The war on fat: is the size of your butt the government's business?

Reason, August-Sept, 2004 by Jacob Sullum

KELLY BROWNELL WON'T talk to me. I can't say I'm surprised. He's miffed that I called attention to his weight at the beginning of a column I wrote last year after attending a conference on obesity at the American Enterprise Institute (AEI). It was an easy shot, I admit. But was it simply a "personal attack," as he complained in an e-mail message after I requested an interview for this article?

Surely it would be legitimate to point out that an anti-tobacco activist was a chain smoker, that an opponent of legalized gambling liked to play the slots, or that an anti-porn crusader was fond of dirty movies. So when a leader of the burgeoning war on fat, a Twinkle tax advocate who never tires of comparing Ronald McDonald to Joe Camel, turns up sporting an extra chin and an ample gut, noting those facts should not be considered out of bounds. And if Brownell does not like it when someone suggests he could stand to lose a few pounds, perhaps he should think twice about enlisting the government in his campaign to slim down millions of his fellow Americans. He would be on much firmer ground in objecting when people note that he's fat if he were consistent in treating weight as a private matter.

Then again, Brownell's portliness--which he attributes to inactivity and overeating while he was working on his recent book about the "human crisis" created by inactivity and overeating--could be viewed as Exhibit A in his case against the "toxic food environment." Here we have a professor of psychology at Yale, an expert on weight control frequently consulted by the press and invited to appear on television, who is reduced to using an old photo of his formerly thin self on the jacket of Food Fight: The Inside Story of the Food Industry, America's Obesity Crisis, and What We Can Do About It (McGraw-Hill). Worse, Brownell directs the Yale Center for Eating and Weight Disorders, which offers counseling to people desperate to lose weight. If anyone has an incentive to stay slim, you might think, he does.

In a sense, then, Brownell's paunch reinforces his argument that Americans have little real choice about what we eat, that we are prisoners of an environment in which food is too cheap, too tasty, and too convenient. Combine these ever-present temptations with meager opportunities for exercise, and you get the "epidemic" that Brownell and his allies decry: The federal government's survey data indicate that two-thirds of American adults are overweight, up from a quarter in the late 1970s. The overweight category includes the obese, who represented more than 20 percent of adults in 2001, compared to 12 percent a decade earlier. (These categories are defined by body mass index, which is weight in kilograms divided by the square of height in meters. If your BMI is 25 or more you're "overweight," and once your BMI hits 30 you're "obese.") Medical conditions associated with obesity include arthritis, gout, sleep apnea, diabetes, high blood pressure, heart disease, stroke, and various cancers. A recent analysis by researchers at the U.S. Centers for Disease Control and Prevention (CDC) attributed 400,000 deaths a year in this country to "poor diet and physical inactivity." When the study was published in March, Secretary of Health and Human Services Tommy Thompson emphasized that "poor eating habits and inactivity are on the verge of surpassing tobacco use as the leading cause of preventable death in America." Last year Surgeon General Richard Carmona declared: "I refuse to accept the spread of obesity ... I am committed to advancing the prevention agenda ... It will take all of us working together to find the solution to this growing problem."

One can argue about the magnitude of the problem that worries Thompson and Carmona. The 400,000 estimate --which covers all diseases related to diet and inactivity, not just those stemming from excess weight per se--is based on risk increases inferred from associations found in epidemiological studies. As a 1998 editorial in The New England Journal of Medicine noted regarding an earlier version of this calculation, "that figure is by no means well established. Not only is it derived from weak or incomplete data, but it is also called into question by the methodologic difficulties of determining which of many factors contribute to premature death." In any case, such death tolls obscure the risks faced by someone who is trying to decide whether the benefits of losing weight are worth the costs in terms of effort and forgone pleasure.

Two studies published in January 2003 give a clearer sense of the dangers associated with excess weight. One, reported in The Journal of the American Medical Association, found that white men in their 20s with BMIs of 145 or more (e.g., a man who is five feet, nine inches tall and weighs at least 305 pounds) live, on average, about 13 fewer years than men who are not overweight; the comparable figure for white women was eight years. By contrast, the merely overweight (with BMIs between 25 and 30) "lost" only a year or so. The other study, reported in the Annals of Internal Medicine, looked at life expectancy for 40-year-olds enrolled in the Framingham Heart Study. Among nonsmokers, it found, overweight men and women could expect to live about three fewer years than subjects who were not overweight. For obese 40-year-olds, the "years lost" rose to six for men and seven for women--similar to the loss of life expectancy associated with cigarette smoking.