Home / General / Inevitable Follow-Up On the Obesity Myth

Inevitable Follow-Up On the Obesity Myth


Murc Marc makes an argument that was inevitable in any thread about the obesity myth:

And then he claims (in other contexts) that it’s impossible to lose weight – ignoring things like the fact that we used to weigh a lot less than we did, or the fact that people in different countries with different diets have very different mean weights and distributions of weight.

As I noted, this is just a non-sequitur; nobody’s arguing that individual weight loss is literally impossible, but it is in fact highly unlikely. The cultural conditions that led to people weighing less on average can’t easily be replicated. Nor, to put it mildly, is it obvious that people were healthier when they were thinner on average.

Murc Marc then responds:

But the difference is very relevant in deciding, say, whether or not we should serve soda pop in schools. Or whether we should promote exercise, or whether we should subsidize vegetables and tax soda.

Not only is it not in fact relevant to these decisions, focusing on weight is transparently counterproductive. Increased exercise and more balanced diets will not, in most cases, make fat people thin. The way Murc Marc posits the question strongly implies that because of this, we should in fact forget trying to make it easier for people to exercise and eat balanced diets, because in the vast majority of cases it won’t “work.” But this is completely wrong, because in fact exercise and eating balanced diets are inherently good things, regardless of whether they transform the look of one’s body or not. (For that matter, having a sedentary lifestyle that involves a lot of bad food isn’t good for you even if your metabolism allows you to remain thin.) Framing the question this way, with weight loss rather than health being the assumed goal, does helpfully illustrate Paul’s point that the obesity myth is about class-related aesthetic preferences in search of a scientific rationalization. Believing that regular exercise is worth doing only if it leads to substantial permanent weight loss doesn’t make any sense if you care about health, but it certainly makes sense if you don’t particularly care about marginal differences in health outcomes for complete strangers but have a strong conviction that fat people are icky. (My favorite recent example of this would have to remain Michael Kinsley and Eugene Robinson arguing that Chris Christie is unqualified to be president, while Paul Ryan apparently is.)

…Atrios puts the point about the perverse incentives here perfectly: “People should eat well and get regular exercise, but actually losing weight and keeping it off is very difficult. If people are focused on that, they’re likely to get discouraged and give up on the exercise and healthy eating.”

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  • Vance Maverick

    Not to mention that exercise makes you feel good (and may, depending on your quirks and the kind of exercise you find, be pleasant in itself), and balanced diets taste good.

    • Leeds man

      à chacun son goo

    • Don K

      I’ll challenge the idea that exercise feels good. Ever since I was a kid, exercise made me feel crappy by making me tired and making my joints sore. Exercise was like the food you hate (for me it was carrots and beets – broccoli and spinach were wonderful) – you do it or eat it because your parents tell you to and because it’s supposed to be good for you, not because it’s enjoyable in any sense of the word.

      • Brandon

        you’re doing it wrong

      • Exercise doesn’t make you tired or make your joints sore if you follow a regular routine on a regular basis.

  • Joe

    Increased exercise and more balanced diets will not, in most cases, make fat people thin.

    what “fat people” are we talking about here? and is the concern being “thin” or “less fat”?

    Exercise and more balance diets will quite often will lead to weight loss and it is not “highly unlikely” this will occur. Our culture encourages overeating and bad eating habits.

    The concern, which Paul Campos provides with his all too typical heavy-handedness, is more limited, it appears to me.

    • Joe

      If we are talking about specific people and specific types of weight loss, that would be different. A careful addressing of the topic would be helpful but repeatedly Campos’ style makes this somewhat harder.

    • L2P

      Totes agree.

      Who are these mysterious people who eat less, exercise more, and don’t lose any weight? AFAIK, that group of people doesn’t exist.

      The group of people that DOES exist has a very hard time actually eating less and exercising more. That group of people doesn’t lose weight. A lot of family were those very people. They swore they were eating less (and they kind of were, in the “Now I’m only eating two breadsticks at Olive Garden” way) and exercising more (in the “Now I’m running/doing yoga/walking 15 minutes a day a couple times a week” way.)

      And then they got diagnosed with diabetes. Or hypertension. Or heart disease. And suddenly that diet/exercise combo became a matter of life and death. And oddly enough, they started losing weight. They’re not all supermodel thin, but they’ve lost significant amounts of weight when before they never could

      So who are these people that exercise regularly for significant amounts of time, stick to significant diets, and don’t lose weight? Where do they live? What’s their secret, and can we use their metabolistic secrets to solve the world’s hunger problem?

      • “Eating less” and “more balanced diets” are not the same thing. You can have a healthy diet and exercise and not lose an ounce. You can even do those things and gain weight. Losing weight (in the form of fat) requires your body to “starve” i.e. to burn more calories than are being taken in so that fat deposits must be tapped.

        There are all sorts of things that prevent that from happening (hunger pangs not least among them). So yes, you can have a healthy diet and exercise, get more healthy and keep the exact same amount of fat on your body. There are certainly some limits, of course: very overweight people would have a hard time making that transition without actually inducing some fat burning.

        • L2P

          I don’t think that’s true, either. You can’t exercise more, eat the exact same amount of calories, and “keep the exact same amount of fat on your body.”

          You might keep the same WEIGHT. For a while, at least. But your fat content is going to go down. You’re still USING more calories – it goes somewhere. You are going to convert fat to muscle and bone. Unless you have some sort of miraculous metabolism, in which case we need to study you to solve the world’s hunger problem.

          It’s still extremely unlikely you wouldn’t lose weight. Once you start converting from fat to muscle and bone your metabolism will increase and you’ll need to increase your caloric intake just to maintain body weight. You’d have to have a very rare metabolism to actually change your diet, exercise more, and not lose weight.

          Very few people that actually stick to a diet and exercise program fail to lose weight. It’s not that it doesn’t work. It’s that diets are hard to maintain and exercise is a pain in the ass.

          • buermann

            “converting from fat to muscle and bone”

            Fat does not turn into muscle and bone. You might replace one with the other, but that’s pretty difficult to do at the same time: adding muscle requires eating more than you burn, burning fat requires eating less than you burn.

            “You can’t exercise more, eat the exact same amount of calories, and ‘keep the exact same amount of fat on your body.'”

            IIRC this is exactly the sort of claim Campos explicitly argues against, not because the math is wrong but that the counting is impossible: you might burn an extra 20-40 calories over your resting metabolic rate walking or jogging a mile, an incredibly easy thing to miss unless you’re preparing everything you eat yourself with a digital scale, etc.. Exercising your way to a healthy calorie deficit means running a 10K every day, and good luck with the hunger that level of training generates.

            • L2P

              Well, you’re right – fat doesn’t literally “turn into muscle and bone.” The fat in your belly and hips doesn’t migrate to your legs and arms. Fat cells don’t magically turn into calcium and protein. But thanks for clarifying that your fat cells will slowly shrink as you consume the extra energy and lose mass while you gain muscle and bone mass from the extra exertion. If you want to go into some detail about how we metabolize food into the creation of bone and muscle and how the body consumes fat when we use more energy than we consume, knock yourself out. You can also talk about water and stuff if you want.

              But Campos is simply wrong if he’s actually arguing that a person that exercises more and consumes that same won’t lose fat. If you actually DO eat the same amount of calories, and run for 30 minutes a day, you will be losing fat. You might not lose weight because muscle weighs more than fat; you might actually gain weight. But you will lose fat.

              And it’s trivial to do. I did it every year for 15 years when I boxed, and I wasn’t a very good boxer. I just stopped drinking beer. Presto! Done – I cut out 300 calories a day and I was done. I had a hard time STICKING to it, but I could certainly DO it.

              I also don’t think Campos argues that you can’t lose fat with diet and exercise. IIRC, what he argues is that most people can’t stick to a diet and exercise program over the long haul. They exercise, but then eat more because they are hungry from using more energy. Or they get tempted by McDonalds or Cheetos.

              That’s a much different thing from arguing that you will lose fat if you diet and exercise. I don’t think that’s arguable.

              • Tharn

                Actually virtually everyone up thread is wrong. It isn’t about exercise or how much you eat. Nutrition science has been giving bad info for the last 60 years…Anyone can lose weight and get healthy without exercising at all. Calories don’t mean shit. Different foods effect your metabolism differently. Carbs of ANY kind will keep your body from mobilizing stored fat and using fat for fuel. Carbs provoke an insulin response. When that happens your body cannot use fat for fuel. It is that simple. If you never ate another carb you would be very healthy and lean. You need to healthy fats and protein. We as a species are not designed to eat carbs. Your body does not differentiate between bread, pasta, soda, potatoes, quinoa or sweet potatoes, etc. All of them provoke an insulin response. Eat a high fat(which is actually very healthy if you are eating very few carbs)diet with pastured animal protein and you will lose weight, be full and be healthy. Sounds heretical but as I stated, virtually all mainstream nutrition information is wrong.

                • buermann

                  “If you never ate another carb you would be very healthy and lean.”

                  Er, wouldn’t that send you into permanent ketosis? Lean, no doubt, but in the long term that couldn’t be very healthy… or at least your breath would really stink.

                • chris

                  Sounds heretical but as I stated, virtually all mainstream nutrition information is wrong.

                  My quackery meter is redlining.

                • Malaclypse

                  Nutrition science has been giving bad info for the last 60 years

                  When you start off with the statement that all science is wrong, not offering any actual evidence for the statements that follow is perhaps not the best persuasive style, unless you are hoping to narrow your appeal to lunatics.

              • buermann

                Nobody has ever argued anywhere that you can’t lose weight with diet and exercise, so I don’t know why you argue against an argument nobody made. The question is whether trivial thermodynamic knowledge is useful health advice.

                “The fat in your belly and hips doesn’t migrate to your legs and arms.”

                This is actually possible: since we are burning and storing fat all the time depending on whether we are fed or fasted, and the whys and wheres of where we store excess energy is complex — e.g. higher cortisol levels are associated with belly fat and the like — changing the environment without changing the calorie balance can shift fat from the belly to the hips or arms or legs, etc..

                “If you actually DO [this or that]”

                Which is a good way to go about utterly ignoring that people are collections of behaviors driven by biochemical processes and the cognitive and environmental overrides of those processes are imperfect, e.g. high sugar consumption increases insulin blocking leptin leading to lower metabolism while also increasing fat storage and increasing appetite. All that Luskin stuff.

                For that matter most of what burns or fails to burn the calories of people with different resting metabolic rates (the variation of which is vast) are entirely involuntary biological reactions to who knows what. Are we going to stuff everybody into calorimeters? We don’t know exactly how many calories are in this sandwich from the lunch place and we don’t know exactly how many calories we need to burn. On an individual basis the trivial thermodynamic balance doesn’t help much since we don’t have the individual empirical data necessary to balance the equation to tight enough constraints: 50 calories a day off and you’ve put on 5 pounds in a year. This was something our appetites were supposed to regulate, not our frontal cortex.

  • JL

    Yeah, that’s the thing. If we want people to exercise more and eat more healthily, both of which I would consider very positive things, we should encourage people to exercise more and eat more healthily. If people also end up with lower body fat as a result of these practices, cool.

    There are a few situations that I’d say are exceptions to this (e.g. knee problems being aggravated by extra weight), but in general I’d rather we focus directly on the health-promoting behaviors, rather than getting at them through a proxy. It seems more efficient.

    • RedSquareBear

      Less easy to apply Victorian morality to, though.

      (See also: drug war vs. harm prevention, needle exchange, etc.)

    • Aaron B.

      Virtually all the negative health outcomes associated with even the most obese individuals disappear with moderate and regular exercise.

      • Scott Lemieux

        Virtually all the negative health outcomes associated with even the most obese individuals disappear with moderate and regular exercise.

        This really is the key point.

  • david mizner

    The only good thing about anti-fat prejudice is it might stop Chris Christie from becoming president.

    • david mizner

      Oh, I see you touched on this at the end. Always read to the end! Good post. I’m surprised to learn that this topic is such a contested one in these parts; the sane and liberal pov seems pretty obvious.

    • RedSquareBear

      The only good thing about racial prejudice is it might stop Alan Keyes from becoming president.

      See what I did there?

      Don’t be an asshole, Dave (too late, I know). Bigotry isn’t a good, instrumental or otherwise.

      • david mizner

        You’re right: I shouldn’t have said that. Apologies.

        • Aaron B.

          I don’t understand what just happened here. Somebody said something rude, got called out, and then promptly and graciously apologized for it?

          Are we still on the Internet?

          • UberMitch

            I know, right? Looks like there are certain traditions of which someone needs to be made aware.

    • xxy

      Or more likely it will gain him sympathy, since a majority of American adults are classified as “overweight” or “obese” under the BMI system. There are plenty of good reasons to oppose Christie. His weight is not one of them.

      • david mizner

        I didn’t say it was a good reason, of course it isn’t; but as I say above, I shouldn’t have ascribed anything positive to prejudice.

      • Oh for God’s sake. It was a mildly funny comment. Nothing more.

      • me me me me

        “his weight is not one of them”

        actually being twice as big as is healthy because you eat twice as much as is healthy is blatant evidence of a lack of
        self control and basic good sense

        • Malaclypse

          actually being twice as big as is healthy because you eat twice as much as is healthy is blatant evidence of a lack of
          self control and basic good sense

          Highlighted the part where you have absolutely no evidence for your assertion. Hope that helps!

          • me me me me

            yeah well i’m sorry your retarded

            • Malaclypse

              your retarded

              You can’t make shit like this up.

              • me me me me


                oh fer crissakes

                and yer socks are funny

          • me me me me

            quit pretending. do you even care about christies health?

            • Malaclypse

              Not one whit. Now can you help me out and start trolling the original thread?

              • me me me me

                no, i’m done….here have some cheetoes and mountain dew..

                • Malaclypse

                  Yes, yes, a Dramatic Exit.

  • Bob

    As a 54 year old man who has spent his entire life see-sawing weight wise allow me to – ahem – weigh in. I have no idea if obesity takes years off of anyone’s lifespan – this blog and others I read and respect seem convinced that such claims are specious at best. Are you cheery picking studies to bolster your point? I don’t know – but I suspect not. You’ve pretty well convinced me the lifespan cost is mostly a myth.
    But I do know there is a pronounced difference in my quality of life when my weight is lower than when it is higher. I have bad knees and a bad back. The more I weigh the more I suffer from both. Very real, very frequent bouts of pain ranging from the inconvenient to debilitating. Sixty pounds makes a huge difference in how often I spend days in agonizing pain. I also find being out of breath at the top of a flight of stairs or unable to complete hikes in the woods to be a serious lifestyle problem.
    I agree what any individual weighs is nobody else’s business. But I’ll be damned if I’m going to pretend that obesity carries with it no health problems. It most certainly does – as I can tell you right now, typing this with a throbbing pain in my left knee. Alas, my weight is very high right now and walking – just nice, slow easy walking – is extracting a toll on me.

    • c u n d gulag

      I’m in the same boat as you.

      I lost 125 pounds over a 2+ year period about 7 years ago, by following a healthier, lower carb, suger, and fat, more whole grain, lean meat, legumes and nuts, diet, and doing non-impact exercise, pretty much on a daily basis.

      I kept that weight off for a couple of years, ’til I lost my job, and, after not being able to find work in the Bush Recession/Depression, moved from NC, back in with my parents in NY State.

      We had to live off their SS, and my unemployment, and so, that diet was too exensive for me to maintain. They’re from the former USSR, came over in the early 50’s, and so, they hated any diet that didn’t include a lot of bread, noodles, butter, and fried food. So, even if I could have afforded it, they would have stuck to what they like, which makes things even more expensive.

      Plus, my disabled ankle, back, and hip, and arthritic shoulders, got worse, and keep me from being able to do much exercize.

      So, guess what?
      I gained back about 75 pounds over the past 3 years.
      And then, my father passed away, and my Mom and I live on a lot lower budget, so the food we eat, is much less healthy.

      Life sucks, when you’re no longer middle class.
      The plus side, if I have to find one, is that I won’t be able to live as long.

      • Sherm

        Sorry to hear that. But having done it once before, you should know that you can do it again. Vegetables, fruits and whole grain pasta are cheap, and walking is free and low-impact. Best of luck!

        • delurking

          Anyone who thinks that vegetables, fruits, and whole grain pastas are cheap hasn’t been buying vegetables, fruits, and whole grain pastas lately.

      • me me me me

        omg cut it out….and eat right

        fer crissakes

        • Malaclypse

          Could you help a brother out, and troll on the original post? I have an over/under to beat…

      • c u n d gulag

        For those who want to scold me:
        It’s kind of tough to walk an an ankle, so pronated, that it’s feckin’ sideways, that I’m walking on my leg bones. Or to ride a bike.

        Walk in my shoes for awhile, and tell me how you feel, before you speak.

        25 years ago, I used to power-walk 13 miles every 2-3 weeks, with 3-pound weight’s in each hand.
        Now, a walk to the mailbox, is like the Bataan Death March, or the Cherokee Trail of Tears.

        I wouldn’t will my pain on the biggest Conservative @$$hole. I’m a Liberal, and, because I can feel other’s pain, I wouldn’t wish mine, upon them.
        Try being an almost 55 year-old person, z immature as any college freshman, in an 85 year-old body.

        It’s feckin’ depressing.

        • Sherm

          Please allow me to rephrase — For those who want to scold c u n d gulag, fuck off!

          You don’t owe anyone any explanation.

          • c u n d gulag

            Thanks, Sherm.

            I don’t like it when, people who don’t know someone else’s circumstances, go and lecture that person, and other people, on how they should go about living their lives.

            I try never to do that. I wish others would do the same.
            But, the temptation of being superior to someone, anyone, is irresistable to a whole lot of people.

        • ajay

          For those who want to scold me:
          It’s kind of tough to walk an an ankle, so pronated, that it’s feckin’ sideways, that I’m walking on my leg bones. Or to ride a bike.

          My immediate response to this was: good lord, that sounds terrible. Why haven’t you got a doctor to sort it out? Get some physiotherapy and/or some corrective surgery on the NHS?

          Then I thought: oh, right, America.

          I wonder how much bad general health is the result of other untreated health issues? You can’t get your ankle fixed, so you can’t exercise…

          • c u n d gulag


            I’m now poor enough to qualify for NY’s Medicaid – which, of course, means all decisions have to go through an insurance company!
            Uhm… Yay?

            So, late last summer, new insurance card in hand, I went to a Podiatric Surgeon, who said, ‘Well, sure I can fuse it – but you won’t like it.’
            Something I’ve been hearing for well over a decade, from both Podiatric and Orthopedic surgeons. And, if they guy’s and gal’s who stand to make some nice bucks off the operation, don’t seem too eager to do it, well, that speaks volumes to me.
            He measured me for an orthotic for my left foot, and a brace, for the right.
            No approval for the orthotic – to get that covered, I’d have to be diabetic.
            He did, however, get approval for making the brace.
            A few weeks later, I got a detailed breakdown of the costs involved in making it – totalling over $4,500, for what is essentially a leather Chuck Taylor with an orthotic inside.
            Over $4,500!

            Then, a couple of days before I thought it would be ready, I got a letter saying that they were declining coverage.
            Why? Who the feck knows.
            So, I call the doctor, and his nurse spent over a week with the insurance company, and all she could tell me after all that time, was that yes, they’ll cover part of it, but they can’t tell her or me how much of that total, until AFTER it’s made. AFTER!!!!!
            It might cost me as little as $1,000 (which, needless to say, we can’t afford), or almost the full $4,500 (LOL!).

            So, in short, the insurance company, which gave me a letter with the feckin’ detailed breakdown of the whole cost of the brace, can’t, or won’t, tell me in any feckin’ detail about how much they’ll cover.
            Not until after it’s made.
            And, it’s not like they can then sell that to some other poor handicapped schmuck.
            Every poor handicapped schmuck’s injury is different.
            So, once it was made, I’d HAVE to pay for having it made. Despite them not being able to tell me how much they’d cover – if anything, that is.
            Ok, so no brace.

            So, a few weeks later, insurance card in hand once again, I went to an Orthopedic Surgeon.
            A gentleman from the Orient. And, lo and behold, he’s the first one I’d ever been to who said he thinks he can fuse my ankle, and that I wouldn’t hate it.
            I don’t know whether he thinks he’s more skillfull than the other’s I’d been to, or more greedy.

            How much will the surgery cost?
            And how much is covered?
            Well, says the Doc, I’ll need a 3-D MRI on that, before I can really tell you whether I can do it.
            He sets up an appointment for the MRI, at a place over 1/2 an hour away.
            And then, a few days before the MRI, I get a letter from the Medicaid insurance company, saying the they’re declining paying for the MRI.

            So, the insurance company that is one of my NY Medicaid options, and which I can’t change until this fall, declined a brace, so that I could walk better.
            And they denied an MRI to see whether a surgeon can operate, so that I could walk better.
            So, never mind about thinking about the fusion – they won’t even pay for a feckin’ glorified X-ray!


            So, I go back to the Orthopedic Surgeon, and ask if he’d help me try to get SS Disability, because I can’t find a job in my area, because there are NO feckin’ jobs in my area – or, at least, ones that aren’t jobs standing is some retail store or kiosk – and, hence, ADA Act or not, ones that I can’t do.

            And this Doctor says he won’t do it.
            Well, I’m not disabled, I can still talk.
            I told him I’ve applied for hundreds and hundreds and hundreds of jobs in the past 3 years, and no one seems to want to hire a 50+ year old man – let alone one who’s handicapped.
            That, he said, is neither his, nor the states, concern.
            I can still talk.

            I wanted to ask him what it’ll take for him to write a letter to a lawyer for SS?
            Which do I need to cut-off before you’ll do that – my feckin’ ankle, or my feckin’ tongue?
            Instead, I just got up and left.

            Can you say, “Catch 22?”


            I’m now trying to find a differen Orthopedic Surgeon.
            One who’ll vouch for the fact that, with an essentially useless ankle, and a hip and back with bad arthritis, I just might be eligible for SSDI – something that I’ve been paying into when I got my first paycheck, back in 1972, when I was 14 – AND FECKIN’ WORKING!!!

            In the words of Yakoff Smirnoff –
            “AMERICA, VAT A COUNTRY!!!”

            • c u n d gulag

              Oh, and I forgot to mention, that I’ve got bad arthritis (is there any such thing a “good” arthritis, gulag, you moron? in my hands – especially in my thumbs.

              So, writing this [email protected]$$ rant took some time.

    • DrDick

      I am 60 years old with a BMI of 31. In my youth I was extremely thin (5’11” and 135#), but started putting on weight in my mid-20s. Indeed, I gained weight during one of the times when I was getting the most exercise and was at my most fit (I could run up 5 flights of stairs and not be winded).

      I do not eat sweets, high fat foods, or drink sodas. Indeed, I eat a balanced and healthy diet (though I am currently working on reducing portion sizes). Increased exercise has some incremental benefits (I have lost 15 pounds in a year by doing so), but soon plateau.

      It is certainly true that, in combination with other risk factors, excess weight can have some adverse affects. For instance, weight is a factor in type 2 diabetes and it sometimes disappears if you lose weight. What is important to remember is that it is the other, underlying risk factors which are determinant and weight is just a secondary contributing factor.

      • c u n d gulag

        I never drink soda’s, and almost never eat sweets – something sweet, about twice a month, is my treat – if that.

        I very rarely eat chips, dips, pretzels, or other snack foods. Not even popcorn – except maybe once every couple of years.

        I don’t drink much beer, except once in a while during games on TV. And then, I make sure NOT to eat any snacks.

        All I drink is water – and, a vodka on the rocks, every evening before dinner.

        Our diet sucks, because my soon to be 81 year-old Mother loves fried and fatty foods, as did my late, 86+ year-old Father, and she doesn’t want to eat a “healthy” diet because she really doesn’t enjoy it (and who am I to argue, since she got to be over 80 years-old eating that crap in the first place?).
        And we can’t afford to pay for two seperate menu’s at meals on our budget. So, I defer to her wishes, and try to sneak in as many fresh and frozen vegetables into all of the meals I make, since she’s legally blind, and can’t do much for herself anymore.

        She always says to me, “I didn’t know you could put fresh/frozen ________________ into a dinner of ____________________, and that it would taste pretty good.”
        In Russian, but of course.

  • Murc

    Dude, not cool.

    I’ve said some stupid shit on this blog over the years, and I’m flattered that when you see a four-letter name beginning with M you automatically thing of me, but I do believe the commenter you are referring to is MARC.

    I haven’t posted in the obesity thread and don’t have plans to.

    If I’m going to be called out on the front page, I prefer it to be for things like, say, my idiosyncratic position on DC statehood.

    • Murc, Marc, whatever, dude.

      C’mon, spill: what’s Pam Dawber really like?

      • Sherm

        Very good!

        And she definitely had a “normal” BMI.

      • Murc

        I actually had to wikipedia that to get the joke.

        • Joe

          Yes. Nice to see a long term Hollywood marriage.

    • Scott Lemieux

      Oops, sorry, will correct! (These arguments would, in fact, have been atypical coming from you, so I should have checked more carefully, my bad.)

      • Murc

        You missed at least one Murc in there, down below the second quote. :)

        And yeah, those arguments aren’t in my style at all. They’re way to short, for one thing. Still, it’s not like you spend hours every day making sure you’re familiar with the rhetorical style of all the regular commenters on the blog you run on the side of your actual real job.

  • Matt

    The study seems largely to be bullshit to me. First, as they point out in the conclusion, “It addresses only all-cause mortality and not morbidity or cause-specific mortality. It addresses only findings related to BMI and not to other aspects of body composition such as visceral fat or fat distribution.” In other words, the study would also consider many athletes to be “obese”, because BMI is over and over again proven to be a terrible way to calculate health. So, a 5’10” tall adult who weighs 185 lbs but is cut from granite is “overweight”; every woman on a NCAA swim team is considered overweight or almost obese by this standard. I am ten pounds overweight according to BMI, but I’m only at about 12% body fat. In short, BMI is just ridiculous. Finally, as they are looking at “all-cause” mortality, any way of dying is like any other. Since heart disease and type II diabetes are THE leading causes of mortality in EVERY older population of adults (younger populations vary until about the age of 40), but are over-represented in overweight (i.e., fat) populations, the article in reality says nothing more than, “People die when they get older.” Yep, everyone dies. But, do you want to die of old age climbing a mountain, or lying in a hospital bed with your legs amputated from type II diabetes like my fat grandmother? That’s your choice. But, the junk food and soda industry is surely happy for this study.

    • L2P

      That doesn’t really make the study bullshit. The study proves exactly what it says it proves.

    • TT

      There is but one way, and only one way, to lose weight and that is to eat less calories. Nothing else will do it. Not better calories or different calories, only less calories. Whether this results in the person being healthy, even if they are still a little “overweight” according to this or that metric, depends entirely on what the less calories are comprised of.

      • John

        Wouldn’t “eating the same number of calories but burning more of them” also lead to weight loss?

      • catclub

        There is one art,
        no more, no less.
        To all things do,
        with artlessness.

        Piet Hein

      • JL

        That is not actually true.

        If you exercise, you burn more calories. Also, certain forms of exercise cause your food to move more quickly through your gut, so that less of it gets absorbed into your body.

        If you start experiencing Celiac disease symptoms, your inability to absorb certain kinds of food through your intestines can lead to weight loss.

        If you have an abnormally low metabolism, and start taking prescribed drugs to fix it, you’ll burn more calories, which may lead to weight loss.

        If you’re female-bodied and have PCOS (which occurs in 5-10% of female-bodied people, it’s not like it’s a rare thing), and then you get your insulin-resistance PCOS symptoms treated, you’ll probably lose weight.

        If you’re significantly sleep-deprived (which wreaks havoc on your metabolism and hormones) and then you start sleeping properly, you may lose weight, as moving from improper to proper sleep will help your metabolism and hormones function better.

        • CaptBackslap

          Really good points there. In general, the whole “a calorie is a calorie” thing is making the assumption the digestive system functions, at all times and in all contexts, with the precise efficiency of a trash incinerator. That assumption is…rather strong.

          • L2P

            Yes, that’s very true.

            There’s also a lot of stuff we THINK we know. We THINK that corn syrup is metabolized differently, so that eating a lot of corn syrup instead of sugar makes your body retain more calories. We THINK similar things about artificial sweeteners. And lots of other things.

            We do the best we can.

          • JL

            Yeah…and one that I meant to put, but forgot, was that if you change your gut microbiome (which is initially set during and just after birth but can be affected by factors like pregnancy, what specific foods you eat, antibiotics, chemotherapy, etc), that can also change your body fat level. Gut flora are important in weight maintenance.

      • BobS

        While getting a history from a diabetic patient a few months back, I asked her whether she’d lost weight without trying- there is more than one way to lose weight, and some of those causes are pretty serious illnesses. Anyway, her answer was “YEAH- when I was a patient in YOUR hospital and got put on the 1200 calorie diet!”
        It would be unrealistic to expect anyone to get by on just 1200 calories in the world we live in, but her message was clear- you eat less, you lose weight. Good luck getting people to understand that.

    • idlemind

      BMI is useful in a statistical sense, given that exceptions to “high-BMI” equals “obesity” are relatively few. But, yeah, there still are plenty of exceptions. Even percentage body fat is suspect, since several pounds of visceral fat are more harmful than the same amount elsewhere.

  • John

    I don’t think it’s Paul’s critics who make the leap from “better diet and exercise can lead to permanent weight loss” to “better diet and exercise are only worthwhile if they lead to permanent weight loss.”

    It is Paul, in fact, who criticizes virtually every actual real world effort to get people to eat better or exercise more on the grounds that the language used to promote it constitutes “fattism”.

    I’d also add that the “aesthetic preferences” involved are often the aesthetic preferences of the person trying to lose weight. Is there something wrong with the desire to be more physically attractive motivating people to have healthier lifestyles?

    • Sherm

      Is there something wrong with the desire to be more physically attractive motivating people to have healthier lifestyles?

      Not if you think that narcissism is an admirable trait and that those who can’t manage to be physically attractive are worthy of scorn and derision.

      • John

        Does any effort to look good actually constitute “narcissism?” And where at any point did I say that people who aren’t physically attractive are worthy of scorn and derision?

        • Sherm

          I did not mean to attribute narcissism or prejudice to you, individually. My apologies. But it seems that in any society where great emphasis is placed on physical appearance and where one must be thin to be deemed attractive, the overweight will necessarily be the subject of derision, as they are already.

      • Richard

        Its not just narcissism. If you look more physically attractive to people to whom you are physically attracted, you are likely to get more sexual opportunities with the people to whom you are physically attracted. Nothing wrong with that. Unless you do not find other people physically attractive.

        • John

          This was, indeed, my thought. And even beyond sexual partners, there’s other reasons why looking aesthetically pleasing may have positive consequences for a person beyond satisfying their vanity.

          • Richard

            I agree. Sex is only part of it.

            • Sherm

              Fortunately, viagra can be taken with or without food.

              • Richard

                Viagra only makes one able to perform. It doesn’t get you over the initial hurdle – having someone give you the chance.

                • Sherm

                  I know. And that’s why its good that you don’t need to consume any additional calories when popping those little blue pills a guy your age needs. :) Sorry, just felt like making an age joke at your expense. My partner is 16 years older than me, so I have a bunch of old lawyer jokes I might have to break out some time.

                • Richard

                  Age jokes are allowed, even aging lawyer jokes.

        • Murc

          This can sometimes backfire.

          My brother is having some problems with his fiancee because when he was in the market, so to speak, he invested a lot of time and effort into making himself pretty. Now that he’s gotten a girl to agree to marry him, he’s basically let himself go; he isn’t UNHEALTHY, he’s way to active for that, but he’s gone completely flabby, his skin looks worse, and he’s put on a gut.

          His fiancee is curious as to exactly what his natural equilibrium will be, as according to her, part of the deal wherein she enters into a monogamous relationship is that she gets 20-40 years of someone she’d enjoy having sex with out of it.

    • Ed

      I’d also add that the “aesthetic preferences” involved are often the aesthetic preferences of the person trying to lose weight. Is there something wrong with the desire to be more physically attractive motivating people to have healthier lifestyles?

      We don’t seem to be talking much about the extra pressures placed on women by our culture and thus by women on themselves where weight is concerned, but yes, the desire to be more “physically attractive” in whatever aesthetic preferences are currently dictated by the culture can go very wrong indeed. The choice may be made by an individual, but the individual is obviously influenced by outside factors.

      These preferences can vary, particularly where the shape of female bodies are concerned. This is a problem for men as well, of course, especially these days when it seems the pressure to have as perfect a body as possible is increasingly intense, but not to the same extent.

      • Richard

        I dont think anyone would argue with that (and that our society, especially with regard to women, puts unhealthy pressure to conform to some unrealistic aesthetic standards). But there are some standards that are pretty much universal and that most of us do things to make ourselves attractive to others. Thats a part of life in all societies.

        I’m an aging male and am physically and sexually attracted to my wife. If I gained fifty pounds (and setting aside any health concerns), I would be less physically attractive to her and, IMHO, that would not be a good thing. I am not going to do the things that would give me a perfect body but I am willing to do the things which would make excessive weight gain much less likely. You can call that narcissism or adhering to injurious societal standards. I don’t consider it to be either of those.

        • Ed

          “Pretty much universal” — arguable, to say the least.

          As to whether your missus would object to a spare tire or two, that’s between the two of you, but it could be she might be more forgiving than you think.

          By the way, does the reverse also obtain? Do you expect your wife also to feel an obligation to maintain certain weight standards in order to remain erotically appealing to you? If so, what’s the maximum weight limit before you tell her that the spice has gone out of your union because of her porkitude?

          • Richard

            Can you cite me any society on earth where there aesthetic standards do not influence sexual attraction? I would be astounded if there was such (even though the precise aesthetic standards might change from culture to culture).

            If I gained 50 pounds and stopped taking care of myself – combing my hair, shaving, etc, my wife might still engage in sex with me but it is very likely that her attraction to me will have lessened. And if she gained fifty pounds and became slovenly, the same would apply. I would still be in love with her but the sexual attraction is highly likely to decrease. Are you denying that adherence to certain physical standards is not a component of sexual attraction? Or that one of the reasons people work to stay trim and fit is to attract and keep sexual partners?

            • Richard

              Mistyped. “where aesthetic standards do not influence sexual attraction”

            • Ed

              Can you cite me any society on earth where there aesthetic standards do not influence sexual attraction?

              I didn’t say that. I said those standards can vary based on time and culture (particularly true where the feminine shape is concerned). Obviously people are influenced by those standards where sexual attraction is concerned.

              You seem to have upped the ante a bit by adding poor grooming to the equation, but I gather your benchmark is a gain of 50 pounds.

              Or that one of the reasons people work to stay trim and fit is to attract and keep sexual partners?

              Uh, no, not denying that, either. You might want to go back to what I originally wrote, and in response to what.

              • Richard

                Listen all I am saying is that sexual attraction for the most part is governed by the aesthetic standards generally agreed upon by the society in question. I didn’t say that those standards were the same in each society. In Samoa,very large men are considered to be the acme of male beauty. Here, not so much. When someone deviates greatly from the standard for beauty, it is likely the case that sexual attraction to that person will not be as great as for the person who meets the standard.. George Clooney is sexually attractive to millions of women in this country, Danny deVito not so much

                If I gain fifty pounds, my closeness to the beauty standard, already remote, will decrease further and it is highly likely that I will become less sexually attractive to women including my wife. (Charm and brains only get you so far). I don’t want to take the chance of that happening so do certain things to not gain weight (although the major factor in that is thin genes from my parents)

                My wife, who is quite the looker and far more beautiful than I am handsome, will look not quite as good with fifty more pounds on her. I will still love her and will be pleased to make love to her but I’m not going to lie and say that the sexual attraction will always stay the same

    • Scott Lemieux

      It is Paul, in fact, who criticizes virtually every actual real world effort to get people to eat better or exercise more on the grounds that the language used to promote it constitutes “fattism”.

      Please to be citing cases in which Paul has criticized a campaign to encourage people to exercise more or eat healthier diets without stigmatizing fat people.

      • Richard

        I think the problem is that Paul assumes every campaign to encourage people to lose weight as necessarily stigmatizing fat people. At least thats the impression I get from his writings. If he has applauded an effort to get people to lose weight on this blog, I sure have missed it (but if you have a link to such posting, I’d be happy to concede the point)

        • catclub

          Indeed he should criticize every campaign to get people to lose weight, because weight (or BMI) is not an indicator of health.

          Programs to increase exercise and to eat a healthy diet, in order to improve health, are what should be emphasized, rather than losing weight.
          It is campaigns which simply say, lose weight and you will be healthier (in spite of no good evidence for that particular claim), which oddly enough, seems to get interpreted as stigmatizing … weight.

          • John

            I’d think that in most cases, overweight people who lose weight by exercising more and having healthier diets will be healthier. There are, of course, other ways to lose weight that are not healthy.

            If a campaign encourages people to do things that will improve their health by saying that it will help them lose weight, I don’t see how that’s a problem. We obviously shouldn’t encourage people to do unhealthy things to lose weight, and we should emphasize the healthy lifestyles over losing weight.

            As far as I can tell, though, Campos has no real interest in encouraging healthier lifestyles.

            • Sherm

              The problem is that so long as the motivation remains weight rather than health, the societal emphasis will remain on weight.

            • JL

              The problem is that we should be focusing directly on the healthier lifestyles, for the purpose of being healthier. Instead, pretty often (not always), we go “Ew ew fat, do these things so you won’t be fat anymore” and place the focus on being not-fat. Even when initiatives are focused directly on healthier behavior, the rationale tends to be “We need to reduce obesity” rather than a more general “We want people to be healthier.” And I do think that contributes to prejudice against and dehumanization of fat people.

          • Scott Lemieux

            Precisely. Campaigns to get people to lose weight, rather than to exercise more or eat healthier, inherently stigmatize fat people. It’s also either useless or counterproductive. Exercising is good whether you lose weight or not. You look how you look no matter what the scale says. There only reason to focus on weight is because you’re more concerned with overclass aesthetic prejudices than health.

            • John

              You look how you look no matter what the scale says.

              What on earth is that supposed to mean? People look different, in fact, depending what the scale says.

              • Richard

                I had no idea what that meant either. The scale determines how many pounds you weigh. More or less pounds on your body directly effects how you look.

                • Scott Lemieux

                  You don’t need a scale to figure out how you look, is my point.

                  I also don’t agree with the assumption that attractiveness is directly proportional to thinness, and I find the idea that I would stop being attracted to my wife if she put on 25 pounds ludicrously shallow, but anyway.

                • Richard

                  I don’t agree that attractiveness is proportional to thinness and never said that. Or anything close to that. I dont think emaciation is attractive or sexy. And I never said that I would stop being attracted to my wife if she gained 25 pounds. Or anything close to that. . What I did say that if she gained 50 pounds, it is likely there would be some lessening of sexual attraction, not that there would be none and not that our sexual relationship would cease. A significant part of sexual attraction, not all but significant,is based on visual appeal. Would you not agree that if you put on 50 pounds, you would be less sexually attractive to most women? And that being less sexually attractive is not something You desire?The point I was making is a simple one. One reason to do things which would decrease the possibility of becoming obese (or becoming emaciated) is to make oneself sexually attractive to persons to whom you are sexually attracted to. I go to the gym near my office about once a week. I see dozens of persons in their 20s and 30s working out. They are not doing that just so they can slightly decrease their chance of dying from heart failure. They’re doing it to make themselves attractive to the objects of their desires

      • John

        The point is that, for Paul, every actually existing campaign to get people to exercise more or eat healthier diets turns out to be a campaign to stigmatize fat people. So, in practice, he seems to oppose every actually existing campaigns to get people to lead healthier lifestyles.

  • Govt Lawyer

    Losing weight is not hard – IF you everything falls into place in your life. I lost about 40 pounds in a relatively short amt of time by putting mostly healthy food into my body and exercising nearly every day for 30 mins to an hour. This is the recipe and it is not complicated.

    However, I also have a 9-5 job, a park right down the street from where I live, enough money to shop at Whole Foods, and no kids. Change any of these and I’m not sure I could have done it. It would have been considerably more difficult.

    • Sherm

      No, it’s not hard, if you are motivated. But its real hard to keep it off. Seriously, how many heavy people have you known in your life who lost a significant amount of weight and managed it keep it off permanently? I know one, and he’s kept it off by being a complete health freak.

      • Govt Lawyer

        And that really is the only way. Nothing short of a major change in lifestyle is required to really lose weight and keep it off. As long as you remain committed to a healthier, active life, you will probably keep it off. But people underestimate, I think, the dedication and discipline required.

        BUT once you instil these habits in yourself, they become easier to sustain. At this point I cannot even imagine returning to my former lifestyle, i.e. one where I ate way too much of the wrong stuff and sat on my ass essentially 24/7. That is not the way humans were meant to live.

        • Sherm

          I don’t mean to be a dick and I hope you keep it up, but lets see where you are in five years. Its much easier to slip into the old habits than it is to maintain the new, healthy ones. Making exercise a permanent part of your life is the only way, I think.

          • Govt Lawyer

            Not dickish at all, quite true. I have kept it up for a little over a year. The difference in my mind now is I know what I have to do, I know what it takes, and I know I can do it.

            But the proof is absolutely in the pudding, npi. Time will tell.

      • Incitatus

        I’m one of those people who lost a lot of weight in my 30s and kept it off, and my friends consider me a complete health freak. I recently spent some time in northern Italy, and there I am completely normal. Exercise every day, eat lots of fruit and vegetables, lots of small meals, no junk food? In many countries that is normal, here it makes you a freak.

        America is unbelievably fucked up about nutrition and exercise.

        • Sherm

          You really have to become a complete health freak to keep it off because that is the only way to avoid returning to the habits which caused you to be heavy in the first instance.

          • brad

            You fully missed his point, unless I’m fully missing your snark.
            Not eating crap or too much of the wrong things plus daily physical activity is a “health freak” in many parts of the US. In many other cultures it’s perfectly normal.

            • Sherm

              I got it. But he made two points, not merely one. The first point being that you have to be a health freak as defined by our society to maintain the weight loss. The second point being that what we consider to be “freakish” is quite normal elsewhere.

              • brad

                I would say that the second point inflects the first, however.
                I’ve become what some consider a “health freak”, but all that means is that, with extremely limited exceptions, I basically won’t eat anything that might be sold in gas station mini-marts or by fast food joints. It’s not about being a snob, but rather what’s in those foods. But those foods are cheap and require no time or energy to procure, so many Americans have no other choice, really.
                The actual freakish thing here is American food culture.

                • Sherm

                  Agreed. And I’m with you, man. I’m trying to follow the lead of my friend whom I consider to be a health freak, and I even signed up for a half-marathon as motivation to keep exercising. I eat no processed foods and I’ve cut back on the beer (weekends only), and I eat mainly fruits and vegetables, bran cereal, lowfat dairy, lean proteins and whole grains, and I treat myself to one weekend cheat meal a week to keep my wife sane. Its not rocket science, and I’ve lost weight before. The key is finding the motivation to do so, and making a permanent lifestyle change. The former is difficult, while the latter is nearly impossible. But no harm in trying.

  • Bloix

    The Flegal study found:

    Relative to normal weight, obesity (all grades) and grades 2 and 3 obesity were both associated with significantly higher all-cause mortality. Grade 1 obesity was not associated with higher mortality, suggesting that the excess mortality in obesity may predominantly be due to elevated mortality at higher BMI levels. Overweight was associated with significantly lower all-cause mortality. The use of predefined standard BMI groupings can facilitate between-study comparisons.

    What is defined as “overweight” would appear to most people in America (outside Hollywood) as normal weight. Grade 1 obesity would appear to most of us as being a bit on the heavy side.

    Grade 2 and grade 3 obesity are epidemic in America, and result from the ubiquitous presence of cheap, empty calories.

    Public health measures that are intended to reduce the occurrence of grade 1 and grade 2 obesity are clearly warranted. Things like limitations on the size of sugared drinks, calorie counts, removal of snack food and drink machines from public schools, and the like are good ideas.

    Changing behavior on the individual level is very hard, but changing social pressures to consume more calories than is healthy is fairly easy. Flegal’s study supports the conclusion that such measures save lives.

  • Bloix

    Oops – the paragraph beginning “relative” is a quote – the rest is me. The Flegal study conclusion reads:

    Relative to normal weight, obesity (all grades) and grades 2 and 3 obesity were both associated with significantly higher all-cause mortality. Grade 1 obesity was not associated with higher mortality, suggesting that the excess mortality in obesity may predominantly be due to elevated mortality at higher BMI levels. Overweight was associated with significantly lower all-cause mortality. The use of predefined standard BMI groupings can facilitate between-study comparisons.

  • Bloix

    More: According to an earlier Flegal study, over 15% of all adult Americans have either Grade 2 or Grade 3 obesity (BMI over 35). For African Americans, over 26%. For African American women, over 30%.


    So this new Flegal study concludes, in effect, that one in seven adult Americans, and almost one in three African American women, have a condition that is correlated with “significantly higher all-cause mortality.”

    Obviously, although correlation is evidence of causation, it is not proof of causation. But it’s a stretch to say that the new Flegal study shows that concerns about obesity are a myth.

    • Paul Campos

      Three things:

      (1) There is a significant difference between claiming that 69.1% of the population weighs “too much” (the public health establishment’s current position) and that one begins to see a correlation between increased mortality and higher weight in the fattest 15.4% of the population.

      (2) Grade II and III obesity correlated with 29% increased mortality risk. This is not, in epidemiological terms, a very notable increase, to put it mildly. By comparison, heavy smokers have a 1900% increased risk for lung cancer compared to never-smokers. It is, as I note in the post below, much lower than the mortality risk associated with being male rather than female — but nobody seems to be freaking out about the mortality differences between men and women, even though they’re much larger than those between “normal weight” people and very fat people.

      (3) I’ve said many times in print that I’m in favor of encouraging healthy lifestyles. I’m not in favor of encouraging lifestyle modification for the purpose of weight loss, because for the reasons Scott notes in the OP, that sort of intervention is going to be both futile and counterproductive. It’s not as if there haven’t been countless attempts in this vein, so we’re not exactly lacking for data regarding whether such interventions work. Without exception, the answer is that they don’t.

      • L2P

        Why would you argue that a 29% increase in risk isn’t “notable”? A lot of seatbelt laws got passed with very similar stats. (I’m not sure what “risk of cancer” has to do with anything. Mortality ~ cancer. Obesity has much higher risks of diabetes, high cholesterol, and other health problems than it has of mortality.)

        People ARE “freaking out about the mortality differences between men and women.” They have been for a long, long time. People have spent a lot of time trying to figure out why there’s a significant difference, but can’t pin down any interesting causes. If there WAS a single, identifiable risk factor involved in “being male” that was creating that mortality rate difference, I’d bet people would be on that like an NRA spokesman at an Uzi sale.

        I think dismissing health risks is a mistake. Somebody in the upper edge (or lower edge, for that matter) of the BMI is not in a a healthy place unless there’s something unusual going on. Arguing that it’s not that big a deal seems like tilting at windmills.

        YMMV, of course.

  • shah8

    BMI sucks…

    When a study does obesity work with the goddamned calipers, then I’ll take it more seriously.

    • catclub

      Can you ‘pinch an inch’, is so much more
      difficult than height & weight.

    • Lindsay Beyerstein

      Calipers are notoriously inaccurate. Under-water weighing is the gold standard for computing body fat.

  • Richard

    The contrary position to the JAMA study from the NPR article yesterday. Not being a medical researcher, I am not offering this for the truth of the matter stated but only to indicate that the medical community is divided:

    “One of the experts who takes issue with Flegal’s conclusions is epidemiologist Walter Willett of the Harvard School of Public Health. He’s read her new paper and says he’s not buying it.

    “This study is really a pile of rubbish and no one should waste their time reading it,” he says.

    Willett says it’s not helpful to look simply at how body mass indexes, or BMIs, influence the risk of premature death, as this paper did. without knowing something about people’s health or fitness. Some people are thin because they’re ill, so of course they’re at higher risk of dying. The study doesn’t tease this apart.

    Also, he says the analysis doesn’t address the bigger, more important issues of quality of life. If an overweight person does live longer — is he or she living with chronic diseases?

    “We have a huge amount of other literature showing that people who gain weight or are overweight, have increased risk of diabetes, heart disease, stroke, many cancers and many other conditions,” Willett says.”

    • Bloix

      The Flegal study is not proof of anything and doesn’t claim to be. It’s a meta-analysis of studies that attempt to discern the existence or non-existence of correlation. It finds correlation within certain parameters and not within others. Nothing that Willett says affects the study at all.

      Now, if Willett had said, “You have to be cautious about drawing conclusions from these results,” or even “press reports about the meaning of this study are rubbish,” that would be one thing. But to say that the study is rubbish is intemperate, and as far as I can tell, ridiculous.

      Does Willett have data showing that people who are a few pounds overweight are living with chronic conditions that would be alleviated by losing weight? Or that a significantly higher percentage of non-overweight people have life-threatening illnesses than overweight people? If he doesn’t, then he’s just blustering.

      What I take away from Flegal’s study is that, given the current state of scientific knowledge:

      – Moderate, non-coercive government measures to reduce severe obesity make sense;
      – intensive interventions at the individual level intended to lead to reductions in the weight of somewhat overweight people do not make sense.

      • Richard

        I haven’t read the study so cant pontificate (and even if I had, I wouldn’t be qualified to pontificate). But Willett is no lightweight. Look him up http://www.hsph.harvard.edu/faculty/walter-willett/. He seems to have done substantial work on diet and health.

      • Paul Campos

        Does Willett have data showing that people who are a few pounds overweight are living with chronic conditions that would be alleviated by losing weight?

        No he doesn’t.

        Or that a significantly higher percentage of non-overweight people have life-threatening illnesses than overweight people? If he doesn’t, then he’s just blustering.

        Again this is exactly the right question. Willett hasn’t produced a scrap of evidence for his hypothesis that higher mortality in the normal weight category in observational studies is due to reverse causation, i.e., thin people being thin because they’re sick, because there is no evidence for this hypothesis. It’s nothing but a made up on the fly explanation for inconvenient data.

  • Bloix

    Paul says: “I’m not in favor of encouraging lifestyle modification for the purpose of weight loss, because for the reasons Scott notes in the OP, that sort of intervention is going to be both futile and counterproductive.”

    I don’t understand this. We have seen decades’ worth of goverment-sponsored “lifestyle modification” – privileging cars over public transportation, zoning walkable neighborhoods out of existence, subsidizing corn syrup and animal feed over vegetables and fruits, eliminating recess and phys ed while installing soda and snack machinse in schools, to name only the government efforts at changing behavior – and the result has been increased obesity.

    Why must we conclude that efforts at reversing the social conditions that produce obesity are doomed to failure?

    • Karen

      Those interventions actually changed the physical environment, by eliminating public transit and inter-city rail lines, building highways so that cars were required, and subsidizing cheap carbs and animal feed so that hamburgers can be sold for an effective price of nothing, but salads are expensive. Also, centralizing agriculture so that our vegetables and fruits are mostly grown in Florida, California, and Arizona, picked long before ripe, and shipped as balsa- flavored spheres to the rest of the country. Meat and grain can be stored for the long journeys without losing flavor but, say strawberries and peaches have a short shelf-life and can’t easily be shipped when deliciously ripe.

      Anti-smoking campaigns worked more by making smoking hideously inconvenient – not indoors – than by hectoring lectures. Also, quitting smoking has really nasty withdrawal symptoms, actually quitting requires only one modification in behavior: stop buying cigarettes. There are, in addition, several decent drugs on the market that alleviate the cravings, such as Nicorette and Chantix.

      Compare both those things to anti-fat campaigns. If we want people to exercise more, the we have to first make safe places for them. Remember that the most obese people are the poor, who live, generally, in ugly crime-ridden pest holes without parks or sidewalks. Before we encourage them to Move! we need to lock up the muggers and gangbangers and build level sidewalks. Before we lecture people to eat more plants, we need to make sure the plant foods available are something more that brown iceberg lettuce and bruised Red Delicious apples.

      Finally, it would really nice if someone acknowledged that food is pleasurable, and exercise can be as well. A commenter upthread discussed how much he hated exercise, but he soldiered on in pursuit do an attractive body. Why??!!!? Compare this, again, to smoking. Smoking is pleasurable, but no one will die without cigarettes, so one we made smoking unpleasant, lots of people quit. (Having to go outside in a Chicago winter or Houston summer weighs against any pleasure from tobacco use, especially if nicotine gum is an option.) Losing weight and keeping it off, however, requires replacing one activity with another. We can’t simply stop eating entirely. So far, all the antifat campaigns I’ve seen rely on shaming lectures, which make thin people feel good but don’t solve the stated problem

  • Anonymous

    Atrios puts the point about the perverse incentives here perfectly: “People should eat well and get regular exercise, but actually losing weight and keeping it off is very difficult. If people are focused on that, they’re likely to get discouraged and give up on the exercise and healthy eating.”

    That is not my experience at all. Losing weight and keeping it off is really the only thing that motivates me to exercise. I hate doing it, and I hate that it takes up time that I could otherwise spend on things I like doing better. Call it vanity and you wouldn’t be entirely wrong, but abstract health benefits that are mostly in the future would never be enough to motivate me.

    • Richard

      I think thats right. Losing pounds gives one an immediate and recognizable goal and incentive. General fitness doesn’t (unless you have a recognizable goal like a seven minute mile, finishing a mini-marathon, a better game of tennis or the like)and is therefore harder to maintain.

      What I think Paul and Scott miss is that putting oneself on a diet and exercise regimen in order to lose weight has the benefit of better health even when the loss in pounds is fairly minimal or nonexistent, has no bad effects at all, and, as far as I can tell, does little or nothing to stigmatize obesity.

      • Incitatus

        Totally agree. It’s perfectly normal to care about how your body looks, without it becoming some unrealistic and narcissistic need to look like an underwear model.

      • I run on a regular basis, but I don’t have any particularly well-defined goal; I know in an abstract way that it helps me stay in shape, but I’m not really working towards anything. All I know is, I feel good when I do and bad when I slack off. I really do think there’s a problem if someone exercises but “hates” doing it. I’m not always wild about it, and sometimes I have to push myself, but it’s just sort of an integrated part of my life, and it would feel weird to stop doing it. I think–and admittedly I’m not any sort of expert; I’m just spouting off here–that that should be the goal: a life where a reasonable diet and exercise routine doesn’t feel like an imposition; where that’s just how it is.

        Of course, as for how one actually GETS from here to there, I’ve no idea. American society certainly militates against it.

      • John

        This, exactly.

      • JL

        What I think Paul and Scott miss is that putting oneself on a diet and exercise regimen in order to lose weight…does little or nothing to stigmatize obesity.

        Doing it oneself probably doesn’t do much to stigmatize obesity. But public health authorities, politicians, etc, constantly lecturing about it in moralistic or alarmist ways, does.

        The whole thing where so many people, especially teens, are anorexic and bulimic, comes from somewhere. Not just from societal emphasis on thinness – biology plays a role, and child abuse seems to be strongly connected – but in part from societal emphasis on thinness. And the average onset age is decreasing.

        • Richard

          I agree with you that societal obsession with thinness is not a good thing (and agree that high fashion and Hollywood and tv set very bad examples of what is desirable) but I dont see how programs that encourage (not mandate or punish) kids and adults to lose weight stigmatize obesity. I just don’t see how Michelle encouraging kids to eat good foods and exercise more or even Mayor Bloomberg making it a little harder to get an enormous cup of soda stigmatizes obesity or creates more harm than good. And I certainly dont see how a personal plan to lose weight in a non dangerous manner for whatever reason (health, vanity, obtaining sexual partners) stigmatizes obesity.

          • JL

            The problem isn’t that they do those things (though I dislike Bloomberg’s policy, while I agree with encouraging kids to exercise more). The problem is that they do those things with a framing of reducing obesity, which is a mediocre proxy for health (I don’t think it’s as poor a proxy as Paul thinks it is, but it’s still a proxy), rather than just increasing health. You could very easily encourage kids to exercise more because it’s just plain good for you – it makes your body work better and feel better, it makes your mind more alert, it strengthens your bones, it makes you less likely to develop all sorts of nasty health problems. There are so many benefits to exercise!

            And I suspect (possibly unlike Paul, I’m not 100% clear on his position on this) that if kids exercise more (and increase their overall health and fitness levels), we will also see less childhood obesity. Because while some people are just naturally fat even when they are fit, for others, fat is a symptom of being unfit. But it seems quite silly to me to frame a public health campaign around getting rid of one particular symptom (a symptom that can also be got rid of in very unhealthy ways, like fasting), rather than framing it around the root issues. Especially when the symptom is something for which people face a great deal of societal prejudice.

            For what it’s worth, I’m a big proponent of exercise. I either run 3-5 miles or bike 10-20 miles five or six days a week. It makes my body and mind work and feel better. I’m also in the “normal” BMI range (though near the upper end of it). And I also have some significant body image issues.

    • Murc

      Call it vanity and you wouldn’t be entirely wrong, but abstract health benefits that are mostly in the future would never be enough to motivate me.

      Mostly in the future?

      You don’t actually feel better, more alert, less listless and bloated, cleaner internally, during periods where you exercise regularly versus periods where you just do whatever?

      If so, then you are either very young or your experience is quite atypical.

      • Anonymous

        I’m pushing 40 – I wouldn’t call that “very young”. I also did say “mostly”. But I was really speaking to things like heart disease, cancer, etc. But as for the things you mentioned, if I do experience of that, it’s still not something I’d consider immediate or something that would be enough, on its own, to get me to spend the five hours a week in the gym that I do. Hell, I know for a fact that I don’t sleep enough, and I’d feel way better, more alert, and less listless if I just slept an hour or two more per night, and the effects would be literally overnight, and that’s still not enough to get me to do it, and sleeping is much easier to do than working out. These just aren’t good motivators for me.

        • Murc

          Fair enough, sir!

          As a random aside, I’m one of those weird people for whom more sleep will actually make me feel worse, rather than better. My body will happily sleep for twelve hours a day if I let it (and make me feel groggy for eight of the remaining twelve no matter what else I do) but if I force it back to six to eight hours a night, I want to die when I wake up but after a shower I’m GREAT for the remaining sixteen.

    • Karen

      If you keep doing something you really hate just out of vanity, you have a problem. There are many forms of exercise that you might not hate and enjoy on its own; try to find one for your own sake. You will not keep this up.

      • Anonymous

        Look, fine, “hate” is perhaps too strong a word. But the fact is, there are only 24 hours in a day, and going to the gym is never going to be at the top of the list of things I *want* to do, when compared against all of the other things I could be doing instead. It has nothing to do with what form of exercise I’m doing.

        Anyway, thanks for the advice, but I know what works for me and I know what I am capable of keeping up.

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