Friday, October 08, 2010

The Fat Police are Coming!

KSL recently posted this article with the stunning headline, “Americans have distorted view of health, weight.” And they don’t mean that it’s distorted in a good way. The photo associated with the article depicts the torso of a morbidly obese woman. (Was that really necessary? I see enough of that everywhere I go.)

For years we have all been treated to endless hand wringing over the indisputable fact that Americans are getting fatter. Almost every newspaper, newscast, and news website nowadays includes some reference to our nation’s “obesity epidemic.”

Who could have predicted back in the days of Soylent Green and alarmists loudly prophesying that billions would starve to death in the upcoming food shortages that 3½ decades later we’d instead be alarmed about ever increasing obesity in every age, income, and race demographic? Somehow even the “poor” and “hungry” are too fat nowadays.

The KSL article cited is a fine example of the fat news fare that is now part of our everyday news diet. It is reported that researchers found that Americans “think they're thinner or healthier than they actually are.” Oh, horror of horrors. How did researchers reach this earth shattering conclusion?

Hello, Fatso
Well, they started out by calling people on the phone. My college statistics professor told us to always be suspicious of telephone surveys because they have a very low verification factor and easily employ manipulative methodologies. Today you could add that it’s difficult to get a representative sample, given that most respondents to telephone surveys still use land lines, apparently have no caller ID, and have time to waste answering some stranger’s insipid questions.

Researchers had respondents tell their height and weight so that Body Mass Index score and category could be calculated. Then they asked respondents which weight category they thought they fell into.

Lots of people that ranked above normal on the BMI scale put themselves in a lower category than the one they actually fell into. 30% of those in the overweight category said they were normal. 70% of those in the obese category said they were normal. 60% of those in the morbidly obese category said they were merely obese.

It’s time to call the fat police. We’ve got an epidemic of people being unable to accurately state where they fall on the BMI scale. (At least among people that are willing to give out personal information to strangers over the phone.) Isn’t this a lot like missing a question on those cleverly worded quizzes we used to hate in school?

The Wrong Measuring Stick
This all raises a few questions in my mind. What is the BMI? How did they come up with the BMI categories? How useful is it for people to know which BMI category they fall into?

For starters, BMI’s developers affirmed that the index was “appropriate for population studies, and inappropriate for individual diagnosis.” But that latter inappropriate use is how BMI has mostly been used. This, despite the fact that the index is “not generally useful in evaluation of health.”

BMI is mainly applicable to relatively sedentary middle age Caucasians of approximately average height. This is what accounted for the bulk of the study group that was the basis for BMI. Those that vary from these controlling factors are likely to produce a less accurate BMI measurement. If you’re tall, short, lean, black, or Asian for example, your BMI measurement less accurate.

Having followed a bodybuilding regimen for years, I am particularly critical of the inability of BMI to delineate between lean body mass and fat. While I do rank in the “normal” BMI category, I know people that are very lean and muscular that rank as obese. Conversely, BMI also tends to under represent body fat among a large segment of the population.

The BMI categories were developed using the same limited (and dated) data mentioned above. What was normal for this population in 1960s when the measurements were being taken is by definition not the same as today’s normal. BMI ignores this fact and insists that some historical normal distribution is in fact normal. One might be able to argue that it’s more ideal, but it’s not “normal.”

The categories above normal were somewhat arbitrarily defined. What does it really matter if your BMI is 29 (overweight) or 30 (obese class 1)? How much does it matter in real life if your BMI is 30 and you incorrectly put yourself in the overweight class?

So far we have established that BMI is flawed and is not useful for individual health interpretations. Yet the whole basis of the KSL article and the study it reports on is that people are bad if they don’t use — or rather, they don’t abuse — BMI in this way.

What the Study Really Shows
The study does show that people can look at their rolls of fat in the mirror and think that they’re relatively normal. Well, heck, just wander around anywhere in America and you’ll see that these folks aren’t far off the mark. They are normal!

As Americans have gotten fatter, fatter Americans are the norm. (See study on changing BMI distribution.) When 34% of American adults are “overweight”, 34% are “obese,” and another 3% are morbidly obese, how can you say that the 29% that rank below being overweight represents normal? You can’t if you’re a statistician. I guess you can if you’re an activist.

Besides, wasn’t it recently reported that Americans actually have a more realistic view of their weight problem than used to be the case? What we have here is a case of somebody wasting money on a relatively useless telephone survey. Who footed the bill for the silly survey anyway? I went to the Harris Interactive website, but it wasn’t immediately clear where all of the funds came from; although, the medical news service HealthDay is presumably the main source of the cash.

Enough Nagging
It would seem that Americans are getting tired of the overabundance of fat news. Or maybe it’s just that they’ve noticed how utterly ineffective this overweening moralistic nag-a-thon is. While this constant pestering and supercilious preaching has succeeded in increased bigotry toward the non-slender among us, it has done little to actually stem the trend of our expanding waistlines.

Last month, the editors of the Chicago Tribune put out a pointed editorial titled We Know We’re Fat. Citing studies showing that people are becoming more realistic about their weight problem, the editors wrote, “Not only are we fat, fellow Americans, but we know that we're fat. Inexplicably, we accept it. We've … forgiven ourselves.”

The CT editors note the ineffectiveness and liberty killing effects of current and potential government programs aimed at tackling the obesity epidemic. After running through a list of things we all know we’re supposed to do to maintain a healthy weight, including eating right and exercising, the CT editors conclude, “Satisfied? Now mind your own business.”

We Know What’s Best for You
But that’s just the point. There are those among us that will never be satisfied with minding their own business. When it comes to obesity, they do not see it as an individual issue. To them it is a matter of “public health.” How so?

It is claimed that nowadays we have some kind of collective right to grieve over what we view to be the premature death of any individual. It is further asserted that the collective has some kind of right not to be subjected to this kind of grief. Therefore, the collective — the ruling class and their bureaucratic minions — have a right to force people to refrain from engaging in unapproved activities that might reduce their lifespans, including the consumption of junk foods, for example.

Even this argument doesn’t wash with most people. Those that would rule over others need something more. Enter the tool of ever increasing socialization of medical expenses. Now that donut you are eating not only causes us grief as it cuts off 20 seconds of your life, that donut is going to increase the government and its crony businesses $1 in future medical expenses.

Now the ruling class has a financial argument to regulate what you eat. And while nothing they do is likely to have much impact on our waistlines, this reality will not stop them from making life less enjoyable for everyone. I suspect that Americans are starting to tune out the professional fat grievance industry already.

Tuning Out
Huge percentages of American adults have tried some form of weight loss. The vast majority of these have achieved little or no permanent weight loss. Speaking from experience — I weigh 65 lbs less than I weighed 22 years ago — it is extremely difficult to lose significant amounts of weight. Once lost, it takes continual vigilance to keep the weight off. It requires a level of near fanaticism that few can maintain over the long haul. Or even over the short haul, for that matter.

To most Americans that exceed ideal weight, the constant harangue about their condition is superfluous. Nothing seems to really work, so why bother? Why pay attention to those loudly and repeatedly declaring that being fat is evil when you feel powerless to do anything about it?

Mark Twain once said, “The only way to keep your health is to eat what you don't want, drink what you don't like, and do what you'd rather not.” Even a century ago, people didn’t like eating “healthy” foods or exercising.

Most people know that they might be able to achieve a healthy weight if they turned their diet and spare time into miserable but physically healthy activities. They’re just not sure the tradeoff would be worth it. There’s more to life than being the perfect weight. Amazing to some folks is the fact that many think there’s more to life than living a long time.

So for all of their exposure, many of the intended targets of the anti-fat industry are likely to ignore the activists’ nagging. In fact, like loud TV commercials and ubiquitous Internet ads, the sheer volume of the messages might result in people developing a mental defense mechanism that allows them to block out the messages.

As long as there are people willing to throw cash at the fat harassment industry, I suspect we’ll continue to be treated to a steady diet of fat-is-bad nagging. It’s just that nobody may be paying attention.

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