends to be more expensive. Food companies don't advertise frozen vegetables because kids and parents don't buy them, but there is also evidence that kids and parents don't buy them because food advertising primes their hunger and increases their desire for bad foods -- foods that are constructed to make kids feel happy and energetic immediately. Parents have less leisure time to shop. Kids are not encouraged to play outside because of crime rates. And poorer people with lots of material concerns don't have the bandwith to pay close attention to the TV ads that saturate the lives of their kids. And lots of other things. We need to be careful about expectations setting; .everyone can process information the same way. But with an economic and social capital imbalance thrown in, it's terribly hard to blame anyone. I'm harping on social capital because it does provide a different way of looking at the SES and racial disparities. Less social capital is correlated with more stress; there is also a relationship between social capital and the belief that things will get better in the future. The more capital you've got access to, the more optimistic you tend to be, and the more likely you are to think prospectively about health.
Most of that may be true, though one stat, which I too have heard from public health obesity researchers, simply isn't; leisure time has increased at the bottom of the income scale, as the relationship between income and working hours has inverted over the past half-century: wealthy people now work more hours than poorer people. This is probably multi-factorial: more disability, better welfare benefits (since 1959), decrease in relative wages, slight increase in real wages. But while the poor and working poor are certainly not enjoying lives of plenty and ease on the public dime, it simply is not true that they have less time for grocery shopping or cooking than they used to. They, like the rest of us, simply have more opportunity and income not to do it.
The other problem with this cluster of social ills as an explanation is the problem with a lot of other explanations: it hasn't increased in recent years. Kids weren't encouraged to play outside during the crack epidemic, either. They watched a whole bunch of television. And their mothers were very stressed and had fewer emotional resources to supervise their children's activities. These are perfectly fine explanations for the difference in obesity between 1955 and 1985. They are not good explanations for the change between 1999 and today, when crime is going down and leisure is going up.
The bigger problem is that we don't have good examples of programs that make significant changes in these areas. You can get very modest persistent changes from a high-quality early-child intervention: fewer high school dropouts, fewer arrests. But those results don't turn poor people into middle class people; they turn poor people into the working poor. They're hard to scale up: pilot programs almost always work better, because of selection effects on both the workers and the subjects. And they are fantastically expensive. The Perry Pre-School Project remains the gold standard in early-childhood intervention studies; it took place in the late 1960's, and cost about $25,000 a head in today's dollars.
Which brings me to the last question: even if all these things would work, could we do them? Let's make a list of some of the ideas that come out of this:
- Reeingineer America's urban infrastructure to discourage car transit
- Eliminate all agricultural subsidies
- Ban television advertising
- Change the schools
- Massive intervention into low income families
- Solve the crime problem
I'm all for spending money "for the children". But let's look at the actual record of Federal education policy before we start making big promises for obesity reduction on a national level--and the even more dismal record of poor school systems before we assume that schools that can't teach math or prevent 30-80% of their high school students from dropping out can somehow take on the job of preventing their students from getting fat.
It would be nice if we lived in this world with a super-competent bureaucracy that isn't constrained by special-interest politics . . . but we don't. At this juncture, I will be accused by at least three (3) commenters and one (1) other blogger of blindly accepting--nay, endorsing--the status quo. This is petulant nonsense. I don't have to like something to recognize that I don't know how to fix it. And I don't know how to fix this. Moreover, I don't think anyone else knows how to fix it either. They think it should be fixed, and that this ardent and well-meant desire somehow translates into the ability to do so, if only the rest of America will join them in really getting serious about the problem. In my experience as a pundit with a jaundiced view of the likely success of any given government program, every single problem in America, including obesity, can be directly traced to our national frivolity. If only we'd get really serious, we could fix anything and everything.
I am skeptical, too, about the benefits of this seriousness, especially since at any given time, we're supposed to really get serious about at least a dozen problems, and there has to be a limit to even the vast untapped resources of our Federal seriousness reserve. Since I don't know how to fix childhood obesity, I'm certainly not going to advocate that we, say, assume that we can fix it while pondering a national health care plan, or that obesity is among the prime avenues we should explore to lower our national health costs. Nor, when all these efforts fail, as I am pretty sure they will, will I join the public health advocates in moving towards the increasingly coercive measures that they have started advising, like stiff taxes, to curb this "problem". Unlike the public health advocates, I do think that there are worse things for a nation than being fat.
Let's hold off on the obesity tax until Michael Moore and Al Gore can fit into 32 waist Levis.
32 waist? Please! What'r'u? 16?
Good stuff, but why did you start out this debate by having a softball interview with a guy who insists that there is no problem?
Because at least on his weaker claims, he's right--a large amount of the panic is over arbitrarily small weight gains with no statistically significant health association. On the edges of the debate, he may be wrong . . . but the edges are hard to change.
Can we stop peddling untruths yet? Campos claims that poor health effects from obesity don't kick in until a BMI of 35. Nonsense:
http://www.economist.com/blogs/democracyinamerica/2009/07/round_figures.cfm
He also claims that losing weight doesn't improve health and can even make it worse. While it's true that rapid fluctuations in weight can be deterimental over the long term, losing weight will improve your health if you are overweight or obese:
http://www.ncbi.nlm.nih.gov/pubmed/7771451
losing weight will improve your health if you are overweight or obese
Ok, here we go again. You folks keep thinking you are disproving Campos point when you are actually closer to proving it.
You're pointing to a study that says losing weight is good if you already have weight related health problems, and trying generalize that losing weight per se is equal to becoming healthy.
Did you even read that 2nd link? The very first sentence -
Although 40% of US women indicate they are currently trying to lose weight, the association between intentional weight loss and longevity is unknown.
Did you read the rest of it? All studies say what they don't know up front to indicate that their study was indeed necessary. The study is designed to fill in the gap:
I never said losing weight is healthy for everyone. Obviously if you are physically fit; have no health problems; have a reasonable BMI, waste size, and body fat percentage; and don't have any genetic risk factors; then there is no medical reason to reduce your weight. You just need to maintain it. This was not Campos point. Campos said there was no health related benifits to losing weight even for the overweight and obese. Read the first link.
"have a reasonable BMI, waste size, and body fat percentage;"
I'd be willing to keep track of my waist size but have no intention of measuring my waste size.
DerHahn's point is over whether the study applies to everyone who is overweight or obese, or only to "women with obesity-related health conditions," which seems to be all that the study claims.
Is it more likely that only overweight and obese women aged 45 to 60 will benefit from losing weight, or that it's within reason to extend the conclusion (which qualifications of course) to cover other groups who are overweight and obese and have health related problems because of it? I would bet my money on the latter.
Also, I don't have to prove a universal positive, just one instance of it. Campos posits a universal negative, that no-one benifits from weight loss, when it's clearly not true.
I blame Star Trek. The fattest kid I knew growing up was a big Star Trek fan so that has to be a factor.
Seriously, though, it is remarkable to see how strong the tendency is for humans to segregate themselves on arbitrary grounds. It's as if these anti-obesity advocates are back in their high school clique picking and choosing who is cool and who is not. Except now they have the ear of lawmakers willing to write their prejudice into legislation!
Eyeballing it, people in other countries are a lot thinner.
Meh... the people in better neighborhoods of New York, Seattle, Boston, Berlin, Paris and Munich are all pretty thin. If you get into the working class and rural areas of Bavaria (for example) you see some beer swilling, sausage eating, fatties just like you do in rural America.
Except for the beer drinking bratwurst eating fatty goes out and clears a field or skis 60 days a year. They've got a beer gut, but a good % of them can work pretty hard too. I'm not the least bit worried about someone being a bit fat.
I'm worried about someone being fat AND unable to do strenuous work, excerise.
Americans don't do agricultural work?
We would, if we didn't allow illegal immigration (/snark)
I agree with the second half of Tim's comment above. Don't forget Megan, this started with that asinine interview you had with Paul Campos. This is no better than government sponsored infomercials masquerading as news stories. It's actually worse because I think people come hear and read what you and other bloggers have to say because they think hope for integrity and honesty in the way you present and question things.
And don't turn this into an excuse to whine:
"At this juncture, I will be accused by at least three (3) commenters and one (1) other blogger of blindly accepting--nay, endorsing--the status quo."
Don't forget, obesity is the problem, not how you or other bloggers are perceived.
Obesity is who's problem?
What about body odor, bad fashion, poor dental hygiene and poor manners? Apparently some think freedom is not worth the risk.
Obesity is rising everywhere, even in poor countries.
First of all, so what? Does this really mean that we can't approach our own obesity epidemic with effective measures that are appropriate to the specific situation here in America, or in specific states and districts? This argument is a lot like the "let's not tackle global warming, since China and India probably won't" argument. It's incredibly stupid and lazy.
Secondly, it should occur to you that some of the rise in obesity in developing nations is directly related to our habits and business practices here, in the world's most powerful economy. For example, I can take you to a shop on a tiny island in Tonga where frozen chicken parts from Arkansas and frozen mutton flaps from New Zealand are only slightly more expensive than fresh fish caught in local waters. People are getting fatter in Tonga—and the rate of obesity has doubled in the last thirty years—because they still eat their staples and they're also buying and eating subsidized garbage that wealthy companies produce, from Coke to canned corned beef to cheese puffs.
"We can eliminate agricultural subsidies. Great: high fructose corn syrup won't be so cheap! But total corn subsidies in the US are about $10 billion, or about $33 per American. Even poor households spend many multiples of that per capita for food. You're talking about a difference of less than a dollar a week per person in the food budget."
Jesus Christ... talk about missing the fucking point. It's not about putting a few bucks back in the family grocery budget, Megan. It's about making junk food less cheap than it is right now by getting rid of the subsidies that allow it to be so cheap. Coke shouldn't be $0.99 for two liters. But it is, because the corn industry is so heavily subsidized and supported by the U.S. government, and Coke only pays peanuts for a barrel of corn syrup. If you make those things more expensive via taxation and/or abolition of those subsidies, then people won't buy those products as much because they'll be too expensive. It's not about the taxes. It's about not using that tax revenue to subsidize a sector that helps make us fat and diabetic... which in turn ends up costing us a lot of money.
Has anyone ever seen a skinny Tongan?
I have. The ones who live there and don't have much tend to be slim, athletic, and healthy. (I lived there for two years.) Tongans are genetically predisposed to obesity but they only get severely obese when they start chowing down on too many root crops and/or garbage food that is imported. The ones who move to the U.S. are fat because food is so abundant and cheap here. It's all related. When big companies export their sugary, fatty foots to poor countries like Tonga, the results are predictable and tragic, especially when traditional sources of food are diminished and people are stuck with ramen noodles, Coke, mutton flaps, and whatever other crap is at the corner store.
Tonga, Samoa and other cultures in that cultural-linguistic group don't have a genetic predisposition to obesity: they have a positive cultural value for it that persists to the present day. Largeness is associated with nobility, authority and power; the Tongan royals were expected to be large and in charge (and it was controversial when Taufa'ahau Tupou IV, in the interests of promoting a national health campaign, lost over a hundred pounds back in the 1990s.
I think getting softdrink companies to use sugar instead of corn-syrup is reason enough to end corn subsidies. Just to get products that taste better.
First of all, so what? Does this really mean that we can't approach our own obesity epidemic with effective measures that are appropriate to the specific situation here in America, or in specific states and districts? This argument is a lot like the "let's not tackle global warming, since China and India probably won't" argument. It's incredibly stupid and lazy.
No, it's not like that. The atmosphere is a commons, so a policy of sacrifice undertaken by some parties without any hope of changing the behavior of the dominant emitters, merely harms the sacrificers to no immediate benefit. In short, massochism.
Last I checked, fatties are not a commons, but are in fact individuals who may or may not have been pushed in a particular direction by factors for which specific action WILL product specific results.
Except, as MM made clear, she doesn't know how to solve the problem and hasn't seen anyone else show that they know how, either. You dancing around the math isn't going to change that. Corn syrup is in a lot of products, not just obvious junk food like soda, and corn also goes into grain-fed beef, corn starch, and other non-obvious food paths. If the NET effect of the subsidy is $33 per capita per annum for all food products containing corn, removing the subsidy doesn't make junkfood products significantly more expensive, since the whole $33 is not going to be put directly into inflating the price of a bottle of Pepsi proportionately, and even if it did, what is, say, $1.70 for 2L compared to $0.99? Meanwhile the price of sugar is artificially inflated by the same farm lobbies that maintain a stranglehold on corn subsidies, so the best you could hope for by destroying the ag lobby is a rebalancing of what kinds of sugar are added to processed foods, not whether it will be added.
"what is, say, $1.70 for 2L compared to $0.99?"
It's almost twice as much. Pretty significant, I'd say.
We're allowing many foods, some of which are awful for us, to be cheaper than they should be. If we stopped the subsidies, we'd stop buying as much of those cheap goods because they wouldn't be so cheap anymore. If a gallon of fresh fruit juice were closer in price to a gallon of brown, sweetened, bubbly water, people might be more inclined to buy the juice. Instead, people who are conscious of their spending see $0.99 for two liters of tasty soda and they grab two of those instead of a single carton of juice. Why not allow foods to cost what they actually should cost? Why subsidize? And yeah, I know corn goes into a lot of other stuff. ALL that stuff should be more expensive.
"Last I checked, fatties are not a commons, but are in fact individuals..."
"Fatties" are part of the commons because the health problems they suffer become a burden on our society and on our families. The notion that we should just leave people alone to do what they want is fine as long as there aren't costs to everyone else. But there are such costs, and so we should pay attention and we should give a shit. A healthier populace would be more cost efficient, more productive, happier, etc.
First of all, so what? Does this really mean that we can't approach our own obesity epidemic with effective measures that are appropriate to the specific situation here in America, or in specific states and districts?
Obesity epidemic? What are you talking about? If a whole lot of Americans want to eat a lot of food and get fat or evenly morbidly obese, what's it to you? Why does everything that people do in their private lives become a problem that busybodies like yourself insist that "we" must solve?
And spare me the carping about how obesity ends up costing "us" a lot of money. The bottom 50% of the income distribution effectively pays nothing in taxes, so *they're* certainly not forking out any dough to cover the public costs of health problems. Near as I can tell, the top 1% pays as much as the bottom 95% put together -- so unless you, tinisoli, are actually Bill Gates or Warren Buffet posting in disguise, I think you can pretty much stuff the argument that an obesity epidemic is costing *you* any money.
In complete seriousness, tinisoli -- why can't you just leave people alone to deal (or not deal) with their weight problems as they see fit? Why do you have to stick your nose in? What is it, in your collectivist soul, that so insistently demands that you and the government get involved in the private affairs of other people? Why do you find it so hard to just mind your own business?
"50% of the income distribution effectively pays nothing in taxes,"
Which country do you live in? I have a few relatives who might want to relocate there.
Sales tax alone in Louisiana is 9%, including on food.
As you describe, the whole obesity and related public health discussion is plagued by too many hypotheses about causes. Based on all this speculation, you could end up regulating vast swathes of people's live and not necessarily address the problem.
I don't know the answer either. But I recently came across this presentation by an endocrinologist from UCSF, which in my mind makes a pretty convincing case that sugar (both sucrose and fructose, which makes a prominent appearance in high fructose corn syrup) is very bad for you: http://www.youtube.com/watch?v=dBnniua6-oM.
So maybe just put a Pigovian tax on sugar? It could be that simple.
As for whether obesity per se is the problem, maybe not. But it's so intricately associated with heart disease, diabetes, and whatnot that it's a pretty decent proxy.
So maybe just put a Pigovian tax on sugar?
First you have to show that sugar has a net negative externality. Once Social Security is factored in, I'm not certain obesity is a net negative externality.
In other words, granting that health care costs are greater for the obese and that they die sooner, the decreased payments due to decreased life span may more than offset the medical costs.
Wow, this is not just callous, but pretty stupid.
You're assuming that anything that represents a net decrease in lifetime cost per person is a positive externality. This would only be true if you take the value of life extension to be zero. Which is not a very reasonable thing to do.
1) Life extension almost always has positive internal benefits (except in the case of some prevented suicides where their preference is to be dead). Net external benefits to friends and family is probable, but not a given.
2) The Pigovian tax on the negative externality of obesity (and govt intervention in general) is premised on obesity costing the government money. If that's the case, seems fair to check if the premise is correct.
3) If you have a better metric to justify a Pigovian tax imposed by the govt than net govt outlay, present it.
Please explain how it is that the fatter Americans get the longer they live.
Thats easy, FatJared. It isn't!
Especially in the areas where obesity is such a problem.
http://www.usatoday.com/news/health/2008-04-21-life-span-study_N.htm
http://www.nih.gov/news/pr/mar2005/nia-16.htm
The point you're missing about advertising is that if the average American is so inhumanly stupid as not to share Marc Ambinder's tastes, he must necessarily be a brainless jellyfish, in hopeless robotic thrall to the TV -- even though when the TV tells the poor common retard to eat veggies, he effortlessly ignores it. Strange... Very strange...
How about instead of a bunch of do-gooders clamoring to have the government "Ban something!" we continue to teach our children and teenagers correct principles and let them govern themselves.
Unlike the public health advocates, I do think that there are worse things for a nation than being fat.
I would imagine some public health advocates have other serious concerns, ranging from other serious public health issues (infectious diseases, cancer, antibiotic resistance) to non-health issues such as war, poverty, and the economy. But no, in your mind they're just this monolithic mob of worrywarts that won't shut up with their annoying theories and their eagerness to scold fat people.
One aspect of your discussion -- our eating habits aren't fundamentally different from the high-carb diets of a few generations ago -- leaves out a significant change: the way the food is produced. Just in my lifetime, I've seen significant changes in production methods on the farm end; particularly in the way animals are raised (that corn lobby, again). But crop production and distribution has seriously changed as well. I do think our diet is a problem, but not because it's gotten worse (which it may have for some families,) but because the food itself has gotten worse. Less dense in nutrition, more additives, etc. The point of tackling the AG lobby isn't to pull twinkies off the shelf, it's to make sure the lettuce is rich in nutrients as it was when my grandmother grew it in composted animal dung.
The point of these posts that I do agree with is the notion that solving the fat problem will solve our health care cost problems; for people who are slightly overweight, it's just nonsense. I think we'd get better health-care outcomes, and save significant money, from simpler solutions like a national dental-care program, two free cleanings a year, etc.
But I wonder about other environmental concerns. Is there a link between estrogen compounds from plastic and obesity? Between Secret and breast cancer? Golfing and gout? Airline travel and embolism?
As rates of smoking have shown, changes in public policy can have a positive impact on unhealthy, expensive habits. But it takes time.
I have to recommend Michael Pollan's latest article in the New York Times. It is not about obesity but it does discuss the changing attitudes towards food, cooking and marketing/availability of foods that I think are very applicable to the conversation that has been happening here the past couple of days.
http://www.nytimes.com/2009/08/02/magazine/02cooking-t.html?ref=dining
Is this quotation from the Junkfoodscience blog wrong? Because if it is right, much of this fuss is woefully misdirected.
"Among nonsmoking people under age 60, being “overweight” (BMI 25-30) and “obese” (BMI 30-35) was actually associated with lower risks for premature death than those of "normal" weight.
Especially troubling is that being thin is 25% more dangerous than being the government recommended “normal” weight (BMI 18.5-25).
And being thin accounts for 37,746 premature deaths. More than even being the most extremely “obese” (BMI >35)!"
Megan,
You said
"And I still haven't found any evidence that advertising actually makes people consume more fast food."
from Pollan's article:
In fact, for many years American women, whether they worked or not, resisted processed foods, regarding them as a dereliction of their “moral obligation to cook,” something they believed to be a parental responsibility on par with child care. It took years of clever, dedicated marketing to break down this resistance and persuade Americans that opening a can or cooking from a mix really was cooking. Honest. In the 1950s, just-add-water cake mixes languished in the supermarket until the marketers figured out that if you left at least something for the “baker” to do — specifically, crack open an egg — she could take ownership of the cake.
First of all, that's not actually evidence, that is Pollan's theory about what happened - TV dinners also took off around the same time, surely at a certain point the sense that women had a moral obligation to cook for their families went away. Women who worked before the 1950s probably felt a certain amount of guilt about not being good mothers. As time went on and more of their friends were also working outside the home, the need to be the perfect housewife started to disappear.
Secondly, even if we accept Pollan's theory, marketing and advertising are actually two different things. Just telling someone repeatedly that they'll be happy if they eat lots of fast food, and actually changing a product so that people feel they are baking by mixing a few ingredients together are very different.
Feh.
This post was written, as have all McArdle's postings on the subject of obesity, by someone who has never cared for or treated obese or even overweight patients. Which is, in fact, the case here - McArdle has never cleaned out a Diabetes Type II patient's infected abscess, she has never changed the diaper of a severely obese patient who cannot wipe himself or herself, or even turn himself or herself in the hospital bed.
So McArdle has no health care experience, but what is worse is that she doesn't seem interested in consulting doctors and nurses and researchers who spend an inordinate amount of time and energy caring for the ravages of obesity - Type II Diabetes and heart disease.
She consults instead.... Paul Campos, who is a LAWYER. I respect and appreciate lawyers. But I do not consider them experts or even experienced when it comes to obesity research or health care issues.
Further, McArdle mentions an interview with Schlosser, but claims he was confused and can't back up his arguments with statistics. But that is exactly what McArdle has provided in every post of this "discussion" - confusion and a lack of legitimate research.
I did, however, enjoy reading Ezra Klein's takedown of McArdle's nonsense in the Washington Post. And I'm hardly a fan of Klein.
Once again, McArdle's blog proves to be a waste of time. You have to slap yourself for spending time replying to a dilettante who doesn't want to get their hands dirty doing the ACTUAL research or labor, but prefers to formulate "concepts" based on their ideology.
You missed the obvious solution: a Pigovian tax on unhealthy foods.
Central heat and air conditioning. The more time we spend in room temperature environments the fewer calories we burn maintaining our body temperature.
I think the benefits of central heat and air conditioning far outweigh any drawbacks, but it has to be recognized as a contributing factor. I'm guessing the prevalence of central heat and a.c. tracks pretty decently with increasing obesity. And as far as I am aware - the US was an early adopter of both particularly a.c.
back again...
My suggestion to everyone here. Step away from this whole debate here and just read Pollan's article in the New york Times. It actually does have to do with obesity and he references some data at the end that is pretty interesting.
I think it's a great read and well written.
I think we also need to consider why people exercise less and why exercise seems less effective. I think it's entirely plausible that inadequate testosterone levels are why exercise is ineffective. And when people exercise and don't see result, they are even less likely to exercise.
Here's a study that says advertising makes children fatter
Chou, Rashad, and Grossman (2008) "Fast‐Food Restaurant Advertising on Television and Its Influence on Childhood Obesity"
http://www.journals.uchicago.edu/doi/full/10.1086/590132
They find, "A ban on these advertisements would reduce the number of overweight children ages 3–11 in a fixed population by 18 percent and would reduce the number of overweight adolescents ages 12–18 by 14 percent."
Here's another:
Veerman, Van Beeck, Barendregt, and Mackenbach (2009) "By how much would limiting TV food advertising reduce childhood obesity?"
http://eurpub.oxfordjournals.org/cgi/content/abstract/19/4/365
I haven't read these papers carefully enough to fully endorse them, but I really think that this discussion could use more evidence and less speculation.
Glad you brought that one up -- the "Google-Fu" runs strong in this one.
...but I really think that this discussion could use more evidence and less speculation.
I fully endorse that motion.
"I haven't read these papers carefully enough to fully endorse them...". It is wise to do so. And it can be scary to see how huge discourses and calls for change are built on decidely shaky foundations:
I went ahead and read them. The Veerman article conclusions are entirely based on simulations of a model of the effect of tv advertising on child BMI, and the crucial input variables they chose as follows, and I quote: "[...]based on a single study that was published in 1983 and did not quantify uncertainty. In view of this paucity of evidence, we decided to obtain current expert opinion..."
So their results are based on the numbers from a single study (Bolton R. Modeling the impact of television food advertising on children's diets. Curr Issues Res Advertising (1983) 6:173–99), and because they realized that this was a bit shaky, they added the numbers from expert assessments, without mentioning that this is almost circular reasoning. They did not collect any data themselves.
I then took a look at the (apprently unique) Bolton 1983 paper, where at least real world data were used, though not collected - the author obtained his data from a marketing research company! This study showed that the effect on child caloric intake from parental eating behavior is large, and the effect of television food commercials, and I quote from the discussion "does not have a significant direct effect on children's caloric intake", though it notes indirect effects (about 2% of variance).
Some people hope that forbidding food advertising would make a great deal of difference for childhood obesity, but the data do not support this. The tendency to draw hasty conclusions from secondary and tertiary data analysis and worse, models, without ever bothering to collect any real world data seems to be endemic and is troubling.
[I am a federally funded physician/scientist, and do not have any conflicts of interest with the matters discussed.]
Ah. You must have the much coveted access to online journals. Thanks for forwarding your thoughts. Although, just because studies on the media influence on children's diets does not exist doesn't mean that media can't influence children's diets. They could, or they couldn't. Data is scarce. I would tend to believe, however, that parental eating behavior is much more influential than food commercials. The kid can't eat five bowls of cinnamon toast crunch if the parents don't buy it for them.
When ever someone quantifies uncertainty, you know they're full of shit. Uncertainty is unquantifiable by definition.
Ooga booga, so do nothing? If only someone could develop a mathematical study of such issues, (let's call it, statistics), and then develop a form of this study that works to discriminate between various contributing factors (let's call it, multiple regression analysis), and then apply this technique to producing an actual study (e.g., "Dietary intake, exercise, obesity, and noncommunicable disease in rural and urban populations of three Pacific Island communities," or "Obesity and Health Status in Rural, Urban, and Suburban Southern Women"). I'm such a dreamer.
Can't we just teach abstinence?
I think schools ought to make all fat kids run 3 miles a day and eat cabbage for lunch.
Is it possible the government knocked off Chris Farley because he made being fat seem cool? Hmmmm.
The same with John Candy. He's gone but we still have Bill Murray and Tom Hanks. If you're a fat actor in Hollywood you better be watching your back!
Much better than your other posts, Megan, but you keep dismissing causes on hunches or because you don't think they fit a trend.
You should be starting with basic scientific princples like: consuming more calories than you burn will result in weight gain. You can't violate this law because it's a simple energy balance. If you violated this law then you'd be violating the laws of physics.
Now look at all the factors that might be contributing to a rise in calories consumed. A rise in calorie consumption is easy: people have to consume more calories in order to increase their calorie consumption. There's no other way to do it. Evidence does support this. Average amount of calories consumed has been trending upwards.
Now look at all the factors that might be contributing to a decrease in calories burned. This is harder, and often the subject of much research. Many factors (genetics, disease, toxins, physical activity, nutrition) can cause such a trend. However, we know that less physical activity means less calories burned and physical activity has been trending downward. Unless people are cutting calorie consumption, then this will have a net upper effect on weight. But we already know people aren't cutting calorie consumption because average calories consumed is trending upwards. Therefore we would expect a trend in physical activity to effect a trend in weight.
Why then, Megan, are you so quick to dismiss the effect of lower physical activity and increased calorie consumption on average population weight? Nutrition (the type of food we eat and how often we eat) also plays an enormous role in regulating our metabolism and can influence the rate at which we burn calories.
In short, calorie consumption, physical activity, and nutrition are behaviors that can be influenced through incentives and public campaigns, much like any other public issue. Texas has done a fantastic job getting people to quit littering. I'm sure there are plenty of other examples of successful public issue campaigns. I don't agree with your fatalism here.
So one is born gay but being fat is a lifestyle choice. Glad to see the social police have the role of genetics all figured out.
I don't think many people are born obese.
You are most likely wrong. Obesity runs in families and it's more than environmental.
My grandfather was fat during the depression. His nickname was "Fats" and you can see from pictures of that time that he was about 80 pounds overweight.
Jennifer Anniston, controlling elitists, thin instead of non-obese or normal, blame, "for the children" sarcasm... Could it be that the whole discussion has hit some nerve in Megan that we are not aware of? It's not what she writes on this topic but rather how? As if she was trying to destroy everything and everybody out there for the sake of I don't know what. It's apparently not just me from what I can tell from the comments?
I generally enjoy reading Megan. I quit reading Reason magazine after discovering that Newsmax seems more genuine and interesting. I checked in with Reason for the first time in months - just to see their spin in obesity and health care - God it made much more sense and sounded honest and less angry than Megan here.
This whole thing might all calm down after the wedding dress thingy? I hope so.
PS: sorry for the digression. I shall contribute beyond meta discussions again soon. E.g. never has the time been better for a national, holistic push to end farm subsidies than now. We doubled our US body mass since Reagan and if the time is not now, it might for the first time be tomorrow. The first trick is to separate the food from the farm lobby. The food lobby should not be scared of less consumption as they can charge health premiums etc. But they are ideologically and historically and culturally and religiously in bed with the farmers right now. This will change over the next few years and then... If we get the food lobby to see the light - the farm lobby will have lost an important last allay.
Discussions about eating less must drive farmers insane but should not scare restaurants and retailers so much.
PS: Is it just me or has Megan just and again written a long book without any historic case studies like smoking in it?
Megan and others,
Better late than sorry. I'd like to apologize for getting personal and for actually doing myself what I've criticized you for. I stand by what I wanted to say but not for how I did it. Sorry.
Megan, I'm going to egotistically assume I am the one other blogger you expect to accuse you of blindly endorsing nay-saying, and say: you're blindly endorsing nay-saying. I am dull and predictable, and no one should read my blog. But more importantly, this whole subject initially came up because you were saying that increased government intervention in the health insurance market would lead to government increasingly telling us what to eat, and, as with the chocolate eclair example, that this was a problem because it entailed a curtailment of freedom.
But now you're saying that the whole of the problem is that there's nothing we can do about what people choose to eat. I still feel that you've got a really serious logical problem here that you're just not addressing. If attempts to limit obesity prevalence don't work, why will increased government responsibility for health care spending raise pressure on the government to waste money on them? If rising obesity doesn't really entail very much higher rates of morbidity or higher health spending, then why will the government feel pressure to attack obesity to lower morbidity or heath spending? You may be saying that the government will do these things because it's irrational, but in that case, what does this problem have to do with universal health insurance? The government does all sorts of irrational things, and its irrational campaigns against drugs and sex have proceeded quite aggressively without universal health insurance.
And, finally, if it's just impossible to control what people eat, then how can there even be any curtailment of freedom here? If government interventions will be limited to TV ad campaigns that don't work, am I really supposed to treat that as a serious harm worth worrying about? The amount of money is trivial; for citizens, it's at most an inconvenience, or perhaps a wasteful subsidy of late-night TV comedy material. Weigh this against the cost of even 100,000 people in the US who actually need insurance being unable to obtain it. Which is more important?
Then, you say that it will simply be impossible to achieve any of the more serious measures that advocates argue might lead to reducing obesity, like cutting corn syrup subsidies or building a less car-oriented society. Again, if these measures will not pass, where is the threat to freedom? If they do pass, and work, isn't that good? What is the harm you're claiming? You may be saying that people should just not use their votes to get government to intentionally intervene in shaping policy or the built environment towards any particular lifestyle preferences, that this is in itself a curtailment of freedom. But then in the next breath you say that the reason we have a car-based society is because people voted for the governments that built it. And I really get the sense that you think this was okay. Well, people are voting now for governments that want to do something about reducing childhood obesity. Explain to me again what's wrong with that.
If attempts to limit obesity prevalence don't work, why will increased government responsibility for health care spending raise pressure on the government to waste money on them?
This most clearly, and the rest of your comment, indicates a belief that the government doesn't do things stupidly. This is, of course, a stupid belief.
A soda tax, for example, will do nothing about obesity. This hasn't stopped Frieden et al. from pushing it as a solution to the "obesity crisis".
Megan argues that we should not make public policy changes, such as eliminating wasteful subsidies because:
1. It won't cure obesity and its associated problems, even though it might help.
2. Political forces that lobbied for and benefit from these bad public policy decisions will object, vociferously.
Bleak. Makes me want to sit on the couch with a pint of Ben and Jerry's and watch TV.
It's very true that people would rather have a plate of mac&cheese then vegetables and a piece of baked fish. Everything is about NOW NOW NOW, give me pleasure NOW. Nobody wants to do the hard work of eating right, exercise and most of all patience that the process will make you get fitter over time. People want immediate results, so you see them pop into gyms on January 2nd and give up a few weeks later. I think this "instant gratification" is the biggest flaw in American culture today. We want everything NOW, whether its food, economic recovery, health care, whatever. We have ZERO patience as a nation.
In the spirit of "more evidence and less speculation," the following lit reviews on the TV/obesity link in kids may be of interest.
The Henry K. Kaiser Family Foundation. 2004. The Role of Media in Childhood Obesity.
http://www.kff.org/entmedia/7030.cfm.
Kunkel, Dale, Brian L. Wilcox, Joanne Cantor, Edward Palmer, Susan Linn, and Peter Dowrick. 2004. Report of the APA Task Force on Advertising and Children: Section: Psychological Issues in the Increasing Commercialization of Childhood. February 20.
Livingstone, Sonia. 2006. Does TV Advertising Make Children Fat? What the Evidence Tells Us. Public Policy Research, 13 (1): 54-61.
Also, marketing to kids is much more than just advertising:
Moore, Elizabeth S. and Victoria J. Rideout. 2007. The Online Marketing of Food to Children: Is It Just Fun and Games? Journal of Public Policy & Marketing, 26 (2): 202-220.
Remove Agriculture subsidies and heavily tax 'high calorie' food. Force all 'food outlets' to write calories in a dish or food packet. Yes both corn subsidy should go and 'sugar' also equally taxed so that sugar does not substitute corn syrup.
Ban soda from schools.
Yes I know these are quite simplistic and populists demands (unlikely to be adopted politically). But the question is should we be trying to get these simple things in order or be after some innovative / exotic measures which could be more elusive.
Keeping it simple and straight forward have it's advantages.
Banning this or that doesn't change the basic toxicity in the culture. Sure you might cite how stigmatizing and making cigarettes expensive has reduced smoking over the last 30 years. However young people continue to light up for the simple reason that it's all about instant gratification. Change the culture instead of attacking the symptoms.
First of all, I think the argument Megan's made is an attempt in the right direction. Its so much easier to find mistakes in a section of any argument than it is to make a complete case from scratch. She's identified that the fact that we need to solve a problem does not always mean we have the solution immediately. I'm with you on that Megan. So long as we don't stop at the 'we don't have a solution now' stage, but work towards finding one. Healthcare is a complex issue, and obesity is just one aspect involved.
I've a few suggestions to the problems you mentioned.
1. Reeingineer America's urban infrastructure to discourage car transit.
Discouraging car transit is too general an idea. Encouraging use of public transport, and making it efficient might be easier. I've always wondered why there isn't any private initiative to improve public transport. Why should the govt. be the only provider?
2. Ban television advertising
That is going too far, and like you said, almost impossible to achieve. But we could place restrictions on the kinds of advertizements targeted at children.
3. Change the schools
I'd suggest just building more playgrounds and physical activity courses into the curriculum. Not easy, but easier than removing the vending machines.
4. Massive intervention into low income families
I think just making healthy food less expensive for low income families would be helpful, if advertised well.
5. Solve the crime problem
While trying to do that, we could create more safe enclaves where children can play with some amount of security provided.
I know these won't suddenly make healthcare affordable, but they might make it incrementally more affordable. Why are we not trying to make changes in every way possible, even if its slower, rather than looking for a cure-all that does it in one go?
In the discussion about universal health care affordability, one question seems never to be asked or answered: Which hurts us worse, large federal deficits or millions of people suffering with inadequate health care?
Most people who don’t have health insurance can’t afford health insurance. So a law requiring people to buy health insurance is silly.
Requiring businesses to pay for health insurance is equally silly. To pay more for health care, businesses would have to lower salaries or reduce the profits needed to survive. Which poison do you prefer?
Any so-called “savings” in the health care system will come from doctors, hospitals and/or pharmaceutical companies. Pay doctors less and you’ll have fewer doctors. Already, some doctors have opted out of Medicare because of insufficient payments.
We want hospitals to offer CT scans and PET scans, lots of well-trained nurses and emergency rooms that accept everyone who walks in. The machinery costs millions. The nurses, always in short supply, cost millions. Pay hospitals less, and you’ll have fewer and less equipped hospitals and fewer nurses.
The pharmaceutical companies we love to hate, spend billions developing drugs to ease our pain and save our lives. Getting a drug developed, tested and approved costs hundreds of millions. For every success, a thousand failures. Pay pharmaceutical companies less and your cancer may not be controlled, and “swine-flu” may kill a million souls.
Now consider those large federal deficits, we also love to hate. The media tell us deficits should be minimized. Except, no evidence exists that deficits have any negative effect on our economy.
No, deficits have not caused recessions, depressions, inflations, deflations or stagflations. Deficits actually have helped cure most of these problems.
No, deficits cannot force the U.S. into bankruptcy. In 1971, we went off the gold standard to give the government the unlimited ability to pay its bills.
No, deficits will not make foreign nations stop buying our debt (though we can pay our bills without borrowing.)
The simple fact the media never tell you: While federal surpluses have caused every depression in U.S. history, growing deficits have cured every recession and depression, and are necessary for economic growth.
So, which hurts worse, large federal deficits, which historically have had a positive effect on our economy, or millions of people suffering with inadequate health care?
The federal government can and should pay for universal health care via deficit spending.
Rodger Malcolm Mitchell
rmmadvertising@yahoo.com
www.rodgermitchell.com
A small defence of corporate America - they may be right to advertise, even if this does not increase the consumption of fast food by one single burger. Why so?
In order for advertising to pay, it is not necessary for people to eat more fast food. Instead, advertising may work by increasing the price people are willing pay for it, hence increasing McDonald's margins on what food they do sell.
There has been a suggestion here in the UK that banning advertising for fast food might have the opposite effect to the one intended. Rather than spending money on advertising (which allows them to sell less food for more money) the fast food chains would resort to price promotions (in other words selling more food for less money). The people who typically respond most to price promotion tend to be existing customers - hence banning advertising may actually encourage the people who already eat a lot of fast food to eat even more of it.
Isn't there a National Strategic Seriousness Reserve where they've put all the seriousness that young people extending their adolescence into their 30s aren't consuming? Surely we could tap that? Or did Bush sell it all to the Chinese so Halliburton could profit from it?
"5. Solve the crime problem": that's so sarcastic!
Just a thought. The huge increase in the percentage of mothers over the last 30 to 40 years working could account for it.
Argh, should read, "the percentage of mothers working over the last 30 to 40 years..."
I'll be the first to admit I have NO answers with regard to solving obesity. That said here's my story.
I grew up in the midwest and my family history is FAT. I continued that legacy through my teen years, until I joined the military at 19. I took up running (30-40 miles per week, biking (100-200 mikles per week), and working out (free weights, nothing fancy), and maintained a healthy weight until about 40. At that point (I had given up running at age 35, due to low back (a weight lifting injury) and other joint pains, I gradually, but very quickly began to pack on the pounds. From there, it feels like a free fall. I've continued a strenuous walking program (I live at 7200' altitude, I walk ~ 20 miles per week at a brisk pace, just today I walked a course that varied from 9,200'-10,400') and free weight program - and yet! I'm 51, 5'10", 230 lbs, and have recently upgraded to 40" pants (thank GOD, the 38's were KILING ME!). Yeah, I drink beer, but that's my only vice.
That said, my uncle, who everyone in my family agrees I'm a spitting image of, had a body type and likeness very much like my own. Yeah, he was fatter and less muscular, but very much the gregarious "take it as it comes, John Candy type," and he never worked out a day in his life. He died at 71 of a sudden undisclosed cardiovascular event (shouldn't we all?). My mom? I'm sad to say that if you've seen "What's Eating Gilbert Grape," you've met her, metaphorically at least.
What's the point of all this? I'll be the FIRST to say I dunno, as I have whenever I looked in the mirror throughout my adult life and said WHY?
http://news.bbc.co.uk/2/hi/in_pictures/4696149.stm
There is a solution to childhood obesity. Bad government.
Derek
This type of stuff is exactly why I love reading Mcardle's blog (not trying to be sarcastic).
I can't find the post, but didn't Mcardle argue a while back that moderately plump people who don't care much about their diet are typically happier.
In all seriousness, I fear that forcing calorie reductions (through tax increases, school/work diets, etc.) will hurt happiness figures in this country.
$10 billion corn subsidies? The only way you can get that figure is by combining the direct payments from USDA to corn farmers with the imputed subsidy from the ethanol rules. And the problem with that is the effect on the consumers differ for each. Diverting corn acreage from animal feed to ethanol results in higher costs for corn and presumably, down the line, to the consumer. (I say presumably because I'm not aware doubling corn prices resulted in any change in cola prices.)
Mcardle, et al.,
Is it possible that--in part--the increase in obesity is becuase the criteria for what counts as obesity has changed? I think I have read that the standards have changed significantly over the past decade or so. If so, then experts should be honest about this.
bls
Americans consume more calories than before.
Manufacturers of corn sweeteners do not receive government subsidies. Our industry buys corn on the open market at the prevailing market price.
High fructose corn syrup, sugar, and several fruit juices are all nutritionally the same.
High fructose corn syrup is simply a kind of corn sugar. It has the same number of calories as sugar and is handled similarly by the body.
The American Medical Association in June 2008 helped put to rest misunderstandings about this sweetener and obesity, stating that “high fructose syrup does not appear to contribute to obesity more than other caloric sweeteners.”
According to the American Dietetic Association, “high fructose corn syrup…is nutritionally equivalent to sucrose. Once absorbed into the blood stream, the two sweeteners are indistinguishable.”
Consumers can see the latest research and learn more about high fructose corn syrup at www.SweetSurprise.com.
Audrae Erickson
President
Corn Refiners Association
The proper relation is:
Calories consumed - calories excreted - calories burned = calories used to gain or lose weight
Calories excreted can change with diet. Also, different kinds of calories are processed in different ways by different people. So the "simple" relationship is actually not all that simple, especially when applied across the board.
I would also like to point out that a lot of "all natural fruit juice" has "concentrated grape juice" in it, which is grape juice concentrated to the point where it's basically sugar syrup. So "all natural" or "no sugar added" fruit juice may still effectively have a lot of extra sugar.
Audrae - I don't think anyone said that corn refiners are directly subsidised, the problem is that the price of domestic corn is kept artificially low while the price of imported sugar is kept artificially high. This is only one of many domestic agriculture subsidies (direct or indirect) that distorts the food supply.
Um, to this: "Food companies don't advertise frozen vegetables," one can only reply: "Ho ho ho! Green Giant!"
Can you please all stop equating boiled fruit juice with added sugars and vitamins to real fruits. Thank you.
Point by point rebuttal for one of the silliest posts I've read in a while...
http://www.examiner.com/examiner/x-2429-Bicycle-Transportation-Examiner~y2009m8d4-An-open-letter-to-Megan-McArdle-on-obesity