Politics with Marc Ambinder

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Jul 30 2009, 4:54 pm by Marc Ambinder

The Politics Of Thinking Thin: It's About The Kids

To Megan McArdle's "thinking thin" post about the causes of obesity,  the relevant question for policy-makers is not whether there is a mono-causal explanation for obesity, it is whether policy-makers can and should do something about it. If everyone responded to the pressures of (a) a corn diet (b) TV advertising (c) the ubiquity of fat and sugary foods (d) the information disseminated by the government and the diet industry (e) technological enabling of a sedentary lifestyle in the same way, it is relatively easy to answer the question. If you tend to blame individuals for their choices, then your answer will be no. But the crucial fact is that obesity does not treat everyone equally. It discriminates according to status, class and geography. And its negative externalities are absorbed by these vulnerable populations.  And in children, being overweight is increasingly become the default. Unless someone intervenes, if you go with the flow,  if you live in a vulnerable population, you're going to be quite vulnerable to an obesogenic lifestyle.  This debate isn't about government dictating lifestyle choices to adults. It's about whether changing policy can reduce obesity among children.


It's easy to say that we're obese because we like to consume fatty, sugary, salty foods, which just happen (actually, because of subsidies and policy, at least partly) to be cheaper. Since we enjoy the food, why should the government get in the business of telling people that enjoying food  and valuing this enjoyment over health is a bad thing?  Especially if the science is murky?

The idea that anti-obesity activists think the problem will be solved by putting grocery stories in urban areas is kind of a myth. A grocery store is fine. Farmers markets are great. But food in them tends to be more expensive. Food companies don't advertise frozen vegetables because kids and parents don't buy them, but there is also evidence that kids and parents don't buy them because food advertising primes their hunger and increases their desire for bad foods -- foods that are constructed to make kids feel happy and energetic immediately.  Parents have less leisure time to shop. Kids are not encouraged to play outside because of crime rates. And poorer people with lots of material concerns don't have the  bandwith to pay close attention to the TV ads that saturate the lives of their kids. And lots of other things. We need to be careful about expectations setting; .everyone can process information the same way. But with an economic and social capital imbalance thrown in, it's terribly hard to blame anyone.  I'm harping on social capital because it does provide a different way of looking at the SES and racial disparities. Less social capital is correlated with more stress; there is also a relationship between social capital and the belief that things will get better in the future. The more capital you've got access to, the more optimistic you tend to be, and the more likely you are to think prospectively about health. 

And with obesity, we're dealing primarily with children and prevention. Obese adults are not going to lose weight unless they decide to have their stomaches separated from their digestive tracts. Megan is pessimistic about any policy intervention and questions any such intervention from a moral level. But any sensible policy is designed to change the environment for children, not for adults. It's not as if children are making choices about food and enjoyment in a vacuum. Childhood obesity is fairly contagious: if you've got an obese friend, you are more likely to be obese. The heritability quotient for obesity is .65, which means that obese people tend to produce obese children; whether this is a consequence of genetics, epigenetic factors, pre-natal nutrition -- it's not clear. As kids and adults, obese people tend to cluster with obese people.  

There are compelling public policy reasons to try and reduce the rate of childhood obesity. Lectures and hectoring and moral suasion don't work, but changing the environment these kids grow up in might work.  Even such a fairly minor intervention as better maternal health habits can influence the likelihood that a child will become obese. Breastfeeding babies reduces the chances for obesity.  Kids who sleep more as children will be less obese as adults. Kids who aren't as exposed to pesticides are less likely to become obese.  

Without reversing the trendline, obese kids will continue to self-segregate; stigma within their group will be reduced, which is good, but it will grow among thin people, there will be more intergroup tension. John Edwards's two Americas: a fat America and a thin America, coming in about 15 years to neighborhoods near you. 

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Comments (9)

Hugo Pottisch

Marc. This is one of the best posts on this subject that I have read - not only on The Atlantic but generally. Your post is taking what everybody knows anyway and instead of re-digesting it for a millionth time - you pinpoint what the policy debate should be about and open up for a tangible discussion.

Has anybody told you that you are on a roll? You seem to concentrate more than ever on the topics at hand - rather than playing the labeling game. Keep up the good work.

chrisbrandow

seriously good writing Marc. You have taken Megan's comments into a much more useful direction.

Abhinav

Great post Marc. I hope you keep up posting on this topic as it is one of the most important issues in the health care debate.

BP Beckley

Without reversing the trendline, obese kids will continue to self-segregate; stigma within their group will be reduced, which is good, but it will grow among thin people, there will be more intergroup tension.

So, okay, fat people are morally obligated to raise their kids so that thin people won't hate them.

I note that there are no moral obligations placed on the thin people whatsoever. Being thin proves they're morally perfect.

freaktown (Replying to: BP Beckley)

i would hope fat people would want to raise their kids to be healthy. and seeing as how obese people are NOT healthy, and have far more health complications, why would parents want their kids to be obese?

it has nothing to do with conforming to society's aesthetic standards. it has to do with being healthy...

but as marc points out...wanting it, may not have as much to do with it as the other factors he mentions, which is why the policy aspect is so important.


AlchemyToday

The moment people who are dedicated to combating efforts to combat obesity start assailing the BMI, I know they're full of shit. Height and weight are the only relevant measurements taken by enough doctors on enough different people to get a wide enough data sample to study the effects of obesity. Of course it's difficult to see a statistically significant difference between someone with a BMI of 31 and someone with a BMI of 29 -- the odds are extremely close to 50% that either one will be healthier. However, if you dropped your BMI from 29 or 31 to something lower, even something moderately lower, you're more likely than not to be healthier. And, contra Campos, this isn't because of some voodoo psychosomatic effect wherein feeling bad because you're fat kills you.

On top of that, morbid obesity (BMI>40) is increasing *faster* than moderate obesity, and morbid obesity is unquestionably associated with a number of diseases (it's called "morbid" for a reason).

maggiemahar

Marc--

I agree with everything you say.

We should focus on kids. And we need to understand the link to environment and poverty.

Isn't the answer to revive a war on poverty? Johnson's war on poverty substantially reduced rate of porverty. But then sometime in the early 1980s, Americans simply lost interest in the poor (As James Galbriath points out in his latest book.)

This time we need to focus on children, focusing on inner-city public schools and schools in
poor rural areas and providing : gymn, gym teachers, playgrounds healthy nutrious school lunches (and even breakfasts.

Many states have laws on the books calling for gymn, nutritous lunches, but the laws aren't enforced, particularly in poorer states. As you no doubt know obesity rates are highest in poor states.

An alternative is to bus kids out of inner cities (and away from the polluted air) to suburban schools that have gymn, better lunches etc.

Rick Kahlenberg has done work on how well this is working in various citites (See tcf.org and serach Kahlenberg). At first suburban parents are resistant, but ultimately embrace the programs.

Inner cities also need safe places for kids (and adults) to exercise, and as you point out, subsidized green-markets--as well as subsidized "urban farming" that cut the cost of healthy food by eliminating transportation costs.

Finally, we need jobs programs for the poor, much smaller classes in public schools and expanded college scholarships based on need. We know that obesity is linked to poverty and lack of education

We tolerate much higher levels of povety than other developed nations--especially among children. We need to lift these kids out of poverty and bring them (and their parents) into the middle class.

There was a time when we had a Department of "Health, Education and Welfare." Reagan, of course, shut it down. We should once again recognize how health, education and welfare are all one ball of wax, and need to be addressed as such.

When people talk about "individual responsiblity" they are usually blaming the poor for being poor.

Thanks again for an excellent post.

crayz

This seems like an attempt at a highly persuasive post, but where exactly are the facts? The post is full of stuff like:

The more capital you've got access to, the more optimistic you tend to be, and the more likely you are to think prospectively about health.

Really? Let's see the data. For this sentence and all the others. The only supportive link you provided is a study describing a number of factors correlated with increased obesity, some as tenuously as pirates and global warming, some a bit better argued. But it only gives evidence for maybe one or two of the various correlations you pass along in a way that lazily implies causation and support for your narrative

Charles

It's not particularly about calories, and it's not about exercise, though it is about poverty.

When we put Native Americans on reservations, and started feeding them mainly refined carbohydrates (wheat, sugar, rice) obesity and diabetes skyrocketed. And it wasn't because of lack of exercise.

Carbohydrate foods are cheap per calorie, but every time a culture starts to increase their intake of refined carbohydrates, obesity, diabetes, high blood pressure and heart disease start to rise.

And it isn't about fat, either. Since 1970 (when the whole low-fat craze started), according to USDA statistics, the percentage of fat in U.S. diets has remained about the same, but the percentage of saturated fat as decreased, and the percentage of polyunsaturated fats has increased. Calories have increased, mainly in the form of grains, particularly wheat, and sugars.

So we're eating less saturated fats, and more carbohydrates and refined/industrial oils. We're doing exactly what the public health authorities tell us we should be doing. And we're getting fatter and sicker. Why do we think more of the same advice will reverse that trend?