Freakonomics Radio, Fat Edition: Is the Obesity Epidemic for Real?

Listen now:

Protestors blame Ronald McDonald for childhood obesity. (Photo by Scott Olson/Getty Images)

Is America’s Obesity Epidemic for Real? Hear from a 280-pound woman, a top White House doctor, and an overweight but underbelieving academic.

We’ve just completed our second full-length podcast. It’s called “Is America’s Obesity Epidemic for Real?” It costs $0.00. (The podcast, that is, not the epidemic.) Get it here at iTunes; if you subscribe, all future episodes will be delivered in your sleep. You can also get it here via RSS feed, read the transcript, or listen with the audio player above.

If you are a regular reader of this blog, you could be forgiven for thinking, Geez, when will these guys shut up about fat already? True, we have written on the topic repeatedly, including: an astounding spike in bariatric surgery; the female-male weight gap; a possible connection between plumbing and obesity; the usefulness of posted calorie information in restaurants; whether behavioral nudges like “piano stairs” help keep people trim; and whether it may be time for a fat tax.

DESCRIPTION

Photo: Damon Winter/The N.Y. Times Michelle Obama, public face of the “Let’s Move” anti-obesity program.

The podcast touches on several of these ideas and more, and features quite a few differing voices and views. It opens with four young women in New York who spent a recent Saturday evening consuming five meals, in a row, at five different establishments. To their credit, they walked from place to place, which had to burn a good 100 calories right there.

I tried to talk to Michelle Obama about “Let’s Move,” her new program to fight childhood obesity, but that interview never happened.

DESCRIPTION

Ezekiel Emanuel, the White House’s go-to-doctor on healthcare reform.

I did speak to a very good proxy: Ezekiel Emanuel, the M.D. and bioethicist who advises the White House on healthcare reform. (He is also the older brother of a certain chief of staff named Rahm; the third brother, FWIW, is Ari, who runs the talent agency now known as William Morris Endeavor, with whom I happen to do business.) Ezekiel made a strong case for government intervention in Americans’ eating habits. When I asked, however, if it was time for a cheeseburger tax, he made clear his limitations. “That’s a political question,” he said. “I think you got the wrong Emanuel brother.”

The podcast also explores the degree to which anti-fat sentiment is a moral one, as opposed to medical or economic. You’ll hear a bit from Steve Levitt on the topic, but more directly from Peggy Howell, a fat and proud woman who has a fascinating (and sobering) story to tell about fat discrimination.

I also interviewed my own physician, who specializes in diabetes control (thanks, Dr. Blum!), as well as Brian Wansink, the outspoken author of Mindless Eating, whose extensive research on eating habits — and his stint at the U.S.D.A., helping rebuild the food pyramid — has given him a ton of insight into the topic.

Eric Oliver

Eric Oliver, a University of Chicago political scientist and author of Fat Politics. He thinks the “obesity epidemic” is gravely overstated.

Perhaps the biggest star of the podcast, however, is someone you’d never think would have something useful to say about obesity: a political scientist. He’s Eric Oliver of the University of Chicago. He is the author of a book called Fat Politics: The Real Story Behind America’s Obesity Epidemic, and nearly all his research runs counter to the prevailing wisdom. In a nutshell, he argues that the “epidemic” is an overwrought product of moralism, shady statistics, and perversely misaligned incentives. His most controversial argument is that the causal relationship between weight and maladies like heart disease, cancer, and even diabetes has not been firmly established.

Here’s one exchange with Oliver from the podcast:

SJD: You write that in 2004, the Centers for Disease Control estimated that obesity is killing 400,000 people a year. Right, do I have that right? That obesity is killing 400,000 people a year?

EO: They issued an article that was published in the Journal of the America Medical Association claiming that, yes, obesity was killing 400,000 people a year.

SJD: And you vehemently disagree, correct?

EO: Well, there were a number of problems with this report, one of which is it was based on data that were about 30 years old. Secondly, the report itself made some computational errors that called into question the findings there in the conclusions. Another set of research from a different division of CDC then later issued a report that said, in fact, that number was probably closer to more like 20,000 people a year. And in fact there were just as many people dying from weighing too little as there were from weighing too much.

I hope you enjoy listening to the podcast; I very much enjoyed making it. As always, feedback is welcome, along with topics you’d like to see covered in the future.


kda

I gotta say-yes, it's real. There was a time during my life where it was unusual to see overweight people. Now, there are lots of overweight people, including children. Many seem to think it's normal, probably because, having not seen it often, they don't know what normal looks like. Very sad, and the main reason we need affordable "healthcare". Where I live, morbid obesity is everywhere.

Neil (SM)

@#1: Your data seems to have a huge sampling error.

hmmm...

I see a lot about the increasing number of people who qualify as "obese" and "morbidly obese", but the weight cutoff for applying those labels has been steadily lowering over time so we would expect and increase in those numbers even if the actual weight distribution had not changed.

I'm not saying people don't weigh more now, but I'd really like to see a plot of ACTUAL WEIGHT of the population over time, maybe plotting mean, median, and sigma.

When experts investigate anything they always find a crisis that requires more funding for the experts, and so now I always ask about the raw data...

DrS

I always notice in this debate that people who argue against it always bring up how flawed BMI is. It's true that it doesn't take into account build type, but it's a good indicator as to how much standards have changed.

When I tell someone I think I should lose weight, they say I am not just ok, but often skinny. I have a BMI of 27.3. To put that in perspective, Jack Lambert - big and strong by 70's standards - clocks in at 26.8 playing weight. My father's BMI when he left the military in his 20s was 22ish, and to look at pictures of him and his fellow soldiers, he was not the skinny one in the bunch.

Standards have changed that much, because the average person is so much heavier. People who are recognized as overweight by today's standards are definitely unhealthy.

Rick

It seems the podcast focuses significantly on the question about whether fat, not just being fat but the substance itself, is the cause of the health issues associated with obesity.

I think any reasonable person would recognize that it's not the fat cells, but the other unhealthy levels of substances (cholesterol, salt, sugars, etc.), lack of physical fitness, etc. that are more causally related to health issues. It just so happens that the behaviors which lead to those items also tend to lead to the accumulation of fat.

So can you be "overweight" and healthy? Sure. Can you be on weight and unhealthy? Sure. Perhaps the public dialogue needs to reflect this nuance. However, I imagine that if people who are overweight were to pursue a course of action to lose the extra pounds, they'd be eliminating many of the items which lead to health problems in the process beyond just shrinking those fat cells.

Lastly, there's the whole "if it can't be measured, it can't be managed" issue. It's really easy to measure how much you weigh. It's a bit more time consuming and costly to check your blood pressure, blood sugar, HDL levels, etc. Maybe the nature of health care needs to change whereby less emphasis is placed on weight and more on frequent measurement of those items which are more directly and causally linked to poor health.

Read more...

Raymond

There needs to be a better fat measure than BMI.

I'm 5'9', 170lb, which puts me in the overweight category. Yet, I wear XS shirts and 31 inch jeans. I don't even look anywhere near buff or athletic.

Adam

This podcast is a bit discerning. If you are going to answer the question of "Is the Obesity Epidemic Real?" then you would have to present two sides to the story. How about some renowned health professionals stating the statistics that overwhelming associate weight gain with heart disease and diabetes.
How does Eric Oliver dispute the 1/3 of the nation that is Obese? There's no doubt the BMI chart is flawed, but the obese range is fairly clear-cut, if your BMI is greater than 30 you have a fat mass problem. I haven't read Oliver's book, but it sounds like his version of controversy is designed to pad his pockets.
I manage the Fitness department at a weight loss camp, hhhealth.com, we see 20-30 new guests per week. I can tell you that based on empirical evidence, when our guests lose as little as 10% of their weight they undoubtedly see decreases in diagnostic factors such as BP, Glucose and Cholesterol.

Read more...

Ray

Maybe its more deeply rooted psychologically. When we see someone that is really overweight maybe our brain is subconsciously assigning fitness factors to this person. We perceive these factors as disgust, prejudice or dislike for that person when we really don't know them enough to dislike them. Obesity as we experience it now in America is a historically recent phenomenon. Prior to the 20th century if you saw someone that was morbidly obese then there probably was something genuinely wrong with them either mentally (in the sense of compulsive behavior) or physically.

Of course this is a generalization and I am no expert in psychology or history related to this but it makes some sense.

Jared

Clearly obesity is nothing new. Otherwise there would be no renaissance paintings of zaftig women or "little fat kid" jokes when I was in elementary school thirty years ago.
I think the point of the post is that the press/popular culture tend to latch onto an issue and create hysteria about it. (Acid rain, Halloween candy tampering, Toyota accelerators etc, etc, ad infinitum) The issue with obesity is real, but it is not a new or outlandish epidemic that we are being told.
People make choices. They eat too much and move to little, they get fat. The only reason that this is a problem is that we have decided to pool our risk through insurance, and now through national health care.
People should be responsible for their own actions. If they want to eat and be pleasantly plump, that is their business, but they should also be willing to accept the consequences without passing the cost to the rest of society.

Read more...

John

Take a trip to, say, Spain or France. Stay there long enough to get used to human bodies there. Then come back to the US. Upon return especially the physiognomy of members of the working classes (but not only). Then decide whether or not there's an obesity crisis in this country.

frankenduf

yeah, let's ask a political scientist what he thinks about metabolic syndrome- how ironic, then, that the MD interviewed declined to comment on a field out of his expertise

Mark

We should examine and question the sources of these data just as much as we should have been skeptical of the global warming data.
If there's money to be made, you're sure to see the media and others jumping on the bandwagon.
If eating fat causes you to be fat, why are inuits no bigger than average? Their diets don't resemble anything close to the food pyramid. Nobody's ever proven that exercise extends lifespan or reduces disease, but we all sure believe it as fact.
The list goes on and on...

Kris Brower

It would be interesting to know what the exact causes of health problems, but I think the real point is that there is a correlation between people who are obese and developing health problems(type-II diabetes, heart problems, etc). Whether it is the actual fat that is causing these problems or something else that lots of obese people do is irrelevant.

We just need to educate people how to be healthy and why they should be healthy. This needs to be done starting in preschool or even earlier.

Sam

Here are some anecdotes to consider: Take a look at photographs of children in the 1950's and 1960's. Take a look at school children today. Take a look at photographs of, say, an outdoor event or even in an airport from the 1950's and 1960's. Take a look at an outdoor gathering, sporting event, and, yes, an airport today. See the pictures? Many more people today are fat, plain and simple. Big bellies and overweight middle aged men, especially, appear to be the "new normal." That is a health care problem.

T

BMI notwithstanding, I'd love to see a frequency distribution of the actual weight of the approximately 2m people who died in the US last year. Forget about age, sex, height, etc. Just show me their actual weights at time of death. OK - if you want to get really accurate, break it out by sex - give me a histogram with two bars per bin, one male, other female.

If 400,000 of them (i.e., 20% of all US mortalities) died due to obesity, regardless of the above factors, there should be a large number of 200+ pounders.

Simplify, simplify, simplify.

Jessica Maciejewski

I just finished the original Freakonomics and as an educator, was left with a question about a seeming conflict in the results about the role parents play; forgive me if this is old news or has been answered in subsequent books! :) So:

How do you reconcile the data that "school choice barely mattered at all" (158) with the finding that "all students in a bad school... do lose ground to students in good schools" (165)?

Thanks for your time! I'm very interested to hear your response.

~Jessica

Travis

Am I the only one who is bothered by the fact that their tax dollars will undoubtably get spent on those morbidly obese people who are certain to develop diabetes and will thus necessitate disability (and or government picking up their health tabs, in one form or the other.)

Whether or not the "obesity epidemic" is real, there's a lot of fat people and an externality related with that in our form of government.

Tom from Wisconsin

I am a Professor of Psychology with specialties in neuropsychology and psychoactive drugs. That is, I am not a clinician. I cover weight and weight regulation in two classes that I teach. I sometimes feel like a lone voice in the wind because most of the material people get fed is based on junk science. I am very happy that Dr. Oliver had a chance to be interviewed.

The actual increase in average weight in America for adults over the past two decades is only 7-10 pounds, and almost all of that occurred in people who already had a BMI of over 30. This is hardly an increase of epidemic proportions. For people with BMI under 30, no change! On the other hand, the number of stories screaming about obesity and the epidemic of obesity has skyrocketed. The annual number of stories on obesity in newspapers increased from about 1000 in 2000 to nearly 6000 in 2006. Hence, we hear about it all the time so everyone seems to think it has to be real.

In the meantime, the NEJMarticle that everyone continues to cite for their 300K to 400K figure was junk science. It was based on data from a study published in the JAMA (see Oliver above) that did not even measure weight but talked about the effects of a sedentary lifestyle. All those diseases of obesity like diabetes actually result from sitting around all day without moving. A skinny person who is sedentary is just as much as risk as a fat person, but an active fat person is no more at risk of those diseases than an average weight person.

The real science comes out of the Flegal analyses. Dr. Flegal works for the CDC and her research demonstrates fairly clearly that people in the so-called overweight category (BMI 25-30) have the longest life spans and fewest health problems. Every study ever done also finds that the worst health problems and shortest life span occurs in the thinnest people, those with BMI under 18.5.
I am at home so cannot give the full reference, but look for Flegal, et al, in the 2008, Nov 7, JAMA.

For an unbiased review of the effects of obesity, the Alameda County longitudinal study is my favorite. It looked at 7000 residents from 1965 to 2000. You can find it here: Strawbridge, et al, (2000) American Journal of Public Health, vol 90, 340-343. Again, the people with the greatest longevity are those who are overweight, and even those with BMIs between 30 and 35 do better than the normal weight group. Of course, this doesn't fit with society's view of obesity and doesn't sell papers.

Please become fully informed over these issues and don't just read newspaper headlines. Today's column is doing a great service for its readers.

Read more...

Adrian

http://wonder.cdc.gov/ is an interesting resource. They link 100k of 2.5m deaths in (fiscal?) 2006 to 'endocrine, nutritional, and metabolic'.

Peggy

I agree that it's frustrating to pay for medical costs for others. Consider uninsured people who mistakenly cross the street at the wrong time, voluntarily ride motorcycles without helmets, soldiers who voluntarily sign up for combat duty, elderly persons (Medicare reimburses doctors less than it costs to provide care) who hate to give up their independence and driving and may be in accidents, people who do extreme sports, run their whole lives and damage their knees, people who don't take needed medicine because they can't afford it and therefore get sick, people who drink too much or use drugs and die or cause death, people who take chances in any number of ways, people who fail to get proper dental care for their children, etc. etc. Add these all up (and add the ones you think of) and compare those costs with the costs of obesity. I assure you the real problem is the demonization of the overweight so that insurance companies can find a scapegoat and redirect people's attention. Blame fat people. It's easy and then people will point fingers at them instead of the health insurers and the government's failure to give us health care that every other highly developed country offers.

Read more...