Obsession with Weight, Part 4

The Obesity Myth
by Paul Campos, J.D.

(Page 4 of 6)

Fear and Loathing in Los Angeles

The cover of the March 2000 issue of Harper's magazine features a photograph of an artwork entitled Sundae 1, by Jeanne Dunning. The photograph is of the head and shoulders of a person of indeterminate gender, lying on his or her back. The person's face is completely smothered by an artfully stacked mound of whipped cream, topped with a cherry.

The cover story the photograph is meant to entice readers to sample is "Let Them Eat Fat: The Heavy Truths About American Obesity," by Greg Critser. This essay is in many ways representative of the sort of reportage regarding weight-related issues now appearing on a daily basis in the nation's major newspapers and large-circulation magazines. The basic thesis of such stories is almost always the same: Americans are eating themselves to death. Yet readers of these stories who remain willing to look just below their surface of alarmist claims and distorted statistics will often find evidence of things a good deal more disturbing than the number of calories in a Double Whopper with cheese. In this regard, "Let Them Eat Fat" is an especially revealing document. Indeed, its author's unusual candor makes this essay an excellent introduction to the underlying cultural sources of our increasingly intense obsession with the dietary habits and waistlines of our fellow citizens.

The essay itself opens with what its author clearly intends to be a shocking and horrifying tableau: In the intensive care unit of the University of Southern California's medical center in downtown Los Angeles, a twenty-two-year-old man whom Critser names "Carl" is being intubated, while surgeons "labor to save his life." Critser informs us that Carl weighs 500 pounds. The author then quotes the patient's mother: "'Second time in three months,' [she] blurted out to me as she stood apart watching in horror. 'He had two stomach staplings, and they both came apart. Oh my God, my boy ...' Her boy was suffocating in his own fat."

"Here ... writhed a real-life epidemiological specter," notes the shocked and horrified author, employing a metaphor that suggests Harper's editors were not at the top of their games when this piece came across their desks. (As we shall see, neither were the magazine's fact checkers.)

The magazine's readers are never told what medical condition has occasioned this emergency. Given the assertions made in the rest of his essay, I suspect it may come as a surprise to the author to learn that "suffocating in your own fat" does not constitute a recognized medical diagnosis. More to the point, using "Carl's" unspecified medical problems to introduce a discussion of weight and public health is typical of the sorts of anxiety-provoking distortions employed by America's anti-fat warriors. Only a tiny percentage of the 135 million adult Americans who the government claims are "overweight" are anywhere near Carl's size. By focusing on the most extreme cases, those prosecuting the war on fat copy the drug war's most deceptive tactics: Just as the average American who our government labels a "drug abuser" is someone who smokes marijuana occasionally, the average American being harassed by our public health authorities about her supposedly unhealthy weight is a 150-pound woman, not a 500-pound man.

But leave all this aside for the moment. Critser goes on to cite the usual scare statistics about an "obesity epidemic" in America, before offering up a particularly choice quote from David Satcher. Satcher, who succeeded C. Everret Koop as Surgeon General, is perhaps even more unhinged on the subject of obesity than his fat-obsessed predecessor. "Today," Satcher solemnly intones to a gathering of federal bureaucrats and policymakers, "we see a nation of young people at serious risk of starting out obese and dooming themselves to the tough task of overcoming a serious illness."

The rhetorical stakes are then ratcheted even higher with a quote from William Dietz, the director of nutrition at the Centers for Disease Control (Critser employs the neat journalistic trick of always characterizing the most histrionic of his sources as "the most careful" and "normally reticent" experts): "This is an epidemic in the U.S. the likes of which we have not had before in chronic disease," Dietz says. Critser expands on this ridiculous claim - which any journalist armed with a scintilla of skepticism would recognize as exactly the sort of thing a CDC honcho angling for a bigger slice of the federal health research pie might say - with an even more preposterous observation of his own. "The cost [of obesity] to the general public health budget by 2020," Critser predicts, "will run into the hundreds of billions, making HIV look, economically, like a bad case of the flu." (An outbreak of influenza in 1918 killed between twenty and forty million people worldwide, including 675,000 Americans, but never mind.)

The essay goes on to frame its subject in a manner that - no doubt unintentionally - recalls Jonathan Swift's eighteenth-century masterpiece of satirical invective, "A Modest Proposal," in which Swift suggested that the Anglo-Irish ruling class should encourage the Irish poor to fatten up their children, and then sell them for slaughter: "How is it that we Americans, perhaps the most health-conscious of any people in the history of the world, and certainly the richest, have come to preside over the deadly fattening of our youth?" Critser asks.

Before getting to his answer, I should note that to this point "Let Them Eat Fat" has been fairly standard stuff. I simply never would have believed, before I began to study the issue of fat in America, how inaccurate most of the mainstream journalism regarding this issue actually is. Typical newspaper and magazine articles on fat are generally worse than worthless: Such stories tend to be nothing more than lemming-like compendia of various gross distortions, fed to a compliant media by those in the medical and pharmaceutical establishment who profit directly from the constant escalation of America's weight anxiety. (If stories on the drug war consisted mainly of rewrites of press releases from the White House's Office of Drug Policy, they would be about as reliable as the average journalistic foray into the war on fat.)

Readers of this Harper's article, and of the hundreds of pieces of journalism churned out annually that repeat its central claims, will never guess that there is a raging debate in the medical literature about whether "obesity" is even a useful concept. They will never be given a hint of the fact that, in the words of the editors of the New England Journal of Medicine, the case for the claim that fat is a significant health risk is "limited, fragmentary and often ambiguous." They are not going to be informed that far more Americans do serious damage to their health by attempting to lose weight than by gaining it. And they will never hear of the powerful evidence gathered over the past two decades that a lack of cardiovascular and metabolic fitness, not an excess of fat, is the key to understanding ill health among both fat and thin Americans.

No, most readers will come away from such articles with the belief (as I did, when my knowledge of the subject came from similar sources) that "obesity" is a major health risk in America, if not an outright epidemic disease - one that dwarfs AIDS in its potential to devastate the children of the poor and the pocketbooks of the rich (more on that particular connection in a moment).

Of course all of this is either greatly exaggerated or flatly untrue. I ask readers to forgive a bit of repetition, intended to fight the reflexive incredulity that, as a consequence of so much weight loss industry propaganda, the following facts tend to elicit among even the best-informed audiences: Weight is on the whole a poor predictor of health. Even quite fat people have better health, on average, than fashionably thin women. Fat active people have half the mortality rate of thin sedentary people. Levels of physical activity are far better predictors of health than body mass. Dieting does far more damage to health than being fat. And so on.

You would never guess any of this from reading or viewing the vast majority of stories published or broadcast about weight in the nation's major media. Attempting to explain the causes of this remarkable level of distortion is one of the aims of this book. One source of that distortion is the understandable hunger to find simple explanations for complex problems. Americans are on the whole pragmatic people who like to believe problems have solutions, especially if these problems are subjected to the rigors of "scientific policymaking." Simply assuming that heavier people are less healthy than thin ones, and that the former would be healthier if they were thinner, makes it much easier to draft nice, straightforward grant proposals, and to formulate nice, unambiguous public health policies. (It's also a great way to secure funding from pharmaceutical companies.) A close cousin of this phenomenon is the professional deformation that takes place when an entire discipline is organized initially around a fundamentally mistaken assumption: in this case, the assumption at the core of obesity studies that higher than average weight is a significant independent health risk.

Another explanation, one illustrated well by the substance of the mainstream journalism discussing weight, is that almost all of us rely on the conventional wisdom regarding a particular subject for essentially all of our information about that subject. Unless we have some fairly specialized knowledge about X, our opinions about X will almost always reflect the opinions about X held by people like us. At bottom, journalists tend to believe what they believe about fat because what they believe about fat simply reflects the views about fat held by the people they know best - many of whom, of course, are other journalists. And even those among their circle who are not journalists will still tend to be people very much like them - upper-class, mostly white professionals who can for the most part be counted on to share the same basic beliefs as their journalist friends, spouses, and so on.

Given all this, it's hardly surprising that journalists will often come to an issue such as the relationship between weight and health with the point of view that will frame the researching and writing of their stories already firmly in place. Since most of their research will, by necessity, consist of reading the work of other journalists on this same issue, supplemented, perhaps, by new quotations from the very same experts and government agencies that were quoted in these previous stories, the new stories inevitably end up looking very much like the old ones.

Copyright © 2004 Paul Campos

About the Author

A professor of law at the University of Colorado and a nationally recognized expert on America's war on fat, Paul Campos is the author of a weekly opinion column that appears in more than forty newspapers nationwide. His articles have appeared in the New Republic, the Wall Street Journal, the Los Angeles Times, USA Today, the San Francisco Chronicle, and the Boston Globe.