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.
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.
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.