So I watched the season premiere of Biggest Loser last night. Thinking it over now the clicking of social media has faded for a bit, I’m punting around some of my own thoughts on the subject of public health and obesity.
Something that concerns me is that much of the commentary on obesity seems less concerned to explain as to absolve. In one of the Melbourne Age’s spinoff websites, an author has said
While we might not like to admit in our supposedly classless society, where everything is a matter of individual choice, there are clear structural links between being obese and being poor.
This doesn’t seem particularly comforting as an analytical tack. Assuming Jesus was right, and the poor will always be with us (1), then we may be looking at a pretty well perpetual problem. Moreover, it suggests a kind of economic determinism that writes off an entire slab of humanity.
Equally worrying is the school of thought that blames weight pretty well entirely on one’s genetics –
Weight is about 50% – 80% heritable … Height, for comparison, isn’t 100% heritable (I’ve seen it pegged in the 70% – 80% range but I still need to dig up this source).
Would you suggest that someone who’s too tall get shorter? No? Didn’t think so. You’ve been sold a pack of lies by the healthists and their corporate sponsors, the diet industry.
This actually seems to harken back to an older ‘biological determinism’ – at least to the 1920s belief that a person’s glands entirely controlled their destiny (2). This school of thought is no more attractive for having a nasty link to the sort of eugenic thinking that brought us the decision in Buck v Bell 274 U.S. 200 (1927).
Both ideas in with a pattern recently identified by a British doctor in which patients wash their hands of responsibility for their health (3):
It would be easy to blame Britain’s fatness on lifestyle changes, but the worst of it is attitude. People just aren’t bothering to lose weight any more. Perhaps obesity is viewed as more normal. But this is also down to the attitude that we doctors increasingly encounter in our consulting rooms: the reluctance of patients to accept that ailments can be blamed on their behaviour, for which they are reluctant to take responsibility.
Patients blame obesity on the government, cunning food manufacturers, their parents and their genes. They demand fat-loss pills on the NHS and stomach-stapling surgery as a right. In a world where health care is becoming consumerised, patients see themselves as customers. There’s not much demand for hard truths.
Neither, however, seems to match well with external reality. A recent article explored the notion of ‘evidence based medicine’ (EBM), an analytical approach in which evidence is “derived from the best available, methodologically rigorous, statistically powerful experimental studies” (4) and which is powerfully argued as the gold standard of knowledge of medical causation. One database of EBM studies is the Cochrane Summaries. These show consistently better health outcomes deriving from – you guessed it – diet and exercise (5). This seems to match with what appears to be clinical knowledge: one obstetrician, commenting on the Albury-Wodonga area (6),
… said it was no surprise why people became so obese.
“They seem to be eating the wrong type of food, including sweet drinks, all loaded with calories,” he said.
“They have huge buckets of popcorn at the pictures, huge meals at takeaways, food snacks between meals.
“Healthy food and smaller portions should be encouraged.”
Dr Mourik said there was no secret to how to reduce weight. Less than 1 per cent of obese people had a medical cause — the rest ate more calories than they burned.
“Eat less fattening food and exercise more,”
What are we left with, then? A deep discomfort with saying – loudly and judgmentally – “put down the fork and put on the runners” validates and cleanses the conscience of people whose actions will bring about their untimely and needless ill health and death (7). What is worse, it corrodes their ability to decide whether to be healthy or not. In the end, it is this ability to choose rationally – at least to have the option of doing so – that is the hallmark of humanity
(1) Mark 14:7; Matt 26:11; John 12:8.
(2) Consider Michael Pettit’s ‘Becoming Glandular: Endocrinology, Mass Culture, and Experimental Lives in the Interwar Age’ in the latest issue of the American Historical Review.
(3) Max Pemberton, ‘Obesity is not a disease’, Spectator (UK), 12 October 2013.
(4) T.M. Davidson and C.P. Guzelian, ‘Evidence Based Medicine: The (only) means for distinguishing knowledge of medical causation from expert opinion in the courtroom’, 47 Tort Trial and Ins. Prac. L.J. 741 at 747. (2012)
(5) See Thomas D, Elliott EJ, Baur L. Low glycaemic index or low glycaemic load diets for overweight and obesity. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD005105. DOI: 10.1002/14651858.CD005105.pub2; Shaw KA, Gennat HC, O’Rourke P, Del Mar C. Exercise for overweight or obesity. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD003817. DOI: 10.1002/14651858.CD003817; and Orozco LJ, Buchleitner AM, Gimenez-Perez G, Roqué i Figuls M, Richter B, Mauricio D. Exercise or exercise and diet for preventing type 2 diabetes mellitus. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD003054. DOI: 10.1002/14651858.CD003054.pub3.
(6) Nigel McNay, ‘Our fat ‘epidemic’: Stop eating, says top doc’, Border Mail, 8 April 2013
(7) See the articles noted in (3) and (6)