Fat Politics: The Real Story behind America's Obesity

Epidemic

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Fat Politics
The Real Story
Behind America’s
Obesity Epidemic

J. ERIC OLIVER

2006
Oxford University Press, Inc., publishes works that
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Copyright © 2006 by J. Eric Oliver

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Library of Congress Cataloging-in-Publication Data

Oliver, J. Eric, 1966–
Fat politics : the real story behind America’s obesity epidemic / J. Eric Oliver.
p. ; cm.
ISBN-13: 978-0-19-516936-2
ISBN-10: 0-19-516936-0
1. Obesity—United States. I. Title.
[DNLM: 1. Obesity—United States. 2. Health—United States.
3. Health Policy—United States. 4. Prejudice—United States.
5. Social Perception—United States. WD 210 O48f 2005]
RA645.O23O45 2005
614.5’9398—dc22
2005012983

987654321

Printed in the United States of America

on acid-free paper
For Thea
This page intentionally left blank
 Contents

Acknowledgments ix

Introduction—A Big, Fat Problem 1

One What Is Fat? 14

Two How Obesity Became an Epidemic Disease 36

Three Why We Hate Fat People 60

Four Women, Fat, and the Sexual Market 79

Five Fat Genes and the Obesity Blame Game 100

Six Food and Weight Gain: Super Sized Misperceptions 122

Seven Sloth, Capitalism, and the Paradox of Freedom 143

Eight Obesity Policy: The Fix Is In 159

Nine Unmaking the Obesity Epidemic 181

Notes 191

Index 220

vii
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 Acknowledgments

This was not the book I intended to write.

When I first became interested in obesity, I, like most Americans,
assumed it was a major health problem. At the time, I was on a post-
doctoral fellowship at Yale University sponsored by the Robert Wood
Johnson Foundation. The fellowship is aimed at getting young political
scientists, like myself, interested in doing “health-related” research. In
trolling for a topic, I happened across an article that described the soar-
ing growth of obesity and its catastrophic consequences. I became in-
trigued and soon had all sorts of questions about how the “obesity
epidemic” might be handled as a political issue. Yet when I went to look
for some answers to these questions, I found that very little had been
written. Politically speaking, obesity was largely uncharted terrain.
Luckily for me, Yale also happens to be the home of Kelly Brownell,
one of the nation’s leading obesity researchers. Ever generous, Kelly
helped get me started in my research and put me in touch with numer-
ous other experts who were equally helpful, including James Hill, Steve
Blair, Jon Peters, and William Dietz. In the summer of 2001, I was able
to bring these researchers together with other social scientists for a mini-
conference. Many of the participants, including John Cawley, David
Cutler, Rogan Kersh, Taeku Lee, James Morone, and Abigail Saguy, pro-
vided many great ideas. After three days of discussions, I had a clear
idea about a book I wanted to write: how was America going to over-
come the political challenges posed by the obesity epidemic? Soon af-
terward, I drafted a proposal and got a contract from Oxford University
Press to write this book.
Then I started to do the research. In early 2002, obesity was only
beginning to emerge as a major news item and so my first task was to

ix
x | Acknowledgments

prove that it was, in fact, the major health and economic threat I pre-
sumed it to be. I started to read through the research papers and sci-
ence journals. Although I had no advanced training in medicine or
biology, I had done a lot of graduate work in statistics and even though
much of the terminology was obtuse, I could still evaluate the basic
estimates and the data on which many of the health claims were made.
And that’s when my mind began to change—for the more papers I
read and the more experts I interviewed, the more I realized that there
was a real problem with my basic argument. Most of the claims about
obesity were based on very shaky evidence. (I didn’t know it at the
time, but, independently, Paul Campos, author of The Obesity Myth, was
coming to a similar conclusion.) I was astonished about how weak most
of the statistical claims really were. Public opinion researchers, like
myself, often get accused of drawing unwarranted conclusions, but what
we did paled next to the breathtaking inferential leaps that were regu-
larly made in many of the top medical journals. Based on the statistics,
most of charges saying that obesity caused various diseases or that obe-
sity caused thousands of deaths were simply not supported. Yet consis-
tently, these pseudofindings were promulgated as fact.
I also discovered another dirty secret about obesity research; many
of the scientists who were sounding the alarms about the “obesity epi-
demic” were also on the payrolls of various pharmaceutical and weight-
loss companies. In the course of my interviews, I started hearing stories
about contradictory research that was hushed-up, bogus numbers be-
ing reported by health agencies, and shifty “scientific” organizations
that were no more than fronts for the pharmaceutical industry. The
politics of obesity were more different and interesting than I first knew.
What I thought was an epidemic began to look at lot more like a po-
litically orchestrated campaign to capitalize on America’s growing
weight.
Around this time I also started to confront my own fat prejudices.
Early on in my research, I heard about fat rights groups, including the
National Association to Advance Fat Acceptance, who argued that obe-
sity was not a health risk. Like many people, I had largely dismissed
them as a fringe and marginal group; after all, who was this weird bunch
of people who were actually proud of being fat? But once I realized they
were right about a lot of the junk science on obesity, I started to seriously
consider their other arguments, particularly about the pervasiveness of
 Acknowledgments | xi

fat prejudice in the United States. I realized that my own preconceptions

coming into this project were shaped more by my own antifat biases than
by any facts. If I was going to clearly examine the nature of America’s
obesity epidemic, I would have to come to terms with what was making
me so judgmental against fat people. Once again, I was fortunate, and I
came into contact with many generous activists including Jennifer
Portnick, Marilyn Wann, and, most important, Lynn McAfee, a long-time
fat activist and perpetual thorn in the side of the obesity research com-
munity. Although not a formally trained scientist, Lynn knows more about
obesity than most “experts” and has a clearer perspective on this issue
than anyone; she is also one of the most courageous people I’ve ever met.
Lynn taught me a lot about speaking truth to power.
I also enjoyed tremendous support from a number of nonprofit or-
ganizations including the Robert Wood Johnson Foundation; the Time-
Share Experiments for the Social Sciences, a program funded by the
National Science Foundation; and the Russell Sage Foundation. The
International Food Information Council provided an invaluable service
with their daily Listserve of obesity news items. The University of Chi-
cago was also supportive, allowing time off to write and letting me
teach a seminar on this subject. Those sources aside, I did not receive
any financial assistance from any food, restaurant, or beverage indus-
try nor any party concerned with obesity policy nor any pharmaceuti-
cal company.
In addition, I have enjoyed critiques, comments, and research help
from a number of academic colleagues and researchers including John
Brehm, Paul Campos, Cathy Cohen, Jeffrey Friedman, Heena Patel,
Bruce Schneider, Gary Taubes, Lisa Wedeen, and Diane Whitmore.
Kathryn Flegal at the National Center for Health Statistics was particu-
larly helpful in steering me through the methodological controversies.
Although some may disagree with my take on this issue, all were ex-
tremely generous and forthcoming with their time and ideas. I am also
grateful to my research assistants Zachary Callen, Andrew Dilts, Shang
Ha, Matsutaka Harada, and Stephan Whitaker, as well as the students
in my obesity seminars at the University of Chicago. My agent, Eliza-
beth Sheinkmen, helped me get the book project started and set me up
with Oxford University Press and its great staff. At Oxford, I was ex-
tremely fortunate in having Tim Bartlett as an editor. The stamp of his
keen insight, patience, and attentiveness appears throughout this work.
 Finally, and most importantly, I could not have written this book
without the unflagging support of my wife, Thea Goodman. Not only
did she provide many keen ideas and much critical feedback, she grace-
fully endured my stress, distraction, and obsession, as well as count-
less dinner conversations dominated by this topic. I promise my next
book will be on something that doesn’t make us feel self-conscious about
what we are eating.
JUNE 2005, OYSTER BAY, NEW YORK
 Introduction:
A Big, Fat Problem

Over the past two decades, a plague has been sighted in our
midst. It is said to afflict one in four Americans and kill as many as 400,000
of us every year. It is purported to cause heart disease, cancer, diabetes,
asthma, hypertension, and numerous other ailments. It is estimated to
cost us 100 billion dollars annually in healthcare expenses and, accord-
ing to some, threatens to overwhelm our medical infrastructure. Surgeon
General Richard Carmona says it’s a greater threat than terrorism and
former heath and human services secretary Tommy Thompson has named
it a public health “crisis.” Congress and numerous state governments
are allocating billions of dollars in search of a cure while the media and
health organizations regularly sound the alarms.
The “disease” I’m referring to is obesity and in the United States it
has become, by most accounts, a full-scale epidemic. This certainly seems
to be borne out by the statistics: in 1980, only about a third of Ameri-
cans were considered overweight and only 13 percent were classified
as obese, rates not much greater than in 1960. But in the past twenty-
five years these numbers have skyrocketed. Today, more than 60 per-
cent of Americans are considered overweight and one in four is obese—a
two-fold increase in less than three decades. Even more alarming is the
rise in juvenile obesity; today, 15 percent of American children are con-
sidered obese, more than twice as many as in 1980. As a result of their
weight, today’s teenagers will be, according to some projections, the
first generation in modern American history to live a shorter life span
than their parents.1
America, it seems, has a big, fat problem.
Or at least this is what I thought when I started writing this book.
Like many people, I, too, believed that America’s growing weight was

1
2 | Fat Politics

a genuine health quandary. Indeed, my initial plan for this book was to
look at why we were gaining so much weight and what we could do to
stop it. But then I started to examine the evidence and a funny thing
happened—the more I read, the more I realized how misguided my
initial assumptions about obesity were.2 While it was true that Ameri-
cans were getting heavier, it was less obvious that this was putting them
in mortal danger or even that it was causing ailments such as diabetes,
heart disease, and cancer. Like many headline-grabbing issues, the truth
behind America’s “obesity epidemic” was far different than the story I
once believed.
What I came to realize was that, contrary to the conventional wis-
dom, obesity is not a problem because more than 60 percent of Ameri-
cans weigh “too much.” Nor is it a problem because hundreds of
thousands are dying from being too fat. Nor is it a problem because it
costs us hundreds of billions in healthcare expenditures. Obesity is not
a problem for any of these reasons because none of them are true. While
Americans do face many health challenges, few of these arise from our
increasing weight. Our growing weight is merely a symptom of some
fundamental changes in our diet and exercise patterns that may (or
may not) affect our health. There is, however, little evidence that obe-
sity itself is a primary cause of our health woes. In other words, telling
most Americans they need to worry about their weight is like telling
someone dying of pneumonia that they need to worry about how much
they are coughing; it conflates the real source of our health problems
with a relatively benign symptom.
Now, understandably, you might view these claims with some skep-
ticism. After all, there is no denying that America is a very fat country.
One need only take a stroll through any airport or shopping mall to
witness the ample size of our population. And our fatness does carry
some genuine health consequences—being very heavy puts more stress
on one’s joints and makes it harder to exercise, which is very important
for one’s health. Then there is all the information we get in the media
about obesity’s dangers—hardly a week goes by without some new
story about another health problem that purportedly comes from being
too fat. From fashion magazines to television shows such as The Biggest
Loser, we are surrounded by messages that fatness is not only unhealthy,
but also unsightly and immoral. And who among us doesn’t worry, at
some time, about weighing too much? Considering all our anxiety about
 Introduction | 3

our appearance and weight, it is perfectly logical to assume that our

growing obesity portends a national health catastrophe. But if you sus-
pend all these preconceptions, at least for a moment, and look briefly at
the scientific evidence, you’ll see a much different picture.
Let us start with the much-cited claim that obesity is a major killer.
In April 2004, researchers from the Centers for Disease Control and Pre-
vention (CDC) released a report in the prestigious Journal of the Ameri-
can Medical Association estimating that obesity was killing 400,000
Americans a year.3 Given that JAMA, as the journal is known, is the
most prestigious medical journal in the country and that one of the
article’s authors was the head of the CDC, this estimate had all the trap-
pings of official truth. Soon afterward, public health officials began to
use these numbers in press releases, reports, and in congressional testi-
mony as evidence that obesity was a major threat. Scientists repeatedly
cited them as a justification for further research funding to address this
important problem. Newspaper headlines across the country trumpeted
how obesity would soon overtake smoking as the number one cause of
preventable death in America.
A closer look at the numbers, however, shows that they don’t add
up. Partly, this was because the CDC researchers did not calculate the
400,000 deaths by checking to see if the weight of each person was a
factor in his or her death. Rather, they estimated a figure by comparing
the death rates of thin and heavy people using data that were nearly
thirty years old. Although heavier people tend to die more frequently
than people in mid-range weights, it is by no means clear that their
weight is the cause of their higher death rates. It is far more likely that
weight is simply a proxy for other, more important factors such as their
diet, exercise, or family medical history. The researchers, however, sim-
ply assumed that obesity was the primary cause of death, even though
there was no clear scientific rationale for this supposition.4 Moreover,
they also made a number of errors in their basic calculations. When
these facts came out (only after a congressionally initiated inquiry), the
CDC was forced to conduct an internal investigation and ended up
amending the report.
In fact, a 2005 study, also published in JAMA, by a different set of CDC
researchers, offers entirely different mortality estimates. Rather than be-
ing in peril, it appears that moderately “overweight” people live longer
than those at a “normal” weight. And instead of finding that obesity causes
4 | Fat Politics

400,000 deaths, the new study estimates that fewer than 26,000 Ameri-
cans die each year from weighing too much, a number that is even smaller
than those who are estimated to die from being “underweight.”5 Weigh-
ing “too much” is less dangerous, it seems, than weighing “too little.”
A similar problem exists with the links between obesity and most
diseases. Doctors, government health agencies, and the news media
frequently warn of the connections between being too fat and various
ailments. Time magazine, for example, recently proclaimed that “being
overweight significantly increases the risk of a long list of medical com-
plaints including coronary artery disease, congestive heart failure, hy-
pertension, diabetes, depression, deep-vein thrombosis, fatigue,
insomnia, indigestion, and impotence.”6 After reading such a long in-
dictment, it would be quite natural to assume that being fat puts your
health in grave danger. However, this, too, is a misperception. Obesity
has not been found to be a primary cause of any of these conditions. Yes,
heart disease, diabetes, and other ailments are more common among
the obese than the nonobese, but there is little evidence that adiposity
(that is, excess fat tissue) is producing these pathologies. Indeed, some
types of body fat are actually protective against many diseases, par-
ticularly for women and people over sixty-five. Nor is there clear evi-
dence that, by itself, weight loss reduces the risk of death or most diseases.
In other words, not only do we lack proof that being fat causes us to
contract most major illnesses, but we do not have any evidence that
losing weight makes us any healthier.
The same situation holds for the prognostications about how obesity
is costing Americans so much money. The researchers who estimated
that obesity costs us 100 billion dollars a year did so by calculating all
the expenses associated with treating type 2 diabetes, coronary heart
disease, hypertension, gallbladder disease, and cancer, but, like the es-
timators of deaths, they did not take into account other factors such as
diet, exercise, or genetics that also might be causing these conditions.7
Once again, they simply assumed that if you got heart disease or breast
cancer it was because you were fat.
In short, nearly all the warnings about obesity are based on little
more than loose statistical conjecture. While heart disease, cancer, stroke,
asthma, and diabetes are undoubtedly serious and costly health con-
cerns, there is no convincing evidence that such ailments arise from
our growing weight. In many respects, body weight is no different than
 Introduction | 5

any other physical traits, such as height, age, sex, skin color, and even
left-handedness that can be associated with higher rates of death and
disease. Based on our current evidence, blaming obesity for heart dis-
ease, cancer, or many other ailments is like blaming smelly clothes, yel-
low teeth, or bad breath for lung cancer instead of cigarettes; it conflates
an associated trait with its underlying cause.
Given these facts, I soon found myself trying to answer a much dif-
ferent set of questions. Rather than trying to figure out how to “solve”
the obesity problem, I realized that the more interesting question was
why so many smart and seemingly well-intentioned people were claim-
ing that obesity was a problem in the first place. Why was our growing
weight being labeled an “obesity epidemic”? What does it mean to judge
our health and well-being by how much we weigh? And what is the
real reason we are gaining weight? The answers to these questions came
as a great surprise.

The Real Sources of the

“Obesity Epidemic”

What I came to discover was that, contrary to the conventional wis-

dom, the primary source of America’s obesity epidemic is not to be
found at McDonald’s, Burger King, or Krispy Kreme Donuts. Nor is it
how little we exercise, our declining smoking rates, a “fat virus,” or
any of the other theories that are often used to explain our rising weights.
Rather, America’s obesity epidemic originates in far less conspicuous
sources.
The most important of these is America’s public health establish-
ment. Over the past two decades, a handful of scientists, doctors, and
health officials have actively campaigned to define our growing weight
as an “obesity epidemic.” They have created a very low and arbitrary
definition of what is “overweight” and “obese” so that tens of millions
of Americans, including archetypes of fitness such as President George
Bush or basketball star Michael Jordan, are now considered to “weigh
too much.” They have also inflated the dangers and distorted the sta-
tistics about weight and health, exaggerated the impact of obesity on
everything from motor accidents to air pollution. And, most important,
they have established body weight as a barometer of wellness, so that
being thin is equated with being healthy.
6 | Fat Politics

Now some of this campaign has been motivated by good intentions—

for those who are sincerely concerned with Americans’ health, the “obe-
sity epidemic” seems like an effective way to highlight the chronic
problems with Americans’ poor diet and lack of exercise. And some
sincerely believe that having too much fat leads to harm and disease,
even if the scientific evidence is inconclusive.
But much of this campaign is driven by less altruistic concerns and
more by the particular interests among the various constituent groups
within America’s public health establishment. Consider, for example,
what an obesity epidemic means for the following groups. For scien-
tists researching issues of weight, an obesity epidemic inflates their stat-
ure and allows them to get more research grants. For government health
agencies, it is a powerful rationale for increasing their programs and
budget allocations. For weight-loss companies and surgeons, it is a way
to get their services covered by Medicare and health insurance provid-
ers. And, for pharmaceutical companies it can justify the release of new
drugs, and help inflate their stock prices. The very same people who
have proclaimed that obesity is a major health problem also stand the
most to gain from it being classified as a disease. For America’s public
health establishment, an obesity epidemic is worth billions.
Of course, obesity researchers, doctors, and drug companies are not
solely to blame. Another reason why our growing weight has come to be
viewed as an “obesity epidemic” is because of our cultural biases against
body fat and fat people. It is common for white, middle-class Americans,
in particular, to think of weight as a barometer of a person’s character—
if people are fat, it is only because they are too lazy or irresponsible to
“take care” of themselves. With such a strong moral connotation, body
weight has become one of our most potent markers of social status
whereby those with the resources or wherewithal to keep themselves
thin rightly deserve their place at the top of the social ladder.
Given all the negative associations we heap on our fatness, it is no
wonder our growing weight is seen as a cause for alarm across the po-
litical spectrum. For some on the right, the obesity epidemic merely
reinforces their beliefs about the cause of the ever-widening gap be-
tween the rich and poor or between whites and minorities. After all, if
African Americans, Latinos, or the poor are becoming fatter than
America’s predominantly white elite, it is only more proof that they
lack the responsibility to take care of themselves. For others, our grow-
 Introduction | 7

ing weight highlights the precarious social position of the middle class
in an ever-stratifying America—if middle-class Americans, particularly
middle-class children, are getting fat, it surely indicates the frailty of
their own class status. And for those on the left, the growth of obesity is
further proof that large, multinational corporations are running amok,
fattening a hapless public with their billion-dollar advertising campaigns
and super size value meals. The American people, particularly the poor
and minorities who have the highest obesity rates, they argue, need to
be protected from these corporate behemoths.
Running throughout all these perspectives is a paternalistic conde-
scension toward fatness and fat people—not only do people with this
view assume that fatness is inherently bad, but they also presuppose
that fat people (that is, minorities and the poor) are too ignorant to know
that they should be thin. Thus, when the filmmaker Morgan Spurlock
sneers at the black kids who actually like McDonald’s food in his film
Super Size Me or the writer Greg Critser derides the Latinos at his local
donut shop in his book Fat Land, it is not simply because they are wor-
ried about America’s moral decline or unbridled corporate power. For
many people, trumpeting the “problem of obesity” is an opportunity
for them to express both their own moral superiority and their latent
class snobbery and racism.8
Yet, it is just these kinds of biases about fatness and its origins that
are dictating how obesity is being portrayed as a health issue. And this
is creating all kinds of inappropriate and ineffective suggestions and
responses for dealing with the “obesity epidemic.” Consider, for ex-
ample, the contradictory policies coming out of Washington and vari-
ous state legislatures. Either they assume that body weight is solely a
matter of individual responsibility, as with the Personal Responsibility
in Food Consumption Act, a congressional bill that protects fast-food
chains from lawsuits, or they assume that obesity needs to be tackled
by reining in the power of McDonald’s, Coca-Cola, and other food com-
panies as with the proposed restrictions on food advertisements and
taxes on snack foods. As a result, we now have a curious combination
of laws that simultaneously forbid people from suing restaurants for
making them fat but also prohibit schools from selling sodas and snack
foods because they allegedly cause our kids to be too heavy.
Neither of these approaches, however, will do much either to im-
prove our health or strengthen our moral fiber because they mistak-
enly equate fatness with both illness and depravity. By calling our
8 | Fat Politics

growing weight an epidemic disease, America’s public health estab-

lishment is sending a message that we can be healthy (and righteous)
by being thin. Not only is such a message inaccurate (weight loss has
not, by itself, been shown to improve most people’s health or reduce
the risk of most diseases), but it ignores the real threats to our health of
which our weight is only symptomatic. If we want to know why diabe-
tes and other diseases are on the rise in the United States, we need to
focus less on the mere fact that our weight is increasing and more on
the question of why our weight is increasing. In other words, we need
to listen to what our growing weight is trying to tell us.

Biological Responses to
the American Way of Life

From a biological perspective, fatness is simply a protective mechanism

against an irregular food supply. Our fat cells are the places where our
bodies store energy for times when food is unavailable or when we are
too busy or active to eat. Because fatness is so crucial for our survival,
our bodies have numerous means for ensuring that we retain as many
calories as possible, such as giving us an appetite for calorie-rich food
and regulating our metabolism to keep our weight within a certain
range. While some people have a metabolism that keeps them thin,
many Americans are inclined to have a weight range that tends toward
corpulence. This is particularly the case for people whose ancestors came
from places, such as Africa and parts of Asia, the Pacific Islands, and
the Americas, where a regular food supply was not always present.
These same metabolic protections are also why it is so difficult for most
people to lose weight—most of us are biologically programmed to op-
erate as if a famine is imminent.
Although our bodies may be expecting another famine, our way of
life floods us with an abundance of foods, particularly sugars and fats,
and allows us to expend little energy at work or in household chores.
When our biological safeguards against privation come into contact with
an environment of abundance and leisure, it is not surprising that many
consequences ensue. Not only do we gain weight, but our cholesterol
levels change, our insulin levels rise, and our blood pressure increases.
And it is these other metabolic changes that are behind many of
the diseases that are typically associated with being too fat. The rea-
 Introduction | 9

son that diabetes and some types of cancer are on the rise is not be-
cause Americans weigh too much, it is because their metabolisms are
out of whack. Fatness may result from the metabolic processes that
are behind these ailments, but it is the underlying metabolic processes,
and not the weight, that cause us so much trouble. So if we want to
know the real health challenges behind our growing weight, we need
to identify what is causing us to eat so many fats and sugars and to
exercise so little.
Here, again, is where political ideology and cultural stereotypes often
cloud our perceptions. Many folks, for example, like to blame our glut-
tony on the extra-large portion sizes in restaurants and supermarkets—
and with a super size value meal weighing in at 1,500 calories it is easy to
see why fast-food has been cast as such a villain. But, once again, this
stereotype is inaccurate. Americans are not consuming more calories be-
cause of how much they are eating during their meals. (Americans con-
sume only slightly more calories in their meals today than they did in the
1970s.) Rather, Americans are consuming more calories because of how
much they are eating in between their meals. The real culprit behind our
increasing wieght is snacking.
Similarly, many public health advocates and urban planners like to
blame our inactivity on cars, sprawl, and television. Given the four hours
the average American spends each day behind the wheel or in front of
the TV, this suspicion, too, is understandable. If we want to get Ameri-
cans exercising more, it seems, we need to figure out ways to get them
to drive less, watch less television, and redesign their communities to
make walking easier.
Once again, however, focusing on driving and television in order to
make Americans thinner misses the real, and important, health issue.
For the problem with both our unhealthy diet and inactivity goes be-
yond how much junk food we eat, TV we watch, or miles we drive; the
problem is with the very principles that define us as a society. Snack-
ing, driving, and television are more than simple conveniences; they
are expressions of our very core values—choice, freedom, and liberty.
Snacks, sodas, and other prepared foods have liberated the American
meal away from the domestic confines of the home, allowing us to eat
by ourselves, when and where we want. Automobiles reduce the physi-
cal demands of walking and give us near-limitless geographic mobil-
ity. Television allows leisure to be spent with little physical effort and
10 | Fat Politics

provides a terrific array of entertainment choices. In short, each is about

fulfilling our wants in as efficient and easy a manner as possible, the
very benefits that our liberal, free-market system promises.
So, from this perspective, the origins of America’s growing meta-
bolic problems, as well as its increasing weight, ultimately derive from
its very core principles. The American credo of “life, liberty, and the
pursuit of happiness” is about giving us the freedom to individually
pursue our own gratification to the extent that we see fit, the very thing
that snacks, cars, and television provide. It is about making us the ulti-
mate arbiters of what is good for ourselves. The market, in turn, re-
sponds by providing us what we want in the most efficient and
inexpensive manner. Thus if we want to eat tasty foods, move about
with great speed and ease, and amuse ourselves in leisurely ways, this
is our right. But this is also why all the public health pronouncements
about dieting and nutrition, such as “eat less and exercise more,” are so
ineffective. Although such simple advice may seem reasonable, it flies
in the face of a consumer economy that is constantly expanding our
choices and freedom. Asking an American to “eat less and exercise more”
is like asking an Eskimo not to fish or a devout Muslim not to say daily
prayers—it runs afoul of the dominant logic of our very culture. Our
growing weight is simply a natural and inevitable biological response
to living in a consumer-oriented democracy.

Why Focusing on Fat May Be

Harmful to Your Health

Yet, with respect to our appearance and our health, this freedom is pre-
senting us with a dilemma. On one hand, the amenities that make our
lives so easy are ill suited to our physiology, particularly in large doses.
The same consumer conveniences that are adding to our waistlines are
also contributing to our chronically high levels of diabetes, cardiovas-
cular disease, anxiety, stress, depression, and sleeplessness. While un-
doubtedly the rise of such maladies is also coming from a medical culture
that is quick to diagnose any ailment as a disorder, the prevalence of
such chronic diseases is also the by-product of a fast-paced culture of
instant gratification and individual license. On the other hand, few
Americans want to relinquish their freedom, particularly with respect
 Introduction | 11

to what they eat or how they move. Few of us want to ban our snack
foods, raise our gasoline prices, get rid of our televisions, or forcibly be
put on any diet plan. When it comes to our diet, lifestyle, and health,
we basically want to eat our cake and have it, too.
The easiest way of resolving this cake-eating dilemma is by simply
treating its undesirable side effects. So, if snacking and inactivity are
making our cholesterol level too high, we jump at the chance to keep it
in check with a pill such as Lipitor, rather than force ourselves to change
our diet or start exercising more. And, to the extent that we are able to
treat these unwanted symptoms, such a strategy is a great success. For
example, much of the recent decline in deaths from heart disease and
other ailments, as well as our improved quality of life, have come from
simple and undemanding treatments. Sometimes, alleviating unwanted
symptoms of an unhealthy lifestyle is the most efficient and effective
response.
Often, however, treating a symptom rather than addressing its root
causes only causes more problems than it solves, and this is what is hap-
pening with weight. Ask any of the millions of frustrated dieters in
America and they will tell you what molecular biologists have long
known—for many of us, our bodies are quite resistant to being slender.
Nor do we have a safe or effective mechanism for helping us lose weight.
Indeed, the same doctors, health officials, and medical researchers who
have spent the past four decades telling Americans they are too fat have
not been able to devise a sound treatment for becoming thin. As a result,
many Americans are going to extreme measures to make themselves lose
weight, such as self-starvation, smoking, taking dangerous appetite
suppressants, or even having their stomachs surgically shrunk. Not only
are such practices ineffective, they often do more harm than good.
Whether it is from a failed diet, a botched gastric-bypass surgery, com-
plications from an eating disorder, or heart damage from diet drugs, ev-
ery year thousands of Americans are literally dying to be thin.
Thus, with respect to our weight, we have put ourselves into a bind.
In calling our growing weight an “epidemic,” we have created a dis-
ease out of a physical symptom that, in turn, we are unable to treat. In
calling fat people gluttonous and lazy, we are ascribing moral charac-
teristics to what is largely a biological phenomenon. We are now being
told to lose weight without understanding that our fatness is actually
an expression of forces that are largely beyond our individual control