Book review: Fat Politics by J. Eric Oliver

I'll come right out and say it: One reason I like political scientist J. Eric Oliver's book Fat Politics: The Real Story Behind America's Obesity Epidemic (Oxford University Press, November 2005) is that it says what I have been saying for years--the so-called "obesity epidemic" is marketing hype promulgated largely by those who benefit financially from fat-related fear-mongering. And that is what's really impacting our health.

Oliver actually set out to write his book believing that "obesity" is a real problem in America -- that  weight gain is causing numerous health problems and will even result in the first generation of children whose lifespans will be shorter than their parents' due to their expanding waistlines (both common declarations by "obesity" terrorists). Along the way, though, he discovered the real story -- which is that those proclamations of an "obesity epidemic" are built upon shoddy science and marketing campaigns developed and promoted by those who either sell purported "solutions" to the "problem" or whose funding depends on belief that they're researching or fighting a terrible disease.

In short, to paraphrase the title of another book, the notion of an "obesity epidemic" is a big fat lie.

Our body weight is not the cause of our ill health but merely the expression of metabolic processes that are meant to protect us in times of privation. In other words, our fatness is like our body hair or the shape of our ears -- it is a natural part of our physicality that has a specific function. The real health problems that are associated with being heavy, including heart disease and diabetes, are not coming from our weight but from the same metabolic processes that determine our weight levels, such as our appetites and insulin levels. (Fat Politics, p. 102)

Environment and, I might add, dieting history also interact with metabolic processes to affect health. See Glenn Gaesser, Ph.D.'s book Big Fat Lies: The Truth About Your Weight and Your Health  for more on how weight loss and regain cycles have been found to harm health.

The old "weight = calories in - calories out" formula is incorrect. It's way too simple. We (or rather, science/medicine) don't know the true equation. But whatever it is, it contains many more variables than simply the number of calories ingested or expended.

Our weights may be written in our genes, but as far as obesity is concerned, it is written in a language that is far too complex for us to understand. This is because body weight is the classic example of what scientists call a polygenic trait, that is, a physical characteristic that comes from many different genetic sources. (Fat Politics, p. 105)

Fat Politics also reveals the statistical (and Powerpoint) sleight-of-hand employed to persuade Americans an "epidemic" is in progress. As Oliver reports, the number of Americans considered "obese" according to official standards increased by 55 percent between 1980 and 1994. But the average American didn't gain 55 percent more weight during that period -- he/she gained only seven to nine pounds.

That's right -- an average weight gain of seven to nine pounds since 1980 is the true "statistic" of the "obesity epidemic."

Oliver also mentions that Americans have, on average, gotten taller over the past century, largely due to the improved nutrition that's contributed to average weight gain. But you don't hear about a height epidemic, do you? That's because we don't vilify tall people the way we do fat people -- especially, Oliver points out, fat white women.

Another one of the many reasons Americans have gained that average seven to nine pounds over the past couple of decades is that the "average" American is getting older. Think about that population burst called the Baby Boomers of post-World War II, and the effect the natural aging of that cohort is having on the profile of the average American. We naturally add fat cells as we age, as a means of storing extra energy. And our set point -- the range of weight/body fat our bodies naturally defend and return to when we eat and exercise normally -- rises with age.

There's more -- a lot more -- to the politics of fat. Oliver also points out that despite considerable hoopla attributing increased incidence of diabetes to weight gain and insulin resistance,

No one has demonstrated that obesity causes insulin resistance. All we really know is that insulin resistance is simply more prevalent among people who are heavier. In fact, we just may have the whole causal relationship backward -- rather than obesity causing insulin resistance, it might be that insulin resistance is causing obesity. (p. 118)

Oliver doesn't mention, however, that diabetes is also a condition whose diagnostic markers have been lowered in recent years.

As Ray Moynihan and Alan Cassels point out in their book Selling Sickness: How the World's Biggest Pharmaceutical Companies Are Turning Us All Into Patients, the level of blood sugar considered indicative of "prediabetes" was lowered in the late 1990s. Some Health At Every Size advocates have also reported that there has been no real increase in the incidence of Diabetes Type II in children -- rather, in recent years more effort has been made to diagnose the condition, thus increasing the number of diagnosed cases.

Even if there is a relationship between fatness and insulin resistance, Oliver notes,

people who exercise more, irrespective of their body weight, are less prone to insulin resistance. This is because the regular usage of muscles seems to facilitate the transference of sugars from the bloodstream. (p. 120)

Fatness is not a disease or a dysfunction of our bodies, no matter how hard many have worked to transform "obesity" into a pathological state of being (or, rather, body). Instead, as Oliver says, fatness

is a protective mechanism that evolved to survive fluctuations in our food supply. Judging someone's health by how much they weigh is like judging a camel by how much water it has in its hump -- in conditions of privation, our extra weight, just like the water, may be exactly what we need to survive. Our weight is merely an expression of this adaptive mechanism at work. (p. 121)

Across the country state and local governments have been considering ways to supposedly fight the "obesity epidemic." Actions they have taken or are considering include removing candy and soda machines from public school buildings and putting students' BMI (Body Mass Index) on report cards. As Oliver points out, all of these efforts are doomed to not only fail, but backfire -- largely because they focus on weight and weight loss rather than directly on health.

I read news reports last year about one Texas school in which candy machines were removed from public school campuses. Within a week, enterprising students had developed a thriving black market in candy, and some young entrepreneurs were earning $200 a week selling sweets to classmates.

Here in Tennessee, where I live & work, the state government is reinforcing unhealthy attitudes and behaviors about weight by, among other things, striking a deal with the Weight Watchers corporation to allow TennCare insurance enrollees to participate in that company's dieting program at a vastly reduced rate.

I wish Tennessee Governor Phil Bredesen and his staff -- and the officials in other states and muncipalities -- would read Fat Politics. As Oliver says,

Instead of convening task forces to figure out ways to combat obesity, state and federal government should simply be telling health agencies to find better measures of health than weight. They should make rules on the conflicts of interest between obesity researchers, weight-loss doctors, and the diet and pharmaceutical industries. And they should develop programs to combat the stigma and prejudice that fat people must face and institute laws, such as those in San Francisco and Michigan, that protect people against size discrimination. In short, they should work on changing all the harmful perceptions we have about weight. This would do far more to improve the health and well-being of the American population than making us so worried about our weight. (p. 180)

The best way to get over a "weight problem" is to stop worrying so much about weight.

Similarly, the cure for the "obesity epidemic" is to stop focusing on weight as a health indicator, and cease manipulating statistics and promoting false assumptions and non-causal associations between weight/fatness and health. Fat Politics is a means to that end. Read it, and recommend it to your friends, family, health professionals, and politicians.