Is America’s Obesity Epidemic For Real? (Ep. 2)
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.
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, 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.
KMan
T-
That's a total red herring. The information would have no bearing on whether obesity causes an increase in mortality rate. Including deaths (those from old age), accidents, etc. would skew the data.
There will always be outliers in terms of the data- the exceptions to rule that each side likes to march out. For example, the smokers who march out the 70 year old who has smoked a pack a day for 50 years and hasn't died.
What is ridiculous is that some individuals scream fat discrimination. Unless there is an underlying medical condition, obesity is caused by lifestyle. Unlike immutable characteristics like, race, national origin, sex, sexual orientation, birth defects or any other characteristics that people are born with- there is a choice involved here. To put this on the same level is an insult to people that have suffered discrimination for immutable characteristics. If people make poor choices, then I think it is ok to promote behavior modification. Just like smoking or drinking excessively (while they should not be outlawed), behaviors that lead to obesity should be actively discouraged.
As far as BMI is concerned, it's only useful for a VERY general population. Using BMI- almost all athletes are considered obese. Body fat percentage is a better indicator. There's also the type of fat that is important too- visceral fat deposits have been linked to insulin resistance, glucose intolerance, dyslipidemia, hypertension and coronary artery disease. (NIH)
Unfortunately, I disagree with Tom's assertions. Overweight is different from obese and is in a different category. In addition- he mentioned average weight gain- which is not the proper number to be looking at- it should be the median. Looking at the study cited- I was disappointed to see the focus of the study was on mortality rates instead of morbidity. While they attempt to explain it away- the focus on mortality is misguided as this metric does not take into account quality of life nor does it give an accurate picture of the expense of treating diseases. Finally- they include stigmatization as a factor- unfortunately- they fail to point out the incidence of obesity is much higher than one of low BMI.
In conclusion- what really matters is that people should engage in healthy lifestyles. If you're trying to lose weight- good for you. If you're thin and smoke or if you're obese- bad for you. No one wants big brother- but when your lifestyle choices create a medical tax on those who choose healthier lifestyles, then it becomes an issue.
Sandra
I have been suspicious of the statistical basis of the "obesity epidemic" ever since I was told that my daughter was at the 50th percentile for weight. She wears a 10 slim and leggings fit her like regular knit pants. By anyone's measure she is a thin girl. If she's the "average" it's not hard to see how many children would register as fat who would look normal to an average bystander, yet would skew the statistics.
Doyle
Obese, schmobese!!! Wimpy says he is just a Aristotelian personification of a perfect sphere - a veritable metaphor for the perfect world that FFFC can help us enter. In this perfect world, BMI stands for "Bery Much Ingest'd", kind of a GDP for Popeye's. Because these meccas of fine food are rarely positioned near either mass transit or conveniently close to parking, they encourage walking of the sort associated with pink, vibrant and radiant health. Praise the sailor-man...
Anna Gawkowska
One of my patients got very offended when I used the term "obese" to describe his obese (BMI 33) body. He stated, with much anger, that he didn't like what is going on in this country, and what the government and "that first lady" are doing. As a medical student about to do some nutritional counseling, I come off as someone who is an extension of bad government. Obesity is a bad word to my patient, not a clinical term describing his condition. Trying to do anything about obesity, even mentioning it, is seen as unpatriotic.
The patient is in his late 50s, with hypertension, hyperlipidemia, diabetes, and history of colon cancer. His diet includes lots of bacon grease and he doesn't move much. When I asked if he thought there was a link between diet and health, he responded, "maybe." He wasn't interested in hearing anything about it. His primary reason for seeing the physician was to renew his statin prescription.
We are fighting a war with mentality.
Catherine
I suspect that the rise in obesity directly correlates with the fact that so many adults quit smoking in the 70's and 80's. I 'm aging myself here, but when I was a kid most adults smoked - especially men - and people who did were generally thinner than those who didn't. (The show "Mad Men" is a fairly accurate portrayal of attitudes toward smoking at that time). Then in the 70's smokers started getting genuinely alarmed about the health risks of cigarettes. Some would justify their habit, rationalizing that they'd get fat if they dropped their smoking habits "and wouldn't that be just as bad?".In fact, most people who quit smoking did indeed gain weight after quitting.
So if that's the case, what's worse? Should people be advised to start smoking again? (OK, just kidding).
I realize that a counter-argument against this is the rise in childhood obesity. Even in the distant past when I was young, kids didn't stay skinny by smoking.
winterfresh
If we found out that there really is no obesity epidemic and that obesity doesn't cause you to die earlier and doesn't give you diseases, there are still reasons to keep your weight down and eat good food and exercise. This issue is kind of like climate change in that regard. People who don't believe in it act as if one day we'll disprove the theory once and for all and they'll say, "It's OK, everyone. We can continue burning oil and gas and driving inefficient cars and polluting the air and the water and the soil. It doesn't cause climate change." Then we'll all live in a non-climate-changed but filthy and ugly world. Exercise can be fun, for one thing. Plus, I mean, who wants to discourage people from maintaining a healthy weight? For me, seeing fat people is like getting sprayed in the eyes with mace. Why don't we all just keep the "ruse" (it isn't, anyway) going and help our overweight brothers and sisters look better and raise kids the same way? Shhhhhhhh...
Murgatroyd
Why is there no mention in the news that obesity is an entirely preventable condition that is an underlying or direct cause of serious illnesses such as Type II Diabetes, some cancers, etc. and has the potential to balloon health costs even more? A complacency has set in that makes people seem to accept obesity as just another physical attribute and companies are only too eager to accommodate them. Extra wide wheelchairs, enormous hospital beds, really extra big sizes--"oh, you're not obese--you are Pretty-Plus". Everyone has the right to look nice and have a wheelchair that fits. But being obese causes or worsens a host of medical conditions. Being obese is just plain extremely unhealthy and we all will have to pay an enormous amount of tax dollars for something that could have--maybe not easily; sometimes it's hard to eat right--prevented.
Russell Potter, Ph.D.
I am distressed to see that this aggressive, normative campaign against a phantasmic "epidemic" is garnering so much press. The real problem is not obesity, but the mistaken correlation between weight and virtue, which has its end in the dark corridor of anorexia.
Ai
I think when we start seeing an increase in the number of chilren who have type 2 diabetes, we have to aknowledge we have a problem!
Charles MD
I must be living on a different planet than Mr. Oliver. He needs to get into the trenches and talk to doctors and see the patients. You simply CANNOT be fat and healthy. The science of obesity has been clearly elucidated since I went to med school. Obesity is a pro-inflammatory state; that is obese individuals can have up to 3X the amount of inflammation inducing cytokines, based on weight alone. There are clear links between obesity, Type II DM, fatty liver leading to cirrhosis, coronary artery disease, sleep apnea and Cancer. Osteoarthritis of the knee is also highly correlated with obesity. The science of atherosclerosis has also been clearly established; one fatty meal absolutely trashes your endothelium (cell lining of blood vessels). Fatty streak, an early manifestation of atherosclerosis starts in the teens. Now that the level of obesity and Type II DM is increasing in children, we can expect to see more coronary artery disease in younger and younger individuals.
Organized medicine profits greatly from obesity and also contributes to it. 40% of top American Hospitals have fast food restaurants in them! One fast food meal showers you system with as much sugar, salt and fat as 10,000 lbs of a hunter-gatherer diet! Yes folks, it's the WESTERN DIET that is making Americans fat and sick.... and let us not forget that only 30% of Americans exercise regularly. As Wm Roberts MD stated in a lecture on the Western Diet and Obesity- "We cannot lead the world with this population". 70% of health care expenditures are related to diseases of lifestyle. Yes, Houston, we have a problem.
matt
what would the Fat Boys say?
Herbert simmens
Gary Taubes, the author of the groundbreaking 'Good Calories, Bad Calories' who turned the nutritional world upside down with his NYT Magazine cover story some years ago praising low carb diets sums up his compelling research as follows:
Dietary fat -saturated or not - is not a cause of obesity or any other chronic diseases.
The problem is carbs -particularly sugars - which raise insulin and change the hormonal balance of the body
Refined carbs are the major cause of heart disease, diabetes, probably cancer and Alzheimers, among other chronic diseases
Most importantly obesity is a disease of excess fat accumulation, not overeating, and not sedentary behavior
Consuming excess calories does not cause us to grow fatter. Expending more energy than we consume does not lead to weight loss, it leads to more hunger
By driving fat accumulation carbs also increase hunger and decrease the amount of energy we expend in metabolism and physical activity.
IMO these propositions while still bitterly resisted and mocked by mainstream nutrition leaders are the key to understanding and ultimately reducing obesity.
LadyDiazepam,SydneyAUS
How anyone can deny that obesity is bad for your health is beyond me. Lugging around excess weight strains your heart and joints, and will hamper your ability to get around as you get older. Fat people have miserable old ages.
Thank God my mother was ahead of her time with regard to nutrition and portion sizes. While my classmates ate Froot Loops for breakfast, had Hostess twinkies in their lunch boxes, and were allowed to scoff potato chips straight from the (family-sized) bag after school, I got 3 balanced meals a day, with a small dessert after dinner.
As a 45-year-old woman, I accept that in order to fit into normal-sized clothing, I have to follow a reasonable diet and exercise 5 days a week. I love Vanilla Coke, but do I have it every day? No. I allow myself one can on Saturday and one on Sunday. I also love alcohol. Had to give it up, as it makes me put on weight.
For Americans, (and Australians, too, I'm afraid) every day has become a feast day, with food eaten in binge quantities. The problem isn't corn subsidies. The problem is poor eating habits, lack of self-control, and stubborn refusal to face facts. Here in Sydney, most fat people live in the far western suburbs, where there's nothing to do but eat fast food and drink alcohol.
Fatties, get your heads out of the sand and your snouts out of the trough.
tomtlee
It's the food Dummy!
Almost anyone coming to the US can't help but notice the unhealthy food EVERYWHERE. I live in Asia now and even the poorest people eat well- lots of fresh vegetables. Children in the US don't even recognize many fruits and vegetables.
What's urgently necessary is to start talking about the problem being systematic. Like most big businesses these days, the food industry is not interested in producing healthy food, only food that looks and tastes attractive, and which yields the biggest profit for them and their shareholders. They are constantly searching for the limit of tolerance for inferior food on the part of the US consumer. Just above that limit is what they aim for.
The system is broken- everywhere in the US. Why do so many of you have trouble seeing that? Is it that you are all so used to eating "good" tasting crappy food?
hello?!
Simon
The causality between being overweight and health problems might be a bit shaky for non-musculoskeletal problems - but the reality is that in order to become over weight, you need to have been putting on weight, which over the long term is the result of metabolic syndrome. If you've put on weight very slowly over many years, perhaps you're okay and only really are dealing with the weight itself - but most people who are obese are not in this group. They gain weight rapidly, for relatively long periods of time. They have chronically high blood suger - which is stored as fat(Hence the weight gain), but also they start to develop insulin resistance. So, the correlation between being overweight and health problems is going to be very strong- one of the ways of becoming overweight is very dangerous, while another is not. So you're going to have trouble finding a causal relationship, because there are two different things occuring.
The point is, people who are overweight who got this way through this behaviour are in trouble if they keep doing it- and the best way to stop that is to get their blood suger down. If it goes down, they start burning fat. So the moral is that people don't need to be at a "healthy" or "unhealthy" weight - they need to be at a stable or decreasing weight. For people with a problem already, decreasing is easier to acheive then stable, and the diet corrections that go with it will make sure it stays that way. Ignoring this basic biochemistry, and interviewing a doctor who evidently doesn't know what he's talking about doesn't prove the orthodoxy wrong. And political scientists who don't understand the argument above are no better.
Please, in future, if you are going to give a shallow view in the podcast, at least reference more reasonable arguments in the body of the work.
Cheryl Hamilton
I've worked as a marketer in the bariatric industry for the past 7 years. I'm pretty familiar with how to write the copy for the advertisements and with the medical studies that back up my ad copy. Mine is always footnoted. I've also had weight loss surgery myself. My main reason for having the surgery is that I thought it was a way to avoid the overwhelming genetic risk factors I personally inherited from both my parents. Everyone but one sister in my family who is dead has died from heart disease. Most have lived past 60 before they started having trouble, many lived until their late 70's or early 80's but when they died, they died from heart disease. One completely fit cousin died of a HA around age 45. My brother had his first at 39, he was not really obese when this happened, thanks to drugs and stents, he's a healthy 62. Every time I've lost weight and controlled my weight I have lowered my blood pressure and lipids except this time. I'm now 55 and no matter what I do these numbers won't come down. In fact, every time I approach my "perfect" BMI my doctor will tell me I'm anemic or vitamin deficient in one thing or another. Here is what I have learned in the past 7 years:
1. None of your experts mentions genetics and how our family traits and breeding may be the cause of the perceived increase in obesity, heart disease and diabetes, and yet my genetics are clearly written in my family history.
2. Statistically speaking when I die it will be from heart disease. I don't do anything risky that will kill me first. I don't even bother to get mammograms anymore, I'm going to die from a heart attack.
3. I feel better thin than I do fat.
4. I get much double talk about obesity from my physicians who tell me to lose weight to bring down my bp and lipids, and when that doesn't work, they say, well it doesn't always work, so take this drug, which by the way is toxic to your liver, so you have to come back and get that checked every 90 days. Then they turn around and tell me to take supplements because I'm starving myself when my
BMI is 21. Right now it's 27.
5. I have no respect for nutritionist or dietitians. The increase in obesity occurred on their watch. First it was fat that was the culprit, then it was red meat, then it was sugar, then it was transfats, now it's "good" fat vs. "bad fat". Does anybody really know?
6. I don't really care anymore, like I said, when I die, it will be from heart disease, until then I'm going to live everyday and if that includes a french fry and cheeseburger, apple pie and ice cream I'm going for it. My days might include a walk and will include climbing several sets of stairs, but they will not include any marathons.
Andrea
You are trying to take away the last openly "hateable" group.
Look at some of the comments, they would never ever say that
"am I the only one who is bothered by the fact that their tax dollars will undoubtably get spent on those " autistic, down syndrome, paraphlegic , MS etc people but it is OK with obese people, even if it might not be true.
It would be really worthwhile to get a couple of more studies like Alameda County longitudinal study Tom in Wisconsin (#18) is talking about, specially if it could be published in the media.
bayrak
Gracias por compartir. un sitio ha sido diseñado felicitaciones muy bonito ;)
Mary
Indeed. Who will there be to hate so openly once obesity has been cured? Or made illegal? No, I'm not exaggerating. I don't know how, but I believe it could happen.
I made the decision several months ago to lose weight. So far I've been successful and hope that I continue on this path. This is something I should have done for my health a long time ago, but I'd be lying if I said that my health was the first consideration for doing it now. I'm in it first and foremost for the desire to not be an object of societally sanctioned hatred and derision.
The study mentioned in #18 sounds like it is a balanced view of the "epidemic." It would be good to see the NY Times give it the front page treatment.
William of Stamford
Eric Oliver, to the extent to which he explained himself on the podcast, seemed totally unconvincing to me. He made a bunch of blanket statements without for the most part going into much detail (in stark contrast to the well-established specific causation factors explained by Dr. Blum, that i've heard elsewhere many times, and that Oliver didn't address). Furthermore, he is a political scientist rather than a doctor, and he wrote a conspiracy theory book which tells many fat people exactly what they want to hear, and this implies; he likes to claim people on the other side of the argument have a conflict of interest, but Oliver is no different. He is only one person, and I think that the medical science on all of this is generally well-established.
Some factors behind the correlation between bad health and obesity may not be a direct result of having too many pounds of fat and rather have to do with overconsumption of certain chemicals (saturated fats, quickly digested forms of carbohydrate, kidney-straining quantities of protein), lifestyle habits (like too little exercise), and bad genetics, and it is almost certainly the case that not all obesity-causing diets and lifestyle combinations are created equal in terms of their negative impact on health. But some of the causation factors such as the straining of the heart produced by the expansion of the vascular system required to service the excess fat tissue, as well as the strain on joints on bones, and probably others, do directly emanate from excess fat tissue. And at any rate, regardless of the fact that there are some less harmful ways of gaining that extra tissue, in the real-world the mass majority of people who do get fat get fat by consuming too much of the wrong things (probably the best way to get fat would by consuming lots of lots of starch) and practicing broadly unhealthy lifestyles. So the lifestyle changes associated with loosing weight drastically improve health. Ergo, by complicating things you might get some counterintuitive results, but the end conclusion is the same: if we successfully reduce obesity than we will successfully reduce the rates of a large number of different health problems that are the biggest and most expensive killers in the US.