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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