Back to basics

Since there seems to be some interest in it, I’d like to clarify a few things about what exactly my position is on various weight and health-related matters.

(1) Obesity does correlate with some increased health risks, and to a largely unknown extent, has a causal role in some of those increased risks. However:

(a) The extent of the correlations is greatly exaggerated.

(b) The extent to which the correlations are causal is also greatly exaggerated, since the baseline assumption tends to be that correlation simply equals causation in this context.

(c) Obesity does not appear to even correlate with increased mortality risk until weight levels that are higher than those of most people in America defined as obese.

(2) Overweight (BMI 25-29.9) does not correlate with increased overall health risk in any meaningful way, and correlates with lower mortality risk than so-called “normal” weight. Most people who are categorized as weighing too much by public health authorities are in the overweight category.

(3) Obesity also correlates with decreased health risk in certain contexts. For example, among people who have cardiovascular disease (the single biggest cause of death in America) “obese” people have better survival rates than non-obese people. This is the so-called “obesity paradox,” which is only a paradox if you take it as axiomatic that obesity is unambiguously a bad thing from a health perspective.

(4) Individual attempts to achieve significant long-term weight loss fail in the the overwhelming majority of cases. Public health interventions designed to produce weight loss fail uniformly. Dieting doesn’t work; furthermore the difference between “dieting” and eating disordered behavior is merely one of degree. Eating disorders are common consequences of dieting.

(5) It is not known if significant long-term weight loss is beneficial to health. Attempts to answer this question have been stymied by (4).

(6) Being moderately physically active appears to eliminate most or all of what increased health risk is observed among “obese” people.

(7) The Health at Every Size movement advocates healthy lifestyles for people of all sizes, including children of all sizes. I strongly support such advocacy. Examples of the HAES approach to these issues, broadly speaking, can be found here, here, here, and here, among many other places.

(8) The official government definition of a a “normal healthy weight” of BMI 18.5 to 24.9, besides being without any scientific foundation, is inherently stigmatizing to people who are not “normal” or “healthy” in these misused senses of the words normal and healthy. (This BMI range isn’t statistically normal, nor does it correlate with the lowest health risk). Stigmatization is, among other things, bad for peoples’ health.

(9) This issue is strongly gendered. Weight oppression is, among other things, a form of sexism, as body surveillance is far more intense toward the bodies of women and girls than toward those of men and boys.

(10) Telling fat people, and especially fat children, that it’s bad to be fat, and that they wouldn’t be fat if they had healthy lifestyles, is both false and destructive.

210 comments on this post.
  1. Brandon:

    Is there anything wrong with our food supply and general dietary options themselves?

    Have you tried shopping for regular foods in your typical grocery store that don’t contain corn syrup as one of the primary ingredients?

  2. Murc:

    Paul, this post is far better constructed in terms of presenting your views clearly and straightforwardly, and far lass inflammatory, than pretty much all of your other posts on this topic.

    I wasn’t active in the other threads, but I was following them, and I felt that the people saying “No, I’m not willfully misinterpreting you, this is how your words can plausibly be read” made strong points. This is much better.

    One comment:

    The official government definition of a a “normal healthy weight” of BMI 18.5 to 24.9, besides being without any scientific foundation, is inherently stigmatizing to people who are not “normal” (sic) or “healthy” (sic) in this sense.

    I think you want to play up ‘without scientific basis’ rather than ‘stigmatizing.’

    Normal is a useful word. So is healthy. I want to have normal, healthy blood pressure. I want to have normal, healthy lung capacity. Just two examples. If either of those things are abnormal or unhealthy, that is cause for concern, and if they’re abnormal or unhealthy due to lifestyle choices I make, as opposed to my being ill due to factors beyond my control, I would say I deserve a bit of societal opprobrium. Not much, but a bit.

    (For the record; my blood pressure is in fact at slightly unhealthy levels, and this is entirely due to lifestyle choices I could change if I really wanted to. My lungs are great, though.)

  3. bobbyp:

    ‘dunno much about the science (though #4 strikes me as pretty obvious), but strongly agree with 8, 9, and 10.

  4. Paul Campos:

    Thanks Murc; post edited to clarify what I see as the misuse of normal and healthy in this context.

  5. Manju:

    That’s really the issue here — players of the 90s were able to obtain records that properly belong to baby boomer icons.

    The wacky stats also mess with the contemporaries. Griffey Jr was denied the center of attention during the Sosa-McGwire year. Fred McGriff would’ve been seen as a sure-fire hall-of-famer. Jeter’s numbers are better than they appear. etc.

  6. Richard:

    I would agree with Murc’s comments. But your previous comments were somewhat inflammatory (to say the least).

    My comments are twofold.

    1.I think there is greater scientific controversy on these issues than you do and I dont, as you seem to do, dismiss the scientific opinion on the other side.

    and

    (10) Telling fat people, and especially fat children, that it’s bad to be fat, and that they wouldn’t be fat if they had healthy lifestyles, is both false and destructive

    I dont think Lets Move does this and dont believe that the Lets Move program, even if turns out to be ineffective, is counterproductive and destructive.

  7. Common Sense:

    I do agree with the OP on 8 and 10, but I can at least sort of wrap my head around some kind of “tough love” counterargument, although admitting you don’t know much about the science kind of makes it difficult to justify this position for health reasons. (Which leaves, I guess, finding an overweight society aesthetically displeasing?)

    But how can anyone possibly deny that women are under more pressure than men in our culture to confirm to beauty standards in general, and to be thin in particular? That’s not to say that men are under no pressure, obviously, but c’mon.

  8. Manju:

    godddammit. i don’t feel like reposting this. so surely there is a way to make it relevant to this thread. Wish I mentioned Luis Tiant.

  9. Scott Lemieux:

    Agreed on all points, very well said.

  10. Common Sense:

    erm, that should be “conform to beauty standards,” not “confirm.”

  11. Malaclypse:

    Is there anything wrong with our food supply and general dietary options themselves?

    This to me is the key question. I think it is perfectly reasonable to question the outcomes of having industrialized food preparation in basically a single generation, without at all criticizing the weight of individuals.

  12. Sherm:

    Would Kirby Puckett have been a HOFer had he been stigmatized for his weight?

  13. shah8:

    I think Campos’ invective is futile and wasteful–particuarly in the original fusillade against Let’s Move.

    Atlanta, and Georgia in general, has despicable fat-shaming campaigns “for the children, of course”. But how much fight does Campos have for crude, and shaming PSAs–but something like Let’s Move, or some other more positive than not campaign deserves more attention?

    This is a major reason why I ignore virtually all of the fat-shaming wars. It’s predominantly discourse by the people who are already anxious about their weight, or something, with a strong narcissistic tendency to be concerned about situations similar to theirs, but not to any broader awareness of health needs.

    And this retreat post, is a typical retreat to Healthy At Any Size dialect where the people that play this game up their bona-fides and good faith image (particularly after people point out the anti-science aspects of the argumentation). About the only thing missing here is that abusive claim to “safe space”, which is logical, since you run the blog, in part, so you own the space.

    We’ve all been through this in progressive circles, for about three years now. Why on earth, Campos, do you think people will be sympathetic to the line you’re spewing now?

  14. greylocks:

    There are a lot of food additives, often unnecessary ones, that are suspected or known to carry health risks for at least some individuals. Caramel coloring is one of the worst offenders. It has no nutritional value, but long-term consumption has been correlated strongly with increased blood pressure and causes other reactions in sulfite-sensitive individuals.

    It’s best to just learn to cook. Processed food is unhealthy for a lot of reasons, regardless of weight issues.

  15. Ted K:

    A useful analogy for people in previous threads who couldn’t seem to do anything other than say “you’ll lose weight if you eat less and exercise more”:

    “You’ll improve your net worth if you work more and spend less. Therefore, an anti-poverty program that explains that major causes of poverty are that people work too little and spend too much, and that focuses on encouraging people to work more and spend less, is obviously an excellent program and absolutely beyond criticism. Furthermore, if anyone suggests that this advice is unhelpful (and indeed stigmatizing, in suggesting that poor people are lazy spendthrifts), that person is obviously denying simple mathematics.”

    If you don’t believe that’s true (and I hope/expect that any regular reader/commenter here will see why it’s not) but have been arguing against Paul, can you explain to me how your arguments against it are distinct from Paul’s criticisms of Let’s Move?

  16. dave:

    Am I the only one who has no idea what this means?

  17. Derelict:

    I honestly do not know enough to come down on either side of this issue. I will note, however, that the medical profession has been steadily moving the goalposts on this and a number of other issues. This constant lowering of thresholds has made many suspicious of the supposed standards put forth by the medical profession.

  18. Steve S.:

    Do you consider a factor that carries “some increased health risks” to be a “problem” or “challenge”?

    Assuming (4) and (5), is there evidence that intervening with children mitigates the problem in adulthood?

    Do you have a link to any independent review of the so-called “HAES approach” which doesn’t involve blindly purchasing a book on Amazon? Do you think quantum physics has anything to tell us about the obesity issue?

  19. Malaclypse:

    My wife is highly sensitive to MSG, to the extent that anything with modified food starch triggers migraines. So believe me, I understand.

  20. Paul Campos:

    I was about to ask for a translation into either English or Spanish.

  21. daveNYC:

    As someone on the last thread mentioned, you’re kind of conflating fat, obese, and now you’re using “obese” too. ‘Obese’ actually has a medical definition, ‘fat’ doesn’t.

    …furthermore the difference between “dieting” and eating disordered behavior is merely one of degree.

    The difference between a good behavior in moderation and a bad behavior in excess is always one of degree.

  22. brad:

    I still fail to see how Campos ultimately doing much of anything beyond (properly) arguing BMI is a bad tool and fad diets don’t work…. so therefore any attempt to honestly assess and respond to the seemingly obvious effects of modern American food and physical cultures are somehow fat shaming.
    As many have said, Campos sounds like a lawyer whenever he broaches this topic, regardless of whether he’s practicing as one. For some topics this form of advocacy can be quite effective, but even then it tends to reduce issues to binary opposites and us vs them. It’s the same weakness that undermines so many of Glenn Greenwald’s arguments. If it’s us vs them then anyone who isn’t “us” is “them”, and preserving the societal tendency to fat shame.
    The pet cause of how wrong fat shaming is, and no one aside from trolls can disagree with this being true, plus zealous advocacy has led into reactionary and inflammatory response to anything beyond full agreement. It gets hits and comments, but it’s “shock blogging”, it makes me think less of Campos, not that I can respect anyone who works with Megan McArdle anyhow, and makes me think less of the LG&M brand. Especially when Lemieux in comments uses professorial blindness “I fail to see cites… fine, I refuse to accept these cites” instead of valid arguments to defend.
    Not that I think my opinion is all that important, but I’m really getting sick of these troll posts by Campos. Isn’t that kind of crap what the Daily Beast is meant for?

  23. Scott Lemieux:

    Yes, it’s a real shame that Jeter has never gotten the recognition from the media that his play deserved. My guess is that he falls off the HoF ballot after a year and is quickly forgotten, just as he was shamefully ignored by the media during his career.

  24. greylocks:

    I bet you’re a skinny little prick.

    The only people who get their knickers in a twist about Campos’ stand on this are skinny people with some kind of fat phobia thing going on in their heads.

  25. Sebastian H:

    Do your early points map directly on to children? Is it just as arc for children to change weight for the long term as adults? Is childhood high BMI safer or less safe than adults?

    Does any of this strongly relate to Let’s Move?

  26. dave:

    Do you consider a factor that carries “some increased health risks” to be a “problem” or “challenge”?

    No. I do not consider driving a car or living in a city to be a problem.

  27. Sebastian H:

    Hmmm I don’t know how just as hard became just as arc. Sorry.

  28. Richard:

    We agree

  29. Anonymous:

    I guess that’s why we don’t have any government-mandated safety features for cars, or speed limits, or air quality regulations.

  30. spencer:

    I suspect the person who wrote it doesn’t even know.

  31. Sherm:

    Yes, its hard to see the normal ranges for blood pressure and cholesterol lowered without presuming that the pharmaceutical industry was somehow involved.

  32. Paul Campos:

    Here’s an article in a medical journal regarding the HAES approach:

    http://www.nutritionj.com/content/10/1/9

  33. Sherm:

    The above was meant to be in reply to Derelict.

  34. Malaclypse:

    I think is is roughly analogous to “Muslims are mean to women, so it is wrong to look at how Americans treat women, until after we nuke Saudi Arabia, to help their women.”

    But I may be wrong.

  35. Brandon:

    Isn’t part of the obesity seen in poverty-stricken areas due to the lack of nutritional food being available and the time and ability to prepare food, even if it was available?

  36. sharculese:

    Griffey Jr was denied the center of attention during the Sosa-McGwire year.

    Yeah, but Griffey had 3 Nintendo baseball titles to Thomas’s 1, so…

  37. bk:

    Thanks for the chuckle!

  38. Superking:

    Paul, I’m not generally inclined to be charitable to you on these issues, because you so often go out of your way to be unnecessarily provocative. With that in mind:

    (4) Individual attempts to achieve significant long-term weight loss fail in the the overwhelming majority of cases. Public health interventions designed to produce weight loss fail uniformly. Dieting doesn’t work; furthermore the difference between “dieting” and eating disordered behavior is merely one of degree. Eating disorders are common consequences of dieting.

    In a way, this depends on how “attempts” is scoped. If you’re talking about all the people who went to the gym on Jan. 2, and decided it wasn’t worth it, then fine. But I bet this is more ambiguous than you let on. I agree that there is a problem with “dieting,” but that doesn’t mean that there isn’t a problem with our national diet as a whole. It seems to me that there is fairly strong evidence for a significant growth in portion size over the past 40 years or so.

    However, in some ways, this is not a relevant point, because programs such as Let’s Move are not designed to get kids to lose weight, but rather appear to me to be designed to influence children’s future choices as they grow up. Instead of trying to get millions of obese adults to diet and exercise, wouldn’t it be better to try to convince children that it’s fun to exercise and healthy food tastes good? And maybe they don’t turn into obese adults who then fail repeatedly at dieting?

    Now, sure, you say interventions don’t work, but I think a lot of people are not sure we have taken all the steps that are reasonable as food choices are often influenced by food availability.

    (6) Being moderately physically active appears to eliminate most or all of what increased health risk is observed among “obese” people.

    (7) The Health at Every Size movement advocates healthy lifestyles for people of all sizes, including children of all sizes. I strongly support such advocacy. Examples of the HAES approach to these issues, broadly speaking, can be found here, here, here, and here, among many other places.

    These points also have serious definitional issues. What is “moderately physically active mean?” If someone isn’t moderately physically active, aren’t you just fitness shaming? That has no place in progressivism! Can you lay off the fitness oppression for a little while, please?

    As for health at every size, can you provide a definition of what it means to be healthy at every size? Are we going to establish fitness standards for people, or is it just going to be, “are you able to do what you want to do in your life?” I’m sorry, but I don’t have the time or money right now to buy three books from Amazon, and the other link you provide is pretty weak sauce.

    Let’s say that there is someone who is obese, but happy with their fitness level who performs moderate physical activity on a regular basis. And let’s say that they develop type 2 diabetes, as is more probable in their case. Should a doctor recommend the standard course of treatment which includes changing their diet, exercising regularly, and taking the appropriate medication? Or is that just fat shaming?

    (10) Telling fat people, and especially fat children, that it’s bad to be fat, and that they wouldn’t be fat if they had healthy lifestyles, is both false and destructive.

    Who exactly is telling fat children that they are bad to be fat and they wouldn’t be fat if they had healthy lifestyles? The problem with your prior post is that people don’t think Let’s Move is doing that.

  39. dave:

    I fail to see how you cannot seem to understand that the entire concept of “an obesity epidemic” which is the impetus for “Lets Move” is based on BMI.

    You keep agreeing that BMI is a poor measure yet you continue to accept the claim that there is an obesity epidemic even though the entire basis for that claim is a measure that you yourself admit is flawed.

    Why don’t you focus your ire on the medical establishment and the Let’s Move campaign’s continued reliance on (by your own admission) a false measure.

    Or perhaps you think that lying to create a public panic is ok as long as it is in service to a worthy cause.

  40. Brandon:

    Right, I’m certainly not going to treat any obesity problem in this country as one that results from individual moral failings of people “without self-control.”

    But, on the whole, culturally, I think we absolutely have a problem with our food supply and food culture. Just look at this:

    http://mjcdn.motherjones.com/preset_51/biggest-big-gulps-resized-watermarked-final.jpg

  41. Bassopotamus:

    This is a heck of a lot better than the other two posts but you don’t really provide any evidence to back up your assertions.

    I am not an epidemiologist, but as someone with a background in social science stats, a spouse who works with nutrition, and a lifetime of ups and downs in weight, I am pretty skeptical of a few of these

    1B. I always dread teaching undergraduates about correlation and causation because they then just turn around and deploy it against any findings they don’t like. Sure, correlation does not equal causation, but it provides some evidence. And some evidence trumps the no evidence that they typically display.

    2. If you parse out the new JAMA study, there is something going on with the folks in the low half of the “normal” BMI range, not the ones in the upper half. It could be that the range for healthy needs to shift a little. That’s how empirical science works. Test hypotheses, update conclusions in light of new data.

    3. But what is the total effect of obesity on mortality from these things? It would be better not to get heart disease than to have a better chance of surviving it, no? I have a strong suspicion that a greater survival rate with the disease doesn’t off set the dangers of the greater risk of the disease in the first place.

    4. The flare up over one of these studies was fairly ridiculous. Most of the people who fail to maintain weight loss also fail to maintain the program. It’s not so much that lifestyle changes don’t work, it’s that they don’t work if you change back. There are lots of crap diets out there, but very few people actually eat sensibly. When I actually started tracking my calories, I was stunned that I had been pretty consistently eating an extra 1000 calories a day over what is recommended for someone of my height. And I’ve seen worse. Is diet everything? Of course not. But an awful lot of people I’ve seen who claim they just can’t lose weight are completely sedentary and eating 3500 calories a day. They reform for a while, then go back to being sedentary and eating 3500 calories a day. As for the eating disorder bit, of course some people take it too far. That’s bad too. That doesn’t mean people shouldn’t try to consume a sensible number of
    calories.

    6. That’s great, but how many overweight or obese people are actually engaging in any exercise?

    7. I’m not familiar with the HAES literature, but I have a hard time believing that people with high BMIs who make healthy lifestyle modifications would not lose some weight, even if it is a consequence rather than a cause of other things.

    8. Somebody in the Let’s Move comments pointed to the scientific derivations of these ranges.

    9. Yup, women get dumped on in all sorts of ways. That doesn’t mean people shouldn’t try to live healthier.

    10. I don’t think anybody should be shaming kids. However, there are plenty of morbidly obese kids, and they have honest to God health issues. And frankly, I think Campos is hyper sensitive to this shaming, especially in the Let’s Move! piece. My wife is in school nutrition and has done some work as part of the new standards. I will admit, I haven’t seen all the materials, but from what I have seen, none of them involve yelling at kids about being obese. On her end, everything has basically been re-configuring lunch so it isn’t 1200 calories of chicken nuggets, and then convincing kids to eat the vegetables and fruits put in front of them. All of it has been about modelling good choices rather than trashing anybody for being obese. And even at that, the pushback has been insane. She met some kids a few weeks ago who had never even seen a sweet potato, and wouldn’t even touch them. The big problem for the first semester under the new federal standards was that most of the vegetables were being thrown out. To be blunt, a program that uses the word Obese, primarily not in front of the kids, is not an evil. Kids living on a terrible diet and ending up with Type II diabetes is.

  42. Ted K:

    Oh, good point, because the government doesn’t regulate food at all, and Paul Campos has of course expressed his opposition to the FDA, menu labeling rules, or indeed any government involvement in the food industry.

  43. Superking:

    This is dumb. Many anti-poverty programs actually do focus on helping the poor people to use their money wisely. http://www.financialeducatorscouncil.org/financial-education-services.html

  44. A Different John:

    Wrong. Let’s not make ad-hominem attacks here, shall we? I am in the BMI > 25 category, and my sister is 5’2″ and roughly 280 lbs. Neither of us has a fat phobia, and both of us recognize that there almost certainly is a range of height-adjusted weights that are healthier for the typical person than weights outside that range. The argument is over a) what the range is, and b) whether the effects of stigmatizing weights in some range is of net benefit to those in the range or not (mostly a). It is not a sign of some mental imbalance to think that implementing a “Paul C.-like Agenda” would do a lot of harm to a lot of people, just a sign of disagreement and, possibly, reading different literature.

  45. Stan Gable:

    beyond (properly) arguing BMI is a bad tool

    I disagree that BMI is a bad tool, just that it isn’t useful on an individual basis. If BMI is increasing for the total population, then it’s a good indicator that weight is increasing. If weight is increasing, then it’s very likely that incidence of metabolic diseases are also increasing.

  46. Brandon:

    who in other threads said nothing but “you’ll lose weight if you eat less and exercise more?”

    Further, is there some difference in agency between your own diet and activity levels and your career path that might be important to take into consideration?

  47. Ted K:

    (Or, to cut back on the sarcasm, our regulations of cars, and of the health hazards of living in various types of places, are aimed at lowering the risk levels associated with them but also with accepting a fairly significant residual risk level. We generally don’t criticize people who drive or who live in less areas with greater levels of hazard and act as if they need to account to us for their choices. Government regulation of food doesn’t strike me as drastically different for these purposes, though to be fair the negative effect of certain subsidies on our diet is a different issue (and, as far as I know, one on which HAES and fat-positive people don’t substantially differ from the average liberal).)

  48. medrawt:

    I’ve previously thought Campos’ posts on this issue were kind of ridiculous to the point of being obtuse, and I’m 6’1″ and 250 or so pounds, which both the government and I can agree is “fat bastard.” Ray Lewis is also approximately this height and weight, and he isn’t a fat bastard, but I’m carrying most his muscles in my gut. I can also report that my quality of life is shittier at this weight than when I weighed 200 pounds (which the government would consider overweight, but which I wouldn’t for my personal frame, which is pretty big to begin with).

    I think this is a much better post but it does not help me understand why Campos spends his time on this subject in the manner he does.

  49. dave:

    But we don’t encourage people to flee the cities or to stop driving.

    The point is that the fact that a certain behavior carries a risk, is not itself sufficient to justify heavy handed intervention.

    Are you really suggesting that we should regulate all behavior that carries any risk at all and that there should be no risk-reward balancing?

  50. dave:

    Or what Ted K said. (better than me I might add).

  51. Anonymous:

    Spot on Paul. Keep teeling Mooch-elle to butt out. I will eat what I want when I fucking want it, and it is nobody’s business how much I weight (and certainly NOTthe federal government’s). Just more bullshit liberal nanny-statism, pure and simple.

    I think I’ll be heading to Hardee’s tonight just to drive the point home…it’s impossible to lose weight and besides you can be healthy at almost ANY size.

  52. Bassopotamus:

    My first job was at a Hardee’s. I’m convinced they are engaged in a silent campaign of genocide against rednecks.

  53. Nichole:

    Huh?

    U shur boud dat?

    What if, instead, those programs focus on referring poor people to paid wealth-building programs run by groups under the aegis of the financial educators council in order to enhance the bottom lines of the non-profits/for profits who run such programs?

    When was the last time you saw a govt program that was NOT run by a group contracted by a govt agency to run the program?

  54. Paul Campos:

    What if the only response we had to wealth disparities in this country was “if you do X, Y, and Z you’ll never be poor?” (i.e., the GOP platform).

    The progressive reply to this is that in any society even vaguely resembling ours there are going to be great wealth disparities, so maybe our response to that should be something other than “don’t be poor, which you won’t be if you do X, Y and Z.” (Especially given that the latter claim is clearly false).

    The analogy to the obesity issue is, as Ted K. says, very suggestive.

  55. Steve S.:

    “Conflict of interests Disclosure
    Linda Bacon and Lucy Aphramor are HAES practitioners. Both also speak and write on the topic of Health at Every Size and sometimes receive financial remuneration for this work.”

    Also, do you consider “problem” or “challenge” to be acceptable descriptors for obesity-related risks?

    Also, are you aware of any evidence that childhood intervention will mitigate the problem referenced in (4) and (5) above in adulthood?

    Also, does quantum physics have anything to tell us about the obesity issue?

  56. Brandon:

    If we accept the premise that obesity carries various health risks, and we want to weigh risk-rewards, what are the rewards for an obese, less-healthy population?

  57. Ted K:

    who in other threads said nothing but “you’ll lose weight if you eat less and exercise more?”
    I don’t particularly want to reread those threads, but one example I found with a quick glance is this comment.

    Further, is there some difference in agency between your own diet and activity levels and your career path that might be important to take into consideration?

    I’m not sure there is, given that many of the extrinsic factors that affect career path also have impacts on your diet and activity levels. It’s a lot easier to eat healthy when you live next to a Whole Foods, work 40 hours a week during a normal day shift, and don’t have to think much about money while grocery shopping. It’s a lot easier to exercise when you can afford a gym membership and can go there during your hour-long paid lunch. And those are just examples.

    And I’m sure there will be people here to say “But I was poor, living in a food desert, and working 80 hours a week but still managed to eat well and exercise!” And I’m sure you did. But I’m not sure how you’re different from the people who tell us that they grew up in terrible conditions and still managed to get rich, and thus there’s no poverty problem in this country (or rather, that the poverty problem is caused by the less virtuous behavior of people who remained poor).

  58. Lee:

    Oh good, I thought my reading comprehension skills were deterioating.

  59. Bassopotamus:

    Heck, he’s not “kind of conflating” these terms, he’s either ignorantly or willfully abusing them. His post yesterday is entitled “The Obesity Myth Revisited” in reference to a study that found that being a little overweight isn’t so bad, but that being Obese (in the clinical definition) was associated with a 29% higher mortality risk.

  60. Brandon:

    How analogous is the individual’s agency in each issue?

  61. Steve S.:

    Our roads are the very definition of heavy-handed intervention. They are centrally planned, controlled, and imposed on the populace.

  62. Brandon:

    If you lack agency over your own diet and activity levels, is there anything at all you have any reasonable amount of agency over?

  63. Goat:

    Fascinating. I had an interesting experience with this recently, in the course of researching the relation of BMI to the efficacy of IVF treatment (as a lay person, not actual research.)

    Had a very stressful and unnecessary disagreement with my wife over some data (i.e., “stuff I read on the internet”) that seemed to suggest that even modestly overweight women (BMI 27-28) were at significant risk of a whole slew of problems, and the procedure was much less likely to work. A subsequent conversation with the doctor revealed that in his experience it doesn’t actually become a statistically significant issue until much higher BMI’s, like 34+.

    Note to readers: Suggesting that your sensitive-about-weight wife who is on fire to have a kid RIGHT THIS SECOND maybe take 6 months off the quest and hit the gym is not exactly a great plan.

    Christmas was expensive.

  64. Paul Campos:

    Again, the meta-analysis found that most obese people did not have a higher mortality risk than “normal weight” people, and that they in fact had a 5% lower risk, although this was not statistically significant (.88-1.101 HR 95% CI).

  65. Bassopotamus:

    It’s not that bad of a tool, it just isn’t as precise as some other measures would be. It gets used quite a bit because it is easy to measure (Height, weight, and some 4th grade math). I’d really like to see many of these studies done with Body Fat as the independent variable, but body fat is harder to measure, whereas you can just pull a bunch of charts and compute BMI real easily. It has some slop, of course (people are built on different frame sizes, it doesn’t differentiate between muscle and fat), but it is better than nothing.

  66. cooperstreet:

    I agree wholeheartedly with Murc, and agree with what those in the ‘Healthy at Every Size’ movement are saying. They presented their arguments about obesity better than you have on this blog. This post clarifies a lot of things.

  67. CaptBackslap:

    I kind of want to see what the Team Gulp container looked like, but I really don’t want to Google Image Search for “team gulp” at work.

  68. Marc:

    This is useful Paul; thanks. I think that your critics depart from you right at reservations a, b, and c. Yes, correlation is not causation.

    I’d approach it more like this.

    There is a normal health weight range for adults, and it’s difficult to measure the impact of small changes because our tools for measuring health consequences are so blunt and imprecise.

    Extreme weight gain stresses the heart, is linked to unhealthy diet and exercise, and is directly causally connected to things such as diabetes and heart disease. It also makes exercising very difficult and painful. I don’t think that there is any scientific dispute at all about this statement at the high end of the weight scale. And that’s where the unease sets in. The tobacco industry agreed that smoking was correlated with lung cancer (grudgingly), but argued against causation using exactly the sort of language that you’re using. The linkage between second hand smoke (or light smoking) and health consequences can be contested on the same grounds.

    There is a lot else on your list that most people here would agree with. I don’t believe that you understand the converse-why progressives would think that obesity really does demand a public policy response, and why its tied to other issues that we care about deeply.

    We’ve gained weight on average because of a series of social policy choices. I think that this is the product of things like urban sprawl and the car culture; moral panic about children getting kidnapped, which has restricted outdoor play and walking to school for children; unhealthy food promoted by corporate farming interests, and the like. I think that these forces are truly destructive to health, the environment, and to our social fabric. I have similar sentiments about medication for things like ADHD. Your posts can be clearly interpreted as calls for inaction on these things.

    And if you dismiss strong statistical evidence it has consequences elsewhere. The statistical case for action on climate change can be dismissed; ditto for the statistical case for health consequences from pollution; smoking; the list goes on. You’re adopting the language and tools that corporations are using on other fronts to block action on major environmental problems. We don’t get to just choose one favored area where we don’t pay any attention to statistics which tell us things that we don’t like.

  69. Superking:

    Dude, I don’t know FEC specifically, I just googled financial education and pasted the first link. Probably a bad choice, but I don’t really care.

    My previous job was at a non-profit that, among other things, counseled indigent individuals and families about their personal finances. As I left they were establishing a financial literacy program that included financial coaching with a matched savings component. Long and the short of it is that many anti-poverty programs do use financial education/financial literacy as a way to help poor families lift themselves out of poverty. It is what it is, man.

    Here’s a more legitimate link if you want it:
    http://nw.org/network/neighborworksProgs/financialfitness/default.asp

  70. Ted K:

    I think the question might actually be: “What are the rewards for avoiding particular regulatory programs aimed at creating a less obese population?” If a program is actually fat-stigmatizing, than the rewards include avoiding the negative psychological impacts of such a program and the increased discrimination against fat people that such a program might cause, either directly (if, for example, it encourages health insurance discounts based on BMI) or indirectly (if it generally further implants the image in people’s minds of fat people as lazy and lacking willpower).

    We also need to go back and consider what the actual positive impacts of the program are. The studies linked in this Campos article suggests it’s entirely possible that the answer is “There aren’t any.”

  71. JL:

    There’s a WC Miller who seems to have done some work studying HAES, judging from the results of my quick Google Scholar search. Unfortunately, unlike in my own field, it appears to be impossible to find free pdfs of papers, so I’m not sure what the papers say or how good they are. But if you’re at an institution with subscriptions to the journals, it might be worth looking.

  72. Brandon:

    you also don’t need to live next to a Whole Foods or have a gym membership to have a better-than-bad diet and have a bit of physical activity.

  73. Joe:

    With the various patting on the back, particularly given the OP skips over a big problem many had was not some of the bland sounding principles cited but the tone and failure of nuance, I appreciate this comment.

  74. Paul Campos:

    That’s a good question, to which I think the answer is something like “American culture has a long tradition of greatly exaggerating the role of individual agency in regard to both weight and SES.”

  75. Marc:

    But the ones at the high end did, at high significance.

  76. L2P:

    The BMI, while flawed, still provides useful information. IMO, this is where the discussion gets off the rails.

    When a statistic is flawed but still provides useful information, generally we don’t just say that we know NOTHING because we only have imperfect information. ERA, for instance, doesn’t tell you everything about a pitcher’s abilities. But if you know several different pitchers’ ERAs, you know something about those pitchers.

  77. Bassopotamus:

    MY BMI is 32, down from 38. I think Campos’ stand is problematic. Subjectively, I feel much better at a lower BMI. Despite his dismissiveness, there is pretty good evidecne that having a BMI of 32 is still not good for you. Watching my family members with high BMIs age exceedingly poorly bugs the hell out of me.

  78. brad:

    There’s so much charged rhetoric in there I’m quite unsure how or where to start responding.
    Put it like this, I agree with you in the same way I agree that climate change is a better catch-all than global warming. The goal should be better health, loss of weight should be, if it happens, one of many gains. But the sad truth is that’s a longer and harder sell, and in many cases will require challenging or finding alternatives to major food sources in the US.
    “Let’s Move”, as far as I can see, seems to be using the vanity play of weight loss to try to teach kids to exercise more and eat more vegetables. I can’t manage any outrage.

  79. CaptBackslap:

    The last study I saw on the food-desert topic didn’t find any correlation between quality food sources in an area and residents’ weight.

  80. sharculese:

    And now I’m confused as to why I thought this comment made sense…

    w/e

  81. dave:

    I firmly believe that if our society magically became “weight-blind” tomorrow, we would begin to see an overall increase in the health of our population. I think fear and disgust of fat is probably a bigger health crisis than actual fatness.

    I also think that Campos would be receiving a great deal less push back if it weren’t for our cultural obsession with weight. I suspect (pure speculation of course) that a lot of anti-Campos commenters have a lot invested (psychologically) in their personal diet and exercise regimens (present or future).

  82. Ted K:

    I think on an individual level, individual people have a lot of agency about a lot of things! When I’m talking to friends who are struggling financially, I sometimes find that the best advice is “Stop being lazy” or “You need to cut back on your spending.” Similarly, when I’m talking to friends who are unhappy with their weight or with their health in ways obviously related to their weight, the best advice sometimes is “Go to the gym” or “Just buy healthier food!”

    However, I would never got to, say, a website where poor people or overweight people congregate and just say those sorts of things to all of them. For many people, while sure of course they have agency in a basic sense over what they do at any given moment, their choices are seriously constrained by their life circumstances. If I, or honestly preferably someone better at this sort of thing than me, sat down with them and spent a few hours discussing their situation, maybe we’d come up with something they could do which would improve their situation. But a top-down, generic advice, one-size-fits-all program? Strikes me as useless at best.

  83. Bassopotamus:

    Darn Tootin.

    I have to say, we make it cheaper to eat bad than good, but you can still eat good stuff cheap. It doesn’t have to be Ho Hos vs wild caught salmon individually prayed over by a medicine man. Bananas are cheap. Sub those for some Ho Hos. People make lots of horrible food choices (and many of them not poverty induced). And there is plenty of physical activity that is free.

  84. Marc:

    I worry a lot about environmental issues. I’ve seen the same logical arguments used by Campos employed by climate change deniers and creationists. I’ve also seen them used by corporations trying to avoid responsibility for the harm caused by their products. Psychoanalyze me all you want, but as far as I’m concerned this is what motivates me.

  85. Ted K:

    And in some ways the FDA is very heavy-handed. There are some things you’re just not allowed to put in food, period. And I’m not saying (I don’t think anyone is saying) that we have the perfect level of regulation right now. I support the NYC trans fat ban (so, per this post, does Scott), and we should probably expand it nationwide. Maybe there are other ways we should restrict the content of food too. I’m not sure what this has to do with whether or not particular programs directed at encouraging people to behave in particular ways are fat-stigmatizing or not.

  86. Superking:

    The situations are similar, but in ways that aren’t really comfortable for you. The appropriate response to both is multifaceted and requires action from the individual level all the way to the federal level. Regarding poverty, we need to have an economic system that is designed to spread its benefits to as many people as possible, but we also need individual people to be educated and capable of interacting with the system in a way that benefits themselves. If you think that banks are just going to steal your money, and you don’t understand what APR is, you are most likely going to be financial prey. Doesn’t happen to everyone, but there is a greater chance. Same thing with “healthy lifestyles” and the health consequences of obesity.

  87. brad:

    And I understand that it’s intended to be used to view extremely large samples.
    The point I wish Campos would calm down and argue is that if the study he’s currently hyping is correct then one very possible interpretation is that BMI is simply too crude a tool. People whose natural body shapes have them in the 30-35 range might be absolutely healthy and normal, whereas people who really have put on massive amounts of weight to reach that range due to poor diet and zero physical activity could be facing huge health risks.
    Fat shaming aside, it does seem possible we need better tools to more accurately measure and understand what’s going on. But I’m no scientist, I realize I’m not qualified to judge.

  88. JL:

    I think that this is the product of things like urban sprawl and the car culture; moral panic about children getting kidnapped, which has restricted outdoor play and walking to school for children; unhealthy food promoted by corporate farming interests, and the like. I think that these forces are truly destructive to health, the environment, and to our social fabric.

    I agree with you that all of these things are destructive to all of the above, and that liberals and leftists should be addressing them. But it’s possible to address them without focusing on weight as the thing that we are trying to fix. You said it yourself. They’re destructive to the environment, the social fabric, and health. I would assert that obesity, in many cases (not all – some people are just naturally going to be fatter), is a symptom of that decreased health (not sure if Paul would agree on that point). But thin people are also being made less healthy by these destructive forces – they just aren’t showing that particular symptom. So don’t center the symptom! Especially don’t center the symptom when it’s a common prejudice target, since you can end up totally unintentionally making life harder for those on the receiving end of that prejudice. Center the destructive forces and the vast destruction that they cause, to everyone, including people without that particular symptom.

  89. L2P:

    I think many of those comments were in response to comments along the lines of “you won’t lose fat if you eat less and exercise more.” That’s just not physically possible for the vast majority of (I’d probably say all) people.

    But that’s also a long, long ways from saying everybody can stay on a program like that, as you point out. It’s easy to say, hard to do, especially in a society like ours that subsidizes corn, cars, and candy.

  90. Brandon:

    But, as Ted may be alluding to, there’s some cultural aspect to this as well.

  91. Anonymous:

    Are you really suggesting that we should regulate all behavior that carries any risk at all and that there should be no risk-reward balancing?

    Uh, no. But I was saying that we already do that.

    And it’s really a way-overly simplistic framing of the debate. If you accept that obesity carries significant health risks that make it rise to a public health problem, then yes, it’s in the interest of the government to do something about it. (Obviously, I am aware that not everyone agrees with that basic premise. But the original comment about cars and cities suggested we never regulate anything that is risky, which is simply not true.)

    Then there is also a question of what to do about it, and how realistic the answers are. It doesn’t have to be regulation, in the sense that people who don’t conform to a standard are penalized. There is nothing wrong with using government to promote positive changes, for example, encouraging people to exercise and eat better (even if one of the goals, reduction of obesity, is objectionable to people like Paul).

    The first thing I would do if I were dictator would be to immediately take all the subsidies for corn and soybeans and give them to growers of fresh produce. But I know that isn’t going to happen anytime soon. But that doesn’t mean I think we should sit on our hands and do nothing, either.

  92. Ted K:

    I honestly think this is connected to my discussion below about the difference between individualized advice and one-size-fits-all programs. I do think some (maybe many) people living in poverty would be (and are) helped by individual counseling and coaching. I don’t think they’d be helped by a nationwide campaign to end poverty which spends a lot of its time explaining that we have the poverty problem because people these days spend too much and work too little and that makes fancy websites and posters and videos giving people really obvious, generic advice on making more and spending less that completely fails to account for individual circumstances.

  93. Karen:

    Bananas are also high in sugar. My husband is an insulin-dependent diabetic, and his doctor strongly discourages consumption of bananas, as well as carrots and other high sugar fruits. His diet is extremely restrictive, making it nearly impossible for me to cook anything he can eat and that’s tasty and nutritious for our teenaged sons. (growing kids do need carbs.) I have read that people with insulin-resistance should also avoid bananas, as well as anything else high-carb. This makes shopping much more expensive, as well as leaving people with almost no options for food that tastes good. (Brussels sprouts can be made only up to not-entirely-gross; they never taste good.)

  94. L2P:

    We also need to go back and consider what the actual positive impacts of the program are. The studies linked in this Campos article suggests it’s entirely possible that the answer is “There aren’t any.”

    Do you truly believe that? Does anybody?

    Would you support the OPPOSITE policy, because, well, why not? Why not support the obesitization of America? After all, studies are inclusive.

  95. Stan Gable:

    BMI is a quick and easy way to identify higher risk populations. This is from the Let’s Move site:

    Determining what is a healthy weight for children is challenging, even with precise measures. BMI is often used as a screening tool- since a BMI in the overweight or obese range often, but not always, indicates that a child is at increased risk for health problems. A clinical assessment and other indicators must also be considered when evaluating a child’s overall health and development.

    I don’t understand how you can argue with this unless you really don’t think the aggregate societal weight gain is a problem.

  96. One of the Blue:

    Some observations:

    BMI is a flawed measure because it completely ignores the contribution of skeltal structure and muscle mass to body mass in any one individual. A heavy-boned, heavy-muscled person is going to have a higher BMI than someone with a more gracile build, even though the heavier person could be both in better shape and with less body fat.

    Exercise may or may not help one lose weight. It certainly does help with cardiovascular health, regardless of one’s weight.

    It is difficult to lose weight by dieting because almost every one of us is a less than ideal intuitive judge of food content. It’s wickedly hard to be consistent among for example, times when one is hungr v. times when one is not, times when one has exercised v. times when one is not, and times when one is served favorite food v. times when one is served food they do not like.

  97. Ted K:

    It probably was; but I think that was a misreading (not necessarily a malicious or willful misreading) of the actual point, which is that many people can improve their diet and increase their activity level in a way that seems fairly significant to them but only lose a small amount of weight and not look any different. Which goes back to the reason that describing “obesity” as the problem is a major flaw in any program; maybe a lot of people could significantly improve their health by improving their diet and activity level, but will only drop 3 or 5 pounds and will still look “fat” to the casual observer (and still be overweight or even obese based on BMI standards). This also has an effect on the people themselves, who feel like failures because there’s no visible change or significant BMI shift.

  98. Superking:

    This.

  99. brad:

    I’m not.

    I’m just saying I wish doctors had a better tool which would help circumvent emotionally charged sidetracks like this.

  100. CaptBackslap:

    As well as everything else. The root problem is the dispositionist framework itself (or naive realism, if you prefer). Almost every right-wing position draws its strength from that, either straightforwardly (as the above issues) or after re-framing (e.g., “she CHOSE to have sex!”).

  101. shah8:

    I am amused by the people going on about their lack of literacy, but I wanted to say that I have had the same experience as Bassopotamus.

    Peeps, well, the peeps who are more serious about this:

    Fat-phobia in the aggregate, is a nasty little quixotic and pseudoprogressive meme on the internet. There are people who are genuinely concerned about fat phobia in useful and progressive ways, but you do have to go out of your way to find them, as opposed to toxic losers who want to feel better about themselves at your expense. They *start* from HAES (healthy at every size), and they *stay* at HAES. They *always* operate from the fact that people should not be judged by their shapes (not some of the time), and that people themselves should be empowered to make the best judgements about weight, image, etc. They won’t get mad at you if you say, OMG, I have XXX, and my doctor told me to lose weight or suffer YYY! They won’t lie about or misread scientific journals or any other flavor of science denialism. They mostly want people to stop being assholes at each other’s expense.

    And what that commitment means, is that they critique more serious problems that actually attempt to control or hurt people, and try to bring to awareness of more problematic government programs people are much less aware of than “Let’s Move”.

  102. Ted K:

    I’m not sure what “that” is here. You may be misreading me; the studies I’m talking about are not the ones that deal with the health and mortality of people at various BMI levels, but instead ones that consider whether programs somewhat similar to “Let’s Move” (but, I believe, involving a lot more intervention on the individual level which should make them even more effective) actually had any impact. I do truly believe that it’s possible that such programs don’t have an impact. I obviously don’t think that we should try to encourage people to eat less healthy diets and be less active; but I also don’t think we should keep creating new programs that are both fat stigmatizing and unlikely to have any effect. I do think we should continue trying to figure out what we can do to effectively encourage healthy eating and activity levels.

  103. Malaclypse:

    I do think some (maybe many) people living in poverty would be (and are) helped by individual counseling and coaching.

    I am the 401k administrator for my company. Some portion of our employees are making between $9 to 15 per hours. Some of them are raising families on that. This situation sucks. And I remember the time the oh-so-perky 401k rep same in and wanted to do a demonstration for why they needed to contribute more to their 401ks.

    Rep: Everybody should save for the future!
    Me: They’re making ten bucks an hour.
    Rep: But everybody should save for the future!
    Me: They’re clearing maybe 300 bucks a week.
    Rep: They need to save some of that! For retirement! Every little bit helps!
    Me: You have no idea what it is like to be poor, do you?
    Rep: But everybody needs savings! For retirement!

  104. dave:

    2. If we move the range to actually reflect “health” rather than an arbitrary definition of “weight” then there would be no “obesity crisis” and no reason for the “Lets Move” program.

    3. As Paul has said, mortality rates for “overweight” are better than for “normal weight”. And mortality rates for “mildly obese” are no different than “normal.”

    4. So basically you are saying that because the interventions could theoretically work we should continue to push them even though they actually result in worse health outcomes for the majority of people?

    6. Shouldn’t the burden of proof be on those advocating for massive interventions which are known to have negative health effects if they fail?

    7. It is probable that such people would lose “some weight”. However, the they would remain “obese” This in turn would result in attempts at more strenuous exercise and dieting (since the goal is weight loss not health) which could not be maintained which would result in weight gain. The end result is a fatter (and unhealthier) person than before the intervention.

  105. Stan Gable:

    There are some ways to get around the fruit issue, particularly if you are on a multiple injection or pump regime. I definitely don’t eat as much fruit & carbs as I’d like but it’s not impossible.

  106. Ted K:

    Sure. And you don’t have to go to an expensive private school or a top 10 percent public school to go to a good college. But we understand that graduates of those schools are a lot more likely to end up at a good college than graduates of high schools with a 50 percent dropout rate for reasons that go way beyond individual agency. And of course there are a variety of situations in between.

    Similarly, we can expect diets in neighborhoods with five high-quality grocery stores to be different from those in neighborhoods with a couple of corner stores and one poorly stocked grocery store to be different for reasons that go way beyond individual agency. And again, there are a lot of situations in between.

  107. Leeds man:

    …put forth by the medical profession.

    You mean medical/pharmaceutical complex? Not suspicious at all.

  108. Steve S.:

    That would be getting far more deeply into the topic than I care to. I was wondering if there might be a brief review, whether popular or scholarly, from a disinterested party, as I was unfamiliar with HAES until today. I clicked a few pages on the Jon Robison site and ran into a couple of (for me) red flags, such as this.

  109. dave:

    This.

  110. Stan Gable:

    those advocating for massive interventions which are known to have negative health effects if they fail?

    Massive interventions? Where is that coming from?

  111. dave:

    This is silly. Just because a logical argument is misused in one situation doesn’t make it wrong in any other instance.

  112. Bassopotamus:

    I suspect (pure speculation of course) that a lot of anti-Campos commenters have a lot invested (psychologically) in their personal diet and exercise regimens (present or future).

    I freely admit that this applies to me. Frankly, I think everyone’s perspective tends to be shaped by their experiences. Having quite a bit invested in this lately, alot of what Campos says just does not comport with my own experiences. This is mostly a rehash of stuff I have posted elsewhere, but I am not narcissistic enough to assume you read it elsewhere, and narcissistic enough to assume that somebody would read it. But some background as to where I am coming from:

    I was mostly an obese kid, until about middle school. I took up cycling, not to lose weight, but because I really liked it. Did some centuries, raced a little, was riding about 200 miles a week for a bit. Unfortunately, at least for my body, I eventually quit riding to pursue girls, rock n roll, and academia. My diet slipped, sometimes badly, although mostly in line with what typical Americans eat. Between the end of High School and the End of Grad School, I put on about 120 lbs. I did a couple stints in weight watchers. While I did it, I lost weight, when I quit, I gained it back.

    3 Years ago, I tried to get back on the bike, and couldn’t make it 5 miles. At one point I had to stop because I thought I was dying, which turned out to be an asthma attack. Pretty much gave up again.

    While I freely admit I look pretty terrible big, I’m not very vain. I really wanted to start getting fit because frankly, I didn’t feel very good, and because a number of my relatives were having heart issues, etc. Then I had a blood test that showed me as pre diabetic. Not cool. Got some albuterol, did some more swimming. What really got me going though was winning a drawing to a place that did cardio kick boxing and resistance training. Kind of a boot camp thing, but with really supportive people. No fat shaming (although some of the folks were ripped). It kicked my ass, but the first session, I lost a little weight, but took 3 mintues off my mile run, tripled my number of pushups in a minute, etc. Stuck with that, got back on the bike, started running. And importantly, started watching what I ate. I realized I had been running about 3500 calories a day, which is way over what I needed when not exercising. Cut back on both portions and calorically dense things. No fad diet, just eat less than I burn. I’ve lost about 45 lbs. More importantly, I’ve done 3 triathlons and am running a marathon next week. I’m still big. BMI is 32, and a flabby 32 at that, but I feel great, and am enjoying what I am doing. Maybe someday I’ll be in the overweight category. Maybe I’ll be in the normal range. Maybe not, but I will keep at it.

    A few observations, as to why some of Campos’ posts the last couple days really bug me, based on these experiences

    1. For most people, if you live a healthier lifestyle, you will lose weight. I’ve put on a bit between finals, bad weather and the holidays. It is entirely attributable to not exercising as much and eating badly. Yes, some people have issues that make it hard to lose weight. But It is not impossible. When I’ve done healthy things, I lose weight, when I stop, I gain. It’s pretty simple really. There is probably more to it than just calories in<calories out, but it is a starting place.

    2. I am so much healthier now than I was a year ago. I actually agree with Campos, to an extent that it is the lifestyle choices, rather than the weight loss per se (and I am healthier now than when I was 15 lbs lighter and not working out). That said, even if the weight health connection is spurious (that is diet and exercise cause both better health and lower BMI), I am pretty suspicious that you could make meaningful lifestyle changes and not end up losing some weight.

    3. The only real interest I have in weight, at this point, is that it slows down my running and biking, especially on the hills.

    4. I am all for people encouraging others to be healthy, and I think the Let's Move program is mostly pretty darn good.

  113. dave:

    I think a society-wide emphasis on losing weight, emphasized by both the culture and the govenrment is a “massive” intervention, especially when it is targeted at a captive and impressionable audience like children. YMMV

  114. Brandon:

    I do not deny a significant cultural role on diet and activity levels. What I reject is when Campos seems to take that to the extreme that individuals have little or no control over their own weight, that any attempt to change their weight is doomed to failure.

    Control for economic conditions and food availability if you want, though there’s some questions as to the legitimacy of the ‘food deserts’. These individuals still have some level of agency, and I would argue it’s a much greater level of agency than over the colleges they can get into and the jobs and careers available to them. There are still plenty of overweight and obese people in the middle and upper-incomes, who do have access to multiple grocery stores, gym memberships, etc. We’re not talking about a topic that impacts only one slice of the socioeconomic range.

  115. Calming Influence:

    TL/DRcomments, but has wasting in cancer patients been corrected for in this study? Seems as though something like that could skew the data pretty significantly.

  116. Brandon:

    Would it be fair to suspect that a lot of Campos’ supporters are equally psychologically invested in their own diets and activity levels?

  117. shah8:

    Yup, my hero…

    @2, yes, there have been a consistent output in studies that being at or slightly below normal weight has aggregate elevated bad outcomes. I don’t really know why this is so. Last I checked, it was mostly guesses.

    Another thing that, more broadly speaking than just fat, is the sheer lack of understanding of how serious diabetes is. In recent years, people have had a nasty tendency to think of type-2 diabetes to be “manageable” without really thinking about the hit in lifestyle qualities, or the chances of losing eyesight or toes. Or the constant need to prick yourself (for those that have to). It can really suck.

  118. Superking:

    Yeah, I basically told our rep to fuck off when she showed up to sign me up for a retirement account. I wasn’t making enough money to justify it either. The savings program we were implementing wasn’t that, though. It was designed for the client to set a small goal, e.g. save enough money to buy a used car, and then the grant would provide matching funds up to $2000. People could then save up to $4000 total, and they could work toward bigger goals. At least that’s what I remember–I left the job in August. This is actually a good idea, because you’d be surprised the number of people who don’t trust the banks and can’t figure out where their money goes on a monthly basis.

  119. Malaclypse:

    you’d be surprised the number of people who don’t trust the banks

    Unfortunately, I wouldn’t be surprised at all. I’m dismayed at the people that won’t open an account at a credit union or coop bank, but will use check cashing services.

  120. Jeremy:

    As long as you put “7-eleven” in front, it’s not offensive.

    That said, there are a lot of other results that come up, mostly jokes.

  121. Leeds man:

    Haven’t read all the comments in all the posts, but I find it odd that there’s been no mention here of bulimia or anorexia. Fairly major weight-related health concerns, I’d have thought.

  122. Stan Gable:

    Is this because you don’t think that there’s any inherent value in reducing obesity or because you think that the effort is unlikely to achieve much of anything?

    I can understand the 2nd point, it’s the first that I struggle with.

  123. dave:

    Thanks for your reply.

    My response would be that it is great that you are eating healthier and exercising more. I actually think Campos would agree wholeheartedly with your point of view on this issue.

    The key point is that the fact that you lost weight is immaterial, except to the extent that the weight was hindering your quality of life (a purely subjective issue that we should trust each individual to assess)

    I would encourage you to continue to live an active and healthy lifestyle as you seem to be doing right now, regardless of its effect on your BMI, your weight, or your body fat percentage.

    The scientific literature suggests that if you are focused on your weight rather than your health, you are more likely to regress and gain the weight back, at which point it would be even more difficult for you to return to a healthy lifestyle.

    The literature also suggests that if you are already living a healthy lifestyle, further attempts at weight loss will not have an appreciable effect on your healthy outcomes and are likely to result in regression and weight gain.

    Please note that these are statistical points and are not meant to apply to your specific situation.

    I have a BMI of 26 and it is likely that you are healthier than I am (I eat a very good diet but I exercise rarely).

  124. Craigo:

    The flaw of BMI is even simpler than than. Physically, volume grows at a much faster rate than length and area. Any increase in length squares that same increase by area, and cubes it by volume.

    BMI completely ignores this fact and simply squares the denominator, which makes it nearly useless for anyone outside the one-sigma range – for American men, 5’7 to 6′, and women, 5’3 to 5’8. You don’t even need to get to the individual level before it loses its utility.

  125. Stan Gable:

    There’s a disagreement about how harmful obesity is but I’d wager that just about everyone on this thread thinks that anorexia and bulimia are at least just as harmful.

  126. dave:

    I suppose it would be.

    I am a Campos supporter on this issue and I am 6’2″ and 205 lbs. I think I have a pretty good diet (at least by Western standards) but I don’t exercise much.

    Am I invested in my diet and activity levels? I wouldn’t say so.

    My investment in this issue comes from the fact that I have always been pretty “healthy-looking” with a “normal” BMI despite fluctuations in my diet and activity levels over my lifetime.

    For this reason I would never have been targeted by any healthy eating or exercise campaign.

    Yet, it is clear to me that many people who would be targeted live much healthier lifestyles than I do. Such people are targeted based on their physical appearance and weight rather than their actual health. They are given endless lectures about being more active and eating better foods. Such lectures frequently come from people who “look good” but live vastly unhealthier lifestyles.

    These lectures take pace in the context of a society that shames and humiliates such people on a daily basis.

    This bothers me.

  127. Paul Campos:

    Weight loss from terminal cancer can be controlled for readily by excluding people who died within a year of entry into a study (since terminal cancer-associated weight loss tends to occur in the final year of life).

    As the JAMA study notes, such attempts to control for pre-existing disease have been found to have little or no effect on study outcomes.

  128. Jeff Fecke:

    And we have a winner!

  129. Paul Campos:

    See (4) in the OP.

  130. dave:

    Like Paul, I think there is some (albeit fairly limited) value in reducing obesity in the case of people who are extremely obese.
    I also think that such an effort is unlikely to achieve permanent substantial weight loss in any event.

    I also think that the health benefits of any weight loss that were achieved, could be achieved without having any weight loss and/or independent of any weight loss.

  131. Speak Truth:

    Fat-phobia in the aggregate, is a nasty little quixotic and pseudoprogressive meme on the internet.

    I think this pretty much says it all.

    It’s just another made-up “unfairness” to rail against when comparing this world to their utopia that never was and never will be.

    There comes a time when you just gotta let the culture evolve and develop on its own without the guiding hand of the progressives.

    I don’t particularly think stigma is a bad thing. It’s a social control for unwanted characteristics. It influences the others not to be that way.

    Fatass

  132. Malaclypse:

    Cracker, please.

  133. Craigo:

    Cancer deaths and, to a much lesser degree, smokers were controlled for. The big problem in the analysis is that it went out of its way to exclude health conditions with correlate highly with both body weight and mortality: Cardiovascular disease, diabetes, hypertension, etc.

  134. Richard Cobeen:

    Also want to second that this is easily the best thing you have written about the weight issue. As someone who is termed obese by government and society standards, I wanted to embrace your past posts, but found them to be inflamatory and poorly argued. This is a wonderful baseline to get a true discussion started.

  135. John Protevi:

    I don’t particularly think stigma is a bad thing. It’s a social control for unwanted characteristics. It influences the others not to be that way.

    If only it would work in your case

  136. anniecat45:

    Not true. I have my knickers in a twist about weight issues because of a friend of mine, a leader in the size acceptance movement, who is so obese, and whose muscles have so atrophied, that she can’t leave her apartment because she can’t go up or down the stairs. Everything she needs has to be either delivered, at huge expense, or brought to her by friends. She also is quite nasty to me because, when I realized I had gained 40 pounds in 4 years, and was told I had high blood pressure, I lost the 40 pounds (and the blood pressure is now controlled with 1/4 of the medication I needed when I weighed 190 pounds).

  137. ACM:

    I’m pretty sure they’re saying you’re a crappy writer, not that they have reading comprehension problems. But keep on keeping on!

  138. Cathie from Canada:

    At a recent nutrition seminar I was at, they said a loss of 10 per cent of weight is significant in terms of positive health effects.
    For a 250 pound person, a loss of 25 pounds doesn’t have much affect on appearance or dress size, but they said it would have a positive effect on things like joint pain, arthritis, heart conditions, diabetes. This was the goal they urged people to set in terms of weight loss.

  139. Murc:

    you’d be surprised the number of people who don’t trust the banks

    Often with good cause.

    When you’re living paycheck to paycheck, a bank account is a liability. I’ve worked alongside people who are, and have been myself, genuinely poor. I’ve been in a situation where I need to empty every single dime out of my checking account, something banks don’t take kindly to. I’ve had banks deliberately process a series of withdrawals before deposits made nearly a week beforehand, and structure those withdrawals in a way that they could slam me with overdraft charges multiple times. I’ve had banks put ‘overdraft protection’ on my account after I specifically told them not to.

    My experiences are far from unique.

    You would think ‘if there is no money in my account, payments drawing on that account should bounce’ wouldn’t be a hard concept for a bank to get.

    I’m dismayed at the people that won’t open an account at a credit union or coop bank

    Around here, the credit union and co-op banks mostly have minimum balance requirements and/or monthly or yearly fees, something else that’s a dealbreaker for the poor.

    The check-cashing service thing baffles me, though. I don’t know what it is like nationwide, but around here both major grocery chains will happily cash a paycheck for you free of charge.

  140. Superking:

    Murc,

    Most banks offer a basic checking option that this point that comes without monthly fees or minimum balance requirements. I had one at Bank of America, but I switched over to PNC when I got sufficiently disgusted with BOA. So, a checking account shouldn’t cost anyone anything. The banks treat these accounts as loss leaders, and they may get credit for them under the CRA (I forget exactly).

    And that nonsense about structuring withdrawals to maximize their fees is now illegal per Dodd-Frank. I think there was a more than credible argument that it was illegal prior to Dodd-Frank, but I’m pretty sure DF made it explicit.

    Dodd-Frank also changed the overdraft rules where they have to ask you to opt-in to the overdraft system. You could always tell the bank that if you didn’t have any money, then you would want it to bounce. I don’t know why they would change it around, but I think it’s a lot harder for them to do it without your explicit consent at this point.

    In any case, it is exceptionally hard to get anywhere in our economy without a bank account, and the goal of financial literacy is to help people understand how to use their accounts wisely, and to know when they’re getting screwed by the bank. If they can interact with the bank positively and know when it’s gone bad, then they can make the most of the financial system. And that’s almost infinitely better than just keeping your money out of a bank in the first place. At a minimum, you’re paying fees at a check cashing place, and bank alternatives like prepaid debit cards charge exorbitant amounts just to open the account.

  141. Anonymous:

    As a 250 lb person (not a healthy weight for me – I’m 5’4″ and feel much better carrying 140-5 lbs, which should be noted is almost in the overweight category and yet kept me fit, healthy, and in a size 6), many doctors have told me to even just aim for the 5% loss range. It seems that at the very high end of the scale, even a little bit of loss should be encouraged because it will take strain off of your joints. In addition, all of the healthy things you do to lose that weight will help with your heart and any pre-diabetes and sleep and all sorts of other good things.

    (I’m aiming for the whole enchilada of 110 lbs, not because I think everyone can or should lose that much weight but because I felt great then and miss my clothes. Might as well give it a shot if I can do it without damaging my body or acquiring an ED.)

  142. Cathie from Canada:

    Here’s my cynical take: somebody always has to be the scum of the earth, the person to whom others can feel superior.
    We’ve done it to poor people, hill people, swamp people, country people, religious people, brown people, women, and smokers.
    Now its fat people who are taking centre stage.
    Next I wouldn’t be surprised if its old sick people. — somehow I always seem to find myself at the top of the list!

  143. Superking:

    I’m type-1, and use a pump. I try to take what the doctors say with a grain of salt. The thing to remember, from my perspective is that it’s a mix of exercise, diet, and insulin, not just one of three. I love bananas and eat them regularly, but I also account for them appropriately. Of course, the trick of the thing is that it’s different for everyone, and if your husband can’t have bananas without effing up his blood sugar, then don’t eat bananas. Apples are a better choice for fruit since they are less dense, and I get my share of them as well.

    Brussel sprouts, however, can be delicious. Try this: http://morselsandmusings.blogspot.com/2011/07/crispy-brussel-sprouts-w-bacon-garlic.html

    Add a little greek yogurt to the plate to balance the warmth.

  144. Murc:

    I actually wasn’t up on all those little details of Dodd-Frank, Superking. The last time I was looking around for a bank account, before that was passed, I actually had to go to three different ones before I found one that would meet my requirements of no fees, no overdrafts, no minimum balance.

    I actually had Bank of America point-blank tell me they couldn’t give me an account without overdraft ‘protection’. That was such a naked and obvious attempt to defraud me I walked right out.

    Hopefully this newer and more friendly banking environment will help people and the word will get out. Although a lot of damage has already been done. People who opened their first checking account and then got nailed by hundreds of dollars in overdraft fees they don’t understand are still going to distrust banks even many years later.

  145. Anonymous:

    Haven’t seen any mention of the discussion about whether or not increased fat on the body increases women’s chance of breast cancer specifically because they have more (and larger) fat cells in their bodies.

    While I agree with Campos’s points (health should be the final target, weight is only one of many imperfect indicators, and at the individual level BMI is a terrible indicator too), having too much of one’s body mass be composed of fat can in and of itself threaten one’s health in that specific way. There are some health issues where the evidence is more than statistical correlations, where the causative pathways have at least been postulated and maybe even demonstrated (another: joints that wear out well before their time (like my bad, bad, bad knees at 26)).

  146. Karla:

    Superking, I have a Bank of America checking account, and the last time I checked, the only reason I don’t have any fees taken from it is that I have automatic direct deposit. Any month in which I haven’t had a direct deposit come into my account, either because I was between jobs or because one paycheck was at the end of the month and the next at the beginning of the next month, I’ve been charged a fee. For someone with less job security, B of A doesn’t have a free checking account that doesn’t require a hefty minimum balance.

  147. sparks:

    Um, my brother also has two very bad knees, one injured at age 11, the other at 18. He was never overweight, but at your age he was on his second knee surgery, and had a third before he was 30.

    My point? Anecdotes are crappy data, and I am convinced much of what drives weight loss is vanity or societally enforced shaming. My ability to lose weight easily is freakish, and I never expect it of others, so I consider it a bad data point. Not that I won’t use it as a counterexample, of course.

  148. FLRealist:

    I read this comment out loud to my husband. He said that his guess is that you haven’t been married very long, and that what can be said when can be a very painful (as well as expensive) lesson to learn.

    Best of luck on the treatments!

  149. cpinva:

    i was going to suggest sanskrit.

    I was about to ask for a translation into either English or Spanish.

    i still wouldn’t understand it, but sanskrit is a lovely looking language, in the written form.

  150. Andrew Burday:

    I agree with most of this and it’s good to see somebody saying it. But I have a couple of problems with point 4. First, “the difference between “dieting” and eating disordered behavior is merely one of degree.” Yeah, but the difference between eating nothing at all and being force fed until your stomach bursts is also “merely one of degree”. Slippery slope arguments are always wrong — unless some specific reason can be given to think we really will slide down the slope in question, and I don’t see any such reason here.

    Second, “Eating disorders are common consequences of dieting.” What happened to the guy who was so careful about distinguishing between correlation and causation in point 1?

    My own experience, for the little it’s worth, is that I have never been on a well-defined diet but I have made conscious efforts to modify my diet and reduce my caloric intake, which have been successful over a period of about seven years. Again for what it’s worth, I’ve been happier at a lower weight. Fat shaming is bullshit. Bullshit science is bullshit. But we shouldn’t lose track of the fact that it is possible for at least some people to modify their diets (including qualitative modifications) in ways which probably do improve their health.

  151. Incitatus:

    It’s actually not that hard. Fruits, vegetables, meat, rice, pasta. But it requires one to make meals, as opposed to sticking a plastic container in a microwave.

  152. cpinva:

    it doesn’t seem to have worked, in your case.

    I don’t particularly think stigma is a bad thing. It’s a social control for unwanted characteristics. It influences the others not to be that way.

    because you’re still here, and still a twit. so much for that theory.

  153. Sherm:

    How the hell did you swim those 750 meters in under 30 minutes? I’m scared shitless at the thought of trying. The biking and the running wouldn’t be a problem for me, but I just can’t imagine doing the swimming.

  154. cpinva:

    this is why i find people like suze ormon so ridiculous. she offers general pablum for the masses, with such compelling advice as: don’t spend more than you make! well, duh! no shit shirley. as near as i can tell, her success is mostly predicated on being a “celebrity”, and a lot of self-promotion. more power to her, but a financial advisor she isn’t, except in the way generally accepted sense of the term.

    i made the mistake of watching (part, i can only stand so much) her show. it was painful. as a cpa, people like her irk me, because they are so full of shit, and make it sound like if just everyone followed her “advice”, the country would be full of millionaires. they’ll also all be buying valuable real estate, with no money down, and flipping it, for huge profits.

  155. Rhino:

    Speaking as a former professional cook and chef, I am shocked every single day by how few people understand even the most basic cooking tasks.

    I would bet that less than 40% of the people I know could prepare an entire meal of meat, two veg, starch without using any preprepared ingredients.

    People who do not know me well are often shocked to learn that I make my own soup, bake my own biscuits without a packaged dough, or can season a chicken without using a bag of poultry seasoning.

  156. GFW:

    So, she’s a leader but not an activist.

  157. Incitatus:

    Totally agree. And to be honest I’m not much of a cook, and don’t particularly enjoy it. But every week or two I spend a Sunday afternoon cooking a huge stewpot of pasta sauce, freeze in individual portions, and then cooking a healthy meal consists of boiling pasta and microwaving the sauce. Canned organic tomatoes, $1 a pound, 91% ground turkey, $3.50 a pound, onions $.50 a pound.

  158. SamR:

    As someone who previously was considered obese by BMI standards and now falls in the “normal weight” range, I can say I breathe better, I sleep better (partially due to the breathing thing) and I feel better.

    Dunno if there are other health benefits, but I certainly like it more.

  159. Superking:

    Karla,

    That does seem to be true at this point, regarding BOA specifically. I don’t know what to tell you, but I did have a free account. I opened it back in 2004, and at the time, I was told that it was free on a monthly basis unless I used in branch banking. So, while that’s weird, that’s what they told me.

    In any case, other banks do offer this option. As I said above, I switched to PNC, which is based in Pittsburgh and convenient in much of the mid-Atlantic region. They have a “basics” account that is totally free on a monthly basis: https://www.pnc.com/webapp/unsec/Blank.do?siteArea=/pnccorp/pnc/home/personal/checking/Checking+Comparison

    It’s not the best account they have, but it’ll do if you don’t have anything else. The thing to do is shop around–banks are providing a service and products just like a plumber or other businesses–and then ask them about the deals they have. For example, the local PNC bank I went to was offering a $150 incentive to employees of businesses in the neighborhood. So, when I switched, they gave me money. I have to say, I’m pretty happy with PNC all things considered.

  160. Superking:

    I should say I seem to have been wrong about little bits in here. The change in the overdraft protection applies to new accounts opened after August, 2010, and appears to derive from federal reserve regulations, not Dodd-Frank. The order of checks thing also changed, but I’m having trouble coming up with it right now, and it might be specific to my state.

  161. Law Spider:

    Oh, Goat. Having gone through IVF myself, you are going to have to re-visit your thought-to-speech ratio if you value your wife at all. Politically correct or not, from my personal experience those various hormones — and the resulting pregnancy — can do a number on one’s emotional and physical state.

    (Thankfully, the hormones were followed by a pregnancy. The resulting two darling children were worth it, mostly (that pregnancy was f-ing horrible)).

  162. sapient:

    If public health initiatives don’t work, why is obesity falling among children in New York and Philadelphia?

    We obviously don’t know everything there is to know about health and weight, and I’m not in favor of stigmatizing people. Very heavy people do have mobility problems, though, and that can’t be good for one’s health.

  163. Sherm:

    Yeah, that was like a tv sitcom husband dumb thing to say. Congrats on the twins — the telltale sign of ivf. My wife and I never needed to try anything more than artificial inshermination.

  164. Walt:

    Speaking as a former professional computer programmer, I’m surprised how many people browse the web without being able to write a simple HTTP client.

  165. djillionsmix:

    Nothing in this post is anything Paul hasn’t said before.

    I’ve found that the people who say “No, I’m not willfully misinterpreting you, this is how your words can plausibly be read,” mostly were.

    Come to that, I’m pretty sure anyone who says “No, I’m not willfully misinterpreting you, this is how your words can plausibly be read,” is.

  166. djillionsmix:

    “Let’s not make ad-hominem attacks here, shall we?”

    I agree, it was in very poor taste for shah8 to make the ad hominem attack to which greylocks was responding.

  167. djillionsmix:

    If you say the word “agency” enough times, does it successfully remove any need you feel to actually care about other people and their well-being?

  168. djillionsmix:

    “Next I wouldn’t be surprised if its old sick people”

    coming soon:

    the ‘retirement epidemic’

  169. Xenos:

    I just had pneumonia and lost ten pounds over a five day period. I am awfully glad I had the ten pounds to spare.

  170. Anonymous:

    They were.

  171. joe from Lowell:

    Eating disorders are common consequences of dieting.

    Common? How “common?”

    Why do I suspect that the correlation between dieting and eating disorders is smaller than the correlation between obesity and negative health outcomes, which is waived away as “exaggerated?”

  172. Sherm:

    http://www.mayoclinic.com/health/eating-disorders/DS00294/DSECTION=risk-factors

  173. joe from Lowell:

    Dieting. People who lose weight are often reinforced by positive comments from others and by their changing appearance. This may cause some people to take dieting too far, leading to an eating disorder.

    Not exactly the strongest of evidence. “May cause” “some people” to some unknown degree.

  174. Sherm:

    http://www.mayoclinic.com/health/eating-disorders/DS00294/DSECTION=causes

  175. Eli Rabett:

    WTF a zillion comments and no one mentions advertising as a driver?

  176. Sherm:

    As a father, let me say that the advertising of junk food to children is fucking diabolical. Its hard to overcome, no matter how much you try to limit tv viewing.

  177. joe from Lowell:

    Still nothing. No numbers, no evidence – just a description of a plausible-sounding route of causation for a correlation that isn’t shown (which is exactly the criticism Paul makes of the obesity-health link).

  178. joe from Lowell:

    It also doesn’t say anything about dieting.

  179. Joe:

    Paul Campos comes out more reasonable with the right level of vague adjectives and general concerns. He at times on this issue sounds like the sort who would call those concerned with some applications of affirmative action someone who doesn’t care about racism.

  180. delurking:

    Did you meet this friend in a taxicab?

  181. harvey:

    Without bogus statistics, we’d have to give up climate change hysteria and the persecution of smokers.

    And why is this a bad thing?

  182. justaguy:

    “furthermore the difference between “dieting” and eating disordered behavior is merely one of degree. Eating disorders are common consequences of dieting.”

    Could you back this up a little, because this seems a little extreem. You’ve done a good deal of parsing the differences between causality and correlation when it comes to negative aspects of obesity, would the causal link you’re claiming here withstand the same scrutiny? Does dieting cause eating disorders, or do people with eating disorders caused by other factors frequently start out dieting and then move on to more severe behavior?

    At the same time, are eating disorders are a “common” consequence of dieting? I did some googling to find the figure of 45 million Americans going on a diet a year, and 8 million people with eating disorders. I’m not sure how many of those 45 million are new each year, but it is safe to assume that the 8 million people with eating disorders have them for several years. So, if you take 10 years as an average time for having an eating disorder for the purpose of a rough guess, you’re looking at 800,000 new eating disorders a year. Even if you assume that all people with eating disorders start out with dieting, that’s hardly common.

  183. Data Tutashkhia:

    Yeah. There is a saying where I grew up; it goes: Пока толстый сохнет, худой сдохнет. By the time the fat one slims down the skinny one will already be dead. Only it rhymes and sounds folksy.

  184. Bijan Parsia:

    Hmm. I think this is too dismissive of criticism of Paul’s past writings on this subject (e.g., see one of my comments; Paul did follow up to an email from me conceding that he was sloppy in that post, but I don’t think we ever got a correction in the post; that people said silly things in reaction to Paul doesn’t preclude Paul from saying silly things).

    I agree with the other folks that this is Paul’s best post on the subject that I’ve read.

    I don’t think we have to choose between passion and scrupulous accuracy!

    (Note that I’m generally rather sympathetic to the HAES movement.)

  185. Leeds man:

    Does dieting cause eating disorders, or do people with eating disorders caused by other factors frequently start out dieting and then move on to more severe behavior?
    /blockquote>

    As JFL points out above, dieting->eating disorder is dodgy. The few cases I know of personally are chock full of “other factors”, and you may as well make the causal relationship veganism->eating disorder, which is patently absurd.

  186. Leeds man:

    Try that again.

    Does dieting cause eating disorders, or do people with eating disorders caused by other factors frequently start out dieting and then move on to more severe behavior?

    As JFL points out above, dieting->eating disorder is dodgy. The few cases I know of personally are chock full of “other factors”, and you may as well make the causal relationship veganism->eating disorder, which is patently absurd.

  187. Bijan Parsia:

    I think this is, indeed, a problematic or at least tendentious point.

    Part of the difficulty is understanding what he means by “continuous”. After all, in some sense, arguably healthy eating patterns are continuous with eating disorders (e.g., people do binge on special occasions and then dial it back afterwards to compensate, or eat less in anticipation; this needn’t be harmful, as far as we know, as an occasional thing).

    One might want to expand the notion of eating disorder to encompass, e.g., yo-yo dieting, but this is tricky.

  188. dfinc:

    Whether BMI is good or bad as a tool, whether health risks increases with weight is “real” or not, I think the key is whether a kid reading the site, or having the program being applied to them, would feel shamed by it.

    Does any part of this program goes into a class room to tell them they are fat and should be ashamed of it? Or does is presented in the way of “obesity is bad, so we are going to teach you about healthier food and exercising more?” Does any part of the program require or encourages teachers/lecturers to tell specific kids they are fat?

    It’s really, really hard to imagine that it implies something that a kid doesn’t already know about themselves.

  189. Bijan Parsia:

    Evidentially, this seems promising:

    Retrospective data from individuals with eating disorders provide evidence of the association between dieting and eating disorders. A number of studies involving clinical samples have found that the majority of individuals with eating disorders report that they started to diet before they initiated their disordered eating behaviors [45, 46]. Further evidence of the association is provided by prospective studies within community samples of adolescents. Among adolescents, self-reported dieting has been shown to predict increased risk of disordered eating behavior [39, 47–49] and sub-threshold eating disorders [26, 50, 51]. These results suggest that self-reported dieting among adolescents may lead to more severe eating pathology (Fig. 2).

    And this:

    Female subjects who dieted at a severe level were 18 times more likely to develop an eating disorder than those who did not diet, and female subjects who dieted at a moderate level were five times more likely to develop an eating disorder than those who did not diet. Psychiatric morbidity predicted the onset of eating disorder independently of dieting status so that those subjects in the highest morbidity category had an almost sevenfold increased risk of developing an eating disorder. After adjustment for earlier dieting and psychiatric morbidity, body mass index, extent of exercise, and sex were not predictive of new eating disorders.

    That’s pretty striking. (It, of course, doesn’t mean that dieting “commonly” leads to an eating disorder…cf Paul on relative risk :))

    More details:

    Our study showed that 8% of 15 year old girls dieted at a severe level and a further 60% dieted at a moderate level. Female subjects who dieted at a severe level were 18 times more likely to develop a new eating disorder within 6 months than those who did not diet, and over 12 months had an almost 1 in 5 chance of developing a new eating disorder. Female subjects who dieted at a moderate level were five times more likely to develop a new eating disorder than those who did not diet, and over 12 months had a 1 in 40 chance of developing a new eating disorder. In contrast, fewer than 1 in 500 subjects in the non-dieting group developed an eating disorder in the next year. Even ostensibly moderate dieting increased the risk for eating disorders, and around two thirds of new cases were in female subjects who had been in the moderate rather than severe dieting group. Although these findings suggest that dieting is a very important risk factor for adolescent eating disorder, it is arguable that for those who already diet severely a process leading to eating disorder has begun.

    So, you can’t say that the dieting is causal (though encouraging dieting might start otherwise predisposed people down the path).

    I think this is enough to make Paul’s claim narrowly defensible, but not particularly helpful.

  190. Bijan Parsia:

    I do not deny a significant cultural role on diet and activity levels. What I reject is when Campos seems to take that to the extreme that individuals have little or no control over their own weight, that any attempt to change their weight is doomed to failure.

    This does seem to be the emerging scientific consensus. In particular, diet and exercise is somewhat effective for short term weight loss, but ineffective for long term (e.g., 5+ year) weight loss and can predict overall weight increase. There’s a lot of speculation as to why, and it’s almost certainly a complex set of factors. But the current best evidence supports it as a real, widespread phenomenon. Furthermore, the health benefits of attempting to reduce your weight seem low and the health risk of attempting to reduce your weight seem high.

    Now, aiming at maintaining a weight level seems to be a good idea as well as getting fitter.

  191. Bijan Parsia:

    Yeah, I’m not sure why Paul is eliding that bit. It doesn’t seem to hugely damage his overall position.

  192. Bijan Parsia:

    One metaanalysis I read was really happy that BMI was being recorded since it allowed them to do crossstudy comparisons and integration with a hell of lot more reliability. (Maybe it’s even the current hyped study? Yeah, I think so.)

    That’s, of course, rather different than using BMI, or rather, certain bins of BMI as clinical or public health guidance. (Even then, it depends on what the guidance is.)

  193. Sherm:

    Since you don’t trust the quacks at the mayo clinic, here’s some stats:
    http://www.bmj.com/content/318/7186/765.short

  194. Sherm:

    Another interesting read:
    http://europepmc.org/abstract/MED/16567152/reload=0;jsessionid=vWdIn0ae8ZGp0EGOtoGN.12

  195. Mo:

    Well, considering the fact that every person with an eating disorder is also a dieter, but only half of diabetics are obese, I would say the two are much more strongly linked.

  196. Anonymous:

    This seems to be a classic all Xs are Ys, but not all Ys are Xs. Almost all heroin addicts started smoking pot, but most pot smokers don’t continue on to do heroin. However, my guess is you will find that pot smokers are X% more likely to do heroin than those who have never smoked pot, yet this still doesn’t mean that most pot smokers are at risk of becoming heroin addicts. What this indicates is that people engaging in self-destructive behaviors have to start somewhere.

  197. UserGoogol:

    Eh, I’m rather skeptical that advertising can really shape mass society all that much. It’s all very bully pulpitty. More specifically, there isn’t really a ton of evidence showing that sort of concrete large-scale effectiveness, and it really seems like the causation could run in the opposite direction: successful consumer products have a lot of advertising because they’re successful and therefore have a lot of money to throw around. You can probably pick out specific examples where advertising has changed things, but for something as general as “people being fatter” it seems hard to really point fingers very effectively.

  198. justaguy:

    That’s only true if you take an incredibly broad definition of “dieter”.

  199. Bijan Parsia:

    This is why I think it’s only narrowly defensible.

  200. mch:

    Can we all agree that eating tastes good?

  201. Dave:

    Yeah, cos that’s TOTALLY the same, dude. People have been writing HTTP clients on their homes for thousands of years…

  202. Dave:

    I’d just like to say, for the record, that ain’t me.

  203. Dave:

    I was thinking rich, white guys needed a turn. But then, we can start to argue about how many regulars here fit into THAT category…

  204. Dave:

    Oh Jeezus f—ing Christ! Advertising has FORMED “mass society” since the late C19. “Mass society” without advertising would have a totally different, and almost literally unimaginable, set of cultural references.

  205. Joe:

    Melissa Harris-Perry dealt with eating issues today.

  206. peggy:

    I once did a combo of serious exercise and Atkins diet and stopped menstruating. My BMI was still “overweight” but my hormones were anti-pregnancy. So cut your wife some slack.

  207. peggy:

    Children are different because they are growing. They do not need to lose weight, merely not to gain, and their BMI will decrease.

    Paul’s discussion ignores the rise in Type II diabetes in children, which is a significant health issue.

  208. chris:

    And it’s great that you have the free time and access to grocery stores to do that.

    Great for you, anyway.

  209. Michelle:

    Your article made me want to cry. It is heartbreaking to think of all the people that the dangerous inaccuracies in your article will reach. While I agree that we need to do better at creating a society that does not judge obese people and treat them with any less respect than a thinner person, feeding them lies is a dishonest and potentially fatal thing to do. It was no surprise to me when I found out you were a lawyer. You went to a great school and learned how to take in all the facts, digest and analyze them, and argue whatever point your analysis concluded. That is not how the human body works. As a medical student, you are taking facts and regurgitating them with no qualification whatsoever. Obesity is but one killer in today’s world. A large number of illnesses that happen slowly cause the wasting of a patient first. By the time cancer claims the life of its victims, few of them have managed to keep on significant weight, yet obesity is a risk factor for many aggressive cancers. Additionally, there are plenty of risky behaviors that cause weight loss. Smoking, drug use, and eating disorders are just of few of the life choices that contribute to a significant increase in morbidity and mortality. I could write all night in the hopes that just one obese person will read this and understand that they are worth it and wonderful and that they do not deserve to be treated the way that they frequently are but that what you claim IS NOT an accurate portrayal of the truth. There is a movement to try to convince doctors not to tell their patients that obesity is a risk factor for breast cancer so as not to “victim-blame,” or place the blame on obese patients who already have the disease. I think it’s highly unethical to keep life-saving information (or in your case, propagate mortality-inducing information) from anyone in order to spare another’s feelings. There are better ways to improve how we treat others and start to bring up their self-esteem.

  210. Michelle:

    This is not true! There are studies out there that tell you that all you need to do to lose weight is add a few raspberry ketones to your diet. You simply cannot gain from one article enough information to draw these kinds of dangerous conclusions. You may try to convince me that this was a “meta-analysis” which considered a vast array of studies but it was ONE study that interpreted these results, leaving the door wide open for investigator bias. There is a science of research, and there is very little scientific knowledge being put forth by the series of articles you have referenced or written. Do you even know the mechanisms by which obesity attacks the human body? If you did, how could you possibly make these inflammatory claims? You have a responsibility to understand these biochemical mechanisms before you can hope to interpret the literature, otherwise your interpretations are nothing more than from a lawyer’s perspective which counts for nothing in the medical arena because the body does not work in a such a way that can be derived in a logical fashion.

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