lady veteran

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It's a Weighty Problem, But A Crisis? C'mon


By Fred Barbash
Sunday, August 31, 2003; Page B01

I am body mass challenged.

Okay. I'm chunky.

Okay, I'm obese. But I'm only obese technically speaking, based on my
body mass index, the government's standard method for determining
obesity. You'd never know it by looking at me.

But since I am technically obese, I find it heartening that there's
rising concern about the "obesity epidemic." Perhaps it will
encourage me to lose more weight. Perhaps a better understanding of
the causes of obesity will help others with serious weight and
weight-related problems. Perhaps Krupin's Deli will include on its
menu a sandwich with just a couple of slices of corned beef as an
alternative to the dozens of slices piled high.

Yet at the same time, the alarm over obesity causes me some alarm. I
feel like a hunted man. I'm "wanted" for increasing the nation's
economic costs by up to $117 billion a year. I'm reading about
off-the-wall proposals to tax my next car as an incentive for me to
walk, not drive, to Krupin's. I'm reading about nutty plans to tax my
junk food and the TV set I watch when I eat junk food, as an
incentive for me to get off the couch and eat an apple.

I'm not trying to make light of heavy. And no specific proposal is
eating at me -- except that truly hideous suggestion that kids be
sent home from school with body-mass-index report cards. I'm alarmed
by the hysteria in the mass media, reflected in words such as
"crisis" and "epidemic." There's been an epidemic of alarmist stories
about obesity and its costs in the past year (about 2,000 according
to my Internet search) that can only egg the politicians on to more
foolishness and encourage insurance companies and perhaps employers
to jettison another risk group.

I'm awed, as well, by the way in which a matter of personal
responsibility has been transformed into a public crisis, whipped up
by the uncritical news media, which swallow and regurgitate the
crudest statistics about the most complicated of problems -- such as
obesity.

This suits the agenda of an extraordinary variety of interest groups
and academics, who, knowing of the media's new hunger for stories
about the "crisis," duly produce studies demonstrating how their
particular thing is actually the cause of it all. It's suburban
sprawl forcing people to drive everywhere. It's health insurers who
won't reimburse for Weight Watchers. It's video games. It's the
lunches parents send to school. It's the lunches served by the
schools.

The rise in obesity is not really new. Specialists have been worried
about it for some time. The statistics indicating dramatic increases
in obesity have been around for several years. It's a 20-year trend.

People who are overweight have certainly known it. That's why the
number of those dieting (54 million) has risen parallel with the rise
in obesity, according to an April 9 study in the Journal of the
American Medical Association.

It's the mass media that are just figuring it out.

Driving the story is a widely accepted and propagated statistic:
Overweight and obesity cost society $90 billion to $117 billion a
year. These numbers -- representing "economic cost" -- are critical
for public policy. Economic cost, tallied by figuring direct medical
expenses and indirect expenses such as lost productivity, has become
the wedge by which government and allied institutions justify
treating your business as everybody's business. Once, personal
matters were personal matters. Now personal matters remain personal
unless they have economic costs.

There are those who want the obese to pay for their obesity, so as
not to burden the rest of society. Some proposals under consideration
-- extra taxes on fattening foods, for example -- would shift the
economic costs to me, in part to discourage the behavior which has
supposedly led to my body mass index and in part, I suspect, to
punish.

Allow me to respond personally to those behind these ideas.

Let's make a deal. If you would like me to pay for my body mass
index, I will come back to you and find something you owe me.

Do you overwork, and suffer from workplace stress? That's $30 billion
a year, says the International Labor Organization. Hand it over.

Do you bike long distances or run marathons or lift weights or do
Eskimo rolls in a kayak or go boating? Injuries from recreational
activities cost $26 billion, says the American Academy of Orthopedic
Surgeons. Pay up.

And don't get me started on occupational injuries, mental illness,
bad driving, heavy drinking, body piercing and all the rest. All
diseases and injuries -- and the behavior associated with them --have
economic costs.

Here's how it works practically. Most of us engage in risky behavior
and are free to do so. When risky behavior becomes expensive behavior
for society, our freedom shrinks. We get browbeaten. Or our behavior
is made to seem antisocial through a campaign of negative publicity.

Whatever makes our risky behavior possible -- say, fatty foods or
fast cars or maybe someday skateboards -- gets taxed, possibly out of
existence. It's not exactly Big Brother. Big Mother is more like it.

But how do we determine which costly behaviors are crises requiring
institutional mobilization and intervention and which are not? Do we
just start with the highest cost and work our way down?

At this point, the economic intervention model fails us and something
pernicious takes over. The test becomes: Who can generate the most
publicity? Whose costly behavior is also distasteful to a majority or
perceived as immoral? We all remember the initial response to AIDS, a
disease that is now viewed with appropriate compassion.

Fat people are already disfavored -- by employers, by insurance
companies, even by other fat people. In addition to having economic
costs, obesity is considered unattractive and connotes, to many,
slothfulness. The current cries of alarm may only make things worse.

I am not in favor of obesity. Who is? Even the Bush administration
- --willing to overlook air and water pollution -- has joined the
crusade against obesity. I accept that obesity is dangerously on the
rise. I favor public health measures to alert us to its dangers and
to help us slim down.

But assertions that we are in crisis tend to encourage crisis
responses. Obesity is too complicated for that.

Consider, for example, the statistics showing a great rise in obesity
among Americans. The definition of overweight and obesity is based on
body mass index. Body mass index is a numeric scale based on a ratio
of height to weight. Go to the Web site of the Centers for Disease
Control (http://www.cdc.gov) and find their little body mass index
calculator. I did.

A man 6 feet tall, according to the calculator, is obese if he weighs
280 pounds. That could make sense. He would still be obese if he lost
55 pounds and weighed in at 225. That makes less sense. He's "normal"
at 160 pounds, which makes sense. But he's also normal at 137 pounds,
which makes no sense at all.

By the body mass index, a man who is 5-foot-7 is "normal" at 120
pounds. Does that sound right? I am 5-foot-71/2. I once got down to
160 and looked drawn and emaciated. I hate to think how I'd look and
feel at 120. Currently, I weigh 194 and am technically obese. But I
play tennis with my 8-year-old, go biking and kayaking, work out at a
gym and feel pretty good. I have a stocky build, as did my father and
both grandfathers.

I am, of course, taking the body mass index too literally. It's a
range. The CDC says that many factors, including muscle mass, bone
structure and family history must be considered. Body mass index is
"only one piece of a personal health profile," according to the Web
site. It's a screening device, after which one may decide whether to
see a physician.

In other words, it's crude. Yet its crudeness does not prevent it
from being applied to the entire population. Nor does it prevent the
CDC and other health professionals from declaring that 64 percent of
us are overweight and nearly half of that number, or about 30
percent, are obese, and that obesity has increased dramatically -- in
fact, doubled -- in the past 20 years.

Calculating that increase is difficult because the data over time are
not really comparable. The definition of obesity keeps changing. You
may remember the day in the summer of 1998 when about 25 million
Americans became overweight overnight. That was because the official
definition of overweight changed -- significantly. On one day, a man
5 feet, 10 inches tall weighing 184 pounds was normal. The next
morning, he was nine pounds overweight.

The estimates of economic costs are even more crude. The medical
literature says that most diseases connected with obesity tend to
have multiple causes, some of which are indeterminate. Do you have
sufficient faith in statisticians to believe that they can slice and
dice the costs of these diseases and declare with any precision that
obesity is responsible for X percent or Y percent versus, say, family
history or smoking or air pollution or stress or hypertension?

The health care professions and policymakers, of course, need these
numbers to set priorities, raise money for their research and,
necessarily, to raise alarm. But the news media find them
irresistible and take them literally. This way, something complicated
becomes simple.

But obesity is not simple. I recommend the April 9 edition of the
Journal of the American Medical Association to anyone interested in
this issue. It's entirely devoted to obesity. What becomes
immediately apparent even to a lay reader is this: When it comes to
obesity, as a professor of medicine writes, "many mysteries remain."

Can we, then, engage in such foolishness as body-mass-index report
cards? Some school systems (Chicago, and one local school system in
Arkansas) think so. I can hear the conversations over the dinner
table at home: "You did great at math, dear. But you flunked the fat
test. Thin out." Wasn't it just a few years ago that we were so
worried that kids were so worried about their bodies? Whatever became
of the "self-esteem" crisis?

I'm a layman, not a physician. I don't question the seriousness of
the obesity problem. But there's no need for panic.

On behalf of overweight people everywhere, I ask, please, call off
the dogs.


LV

Remove "intel" from address to reply

Lady Veteran
- -----------------------------------
"I rode a tank and held a general's rank
when the blitzkrieg raged and the bodies stank..."
- -Rolling Stones, Sympathy for the Devil
- ------------------------------------------------
Support bacteria - they're the only culture
some people have." -Stephen Wright
- -------------------------------------------
Before you criticize someone, you should walk a
mile in their shoes. That way, when you criticize
them, you're a mile away, plus you have their shoes.
- -Unknown
- -------------------------------------------------


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