The Land of the Fat

The big news in the War on Fat this morning is a research analysis paper published in The Lancet. It is a survey of studies and reports of height and weight in populations around the world. It is, oddly enough, an encouraging report, even as it indulges in a bit of pearl clutching and hand wringing.

The US has the largest number of obese (BMI >= 30) people in the world, with 13% of the obese world population. Compared to our own population, this means about 32% of men and 34% of women have a BMI of 30 or more. Overweight (BMI >= 25 and <30) values are 39% of men and 28% of women. Substantially more American men are overweight than women, but people who are obese are slightly more likely to be female than male.

The report, unlike most media hyperventilation about Teh Fatz, is a just-the-facts-ma’am statement of the statistical findings, with a focus on environmental factors and changes that can help to explain the body mass increase trend. The most interesting fact (to me, anyway) in the report is that the rate of gain is slowing. Populations are still getting heavier, but the rate at which body mass is increasing has dropped measurably since 2002. This indicates to me that populations are more aware of the issue and that people are taking effective steps to prevent weight gain. Also of interest to me is that weight gain in developed countries affects men more than women, while in developing countries, the opposite is true. Women in developed nations are the most effective at reducing rates of gain, particularly obesity, which should come as no surprise as we are the champions of body manipulation for mental torment and (other peoples’) profit.

Two other very sensible statements come out of this report. First, the researchers are not interested in moralizing the problem. They do not appear to have the eliminationist mind set so prevalent in popular media, and instead look at large scale environmental factors – which are the only ones that can explain large scale environmental changes – and end up citing the two obvious changes of reduced activity and food ubiquity:

Prof Mokdad said rates were higher for men in developed countries because of longer commutes to work, fuelled by a move to the suburbs, and spending more time inactive, using computers, he said.

Prof Hermann Toplak, at the University of Graz, in Austria, said: “Over the past decades the modernisation of our world, with all the technology around us, has led to physical inactivity on all levels.”

Inactivity caused self-control to spiral, he said.

Children and adults were not building up enough functioning muscle mass, and “classical eating” had been replaced by “uncontrolled food intake” spread over the day. he said.

Reduced muscle mass due to reduced activity levels and constant provision of high-calorie and easily consumed food is the formula for increased body mass. Not lack of moral fiber. Not failure to commit to all-consuming exercise programs. Subtle but significant changes to our environment, like longer work commutes and larger bagels delivered in big boxes to the office, have added up over the years.

This leads to the second statement, that solutions to increased body mass will take time to implement, and it will require broad environmental change, not just scolding individuals to stop being such fat cows.

The study called for “urgent global leadership” to combat risk factors such as excessive calorie intake, inactivity, and “active promotion of food consumption by industry”.

Prof Ali Mokdad, of the IHME, said no country was beating obesity as it was a relatively new problem.

“It takes a little bit of time to see success stories,” he said.

Changes to the food culture happened over a three decade span of time, people have steadily gained weight over that time, and it will take time for changes to take effect. If nothing else, a healthy rate of weight reduction is less than 100 pounds in a year (2 pounds per week) and probably best to reduce at 25 pounds (half a pound per week) in the course of a year. Weight loss carries health risks, too.

I am, as always, wary of the food police and the health enforcers. I do think it is good not to see continued body mass increases, individual or societal. There are long term health concerns for individuals, especially when a specific issue, such as degenerative joint diseases or diabetes, can be made worse if a person’s body mass is high. However, the hysterical and savage discourse about the dangers of extra weight that dominates our media do no one any good. Moralism abounds, the possibility of  balancing health benefits from higher body mass are ignored, and pernicious attacks on personal autonomy are deemed acceptable because done “for your own good.”

In truth, figuring out how to approach increased weight across society is the same as addressing any other public health concern. We’re dealing with two distinct issues that will take different solutions, though they should complement each other. First, how best to reduce the rate of gain and the overall incidence of high body mass? The emphasis here is prevention, which is almost entirely an environmental challenge. How can we create an environment that does not foster weight gain as a normal condition? This is going to be very slow going and will have a lot of moving parts because it means changing the environment in which we live. If it has taken 30 years to get into this situation, it’s probably going to take that long to extricate ourselves.

Second, and of very personal concern, what will happen to those who are already fat? How will we treat these people – and that means how will you treat me – which is a sociological, not a medical, challenge. The medical literature is pretty clear; long-term sustained weight loss is rare. I’m a walking, talking, living laboratory experiment on that topic. The focus can’t be solely on weight reduction because it probably won’t work, especially the way that said reduction is currently handled, basically as a profit-making opportunity for the rapacious diet industry. We’re going to have to change our perceptions of healthy and stop confusing health with aesthetics.

We aren’t going to find answers to either of these issues by engaging in some flight into a fantasy of pre-modern food production or by imposing unrealistic “fitness” regimens that are incompatible with balanced enjoyable lives. It will probably mean a new focus on every day activity levels and a conscious rejection of all food extremism. It will definitely mean getting a less moralistic and less paranoid perspective on our bodies, our food and our health.


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Posted in Health, Obesity

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