Fat Is Low Status

Adult obesity is a growing problem. … Should this widespread obesity epidemic be a cause for alarm? … A common starting point is the assertion that those who are obese impose higher health costs on the rest of the population—a statement which is then taken to justify public policy interventions. … The existing literature on these topics suggests that obese people on average do bear the costs and benefits of their eating and exercise habits. (more)

Many are eager to push policies that “help” fat folk get less fat. Many justify such policies as compensating for harms fat folk impose on others. But there doesn’t seem to be much net harm via health insurance, and fat folk help others via dying young and encouraging med research. It is pretty hard to argue that fat folk aren’t aware of health harms of weight, or that others would rather they were thinner. Some argue fat folk lack self-control, but very few of those who are aware of and have access to self-control mechanisms like stickk.com choose to use them.

The health harm from being over weight is much less than from being underweight, and there seems to be little health harm from weight once one controls for exercise – exercise is the key. Why then does policy focus so much on fatness?

I’d guess that since fat is low status, thinner folks enjoy asserting their higher status by belittling and controlling fat folk. Places like the US with more fat folk are also embarrassed to have their status lowered in distant eyes, and want local fat folk to get thin to raise the place’s status.

More quotes:

Obesity is associated with both reduced life expectancy and increased healthcare expenditures. The former is a largely private cost borne by the obese individual. … The vast bulk of the total marginal costs (over 95 percent) are due to the reduction in life expectancy. ..

Employee premium contributions are rarely risk-adjusted for obesity or any other observable risk factor except family size. This is partly because of the administrative burden involved and partly because of legal provisions. … Any subsidy the obese receive through pooled health insurance is offset by wage differentials. … obese workers earn less than thinner workers, but … this relationship holds only in jobs that provide health insurance! … There is no real pooling between the obese and thin in employer-provided health plans. … In public health insurance, there is an implicit transfer from thin people to obese people, but this transfer is progressive and seems unlikely to induce substantial social loss. …

Obesity is a complex social problem, inter-linked with a variety of issues, including healthcare research and development, prices for food and exercise, agricultural price supports, Social Security, peer effects, and even the level of crowding in airplane seats….

Biomedical researchers have responded to the increased prevalence of obesity by focusing their research efforts on the diseases associated with obesity. …Many nonobese individuals suffer from these diseases, and they will benefit when scientists make breakthroughs in treating those diseases. This induced innovation effect represents a positive externality from the obese to the thin. … Another way in which the obese “subsidize” the thin is, presumably, by dying earlier and not claiming as much in Social Security benefits. …

Does the formation of a friendship between a thin person and an obese person induce a transfer from the thin person to the obese person? If the friendship is voluntary, then the answer is presumably “no,” … Another common suggestion is that obese individuals
impose negative externalities on others in close quarters, such as in coach seats in
commercial airplanes. A full accounting of this externality, … would consider the extent to which the social opprobrium of impinging on another person’s space is internalized by the obese person.

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  • http://jaltcoh.blogspot.com jaltcoh.blogspot.com

    I’d guess that since fat is low status, thiner folks enjoy asserting their higher status by belittling and controlling fat folk.

    This is probably the key sentence in this post that you’d like to see quoted, so you’ll want to change “thiner” to “thinner.” (Feel free to delete this comment if you do.)

    Sorry for the lack of substantive comment, but I only wish my blog readers would do this for me.

  • Jeff

    “The health harm from being over weight is much less than from being underweight, and there seems to be little health harm from weight once one controls for exercise – exercise is the key. Why then does policy focus so much on fatness?”

    I challenge this premise, in two ways. First, it is not my understanding that there’s little health harm from obesity. This is an extraordinary claim. Second, even if it were the case that exercise permits good health for the obese, it may be the case that obesity prevents exercise for most people.

  • Chris

    The health harm from being over weight is much less than from being underweight, and there seems to be little health harm from weight once one controls for exercise – exercise is the key. Why then does policy focus so much on fatness?

    I was under the impression that for the most part, the correlations between being underweight and negative health outcomes were caused by wasting diseases. Is that not correct?

    In any case, there is a very simple reason we focus more on the fat than the thin – there are far more overweight people than underweight people.

  • tzenes

    I’d like to focus on a single quote that you reposted:

    In public health insurance, there is an implicit transfer from thin people to obese people, but this transfer is progressive and seems unlikely to induce substantial social loss.

    Now while the reference here to “public health insurance” may have been predictive, the reality is that a large portion of the money spent on health care in the US is the result of government spending (mostly on the elderly, but some portion does support obesity); so this is a very relevant point to the discussion at hand.

    In your own blog post you express as similar idea
    But there doesn’t seem to be much a net harm via health insurance

    Again, health insurance may be a buffer, but some portion of this expenditure is still tax dollars.

    If I understand the underlying theme of your post it is: social policies on obesity are a form of class-ism, as obesity doesn’t have a significant harm on those who aren’t obese. To justify this you have both of the quotes I listed above.

    What I’d like to challenge is the idea that this “seems unlikely to induce substantial social loss.”

    From my perspective there is a very substantial social loss. The federal support for health care which continues to provide for obesity is money that could otherwise be spent on important social program (eg. Education, Social Security, etc). The idea that it is some how “progressive” as a justification goes right out the window the moment you start to consider the number of underfunded social programs which could otherwise receive that money; and I shouldn’t have to mention the deficit…

    Ultimately, while there may be a level of class-ism between the thick and the thin, obesity does have demonstrable social harm on the rest of society, and to suggest that policy is inappropriately focusing on obesity is mildly irresponsible.

  • http://un-thought.blogspot.com/ Floccina

    I have always thought that it is mostly aesthetics. Fat people are displeasing to look at and so is unattractive and thus low status. I also think that aesthetics is also a driver behind democrats desire to make relatively poor Americans into middle class Americans while ignoring the absolutely poor in other parts of the world.

    To the above posters here is some data on health effects of obesity.

    But even ‘obesity’ wasn’t nearly the risks we’ve been led to believe. Nonsmokers with ‘class I obesity’ (BMI 30 to 35 were associated with a mere untenable 12-17% increased risk — still nowhere near those of thin people with 50-69% higher risks. And yes, the researchers had accounted for smoking, chronic diseases and preexisting health problems and cancer, involuntary weight loss and long-term obesity… and the results were the same.

    No way around it, being overweight was associated with a total of 138,281 fewer deaths from all causes. That’s a generous 72 pound weight range for a 5’-4” woman that’s linked with lower or the same risks as someone of a government-recommended ‘normal’ weight. But that’s not all…

    • http://www.gwern.net/ gwern

      If fatness is about aesthetics, then how did we come to consider thinness attractive? Pudginess used to be attractive; spend some time looking through medieval or Renaissance art and you’ll understand old increasingly unpopular adjectives like ‘zaftig’ or ‘rubenesque’.

      • Sister Y

        Waist-hip ratio preferences for females are consistent across cultures.

      • http://un-thought.blogspot.com/ Floccina

        The people in Renaissance art were not obese just not very thin.

        Symmetry is lost when people get very fat. A fat stomach is particularly unattractive to men because it could be caused by age or pregnancy either of which means infertility.

      • http://danweber.blogspot.com/ Dan Weber

        What is harder to achieve is always more valuable.

        If one can easily change A into B, but it is hard to change B into A, then A will be at least as valuable as B.

        In the Middle Ages, being fat was hard and being skinny was easy. These days it is the opposite.

  • http://www.gwern.net/ gwern

    > Some argue fat folk lack self-control, but very few of those who are aware of and have access to self-control mechanisms like stickk.com choose to use them.

    You need self-control to commit at all. We can have akrasia about an individual action, but also meta-akrasia about an individual action (that would commit us in the future to individual actions).

    If I am fat and know that I am powerfully compelled to remain fat, I would have to be crazy to sign up for StickK unless I think my lack of self-control is so weak that the amount I can afford to put on StickK will beat it. But even then I would be running a risk, and the more money I gave StickK, the bigger the risk gets.

    I might as well just dump my wallet on the sidewalk and walk away!

  • Abelard Lindsey

    Being fat is considered low status for two reasons. Obesity seems to be more common these days among lower class people. The other reason, which I think is more significant, are the MD’s themselves. MD’s tend to be tall and lean and tend to run a lot. Running is considered higher class. MD’s almost never are body builders. They consider body building to be low class. MD’s tend to favor that people have physiques like themselves.

    • http://www.uncrediblehallq.net/ Chris Hallquist

      I think there have been studies done showing that most women prefer the runner’s/swimmer’s/soccer player’s physique to bodybuilders. You might say this is cultural, but I suspect it’s because until recently there were no bodybuilders for women to be attracted to, so “runner’s physique” was roughly synonymous to “healthy male physique.”

  • http://un-thought.blogspot.com/ Floccina

    BTW one thing to keep in mind is that the tendency to get very obese could correlate with poor health. It could be for example that a natural lack of muscle causes one to get obese and causes other health problems.

    • http://un-thought.blogspot.com/ Floccina

      Study

      We investigated whether confounding from genetic factors could explain some of the observed associations between BMI and mortality.1 We used co-twin-control analyses, a well-known method2 that has contributed to many important findings in the past.3,4 We found that within monozygotic (MZ) twins there was no association between BMI and mortality from causes other than CHD, suggesting that part of the well-documented association between BMI and mortality may be due to genetic factors rather than causality. In their commentary, Kaufman and Glymour5 express concerns about potential sources of error—including violation of the equal-environment assumption, selection and survivor bias, and lack of representativeness—that may limit the validity of this finding.

  • http://daedalus2u.blogspot.com/ daedalus2u

    Being fat is low status now because it is largely due to being at the bottom of the social status hierarchy and the very high stress levels that being on the bottom cause.

    In the past, being thin was a sign of not being able to afford enough to eat. Food is so cheap now that even poor people are fat because poor people are under much more stress.

    • Evan

      i doubt that you could find a correlation between peoples stress levels and BMI. you may be able to find correlation between fat people and how they deal with stress (ie eating)

  • RickG

    I do not buy the claim that subsidies to the obese due to pooled health insurance are justified by offsetting wage differentials. The wage differentials are due to differences in worker productivity, which is related to the obese being less productive (for a variety of both correlative and causal reasons); they aren’t just arbitrary penalties imposed on the obese. So how can the lower wages of the obese be considered a kind of compensation to the non-obese, which is supposed to make up for the pooling of risk premia? I obviously still have an incentive to encourage them to lose weight, as any increase in wages will be offset by increased productivity of the workplace, and the reduction in insurance costs will be had for free.

    And as for public pooling, “This transfer seems progressive and is unlikely to induce substantial social loss”. Really? The current estimate is > $100 billion. And this ignores many obesity risk factors which are not included in those studies, as well as the fact that the obese, by either working less or being on disability, are contributing less to the public insurance pool. I’m open to the possibility that the obese dying at or before retirement age saves public money, but does the lifetime product of such individuals really meet or exceed their lifetime public costs? And if subsidizing obesity is considered a progessive virtue, then lets subsidize drinking, smoking, and dropping out of school as well.

    • tom

      Well put, RickG. It’s always interesting to read counter-intuitive, contrarian posts like Robin’s, but sometimes these discussions get completely untethered from reality. Thanks for the dose of common sense.

  • Whateverfor

    “> Some argue fat folk lack self-control, but very few of those who are aware of and have access to self-control mechanisms like stickk.com choose to use them.”

    People who know about those specific self-control mechanisms are a very small subset of the overall population. The weight loss industry in the US totals over 50 billion dollars in annual revenue.

    It should not surprise us that people who have demonstrated a lack of self control don’t know much about self control, and that people who are fat know less about nutrition than average. So, you should look for evidence that they are making an effort (and to what degree), not whether that effort is particularly effective. The total expenditure of money and effort hardly indicates that the overweight don’t actually care.

  • David C

    I don’t disagree, but I question the use of BMI instead of body fat percentage. My guess is most people with a low BMI are undernourished and not just low fat whereas individuals with a high BMI are a mixture of high fat and fit.

  • Michael E. Sullivan

    RickG: “The wage differentials are due to differences in worker productivity, which is related to the obese being less productive (for a variety of both correlative and causal reasons); they aren’t just arbitrary penalties imposed on the obese. ”

    How do you know this? Do you have empirical studies to cite?

    Other physical features that are status markers but have no obvious related to productivity (height, skin color), also carry wage penalties even after controlling for things like intelligence and education.

    How do you know what percentage of the obesity wage penalty are due to productivity correlations versus unconscious discrimination?

    • Jeffrey Soreff

      Many thanks! Those were precisely the questions that I was going to raise.

  • http://daedalus2u.blogspot.com/ daedalus2u

    Here is another paper that very specifically relates particular types of “injustice” to bad health, an effort-reward imbalance and procedural injustice.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2078405/

    This is interesting. I wonder how much of the increase in health care costs are due to the increased inequalities in income distribution due to effort-reward imbalances? It would be interesting to do the experiment, reverse the trend of the last 30 years or so and see if there is a change in the slope of health care cost increases.

    Of course that experiment will never be done because it is low status individuals (i.e. poor people) that would benefit. The whole point of the changes in the last 30 years has been to put them where they are, deprive them of status and keep them there.

  • Brendon

    Speaking as someone who just dropped thirty pounds over the past two months, I wanna correct the original post that said exercise matters more than diet – diet is everything. I actually think it’s more important than how much you workout – even if your goal is to build muscle rather than lose weight.

    The literature that says “exercise more” if often funded by food companies who want to tell you that “Krispe Kreme is part of a healthy diet” (quote from an actual spokesperson of theirs). If we were actually serious about ending the obesity epidemic, we’d stop subsidizing corn and high carb foods. Right now meat and vegetables are only more expensive than bad carbs because of government subsidies to the food industry (which they lobby for heavily). So we’ve artificially made it so the cheaper choice for the poor is unhealthy. But if we were to actually talk about diet, then all these subsidized companies might lose their money and buisness.

    • Matthew C.

      Brendon is absolutely correct.

      If you want to lose weight like mad, cut your carb intake to the bone and eat all the protein / fat you want (you won’t feel like eating much and you won’t be hungry and irritable either without all those insulin doses shooting into your bloodstream).

      Eating carbs releases insulin (which make your cells suck up fat and makes you more hungry). For susceptible people over time this leads to varying degrees of overweight and obesity (as well as causing heart disease, dental caries and many other conditions).

      That this well known fact was “lost” some time after the 1960s and replaced with the idiotic, obesity-creating carbo-laden “food pyramid” and the diabetes-inducing low fat (= high carb) diet craze tells you all you need to know about the quality of scientific consensuses in many areas.

  • Josh

    Brendon and Matthew are essentially correct. The OP is more or less incoherent because it takes so much of the (false) conventional wisdom for granted. First, there is a huge correlation between obesity and wealth (poor=fat), mostly because carbs are cheaper food. People see this and naturally associate fat with low status. No conspiracies necessary.

    There IS a hellish self-sustaining memeplex dynamic where rich hi-status folks get to look down on the poor for poor self-control when their problem is the deadly diet advice that has become standard over the past few decades. It’s always easier to blame the victim. Doctors and bureaucrats have a very natural reluctance to entertain the hypothesis that they’ve been killing people in the millions since the 60’s.

    The canonical reference here is Gary Taubes’ Good Calories, Bad Calories.

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