Tag Archives: obesity epidemic

An Open Letter to Liz Dwyer at TakePart

Debbie says:

Dear Liz Dwyer:

You don’t know me.

I subscribe to TakePart.com’s newsletter, which I find very useful in keeping me informed about a variety of social justice issues. I’ve taken to looking for your byline, or finding that when I read an article I like about body image issues, your byline is there. I love your interest in the same kind of wide range of body issues Laurie and I write about here. I love how you call out body shaming, over and over and over.  But interspersed with these fabulous articles, many of which are so clear about how wrong it is to body shame anyone, including fat people, you still write articles like “The Five Shocking Facts About Obesity in America.”

Hint: There really isn’t an obesity epidemic in America (or at the very least, not one that reflects people eating badly and not taking care of ourselves). Being fat (especially if we lived in a world without fat shaming) is not a major health risk.

It’s time you cop to those facts, and write about them. I’ll give you some resources.

Let’s look at your five shocking facts:

1. More Americans are obese than overweight.

This paragraph is based on BMI, which I hope you know was invented by a statistician with no medical training. The distinction between “obese” and “overweight” which you are giving credence to is arbitrary, and makes no distinction between a weight-lifter with a huge amount of muscle and a person with a large amount of fatty tissue. And study after study shows that “overweight” BMI is the category with the longest life expectancy.

Overall, people who were overweight but not obese were 6% less likely to die during the average study period than normal-weight people. That advantage held among both men and women, and did not appear to vary by age, smoking status, or region of the world. The study looked only at how long people lived, however, and not how healthy they were whey the died, or how they rated their quality of life.

The study abstracts don’t say how “underweight” and “normal” fared, but they do say that what they call “Category 1 obesity” (BMI of 30 to less than 35) is effectively indistinguishable from overweight life expectancy, thus making the categories even more ridiculous.

2. Overall, more men than women are too heavy.

Well, statistically, men have larger bones and more muscle mass. So if you use BMI as your criterion, that’s an automatic likelihood. It probably means nothing.

3. If they’re heavy, women are more likely to be obese than overweight.

I take exception to “Of the ladies that need to drop some pounds,” especially given the life expectancy numbers above. Also, BMI remains meaningless.

4. Black Americans are the most obese racial or ethnic group.

5. Latino Americans are struggling with the scale too.

You invoke Black Lives Matter here (we could not agree more) and you also invoke poverty. You say nothing about genetics, and nothing about food deserts. Closer to my heart, you say nothing about how being shamed is bad for your health, how internalized oppression expresses itself through the body. Black and Latino people are oppressed in so many ways; fat people are oppressed in other ways. Black and Latino fat people face double oppression. Black and Latino/a fat women, trans people, gay people,  disabled people, or Blacks and Latinos in more than one of the above categories) face additional oppression. And the illnesses that stem from oppression are the illnesses we attribute to fatness: high blood pressure, cardiac issues, stroke, and so on. You are so very capable of connecting the dots; why don’t you connect these?

You close this article talking about soaring health care costs and make the oh-so-common, oh-so-unproven claim that diet and exercise are the solution. Do you really still believe in dieting? Have you read Gina Kolata’s Rethinking Thin? Do you know David Berreby’s amazing article about leptin and ghrelin?

Consider, for example, this troublesome fact, reported in 2010 by the biostatistician David B Allison and his co-authors at the University of Alabama in Birmingham: over the past 20 years or more, as the American people were getting fatter, so were America’s marmosets. As were laboratory macaques, chimpanzees, vervet monkeys and mice, as well as domestic dogs, domestic cats, and domestic and feral rats from both rural and urban areas. In fact, the researchers examined records on those eight species and found that average weight for every one had increased. … Allison, who had been hearing about an unexplained rise in the average weight of lab animals, was nonetheless surprised by the consistency across so many species. ‘Virtually in every population of animals we looked at, that met our criteria, there was the same upward trend,’ he told me.

That article links junk food not just to calories but to calorie retention. This, of course, would put the burden of weight gain onto the corporate food industry. It’s so much easier to blame individuals, but you are better than that.

One more reading suggestion, one I haven’t gotten to yet myself: The Big Fat Surprise, by Nina Teicholz. The Wall Street Journal, hardly a radical publication, had this to say:

It is a commonplace in public-health discussions of obesity to warn that the search for “perfect” or “better” evidence is the enemy of good policy and that we can’t afford to wait for all the information we might desire when there is a need to do something now. Yet Ms. Teicholz’s book is a lacerating indictment of Big Public Health for repeatedly putting action and policy ahead of good evidence. It would all be comical if the result was not possibly the worst dietary advice in history. And once the advice had been reified by government recommendations and research grants, it became almost impossible to change course. As Ms. Teicholz herself notes, she is not the first to point out that saturated fats have been sinned against by bogus science; and yet, the supermarket aisles are still full of low- and no-fat foods offering empty moral victories.

Teicholz’s book is near the top of my to-read list.

So please, keep up your remarkable work talking about race and gender, body shaming, and other political issues. And please think about how to address the “obesity epidemic,” BMI, and the American (and increasingly global) diet. I promise; I’ll keep reading your work even if you don’t change your mind.

Know Your Rights: Obesity, Disease, Employment Discrimination

Laurie and Debbie say:

In the last month or so, the AMA, acting against its own science council’s advice, has declared obesity to be a “disease.”

Vik Khanna is an “independent health consultant with extensive experience in managed care and wellness.” Looking at the first of his two-part series on obesity and the AMA, it is clear that he is no fat activist, and not much of a believer in HAES:

This decision’s willful disregard of salient facts is staggering: first, most obesity is not the result of a disease process or a frank genetic defect, it’s the result of algebra. We eat more and move less than our ancestors, even of just four generations ago. Second, a surprising number of obese people are still quite healthy. Third, the ones who work hard enough to improve their fitness level will do more for their survival than those who remain unfit, regardless of BMI. Fourth, telling everyone who’s obese that they are sick is a cruel canard that encourages dependency on the professions in such a way that must make Ivan Illich roll over in his grave.

So, here’s the challenge for the AMA. Since you’ve now told the culture to show you the (obesity-related) money, here’s what we taxpayers and funders of your enterprise want: win the war on obesity using a very clear metric…restore the status quo ante…the distribution of BMI in American adults in 1980. And, while you’re at it…fix the industry’s obsession with overdiagnosis and overtreatment because there’s no money to be made in the obverse. Finally, measure both fitness and health-related quality of life in all these “sick” people so we can see how much they really benefit from your efforts. Still think that medicalizing a lifestyle problem was the best step toward long-term success? Fat chance.

So far, this is centrist common sense, and we wish doctors would listen. The second part of his post, however, is even more important. In this post, Khanna is talking about how the disease label can be used in employment discrimination. He doesn’t address the ongoing issue of people not being hired because they are fat, including the relatively new version of that where fat people are seen as more expensive employees. (Of course, to the extent that this is true at all, the medical/social perception that fat people are unhealthy is the reason fat employees can be more expensive.) Instead, he is focusing on mandatory wellness programs, which gain significant teeth from this decision. And he’s giving us a roadmap for how to face these programs in our various workplaces. As Khanna says, these “wellness programs … often hinge [on] vastly overblown claims of being able to help the obese who they almost universally label as ‘high risk’ people.”

Well, what if people who are obese, who are no doubt tired of being condescended to, first by wellness companies, and now by the AMA, decide that they are going to seek medical approval to opt out of wellness programs?  A study recently published in the journal Translational Behavioral Medicine reports on a highly coercive, electronically monitored walking program for obese people: 17% opted not to participate and another 5% actually got their physician’s approval to opt out.  The physician approval to opt out is key to any resistance strategy.

Under the final wellness rules issued by the federal government earlier this year, physician certification that it is medically unadvisable for an employee to participate in a wellness program creates a burden for the employer and wellness vendor.  They must provide reasonable alternatives that do not disadvantage the employee in terms of either time or cost and that address the physician’s concerns. … The coup de grace is that “adverse benefit determinations based on whether a participant or beneficiary is entitled to a reasonable alternative standard for a reward under a wellness program are considered to involve medical judgment and therefore are eligible for Federal external review.”

As many fat people know, it isn’t usually going to be easy to convince your doctor that such a program is bad for you, but it will probably be easier than convincing your employer, if your employer is the type of place that goes for these horrible programs. (Electronically monitored walking programs can kiss my ass!)

Khanna goes on to state his opinion of current medical thinking on fat in no uncertain terms, and we intend to quote this forever:

Targeting people based on body mass index (BMI) is an intellectually, morally, scientifically, and mathematically bankrupt approach.

Finally, his clear conclusion is not only an argument against the disease model of obesity, it’s a brilliant argument against the childhood obesity panic. We’d like everyone in the country–every teacher, every doctor, every employer, every parent–to post it on the wall and read it every day.

Above all else, tell your people (obese or not) that your wellness goal is not to insult them, diminish them, or make them feel sick when they aren’t.  Wellness, by any reasonable definition, should give people tools that empower them.  How much they are willing to do is ultimately up to them.