Critser - Fat Land

August 16, 2004

Greg Critser
Fat Land: How Americans Became the Fattest People in the World
Boston: Houghton-Mifflin, 2003

This is a powerful polemic about a serious public health crisis in the United States. But, because that public health crisis is a crisis of personal health, one that must be addressed both by national policy and by millions of individual, private, decisions, I found that I read the book with a split personality. On the one hand, I read it with an eye to public health and public policy, the class components of morbid obesity and food health, and the role of voters, school boards, and elected officials in fighting this battle. On the other hand, I read it as a dad, checking our food policies and thinking about whether we are doing the right thing with our fat baby and chubby toddler.

Critser's book is a polemic. By that I mean that almost every separate piece of his evidence comes with a "yes, but." He points out that womens' clothing sizes have gone up, so that 16 is now a medium. But, he forgets to mention that women are also taller than they were in 1942 when the standard sizes were invented. We are fatter, but we are also taller. Fatter is more important, but the change in clothing sizes reflects two trends, not one.

Much of life fits the old patternn of "two steps forward, one step back." Much of Critser's evidence is a presentation of the two steps forward. He does not mention the one step back. And, while this does not affect the overall point he is making, I am always bothered by people who write critically while ignoring contrary evidence.

That said, Critser does make a strong anecdotal and statistical argument that there is a substantial confluence between several trends, and that most of these trends reinforce one another in a positive feedback loop. Fat and hfcs are cheap, and food is a lot cheaper than it was during the 1970s. Fast food restaurants have dramatically increased portion sizes as a way to increase profit margins. Americans watch more TV. Americans exercise less. American child-rearing manuals during the 1980s emphasized child-directed food habits rather than adult-directed food discipline. Americans feel that their streets and neighborhoods are dangerous, a true feeling for people in the inner cities because of the violence that follows drugs and gangs. Schools have cut PE. Exercise has become a class-based leisure activity, especially for children. National health and fitness recommendations have gotten less challenging, more supportive. People have used tiny and class-biased data sets to argue that fitness and fatness are irrelevant to one another. Americans feel busier. Americans eat more food away from home. Food away from home is far more calory-dense than food prepared at home.

He makes a compelling case for a multiple-causation feedback loop creating a public health crisis, especially among poor people. He gives terrifying anecdotal evidence about the spread of type II diabetes among children, about the effects of morbid obesity on growing children, and about the long term health crisis we have brewing. He does not use these words, but his message is that we are become a nation of Dudley Dursley's: overindulged, overweight, over our heads.

What to do?

On a policy level, Critser implies that a change in agricultural policy to cut back on the subsidies for HFCS, Palm Oil, and Soybean oil would raise food prices (a bad thing) but also create profit signals that would encourage food processors to reformulate their products. He would like to see a return to meaningful physical fitness tests for children, a return to physical education in the schools, fast food and soft drinks banned from the schools, and a systematic public health education and intervention program aimed at changing behaviors. If not, we will all pay for it as we pay for our neighbors' health coverage.

What about on a personal level?

Here we get into the dilemma between cruelty and compassion. On an individual basis, it is a good thing to be kind to others. One of the core principles of the enlightenment was the attempt to reduce or remove pain from life, and that is a good goal. So we are tempted to try to help an overweight friend or neighbor, we are told not to mock people for their physical appearance, just as we tend to go out of our way to encourage, say, a teen mom who completes her education. And yet, every time we engage in that individual act of kindness, we are also lowering the social stigma against obesity, or teen motherhood, or other individual acts that have social consequences. How to be critical without being mean is a hard balancing act, and the current tendency is to bend over backwards to avoid appearing mean.

Finally, public health begins at home. It is created by a combination of policy, laws, and institutions with myriad individual choices and decisions. Policy, in the end, is there to make it easier for individuals to help themselves.

Both J and I are heavy for our height, slim for our weight. I have a BMI of about 27 but an 8 to 10 inch drop from chest to waist. Despite the love handles, I am slim for my age.

The toddler is a little heavy - he is a good eater. We already encourage him to be active - I walk and run and he comes to. "Runnah, runnah!" I need to remember to keep the serving pot on the stove and give much more reasonable portions to him. I can say "eat till you're done, then stop." But I have noticed that he is a social eater, and will continue to eat as long as his little brother or his parents are sitting at table. So, portion control. We are already eating low fat because of my diet. We are currently able to maintain family dinner time and hope to keep that sit-down dinner. He already snacks on fruits and vegetables, with a house rule that food stays in the kitchen (or on the front porch.)

The infant is a little fat, complete with leg creases. He is also being very spitty. I wonder if the two are related. He goes for his 6 moth checkup on Wednesday, and we will see what doctor says.

Finally, Critser is very critical of the literature suggesting that it is better to be fit than to be fat, and that if you are sufficiently active then your pudge does not matter. I know some wicked fast running butterballs (although distance running is a sport where you are better of being fat than being muscular). I also continue to believe that for a heavy person seeking to improve their quality of life, they are better off focusing on fitness and letting the belt come in as a side effect than they are focusing on yet another diet. But, how to sell this message without, as Critser warns, selling the message that fat does not matter?

So, from public health to private concerns, and back again.

Posted by Red Ted at August 16, 2004 09:28 AM | TrackBack
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