Is America’s Obesity Epidemic For Real? (Ep. 2)

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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.

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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.

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 — 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.


Trudy Johnson

The paradox is, obese people are malnourished. Though it may seem to some as if they are very well fed. They are just as much at risk for certain cancers as are those who smoke and drink to excess. How on earth did we come to this point? Is it part of natural selection, survival of the fittest, or a part of evolution?

Kimota94

Every time I venture across the border from Canada into the U.S., it's like a slap in the face to see how much the average body shape differs between our two countries. Not that Canada isn't headed in the same bulky direction, but our American cousins are well ahead of us on that road and it's visibly discernible. Whether it's unhealthy or not, I can't say... but at least in Canada we all have access to health care!

Heather

Remember when fat people used to be described as having "glandular problems?" We don't hear that said anymore... now everyone is obese and it's all TV and McDonald's fault. While that may be true to an extent, there are still "glandular" problems at work. We're all being exposed to a cocktail of chemicals that disrupt our endocrine systems in ways that cause us to gain weight. Researchers are calling these chemicals "obesogens." see: http://www.amazon.com/New-American-Diet-obesogens-flatten/dp/1605294640

Joachim

Does this discussion strike anyone else as insane? Let's interview celebrities and people who are experts in different fields to determine whether we have a health problem. Let's look for fringe, poorly done research to justify our pre-existing opinions. Let's just throw science and medicine out the window (who needs 'em?) and find someone with "Dr." in front of their name to disagree with established fact and sell controversy. (Diabetes and weight gain aren't linked, really!? What BS.)

Way to work the marketing machine, Mr. Dubner. This is dishonest, immoral journalism at its very worst.

dema

Dr. Dubner, could you and Dr. Levitt please look into the (I admit, vast volume of) obesity and health problems studies, and determine whether obesity is or is not likely to put you at much higher risk for diabetes, stroke, heart disease, etc.?

I certainly believe they do, having seen obese people in the practice of medicine and noted the increased risks anecdotally and through studies cited in lectures, but there seems to be a stubborn minority that doesn't. Perhaps there have been some flawed studies of the question, but my respect for your and Dr. Levitt's opinions is enormous, and I'm sure you could resolve at least the statistics of the issue, if not the medical mechanisms.

If you don't feel the motivation is great enough, please do it for the sake of the increasing contingent of obese people I'm beginning to see who are citing these opinions in justification of their own obesity-inducing behavior: they thus risk their own health, and those of others, if I'm right.

(Of course, if I'm wrong, then I'd like to know for the sake of knowledge itself - and so I can spend more time eating red meat and less at the gym!)

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Jesse

Corn subsidies are our biggest problem. They make unhealthy food too cheap. It's too easy for someone to get a meal at a fast-food restaurant. Junk food would be a lot more expensive without corn subsidies and people would naturally eat healthier food.

Obviously, lifestyles need to change as well. Walking needs to become part of our culture again. I'm shocked when people will drive around the block 5 times to get a closer parking space.

happyzor

Screw that. If you're overweight or obese, you need to shape up or be shamed into shaping up. You are raising insurance premiums for everyone else just because you can't control yourself. Have some personal responsibility please.

Big Joe

"And in fact there were just as many people dying from weighing too little as there were from weighing too much."

Spam logic.

Barbara

You know what happens in your family. I am a baby boomer. I have 3 sisters. All of them are overweight and 1 is severly obese. 2 have overweight children and one severly overweight grandchildren. They are very defensive and feel that society is biased against people who are overweight. Hmm

We grew up at a time when fast food became the affordable luxury of the working class. Snacks and prepared foods replaced home made meals. Soda pop and sweets were marketed for every holiday and special event. They became a successful way of fundraising for churches, schools and sports teams.

All of my sisters shop in bulk at Sam's Club and Costco. Their
pantries are filled with soda, snacks, and canned goods. It
is rare to find any of them buying food from a farm market as
our mother did and growing her own.

All of my sisters have weight related health problems. 2 of my sisters have diabetes. 1 on my nephews has also got diabetes.
He is in his forties. His wife has severe thyroid illness. My sisters son suffers from some form of hyperactivity. They all
have cable tv which is on much of the time. It is a very different lifestyle than I experienced in the '50s which has shifted from
family life to consumerism. It has an addictive outcome.

I think obesity is very real. It not only impacts on a person's
health but their ability to see themselves and the world. The idea of more is very appealing to them. Holidays are often a glut
of stuff. I would guess that a lot of people have become like this.
It's an addictive and unhealthy lifestyle.

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Jen

I think that adults in the US are roughly the same size as they were say 50 years ago, probably a bit heavier but not shockingly so. Have you ever looked at images of women from the 1940's for example? Or the 1880's? They are NOT skinny. Far from it. Women were round, had soft hips and thighs, healthy young women had round cheeks and arms. They weren't fat, but they were FAR from looking like models. Which brings me to... I think the problem is that we now see emaciated models (and Hollywood actress - same difference) as our body ideal. But it's an unttainable and unhealthy ideal. So the difference between the average woman today and this skinny woman who is say 5'7" and 105 lbs. soaking wet is what is shocking, and my guess is this is what makes people think there is an obesity epidemic. What there is, is an anorexia epidemic people.

Andrew

This reminds me of the years where people said "the link between cancer and smoking has not been proven." Folks in these emails point to the obvious - look around at the airport, in the mall, or at the supermarket. People sure look bigger. Just look around - you see fat people everywhere, huffing and puffing as they walk up stairs, stuffing hamburgers down their throats, watching TV as their source of "entertainment" and mocking exercise as a "crazy California thing". And to address his main point, I've seen plenty of data to show that the same people are more likely to suffer from diabetes, suffer from heart attacks and die young. Additionally, from my own personal sample of friends and family, the fat ones have all died younger and lived a less healthy life than the ones that watch their diets, keep the pounds off and exercise.

And it amazes me that I'm even having this conversation in 2010.

We could spend time agonizing IF there is a link, but I'd rather spend the energy on trying to solve the problem.

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Stop Yakkin and Run

To #7, You're missing Oliver's point. What he is saying is that the causal link between obesity and "poor" health is empirically weak (actually nonexistent). This is "academic" speak. The point is that with historical data, the data is never complete or perfect, these limitations can cause all sorts of statistical issues and even so, statistical analysis will only show a correlation (relationship) and not causation. In other words there is a relationship between obesity and (pick your affliction) rather than saying obesity causes (pick your affliction). So again, he is saying that due to data limitations and methodological limitations research findings are suspect. That's all. He NOt necessarily saying the link isn't there, or that obesity doesn't cause health problems - just that the evidence really has not been shown, most importantly unequivocally shown (no room for doubt or debate). Granted, at the conclusion of the podcast he did seem to brush off obesity, but I think his points are valid. In addition, this is a long term effect. It takes years for any health effects to show up and that makes demonstrating the link even tougher (more intervening events to confound potential results). However, I don't doubt for a second that losing weight will get a person's blood chemistry back in line. Saw it with a friend's weight loss recently and others as well.

Yes, BMI is imperfect, better to do a blood chemistry. I mean if your BMI is 32, but cholesteral, BP, blodd serum & everything else is in line, so what if your BMI is 32?

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Eduardo Siguel, MD, PhD

I have 20+ years experience seeing patients. I invented a blood test to measure fatty acids in humans. I explained why isocaloric low fat diets lead to cardiovascular disease (see essentialfats,com or NIH Mediline for my articles).
Over the past 30 years, Americans, on average, have gained substantial weight. No doubt about it.
Over the past 30 years, health professionals have gained substantial weight. Single girls. Single guys. Young children.
However, if you look at the weight of one skin hair, it has not increased substantially. Which proves that not all parts of the body gained weight. It also proves that you can pick your biomarker. Over the past 30 years, if you measure the weight of people who were 70 years old 30 years ago, most lost weight (in part because they are dead).
Overweight is almost always associated with substantial nutritional and biochemical imbalances (read my papers, I did measure fat composition in humans).
Overweight is a primary factor in disorders caused by biochemical abnormalities, such as high BP, diabetes II, cardiovascular disease, Alzheimer's, Cancer.
If you measure the following variables in the Freakonomics home neighborhood: # trees, # flowering plants, Length sidewalk, water gallons used, electricity and gas used, Average sun radiation in Jan, and correlated them with death rates, the odds are high that one of them is positively correlated. If we do the same for 1,000 communities, the correlation will be statistically significant.
Moral: to save lives we must cut off water, electricity, gas, trees, flowering plants, etc. in the Freakonomics neighborhood.
By the way, did you hear the story that proved that germs do not cause disease, but disease causes germs? Or the one proving that malaria is caused by diseased goats, not mosquitoes? There are thousands more truths on the Internet. That is why I never let a black cat cross my path. And throw salt over my shoulder (unfortunately, people no longer invite me to parties because I throw too much salt).
Better safe than sorry.
Cheers, keep up with the funny stuff.

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Robert

I have often wondered how much of the evidence is from the tails of the distribution. Many of the comments here about Americans becoming fatter do seem to be influenced by tail bias -- witnessing a substantial number of morbidly obese people might lead one to mistakenly conclude that people as a whole are becoming fatter.

This also kind of gets to Tom from Wisconsin's point. Weight is distributed on a highly skewed distribution with a finite left tail (one can't get lighter than 0 kg or lbs). Further, I'd guess that it is very difficult to push the effective left boundary lower. However, an increase in the weight of the very obese will tend to pull up the mean at a faster rate -- since this is essentially unbounded, it could significantly skew the distribution.

Murray Bolesta

The obesity epidemic is absolutely real and has a pernicious impact on everything going wrong in society, including health care costs. It is a symbol of the excess of our consumerist society.

It is not natural and must be stopped (mainly through children's diet and exercise - the next generation).

It is caused in part by a switch from a smoking epidemic of 25+ years ago. Also, it is caused by the corporate food companies including the corporate restaurants. Further, it is caused by the demise of the family farm 30+ years ago.

Obesity is in the top 3 social problems of our time.

Maureen

Are obesity rates age-adjusted? I've read that body mass peaks around age 55. Perhaps our aging population accounts for some of the rise in obesity rates?

Eduardo Siguel, MD, PhD

Strawbridge, et al, (2000) American Journal of Public Health, vol 90, 340-343. I read the study and did not find adequate data to support their conclusions or the conclusion that obesity does not increase mortality and morbidity. They should have reported individual data elements, actual weight, the regression equations, the R square of their models and other critical data.
Chenney is overweight, had apparently 5 heart attacks. And is alive and talking well. Some runners dropped dead. Moral: overweight and heart attacks don't kill you. Exercise is the real killer. Solution. Instead of another government intervention program and mandates to lose weight, we should have more free markets. Let people decide whether they want to run for their lives, or sit at home watching TV eating potatoe chips, pizza and drinking bear. Instead of tax on junk food, we should give people incentives, tax rebates, for eating excessive calories. It is a win-win situation. If excessive calories are healthier, people will work longer and contribute more $ to Medicare and SS. If excessive calories kills them prematurely, we save $ on Medicare and SS.
Reading these posts really makes one creative, thinking outside the box, outside the galaxy.

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Nosybear

A couple of very unscientific observations: I just got back from two weeks in Germany. There is a profound difference in the Germans' figures and Americans' although the gap appears to be closing. The second, I just got back from three days' skiing at Copper Mountain, CO. The population there looks different from the typical American figure as well, result of active lifestyles and very expensive food at the base.

peg

We recently stopped at a diner in the midwest that was serving-- wait for it, --5 egg omelets. The place was packed with people eating 2,000 calorie breakfasts. (It didn't stop with the omelets.) And there was hardly a person of normal weight in sight. These people aren't putting in a day doing farm chores as their parents might have.

Surely, this can't be good for us. There is no reason to moralize about this subject, but we do need to get people to think. How could this be good for me? How could this be right to thrust on others, especially children?

Nevermind mortality. I don't want diabetes. I don't want to overtax my joints. I simply don't want to be willfully ignorant.

Paul

Where is the explanation for the dramatic increase in type 2 diabetes (formerly known as "adult onset diabetes") among children as young as age 6.

Sure, these kids are sedentary. But they're also obese. There are very few six year olds with type 2 diabetes who aren't overweight. If they weren't sedentary, they wouldn't be obese OR diabetic (type 2).

For most people, type 2 diabetes and obesity are two sides of the same coin. To argue that you can be healthy and obese is completely disingenuous. Especially if you're a polticial scientist. Unless you happen to be getting a paycheck from the insulin industry...