‘Obesity rates have been flat for over a decade’

Paul Campos answers your questions on soda taxes, 'eating disordered' academics and the snobbery of the obesity panic-mongers.

I saw a startling statistic a little while ago that suggested that nearly one in six African Americans is not just obese but morbidly obese. Why do you think African Americans seem to have such a specific problem? With numbers that large, can you really call the problem for African Americans a ‘myth’? Shawn Edwards

Interestingly, studies of this issue have found no correlation whatsoever between increased mortality risk and even very high levels of obesity among African American women in particular. I don’t think it’s coincidental that black women have on average better body images than white women, lower prevalence of eating disorders, and no observable mortality risk increase associated with even very high weight. Of course, the weight loss industry is working hard to make women of colour feel as bad about their bodies as white women, so whether this difference subsists remains to be seen.

I like your sceptical attitude, Paul. But when Harvard professor of medicine Walter Willett says I should be worried about obesity and a law professor from Colorado says I should not, it seems like the Harvard guy is the expert. Why should I believe you? (I’m all ears, by the way.) Grainne Fitzgerald

Data are data: you don’t need a medical degree to interpret an epidemiological study. Walter Willett is in my opinion an eating disordered individual who is projecting his increasingly bizarre obsession with the supposed dangers of body weight on to data that directly contradict his views in a very powerful way. His reaction to the Flegal study, which consisted of calling it ‘rubbish’ without managing to make a single cogent criticism of its methods or conclusions, was an intellectual disgrace, and suggests that Harvard University has at least one charlatan on its faculty.

To what extent do you think rising obesity panic is a contemporary proxy for increasingly socially less acceptable prejudices such as class and/or race? James Hayward

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Given the strong correlation between fatness and both lower SES and non-whiteness there are good reasons to believe that it is functioning as this sort of proxy.

Who gains from obesity panic and why? For instance, what kinds of political capital or legitimacy can be gained by being seen to ‘punish’ fat people? James Hayward

Many powerful social interests benefit financially from obesity panic, including the pharmaceutical industry (diet drugs have fantastic profit potential if an even minimally effective non-fatal one could be developed), the weight loss industry in its many guises, and public health authorities who need to whip up panic to ensure continued funding for their pet projects.

Academia’s response to the recent Flegal study in the Journal of the American Medical Association has been overwhelmingly negative. However, the majority of the concern seems to have been directed toward the social and behavioural implications of accepting the conclusion rather than whether the conclusion is correct or not. With the exception of your New York Times op-ed (and the coverage by Timandra Harkness on spiked), the media seem to have glossed over this distinction when publishing quotes and stories of criticism of the study. Given that there seem to be a lot of parties who are at best unwilling to challenge, or at worst invested in preserving the status quo of obesity panic, how can an effective counter-narrative be told? James Hayward

I am of the old-fashioned opinion that evidence and logic can actually win out – if only in the long run – over irrational hysteria and prejudice. The very fact that Flegal’s study and others like it are appearing in the most prestigious medical journals, while an opinion piece such as mine gets published in America’s most prominent newspaper, are signs of real progress.

I keep reading reports of research suggesting that we’re all going to keep on getting fatter, with scary percentages of the population being obese by 2050. Do you think there is any merit to those claims? Marie Wallace

Obesity rates have been flat all around the developed world for more than a decade now. This is chronicled in detail in Australian researcher Michael Gard’s recent book The End of the Obesity Epidemic.

What do you think about bans on big sodas and junk-food taxes? I don’t think anyone would argue that 64-ounce sodas are a sensible idea, so why not just ban them or tax the hell out of them? Janet Lawrence

There is no evidence that fat people drink more soda or eat more junk food than thin people. Such proposals are folk psychology masquerading as rational public health interventions.

How much does genetics affect obesity? I’m always struck by how big Pacific islanders are compared to pretty much everyone else, apart from Americans maybe. Is it genes or diet that makes that difference? Tom Wilson

The genetic component in variation in body mass is extremely powerful. Studies of identical twins indicate that the solid majority of variation in body mass between individuals can be accounted for by genetic differences. The Pacific islanders are genetically predisposed to be extremely efficient at storing caloric energy. Naturally they will be quite fat on average if they are not on the verge of starvation (as many of them were until quite recently). The average body mass in Polynesia has skyrocketed over the past couple of generations, while life expectancy on these islands has improved by about 30 per cent over the same time period. This is just one of an endless number of examples of how economic development makes people fat and greatly improves overall public health.

In the UK we have a lot of NHS resources devoted to non-clinical work, eg, good-health promotion or bad-health prevention, call it what you wish. Examples are the Child Health Promotion Programme, now called the Healthy Child Programme, Change4Life, 5-a-Day etc. They are well-intentioned, and presumably justified on the grounds that if diabetes, heart disease, etc can be reduced by promoting behavioural changes then the cost to the taxpayer of the clinical side of the NHS should come down.

Is there any evidence that this is happening, either in the UK, US or any other country? And if so, what for you is the health-promotion industry’s flagship success story or best card? And which for you is the most embarassing failure for the health-promotion industry, the programme that was shown by the statisticians to have had least effect for the money spent, and may even have made the problem worse? Andy Carey

It’s unknown whether health promotion programmes among children produce improvement in long-term health outcomes. What is known is that they don’t produce any significant weight loss among children. In this latter respect they are identical to health promotion programmes among adults. Health promotion programmes among adults do in some cases lead to improvement in risk factors for diseases such as CVD and diabetes. But these improvements are quite independent of any weight loss such programmes produce, which is minimal to non-existent, and does not correlate with the observed improvements. (In other words, there’s no ‘dose response’ between weight loss and health improvement, to use the technical jargon).

Paul Campos is professor of law at the University of Colorado at Boulder and author of The Obesity Myth: Why America’s Obsession with Weight Is Hazardous to Your Health, published by Gotham Books.

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