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May 28, 2013 5:12 PM   Subscribe

Fat City. Physician Karen Hitchcock writes eloquently in The Monthly on obesity in Australia and the obesity-as-disease paradigm.
posted by nicolas léonard sadi carnot (105 comments total) 30 users marked this as a favorite

 
> The thought of her pizzas made me sick.

It's true. Australian pizza is terrible.
posted by The Card Cheat at 5:21 PM on May 28, 2013 [13 favorites]


Italics even!
posted by seanmpuckett at 5:23 PM on May 28, 2013


Yeah, that's not really adding anything new.
posted by MartinWisse at 5:33 PM on May 28, 2013


The article was referencing fatty pools of American pizza (which do lack finesse).
posted by de at 5:34 PM on May 28, 2013 [2 favorites]


That was a terrific read. Thanks for sharing.
posted by kbanas at 5:37 PM on May 28, 2013 [2 favorites]


> Her bulk did not disgust me.

Clearly the author is some kind of saint, at least in her own mind.
posted by edheil at 5:38 PM on May 28, 2013 [5 favorites]


Clearly the author is some kind of saint, at least in her own mind.

Well, you read the first three paragraphs, so there you go.
posted by kbanas at 5:41 PM on May 28, 2013 [15 favorites]


We are attracted to what is forbidden and will resist only if we have a compelling reason to do so: pain, punishment, family disintegration, death. ... Kant famously formulated that no man would sleep with the woman of his dreams if the consequence for him were death immediately afterwards.

Well, hold up, Immanuel, not so fast there...
posted by Cool Papa Bell at 5:51 PM on May 28, 2013 [6 favorites]


This is actually a fantastic article.
posted by Cool Papa Bell at 5:52 PM on May 28, 2013 [5 favorites]


When a fast-food chain dropped its television ads for a weekend, its revenue that week fell by more than 25%.

Anyone have a link about this?
posted by stavrogin at 5:59 PM on May 28, 2013 [1 favorite]


Annoyed that the last two sentences trivialize all that came before. Still a good read.
posted by seanmpuckett at 6:00 PM on May 28, 2013 [1 favorite]


Surprising that she describes feeling uncomfortable talking to a patient about weight loss, because most physicians don't hesitate to do so, even if a patient is seeing them for totally non-weight-related issues.
posted by larrybob at 6:00 PM on May 28, 2013 [7 favorites]


It's true. Australian pizza is terrible.

Actually, given the massive number of Italians that we have around the place, Australian pizza can be pretty awesome.
posted by His thoughts were red thoughts at 6:05 PM on May 28, 2013 [4 favorites]


Kant famously formulated that no man would sleep with the woman of his dreams if the consequence for him were death immediately afterwards.

I call bullshit. That really doesn't sound like Kant. I have never heard a philosophy professor trot this out (most professors have a little repertoire of amusing asides, and this would do well).
posted by thelonius at 6:06 PM on May 28, 2013 [1 favorite]


Well, you read the first three paragraphs, so there you go.

You forgave the first three paragraphs? They were the equivalent of "Don't get me wrong, I'm not fat-ist, but ...". She lost me at "Emily was ... the fattest person I had ever seen outside a caravan park."
This year I started work as the physician in an obesity clinic with a group of bariatric surgeons.
Really? What's that all about? This woman doesn't have to practice medicine. No-one has a gun at her head. She could exercise her will, and quit.

Tonight, 3.
posted by de at 6:11 PM on May 28, 2013 [4 favorites]


The doctors I work with have an excellent grasp of the bio-psycho-social factors that contribute to our patients’ states, but we are only doctors. All we have are the tools of our trade: our ears, our voices, our hands, our pills and our scalpels. The waiting rooms are full, the waiting lists are long, the demand is swelling. Obesity is in many ways the logical endpoint of the way we live. Prevention beats palliation, but we’d need psychologists, motivational speakers, social workers, dieticians and physiotherapists to work with us in order to have any hope of tackling the problem. We’d need policy makers and activists. All we have are doctors like me.

This is so true for many things in our society, unfortunately, from education to the justice system. People who study these things see them as having so many causes, but the public only ever seems to want to grab onto or support single causes at once. There are people in all of those areas trying to help, but funding becomes more tricky with interdisciplinary treatments, as does keeping and sharing cohesive records. The current focus on treating the end result is also an attempt at what seems more manageable. Palliation is simple, as it says "here is the person with x" vs prevention with its "here is the person who might one day perhaps have x".
posted by bizzyb at 6:19 PM on May 28, 2013 [3 favorites]


They were a goddamn eyesore, but I will say those soda-cups-overflowing-with-fat-and-viscera ads in the NYC subway put me off sugary soda for life.
posted by Sokka shot first at 6:26 PM on May 28, 2013 [2 favorites]


Philosophy professor here. It's in the Critique of Practical Reason, iirc.
posted by professor plum with a rope at 6:26 PM on May 28, 2013 [16 favorites]


So she saw a well-educated woman with "literary novels" stacked beside her bed and didn't want to tell her she was too fat? Presumably if she'd been a working class woman reading a Harlequin romance she'd have gone right ahead and shamed her as one of those "women from caravan parks" she mentions in the opener.

Classist crap. Mixed up with some personal responsibility narrative/just world hypothesis ("You're not addicted, you're not hungry, you just have low will power"), and sort of true but banal and confused observations about the social determinants of obesity.
posted by dontjumplarry at 6:34 PM on May 28, 2013 [17 favorites]


Re the Kant quote, professor plum has it:
Suppose some one asserts of his lustful appetite that, when the desired object and the opportunity are present, it is quite irresistible. [Ask him]- if a gallows were erected before the house where he finds this opportunity, in order that he should be hanged thereon immediately after the gratification of his lust, whether he could not then control his passion; we need not be long in doubt what he would reply.
It's in Chapter 1 (VI. PROBLEM II.)
posted by His thoughts were red thoughts at 6:36 PM on May 28, 2013 [2 favorites]


Thanks.

Is that experimental philosophy thing still going? This could make a good dissertation project.
posted by thelonius at 6:38 PM on May 28, 2013 [1 favorite]


> The thought of her pizzas made me sick.

It's true. Australian pizza is terrible.


One word: Manoosh

As a doctor, I no longer know what to do about the obese. Australians are getting fatter, and our society is geared towards making them that way – consumption doesn’t just drive economic growth.

Oddly enough, this comes out the same day that Australia was named the happiest nation on Earth.

I kinda feel like obesity should be lower in Australia 'cause of the weather. I'm a fat geek, and even I end up spending half my summer at the beach and going for the odd jog.

We are attracted to what is forbidden and will resist only if we have a compelling reason to do so: pain, punishment, family disintegration, death. Eating ‘bad’ food is a relatively benign transgression; you can do it in public, you can do it in the park, in a primary-school playground. The consequences – fatness, disease, early death – are distant enough to be out of sight. Kant famously formulated that no man would sleep with the woman of his dreams if the consequence for him were death immediately afterwards. To stop people consuming vast amounts of the most desirable, calorie-laden, heavily promoted and affordable foodstuffs to appear before our naturally longing eyes, a public-health campaign would need to cause an aversion more powerful than the pleasures promised.


I totally agree with this. I'm gonna die anyway, and the more people to tell me to eat healthy and ethically the more I want to eat a veal parma with fries.
posted by Charlemagne In Sweatpants at 6:45 PM on May 28, 2013 [1 favorite]


That for the link, well written piece I thought. I was worried she would end up selling lap-band surgery as a panacea, but she outlined the many risks quite well. It's interesting - Australia has apparently taken over America as the "fattest" country" in the world, but I think most or many Australians would reject that fact.

I used to be a childcarer, and sad to say, I can see the change from when I was in childcare 10 years or so ago, and school photos of my own primary school class, and the median weight of kids at my daughter's centre now. Put bluntly, they are bigger. There are more kids that are - no ifs and buts - obese, and there more more kids that are overweight. The idea of what an "average" weight for kids are has definitely shifted upwards in my opinion.

I cannot lie, my daughter is only 19 months old, but it makes me worry when she gets older. If she is overweight, will I normalise that, as my nieces and nephews' parents have with their overweight kids with all the attendant health issues? Or will I pathologise her weight and give her a complex or god forbid an eating disorder? I'm just a parent, not a doctor, but I empathise with the writer's feelings of impotence against a society and vested interests - and, to be fair, individuals - that champion cheap but unhealthy foods. It's a growing problem here.
posted by smoke at 6:46 PM on May 28, 2013 [4 favorites]


Oddly enough, this comes out the same day that Australia was named the happiest nation on Earth.

They should have renamed that piece "Australians should be the happiest on Earth.
posted by smoke at 6:47 PM on May 28, 2013 [1 favorite]


Terrific article, really well written and honest. It's always nice to see an example of compassion and rationality coexisting on the internet.
posted by mikoroshi at 6:58 PM on May 28, 2013 [3 favorites]


I'm a relatively thin person who sometimes eats very large amounts of crappy food, like the people in the article. But you know what? No one moralizes at me for it, because I am thin. And, likely also because I am thin and always have been (which is in part due to genetics), I have no major emotional baggage around the idea of eating a lot of vegetables or exercising. Those are just things I do because I like how they make me feel and they're good for me. I have the liberty of enjoying those things because no one has ever thrown them at me as things I need to do in order to try to make my body acceptable, attractive, passable enough to appear in public without shame.

I think that societal attitudes toward fatness--including the likes of this article--serve to poison healthy behaviors for a lot of fat people.
posted by needs more cowbell at 6:59 PM on May 28, 2013 [34 favorites]


Re:experimental philosophy--It is still going. Not my cup of tea exactly, but it's not uninteresting. Check out the Knobe/Nichols anthology for more.
posted by professor plum with a rope at 7:01 PM on May 28, 2013


I'm a relatively thin person who sometimes eats very large amounts of crappy food, like the people in the article. But you know what? No one moralizes at me for it, because I am thin.

Yeah and when I was a functional alcoholic no one moralized at me for being an alcoholic, because I was functional. QED alcoholism is ponies.
posted by crayz at 7:09 PM on May 28, 2013 [7 favorites]


(By the way, that's my weight loss secret: become an alcoholic. Then, stop drinking. I must have been drinking an 8th day of calories every week).
posted by thelonius at 7:18 PM on May 28, 2013


So many fat people who comment on these threads are all like "Doctors have misjudged me! I am actually fit because I exercise and have great endurance and my bulk is mostly lean anyway. Shame on them!" That's great for you (if it's true, which I believe it is not in most cases), but try being the person who is medically responsible for a large number of similarly obese people who can't all be as fit as you claim to be, while knowing based on the best available evidence that most (not all, but again, try being the person responsible for predicting) of them will face serious medical consequences. Fat acceptance advocates and denialists are promoting irresponsible behavior to balm their own egos.
posted by fraxil at 7:18 PM on May 28, 2013 [9 favorites]


No, I didn't read past the first three paragraphs. She wrote that shit, I don't care what else she wrote.
posted by edheil at 7:22 PM on May 28, 2013 [1 favorite]


Fat acceptance advocates and denialists are promoting irresponsible behavior to balm their own egos.

Yeah, it's always anecdata because the real data completely contradicts what most of Mefi wants to believe about fatness. The anecdata has about as much validity as people's kids who "got autism" right after a vaccine, but because it's about "acceptance" of the obese and concomitant feigned ignorance of the fact that 98% of them could make personal dietary/activity decisions that would dramatically improve their long term physical and mental health is just left out of the discussion.
posted by crayz at 7:24 PM on May 28, 2013 [4 favorites]


The choice for him is to eat this food or experience no pleasure.
I have no hope of resolving his loneliness, his hopelessness, his lack of a job.
Prevention beats palliation, but we’d need psychologists, motivational speakers, social workers, dieticians and physiotherapists to work with us in order to have any hope of tackling the problem. We’d need policy makers and activists.
Most people do not overeat because of a feeling of hunger emanating from the stomach; they are giving in to a desire to consume – they are seeking pleasure or relief, or hoping to fill a void.


To draw back the frame a bit, although she doesn't seem to realize it, what she is critiquing is capitalism. What she describes above is Marxist alienation, and she recognizes that it exists in symbiosis with one of capitalism's proposed solutions: pleasure supplied by the consumption of commodified food products engineered for maximum convenience, low cost and appeal, manufactured and sold by profit-making companies most interested in their own continued existence and increased profitmaking.

She has all the pieces but can't seem to assemble the puzzle, and like most public-health moralizers, has been conditioned to expect the solution lies somewhere in individual willpower or psychological makeup. As long as you are trying to peer between people's ears, you will miss the very obvious big picture.
posted by Miko at 7:25 PM on May 28, 2013 [48 favorites]


[Folks, this is a thoughtful article, we can do better than just having the exact same old fight again.]
posted by LobsterMitten at 7:26 PM on May 28, 2013 [6 favorites]


has been conditioned to expect the solution lies somewhere in individual willpower or psychological makeup.

Really? I didn't get that so much, I thought she was pretty frank in talking about legislating and the issue as a public health problem with the comparison to regulation around cigarettes (world-leading in its strictness) in Australia. She talks about the issues of a society that promotes consumption in general and eating food like this in particular.

I dunno, I think it's pretty natural for a doctor to see an issue through the lens of public health, rather than marxism; I don't think that's necessarily a failure - especially since the odds of addressing this through regulation and evidenced-based public health initiatives are much higher than through a more speculative proletarian revolution.
posted by smoke at 7:33 PM on May 28, 2013 [8 favorites]


I see it through the lens of public health too, but i felt she was giving public health lip service: basically saying "we don't have armies of psychologists, so these people need to learn to limit themselves." that is not the pragmatic, outcomes-oriented approach of public health at all.

The piece reflects a thought process that is not complete. She is struggling and wandering with these thoughts; they haven't resolved. She knows that she should be advocating a public-health paradigm (which is totally compatible with my read), but she doesn't embrace it. She keeps returning to the inability of individuals to stick with her prescribed program. Her mentions of "couldn't we do a campaign" seem weak.

I'm not actually advocating a revolution. But I'm pointing out her mistake in not connecting the two major pieces of evidence she cites - individual alienation and a profit-driven food supply regime - and devising a public-health approach that addresses both aggressively with collaborative wellness, legislation, campaigns, clearer rhetoric and meaningful support and caring. She stops short of doing this, throwing up her rhetorical hands, as if the problem is just too complex and unsolvable because people will think she's mean or are just unable to change. It's pussyfooting - she isn't convinced enough to do what needs to be done, and so she is writing a piece that communicates her general contentment with leaving people to fail and be targets of her and others' contempt.

It's a solvable problem. If she doesn't want to articulate a solution, I'm not sure why we should read what amounts to a long, wandering rumination akin to a diary entry which offers no conclusion.
posted by Miko at 7:47 PM on May 28, 2013 [10 favorites]


And an important part of the reason we are not addressing this through legislation and regulation is the structure of the globalized food industry and particularly (in the US) its interactions with policy, especially tariffs and subsidies. This is a systemic issue, not an individual one.
posted by Miko at 7:51 PM on May 28, 2013 [10 favorites]


I thought she was pretty frank in talking about legislating and the issue as a public health problem with the comparison to regulation around cigarettes (world-leading in its strictness) in Australia.

Yeah. The cigarette thing in Australia looks great on paper, but it too, is a class issue. Making smokes cost $20 a packet is a great little market-based solution, a useful little vice tax - unfortunately for a huge class of people it just means an even huger proportion of their low income is being sucked back up, due to their lack of "willpower", because they're pathetic, weak poor people. Maybe if their smokes were cheaper, they wouldn't have to spend what little money they have left on shitty, fatty food. If you want people to not smoke, just ban the things. Don't punish the vulnerable.
posted by Jimbob at 7:52 PM on May 28, 2013 [1 favorite]


Actually Jimbob, if you look at the data (I have, and there is reams of it, I assure you), increasing the cost of cigarettes unequivocally results in a drop in consumption. Every single increase in prices shows a corresponding reduction in number of smokes being sold - as a public health policy, it's almost astonishingly effective. So, actually, many of those people don't spend more on cigarettes.

I suspect this is because so many smokers want to quit, anyway, and the increase in price is simply the last push they need to either quit entirely, or reduce their volume which will make future attempts to quit easier.

I agree with your general point around the inequity of consumption taxes, and the attractiveness/need for various "opiates" for the masses. But our tobacco policies have been a world-leading, inter-generational success, and from a utilitarian perspective - not just a govt financial one - they have prevented much more suffering than they have caused.

Given our governments' inability/unwillingness to treat problematic alcohol consumption with the legislative response that it warrants, I am extremely skeptical they will ever make a decent effort to do the same with unhealthy foods.

In this respect, Miko, I suppose I read the piece as somewhat of a cri de coeur - she doesn't offer a solution because she feels incapable of one, as a doctor, as a person, as an Australian living with the governments we have and the society we have. I can empathise with that. To me, her contention seems to be that there is a conversation we should be having over this - overweight and non-overweight alike, and it's not happening because the focus is fragmented, individual, personal discourse. By relating her own (fragmented, personal) discourse, she illustrates how little one person can do to resolve this problem.

I dunno, I see a lot of pat conclusions to social issues plastered across the op-eds here; I don't think we need any more easy-to-digest-impossible-to-implement bromides from journalists. Having one acknowledge a growing problem that's not much spoken of here in Australia, yet (I feel), the actual costs of it, and the challenge it represents doesn't seem to be a bad thing to me.

With regards to the individual responsibility angle, I think it's useless to deny that individual agency plays a role in weight gain (and loss), sometimes because of, sometimes despite, other social factors . This doesn't obviate the social factors, but I think skirting the individual factors is as myopic as skirting the social factors. It's a complex, matrixed, problem, and I think a doctor would be well-placed to see that, as they know how different individual patients can react very differently to the same illnesses.

I guess I see that as another part of the national dialogue she feels that we're not having.
posted by smoke at 8:11 PM on May 28, 2013 [12 favorites]


If you want people to not smoke, just ban the things.

It's more complex than that; the Government is torn between wanting to reduce the public health costs of smoking, and not wanting to give up the lovely tax revenue (somewhere over $5 billion per year) they get from taxing cigarettes. Not to mention the lobbying; the tobacco companies put millions into the political parties on boths sides.

I mean, this is obscenely short sighted, given that the social costs of smoking in Australia are estimated to be around $31 billion per year.

Which raises the question; is 'Big Food' adopting the same tactics as Big Tobacco?
posted by His thoughts were red thoughts at 8:12 PM on May 28, 2013 [2 favorites]


I don't really read that much contempt from the piece at all. Perhaps I'm being charitable, but I feel like the author is really struggling as a health expert to reconcile medical and social views of obesity. Medically, obesity is generally fairly black and white, but it's so inconsistent with the social narrative - both the culture and the counterculture narratives. And for someone who works in medicine, it's often exceeding difficult trying to figure out personally, how much of your attitudes come from your intellectual background, and how much of your attitude comes from being steeped into the culture. Equally difficult is trying to uphold your medical tenets and knowledge without minimizing the massive medical and health policy impact that social views can still have.

It's not just for obesity, but a lot of the stuff that goes on in health policy is really like this. And as someone involved in the field, I can really relate with her reflection.
posted by Conspire at 8:13 PM on May 28, 2013 [13 favorites]


Which raises the question; is 'Big Food' adopting the same tactics as Big Tobacco?

Indisputably, HTWRT. They did exactly that when fighting a ban on palm oil with the feds (they won, incidentally).
posted by smoke at 8:19 PM on May 28, 2013 [2 favorites]


Actually, looks like food lobbying is pretty widespread. Probably worse in the US.
posted by His thoughts were red thoughts at 8:28 PM on May 28, 2013 [1 favorite]


As a doctor, I no longer know what to do about the obese.

I heard almost this exact same line. This is the most honest discussion I've had with a doctor in a long time. I don't know what it is with the Military, but they produce the finest, most intelligent and honest physicians I have ever dealt with. I've had two of them, now, one a USMC who was re-assigned halfway across the planet, and my current doc, who's semi-retired Navy.

He asked me about the exercise I got... and was utterly unsurprised to learn that a 350 370lb man loves to ride bikes every weekend, for dozens and dozens of miles, hauling a toddler in a trailer all the while.

"You ever see construction workers? Big, strong guys. I see two types now... skinny ones and big ones like you. They both lift and haul all day long. Why is one skinny, and the other not?" he asked me.

"I don't know," I said.

"I don't know either," he replied.

Other weird shit is going on, too... food allergies are skyrocketing among kids these days. Deadly ones requiring hospitalization for the slightest exposure. Autism rates are sky-high, too... causing desperate parents to embrace ant-vac psuedoscience.

Recently, it was revealed that smoking cigarettes damages your genes, passing on adverse changes not to your kids, but to your grandkids. Lysenkoism having the last laugh.

Epigenetics is a new frontier for science... the obesity epidemic likely rests there in my layman's opinion. Any way you slice it, something damages your appetite and satiation instinct. It can be reset back to normal in only one way.

I met with my bariatric surgeon in a strip-mall office in a real bad part of a real bad New England mill town gone bust. The AC was on the fritz, and the office was a claustrophobic warren of hastily sheetrocked examination rooms, painted industrial battle-ship grey. The patient chairs in the waiting room and in the exam room were the new kind - like a steel stacking chair that's a love-seat. A seat big enough for two, but meant for one... I first encountered one like it at the sleep specialists office two years ago. It's for fat people who can't fit in normal waiting room chairs. I was grateful for it... ashamed, but comfortable. When he came in, he put his back to the wall, thrust his hands into his labcoat, and slumped. He was tired and hot and didn't want to be there... "So. Any questions?"

No, not really, did all the homework. Spent eight months going through medical tests, psychiatric exams, support groups, both great and terrible (the bigger the town, the less they give a fuck), and all manner of hoops and indignities. This is the easy way out? I still have uncontrollable vomiting and power-pooping to look forward to. The penalty for eating something the new digestive system decides it can't handle. I've been warned to keep a spare pair of pants and boxers at work.

"Nope," I said.

"Just want to get it over with, now, huh?"

"You have no idea," I said with a smile I didn't feel, and he smiled back, hauled himself up off his slump, and shook my hand and laughed. He's good at his job.

He will carve away 90% of my stomach, including all of the glands that create and regulate sensations of hunger and satiation. I'll grow new ones, in a few years. I'll have to understand how to control and live with them. The surgery gives me a fighting chance, not a guarantee. I'll still be fat... just less fat, and with much less year-over-year weight increase. Maybe.

I went to my semi-retired Navy physician, he still has a buzz-cut and a prairie accent, and asked him for a clearance for surgery. He said...

"I don't know what to do about obesity... but this is the best idea we've got. You are an ideal candidate for this kind of surgery, and we'll work together once you have it done."

In three weeks, I go under the knife. If I don't die of surgical complications, I'll have two years or so of misery adjusting to my new guts. There's a not insignificant chance that I'll become an addict or alcoholic.

Plus, I'll kind of miss looking like '80s wrestler "The Big Bossman"
posted by Slap*Happy at 8:54 PM on May 28, 2013 [44 favorites]


Other weird shit is going on, too... food allergies are skyrocketing among kids these days. Deadly ones requiring hospitalization for the slightest exposure. Autism rates are sky-high, too... causing desperate parents to embrace ant-vac psuedoscience.

There is the increasingly widespread belief that food allergies are tied to hyper-santization of the environment (compare food allergy rates in third-world countries to food allergy rates in developed countries). As for diagnoses of autism, I don't know if we can take the fad-diagnosis-of-the-decade and apply it as a real marker of deep psychosocial changes.

As much as I feel for you and the surgery you're facing, I hate the characterization of obesity as a mystical, incomprehensible, unstoppable force. If we're going to start acting like medical conditions are a result of Fate then we may as well return to bloodletting and healing crystals. It results from a terrible combination of social, psychological, and physical factors that start and end with people eating too much food. If I run a marathon, and then eat two marathons' worth of calories, I will gain weight. But as this article so helplessly concludes, "Eat less" is hopelessly reductionist when one considers the cavalcade of factors that went into the person overeating in the first place.
posted by schroedinger at 9:48 PM on May 28, 2013 [11 favorites]


There's also the fact that when I lived in England and ate exactly the same way I had in the States, I lost 20 pounds. In two months. And the food tasted better, too.
posted by subdee at 10:08 PM on May 28, 2013 [4 favorites]


It's more complex than that; the Government is torn between wanting to reduce the public health costs of smoking, and not wanting to give up the lovely tax revenue

Hence my belief that the incremental increases in tobacco taxation are about stable revenue raising (disproportionally affecting the poor), not health outcomes. Especially since aids to quit smoking are unsubsidised and expensive (a pack of patches or gum costs more than a packet of smokes) and harm reduction (ie. snus) is also off the table. Smoking rates in both Australia and the US are both around 20%, yet Australia's taxation is an order of magnitude higher - I'm really not sure of the marginal benefit of tax increases, but I will read more, smoke.
posted by Jimbob at 10:14 PM on May 28, 2013


(Obesity) results from a terrible combination of social, psychological, and physical factors that start and end with people eating too much food.

Why is it that this rule of thinking only applies to fat people, and not, say, my best friend who, at barely 115lbs and 5'8", wouldn't bat an eye at eating two cream filled donuts and a milkshake for breakfast?
posted by FirstMateKate at 10:18 PM on May 28, 2013 [6 favorites]


like most public-health moralizers

She's a doctor who has had to deal first-hand with patients who suffer health consequences from obesity. She's not moralizing but calling for an adult discussion about those consequences and what kind of society industrialized countries that ration healthcare want to have. Her words deserve a great deal more serious consideration than empty platitudes about moralization from users on Metafilter.
posted by Blazecock Pileon at 11:03 PM on May 28, 2013 [14 favorites]


Why is it that this rule of thinking only applies to fat people, and not, say, my best friend who, at barely 115lbs and 5'8", wouldn't bat an eye at eating two cream filled donuts and a milkshake for breakfast?

Probably because your friend is manifestly not eating too much food for his or her metabolism.
posted by Justinian at 11:15 PM on May 28, 2013 [3 favorites]


Well, that's terrible.

It's all anecdote (she makes sure we know her likely-fictional American host was "white" even though it's completely irrelevant, because she knows how it would sound if she was preaching her pious garbage at a black or Latino person), pseudo-philosophical speculation and citations of dubious "studies."

I don't even know how to begin to process a doctor who thinks shaming her patients is justified or helpful, except to say "how awful" and close the tab.
posted by drjimmy11 at 11:24 PM on May 28, 2013 [4 favorites]


Why is it that this rule of thinking only applies to fat people, and not, say, my best friend who, at barely 115lbs and 5'8", wouldn't bat an eye at eating two cream filled donuts and a milkshake for breakfast?

(1) Your friend is not actually eating too much, given that she's maintaining her weight

(2) Your friend may be undermuscled/overfat and thus still be in a risk category.

-----

Pretty disturbed by the number of people who associate "Wrestling with the compassion she feels for her patients' struggles, the recognition of their individual worth as human beings, and maintaining realism about the risks of obesity" with "shaming".
posted by schroedinger at 11:31 PM on May 28, 2013 [11 favorites]


I was peeved at the rugged individualist bent towards the beginning of the article, then got happier when she started addressing some other issues (food industry, etc), but then left dismayed at the last two sentences: back to rugged individualism.

Yes, we are responsible for what we put in our mouths. Yes, we can effect change in our own health by eating better and staying active. But none of these things explain the massive increases in the number of overweight people within like one generation. Something radical has changed and it's not our morals.

Sure, the US is fat as hell and some might argue, hedonistic and immoral. But guess what… the tide of fatness is washing over the planet. One by one, other countries are suffering the same epidemic as the US already has been. This article addresses Australia, but we are seeing similar problems in the UK. In Mexico. In Canada. In South America. In Saudi Arabia. Even in some African nations. Something has changed. And mocking people's willpower or morals isn't helping at all.

Look at the numbers yourself. What has changed? It can't just be individual willpower that explains these maps. It can't be that people are "pigs" now and didn't use to be.


The wiki quote that got me: "The only remaining region of the world where obesity is not common is sub-Saharan Africa."
posted by readyfreddy at 12:09 AM on May 29, 2013 [8 favorites]


Thank you, readyfreddy: yes. There is something new, or maybe a bunch of somethings (hormones in the food supply? plastics? a steady diet of processed foods, with added sugar?) that has raised the tide for all of us, individually and collectively. We are all fatter, but we are also all much bigger on every scale: tall, broad, just plain big. Part of this is nutrition, especially in childhood, but there is something else going on too.
posted by jrochest at 12:48 AM on May 29, 2013 [2 favorites]


Your stomach is full, but will you say no if I hold my finger dipped in melted dark chocolate to your lips?

Woah lady I know we've spent like twenty-seven paragraphs together but this is all moving a little fast for me
posted by threeants at 1:22 AM on May 29, 2013 [32 favorites]


Anyway yeah, I feel like in many respects public health practitioners and Fat Acceptance/HAAS folks tend to talk past each other in a way that's not productive. I don't think it's inconsistent to adopt a Health At Any Size approach while also deploying interventions to help increase people's options to be the size they'd like to be. I see it as options-- if you have the tools at your disposal to lose weight and choose not to, I stand 100% behind your decision. However, I don't think it's fair to burden poor people and people of color, who are more likely to be functionally limited in choice, with a disproportionate health burden and then flimsily dress that up in "acceptance". On the other hand, the public health field needs to remember it has a mandate not only for our physical wellbeing but for our mental health as well. And clinicians need to get the fuck real and start treating patients where we're at, not where the BMI chart would like us to be.
posted by threeants at 1:43 AM on May 29, 2013 [5 favorites]


readyfreddy: Yes, we are responsible for what we put in our mouths. Yes, we can effect change in our own health by eating better and staying active. But none of these things explain the massive increases in the number of overweight people within like one generation. Something radical has changed and it's not our morals.

I'm just not sure I understand the point you are trying to make. It may be (and it certainly seems to me) that it has become easier and cheaper to make bad nutrition choices, and that the tempo of life and work has changed to amplify them, but this doesn't detract from what you (and the author) say about being finally responsible for our bodies. It is not fair that some people are more vulnerable than others to these factors, and it's not fair that they be visited upon our generation and those to follow, but that seems to be just how it is. Other generations dealt with unfairness, including lethal unfairness, of their own.

I don't think the statement that the choice of futures is "in your hands" is a moral judgment, it just seems, well, accurate. If we were in a burning house, we would surely do our best to escape. It would not be to the point to complain that our parents never had to flee from a burning house, or that our neighbours' (in sub-Saharan Africa, for example) houses, while smaller perhaps, and not as luxurious, are at least not ablaze. It would not be to the point to say that our builders and planners and regulators built poorly, and that conflagration was foreseeable, even inevitable. There's no time for that. We'd just have to go.

Our diets and the elements of our society that interact with them are on fire now, and for some of us, the flames are well and truly licking at the eaves. I can't believe that systematic change will arrive in time for those who feel they are at risk today, and I think that leaves them (and us) with two options: to either attempt to save ourselves, or to make peace with our condition, which is exactly the choice the author describes.
posted by curious.jp at 1:45 AM on May 29, 2013 [11 favorites]


curious.jp, what I'm trying to say that there are forces that are preying on human diets and as a result are making humans fat. My guess is that they are financially beneficial for the predators. Without those predators, I would also guess that we wouldn't have the obesity epidemic that we now have. If this were, say, heroin, we would be up in arms: Stop the heroin trafficking! But since it's food, then it's all you and your big fat mouth's fault. And the winners of the smugness awards are always those that "got lucky". I already agreed that individuals can effect change. That doesn't mean we shouldn't point fingers at the predators. I'll leave it to you to figure out who they are, because I don't know fully who they are. I think we can all make some educated guesses though. I'm more concerned about the chronic nature of this issue than I am the acute. There are obvious trends happening. Why?!? We hem and haw about some possible causes and then throw up our hands… "it's your fault, fatty".
posted by readyfreddy at 2:14 AM on May 29, 2013 [2 favorites]


The wiki quote that got me: "The only remaining region of the world where obesity is not common is sub-Saharan Africa."

The only time I ever lost weight without trying was when I studied abroad in Cameroon back in 1995. Zero American fast food chains or convenience stores. So much fresh, cheap fruit and vegetables. But I also drank lots of Coke (cane syrup, not HFCS) and ate lots of bread (baguettes, made daily). I very rarely had any food that was processed. Lost 40 pounds in five months. Food is different here.
posted by candyland at 3:00 AM on May 29, 2013 [3 favorites]


The bit that got me was this:

The author suggests that medical students should be taught to be less reductionist, to learn how psychological, social and economic factors all act as determinants of disease. I do not know what medical school is like in the US, but even our surgeons – the most hard-arsed of doctors – sit reeling before the tragic combinations of circumstance and choice that lead our patients to weigh two or three (or four or five) times what they should. The doctors I work with have an excellent grasp of the bio-psycho-social factors that contribute to our patients’ states, but we are only doctors.

I have known health care professionals who are aware of these factors and can treat me as a person, with respect. These are the ones I continue to see. I have also known plenty who, if they were aware of these factors, decided to treat me as though I were a subhuman species of substandard intelligence and did not hesitate to belittle (hah), patronise, and bully me. Coz that's going to make me shed the kilos, isn't it? Oh yes, at least one was a surgeon.

The article was thoughtful, but did read to me as if she has never had any problems with food herself. That doesn't mean she's not allowed to have opinions, far from it. But when a person who has all their limbs starts talking about their excellent grasp of the bio-psycho-social factors that contribute to the difficulties experienced by someone who is missing one or more limbs, I am skeptical. I have all my limbs, and an excellent imagination, and I know that I can't really understand what a quadriplegic's life is like. Doesn't mean I shouldn't try, but I also shouldn't set myself up as an authority on the enormous bio-psycho-social difficulties experienced by people with less than four limbs.
posted by Athanassiel at 3:11 AM on May 29, 2013 [5 favorites]


Good luck, Slap*Happy. I hope you get a good result at the end of it all.
posted by harriet vane at 3:53 AM on May 29, 2013 [2 favorites]


Man, am I late to the party.

Let me just suggest that the primary issues in treating obesity, like any eating disorder, are first emotional and psychological. Until you can learn to deal with all the crazy shit your stupid brain keeps telling you, success can be elusive.

Get your head right first, then the rest is just a regular process. I think *that* is what Doctors are missing. Calories in - Calories Out = only works if you're not sabotaging yourself in sometimes subtle ways.

Practical application of this has me down over 130 pounds since the discussion in December 2011 about intermittent fasting.
posted by mikelieman at 5:13 AM on May 29, 2013 [9 favorites]


I don't really read that much contempt from the piece at all. Perhaps I'm being charitable, but I feel like the author is really struggling as a health expert to reconcile medical and social views of obesity.

I dunno; to me, her descriptions of people's bodies seem a bit colorful for that interpretation.
posted by The Underpants Monster at 5:33 AM on May 29, 2013 [4 favorites]


That was a key I noticed in the Fat City piece too, mikelieman. She was on that topic here...
Most people do not overeat because of a feeling of hunger emanating from the stomach; they are giving in to a desire to consume – they are seeking pleasure or relief, or hoping to fill a void.
but she took it no further. Her next paragraph was how industry and economies are arrayed against individual health. Maybe it was a logical progression and the food industry is ever more expertly exploiting our voids.

Doctors aren't so good at dealing with other addictions, either. I guess I'll thank them for trying.
posted by surplus at 5:39 AM on May 29, 2013 [2 favorites]


"You ever see construction workers? Big, strong guys. I see two types now... skinny ones and big ones like you. They both lift and haul all day long. Why is one skinny, and the other not?" he asked me.

"I don't know," I said.

"I don't know either," he replied.


I've seen enough articles lately on new discoveries about gut flora affecting things like weight gain/retention to wonder if that isn't some kind of a factor, along with lifestyle.

Until a few years ago, no one was talking about the fact that fat is not just one type of thing; it comes in brown and white, and the two types act differently in the body, and once it builds up in your body, it sends out signals the way other organs do, to influence certain body functions. It's not inert, but active. Which is why liposuction doesn't always work as planned.

We seem to be in the dark ages in terms of dealing with obesity; we just don't know much at all. Which isn't surprising, since starvation was a much bigger issue for most of human history.

Slap*Happy, my sister had the surgery 10 years ago, and has kept the weight off and adjusted to eating for her new gut. She got so much of her previously athletic, active life back, I can't help but be glad she did it. She is in good health.

I hope the same result for you. Best of luck.
posted by emjaybee at 6:31 AM on May 29, 2013 [2 favorites]


And I meant to add; in my own dealings with disordered eating, I often feel like we treat it now the way we used to treat depression; something you are supposed to shame yourself out of. Which works, for a few, but doesn't for most. Certainly, trying to change bad eating habits feels a lot like trying to throw off depression by yourself. It doesn't help that most of the drugs for weight loss don't do much or come with awful side-effects; my sister who had weight-loss surgery had previously been a fen-phen success story and was angry when they took it off the market.

Eventually, I think we will end up with more effective medical solutions and stop expecting shame and individual willpower to solve this issue. There is a sort of vortex of physiology and behavior around disordered eating and obesity that traps a lot of people and it's foolish to keep treating this as a result of laziness over making trivial changes to your life.
posted by emjaybee at 6:37 AM on May 29, 2013 [4 favorites]


Most people do not overeat because of a feeling of hunger emanating from the stomach; they are giving in to a desire to consume – they are seeking pleasure or relief, or hoping to fill a void.

but she took it no further.


I think -- in part -- because without getting all 'hippy-dippy', there really isn't much further to go.

I suppose you could wrap it all in a "The Buddhist Tradition teaches us 'All Suffering Comes From Desire'", and from there the well-known paths can be followed. Maybe casting it in Jack and Lois Trimpey's "Addictive Voice" model? But it's really window dressing at that point.


There is a sort of vortex of physiology and behavior around disordered eating and obesity that traps a lot of people and it's foolish to keep treating this as a result of laziness over making trivial changes to your life.


YES! "Overload" is one of the main complications here. All of the messages I was swamped with -- all contradictory. That's why I went with Action Science!
posted by mikelieman at 6:42 AM on May 29, 2013 [1 favorite]


drjimmy11 said:
I don't even know how to begin to process a doctor who thinks shaming her patients is justified or helpful, except to say "how awful" and close the tab.
Others have echoed this sentiment. This perspective strikes me as odd, since to me, this entire piece is about the author wrestling with the position you describe, and which she feels forced into:
This is where the obesity-as-disease concept leads us – to a situation in which people demand that medicine shoulder the responsibility. What about the responsibility of the individual? And of society? My patient cries because the highlight of his day is returning from the supermarket with a plastic bag full of junk that he will eat and drink in his empty lounge room. What can I do for him? I can threaten him with his early demise, intensify his shame. I can offer him some evidence-based motivational lifestyle interventions – swap Coke for Diet Coke! Prescribe exercise? Walk for an hour at an average pace and you’ll only burn off the equivalent of one slice of bread. I could take the old-fashioned approach and wire his jaw shut. I have no hope of resolving his loneliness, his hopelessness, his lack of a job. I could, and do, refer him to a psychologist – if he’s lucky he may land one who is talented and sensitive and will try to get to the root of why this young man hates his own guts. More likely he’ll be offered a few sessions of behavioural therapy that will make everyone except him feel better.
Emphasis mine. She knows that shaming her patients won't work. She also knows that she can't change the systemic causes (ag subsidies, consumer marketing, sedentary professions, car culture) behind this population-wide shift. She also knows that even with an empathic approach, she has virtually no ability to fix the very real medical issues this patient is presenting with, and which most obese patients present with.

She is trying to reconcile medical fact with the also very real fact that mentioning those medical truths makes people feel terrible and exacerbates the issue. She has a handful of techniques that (kind of) work for (some) people (and require enormous lifestyle change for the patient), but which are much more likely to fail if she suggests them instead of the patient doing them of their own volition. She's being told she can help, she must help, but when she tries it makes things worse.
posted by daveliepmann at 6:45 AM on May 29, 2013 [9 favorites]


without getting all 'hippy-dippy', there really isn't much further to go.

Actually, it's the heart of the issue which she stumbles on and then ignores. If you aren't really willing to do anything about alienation interacting with overconsumption, then yeah, your remaining options are things like bariatric surgery. Which, incidentally, is a profit-earning enterprise which is part of what you might call the food/industrial complex as well (at least under the US system).
posted by Miko at 7:44 AM on May 29, 2013 [5 favorites]


Without getting too involved, let me just say that I don't believe that getting all 'hippy-dippy' is a bad thing. It's that the 'soft' things that it deals with are difficult for 'conventional' treatment styles to reconcile generally.
posted by mikelieman at 7:56 AM on May 29, 2013


And very very late--I am trying to figure out how/why "miko's" post got so many favorites (30). Not that it is wrong, bad or ill conceived but to lay much of this on capitalism just does not wash with facts. Some of the least obese are surely capitalist ( Switzerland, Japan, South Korea, Norway, Austria, Denmark, Singapore etc) and some of the most obese are certainly not awash in capitalism (South Pacific Islanders, Saudi Arabia, Egypt, Mexico, Greece etc.) As most of the posters have indicated--it is much more complex than fast food and capitalism. Cultural values, abundance, mechanization/automobiles, disposable income, human nature, availability, public health initiatives, government intervention/regulation etc. Certainly the US is right up there but I am not at all sure capitalism is the common element--I would more likely guess it is that component of capitalism and some western democracies that says " no one is going to tell me what to do--it is my land, my body and my life and will do what I damn well please". Where the values of the "commonwealth" are more prominent there does appear to be some moderation in in personal "excess". Just a thought.
posted by rmhsinc at 8:05 AM on May 29, 2013 [5 favorites]


I am one of those who lost weight in Europe. Granted the streets of Sarajevo can be dizzying, there are only thin slices of sidewalk, the streets, as you get into higher altitude or older parts of the city are car-hostile.
You do see less convenience food. Even small neighborhood stores have decent fresh vegetables. There are SOME convenience foods, there's even some junk food, and assorted sodas. I drank sodas. I drank coffee with sugar.
I still lost weight. I did so before figuring out that I am lactose and casein intolerant. IBS can actually impede weight loss. My difficulties with bovine lactose and casein made me have terrible problems.
I lost weight despite those problems.
So yes, I think there is a problem with some of our foods.
I have stabilized at overweight but not obese.
I wish I had the metabolism I had when I was younger! That changed when I moved to where I live now. Really skinny people fare poorly in our Winters.
Mr. Roquette and I don't eat out much. We don't eat lots of unhealthy things.
We do have barriers to adequate exercise. His back is genuinely bad.
He worked construction and took damage as a result.
I have bad ankles due to previous injuries, and nasty arthritis in my neck.
Unstable weather sets off arthritis for both of us.
We still manage to go for walks sometimes.
He really suffers though. Insetimes could go longer, but he'd take a couple days to recover to my half day or day. He is younger than me and fairly strong as far as lifting things.
Both of us probably are in better shape than our neighbors of similar ages.
We eat smarter.
We do have a 300 pound neighbor who is missing a leg. She pretty much lives in her power-chair.
It's dreadful walking by her apartment. Her digestive system has been abused. I don't go to functions here which involve food very often. Neither does Mr. Roquette. Between what we don't eat for religious reasons and what we can't because of allergies and digestive issues, it's a mine-field.
We can't go to the Indian place since hot foods hurt him. The Indian place is about the only 85%!safe for me eatery.
We only go out to eat once or twice a month and proceed with caution.
posted by Katjusa Roquette at 8:08 AM on May 29, 2013 [3 favorites]


It's unfortunate that the author uses loaded and pitying language when discussing every obese person that is not her brother, because the cold hard realities in between are well worth reading.

Health at Every Size is a great concept at its core and points out that it is possible to be healthy across a range of body types. The challenge is that some people have taken "Health at Every Size" to mean "There are no health problems associated with weight."
posted by rednikki at 8:28 AM on May 29, 2013 [5 favorites]


She links obesity to depression at one point, but it's not clear to me which way that causality arrow really points.

I, personally, feel sluggish and miserable when I'm on diets that are "good" for my body. When I need to work on something that requires brain power, eating calorie-dense food is the most reliable and sometimes the only way I can get my concentration and focus up. People don't only "over" eat for entertainment, sometimes to feed your brain you have to overfeed your body.

Of course, it's a balancing act because there are long-term consequences to those short term boosts. But it's just a mistake to think that everyone can get by without boosts.
posted by subdee at 11:15 AM on May 29, 2013 [2 favorites]


>I, personally, feel sluggish and miserable when I'm on diets that are "good" for my body

This is as good a point as any to throw out a word for a low-carb/high-fat diet. After a few days' adjustment, I felt better than I had in years and have lost 75 lbs without counting calories.
posted by callmejay at 5:47 PM on May 29, 2013


I was going to order a pizza tonight. Now I'm eating a bag of snap peas.
posted by dobie at 6:01 PM on May 29, 2013


I think she gave a big part of the solution in one sentence:

Very few people get obese and none get morbidly obese through the consumption of home-cooked whole foods.

I've been going this route for the past couple of years and have lost around 25 lbs. I eat out occasionally but either cut the meal in half or sometimes even thirds.

I actually think this is a big part of the obesity problem, that so few people cook anymore. I have a full-time job and I'm single. I cook on the weekends and make enough for the whole work week so I can have a home-cooked meal when I get home. Yeah, it's repetitive, and it takes effort, but in my mind it's much tastier and healthier than the alternative.
posted by jenh526 at 6:32 PM on May 29, 2013 [1 favorite]


She's being told she can help, she must help, but when she tries it makes things worse.

Even when I give Hitchcock the benefit of the doubt — perhaps she is driven to not only write, but to conquer the world's obesity — there's a self-serving subtext to her writing about what she knows, and it's not just defeat, frustration and helplessness she's expressing.

Hitchcock writes disparagingly about obese patients (especially those who don't even break out in a sweat). Yet she takes a position as the admitting-physician in a private surgical clinic for the treatment of obesity, a position no-one else wants, then what? We all conclude she's riddled with compassion? No. To some of us her article is off.

Miko's insights help twice: One, "It's a solvable problem. If she doesn't want to articulate a solution, I'm not sure why we should read what amounts to a long, wandering rumination akin to a diary entry which offers no conclusion"; and two, "[The essentially private sector bariatric industry] is a profit-earning enterprise which is part of what you might call the food/industrial complex as well (at least under the US system)."

I believe Dr Hitchcock is justifying selling out to the lucrative and growing bariatric industry, which still exists in Australia only for the financially comfortable and/or privately insured. Medicare rebates are selective and a pittance. Our future treasurer and a man with the prime minister's chair always in his sights has recently undergone bariatric surgery with conspicuous and rapid results. Nice timing. Australia is starting to reason that investing in bariatric surgery is sound public health care policy.

A dramatic expansion of the Medicare rebate system for bariatric surgery is now one step closer.

Dr Karen Hitchcock has her finger on a particular pulse. She has secure employment, good future prospects, and private clinic hours apply. Even she won't break out in a sweat. Maybe that's what's going on. Hitchcock's busily justifying her medico-self at the literal expense of Australia's growing obesity. She'll being living off the fat of the land. Fine. Why not just write that?
posted by de at 7:50 PM on May 29, 2013 [1 favorite]


Some of the least obese are surely capitalist ( Switzerland, Japan, South Korea, Norway, Austria, Denmark, Singapore etc) and some of the most obese are certainly not awash in capitalism (South Pacific Islanders, Saudi Arabia, Egypt, Mexico, Greece etc.)

I think you make a fair critique, but you mention "cultural values," and in fact cultural values help to restrain the trend toward alienation in many cultures (definitely in some of your "least obese" list, this is the case). So they act in a way that restrains capitalism and moderates alienation. Some of the most obese, on the other hand, are so and have been so historically because of cultural values which prize obesity as a sign of wealth or authority and don't punish it as a moral failing (combined with certain dietary abundances). I think my alienation + profit motive model stands up pretty well. The other big bit of evidence for that is change. There was a time when America was not one of the world's most obese countries. That changed, and it changed not because individuals' level of willpower changed but because an industry and policy complex grew up in the latter half of the 20th century which explicitly aimed to separate food consumption from the values which previously governed it, and unlike in many other Western democracies, that industry is neither restrained by health-focused public policy nor counterbalanced by strong enough cultural values to assert relationships, quality of life and well-being over consumer goods.
posted by Miko at 8:16 PM on May 29, 2013 [2 favorites]


can't you turn it around - since the obese are in rich countries, obesity should again be seen as a status symbol? i'm glad i can eat enough to be fat and don't have to work a backbreaking physical job to force me to lose that weight. as for health - everything can kill you
posted by Charlemagne In Sweatpants at 8:33 PM on May 29, 2013


Very few people get obese and none get morbidly obese through the consumption of home-cooked whole foods.

I missed this the first time. (Thanks to jenh526 for pointing it out.) It is in fact possible to get obese through eating home-cooked whole foods. I'm living proof. Because of my food allergies (soy and corn), I can't eat junk food. But it's just as easy to get fat on whole foods.
posted by rednikki at 8:59 PM on May 29, 2013


Recently published in Nature (just read by me) "people deemed 'overweight' by international standards were 6% less likely to die than were those of 'normal' weight over the same time period". Which is not as simple as overweight = good, and as always there are complexities. I hope Karen Hitchcock reads it.
posted by Athanassiel at 9:23 PM on May 29, 2013 [6 favorites]


That was a very interesting article, Athanassiel, thanks for linking it.
posted by smoke at 9:50 PM on May 29, 2013 [1 favorite]


People point at that information without actually understanding it.

First, we're talking about people with BMI about 26 having the slightly lower mortality rates. Normal is considered 20-25. So we're talking about very marginally into the "overweight" category. As in maybe an extra 5 pounds. It does not mean carrying an extra 25 pounds. So that has almost nothing to do with what Karen Hitchcock is talking about and trotting it out in this context is misleading.

Secondly, it is not clear that it isn't a statistical artifact due to people with severe illness losing weight and smokers tending to weigh less than non-smokers because they are smokers. A smoker is going to die more often than a non-snoker who weighs 5 pounds more.

But, hey, it does mean that carrying an extra 5 pounds is no big deal. If you think the problem with obesity is that too many people have an extra 5 pounds then we're all set!
posted by Justinian at 10:27 PM on May 29, 2013 [2 favorites]


Ah... I forgot. The effect only kicks in as you age. It is not true among young folks, even with that extra 5 pounds.
posted by Justinian at 10:28 PM on May 29, 2013


I did not post the link saying, "Yay, obesity is great and we should all eat as much as we want!" I posted the link because it gives some additional information showing that there's a lot of complexity around this issue. Given that Hitchcock's article does specifically mention overweight people (whilst primarily focusing on obesity) I thought it was germane to the topic at hand. There's also a lot of background relating to how the correspondences between morbidity and weight were made, which I found interesting and thought others would too.

I don't care if you disagree, that's fine. Just don't patronise me by telling me I've pointed at the information without actually understanding it. Unless you are in my head, you have no way of knowing.
posted by Athanassiel at 10:59 PM on May 29, 2013 [3 favorites]


Despite being overweight or obese being linked with increased mortality, it's not clear that weight loss decreases that mortality. There is evidence, though, that healthy habits (exercise, eating fruits and vegetables, not smoking) decrease mortality, even in overweight and obese people. So if we could help people do those things, regardless of whether they lose weight as a result, we'd be ahead. But, as I said upthread, I have a feeling it can be really hard for people to do those healthy things when those same things have been thrown at them as things they need to do to make their unacceptable body acceptable.
posted by needs more cowbell at 11:12 PM on May 29, 2013 [4 favorites]


I don't care if you disagree, that's fine. Just don't patronise me by telling me I've pointed at the information without actually understanding it.

I didn't mean you don't understand it necessarily, I meant that a lot of people don't actually take the time to read what you linked to or understand what it means. They simply read the headline and file it under "SEE? BEING OVERWEIGHT IS FINE" and then bring it up themselves later.
posted by Justinian at 1:13 AM on May 30, 2013


Dr Karen Hitchcock has her finger on a particular pulse. She has secure employment, good future prospects, and private clinic hours apply. Even she won't break out in a sweat. Maybe that's what's going on. Hitchcock's busily justifying her medico-self at the literal expense of Australia's growing obesity. She'll being living off the fat of the land. Fine. Why not just write that?

Completely misses the point of the article and makes ad hominem attacks.
posted by fraxil at 5:43 AM on May 30, 2013 [1 favorite]


miko: I like the way you think (seriously) but I do think you are overreaching the alienation/capitalism analogy by about 47%. I think a simpler explanation for the "change" hypothesis is that the nature of work, physical activity and dietary abundance ( particularly refined carbs) has changed dramatically. Going through the drive through/parking close at a Starbucks for a 16 oz.latte versus parking a 5 minute walk away and getting an Americano is a net difference of 250 calories ( 14 days = 1 lb.) or about 15 +/- pounds a year. I never ceased to be amazed at how much people over estimate their exercise and underestimate caloric intake. One small bag of chips/crisps approx 150 calories times 5 days per week=10 lbs a year. walking 15 minutes=100 calories times 365 days equals roughly losing 10 lbs. Now I hope mefiers do not quibble--yes, people metabolize calories differently, etc. I would posit that besides the cultural differences in countries(and this is very real) the "thinner" capitalist countries tend to be urban, less auto reliant for daily living, have more accessible public transport etc. It is a fascinating topic and, from my point of view, a very important issue to understand. Thanks for the discussion
posted by rmhsinc at 12:35 PM on May 30, 2013 [2 favorites]


I don't think there is a simple explanation. I think we have an entirely sick system. And I know people sound like crazy lefties when they talk about how Marxist theory is playing out, but I am entirely serious about alienation/exploitation being at work here and being the principal change that is accounting for most of the context in which people can become morbidly obese.

Yes, we're a bit more sedentary now than in the past. So why, then, do you think American food producers are producing more than 500 more calories per person per day than they did in 1970? How would you answer that?
posted by Miko at 5:15 PM on May 30, 2013 [1 favorite]


Hey, I gave you 53% as being on target. You are absolutely right, there is no simple answer. I am just attracted to maximum parsimony. That is an interesting link--it seems to me the answer as to why American food producers are............. is because we are consuming them. Which does beg the question as to why are we now consuming them. Alienation, boredom, seduction, advertising, accessibility, product placement, more alcohol/drugs > increased dis-inhibition, less smoking--All of these and more. Regardless, thanks for taking the time and providing the additional information.
posted by rmhsinc at 7:09 PM on May 30, 2013


OK, so producers are producing because Americans are itnerested in consuming, and they're interested in consuming because of alienation (boredom, seduction, increased disinhibition) and the profit motive and gains-driven strategies of capitalism (advertising and product placement, more alcohol/drugs which are also commercial products and so can work in synergy, less smoking and so a gap in the market leading to the need for other products to soak up consumption dollars and drive medical consumption)...

I think you're mostly supporting my argument - to the tune of more than 53%.
posted by Miko at 7:17 PM on May 30, 2013


It isn't an 'American' problem. Its the human condition, and acting like its bad is like calling gluttony 'sinful'.
posted by Charlemagne In Sweatpants at 8:35 PM on May 30, 2013


If it's the human condition, then the US is the most human:
Of all countries, the United States has the highest rate of obesity. From 13% obesity in 1962, estimates have steadily increased, reaching 19.4% in 1997, 24.5% in 2004, 26.6% in 2007,and 33.8% (adults) and 17% (children) in 2008. In 2010, the Centers for Disease Control and Prevention (CDC) reported higher numbers once more, counting 35.7% of American adults as obese, and 17% of American children.
posted by Miko at 8:39 PM on May 30, 2013


I thought Australia was the most obese? Either way, isn't having a surplus of ability to eat food a good thing?
posted by Charlemagne In Sweatpants at 8:41 PM on May 30, 2013


You should try reading the article, homes.
posted by smoke at 12:16 AM on May 31, 2013


Completely misses the point of the article and makes ad hominem attacks.

Guilty. I was right into confusing the author with the protagonist, and feeling disgust for an unlikeable character. The story certainly has us thinking solutions given the medical profession really can't be held to account for obesity.

Karen Hitchcock is as much a writer as she is a doctor. I've read a couple of her less antagonistic short stories now, and am much less given to believing she is the disaffected doctor in "Fat City".
posted by de at 5:25 AM on May 31, 2013 [1 favorite]


isn't having a surplus of ability to eat food a good thing?

That was the argument of the government strategists who brought us modern agricultural policy and the "Green revolution." They were acting out of reaction to the shortages and rationing of World Wars I and II and the Great Depression, and out of a Cold War sensibility that sought to strengthen domestic resources to prevent any food crises that might weaken the US before its enemies. But they also used the tools of government to create financial structures that rewarded the expansion of corporate agriculture, and once so empowered, those agribusiness corporations continued to push the envelope, today cleaning up to the tune of more than $1 billion in subsidies and incentives annually at the expense of the people. Today we have gone well beyond a surplus, since these companies are producing a massive excess of calories (of which at least a sixth go to waste), and moved into a system in which their interest is to continue to identify new ways to package the products for which they receive government support (such as developing widespread new uses for corn syrup, even beyond replacing sugar) and new ways to incentivize American consumers to eat even when they aren't hungry and don't need the nutrition.

It's an excess of a good thing, but if rational policy prevailed, we would have curbed the tendency to produce more calories than we need and more than we can export. The reason we don't is that agribusiness has a strong interest in continuing to grow by pushing out additional calories and creating new kinds of food product. They need people to eat, and at this point, they need us to eat too much, and they deploy a lot of psychological, economic, structural and political expertise in making sure we do so. If individuals had the same levels of analysis and support that food companies do, it would probably be trivial to support individuals in resisting overeating. Obviously, they don't have access to that. Many don't even have access to the most basic medical care, let alone the kinds of psychological, therapeutic, social and medical support it would take to set people on a healthier path.
posted by Miko at 5:40 AM on May 31, 2013 [3 favorites]


MIKO, I will give you 61% but no more--I will say, you do not give up. I was thinking while walking early this AM--and I do not mean this to take away from your hypothesis. If you control for the commonsense variable--education, socioeconomic/demographic variables, family history, etc I wonder what discriminates between those who are obese/non-obese since most are exposed to corporate/government policy and influence. My guess, and that is all it is--is that the predictive variables remain education, income, geography, family history obesity, etc. thanks again.
posted by rmhsinc at 7:31 PM on May 31, 2013


education, socioeconomic/demographic variables, family history

...because those are not influenced by the economic environment?

most are exposed to corporate/government policy and influence.

To equal degrees?

I will say, you do not give up.

Not spitballing; I know a lot about this stuff.
posted by Miko at 8:29 PM on May 31, 2013 [2 favorites]


Miko, I can see and I agree that you know a lot about this. Really very impressive. I am holding to my 61% until I see some good reliable studies that sort out those variables that have predictive validity for obesity while controlling for socioeconomic/cultural variables. It seems to me your , and others, position/hypothesis that corporate/government policy and practices is sufficiently broad that it can almost almost explain changes in obesity rates. I still think very important components (39%) are just a bit simpler. Abundance/accessibility of food/calories and the nature of work/transportation (caloric expenditure). I would posit that these factors exist independently of any particular corporate or government policy, manipulation, activity etc. Regardless--Once again. Thanks.
posted by rmhsinc at 1:17 PM on June 1, 2013


Abundance/accessibility of food/calories and the nature of work/transportation (caloric expenditure). I would posit that these factors exist independently of any particular corporate or government policy, manipulation, activity etc

You really think that the kinds and quantity of calories a person has access to is indepedent of their socioeconomic status? When was the last time you tucked into a free school lunch, shopped at a local farmer's market or Whole Foods, or made dinner out of a box of mac and cheese because that's what they have at the corner store? Or taken a bunch of kids out to McDonalds or Cold Stone Creamery as a reward after soccer or the school play? Also, the controls you are seeking have certainly been explored. Between 1988-1994 and 2007-2008 the prevalence of childhood obesity increased at all income and education levels.

Among men, obesity prevalence is generally similar at all income levels, however, among non-Hispanic black and Mexican-American men those with higher income are more likely to be obese than those with low income

Between 1988–1994 and 2007–2008 the prevalence of obesity increased in adults at all income and education levels.

As far as work/transportation, well, that's an interesting one. On the face of it it might seem that the most physically demanding jobs are the least likely to be held by obese people, but that doesn't turn out to be true. Many physically demanding jobs (manufacturing, construction, repair work, housekeeping, fast food service) are the ones with higher obesity rates. IT seems as though it's not actually the level of activity on the job, but the level of activity off the job (ie, regular exercise), having access to opportunities to exercise, and the pyschological nature of the job are more important.

So how does this relate to capitalism? In addition to noting that "high-demand, low-control" jobs are the ones likeliest to produce obesity, this study notes that when we locate the causes of obesity in individual decisions and psychology, we immediately let employers off the hook for the public health risks they are creating in designing unhealthy jobs whose expectations, locations, break policies, eating policies, and structures directly contribute to the obesity of those who do them. In short, employers are allowed to create health problems, and then not accept the consequences of the problems they are creating or contribute to their solutions, because this is the most financially advantageous situation for them. By framing it as an individual issue, they foist responsibility onto the individual or the public sector.
Obesity arises from complex social and biological phenomena, but is often perceived as the result of an individual’s behaviors. By contrast, occupational disease and injury prevention is primarily the responsibility of the employer. Strategies to combine protection from occupational risk with programs to encourage individual change to diminish health risk from obesity warrant consideration. Poorly done, such efforts may result in the individual workers being blamed for their obesity and may distract from the workplace contribution to injury or illness. Even if this shift does not occur, there is concern that scarce resources for reduction of risk from workplace hazards will be diluted or decreased by the focus on obesity in workers. Moreover, such attention to the individual’s behavior may shift focus from the more important social, cultural, and environmental causes of, and interventions for, obesity.
posted by Miko at 9:29 PM on June 1, 2013


Excellent data--I am getting to the point where I am about to say we really do not disagree. Isn't that a loser's last refuge? There is absolutely no doubt that sociocultural factors/variables can, and often do, create the necessary conditions to explain changes in obesity rates but I do not believe they are both the necessary and sufficient conditions. When I hear/read that (x,y,z or sum of x,y,z) is/are the causes of obesity it simply does not explain the variations within that population(s). Given any set of sociocultural independent variables there will most likely to be a normal distribution of the dependent variable (obesity) with in that specific population. Yes, poor people in Alabama with a 10th grade education, who watch 4 hours + of TV and out of necessity have school lunches and get food at a convenience store or food bank will most likely weigh more than a wealthy Coloradan who shops at Whole foods. What socioeconomic.cultural variables do not explain is the variation with in groups nor does it identify the sufficient condition to explain individual obesity. My feelings and thoughts are clearly colored by the fact that for years one of my specific professional interests, and commitments, was developing systemic, programmatic, and clinical interventions to address metabolic syndrome for persons with serious mental illness. Talk about a high risk population--drugs that can cause weight gain, often poor/isolated/alienated, etc. I think perhaps it is time to terminate the MeFi discussion but I would be more than glad to continue it here or a different on line venue. My email is in my profile. Thanks rmhsinc
posted by rmhsinc at 7:34 AM on June 2, 2013 [1 favorite]


Your experience with mental illness is really interesting. Yeah, alienation is huge. Why do we not have better societal roles/support for people in mental illness? Why are people with mental illness so isolated? Can't that perhaps be related to some of our presumptions about who has economic value and who's responsible for taking care of those who are unable to be part of the economy? I know it's quite complicated but I think there are economic dimensions to the question. As well as variances in individual resources for addressing it, and type/quality of care people can access.

it simply does not explain the variations within that population

No, but even if you could do a study with perfectly matched populations, some portion of the phenomenon will come down to individual biology, some portion will come down to epigenetics, some portion to formative-age conditions (abuse, neglect, messed up parenting, crisis/trauma etc) and finally some portion to individual psychology. So playing your percentage game, if we could agree that, say, 15% of the obesity epidemic was down to individual causes rather than systemic ones, then even that will be divided into causes that are individual because of and/or abetted by biological inheritance, leaving only perhaps a single-digit fraction of influence from individual psychology, and a still smaller fraction of that by adult psychology.

So I still think if we wish to solve this problem, we need to look first at the conditions responsible for 85% of the cause, not the 5% of the cause that might be solidly within individual control.
posted by Miko at 12:00 PM on June 2, 2013


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