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The Fat of the land: The Obesity Epidemic and How Overweight Americans Can help Themselves.

A few years ago the National Center for Health Statistics reported that one-third of Americans were obese in 1991, compared to one-fourth in 1980. You might have seen the front-page article in The New York Times. Perhaps you shook your head and thought, "Those poor fat bastards."

Not so fast. Michael Fumento wants you to know that obesity, "defined as being at least 20 percent fatter than [you] should be," is only part of the story. "According to the Institute of Medicine of the National Academy of Sciences," he writes on the first page of The Fat of the Land, "about two thirds of us are too heavy for optimum health." Two-thirds.

I hope I have your attention now. Do you remember the last time you looked at that weight table in your doctor's office? You probably thought, "Come on. Nobody stays in that range once they get out of college." In fact, according to survey data from 1996, 74 percent of Americans exceed their maximum recommended weight. "So instead of talking about a third of Americans being at risk because of being overweight," Fumento writes, "we really should be talking about somewhere around three fourths."

Worse, it turns out that the current weight table, based on 1983 figures from the Metropolitan Life Insurance Company, is relatively lenient. The 1959 table allowed even fewer pounds. The targets were changed as Americans got fatter - for no good reason that Fumento can see. Like the Center for Science in the Public Interest, he seems to prefer the older, stricter table, which better reflects the weight ranges associated with the lowest mortality rates. So we really should be talking about...nearly everyone, I guess.

Fumento, a medical journalist, resident fellow at the American Enterprise Institute, and former REASON science correspondent, has tackled many overhyped or imaginary hazards in his books and articles, including heterosexual AIDS, radon, electromagnetic fields, pesticide residues, and secondhand smoke. He has argued tenaciously and persuasively that highly publicized "illnesses" - Gulf War Syndrome and multiple chemical sensitivity - do not exist. Now, having lost 25 pounds of extra weight after years of trying, he turns to obesity, and his message is: It's worse than you think.

This might seem like a bold thesis, given our national obsession with thinness. To most Americans, though, weight is primarily a matter of physical attractiveness, and Fumento emphasizes its impact on health, including an increased risk of heart disease, high blood pressure, diabetes, and certain cancers. Furthermore, he argues convincingly that false beliefs about the causes and consequences of obesity help explain why Americans keep getting fatter despite their preoccupation with weight. Having digested a mountain of research, he takes on the cranks, hucksters, activists, and government officials who help perpetuate these misconceptions. Unfortunately, in his single-minded pursuit of the facts, he neglects the role that values, tastes, and preferences play in decisions about diet and exercise.

Maybe you've put on a few pounds - moved up a pants size, started to round down when asked your weight - but you figured it was purely an aesthetic issue. Wrong. The latest research shows that being even just a little overweight can shorten your life. "Unless you are affecting your immediate health (such as some anorexics do) one cannot be too thin," Fumento writes. "Making yourself little but skin and bones is not healthy; being below average weight in a country where most people are overweight is healthy." Judging from the results of one study, "the average woman weighs 30 pounds too many to have a full life expectancy."

Are you depressed yet? Maybe you're just annoyed. Maybe you're wondering, "What's 'a full life expectancy'? How many years will I lose because of an extra 10 pounds?" You will not find the answers to such questions in The Fat of the Land. Fumento gives us an annual death toll (300,000) and the increase in mortality associated with certain weight ranges in a couple of studies. But he never gives us an idea of the lifetime risk facing someone who does not quite fit into the appropriate range on the 1959 Metropolitan Life Table.

It's a telling omission, because this is the sort of information you'd want if you were trying to decide whether losing those extra pounds and keeping them off would be worth the effort and forgone pleasure. For Fumento, the answer is obvious: Of course losing weight is worth it. After all, this is a matter of health. He never concedes that people could rationally accept the risks of being overweight in order to eat as much as they want and skip all that dreary exercise. He is dismayed by "an obese friend" whom he encouraged to lose weight with the help of prescription diet drugs: "But nothing doing. He's a gourmet; food is an integral part of his life and he wasn't going to give up any part of it." Imagine!

Fumento seems to start from the assumption that physical health trumps all other values, that it's irrational - and, indeed, immoral - to trade longevity for pleasure. It's not clear how far he would push this premise. There is some evidence, for instance, that severe, long-term calorie restriction can extend your life span. It works in mice, anyway. A UCLA researcher recently told The New York Times Magazine that an 18-year-old man who sticks to a spartan diet of 1,800 calories a day (vs. the recommended 2,000 to 2,500) "would have a chance of living to 160." Suppose this is true. Should all of us adopt such a diet? If we are not willing to be hungry most of the time for a chance at a few extra decades, are we crazy?

Fumento not only condemns heftiness, he pathologizes it, leaping from the observation that being over-weight increases the risk of certain diseases to the conclusion that being overweight is itself a disease. It is "the underlying disorder," "a chronic illness," "one disease that can just keep getting worse and worse," "a national epidemic." A disease is something inherently undesirable; no one in his right mind wants to be sick. The disease metaphor therefore reinforces the idea that no sane person could prefer to be fat, given the alternative of eating less and exercising more.

Since a disease is also something that happens to you against your will, it's puzzling that Fumento adopts this terminology, because his message is mainly one of individual responsibility. Over and over again, he stresses that people are overweight because they eat too much and don't exercise enough. The fact that Fumento has to argue this commonsensical point is a measure of the flimflammery and magical thinking fostered by the desire to lose weight.

"Telling people to eat less and exercise more might send them fleeing for the hills," he writes, "so the diet book authors and women's magazines search valiantly for some aspect of eating to blame, some way of telling people they can stuff their faces - and still lose weight." Intelligent, well-educated people will plunk down $25 for a book that claims you can lose weight by eating chocolate, or cutting out fat, or cutting out carbohydrates, or eating foods in certain combinations, or eating as much as you want of whatever you want. If you know some of these people, you may want to give them copies of Fumento's eminently sensible book instead, before they fall for the latest fad.

Fumento is at his best debunking nonsense, and his chapters on diet gimmicks and "Big Fat Myths" are thorough, informative, and entertaining. He refutes the notion, promoted by government-required labeling as well as diet gurus and food manufacturers, that limiting fat is the key to losing weight. It's true that one gram of fat has more calories than one gram of carbohydrate or protein, so reducing your fat intake may reduce your total caloric intake, thereby helping you lose weight. But calories are the bottom line: If you eat virtually no fat but take in more calories than you burn, you will gain weight, no matter what Susan (Stop the Insanity!) Powter says. Furthermore, Fumento reports, there is no evidence that restricting fat to 30 percent of your calories - a goal urged by the federal government - will have any effect on your risk of heart disease.

Fumento argues that the 30 percent formula and the general fixation on fat distract people from the fundamental importance of total calories. "The government doesn't say how many calories the fat should be 30 percent of," he notes. "Thus, some people, bizarrely enough, have taken this to mean it's OK to eat more calories just in order to reduce the percentage from fat." One diet book author "says it's OK to order a fatty (and high-calorie) sandwich or side order at a fast-food restaurant so long as you drink enough orange juice along with it." Similarly, "low-fat" foods may have just as many or nearly as many calories as the regular versions. Even when they are significantly lower in calories, the advantage may be erased by people's tendency to eat more than they otherwise would. Writes Fumento, "Low-fat and no-fat foods are a Siren call to gluttony."

Fumento debunks easy excuses as well as easy solutions. He discredits the notion that your "setpoint" - the weight where your body "wants" to stay - is an insurmountable barrier. While your metabolism does tend to adjust over the short term to maintain a given weight, he says, the fact that formerly slim people get fat to begin with shows that behavior can overcome this tendency. He notes that the setpoint excuse is pushed by "fat acceptance" advocates who had to defeat their own setpoint again and again to reach their enormous girth. These activists assert that losing weight is not only futile but harmful, that the risks of obesity are outweighed by the risks of "yo-yo" dieting. Fumento shows there is little basis for this claim.

Fumento also refutes the idea that your weight is determined by your genes. Whatever the role of heredity, he says, it clearly cannot explain the dramatic increases in obesity we've seen in recent decades. "There are genetic differences, but they aren't things that can't be overcome by eating right and getting exercise," one researcher tells him. "A lot of my patients say they're exercising regularly and eating very little, and I look them square in the face and tell them they're violating the laws of physics."

Fat activists like to cite studies in which self-reports indicate that obese people don't eat more than thin people. But as Fumento notes, what these studies really reveal is one of epidemiology's dirty little secrets: Subjects lie. To be more charitable, their recall is skewed in a direction that reflects favorably on them. The more unhealthy their habits, the greater their tendency to misremember.

On the constructive side, Fumento offers sound but unsurprising advice for chubby people who want to slim down and are prepared to face reality: Lose weight gradually; exercise regularly; make changes in your lifestyle you can stick to in the long run; fill up on foods rich in fiber; cut out needlessly caloric beverages; learn to distinguish true hunger from mere appetite; watch portion sizes and don't habitually clean your plate; don't rely on food for emotional support. He draws effectively on his own experience to illustrate the pitfalls of weight loss and motivate the discouraged.

The downside of Fumento's personal stake in this topic is that he sometimes displays the zeal of a convert, with rhetoric reminiscent of the anti-smoking movement: "Overeating kills....most fat people desperately do not want to be fat....obesity is a socially contagious disease." He decries "the overveneration of personal autonomy" and criticizes those who "acknowledge obesity as a personal health problem but deny its importance nationally, thereby relegating it to a simple matter of choice and assumption of the risk."

This sort of talk makes me a little nervous. It's not that Fumento himself advocates much of a role for government in "the battle against obesity." He explicitly rejects the idea of imposing special taxes on "unhealthy" foods, and I doubt he would endorse, say, a ban on fast-food commercials. The specific policy changes he does recommend are unobjectionable: scrapping the "calories from fat" and "total fat" labeling requirements, revising official dietary recommendations, improving nutritional instruction in public schools.

But Fumento is a bit too comfortable with the puritans at CSPI and with public-health types like Yale obesity maven Kelly Brownell, who advocates better eating through taxation and compares Ronald McDonald to Joe Camel. More to the point, paternalists will be a bit too comfortable with this book, and they will be perfectly happy to take Fumento's arguments further than he does. By marking out an area - overeating and underexercising - where people's behavior is presumptively irrational, he undermines the utilitarian case for individual freedom.

Richard Klein recognizes the busybody implications of the impressive to be thin. "Big brother lies at the end of the dreams of some of those who want us, at all cost, to be healthy, slim, and beautiful," he writes. A professor of French at Cornell, Klein is best known for his 1993 book Cigarettes Are Sublime, which sought to explain the cigarette's appeal to an increasingly tobaccophobic society. He attempts something similar in Eat Fat, a 1996 book that will be out in paperback this year. Klein reminds us that fat, like tobacco, was not always hated. At various times in history, plumpness was considered fashionable and desirable, a sign of affluence and beauty. Fat things were rich, fertile, abundant, nourishing.

Now that thinness is the ideal, we are all getting fat. "But rather than regret this trend, as many with alarm so often do," Klein writes, "we ought to consider that what is actually happening might just have some good reason to happen. Perhaps we are all supposed to be getting fatter, since that's what we're doing anyway, despite all our efforts to the contrary....But instead of our celebrating what we are in fact becoming, the shrill voice of skinny is heard across the land, magnified by the chorus of doctors, nutritionists, beauticians, and insurers of all kinds who deplore what we already despise."

The "shrill voice of skinny" comes through clearly in The Fat of the Land, and Eat Faris a useful supplement, offering a perspective that is missing from Fumento's book. When Klein rhapsodizes about a fat-laden breakfast at an Ithaca diner or cognac-soaked prunes stuffed with foie gras, he is making a case for pleasure as a value to be weighed against the benefits of always watching what you eat.

Concerning Kelly Brownell's policy proposals, he writes, "Nowhere in all this talk of taxing fat food do we hear a single good word for the blessing of chocolate, the balm of chicken soup, or the comfort of a nicely schmeared bagel." Though Klein quit smoking while writing Cigarettes Are Sublime, he apparently does not plan to slim down anytime soon.

By reminding us that standards of beauty have changed dramatically over the years, ranging from Rubens's zaftig nudes to the emaciated women in today's clothing and perfume ads, Klein calls our attention to the arbitrary dictates of fashion that drive so many to despair. By focusing on our paradoxical tendency to get fatter and fatter as our models get thinner and thinner, he suggests some troubling psychological truths. And by wondering how dangerous a few extra pounds really are, he raises a legitimate question for those who insist that we stick to our recommended weight range.

Too often, however, Klein's skepticism lapses into dismissiveness or self-delusion. While he concedes that obesity can seriously threaten one's health (as he witnessed in the case of his own mother), he insinuates that the evidence is not what it's cracked up to be. "The medical risk of obesity, this book aims to suggest, has been severely overstated," he says in the preface, but he never substantiates that claim. And while Klein, like Fumento, decries the low-fat/no-fat fallacy ("It's not eating fat that makes you fat," he says, "it's eating"), he repeats several of the fat-acceptance myths that Fumento so ably deconstructs, including the futility of losing weight, the hazards of yo-yo dieting, and the idea that many people are fat because of slow metabolisms, not because they eat too much. So if Eat Fat is an antidote to The Fat of the Land, the reverse is also true.

More broadly, Klein and Fumento offer competing visions of how one ought to live, and each is worth considering. But lurking in the background is a hint that persuasion might give way to coercion. Klein is quite sympathetic to the fat-acceptance movement that Fumento rightly criticizes for contributing to "the cult of victimization"; it's not hard to imagine him supporting legislation or litigation aimed at forcing businesses to "accept" and "accommodate" the obese.

Fumento, for his part, is aware that his book could be taken as a call for the government to wage a war on obesity. "Nobody's arguing that it should be illegal to be such a glutton and such a sloth that you can't get around without an electric scooter," he writes. Although I'm sure this was meant to he reassuring, it had the opposite effect on me. Fumento says "gluttony and sloth need to be demonized to the extent that cigarettes have been," but "this doesn't mean oppressing fat people." The precedent is not exactly encouraging.

Senior Editor Jacob Sullum (jsullum@reason.com) is the author of For Your Own Good: The Anti-Smoking Crusade and the Tyranny of Public Health, forthcoming this spring from The Free Press.
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Author:Fumento, Michael
Publication:Reason
Article Type:Book Review
Date:Feb 1, 1998
Words:2945
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