A Smart Incentive or Obesity Persecution?

French diet guru Pierre Dukan is urging his government to give extra marks in school for a healthy BMI. The Telegraph reports:

“Obesity is a real public health problem that is rarely – if at all – taken into account by politicians,” Mr Dukan told newspaper Le Parisien ahead of the book’s launch.

Mr Dukan said his education plan would be “a good way to sensitise teenagers to the need for a balanced diet.”

He denied it would punish overweight children, saying: “There is nothing wrong with educating children about nutrition. This will not change anything for those who do not need to lose weight. For the others, it will motivate them.”

This reminds me of the fitness test the University of Chicago administers to all incoming undergraduates, and the rampant cheating it inspires. The “punishment” for failing the fitness test was P.E. classes through your first year. So on the one hand, you had those who would try to trick the fitness test (these tips are traded on message boards before school starts, one being holding the heart rate meter at varying intensities to trick it) in order to place out of gym classes. On the other hand, you had students who wanted to take the P.E. classes, trying to game their way into them, since those who fail the fitness test have priority status into all gym classes.

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  1. Erik Jensen says:

    BMI might be good for epidemiology, but it says little about an individual. Arnold Schwarzenegger in his physical prime was probably “morbidly obese” by this measure. The University of Chicago has the right idea with a variety of fitness measures.

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    • Ahnold says:

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      • Enter your name... says:

        You don’t have to be an “Arnold” to have a problem with using the BMI as a sole measurement. Talk to anybody in the military, where being overweight is a career-destroying move: everyone knows people who have failed the BMI test but passed easily when they got “taped out” (physically measured to calculate their body fat).

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    • Mark says:

      The thing that cracks me up about BMI measurements is that they were supposed to do away with the old height/weight charts – no more looking up the X and Y coordinates of your height and weight on some silly chart you can never find; just take the cube root of your height (in furlongs) and divide it by the cosine of your weight (in troy ounces) and voila – you get your BMI!

      In practice this is all too complicated for most people, so how do we make it easier? With height/weight charts, of course! Only now, instead of finding that this height and that weight makes you borderline overweight, you find that this height and that weight give you a BMI of 28.3, and then you have to go look at ANOTHER chart to determine what your BMI means.

      P.S. To make at least one borderline-relevant observation: the very fact that the BMI calculations can be reduced to height/weight charts means they’re no more (or less) accurate or helpful than the old height/weight charts were – that is, the governator would have appeared equally unfit on the old charts as with the new-fangled BMI.

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  2. Mitch says:

    The gym classes at my university were actually a lot of fun. I regret not having taken more of them

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  3. Clancy says:

    Yeah, if only there was some way to make teenagers self-conscious about their weight. If only we could make high school more of a living hell for fat kids, we could shame them into loosing weight! If only we’d thought of it sooner.

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    • Enter your name... says:

      And if we give them “bad grades”, we can make sure that those fat kids have a worse chance of graduating or going to college, which will make it easier for future researchers to prove that obesity causes poverty.

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      • James says:

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      • Enter your name... says:

        And whether you’re overweight or not should have what, exactly, to do with whether your ACADEMIC grades are high or low? Why exactly should being overweight make you flunk high school or be unable to attend college?

        Schools are fundamentally supposed to be academic institutions, not the student’s entire life. Let the doctor give the child a bad grade if the child has controllable health problems. Don’t pretend it’s an academic problem.

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      • James says:

        “Schools are fundamentally supposed to be academic institutions, not the student’s entire life.”

        Maybe we should re-think that “supposed to be” a little, and have schools which are fundamentally about preparing students for life. Which means that in addition to academics, they should teach things such as basic financial literacy (see earlier column), what used to be called “home ec” (one of the most useful courses I took in high school, and not just because I was one of two guys in a class of girls), shop classes, health & sex ed, and basic physical fitness.

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  4. Gerry says:

    This proposal would reinforce a rewards system that the science increasingly repudiates. I’m not saying the argument is settled, but at the very least, offering rewards for activities that would otherwise be undertaken willingly decreases motivation and performance. (Lepper, Greene, & Nisbett, 1973) Rewards have negative effects mainly when they are clearly contingent on doing another activity, when they are expected, and when they are tangible, such as money or prizes or grades (Lepper & Henderlong, 2000, p. 261).

    Lillard, Angeline Stoll (2008-08-12). Montessori : The Science Behind the Genius (p. 157). Oxford University Press. Kindle Edition.

    Lillard, Angeline Stoll (2008-08-12). Montessori : The Science Behind the Genius (p. 155). Oxford University Press. Kindle Edition.

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  5. Mike says:

    Why not have a separate “health” grade? It doesn’t even have to mean anything. The sheer fact that kids are getting graded on it will have some impact. Though it could be upsetting to people who have known chronic health issues that can’t be improved…

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  6. Kyle says:

    This is unfair on the children of parent’s that don’t care about grades. These kids are still living with their parents and have little to no control of their diet. If your parents provide you with nothing but pizza and hot pockets then how are you supposed to lose weight?

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  7. Travis says:

    combining two horrible things: “weight shaming” and “arbitrary grading” can’t lead to anything productive or good.

    I’m all for addressing the obesity epidemic pretty much anywhere, but this is definitely the wrong way to do it. Particularly when relying on the archaic BMI…

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  8. Rider says:

    So this character thinks that a) losing weight is about motivation and b) fat kids have no motivation? (Oh and c) fat people are stupid and illiterate. Does he really think anyone over the age of 3 knows nothing about “healthy” foods?)

    He’s not been looking at the research in either area has he.

    I’m not sure I go for UC’s idea either. They are just using a different proxy for health and one that isn’t that useful anyway. I know diabetics who have good results on heart rate monitors after running, I am not that fit but my bloodwork says I’m very healthy indeed: low blood sugar, low blood pressure, low cholesterol. Why should I be forced to take classes?

    It’s well known that if you want to measure something you have to measure that thing, not proxies for it, and that most things are measured because they can be, not because the result is useful.

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  9. Clare says:

    Grade them on their number of sick days. Even better, and a much more direct measure of their health!

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    • Enter your name... says:

      So the kid who spent a month in the hospital because a drunk driver hit him flunks health, but the kid with perfect attendance now, and who’s obesity means he’ll have a heart attack in his 40s, gets a perfect grade? I don’t think so.

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  10. Rrose Selavy says:

    Most of us who are overweight are pretty well aware of it. This does nothing to help people achieve a more desirable, healthy weight.

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  11. Dan says:

    Why not bring back daily gym class?

    Back in the day I had gym class every day at school and we were graded on it. The gym teacher didn’t fail all the fat kids, but you failed if you didn’t try or make progress. There were fitness tests of strength and endurance. I got exposure to tons of different sports and status was associated with fitness and athleticism and not merely who could be the most sarcastic in the cafeteria.

    Is it any wonder that fitness has declined since then?

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  12. Dan says:

    I have got to say, weight shaming is big in Japan and there are hardly any overweight people there. They have the longest life expectancy of any nation in the world.

    My Japanese wife has born me three kids and she remains in terrific shape. She is happy to make fun of my weight, cutting a sharp insult and then soothing it over with warm words. Its been good for my health I think.

    When did we get so thin skinned? Overweight will shorten y0ur life, reduce your odds of being able to have kids and give you lots of health problems. It’s not cool.

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  13. Anna says:

    According to the CDC:

    1) Chronic conditions are responsible for 75 % of all healthcare costs in the U.S.
    2) Chronic conditions are behavioral in nature and are entirely preventable.

    Actions have consequences.

    But today those who are doing themselves harm are not paying the cost of that harm. According to a report on NPR last week, the least healthy 50% of the population are responsible for 97% of healthcare costs. The healthiest 50% (the ones who produce only 3% of the costs) are enablers. They pay the bills for those who make themselves sick.

    To fix our healthcare system we must reconnect actions with consequences. We must stop enabling willful healthfulness.

    Each and every one of us has every right to eat exactly what we want. We should also pay the costs of our choices.

    While BMI may not be perfect, there are some very good measures to determine health. Start grading kids in school. More importantly, continue to grade adults by charging them health insurance premiums commensurate with their unhealthy behaviors. Charge them what they cost the system…. just like car insurance.

    That’s when we’ll see a rush to health.

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    • Enter your name... says:

      The CDC says nothing at all like “2) Chronic conditions are behavioral in nature and are entirely preventable.”

      Genetic disorders are chronic conditions. They are 100% non-behavioral.

      Type 1 (“juvenile”) diabetes is a chronic condition. It is 100% non-behavioral.

      Autoimmune diseases are chronic conditions. Almost all of them are 100% non-behavioral.

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  14. CL says:

    Just make gym class mandatory for all freshmen. Measure the weights of all incoming freshmen and then through their years (including 5th year seniors). This should give some trends on at least weight, which my not neatly correlate with health (one reason BMI is not the best measure). Schools could give a wealth for health credit (i.e,. slight tuition reduction), but they’re making too much money off of the pop/candy machines to care.

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  15. Curt says:

    It seems to me there’s a difference between health awareness/education and ‘lol u r so fat go 2 da gym fatty.’

    Also isn’t BMI just a collection of average height/weight ratios anyway? Sounds like a meaningless metric, but I could be wrong.

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  16. KJ says:

    Some sense to this, only it’s probably not wise to embark on any argument with something the CDC posits. They are the very organisation that is responsible for ensuring – in the name of preventative medicine – that thousands of people have become chronically ill.
    Here’s how you do it.
    Encourage everyone to go to their doctor even when they are well and have no symptoms. Have the doctor perform a barrage of tests. Regularly alter the desirable outcomes (on Big Pharma based studies) so that more and more people – with no symptoms mind you – are considered ‘at risk’. Ensure those people are prescribed medicines (which, uh, have those funny incidentals called ‘side effects’ which are likely to bring them back to the MD’s office) Hey presto, you’ve got a chronically ill person.
    But, yes, I’d love to have an insurance policy and premium that reflect my beliefs and health spending instead of being lumped in with this sort of lemming.

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  17. Amber says:

    I work with obese youth on a regular basis. They know that they are obese/overweight. They are aware of what a healthy lifestyle entails. The problem lies in the lack of healthy options in school lunches, lack of parental cooperation, and limited access to exercise equipment. Heavier kids don’t want to try out for sports because it can be intimidating. Many kids skip breakfast, go to school, eat lunch there, and go home after school to take-away dinners their working parent(s) bring home or have to make themselves. If we are going to grade someone, it should be the parents.

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    • James says:

      “Heavier kids don’t want to try out for sports…”

      But “sports” of the school team sort you’re apparently thinking of as an exercise option really make very little contribution to physical fitness. Indeed, it’s often just the opposite: coaches will have the team members running, lifting weights, and doing other basic exercises in order to build the fitness needed to play the sport well.

      As for lack of exercise equipment, last I heard going for a good walk (known to be man’s best medicine since the days of Hippocrates) requires no equipment. Neither do pushups, situps, ab crunches, squat thrusts, or any of the other exercises I remember from boot camp. Likewise, yoga requires no equipment, nor do tai chi, Pilates, or many other proven fitness systems.

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  18. Scott says:

    This simply adds to the very profitable cognitive dissonance that the food industry and their sponsored “objective” researchers have made fortunes with for more than a century. For all of the fracas and fiasco that is published about overweight children, our primary education about such things comes from food advertisements, the central them of which is “consume more”. The result of the lack of competent and objective advisement from researchers, lack of unlobbied oversight from government agencies and the relentless push to sell more calories speaks for itself.

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  19. Enter your name... says:

    Pierre Dukan said, “This will not change anything for those who do not need to lose weight.”

    I say, “Pierre Dukan appears to be completely ignorant about eating disorders.”

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  20. Dan says:

    The BMI is a good tool for general use, but I think it’s unfair to issue a grade for it. Is an obese or overweight rating an automatic fail? What if a child improves their BMI rating through a semester of hard work but is still obese or overweight , did they earn an A or just an E for effort with a failing grade?

    I am all for an increase of health and nutrition education in school. I have been shocked repeatedly by the “average person’s” lack of general nutrition knowledge. A program that instructs children on basic nutrition, with hands on approach (say monitoring of caloric intake/expenditures, daily instruction on exercise, etc…) would be extremely beneficial for all kids, regardless of BMI score. That skinny 12 year old kid who never stops moving will eventually be an overworked, overweight, adult who sits in an office all day and thinks lean hot pockets and diet coke are health food.

    I remember lining up and getting callipered in Gym class in junior high. Kids who scored a high percentile were systematically teased by their peers, looked down on by the gym teacher, and given nothing but grief and embarrassment. No information, education, or support to improve, beyond a half hearted suggestion to turn the TV off. That kind of negative reinforcement didn’t work. I don’t think stamping them with a “scarlet letter” grade for being overweight will work either.

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  21. Howard Brazee says:

    I see two very similar groups of Righteous people wanting to control everybody else. (I use Righteous in its worst meaning):

    Food Nazis on the left, and sex Nazis on the right.

    Maybe they want to avoid temptation from doing stuff they are attracted to, maybe they want to save us from icky stuff. (or both – even Nazis are different).

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    • James says:

      You know, it is quite possible to like good food, even to be something of a “foodie”, and still maintain reasonable weight and good physical fitness. You just need to distinguish between quantity and quality. Indeed, I’ve found that few things are better at inducing an appreciation for one’s dinner than a day spent hiking, biking, skiing, etc.

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  22. Enrico says:

    Hello Levitt ,

    I stumbled on some academic research that proves that the Mediterranean diet has better cholesterol effects, as well as less weight regain than low fat and low carbs diets. It was conducted at the Nuclear Research Center Negev (Israel) and published by the New England Journal of Medicine. The researchers found that at 6 years after study initiation, 67% of the participants had regained 2.7 kg of weight lost in the low-fat group, 1.4 kg in the Mediterranean group, and 4.1 kg in the low-carbohydrate group.

    That said, I think this is truly a perfect match for your French diet article
    here: http://www.freakonomics.com/2012/01/20/a-smart-incentive-or-obesity-persecution/

    If you’d like me to forward that info your way, let me know and I’ll gladly send it over.

    Kindest regards

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