Fat Policy Is Not About Health

Megan McArdle interviews Paul Campos, author of The Obesity Myth:

Paul: I know for a fact (because they’ve told me) that some public health officials engage in what they think of as a noble lie about the effects of physical activity on weight, because they know people won’t become more active just to be healthier.

Megan: Is there any evidence this works? Don’t people just stop going to the gym when they notice they haven’t lost any weight?

Paul: Of course. People aren’t dumb. They do the experiment, the experiment doesn’t work in the vast majority of cases, so they quit until they get desperate again. Or (like the upper West Side women) they stay on a permanent restricted lifestyle that the vast majority of people don’t have the combination of willpower and social privilege to maintain. There’s an important class angle here. Thinness is a sign of social status, and is to some extent a product of it, which is one reason — probably the main reason — why it’s so prized, especially among women.

Megan: An economist recently pointed out that we don’t encourage people to move to the country, even though rural people live more than three years longer than urban people, and the difference in their healthy life expectancy is even more outsized. Nor do we encourage people to find Jesus or get married. We target “unhealthy” behaviors that are already stigmatized.

Paul: Right, as Mary Douglas the anthropologist has pointed out, we focus on risks not on the basis of “rational” cost-benefit analysis, but because of the symbolic work focusing on those risks does — most particularly signalling disapproval of certain groups and behaviors.  In this culture fatness is a metaphor for poverty, lack of self-control, and other stuff that freaks out the new Puritans all across the ideological spectrum, which is why the war on fat is so ferocious — it appeals very strongly to both the right and the left, for related if different reasons.

Megan: And now a convenient scapegoat for our health care costs: if we can just eliminate the folk devils, we can have a new national health care program, and more room on the bus, for free!

Paul: Yes it’s a low-calorie free lunch.

That “economist” is me I think.  Hat tip to Robert Wilbin.

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  • http://t-a-w.blogspot.com/ Tomasz Wegrzanowski

    There’s nothing “ferocious” about “war on fat” – things that make people fat are not only legal but heavily subsidized (like high-carb junk food, and car-based lifestyle), and what’s promoted aren’t easy fat reduction methods (like fen-phen – illegal, ECA – barely legal, amphetamines – illegal, gastric surgery – legal but never mentioned), or even slightly more difficult but working ones (the things bodybuilders do), but ones that are known not to work at all (small amounts of low intensity exercise and high-carb diets).

    Fat policy doesn’t seem to be about fat at all.

  • Adam

    definitely read Gary Taubes’ ‘Good Calories, Bad Calories’. one of his main points is that exercise doesn’t make you thin, it makes you hungry.

    obesity has taken off with the prevalence of high fructose corn syrup and simple carbs. it triggers the body to store fat.

    being fat is simply another symptom of the “Western disease” – a diet high in sugar and white flour.

    • Dan

      The exercising slamming is to be honest against the law of physics. If you park your fat ass on a treadmill you will lose weight… Of course the energy rule still apply, if you eat more, well you just canceled out the energy consumption. This is just common sense which the author obviously lack.

      Cardio Exercise that raises body temperature actually suppresses appetite. Like I said common sense, obese people should be on treadmills and cardio machines not lifting 100 lb weights (weight training DOES make you hungry).

      If you are on a treadmill with a candy bar in hand, or fat people that tries body-building then yes expect to die young!

      Modern exercise is not an art, it’s a science.

      • Adam

        that’s a pretty mechanistic view of how the human body works. like a black box – calories in, calories out.

        does an adolescent girl change her diet to gain those fat deposits (ie breasts)? no. her hormones store the fat. diet and exercise do not drive this process.

        the idea that cardio suppresses appetite is ludicrous. is it for the short term?

      • Dan

        Higher body temperature, suppresses appetite. So yes for a couple of hours. But you won’t be more especially more hungry after that, if it is a regular thing, it will have an overall lower appetite effect.

        The body is quite mechanistic actually. Yes your body will scale down the metabolism when you diet (it thinks you are starving and initiates a survival response). But it is quite predictable and understandable. I am not denying it is may be a hard problem, but a scientific one it certainly is.

      • ElamBend

        Dan,
        You are wrong. I second Adam’s book recommendation. Excercise does have many beneficial effects, but it is NOT the most effective weight control action. Instead, what one eats is the controlling factor. The consumption of simple sugars drives an insulin response in the body which creates fat. They have created mice that cannot process sugars (they pee them out) and can eat as much as they like without gaining weight.
        When it does come to exercise, though, the most effective exercise it the quick and sudden. Sprints and weight lifting, NOT parking your ass on a treadmill. Next time you’re in a gym, look at the people on the treads and elipticals, what do the majority of them look like. In every gym I’ve belonged to, most are doughy.

  • babar

    it will be interesting in 50 years to draw parallels between the historical progressions of

    — increased fertility (kids per woman)
    — increased girth per person

    improved nutrition and medicine led to a massive increase in fertility, until public health education and birth control technology and economic factors led fertility to decrease dramatically almost worldwide.

    i wonder if we will see the same thing with obesity over time.

  • Floccina

    I have been saying fat policy is not about health for years. IMO it is about ascetics. I do not want to see fat people nor be associated with them (it is embarrassing to some that so many american are fat). I think that the fact that even poor american can afford enough food to be fat is a testament to our success.

    • Constant

      Ascetics or aesthetics? Both fit the topic, in different ways.

      • Floccina

        Sorry, aesthetics.

  • Jeremy Corbett

    I don’t know if posting content that involves Megan McArdle helps anyone overcome any bias.

    People have this conversation to usually dispute whether anyone with 20lbs of extra weight should be castigated for their figure. This has little relevance to the American discussion of obesity, which is much more about hyper obesity that woman making fun of dress sizes larger than 3.

    Millions of a Americans are hyper-obese and suffer daily with all sorts of health consequences. This is not puritanism, this is trying to understand and help ameliorate an epidemic.

    • Psychohistorian

      The interview explicitly addresses this issue by saying that, at the extreme ends, obesity is a serious health problem. They then focus on the non-extreme ends, and how the arbitrary BMI>30 cutoff leads to some seriously misleading statistics, and also that we don’t know making very heavy people lose weight will do any good because not many of them ever do lose weight. The entire point is that people who are worried about their dress size being too high are generally not a health concern. Our cultural focus is on overweight and obesity, not hyper-obesity – it has no real correlation with health outcomes. This is the point, and it seems to agree with your point, which is actually rather funny.

      “I don’t know if posting content that involves Megan McArdle helps anyone overcome any bias. ”

      Considering that you did not actually check out the blog and see that she basically agrees with you, and criticized her for ignoring problems that were addressed, this comment may belong under the definition of “Irony.”

  • Requia

    “Megan: And now a convenient scapegoat for our health care costs: if we can just eliminate the folk devils, we can have a new national health care program, and more room on the bus, for free!”

    I’ve been seeing this one a lot, and I have to say its complete and utter BS. the NHS (Britain’s socialized healthcare system) ran a cost analysis against the weight of a person. They found that fat people actually cost much less over their lifetime. Presumably do to the life being shorter.

    • Dan

      Still I find it difficult to see how obesity doesn’t have an adverse effect on the general welfare (this includes the health-care system). When you die young you stop contributing, also there is issues with dependents, spouses and family that dead people obviously cannot support anymore.

      Regarding the health-care system what is the net effect, not the gross revenue…

      Life-expectancy is one of the most important factors that enabled the prosperity of the modern developed countries.

  • http://timtyler.org/ Tim Tyler

    Which fat policy? Don’t get fat?

    It’s true that that being slender signals other things besides health – for instance it signals youth, provided one is not very old.

  • Pingback: Interessantes woanders (2009.07.31) › Immersion I/O

  • http://www.healthinlife.com Interessantes woanders (2009.07.31) › Immersion I/O

    [...] Fat Policy Is Not About Health [...]
    P.S. – Sorry, forgot to tell you great post!

  • Thomas Ryan

    Fellas, THE fat people thread (extremely NOT SAFE FOR WORK):
    NSFW

    It goes on for 151 pages. Fascinating.

    (don’t ban my IP please)

  • http://andrewkemendo.blogspot.com Andrew Kemendo

    definitely read Gary Taubes’ ‘Good Calories, Bad Calories’. one of his main points is that exercise doesn’t make you thin, it makes you hungry.

    This is one of those terrible lines of bullshit that I hear over and over. How many professional athletes, navy seals, marathoners, competitive swimmers or competitive cyclists out there are fat? Zero. And they eat up to 10,000 calories a day.

    Do you know why? Because their Energy out > Energy In.

    You can cut calories or you can increase energy use.

    Basing the statement that exercise does not reduce weight on the sample of people overeating after exercise because of induced hunger does not make it true.

    • Dan

      Correct. Cardiovascular exercise that raises body temperature, suppresses the appetite. Strenuous weight lifting has the opposite effect.

      • Rod

        Then why is it that when I used to go on 10-mile runs at 90 degrees and 90% humidity, I was ravenous an hour after I finished?

        You’re right that heavy weight training also makes you hungry. But if you’re eating enough protein and fat while doing it, most people mostly gain muscle. And while it is possible to have a lot of muscle yet appear outwardly obese (sumo wrestlers, offensive linemen, etc.) those body types are outliers. More muscle typically requires more calories, so you can eat as much as you always did, while still losing fat.

        Doing either only cardio or only weight training consume calories. But it does take a lot of willpower not to simply replace those calories by eating more when you’re doing cardio. Whereas with weight training typically as you gain muscle you lose fat. So you might end up staying at the same weight, but body fat percentage goes down.

        Recently, there was news about a study that showed a significant correlation between higher BMI and longer lifespan. But BMI is a terrible metric for evaluating health, because it doesn’t distinguish lean muscle from fat. So there is a good chance that the results were confounded by people with high BMI, low body fat percentage.

        In my amateur experience, if calories in are less than calories out you will probably lose fat. But it takes a lot less willpower to do it with weight training mixed with cardio, than cardio alone. If more people knew this (especially women!), I think that more obese people would get better results and not quit out of frustration.

        By the way, if anyone is interested, Crossfit is a very effective program that combines high-intensity cardio with weight training. I’ve seen a lot of people have great outcomes while doing it. It does take a bit of dedication, but mostly you don’t have to worry too much about what you’re eating as long as you’re getting enough protein.

      • Dan

        Rod, it’s the higher body temperature. Still I have found it very effective, especially if I do like a 2 hour session before dinner. I am not really hungry, but I still eat and then sleep I am not more hungry the next day. But then I apparently have more than average will-power, I sometimes do weight-training with friends, while i feel hungry i can suppress it while they usually can’t.

    • Constant

      You’re not really contradicting Taubes. I haven’t read the book but the following line has a pretty clear meaning:

      “exercise doesn’t make you thin, it makes you hungry”

      Just reading that statement, I can expand it to:

      “While exercise burns calories, it also makes you hungry, which causes you to eat more, replacing calories lost from exercise. The net effect is no weight loss.”

      He’s not denying that exercise burns calories. He’s really not saying anything at all about the mathematics of calories in/calories out. He’s saying that once we include the effect on hunger, the net effect is no weight loss. He’s pointing out that while people in principle can lose weight by exercising more and eating less, in reality this is not what they end up doing, because of the factor of hunger.

      Furthermore, to give it an honest the statement must be read as implicitly softened and qualified, in obvious ways. Almost any statement of this sort is intended as a general rule, valid in the majority of cases but not necessarily all, and furthermore restricted in scope to the population being discussed. It’s just the nature of the subject. So here’s how I think it is implicitly softened and restricted:

      “The mild sort of exercise that overweight people typically do who are trying to lose weight burns more calories but, because it also makes them hungry which makes them eat more, ultimately has no net effect on their weight in the great majority of cases.”

      He can’t rightly be interpreted as saying anything more.

      So, Olympic level and military training programs are implicitly excluded from the statement, since he is talking about typical overweight people who are trying to lose weight. If you think that military experience must be included I can supply an argument explaining what is different about it (e.g. the people who enter it are selected, the program is, once the person is enlisted, coercive, there is a third party trainer involved whom the typical overweight person trying to lose weight does not have, etc.). But my point here is that the statement needs to be understood.

  • Lauri

    The effect of exercise is highly overstated when weight control or weight lose is discussed.

    Weigh can be easily lossed without any extra exercise. It’s all about diet.

    Of course exercise increases ones energy usage and it’s otherwise healthy, but for weight controlling it’s not nessessary.

    The overstating the importance of exercise is leading to the fact that many over weighted people won’t start losing their weight because they think that they have to begin exercising in order to lose their weight.

    Weight control is really easy and simple. Don’t eat more than you consume. And to be sure, eat healthy foods.

    Don’t bother yourself with any of the fancy diets. To comprehend which foods are healthy just think about what foods the hunter gatherers that we are have eaten for the most of our existence. Lots of greens, vegetables, berries, beans, seeds, meat, fish and some fruits.

    Our bodies are built to use those foods. The body is optimized to live healthy with the hunter gatherer diet. Everything that has been introduced to our diets in the last few thousand years is unhealthy. Body has to work overtime to manage all the foods it isn’t adjusted to.

  • Chuck E

    Reading Seth Roberts’s stuff really might change your mind about how your body ‘decides’ how much to eat. Oh yeah, and he may have cured obesity too, if only people would take him seriously.

  • http://www.culturalcognition.net/braman/ Donald Braman

    I think the Mary Douglas angle is on the mark. Dan Kahan had a grad student, I think, who did some research on the cultural cognition of obesity. -Don

  • Gary

    Robin, where did you mention the stats about urban vs rural life expectancy/quality? I’d love to have a look.

  • Dave

    I regularly read Journal Watch published in by the same people who published the New England Journal of Medicine. The latest data seem to show that many truisms about obesity are wrong.
    1.)Yo- yo dieting is of no proven harm.

    2.) There is no superior dieting strategy. They all work and they all result in weight loss that quickly returns.

    3.) Moderately fat people have little decrease in longevity but do have added health problems resulting from increased type 2 diabetes, and musculoskeletal injury and deterioration.

    4.) It is not proven that fat people who exercise are healthier. They probably feel better.

    5.) The reason fat people are living longer now is not known. It may be due to control of hypertension, which is very prominent in the obese.

    6.) There is no proven etiology for the increase in obesity in America .

    7.) The longevity of Americans is continually increasing.

    I read the Campos interview which contains who knows how many distortions.
    For instance –Campos : “Now lets talk about excess health care costs. If you look at the study, nearly half of the excess health care costs associated with being fat are from higher rates of drug prescription. But why are fat people being prescribed more drugs than thin ones? Largely, because they have the “disease” of being fat, which is then treated directly and indirectly by prescription drugs!

    For instance, statins. Statins are a multi-billion dollar business, but there’s very little statistical evidence that they benefit the vast majority of people to whom they’re prescribed.—- “

    This is entirely erroneous and typical of his shoot from the hip style. Statins are never prescribed for uncomplicated obesity, but for the secondary effects of obesity such as high cholesterol and type 2 diabetes. The jury is out on statins for people without symptoms, but diabetics are very high risk for heart attacks. He is right that the treatment is costly but he wrongly concludes that it is not needed. Old fashioned diet pills aren’t recommended anymore and cost practically nothing if they were used.

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