The Dark Side of the Anti-Obesity Movement

Fat-person When I was in grad school and working in a policy center, one of my friends went to the corner where an outdoor vendor sold some wonderful Indian chicken and rice. He cooked raw chicken out there in the open sun on the streets of New York, but our digestive systems were young enough to withstand it.

When my friend came back into the office to eat her chicken and rice at the desk, she told me that some stranger on line turned to her and said "you shouldn't be eating this." My friend was overweight, and frequently had random people come up to her on the street who felt that it was important to point out this fact to her. Like she didn't know.

There are two dark sides of the anti-obesity movement. The first dark side is shame. Now, shame in some cases can be a very effective method of reducing undesirable behavior. It has helped millions of people quit smoking or at least hide it from others. But there's something icky about it, too, especially when it's heaped at kids who don't have control over what is served for dinner and who have been cursed with slow metabolisms.

Marc Ambinder did an excellent job discussing his own battle with obesity and the humiliations that he faced as an over weight man in America. 

The other dark side of the anti-obesity movement is that many people are simply unable to control their weight. Diets and exercise don't work. Ambinder only conquered his weight through surgery, which reduced his stomach to the side of a walnut. How useful is it for Jamie Oliver to be yelling at schools about french fries, when for many people, the problem is deeper than french fries? Ezra Klein thinks that the forces that create obesity are so strong that "a mix of surgeries and pharmaceuticals eventually becomes our society's answer to obesity."

Klein also writes,

Obesity is much more structural than it is personal. That's why it's so
depressingly predictable. It afflicts certain communities, with certain
socioeconomic characteristics, and it has only really emerged across a
certain time period. Those communities contain a lot of different
individuals, but their environments and their time and money stresses
and their transportation and grocery options and their street safety
and exercise opportunities are broadly similar. How we live has changed
much more quickly than who we are, and no effort to turn back the tide
on obesity will succeed without an accurate understanding of what's
made us obese.

In other words, beating obesity means a complete overhaul of society from transportation to grocery options to healthcare. A jog on the treadmill isn't going to change anything.

25 thoughts on “The Dark Side of the Anti-Obesity Movement

  1. Speaking as a fat lady:
    1. Food tastes really good.
    2. Food (especially sweets) is really cheap compared to other amusements.
    3. Little kids eat 6 or so times a day and if you are with them and not extremely wary, you will, too.
    4. Anybody who thinks that high fructose corn syrup and processed food is the serpent in the garden of Eden should have some of my husband’s homemade muffins (he makes whole wheat apple, whole wheat blueberry pecan, whole wheat cranberry, whole wheat chocolate with chocolate chips, whole wheat pumpkin). You can totally get fat eating this stuff.
    4. When I’m on track and the college gym is open (like right now) I routinely do 80 minutes and 4 miles on the treadmill on an incline while listening to an audiobook (I’ll be heading off to do that later this morning). This is not slimming me down (see #4), but my weight (which is substantial) is under control. I am not ballooning up, and my weight stays within a certain range (less in the summer, more during the holidays). I certainly don’t want to go into my sunset years at this weight (I’m concerned about my knees, mobility, and the possibility of diabetes), but it’s currently mostly an aesthetic issue rather than a health problem. More pressingly, I’d also like another baby or two over the next few years, and weight-wise, I need to be in a place where I can safely gain 35 pounds.
    5. I’ve mentioned it before on this blog, but my big weight gains were in grad school and after my second child was born. In both cases, I was tired and sleepy all the time, and I was eating all the time just to stay awake and alert. Nowadays, I make a point of getting a nap every chance I get. A mixture of sleep, exercise, and being outdoors keep my appetite down, whereas being home all day and unable to nap makes me ravenously hungry.

  2. There really is a deep thread of fat-loathing and contempt running through the journalism about and even the studies on obesity. It alarms me.
    And I don’t know about Ambinder, who seems to have been really fat, but there seems to be a lot of confusionand paranoia about the measurement of what “fat” is (BMI doesn’t seem to be very definitive). You get into weird discussions about denial and who is “really” obese but doesn’t know it. (Kate Harding has put up a big gallery of photos here where people publish their BMI and a picture of what that looks like: http://www.flickr.com/photos/77367764@N00/sets/72157602199008819/). And then there’s the question of whether people who are chubby at any stage of life are just sitting ducks waiting for obesity to happen. There was that recent article panicking about fat breastfed babies and whether they should have food withheld. (My oldest was the fattest baby and young toddler imaginable, and now is quite slender.)
    Of course the media message is always “yes, panic” about everything, but it would be more useful to have some kind of idea of when to panic. My parents were were somewhat fat when I was growing up–but they are still mobile, still just kind of fat and not fat enough to have to ride on scooters and take up extra seats, and approaching their 70s I think my Dad’s actually gotten skinnier–so should I be freaking about their health and eventually mine, or should I be patting myself on the back because I am merely mildly chunky and call it good? I don’t think there is a definitive answer available right now.

  3. I wonder where the intersection lies between obesity and expense? Isn’t part of what’s happening here just that food is really, really cheap?
    In the WWI era food expense used to comprise something like 40% of a family’s budget. These days it’s what, 15%, including restaurant eating? (You can find more on these statistics at http://www.bls.gov/opub/mlr/2001/05/contents.htm; look for “A Century of Family Budgets”.)
    What would happen to our collective calorie counts if it were actually costly to eat more? And what role do farm subsidies play?

  4. I thought British teeth were not actually bad post-NHS, that everybody had bad teeth before then anyway, and that the British don’t go in for cosmetic dentistry. They have crooked and stained teeth, but not worse teeth than anybody else.

  5. What would happen to our collective calorie counts if it were actually costly to eat more? And what role do farm subsidies play?
    My strong guess is that any increase in the cost of food sufficient to put a dent in collective calorie counts in the U.S. would also result in actual starvation in some group that was too disorganized/distrustful/illegal to get food stamps.

  6. “In other words, beating obesity means a complete overhaul of society from transportation to grocery options to healthcare.”
    Actually, I agree with Ezra Klein, that a mix of palliative measures, rather than a complete overhaul of society to make us healthier ab initio, is more likely. Just as, for example, we have reduced venereal diseases not with chastity nor even with condoms, but with antibiotics. Or as we have reduced pollution not by consuming or driving less, but by putting scrubbers on smokestacks, catalytic converters on cars, etc. (Or as, I suspect, we will deal with global warming not by reducing emissions, but by geoengineering to produce an offsetting cooling effect.)

  7. If you remove subsidies, would it not stand to reason that the artificial low cost of ultra-processed food would wash away? And we’d end with what we really want: carrots that are cheaper than Fritos.
    Also, isn’t it food stamp-level SES folks who are currently suffering the most from obesity issues? What does that mean for the “some people will starve” argument?

  8. Why can’t people choose for themselves how to live their lives? We haven’t made drinking or being an alcoholic illegal even though many people die–and we don’t really punish drunk driving very hard.
    Is this really about health or just body size? And if it’s just body size, why is it society’s business? Lots of choices we make affect other people’s lives, but we don’t regulate or legislate those choices.
    If you’re really concerned about yourself and your family, how about focusing on health instead of fat? Focusing on health means looking at *everybody’s* blood pressure, cholesterol, aerobic fitness. There are plenty of people whose size appears normal but who haven’t checked their blood pressure etc. in years.
    I think fat people have become the new scapegoat (well, not new–it’s been happening for more than a decade now), because we’re not allowed to be racist or sexist, and the psych view of many other problems means we don’t blame people for their bad choices (like drug abuse or gambling or committing crimes–they all grew up in bad families or had trauma or something to explain away their responsibility)–except in this one area. It’s okay to blame people for eating too much (which you don’t know for sure that they do) or for failing to exercise enough (whatever that means) because it just seems intuitively obvious that being fat is (a) a personal choice and (b) the reason for all ills-overuse of medical resources, narrow airplane seats, etc.
    Othering is bad, even when you justify it by blaming them for doing it to themselves.

  9. If you remove subsidies, would it not stand to reason that the artificial low cost of ultra-processed food would wash away? And we’d end with what we really want: carrots that are cheaper than Fritos.
    The problem is, what they are ultra-processing is mostly corn and beans, which are what keeps a large part of the poorest people in the world alive. These ingredients do not make-up much of the cost of making the processed food you see at the minimart and it would take a huge increase in price to greatly affect the consumption patterns of all but the poorest Americans.

  10. [quote]I thought British teeth were not actually bad post-NHS, that everybody had bad teeth before then anyway, and that the British don’t go in for cosmetic dentistry. They have crooked and stained teeth, but not worse teeth than anybody else.[/quote]
    Well, this is more orthodontia, but my husband had to get his teeth entirely re-fixed at age 12 after moving from Scotland to the U.S.
    Sidney Mintz’s “Sweetness and Power” argues that sugar started out as a status item and then as it became accessible to the working classes lost its status, and that working-class Britons definitely overdepended on sugared tea and bread and now, junk food. I don’t know if he has been debunked: I read this first as an undergrad many years ago.

  11. I agree with Kai. By the current definition, many Americans are obese.
    From my obligatory time chaperoning school trips, or attending children’s birthday parties at commercial centers, I’ve noticed a pattern. If the museum or party place draws from a variety of towns, you can tell which children belong to which group. A rather awkward way to say that a community’s SES correlates with the level of obesity in that community’s children. The more affluent a town is, the fewer obese children it will have.
    If you practice medicine in one of the struggling mill towns, which are home to many poor, immigrant families, you will have an entirely different picture of American youth than if you practice some 15 miles away, in a town populated by the upwardly-mobile middle class.
    The moral panic over childhood obesity is a convenient way to criticize those who are poor, less-educated, or not caucasian.

  12. Speaking about my own situation, there are a myriad of causes for obesity.
    1) I have small children and thus hardly ever get more than 5-6 hours of sleep. The link between lack of sleep and inability to lose weight has been documented recently.
    2) I have a full time job and 2 small children. I don’t always have time to get a shower every day or brush my hair–I don’t have time to exercise.
    3)I also don’t have the time to plan healthy meals. I end up eating my lunch out of the vending machine or a drive thru once a week because I can’t get to the grocery store. I HAVE NO TIME. Being healthy is like having a part-time job–you need time to exercise and eat right.
    4)I would love to bike to work. It would allow me to incorporate exercise into my day and it would be better for the environment. But even though my office is less than 2 miles from my house, my town is not set up for this. I would really be running a risk of getting hit by a car on a certain stretch of the highway (and with my kids in the carriage, I definitely don’t want to run any risks).
    Basically, though, for me, being a good mom (in order for my child to go to the good pre-school, I need to run a car pool at a certain time–that conflicts with Weight Watchers), spending time with my kids, and being good at a highly demanding, time intensive job (English instructor with lots of papers to grade and classes) means that I have no time left over to be healthy. Well, I am pinning my hopes on this summer–with no school, I should be able to exercise and eat right, but our society just places so many demands on our time, that being healthy just keeps moving on down the list of my priorities.

  13. Carrots and Big Macs could be offered at the same price. Many people will choose the Big Mac. It takes more work to prepare a bunch of carrots for dinner.
    One huge part of this problem is the rise in convenience foods. A company creating food products for the market will stuff those products with fat, salt, sugar, and color enhancing agents.
    When I cook at home, I don’t have a panel of food scientists and marketing researchers helping me to make every bite “taste like more.” It’s much easier for my children to eat until satiated–and not beyond–with home cooking. Commercially produced foods are created to be easy to serve, and to increase sales.
    I suppose I’m conservative–my opinion of ready-made food decreased markedly, though, once I started reading food labels. I was originally checking for allergens, but the labels got my attention, too. Why does applesauce need to be sweetened? Why is HFCS in so many products?
    I haven’t heard many jokes about “home cooking” recently. I think it’s because so few people feel they have the time to cook. It’s not part of the shared cultural experience. A joke about cellphones has more impact.

  14. “Being healthy is like having a part-time job–you need time to exercise and eat right.”
    Right.
    “From my obligatory time chaperoning school trips, or attending children’s birthday parties at commercial centers, I’ve noticed a pattern. If the museum or party place draws from a variety of towns, you can tell which children belong to which group. A rather awkward way to say that a community’s SES correlates with the level of obesity in that community’s children. The more affluent a town is, the fewer obese children it will have.”
    Right. I’d add that at a certain socio-economic level, after you’ve dealth with all the basic issues like food, shelter, health, and education, the worst thing that can happen to you is that you have a fat kid.
    Having slender, athletic kids with good teeth doesn’t happen by chance. In the face of the attractions of indoor entertainment and the snack aisle at the grocery, it’s the product of real work and expenditure of major resources on the part of families. Why a lot of people are fat is not a question that is hard to answer. What’s amazing is that in the face of all of the temptations we are surrounded with that we don’t all swell up like Violet Beauregarde on Willy Wonka’s factory tour.

  15. And we’d end with what we really want: carrots that are cheaper than Fritos.
    Maybe cheaper than Fritos, but not cheaper than grains/grain-based food in general, unless processing costs go way up. Vegetables, and particularly fruit, are more labor and land-intensive to grow. (Which was a great thing for the population of China in the rice regions, back when. Lots of calories from little land.)

  16. I still remember a chilling comment from a former colleague of mine, referring to Chicago’s (very wealthy) north shore. And I quote: “I didn’t know fat girls had friends until I moved out of Evanston.” Wow.

  17. as a tubby middle-aged guy, I can testify that there is lots of pressure on the fat. A couple of public service announcements and a dime on a bottle of Coke is not going to do it. They have to run me down and do compulsive bariatric surgery. And for what? Best estimate is that ‘fat’ takes on average a year off the end of your life. There are real problems the government ought to be worrying about.

  18. Well, sure. Just look at Taft.
    OH, you mean in the age of television. Who knows? He’d look like half of the adult voters.

  19. “as a tubby middle-aged guy, I can testify that there is lots of pressure on the fat. A couple of public service announcements and a dime on a bottle of Coke is not going to do it.”
    Right. Starbucks is able to charge $4 for mixtures of coffee and milk–there’s quite a bit of wiggle room for what people will pay for treats (as you can see by the prices for very basic desserts in restaurants). Plus, any significant tax would be pure electoral poison. Americans would come with (metaphorical!–I think) pitchforks and torches for anybody responsible for putting a $1 tax on a $1 drink.
    “Best estimate is that ‘fat’ takes on average a year off the end of your life.”
    That is certainly not very impressive.

  20. And for what? Best estimate is that ‘fat’ takes on average a year off the end of your life.
    It’s not the mortality that epidemiologists are worried about, it’s the morbidity.
    There are two dark sides of the anti-obesity movement. The first dark side is shame.
    I expect that this will only increase in the age of Obamacare. Not because of the subsidies, exactly, but because forced community rating means that someone’s choice to eat themselves into a highly diseased old age is now financially far more everyone else’s problem than it was before.

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