There is so much noise these days about obesity that it can be hard to figure out what’s important about the issue and what’s not. To try to keep track, I sometimes divide the obesity issue into three questions.
1. Why has the U.S. obesity rate risen so much? Many, many answers to this question have been offered, most of them having to do with changes in diet and lifestyle (and, to some degree, the changing definition of “obese”). There is an interesting paper by the economists Shin-Yi Chou, Michael Grossman, and Henry Saffer that sorts through many factors (including per capita number of restaurants, portion sizes and prices, etc.) and concludes — not surprisingly — that the spike in obesity mostly has to do with the widespread availability of very cheap, very tasty, very abundant food. They also find that a widespread decline in cigarette smoking has helped drive the obesity rate. This seems very sensible, since nicotine is both a stimulant (which helps burn calories) and an appetite suppressant. But Jonathan Gruber and Michael Frakes have written a paper that calls into doubt whether a decrease in smoking indeed causes weight gain.
2. How can obese people stop being obese? This, of course, is the question that sustains a multi-billion-dollar diet and exercise industry. A quick look at Amazon.com’s top 50 books reveals just how badly people want to lose weight: there’s Intuitive Eating: A Revolutionary Program That Works, The Fat Smash Diet: The Last Diet You’ll Ever Need, and Ultrametabolism: The Simple Plan for Automatic Weight Loss. All these books make me think of the argument that every story in human history, from the Bible up through the most recent Superman movie, is built from one of seven dramatic templates. (FWIW, Superman and the Bible are plainly cut from the same template: baby Superman and baby Moses are both rescued from certain death, sent off by their desperate parents in a rocket ship/wicker basket, and are then raised by an alien family but always remember the ways of their people and spend their lives fighting for justice.) This seven-template theory is even more true of diet books. They are pretty much all the same idea with some scrambled variables. Perhaps the weirdest variable yet is the olive oil/sugar water “diet” put forth by Seth Roberts in The Shangri-La Diet, which we have written about a few times on this site.
3. How dangerous is obesity? This is, to me, the toughest question of all. The conventional wisdom holds that obesity is like a huge wave that is just starting to break across the U.S., creating an endless swamp of medical and economic problems. But there is a growing sentiment that the panic over obesity is a worse problem than obesity itself. Among the proponents of this view is Eric Oliver, a political scientist at the Univ. of Chicago and the author of Fat Politics: The Real Story Behind America’s Obesity Epidemic. Oliver argues that the obesity debate is rife with lies and misinformation. According to his publisher, he shows “how a handful of doctors, government bureaucrats, and health researchers, with financial backing from the drug and weight-loss industry, have campaigned to misclassify more than sixty million Americans as ‘overweight,’ to inflate the health risks of being fat, and to promote the idea that obesity is a killer disease. In reviewing the scientific evidence, Oliver shows there is little proof either that obesity causes so many diseases and deaths or that losing weight makes people any healthier.”
Well, even if Oliver is right, and putting aside for a moment Questions 1 and 2, obesity seems to be the culprit in at least 20 recent deaths. Last October, a tour boat carrying 47 elderly passengers sank on Lake George in upstate New York, and 20 of them died. Now, according to a National Transportation Safety Board report, this happened because the boat was badly overweight since the tour company used outdated passenger-weight standards to determine how many passengers the boat could safely carry. (Here is the NTSB’s press release announcing the report; the report itself isn’t online yet, but will probably show up here eventually.)
So even though the boat wasn’t over the passenger limit, it was very much over the weight limit. And when the tourists crowded to one side of the boat to take in the view, disaster struck. According to the New York Times‘s report, the tour company had been using the old standard of 140 pounds per passenger — which the NTSB had already warned was no longer valid, and which N.Y. Governor George Pataki has now updated for New York State, setting the new average-passenger weight at 174 pounds.
The legal wrangling, documented here, has already been intense, with everybody looking to blame everybody else for the accident. The tour group has called the accident “an act of God”; others blame a company that modified the boat; there has also been talk that the captain was drinking. Now it seems only logical that someone will step up to try to sue McDonald’s for putting all those extra pounds on the passengers in the first place.
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You have to distinguish between obesity levels, I think, and also look at health, not just morbidity. For the very obese – the Shamu-of-the-boardwalk set with 30 or 40 kg overweight or more – there is very little doubt that it is downright dangerous. Those people really are eating themselves to death.
For the moderately obese the morbidity may not change all that much (it does, but not a whole lot), but that does not mean there’s no negative effects. Living as long as other people but with an array of lesser health problems still means quality of life is worse, more lost work due to sick days, and still “burdens” the health care system with an array of health problems (perhaps more so than someone with the good grace to go quickly in a massive coronary).
The real debate is where to draw the line between normal weight and obesity, and there I believe critics may be right that the current focus on a fairly arbitrary BMI limit may not be the right way to do so. THere’s also good indications that the overall level is probably too low.
The better measuse is probably fat proportion, not mass. Also, there should probably be separate limits not only for men and women, and for different ages but perhaps for different body types as well. The downside is of course that unike BMI this is not something you can measure yourself with any accuracy.
You have to distinguish between obesity levels, I think, and also look at health, not just morbidity. For the very obese – the Shamu-of-the-boardwalk set with 30 or 40 kg overweight or more – there is very little doubt that it is downright dangerous. Those people really are eating themselves to death.
For the moderately obese the morbidity may not change all that much (it does, but not a whole lot), but that does not mean there’s no negative effects. Living as long as other people but with an array of lesser health problems still means quality of life is worse, more lost work due to sick days, and still “burdens” the health care system with an array of health problems (perhaps more so than someone with the good grace to go quickly in a massive coronary).
The real debate is where to draw the line between normal weight and obesity, and there I believe critics may be right that the current focus on a fairly arbitrary BMI limit may not be the right way to do so. THere’s also good indications that the overall level is probably too low.
The better measuse is probably fat proportion, not mass. Also, there should probably be separate limits not only for men and women, and for different ages but perhaps for different body types as well. The downside is of course that unike BMI this is not something you can measure yourself with any accuracy.
At last, another perfect opportunity to sue a fast food chain for the decadence of the American eater. Burger King, anyone?
At last, another perfect opportunity to sue a fast food chain for the decadence of the American eater. Burger King, anyone?
Hello,
I enjoy the blog. Regarding possible causes of obesity, there’s one cause I don’t see mentioned much in the news, but I think may be quite important. It has to do with the design of modern cities. In many post-WWII cities and developments particularly out west, the residential areas are kept separate from commercial districts, and sidewalks connecting the two are either non-existent, unsafe, or unattractive when compared to roads. Thus, this encourages driving instead of walking. In contrast, traditional urban environments like Manhattan offer wide sidewalks and numerous routes to choose from.
The CDC did a great study on this a while back that can be read here:
http://www.cdc.gov/nccdphp/dnpa/physical/health_professionals/active_environments/aces.htm
Of course, this phenomenon doesn’t explain everything by itself, and it is just another piece of the puzzle.
Hello,
I enjoy the blog. Regarding possible causes of obesity, there’s one cause I don’t see mentioned much in the news, but I think may be quite important. It has to do with the design of modern cities. In many post-WWII cities and developments particularly out west, the residential areas are kept separate from commercial districts, and sidewalks connecting the two are either non-existent, unsafe, or unattractive when compared to roads. Thus, this encourages driving instead of walking. In contrast, traditional urban environments like Manhattan offer wide sidewalks and numerous routes to choose from.
The CDC did a great study on this a while back that can be read here:
http://www.cdc.gov/nccdphp/dnpa/physical/health_professionals/active_environments/aces.htm
Of course, this phenomenon doesn’t explain everything by itself, and it is just another piece of the puzzle.
Going to the idea of definition, I vaguely remembered an argument about the Metropolitan Life tables — which were the basis of most recommendations — being biassed because they were based on mortaility figures from people insured. That is, they ignored the (possibly very fat) people who were turned down for cover.
I can’t dredge that up, but there’s an interesting article at http://query.nytimes.com/gst/fullpage.html?res=9A03E2DF1138F935A3575BC0A963948260&sec=health&pagewanted=print
Going to the idea of definition, I vaguely remembered an argument about the Metropolitan Life tables — which were the basis of most recommendations — being biassed because they were based on mortaility figures from people insured. That is, they ignored the (possibly very fat) people who were turned down for cover.
I can’t dredge that up, but there’s an interesting article at http://query.nytimes.com/gst/fullpage.html?res=9A03E2DF1138F935A3575BC0A963948260&sec=health&pagewanted=print