BROOKE GLADSTONE This is On the Media. I'm Brooke Gladstone. Freedhoff suggests that the headlines linking obesity and COVID resonate because they slot neatly into a larger, long standing narrative that we are increasingly, terminally, deplorably fat.
NEWS REPORT Eye opening new numbers tonight about America's obesity epidemic hitting a new high. The CDC now says 40% of American adults are obese and nearly 20% of children.
NEWS REPORT Opinion contributor Susan Pierce Thompson writes, quote, Obesity related illness kills 325,000 Americans every year. She continues, quote, It is the packaged, highly refined products marketed to us as food that are killing us. Established behavioral studies have shown that sugar can be more addictive than cocaine.
BROOKE GLADSTONE That 325,000 number came from a 1999 National Institutes of Health study. In 2004, a CDC study claimed obesity related illness kills 365,000 of us each year. Epidemiologist Katherine Flegal was a senior scientist at the Centers of Disease Control when that 365,000 number came out. She and her team thought they could do better.
KATHERINE FLEGAL Well, we had a better statistical approach, and we had better data because the data from the studies we used were nationally representative and they had measured body mass index, measured weight and height data. And I think we did a better job of accounting for confounding factors like age and sex and smoking and alcohol consumption. And the previous estimates didn't really adjust for any of those things.
BROOKE GLADSTONE One year later, Flegal and her colleagues published their study, also sponsored by the CDC, with remarkably different results.
KATHERINE FLEGAL Overall, we came up with a number of 112,000 deaths associated with obesity and overweight. I think the finding we had that really perturbed people or alarmed people or impressed people in some way was that overweight was associated with fewer deaths than expected compared to somebody with normal weight. That was a surprise to a lot of people, although it shouldn't have been because there are actually many studies in the literature that show the same thing. But this was a very dramatic finding, and that's what I think got most of the interest.
BROOKE GLADSTONE In other words, if weight were directly correlated with death, Flegal would expect to see death rates rise along with a person's BMI. But she didn't. At first, the work got some good press, but then the critics came along who had no issue with the data or the methodology, just the conclusion.
KATHERINE FLEGAL Journalists would quote people saying that our article was rubbish and ludicrous. Like what makes it ludicrous? What makes it rubbish?
BROOKE GLADSTONE So in 2013, she decided to check her work and organized a meta analysis, a study of studies to see what the literature said about BMI and death.
KATHERINE FLEGAL Where real careful search of all the literature that's used these same categories of body mass index and see what they found. We were able to find 97 studies with almost 3 million people, and we combined the data from all those studies to get estimates.
BROOKE GLADSTONE That meta analysis confirmed the results she'd seen in 2005.
KATHERINE FLEGAL We are comparing people in different categories, like the overweight categories, a body mass index of 25 up to 29.9, and the grade one obesity categories a body mass index of 30 up to less than 35. And we found that compared to people of normal weight, which is a body mass index of 18.5 up to 25, we found fewer deaths than expected in the overweight category.
BROOKE GLADSTONE Grades two and three, obesity described as BMIs above 35 and 40 respectively, did have a slightly elevated mortality risk. But her conclusions pointed to a dramatically different reality than the big numbers we so often see. Weight and health exist on a spectrum, and yes, at the extremes there can be greater associated risks. But most of that spectrum, people in a wide variety of bodies thrive. Why do you think the earlier studies didn't get the publicity or the blowback that yours did? The ones that found the same thing you found?
KATHERINE FLEGAL One thing I noticed with earlier studies is that probably people were reluctant — and I could see why they were reluctant, now -– reluctant to really present this. So sometimes you would see the number somewhere in the article which I had read, but it was tucked away. It wasn't in the abstract, it wasn't considered a finding, really. It wasn't mentioned prominently, and sometimes it was only in a table, or sometimes there was just no mention at all. I think people are reluctant. They're right to be reluctant because of what happened to us. Not to say, well, overweight is actually associated with lower mortality than normal weight. They're just not comfortable with that finding, and they don't make any effort making the emphasis about it.
BROOKE GLADSTONE That reluctance to be specific about the alleged risks of obesity still plagues us. In 1995, when the World Health Organization published a very long report looking at body measurement and their relationship to health:
KATHERINE FLEGAL They were very cautious not to use the word obesity, and they developed three categories of overweight, which they called one, two, and three. And they state very clearly that these are not measures of body fat.
BROOKE GLADSTONE The word obesity from the Latin meaning to eat oneself fat was not to be used, declared the W.H.O., because it refers to body fat composition, which BMI does not measure. The W.H.O.'s categories of overweight were meant merely as loose benchmarks because the ranges were too wide and health too complicated to say exactly when things got good or bad.
KATHERINE FLEGAL Now, fast forward just a couple of years. Suddenly there's another W.H.O. conference about this, and this conference was funded really by something called the International Obesity Task Force, which itself was funded by drug companies because drugs for weight loss have begun to be developed. And there was a huge market there, obviously, if you can just get something approved. So somehow in the second W.H.O. meeting, the words were changed. So now 25, up to 30.
BROOKE GLADSTONE That's a BMI of 25 to 30.
KATHERINE FLEGAL Was called overweight, but now 30 and above was called obesity. And that was not true of the previous W.H.O. report, although it had only come out a few years earlier. And so it became government policy because it was from the World Health Organization. Now we got a definition of obesity in terms of body mass index, and that changed the whole picture because now there was a different kind of perspective. Not just being overweight, but obese is a more powerful word and that can be defined as a disease.
BROOKE GLADSTONE A disease, but a rather peculiar one.
KATHERINE FLEGAL And we're also publishing data on things like prevalence of hypertension, the prevalence of diabetes. Well, you have to have a medical encounter to have a diagnosis of hypertension. Someone has to measure your blood pressure. Diabetes — the doctor will decide or assess you to see if you have diabetes. We are publishing estimates of obesity based just on our own measure. We're diagnosing ourselves. You don't even have to have any medical encounters or anything to have a diagnosis of obesity. So that's a very strange kind of disease that really doesn't need any medical person to diagnose it.
BROOKE GLADSTONE That's what makes obesity so baffling. Just step on a scale, mark your height on a door frame, check out a chart, and you can see whether you're part of the great American obesity epidemic. Some decry the lack of science, others the insult of a diagnosis borne more of bias than data. Now that we have good research to back up more qualified conversations about weight, what gives the BMI, still, the power to sound the alarm? Why aren't Flegal's numbers so often cited on the nightly news?
KATIE LEBESCO A moral panic is kind of a cultural freak out.
BROOKE GLADSTONE Katie Lebesco researches food, pop culture and fat activism. Just a few years before, Flegal published her meta analysis, debunking the deathly data about Fat, Lebesco was probing our attitudes about it. She found a moral panic. In her 2010 essay “Fat Panic and the New Morality,” she argued that the current obesity epidemic was simply old fat panic in new sciency bottles. And like the red scare of the fifties or the Satanic panic in the eighties in the nineties. Well, here she likes to quote sociologist Stanley Cohen:
KATIE LEBESCO He said that a moral panic is a struggle to control the means of cultural reproduction. So in a moral panic, you see a bunch of common threads: some kind of concern that there's a threat, a consensus that something has to be done about the threat, kind of blown out of proportion, sense of the effect of the threat, and a lot of hostility toward the people who are responsible for it. And moral panics tend to… they emerge rather rapidly. So you'll see a huge escalation about something that people maybe two or three years ago didn't really care so much about. And the obesity epidemic follows that same kind of pattern as the other moral panics you mentioned.
BROOKE GLADSTONE I hate fat panic, but I am susceptible to it. So help me with separating fact from fiction.
KATIE LEBESCO Let me take a stab at that. We can grant that there has been a slight increase in the body weight of the average American over the last 50 years. During that same time, there's also been an increase in the average height of an American. But certain shifts freak us out, and other shifts are less likely to freak us out. We see headlines every week about obesity threatening women's fertility. Fat babies, fat toddlers, you know, fat time bombs, insurance costs going up, air travel being expensive because fat people are weighing down airplanes.
BROOKE GLADSTONE That's a sign that there's a moral panic going on.
KATIE LEBESCO Concern about an imagined threat is definitely one element of a moral panic.
BROOKE GLADSTONE And then there's hostility in the form of moral outrage towards the individuals and agencies responsible for the problem.
KATIE LEBESCO Yes, there's definitely hostility toward fat people or in fewer cases, toward the social structures that we think make people fat. So if it's the individual, we think, ‘oh, that person's lazy’ or ‘they're completely out of control.’
BROOKE GLADSTONE And there are TV shows like The Biggest Loser, which personalizes the concern.
BIGGEST LOSER It comes down to what is your self worth? These 12 people will lose the fear....
BIGGEST LOSER COACH Don't carry this weight any longer.
BIGGEST LOSER Lose the excuses.
BIGGEST LOSER COACH Be a leader, let's go.
BIGGEST LOSER And lose the weight. [END CLIP]
KATIE LEBESCO And if it's hostility not toward the individual but toward the social structures, maybe it's ‘why is the government subsidizing corn and putting corn syrup in junk food?’ ‘Why is the fast food industry so profit hungry?’ ‘Or why do we have a culture that's based on cars and thus making people less likely to move?’
BROOKE GLADSTONE A moral panic has to be an imagined threat, right?
KATIE LEBESCO There's something real that is happening. The reports of harm in a moral panic are wildly out of proportion to what's actually going on. So in the fat panic. We see it almost impossible to think that somebody could be fat and healthy at the same time. We think that people who are fat have signed their own death warrant. Research suggests that people who are labeled overweight or obese actually don't increase their risk for early death until their BMI gets quite high in the upper thirties or higher. Why do we think, then, that being fat means you're going to keel over tomorrow if in fact that is not what we find in most of the cases of people who are fat.
BROOKE GLADSTONE You referred to sociologist Stanley Cohen, who was a popularizer of the concept of a moral panic. He said that successful moral panics owe their appeal to the ability to find points of resonance with wider anxieties.
KATIE LEBESCO Yeah, Cohen would definitely be interested in what the wider anxieties were fueling fat panic. And I think there are a couple of anxieties. One is about the changing bodyscape of privilege; whose privilege is being threatened by folks who didn't used to have power? What do those bodies look like?
BROOKE GLADSTONE Well, according to the professor and conservative culture warrior Jordan Peterson, that body looks like that of Yumi Nu, the full figured Sports Illustrated cover model.
JORDAN PETERSON All of a sudden, this non-athletic body type is as beautiful as the standard swimsuit model for Sports Illustrated. And it's not. The whole thing is a lie. [END CLIP]
KATIE LEBESCO I've seen the argument in media studies that there is a kind of crisis of masculinity, as white men in particular were seeing themselves threatened by the rising power of women, threatened by people who are black and brown. I think what you see in a kind of condensed struggle around fatness is over whose bodies signify privilege and whose don't.
JORDAN PETERSON And I'm also not willing to sacrifice these ideals for inclusiveness. It's like, no, not everyone's a genius. No, not everyone's Picasso. No, not everyone is young and healthy. And no, not everyone is a Sports Illustrated swimsuit model. Period. And f*** you if you don't like it. [END CLIP]
KATIE LEBESCO We have a lot of anxiety, both from a racial and gender political perspective. And it's a perfect opportunity for a moral panic.
BROOKE GLADSTONE I'm wondering if you were writing this essay today. Do you think that any of your conclusions might be different?
KATIE LEBESCO Something I wrote in the piece was, whether the individual or the larger structure is targeted, the tone is typically hostile and morally righteous, like, ‘how dare they?’ What I was talking about 15 years ago was almost these scolds, these finger wagging scolds. And I think that finger wagging has sort of gone on the down low. So it's still there, but it's taking different forms now. I think the way people in my part of the world, the fairly well educated, white, suburban, middle class or upper middle class crowd, the way we talk about fatness is a little bit less explicitly damning than it was 15 years ago. Friends in my community will never talk about diets anymore — how you know, someone should go on a diet. But we talk about wellness and clean eating, and there's a whole host of new language that I think is doing a lot of the same cultural work that the old language was doing. But it's harder to pin people down.
BROOKE GLADSTONE Katie, thank you very much.
KATIE LEBESCO You're welcome.
BROOKE GLADSTONE Katie LeBesco is an author and researcher specializing in the study of food, pop culture, and fat activism. Coming up. There wasn't always a fat panic, just in the last few centuries or so. This is On the Media.
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