 Supersize Nation?
Are Americans getting fatter–or do trial lawyers just smell an
opportunity?
by Howard Fienberg
Winter 2003
The Hungry Gene: The Science of Fat
and the Future of Thin. By Ellen Ruppel Shell, Atlantic Monthly Press, 256 pages, $25
We seem to be getting fatter all the time. The incidence of disorders and
diseases associated with being overweight or obese—like high blood
pressure, diabetes and hypertension—is also on the rise. In December
2001, Surgeon General David Satcher said that 34
percent of adults were overweight and a shocking 27 percent more were obese.
More than nine million American adults are “morbidly obese,”
roughly one hundred pounds or more overweight. Satcher
estimates that excessive weight was responsible for $117 billion in health
care costs in 2000 and called obesity America’s number one public
health threat.
How did it happen and why is it getting worse? Ellen Ruppel
Shell endeavors to find out in her new book, The Hungry Gene: The Science of Fat and the Future of Thin. She
opens by recounting an interview with the chief business officer of a major
biotechnology company. She asked him what disease or ailment on which he
would focus his company’s work if he were given the choice. His choice
was “the trillion-dollar disease”—obesity. Americans spend
$33 billion a year on weight loss products and fad diets. The prospect of
taking over that market and growing it, with products that control or change
the body’s biological processes, had him salivating.
Shell is co-director of the Knight
Center for Science Journalism at Boston University and a science journalist
who has written for the Atlantic Monthly, Discover, Newsweek, and the New
York Times Magazine. She exhibits the best qualities of a science writer, the
ability to find compelling stories inside the arcane world of research and
explain complex scientific concepts to a general audience. Her compelling
narrative on the history of obesity science starts in antiquity and continues
to modern research on the biological and genetic underpinnings of obesity.
At one time, obesity was a status symbol among the rich and powerful. However,
life became progressively easier with the advent of industrialization and
mass production. Improved infrastructure and transportation made traveling
under one’s own power unnecessary for most people, not just the elite.
The average person’s work became less physically demanding. As well,
food became cheaper and easier to get, thanks to more efficient distribution
and production. It wasn’t long before even the proles
could get fat. As a result, excessive weight became less a badge of
prosperity or good fortune than a sin, one that couldn’t be
hidden—a “glaring manifestation of carnal appetites, a stick in
the eye of the sanctimonious.”
For most people, contrition for this sin is behavior modification. Food is
the enemy; constant vigilance is required. The overweight receive constantly
shifting recommendations on what to eat and what not to eat, what to count
and track and what to ignore. The fight for thin can be so confusing it can
drive some people downright loopy: a 1997 Psychology Today survey reported
that 15 percent of women and 11 percent of men would sacrifice more than five
years of their lives if they could achieve their target body weight.
The Hungry Gene shows how
genetic research could ride to the rescue of the overweight and obese. Why mess
around with diets and pills and exercise routines when you can go straight to
your DNA?
Shell’s book is a difficult melding of science, history, and
polemic. For all her enthralling narrative, she has a tendency to bog down in
personalities; her elaboration on scientific research, while convincing,
allots too many words to the rivalries and personal problems of her subjects.
To that effect, the book’s biggest strength, Shell’s
storytelling, is also a major weakness.
However, the bigger weakness has little to do with genetics. Since obesity
rose dramatically only over the last few decades, such a change seems
unlikely to be simply genetic. Evolution simply does not work that quickly;
something else must be responsible. Shell fingers environmental influences as
the culprit and launches from careful history and science into an extended
sermon on how government should regulate American eating.
Fighting Big Food
Marketing and advertising must be curbed, Shell says. Big Food corrupts
children, turning them into its biggest lobbyist, and parents cannot
withstand their children’s artificially-induced desires. Any time Big
Food offers halfway healthy food, it deliberately sabotages its own marketing
campaigns—as Shell contends McDonald’s did with its McLean Deluxe—so
that it can discontinue the healthy products while claiming that consumers
“just don’t buy them.”
Americans don’t know anything about good nutrition, so funding for
more research and education must be authorized. Likewise, because consumers
cannot be trusted to make their own decisions, the government must guide them
by taxing any “bad” decisions, like eating fatty foods. Thus, we
need a fat tax.
Shell also lobbies for bigger and more detailed labeling of Big Food
products. While grocery items automatically contain an ingredients list and
nutritional information and restaurants either display nutritional
information or offer it on demand, Shell would prefer that consumers have
labels shoved in their faces any time they consider making a bad eating
decision. She also feels that having the real information about their
insidious products on display will drive Big Food to “reconsider the
‘bargain’ of super-sizing.”
Finally, in her most blatant salute to Stalinist economics, Shell suggests
price controls. “Fresh fruits and vegetables should be subsidized in
publicly supported food service venues, their price and quality regulated to
make them attractive options.”
Shell is by no means the first to advocate such policies. Oodles of
researchers, “public health experts,” and, most recently, trial
lawyers have done the same. Two landmark class-action lawsuits against Big
Food were filed in 2002 by trial lawyer Samuel Hirsch. The first, brought in
July against McDonald’s, Wendy’s, Burger King, and KFC, was on
behalf of overweight fast food patron Caesar Barber. The second, brought in
November against McDonald’s alone, was on behalf of two obese teenage
girls. Both suits allege the same: that Big Food conspired to limit the
plaintiffs’ choices and drive them to eat more than they should. In
other words, Big Food stands charged with making the plaintiffs
fat.
How is this possible? Grocery stores are easily accessible for most
Americans. For the truly needy, food stamps give consumers a chance to
purchase nutritious food at such a store for far less than they would
otherwise have to spend out of their own pocket at a fast food restaurant.
Healthy choices are everywhere. So how do we still get so fat?
Fat’s Not All, Folks
It may be that we are not quite as bloated as we are continually told. For
instance, Americans are often told to calculate their Body Mass Index to see
how fat they’ve become (divide your weight in kilograms by your height
in meters squared). A BMI of up to 24 generally means there is very little
health risk. A BMI of 27 or greater correlates to an increased risk of heart
disease, diabetes, and other weight-related complications. A BMI over 30
means you’re obese. Traditionally, subjects were not deemed “overweight”
until their BMI hit 27, but standards adopted in 1998 lowered the bar to 25,
below the worrying point for health risk. That is why such porkers as Russell
Crowe and Arnold Schwarzenegger are “overweight” and such
blubber-barons as Sylvester Stallone and Sammy Sosa are “obese,”
according to the new BMI measurements.
In truth, BMI doesn’t explain everything. It can’t account for
personal habits: a smoker may not be obese, but he is at an increased health
risk anyhow; an alcoholic may be overweight, but the weight is unlikely to be
what kills him. BMI also makes no distinction between different kinds of
weight. Muscle mass, while heavy, is not a health risk indicator like fat,
but the BMI makes no distinction between the two. That is how superstar athletes
like Michael Jordan get classified as “overweight.” Statistical
researcher Iain Murray says that one of the easiest ways to distinguish
between healthy and unhealthy in the overweight category is correcting the
BMI for the circumference of the waist, since fat tends to cluster there.
Making that correction for Michael Jordan drops his BMI to 21—although
fellow NBA dunkster Shaquille
O’Neill still comes out too heavy, so even that measurement obviously
is not perfect.
But it is not just on a person-by-person basis that the concept of an
“obesity epidemic” may have been overblown. The New England
Journal of Medicine, in a January 1998 editorial, questioned the severity of
the epidemic. “The data linking overweight and death ... are limited,
fragmented, and often ambiguous.” The Journal also expressed skepticism
about the commonly quoted statistic (repeated in The Hungry Gene) that
obesity causes 300,000 deaths annually: “Not only is it derived from
weak or incomplete data, but it is also called into question by the
methodological difficulties of determining which of the many factors
contribute to premature death.”
The science on the health effects of obesity actually appears quite shaky.
For instance, the oft-quoted annual deaths statistic originated in a 1999
study in the Journal of the American Medical Association that failed to
control for possible confounding variables, aside from age, sex, and smoking.
Glenn Gaessner, in his recent book Big Fat Lies,
lamented that “there has not been a single study that has truly
evaluated the effects of weight alone on health, which means that
‘thinner is healthier’ is not a fact but an unsubstantiated
hypothesis for which there is a wealth of evidence that suggests the
reverse.”
It appears that exercise is just as important to our health as
consumption, if not more so. A recent study from the Annals of Epidemiology
concurred. “Consistently, physical inactivity was a better predictor of
all-cause mortality than being overweight or obese,” said lead author
Carlos J. Crespo. After controlling for other risk
factors, like hypertension and smoking, Crespo
found that growing fat on the couch is not as daunting a prospect as never
leaving the couch. “The benefit may derive from the fact that regular
moderate physical activity, no matter how much you weigh, appears to
stimulate the immune system, improve insulin sensitivity, and increase bone
density, among other positive effects.”
Freedom of Choice
U.S. Surgeon General Dr. Richard Carmona,
speaking before a January 6 conference in San Diego on childhood obesity,
insisted that Americans “will make healthy choices if given the
chance,” implying that consumers lack the chance to make their own
choices. Others at the event were much more explicit. Kenneth Hecht, head of
California Food Policy Advocates, said, “The environment has to change
so people have access to healthy food.” Nutritional scientist Joanne
Ikeda worried that individual families cannot make changes on their own
“without society doing something to help families make these
changes.”
Americans eat 76 percent of their meals at home. When they eat out,
research demonstrates that as many as 95 percent of individuals feel they
have the necessary qualifications to choose their own diet. Shell disparages
this as a mere “perception of choice.” Not only can she not back
up her observation, her book provides no new compelling reason to curtail
Americans’ choices.
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