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7/30/2009
NOW THEY’RE COMING FOR THE FAT PEOPLE

Megan McCardle has a disturbing interview with Paul Campos, the author of The Obesity Myth (republished as The Diet Myth) that smashes the idea that obese people are necessarily more of a drain on health care resources than thinner people.

McCardle:

With health care in the news, everyone’s looking for magic bullets to save money. Obesity seems to be a growing favorite: wouldn’t it be great if we could make everyone look like Jennifer Anniston, and be cheaper to treat? There are a lot of holes in this theory–the morbidly obese are very sick, but die young, while lower levels of overweight/obesity aren’t so well correlated with poor health. But still, the idea’s power seems to be growing every day.

This week, Health Affairs published a new study showing that–quel surprise!–obesity accounts for an ever growing share of our health care costs. They put the number at about 10%. So I decided to ask Paul Campos, the author of The Obesity Myth, what he thought. The book, which everyone should read, argues that the health benefits of losing weight are largely imaginary; that we are using “health” to advance our class bias in favor of thin people, particularly thin women.

Following are some selected cuts from the interview that should open you eyes about the efficacy of studies touted by government health professionals as well as the difference between being thin and being healthy.

On trying to control health care costs by reducing the number of obese Americans:

It’s a terrible idea on all sorts of levels. There are three big problems with attempting to control health care costs by reducing so-called “obesity.” First, it’s a fake problem. Second, the solutions for the problem are non-existent, even assuming the problem existed. Third, focusing on making Americans thinner diverts resources from real public health issues.

Is being fat really being unhealthy?

The correlations between higher weight and greater health risk are weak except at statistical extremes. The extent to which those correlations are causal is poorly established. There is literally not a shred of evidence that turning fat people into thin people improves their health. And the reason there’s no evidence is that there’s no way to do it.

So saying “let’s improve health by turning fat people into thin people” is every bit as irrational as saying “let’s improve health by turning men into women or old people into young people”. Actually it’s a lot crazier, because there actually are significant health differences between men and women and the old and the young — much more so than between the fat and the thin.

Campos calls this obsession in the public health community over obesity “a moral panic” and debunks the statistics:

OK, the CDC honchos and the authors of this study you referenced are in hysterics because the obesity rate, so-called, has roughly doubled in the last 30 years. But let’s consider what that actually means.

Obesity is defined completely arbitrarily as a body mass index of 30 or higher (175 pounds for an average height woman). Now body mass follows more or less a normal distribution, whiich means if the the mean body weight is in the mid to high 20s, which it has been for many decades now, then tens of millions of people will have BMIs just below and just above the magic 30 line. So if the average weight of the population goes up by ten pounds, tens of millions of people who were just under the line will now be just over it.

This might be meaningful if there was any evidence that people who have BMIs in the low 30s have different average health than people with BMIs in the high 20s, but they don’t. At all. So the “obesity epidemic” is 100% a product of tens of millions of people having their BMIs creep over an arbitrary line. It’s exactly as sensible as declaring that people who are 5′11 are healthy but people who are 6′1″ are sick.

Adding to the absurdity of all this, people with BMIs in the mid to high 20s actually have the best overall health and longest life expectancy — ,more so than those in the so-called “normal” BMI range.

Debunking diets:

If you put people on starvation diets, which is what these methods do, of course you’ll get huge amounts of weight loss. Then most or all of it will be gained back, which among other things is a recipe for congestive heart failure. I’d love to do a “reality” show on the contestants on shows like The Biggest Loser three years down the road. But that would probably be a little too much reality.

Gastric bypass is the most radical method available for weight loss, and it basically doesn’t work. Everything else is even less successful, though usually not quite as dangerous.

Finally, increasing government coercion to get obese people to lose weight.

It’s the classic pattern of moral panics. As public concern about the damage being done to the fabric of society by the folk devils increases, increasingly intense demands are made on public officials to “do something” about the crisis, usually by eliminating the folk devils.

That of course is the strategy for this crisis. If fat people are the problem, then the solution is to get rid of them, by making them thin people. The most amazing aspect of this whole thing, for me, has always been the imperviouusness of policy makers, and even more so people who consider themselves serious academics and scientists, to the overwhelming evidence that there’s no way to do this.

I mean, there’s no better established empirical proposition in medical science that we don’t know how to make people thinner. But apparently this proposition is too disturbing to consider, even though it’s about as well established as that cigarettes cause lung cancer. So all these proposals about improving public health by making people thinner are completely crazy. They are as non-sensical as anything being proposed by public officials in our culture right now, which is saying something.

There is perhaps no part of government that bases its policies on flawed research, unproven assumptions, and is driven by politics more than the public health sector. From the Alar scare that cost apple growers $100 million to the myth that salt causes high blood pressure, our public health bureaucrats have not been as helpful as they should be in contributing to the health of Americans.

Beyond the question of how effective they are, there is the growing realization that altering personal behavior to conform to what some health professionals believe to be necessary for good health results in a loss of freedom for the individual to manage their own lives without interference from the government.

The excuse to intervene in such personal decisions as what we should eat or drink will be even more prevalent once national health care is a reality. The logic that eating certain foods or partaking in some behaviors results in an individual using more than one’s fair share of scarce health resources will be more than enough to tax, to ban, to regulate, to dictate the kinds of foods that should be available to us. It may even result in penalties if we fail to abide by these strictures, such as not treating people whose behaviors or diets are self destructive.

When I was 280 lbs (42 lbs ago), I felt tired all the time, caught colds often, and found it very hard to get around. I’m still about 50lbs overweight but am losing the weight without dieting. It’s a slow process - no more than 2-3 lbs a month, sometimes none at all. But I’m eating better while still enjoying all the foods I ate when I was 280. I figure that there are so few true pleasures here on earth - one of them being good food - that to shortchange yourself, even at the expense of your weight and ultimate life expectancy, isn’t worth it. Better to live well than make yourself miserable by dieting all the time. If that results in a few fewer years on this planet, so be it.

This may not be your attitude and that’s fine. That’s your choice. But the point is, it should be our choice, not the governments. This is the same mindset that forced auto manufacturers to make it impossible to start a car without buckling up. Is buckling up a smart thing to do? Sure. But the idea that the government is forcing you into a behavior - no matter how much money it saves (no evidence it does due to different injuries suffered while wearing a belt), - that isn’t and shouldn’t be the point.

Where does it stop? At what point do government diktats on health or controlling behavior become so onerous that the very idea of individual responsibility and personal freedom is destroyed? I am not that much of a libertarian to believe that ingesting anything we please - including drugs that are currently banned or illegal - should be the standard under which we measure our personal freedom.

But government comes perilously close to unnecessary intervention in our personal lives when it determines for itself what is “healthy” and what is not, and then tries to impose that idea on us by reducing our freedom to decide for ourselves.

By: Rick Moran at 11:17 am
11 Responses to “NOW THEY’RE COMING FOR THE FAT PEOPLE”
  1. 1
    Foobarista Said:
    11:59 am 

    This is a textbook example of why I don’t want the government “doing more”. The more it does, the more it has to control. If the government isn’t running healthcare, it won’t have a reason to “care” about non-criminal personal behavior beyond reasons of public health (where “public health” is limited to handling epidemics and such things, which is a legitimate government function).

  2. 2
    Michael Reynolds Said:
    12:24 pm 

    Guys what do you think private health insurers do? The reason so many people are so clueless is that most of you have employer provided insurance. Try getting an individual policy then come back and whine about government.

    The only reason - literally the only way — I could get insurance is to use a CA work-around that required me to form a corporation. The sainted free market said no.

    So sorry, this is not support for private over public.

  3. 3
    nano Said:
    12:56 pm 

    If I read it right they are suggesting a 3 cents a can soda tax to deal with this.

    Hey gang lets be sporting here ,the SCHIP funding hit smokers for 63 cents a pack and their are likely more people who are fat than smokers with some overlap of course.

    Why should smokers have all the fun.

  4. 4
    Eddie Said:
    1:36 pm 

    I agree the gov’t should not be getting ever more into our lives by restricting/taxing/banning certain fatty foods.

    I agree w/ Michael that the private insurers don’t take kindly to obesity out of an ideological knee-jerk reaction to not being slim. There are obvious and true health concerns with being seriously obese or “fat”.

    I agree BMI is essentially useless but refuse to concede being fat is “healthy” as Campos has claimed repeatedly in his book and in the interview.

    There are good reasons for why most obese individuals are the way they are. It mostly boils down less to what they eat but how much of it they eat (they gorge). Why eat half the bag of chips quickly when you can eat a quarter of it gradually?

    As a PRT coordinator on my last ship I had to escort overweight sailors around during meal hours in order to keep them from gorging themselves as they were wanton to do. I didn’t do this for their health so much as so they could keep their weight down to an acceptable level of progress for the Navy’s slightly overzealous weight standards. To a man these people had seriously flawed eating habits, eating way too much way too fast, then going back for more or eating a snack because they were still hungry. No wonder they were 15-25 pounds out of standards!

    It doesn’t help that some of the popular foods we have had in the past few decades were chock full of chemicals and additives that have been shown to be less than helpful to a healthy lifestyle. It also boils down to people living very sedentary lifestyles. We’re not asking for everyone to join a health club but if more Americans would simply walk around their neighborhood, in a park or do other forms of easy, enjoyable exercise, they would be healthier and less obese.

    Thin and fat are both not healthy. Spreading myths like Campos and the anti-fat police do are not helpful.

  5. 5
    Eddie Said:
    2:09 pm 

    I should clarify that Campos doesn’t come out and say explicitly that being fat is not unhealthy, but he muddies the water as bad as his critics do by not distinguishing enough in the book (and in interviews) the significant variances in overweight classifications.

  6. 6
    KingShamus Said:
    2:17 pm 

    Using bad science to make massive policy decisions using leads to bad policy. Then again, when has that ever stopped the geniuses that run our government.

  7. 7
    jackson1234 Said:
    2:21 pm 

    A small quibble with Campos here:

    “The most amazing aspect of this whole thing, for me, has always been the imperviouusness of policy makers, and even more so people who consider themselves serious academics and scientists, to the overwhelming evidence that there’s no way to do this.”

    Oh, yes we can. Make insurance rates higher (this also happens in the free market, as Michael pointed out, although not in larger pools), deny coverage (same), or more ominously, tax employers out of business who don’t have government-mandated exercise and nutrition programs (Obama-type public madness here).

    Campos absolutely is right about BMI and mean mortality rates. There is a strong correlation between diabetes and morbid obesity, and some evidence of a link between obesity and heart disease. What doesn’t get mentioned as often, of course, is the total lack of correlation between cancer and weight. I’m certain the red meat police will be put on that one, although recent studies tend to show no correlation there, either.

    Campos nails this hysteria when he imputes it to the left-wing’s incessant need to demonize groups to advance hair-brained schemes. The attempt to hang health care costs around the necks of the elderly prompted such outcry that new demons were needed after the old folks came after Democratic party hacks. Maybe you fat folks need an equivalent of AARP and need to bitch more and need to bloc vote all the time. Then new demons can be created.

  8. 8
    mike farmer Said:
    9:04 pm 

    Those damn Gorgons and dragons!

  9. 9
    Chuck Tucson Said:
    9:23 am 

    This entire piece could easily be said about private insurance. There is no difference.

  10. 10
    michael reynolds Said:
    11:34 am 

    Chuck:

    Yes, but that conflicts with their religious faith in business and their knee-jerk demonization of government.

  11. 11
    HyperIon Said:
    11:08 am 

    You wrote: “the myth that salt causes high blood pressure”

    Your link does not support this. It merely cites ONE study that indicates that sodium is PERHAPS not the main cause. Your statement is misleading. Perhaps because you are more dedicated to making your point than the truth.

    Fat smokers who eat too much salt look forward to kidney failure. And no one is going to enjoy paying for their dialysis. Dialysis is currently financed largely by government funds.

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