following up: banning food for the obese

Yesterday I wrote about the Good Idea/Bad Idea legislation Mississippi was considering that would make it illegal to serve obese people food. Since I wrote about it, the news wires have been flooded with people picking up and reporting the story in wider circles, which means more details have come out (for example, it's a cosponsored bill, two Republicans and one Democrat). But most noticeable in the new coverage is the seemingly pervasive comment that I'd like to address here: that not serving an obese person food in a restaurant is the same thing as not serving a drunk person alcohol in a bar. It's apparently the analogy du jour.

Well, okay. First, let's take a look at the law itself:

Any food establishment to which this section applies shall not be allowed to serve food to any person who is obese, based on criteria prescribed by the State Department of Health after consultation with the Mississippi Council on Obesity Prevention and Management

The analogy to alcohol starts immediately. How do you know someone is obese? Well, how do you know someone is drunk? The bartender knows based on a series of signs, including slurred words, loose body movements, uncoordination, loudness, etc. It would appear that they'd like this same vague "knowing" to apply to judging someone's weight - except, weight isn't that easy to determine. Looking at me, you wouldn't guess I weigh what I do (it even surprises my doctor), and I certainly would never be a candidate for withholding a meal in a restaurant...based on my looks. But at one point in the recent past, my BMI certainly was in the category that qualified for obese.

So then, what - wait staff are supposed to take their average best guess on someone's weight, BMI, fat versus muscle mass, and etc? Can we say lawsuits based on discrimination? (I thought we might.)

The problem here, and the way that as much as it might be nice to draw parallels between drunkenness and obesity, is that drunkenness does typically have the same basic set of signs no matter who you are. It doesn't matter how tall or short you are, your genetic history, your medical history - nothing. Being drunk is the same thing, and therefore relatively easy to determine (and especially the ones who should be completely cut off).

Being obese is not the same thing. Your rate of obesity does vary on size, on body type, your genetic history, your medical history. Everything. Obesity is a matter of your physical body and its relationship to your environment and your culture, and therefore not at all easy to determine (and certainly not by inexperienced wait staff).

Finally, and perhaps the clearest distinction, and hole in the argument being made, is that if you don't cut off someone who's drunk, their potential for death goes up that night - as does their potential to kill someone else. Even if someone who's obese eats themselves to death, they're not going to kill another person as they do it. They're not going kill another person with them or through their mistaken judgment. Time is on the obese person's side, it's not on the side of the drunk person trying to drive.

Perhaps it's a rather strict utilitarian view, but it does seem to me that if you choose not to cut off someone who's drunk, and they go on to hurt or kill another person, you are at least to some degree at fault for not trying to stop the drinker. But the chances of someone who's obese not being cut off from their food and then going out to hurt or kill another person seems... unlikely, to say the least. This is not to say there are not consequences from being obese, but they are a different set of consequences, and primarily affect the obese individual rather than a person who's suffering at the hands of a drunk driver.
-Kelly

The link between weight and likely cause of death

As our bloggers have commented several times before, the science of obesity is contested, uncertain, and as Medical Humanities Blogger Daniel Goldberg said, 'heavy with value-laden beliefs'. Confirming this uncertainty, today, Gina Kolata of the NY Times reports that an article in the Journal of the American Medical Association shows overweight people are much less likely to die from diseases such as Alzheimer’s, Parkinson’s, infections, and lung disease, and that the lower risk is not counteracted by increased risks of dying from any other disease, including cancer, diabetes or heart disease.

Of course, the study cannot speak to cause and effect -- but it certainly underscores that science has a lot to learn when it comes to studying optimal weight.

Obesity in the News, part two (or 'Can Fat Be Fit?')

In light of Kelly's earlier post about the media's obsession with obesity being more epidemic than obesity itself, I thought it was timely that this article just came out in Scientific American:

"Can Fat Be Fit?

A well-publicized study and a spate of popular books raise questions about the ill effects of being overweight. Their conclusions are probably wrong.

By Paul Raeburn

Two years ago Katherine M. Flegal, a re­search­er at the Centers for Disease Control and Prevention, did a new statistical analysis of national survey data on obesity and came to a startling conclusion: mildly overweight adults had a lower risk of dying than those at so-called healthy weights..."[Full text here]

The article goes on to explain that the states are high in this debate...that a "major thrust of the nation’s disease prevention efforts are aimed at ending what orthodox researchers say is an epidemic of obesity." And if obesity is not the primary cause of heart disease and other serious illnesses, then efforts to trim American waistlines are entirely misplaced.

Language does matter -- I've heard it said that obesity is the last bastion of socially acceptable bigotry. I recently overheard some young women in Europe, standing outside a hotel having a cigarette break, saying that the reason they smoke is so that they don't 'get fat'. But there are worse than being 'fat' -- likely being sedentary. Or dead from lung cancer.

One the things that so many of the articles fail to mention is the importance of regular physical activity -- that the fitness that results from regular exercise confers a variety of health-related benefits in obese patients even if they lose no weight. It seems to me that regular exercise is a far more reliable indicator of health than simple body mass -- based on BMI alone, Brad Pitt, Keanu Reeves, and Michael Jordan are all overweight. And George Clooney and Matt LeBlanc are obese. In fact, a quick review of literature revealed this gem of a study, by Warburton, Nicol, and Bredin: "We confirm that there is irrefutable evidence of the effectiveness of regular physical activity in the primary and secondary prevention of several chronic diseases (e.g., cardiovascular disease, diabetes, cancer, hypertension, obesity, depression and osteoporosis) and premature death." All that, with barely a mention of BMI.

To which I say, let's do a celebratory jig.

Obesity in the News (or, Why Language Matters)

Obesity research is all over the news today:

From the BBC, obesity is linked to birth defects and health risks: a large scale study in the journal Archives of Pediatrics and Adolescent Medicine says that women who are obese when they conceive are more likely to have chronic diseases, fertility problems, miscarriages and complications during pregnancy, as well as birth defects including missing limbs and malformed hearts.

Then there's a study reported in Cell, which suggests that the skeleton is part of the endocrine system, specifically helping with the regulation of osteocalcin, which in addition to regulating mineralization appears to regulate glucose and deposits of body fat. This likely explains, at least in part, the connection between obesity and type two diabetes; researchers will move forward to look more closely at this link, next.

Following that, a study out of UPenn says that obese kids are more absent from school than others, and in fact suggests that obesity is more an indication for how much school a child will miss than any other factor, including race, gender, or socioeconomic status. The lead researcher is pretty succinct about why this is, too: the kids don't want to be teased or bullied over their weight.

According to a report at an American Physiological Society meeting, estrogen loss leads to weight gain, as well as hypertension, suggesting that estrogen treatment is beneficial for both the heart and the body.

And finally, it looks like people overeat due to another hormone-gone-wonky. People who don't manufacture leptin tend to overeat, becoming chronically obese. People who are deficient in leptin have the same areas of their brain react, at the sight of food, that react to rewarding emotions/desires.

So what's the point to all the fat talk? For some people, fatness, being overweight, obesity, is simply a medical issue. You are overweight for a reason, be it medical or psychological, it is bad for you, you should work on not being overweight, which is good for you. There are clear concepts of good and bad tied to this model of viewing weight, and it tends to be a part of the general medicalization of weight we see - to be thin (but not too thin) is healthy, to be fat is to be unhealthy. And within healthy/unhealthy there are specific moral and value-laden beliefs that tie into good and bad; to be healthy is to be good, to be fat is to be bad.

But there are people out there, often people who are overweight, that reject this sometimes value-laden, binary attitude towards weight. They are comfortable with their weight, and don't appreciate being "bullied" by society to adhere to an ideal they don't believe is accurate. These folks often espouse the motto "healthy regardless of weight", placing an emphasis on health outside of weight. After all, the reasoning goes, if someone is 65 lbs overweight, but perfectly healthy otherwise, what business is it of anyone just what that weight is? People come in all sizes, and as long as the individual is healthy, what that size is shouldn't matter to anyone. While this group, often known as fat activists, embrace the notion of being healthy, they reject the idea that healthy is thin is good, and unhealthy is fat is bad.

How news reports discussing obesity are received tends to depend on how they are written. If they are written, as most are, in the medicalized and moralized language of the first model, a group of people - perhaps the group of people most affected by the research being reported on - are alienated from the outset by the language, and judgment, being used. People are sensitive to the language being used to describe them, and very few people respond positively to being preached at.

A healthy body is a goal that is hard to argue with, and if we communicated consistently in such a manner, we might very well discover that many of the medicalized concerns about the overweight/obese would be addressed to everyone's satisfaction.