Weight watchers

‘You’re getting sick as a result of your excess fat, and as a result of the fat lifestyle that leads to being fat.’

This is Greg Critser’s diagnosis for the ballooning problem of obesity in America and the UK. His book, Fat Land: How Americans Became the Fattest People in the World has attracted plenty of attention, and a fair amount of criticism, by suggesting that obesity is increasing and it is a problem that cannot be ignored any longer.

Critser argues that as bodyweight increases past the point of clinical obesity, so the likelihood of developing a number of chronic diseases increases. ‘The research is very clear that in terms of health problems, your risks go way up: for type II diabetes (1), glucose intolerance, coronary heart disease, even things like asthma, osteoarthritis and sleep apnoea’, he says.

A person is defined as clinically obese if their body mass index is 30 or above. Body mass index (BMI) is simply a ratio of weight to height: weight in kilograms divided by the square of height in metres (kg/m²). A BMI between 20 and 25 is usually defined as healthy (2).

Critser’s point about the relationship between obesity and ill-health needs some clarification, however. Studies that have made a link between rising body mass index and mortality generally note that the risk rises exponentially. In other words, while the risk of mortality starts to rise when someone becomes clinically obese, it only doubles when someone is 50 percent or more heavier than their ‘ideal’ weight, and accelerates thereafter (3).

Moreover, as people get older, age seems to become a much more important predictor of mortality, no matter how fat you get. In younger age groups, where the obesity factor seems to be strongest, the chances of dying are low in any event. And the whole discussion assumes that just because obesity is associated with increased risk of disease, obesity is the cause. There is, for example, good evidence to suggest that fitness is as important as fatness – fat people tend not to be very fit.

Obesity may have some negative health effects, but the notion of an epidemic of obesity needs to be taken with a large pinch of salt. Life expectancy is rising and is expected to continue to rise. Waist sizes may be expanding, but, as the graph below indicates, so are life spans.



_{[source: UK Office of National Statistics]}

Nonetheless, people do seem to be getting heavier, and that weight increase does seem to be quite marked in the past 20 years or so. What has caused this rise in obesity? The weakest aspect of his book is that Critser covers such a multitude of factors, it is difficult to determine which he thinks are the most important.

The list of suspects he discusses include: class; poverty; the agricultural lobby pushing cheap food; high-fructose corn syrup and palm oil; super-sized fast-food meals; skilful marketing by fast-food chains; fast-food concessions in schools, driven by education budget cuts; outsourcing of school meals; permissive parents; changing family structures causing a fall in food preparation at home; an excessive variety of new food products; lack of self-control, and the loss of moral strictures against gluttony; bigger clothes sizes; weakening of state-led exercise initiatives, particularly in schools; relaxation of official advice on appropriate weight levels; race; excessive concern with eating disorders; and insulin resistance caused by excessive refined carbohydrates.

In fact, reading the book could provide ammunition for any axe you wish to grind. Anti-corporatists will enjoy the criticism of the fast-food chains. Globalisation can be blamed for making our food a tool of free trade. Fundamentalist Christians will concur as Critser laments the loss of the sin of gluttony. In that respect, Critser is all things to all men, a man for all seasonings.

So, which factors are most important? ‘I think there are two factors that probably are most important’, says Critser. ‘One is the kind of co-dependent linkage between the modern parent, and convenience foods or fast foods’, he says. Two-income families, with little spare time, tend to eat together less, and when they do, they are more likely to eat more fattening convenience and take-away foods.

But Critser fails to distinguish between what we eat and how much we eat. He notes how the type of sweeteners and oils used, especially in fast-food, changed from the late 1970s onwards. Yet the suggestion that the kinds of things we eat today are somehow worse than the relatively monotonous food of the past, simply because the calories come in a different form, seems implausible.

The ‘second big factor’, for Critser, is ‘the expenditure of calories. What we have to realise is that, essentially, we are paid to be sedate. We have to pay money and time to get rid of calories. Really, it’s a reversal of what, historically, human beings have had to do’. It may well be the case that we eat too much given the declining level of exercise we take. But the quality and variety of our food is getting better, not worse.

The main criticism that Critser has faced is his emphasis on personal responsibility. Many critics believe he should have spent more time attacking fast-food companies or the state of the environment. He thinks, however, that ultimately we can only rely on ourselves. ‘My point is that that’s really all we’ve got’, he says. ‘My feeling is that if you wait around for government, for academics, or for professional political people, to start doing something about this for your kids, you’re just going to see a huge fat kid.’

In particular, he emphasises the need to teach children good habits. ‘I don’t think value-added taxes and requiring people to lose weight in order to get their NHS appointment is the way to go. If very early on, the child is taught to eat a certain way, to eat with a certain structure, to not snack, really almost prevented from snacking, we know that child is going to go into adult life, as someone who has the ability to say “no”.’

Critser believes we simply need to learn how to deal with a historical novelty, the fact that it isn’t just a small minority of society that has plenty to eat and is freed from back-breaking toil.

‘I like to say that what we are learning as the middle class now is what the rich, at least the rich who managed to live through being rich, found out a long time ago. That is: the price of living in a modern, abundant culture is twofold. One is restraint and moderation, conscious moderation even. And the second is being consciously vigorous every day. The rich learned that a long time ago. Now the middle class really needs to learn that.’

Whether we really need to be ‘consciously vigorous’ every day about our diet and that of our children is questionable. But in fact, it is this emphasis on personal responsibility that is the saving grace of Critser’s book, and that sets it apart from a culture in which obesity is labelled, not as a cause of disease, but as a disease in itself.

This culture presents us as helpless victims of our own fat, in constant need of government intervention. At a time when the legitimacy of many established institutions has been undermined, it is a role that government, at least in the UK, has been only too happy to play.

We are not being killed off by an epidemic of obesity. There are some seriously fat people who may develop health problems, and many more who want to lose weight for any number of reasons. The bottom line is, if we do decide to lose weight, we don’t need a helping hand from the public health authorities: we need to stop helping ourselves to more food.

Buy Fat Land: How Americans Became the Fattest People in the World, by Greg Critser, from Amazon (UK) or Amazon (USA).

(1) Type II diabetes is when the body produces too little insulin or cannot respond to insulin properly. See Diabetes, by Dr Beckie Lang, BBC News

(2) See, for example, Weight Loss Information

(3) ‘Evidence from studies suggests that for young adults in general the risk of mortality for someone with a BMI of 30 is about 50 percent higher than that for someone with a healthy BMI (20 to 25), and with a BMI of 35, the risk is more than doubled’. Tackling Obesity in England, National Audit Office, 15 February 2001