Showing posts with label the obesity myth. Show all posts
Showing posts with label the obesity myth. Show all posts

Kevin Smith and MeMe Roth

>> Thursday, February 18, 2010

I have a piece in The Daily Beast on the Kevin Smith Southwest Airlines incident. What happened to Smith, who was apparently aribtrarily thrown off a flight for being too fat, is the kind of humiliating incident to which bigger than average people are subjected to constantly. Some day they're going to start getting mad.

(MeMe Roth's birth name was Meredith. I wonder if anyone has ever pointed out to her that changing your name to MeMe is like sticking a post-it note on your forehead saying "I have narcissistic personality disorder.")

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Tom Friedman's furrowed middlebrow

>> Friday, February 12, 2010

This column is a few months old, but it's a particularly good example of something illustrated by any number of Thomas Friedman columns, or indeed any amount of free-wheeling high-profile punditry. Various aspects of the argument strike me as absurd (the idea that the only really big problem the world had when Friedman was a kid was the fact that the Soviet Union was a nuclear state) to at best dubious and strained (the analogy between increasing U.S. government debt and increasing carbon emissions). But what struck me about it at the time, and why I remembered it this week, was something else: the breezy style in which Friedman issues pronouncements on three immensely complex subjects -- nuclear proliferation, the world's financial system, and climate change -- as if these are straightforward matters that he, Thomas Friedman, has sufficient expertise to comment on in a useful way because he slept in a Holiday Inn Express last night or something.

I was reminded about that this week because I've spent a lot of time doing media stuff on the childhood obesity panic (I'll be on CNN tomorrow at 7:45 PM eastern Update: link to video here), and I was struck, if I might indulge in a bit of liberal condescension, by how much I know on this subject, at least in comparison to almost everybody who is commenting on it.

Now this isn't because I'm some sort of genius, but simply because I've spent literally thousands of hours studying the subject of the relation between weight and health. I get a bemused smile when somebody in a comment thread starts pontificating about the "fact" that very thin people have high mortality rates because people lose lots of weight right before they die. As anyone in my position would be, I'm intimately familiar with the methodological debates about what to do to control for occult wasting in observational studies. Indeed I'm hip to all the tricks researchers use when trying to squeeze certain conclusions out of the data. That's why people like, to name names as they used to say back in the 1950s, Walter Willett and JoAnn Manson of the Harvard School of Public Health hate me with a visceral passion -- and I welcome their hatred.

Normally, people like Willett and Manson can shut dissenters up, or at least make them extremely cautious and mealy-mouthed, through the raw exercise of institutional power. They review articles for publication, consult on grant proposals, invite people to conferences, write tenure letters and letters of recommendation, place former students in key positions, and even hold press conferences to denounce researchers who publish inconvenient truths, to name just a few of the many tools at their disposal.

But hey I'm not a doctor, as I'm so often reminded. No kidding -- which means, among other things, that I'm off the grid. They can't do anything to me and it drives them nuts. It's hardly a coincidence that the most trenchant criticisms of the obesity orthodoxy are coming from academics who are mostly outside the public health establishment: from political scientists and sociologists and historians and physiologists and yes even a law professor or two. These are people who don't have to curry favor with the obesity powers that be to get hired and funded and tenured and promoted.

[Update: A few comments in this thread and in the torture/body stigmatization thread take the rather inexplicable view that I'm claiming "academia" is out to get obesity dissidents. To the contrary, academia enables obesity dissidence, as the links in the post indicate. The parallels between obesity dissidence and global warming denialism are interesting, but also highly problematic for all sorts of reasons. That's a subject for another post].

Anyway, back to Tom Friedman. One advantage of actually knowing a lot about something is that (unless you're an egomaniac) you have a keen sense of how little you know about almost everything. Here's what my opinion is worth, on the margin, to debates about nuclear proliferation in an age of terrorism, and managing the U.S. debt in the context of the world financial system, and dealing with the problem of anthropogenic climate change: Nothing. If I studied one of those things intensely for say five years I might have something to add. But I haven't and I don't. So I try to draw a distinction (at times unsuccessfully no doubt) between opining on subjects on which I actually know something (there are about two others besides fat), and everything else. I doubt, however, that someone like Friedman could do what he perceives to be his job if he drew a similar distinction.

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Torture apologists and body stigmatizers

Having spent the better part of a decade now listening to people patiently explain why it's a good thing to pathologize the bodies of 71% of the American population in order to improve their health (68% of adults are supposedly "overweight" and "obese," and another 3% are "underweight") I've been struck by a number of parallels between torture apologism and the proponents of body stigmatization.

(1) Both the torture apologists and the body stigmatizers display a curious indifference to the copious evidence that their methods don't actually produce the results they claim to be pursuing. Experts on the subject emphasize that torture is a lousy way of getting reliable information. Similarly, even the most rabid fat-haters have to admit that the evidence is overwhelming that attempts to produce significant long-term weight loss fail in the vast majority of cases.

(2) In each case this produces laughably transparent attempt to put the bar for what counts as "success" pretty much on the ground: Torture apologists point out that it's not true that torture never produces true confessions and actionable intelligence, while body stigmatizers point out that some people do manage to achieve significant long-term weight loss. That both facts are of very limited relevance to any rational cost-benefit analysis of the respective practices remains irrelevant to true believers.

(3) Both subjects feature the use of disingenuous semantic smokescreens: "Of course we oppose torture, and we don't torture. What we support is, under strictly supervised conditions, enhanced interrogation techniques." "Of course dieting doesn't work, and therefore we oppose dieting. What we support is chronic restrained eating."

(4) In both cases, what opponents consider an unacceptable cost of the policy is considered by proponents to be a positive good. For torture apologists, the fact that "terrorists" (never, of course, terrorist suspects, or low-level foot soldiers in a distant civil war, or completely innocent people caught up in a Kafkaesque nightmare) are being tortured is a good thing in and of itself, quite apart from whether the torture actually produces any actionable intelligence. Similarly, for body stigmatizers, the destructive effect of stigmatizing bodies that fall outside the 29% of the U.S. population that currently maintains a "normal" (sic) weight is a feature of anti-obesity policies, not a bug.

Torture apologists like torturing people because the people who are being tortured deserve, in their view, to be tortured. Body stigmatizers like to stigmatize "fat" (again, 68% of the U.S. population) people, because they hate and fear fat at a visceral level, and naturally they therefore believe it is appropriate to stigmatize this type of deviance from the approved norm.

(5) Because of a widely held suspicion that people who like torturing people are actually sadistic creeps, people who like torturing people will usually go out of their way to deny that they like torture. They will make a great show of seeing their advocacy of torture as "realistic" and a sign of "moral clarity" in a world full of inevitably tragic choices. Similarly, people who advocate ridding the world of body diversity will make a great show of how they absolutely deplore stigmatizing the bodies they wish to eliminate, and insist that it couldn't be further from the truth that they have anything like prejudice in their hearts (they just want to make sure we live in a world in which everyone is thin).

(6) A certain percentage of torture apologists and body stigmatizers are surely aware that their putative reasons for supporting the policies they do are invalid, but they support the policies anyway, for unstated reasons. Some torture apologists are perfectly well aware that torture is actually counter-productive as an interrogation method if the goal is to produce reliable information, but they support torture for unstated reasons, such as signaling that, as Thomas Friedman once so eloquently put it, under our placid veneer of technocratic rationality, Americans are really violent crazy people who are not to be trifled with. Many anti-fat crusaders are perfectly well aware that there's no reason to believe increased activity levels and better nutrition will eliminate a significant percentage of the 71% of American bodies that they are classifying as being at a pathological weight, but they're nevertheless happy to engage in stigmatizing more than seven out of ten Americans in pursuit of a worthwhile goal, i.e., making people less sedentary and getting them to eat more fruits and vegetables.

(7) Opponents of torture and of body stigmatization will do well to remember that, when reaching out to fence sitters on these issues, it's better to emphasize that torture and body stigmatization simply don't, as a practical matter, work. That both policies are also deeply immoral is of course extremely important and even more fundamental, (any decent person would still oppose torture and body stigmatization even if they did "work"), but it's much easier to demonstrate that a policy is nonsensical even on its own terms than it is to prove that certain means should never be used in the pursuit of "security" or "health."

Update: From Jack in comments:

"I guess this could be read that Paul is saying these parallels mean that both groups of people are equivalent in some substantive way, like hating fatties is morally the same as torturing them. Some commenters have made that association and I suppose it's fair critique given the text.

I took it differently. I believe Paul was arguing that the mental processes involved in both were similar. Whatever defective reasoning allows otherwise smart and (we assume) morally competent people to argue for torturing terrorists, the same defect is at work in the case of stigmatizing obesity. The two are not equivalent things, but the logical fallacy is the same."

I would largely agree with this (individual acts of literal torture are usually going to be vastly more rephrensible and damaging than individual acts of body stigmatization, although severe body stigmatization can quite readily be considered a form of genuine psychological torture by those who endure them), but at the same time it's important to consider that individual acts of literal torture are vastly rarer than individual acts of body stigmatization. Which institution is currently a bigger problem in the USA as a question of social justice is not an easy question to answer.

Update #2: I'm reprinting this reaction from the brilliant fat activist Marilyn Wann with her permission:

I found the comparison of logic/motivations behind torture and weight-loss programs [a] quite cathartic way of thinking about this new "eradicate the fat children" harangue!

I find there's a similarity perhaps in the exasperation. It's as if the situation being dire, or rather someone *feeling* dire about the existence of terrorists or of fat people, justifies extreme/immoral actions. If one whips oneself up into enough of a frenzy of fear about the very existence of terrorists (or fat, or fat people), then it seems reasonable and perhaps necessary to take horrific action, to call for inhumane goals.

I'll try to capture it as dialogue...

"Those terrorists threaten and scare me so much, torture is the mildest thing I can imagine doing to them."

"Fat people distress me so much, I can't look at their faces on television just their headless and jiggling bodies. I want them not to exist at all!"

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The body politic

>> Thursday, February 11, 2010

Thoughts on Michelle Obama's dream of a nation with no fat kids.

I'm going to be on the Diane Rehm show on NPR at 10 AM eastern to talk about this.

Update: Shorter Diane Rehm Show

Me: The things Michelle Obama is advocating have been tried a bunch of times in large well-designed studies. They make kids healthier but they don't make them thinner. We know how to make kids healthier, we don't know how to make them thinner. So why are you trying to make them thinner?

The other three participants: Clap louder!

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Whole Foods, junk science, healthism, and other stuff white people like

>> Tuesday, January 26, 2010

Union-busting, health care reform-opposing, global-warming denying John Mackey, CEO of Whole Foods, has come up with a super idea for cutting his health insurance costs: giving his employees extra discounts on their company store purchases if they maintain or achieve a "healthy" (sic) weight.

The details: employees with a Body Mass Index of between 28 and 29.9 will get a 22% discount on their purchases; those with a BMI of 26-28.9 will get a 25% discount; those with a BMI of 24-25.9 will get a 27% discount; and those below 24 will get a 30% discount (employees must also meet blood pressure and cholesterol criteria and not use nicotine).

How crazy is this? Let me count the ways:

(1) In terms of BMI, the Whole Foods discounts correlate with increasing mortality risk. The most sophisticated study on this subject, published in 2005 in JAMA by Katherine Flegal et. al., used a BMI of 23-24.9 as its referent category for baseline risk of mortality. (This corresponds with the higher end of the government's "normal/recommended" weight range of 18.5-24.9. The lower one goes in the "normal" weight range, the greater the mortality risk becomes, so using the top of the "normal" range as the referent category actually minimizes the risks associated with "normal" weight). It found 86,000 excess deaths per year in the United States associated with "normal" weight when compared to the mortality risk among people with BMIs in the 25-29.9 range.

You're reading that right: Whole Foods' employee discounts based on weight are inversely related to mortality risk. So you have a policy that's not merely discriminatory on its face, but completely irrational on its own terms.

(2) The highest employee discount has no floor, only a ceiling. In the Flegal study, underweight (BMI <18.5) was associated with a stratospheric increase in mortality risk. (This remains true even when the data is controlled for smoking and pre-existing disease). But if you're an underweight college student suffering from an eating disorder and working as a checker at the Boulder Whole Foods (not a hypothetical as anyone who has ever shopped there can attest) you get a 30% discount for maintaining the "healthiest" weight.

(3) Even if one decides to enter John Mackey's Epidemiological Fantasyland, where good health is achieved by purchasing $27 a pound Ahi tuna in order to achieve Optimal Thinness, how much sense does it make to make it more expensive for your non-thin employees to purchase said tuna?

All this is a classic example how the habitus of upper class people in America ends up getting projected onto the broader culture, under the rubric of "a healthy lifestyle." It's also an example of how healthism and junk science are powerful weapons in the fight to avoid that most dreaded thing, a fair and efficient health care system for all Americans. Few myths in that fight are more pernicious than the idea that if you get sick it's your fault, because you didn't make healthy choices, such as searing that Ahi tuna you bought at Whole Foods after lightly coating it in $30 a bottle olive oil.

Relatedly, here's a talk I gave last week on the general topic. The first link is the talk; the second is the Q&A.

Talk

Q&A

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Fat and Identity Politics

>> Tuesday, January 19, 2010






I'm doing a talk on this topic at UCLA tomorrow. The price is right for any LA LGMers looking to stretch their entertainment dollar.

I'm staying at a guest house on campus tonight and there's a photo of Lew Alcindor on the wall.

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Four-month old engages in unhealthy lifestyle; denied health insurance

>> Monday, October 12, 2009

Ask your doctor if cultural hysteria is right for you.

Couple of notes:

(1) "Obesity" among infants is currently defined by the CDC by taking what was the 95th percentile of height-weight among infants 30 years ago and treating anything above that as "obese."

(2) This definition is based on no data regarding any correlation between infant weight and present or future health risk.

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