It's a Weighty Problem, But A Crisis? C'mon
By Fred Barbash
Sunday, August 31, 2003; Page B01
link to article
link to followup discussion
I am body mass challenged.
Okay. I'm chunky.
Okay, I'm obese. But I'm only obese technically speaking, based on my body mass index, the government's standard method for determining obesity. You'd never know it by looking at me.
But since I am technically obese, I find it heartening that there's rising concern about the "obesity epidemic." Perhaps it will encourage me to lose more weight. Perhaps a better understanding of the causes of obesity will help others with serious weight and weight-related problems. Perhaps Krupin's Deli will include on its menu a sandwich with just a couple of slices of corned beef as an alternative to the dozens of slices piled high.
Yet at the same time, the alarm over obesity causes me some alarm. I feel like a hunted man. I'm "wanted" for increasing the nation's economic costs by up to $117 billion a year. I'm reading about off-the-wall proposals to tax my next car as an incentive for me to walk, not drive, to Krupin's. I'm reading about nutty plans to tax my junk food and the TV set I watch when I eat junk food, as an incentive for me to get off the couch and eat an apple.
I'm not trying to make light of heavy. And no specific proposal is eating at me -- except that truly hideous suggestion that kids be sent home from school with body-mass-index report cards. I'm alarmed by the hysteria in the mass media, reflected in words such as "crisis" and "epidemic." There's been an epidemic of alarmist stories about obesity and its costs in the past year (about 2,000 according to my Internet search) that can only egg the politicians on to more foolishness and encourage insurance companies and perhaps employers to jettison another risk group.
I'm awed, as well, by the way in which a matter of personal responsibility has been transformed into a public crisis, whipped up by the uncritical news media, which swallow and regurgitate the crudest statistics about the most complicated of problems -- such as obesity.
This suits the agenda of an extraordinary variety of interest groups and academics, who, knowing of the media's new hunger for stories about the "crisis," duly produce studies demonstrating how their particular thing is actually the cause of it all. It's suburban sprawl forcing people to drive everywhere. It's health insurers who won't reimburse for Weight Watchers. It's video games. It's the lunches parents send to school. It's the lunches served by the schools.
The rise in obesity is not really new. Specialists have been worried about it for some time. The statistics indicating dramatic increases in obesity have been around for several years. It's a 20-year trend.
People who are overweight have certainly known it. That's why the number of those dieting (54 million) has risen parallel with the rise in obesity, according to an April 9 study in the Journal of the American Medical Association.
It's the mass media that are just figuring it out.
Driving the story is a widely accepted and propagated statistic: Overweight and obesity cost society $90 billion to $117 billion a year. These numbers -- representing "economic cost" -- are critical for public policy. Economic cost, tallied by figuring direct medical expenses and indirect expenses such as lost productivity, has become the wedge by which government and allied institutions justify treating your business as everybody's business. Once, personal matters were personal matters. Now personal matters remain personal unless they have economic costs.
There are those who want the obese to pay for their obesity, so as not to burden the rest of society. Some proposals under consideration -- extra taxes on fattening foods, for example -- would shift the economic costs to me, in part to discourage the behavior which has supposedly led to my body mass index and in part, I suspect, to punish.
Allow me to respond personally to those behind these ideas.
Let's make a deal. If you would like me to pay for my body mass index, I will come back to you and find something you owe me.
Do you overwork, and suffer from workplace stress? That's $30 billion a year, says the International Labor Organization. Hand it over.
Do you bike long distances or run marathons or lift weights or do Eskimo rolls in a kayak or go boating? Injuries from recreational activities cost $26 billion, says the American Academy of Orthopedic Surgeons. Pay up.
And don't get me started on occupational injuries, mental illness, bad driving, heavy drinking, body piercing and all the rest. All diseases and injuries -- and the behavior associated with them -- have economic costs.
Here's how it works practically. Most of us engage in risky behavior and are free to do so. When risky behavior becomes expensive behavior for society, our freedom shrinks. We get browbeaten. Or our behavior is made to seem antisocial through a campaign of negative publicity. Whatever makes our risky behavior possible -- say, fatty foods or fast cars or maybe someday skateboards -- gets taxed, possibly out of existence. It's not exactly Big Brother. Big Mother is more like it.
But how do we determine which costly behaviors are crises requiring institutional mobilization and intervention and which are not? Do we just start with the highest cost and work our way down?
At this point, the economic intervention model fails us and something pernicious takes over. The test becomes: Who can generate the most publicity? Whose costly behavior is also distasteful to a majority or perceived as immoral? We all remember the initial response to AIDS, a disease that is now viewed with appropriate compassion.
Fat people are already disfavored -- by employers, by insurance companies, even by other fat people. In addition to having economic costs, obesity is considered unattractive and connotes, to many, slothfulness. The current cries of alarm may only make things worse.
I am not in favor of obesity. Who is? Even the Bush administration -- willing to overlook air and water pollution -- has joined the crusade against obesity. I accept that obesity is dangerously on the rise. I favor public health measures to alert us to its dangers and to help us slim down.
But assertions that we are in crisis tend to encourage crisis responses. Obesity is too complicated for that.
Consider, for example, the statistics showing a great rise in obesity among Americans. The definition of overweight and obesity is based on body mass index. Body mass index is a numeric scale based on a ratio of height to weight. Go to the Web site of the Centers for Disease Control (www.cdc.gov
) and find their little body mass index calculator. I did.
A man 6 feet tall, according to the calculator, is obese if he weighs 280 pounds. That could make sense. He would still be obese if he lost 55 pounds and weighed in at 225. That makes less sense. He's "normal" at 160 pounds, which makes sense. But he's also normal at 137 pounds, which makes no sense at all.
By the body mass index, a man who is 5-foot-7 is "normal" at 120 pounds. Does that sound right? I am 5-foot-71/2. I once got down to 160 and looked drawn and emaciated. I hate to think how I'd look and feel at 120. Currently, I weigh 194 and am technically obese. But I play tennis with my 8-year-old, go biking and kayaking, work out at a gym and feel pretty good. I have a stocky build, as did my father and both grandfathers.
I am, of course, taking the body mass index too literally. It's a range. The CDC says that many factors, including muscle mass, bone structure and family history must be considered. Body mass index is "only one piece of a personal health profile," according to the Web site. It's a screening device, after which one may decide whether to see a physician.
In other words, it's crude. Yet its crudeness does not prevent it from being applied to the entire population. Nor does it prevent the CDC and other health professionals from declaring that 64 percent of us are overweight and nearly half of that number, or about 30 percent, are obese, and that obesity has increased dramatically -- in fact, doubled -- in the past 20 years.
Calculating that increase is difficult because the data over time are not really comparable. The definition of obesity keeps changing. You may remember the day in the summer of 1998 when about 25 million Americans became overweight overnight. That was because the official definition of overweight changed -- significantly. On one day, a man 5 feet, 10 inches tall weighing 184 pounds was normal. The next morning, he was nine pounds overweight.
The estimates of economic costs are even more crude. The medical literature says that most diseases connected with obesity tend to have multiple causes, some of which are indeterminate. Do you have sufficient faith in statisticians to believe that they can slice and dice the costs of these diseases and declare with any precision that obesity is responsible for X percent or Y percent versus, say, family history or smoking or air pollution or stress or hypertension?
The health care professions and policymakers, of course, need these numbers to set priorities, raise money for their research and, necessarily, to raise alarm. But the news media find them irresistible and take them literally. This way, something complicated becomes simple.
But obesity is not simple. I recommend the April 9 edition of the Journal of the American Medical Association to anyone interested in this issue. It's entirely devoted to obesity. What becomes immediately apparent even to a lay reader is this: When it comes to obesity, as a professor of medicine writes, "many mysteries remain."
Can we, then, engage in such foolishness as body-mass-index report cards? Some school systems (Chicago, and one local school system in Arkansas) think so. I can hear the conversations over the dinner table at home: "You did great at math, dear. But you flunked the fat test. Thin out." Wasn't it just a few years ago that we were so worried that kids were so worried about their bodies? Whatever became of the "self-esteem" crisis?
I'm a layman, not a physician. I don't question the seriousness of the obesity problem. But there's no need for panic.
On behalf of overweight people everywhere, I ask, please, call off the dogs.
Fred Barbash, a former editor and reporter for The Washington Post, is a freelance writer currently working for KidsPost.