Monday, January 28, 2013

Punishing Smokers and the Obese--what?

Heidi Klum: Role model for the obese?
I just read an Associated Press story in my local paper with the headline, "Do penalties for smokers and the obese make sense?" It proposes either punishing folks whose conditions are likely to require greater health care expenditures or letting "these health sinners die prematurely."
In other words, there are only two options for smokers, whose annual health-care costs are "about $96 billion," and the obese, ($147 billion): Death before they otherwise would go--perhaps saving the system old-age-related health care costs--or taxes and restrictions designed to curb smoking or eating, to offset the extra services they'll likely need while alive the usual length of time.

Does this sound crazy to you?

The most glaring and offensive assumption is that smoking is a choice that is equivalent to a choice to be obese.

The big argument in the article is whether penalties are unfair to the poor, who tend to be both smokers and obese. A secondary argument is about whether it's fair that other people sharing a health carrier should be forced to absorb the expenses of your smoking or obesity. Sorry, those are not the relevant questions, and certainly shouldn't be posed as if these two divergent health problems are comparable.

Daniel Callahan: shame fatties
Quoted is bioethicist Daniel Callahan, senior research scholar at The Hastings Center, New York. He got in trouble last week for a paper in which he suggests that the obese, already "lost," aren't going to be helped, but overweight folk don't really realize how badly-off they are, and need "nudging" by policy and practice toward eating less and having some self-control. His paper got press under the term "fat-shaming," though that isn't exactly what he advocates. He describes how social pressure got him to quit smoking, and thinks that when the brains of the bulging understand how they're harming their bods with excess weight, they'll gain motivation to slim.

Does he have any evidence that fat people are unaware they're chunking up? Does he think our society, that confronts everyone purchasing food in a check-out line with magazine covers of impossibly thin movie stars, offers little pressure to be healthy, fit and slender?

Here we have an individual who truly has little understanding of the complexities of the obesity issue, yet suggests we ask the portly, "Fair or not, do you know that many people look down upon those excessively overweight or obese, often in fact discriminating against them and making fun of them or calling them lazy and lacking in self-control?"

The central mistake in both Dr. Callahan's paper and the Associated Press piece is the belief that the smoking and obesity problems are parallel, subject to the same causes and cures. The causes of both, implicitly, are exactly the taunts Dr. Callahan points out to those of size: laziness, lack of will-power and self-control.

That such a paper could be called scholarly and get published is astonishing; that newspapers would carry such assertions and suggestions is appalling.

You can teach a smoker to completely stop smoking--but never an eater to completely stop eating. Smokers have a range of physical and emotional reasons for smoking; science is constantly revealing new causes for overweight and obesity, many of them out of individuals' control.

A few days ago, Nicholas D. Kristof wrote in the New York Times about the impact of en-utero and at-birth influences on offsprings' obesity. He described research in which genetically identical mice fed and exercised the same were of greatly differing sizes--depending on whether they were exposed to an endocrine-disrupting chemical at birth. A single exposure determined whether they spent life obese or normal-sized. Kristof used the information to argue against endocrine-disruptors, such as the plastic additive BPA, in the environment.

'Flabby' and normal mouse differ only by at-birth endocrine disruptors
I wonder how he feels about dieting, then. If the "flabby" mouse ate and exercised the same as his thin brother, yet was programmed to be obese in a way he could never change, why ever argue for eating less and exercising more? For these mice, is a calorie a calorie, or does the calorie do something different depending on warped or healthy chromosomes?

Could you shame an endocrine-disruptor-exposed obese person into losing weight? How about someone with obesity as a souvenir of the Adeno 36 virus, also shown to change both people and animals from svelte to swollen after exposure? Can you "nudge" into skinniness someone whose hormones have gone wacky? Or those experiencing obesity as a side-effect of needed medication for another condition?

The Associated Press story talks about the success of rules limiting smoking in public places, and cites NY Mayor Bloomberg's ban of sugary drinks in 16-ounce or larger cups as another policy to address a health problem. I've never seen anyone harmed by second-hand soda, and there's scant evidence that selling16 versus 20-ounce fountain drinks makes for smaller bodies. New York government is meddling in restaurant commerce with a kindly intent but with the erroneous assumption that like smoking, obesity can be extinguished through laws better able to help people than they, themselves, can.

Another striking and shockingly erroneous parallel appearing in news media, by the way, is between smoking and gun ownership, seen as similarly dangerous. If we can legislate limitation of smoking, and thereby save lives, we can legislate limitation of gun ownership, again saving lives. The comparison fails, however, in that the vast majority of gun owners are responsible, law-abiding citizens whose weapons could stop a crazy person's rampage, thus saving, rather than taking, lives. Current campaigning to eliminate gun ownership (gift cards for guns turned in; creating hurdles to gun ownership; limiting size of ammunition clips), especially as portrayed by the New York Times' "expose" this weekend on what the paper considers the gun industry's efforts to capture children as future customers, contains the same misguided underpinning: Big businesses want profit despite causing harm, and government needs to step in to protect people from their own deleterious decisions in patronizing them.

The Associated Press story does acknowledge a difference between second-hand smoke and first-hand-to-mouth imbibing: "When you eat yourself to death, you're pretty much just harming yourself," University of Illinois professor Jay Olshansky concedes. The Affordable Care Act allows a surcharge for smokers, but none for the overweight or obese, however. New studies showing that overweight and mild obesity correlate with greatest longevity don't do much for the argument that smoking and obesity are equal evils.

And that's my point: The thickening of America is a unique issue, and, if these longevity studies are correct, doesn't have to be, in all cases, a problem. I think our culture has thoroughly shamed people whose bodies are wider than ideal, and the number of diet books and slimming industries, feeding $20 billion annually into our economy, testifies to the extent Americans care about their weight, health and appearance. Don't tell me our nation needs "nudging" or penalties or restrictions to motivate us toward healthy size. Don't even suggest that people are unaware of their shapes or even the healthfulness of their diets. They know, and a plethora of forces acts on their food decisions and ultimately, whether they are fat or thin.

Wednesday, January 16, 2013

New Year Brings (Ridiculous) Barrage on Weight Loss

Did you resolve to lose weight in 2013? According to an endless media parade, you have, or should have vowed to get in shape, or otherwise deal with your weight, eating or fitness.

I've been catching up on all the newspaper I've skipped while away several weeks, and notice that in every issue of the four different papers I peruse, there are at least two items about obesity, eating or dieting that I feel compelled to clip, given my work on a book in that area.  I find something objectionable about them all, because appearance/eating journalism features guilt, shame and failure as themes. No wonder newspapers are sunk.

Here's a piece in USA Today, "Critics pounce on Coca-Cola obesity campaign" from Tuesday, January 15. The Coca-Cola company makes a video trying to define its role in making people fat--after all, consumers pay to guzzle their products--and the anti-obesity establishment jumps all over it. The article's headline nods to the disdainful Michael Jacobson, executive director of Washington's Center for Science in the Public Interest, who says Coke's video "is a page out of Damage Control 101, which is try to pretend you're part of the solution rather than part of the problem."

If nobody bought Coke, the company would go under. Enough people are willing to pay for it to generate profits instead. Banning soda whether in Mayor Bloomberg's favorite 16-oz. cups or any other form, or shaming its imbibers is no solution for obesity, but nobody wants to hear it. At the end of the article, a Coca-Cola spokesman offers, "Obesity is complex, and it requires partnership and collaboration to help solve it. We have an important role to play in the effort to find solutions that work for everybody."

Barry Popkin of the University of North Carolina won't buy it, responding, "The Coca-Cola Company still remains one of the major causes of obesity in the USA and globally." So there.

On the very same page of that day's newspaper was an interview with "Manhattan socialite" Dara-Lynn Weiss, 41, whose new book explains why she put her obese 7-year-old on a diet. She wrote about it in the April issue of Vogue, to subsequent viral web vilification.  Now she's hyping her story further, and says little Bea, now 9, is a "healthy" weight. Bea bulked up by age 6, despite living in a home of thin people who shared healthy meals together, because she "was a child with an enormous appetite."

Dara-Lynn Weiss and Bea
What do I take from this? Just what the Coca-Cola spokesman says: Obesity is complex. Here was a little girl with skinny parents and a little brother "who doesn't want to eat sweets," whose natural physiological makeup gave her more appetite. Should she restrict her diet her whole life? Should her mom have enforced her weight loss? I don't know, but can you blame Bea's obesity on the Coca-Cola Company?

I can understand how difficult it is for a fat child. No mother wants to see her daughter suffer with something that can be addressed. On the other hand, few mothers would describe their efforts to slim their 7-year-old in Vogue Magazine.

That aside, the message remains: Fat, shape, obesity and dieting are enormous problems in America. Perhaps as much for their psychological impact as their physical manifestations. They're also huge sources of wealth for businesses large and small who deal with them.

Yet, being fat could be good for you. I found a slew of articles reporting on a new US government meta-review of 97 studies on longevity that found that overweight people had a 6%, and "Grade 1" obese a 5% lower risk of early death, than either higher-level obese or normal-weight people. The study's release was followed by a New York Times Op-Ed piece by Paul Campos, one of my favorite writers on the subject, who's made the same point repeatedly since his 2004 book, The Obesity Myth.

I'm also a fan of the lead author of the massive new study, Katherine M. Flegal of the CDC and National Institutes of Health, who discusses her process and findings in a three-and-a-half-minute video. Her team looked at 7,000 studies, eventually selecting 97 that met their criteria: body-mass index as the measure of girth, and broadly representative populations (not subsets, such as those suffering from a disease). Their many analyses yielded "strikingly consistent findings," across age, sex, smoking, gender and parts of the world (most studies were from North America). Being somewhat obese or overweight was simply not a hazard for dying; being overweight was a statistically significant advantage to longevity.

The obesity police? Watch out!
This is not a message that the obesity police want to hear. They immediately set to work tearing apart this unassailable, respectable analysis. Walter Willett of the Harvard School of Public Health erroneously said the study's flaw was "because the overweight and obese groups were compared to this mix of healthy and ill persons who have a very high risk of death, this led to the false conclusions that being overweight is beneficial and that grade 1 (moderate) obesity carries no extra risk." I wonder if he actually read the research, but he was emphatic in his review: "The paper is a pile of rubbish." With three million subjects studied, that's an awfully high pile.

Perhaps you can grouse that BMI isn't an accurate measure of overweight since it doesn't account for percentages of muscle, or location of fat, but when you talk about 97 high-quality studies of three million people, you've got enough information to say something important. The health establishment is so invested in its anti-obesity campaigns that it can't even acknowledge a bit of good news.

And the reason that establishment is so dismissive is the same cultural bias that prompted Dara-Lynn Weiss to print in a fashion magazine the dragon-mother tactics she used to whittle her 7-year-old ("I stopped letting her enjoy Pizza Fridays when she admitted to adding a corn salad as a side dish one week. I dressed down a Starbucks barista when he professed ignorance of the calorie content of the kids' hot chocolate...").

And that reason is our hatred of body fat. We associate a bulbous appearance with negative personality characteristics. Here's another article I clipped today, from the Wall Street Journal: "Want to be CEO? What's Your BMI?" "Executives with larger waistlines and higher body-mass-index readings tend to be perceived as less effective, both in performance and interpersonal relationships," according to a study by the Center for Creative Leadership, a non-profit group. "Excess weight can convey weakness or 'lack of control,'" adds New York image consultant Amanda Sanders.

A 2010 Australian study found that "obese people were rated less favorably, and as more disgusting, than all other social groups." Yale University researchers (2005) tried to improve anti-fat bias by combatting the perception that obesity is within an individual's control, and that "people get what they deserve and are responsible for their life situation." Interestingly, prejudice against the rotund has grown to a global phenomenon, with Arizona State University researchers reporting cross-cultural agreement with the statement, "fat people are lazy."

A generation ago, we might have considered it impolite to comment on others' sizes. I remember my mother admonishing that one's inner soul, or "the content of his character" is what counts, not how he looks on the outside. At the very least, we judge by behavior, right? No longer.

We despise fatness, and now in the guise of ending an epidemic, the obesity police have free rein to butt into our most personal decisions ("what size beverage do I want?"). It doesn't matter that health and BMI are for most people unlinked. Paul Campos can wisely repeat that "baselessly categorizing at least 130 million Americans--and hundreds of millions in the rest of the world--as people in need of 'treatment' for their 'conditon'" merely feeds big pharma and weight-loss industry coffers. He can insist that there's no health reason to push present ideals--but he won't change anything, because in our culture, fat is abhorrent.

I've spent a lot of  time researching causes of obesity, and they are many. Certainly not soft drinks, though glugging full-sugar sodas throughout the day adds calories, just as enjoying a morning latte does. Pure fruit juices count as "sugary drinks" equally, despite their enrichment with extra vitamins, since their calorie-counts are similar to Coke's (for example, 8 oz. of Florida's Natural orange juice is 110 calories; regular Coca-Cola has 96 for the same amount). What few people mention is that "normal" eaters, the ones in touch with their body's cues of hunger and satiation, feel full when they consume food or drink, and the more they consume, the less additional they want.

And that's my answer to the obesity issue, though certainly not a complete or perfect solution. Rather than listening to the prattle of pundits or exortations of experts, all of us can relax and strive to trust our bodies' messages. Even doing that, many people will be fat. I think of poor little Bea Weiss, whose mother watched in horror as she responded to her inner call for food. Dara-Lynn Weiss only wants the best for her daughter; she only wants her to grow up healthy and happy, and the only means she knows to facilitate that is to teach Bea very young to deny her desires and place a major emphasis on staying thin. "It's absolutely a problem every day that we are attentive to," Dara-Lynn Weiss tells Fox and Friends in an interview about her new book, The Heavy.

My hope is that medical science can learn more about the causes of obesity, and means to regulate them--and there's a lot to learn. Some obesity is caused by a cold virus. Some is the result of imbalanced hormones. Some is a medication side-effect. Some obesity is inherited, and some is the result of genetic changes caused by environmental factors. Stomach acids play a role; the amount of calories expended in breath impacts metabolism, too. If you ever watched the excellent BBC series "Why are Thin People Not Fat?" you know that a range of influences determines how calories are burned.

Exercise is not necessarily central among them. Some sedentary people eat whatever they want in any amount they choose and remain thin. They may not have finely-toned muscles, but they stay slender. What determines one person's desire for soft drinks versus another's preference for black coffee? Is the black coffee drinker more likely to be thin? Is a Cheetos-eater more likely to be fat? Not necessarily. We just don't know enough.

This is never the message of the articles I cull from the newspaper daily. I have folders on all sorts of interesting fat-related themes, including psychological influences on weight, what crusaders are doing to shrink the populace, and various substances certain loud voices dub deleterious (think sugar). I have files on childhood obesity (Bea!) and exercise and the food industry.

But aside from awaiting research, what can Americans do? Learn to turn inward. To thine own body sensations be true. Separate psychological, media and presence-of-food influences from real hunger, and when eating, focus on physical reactions. This is a learnable way to live, natural and effortless for a swath of the population. It's just too bad all this publicity about obesity and sloth has everyone so unfairly and wrongly uptight.