Coble sent me a link to this really interesting article over at Wired about the competing interests in the “obesity as a health issue” arena. The hook is a little trite, but the article is actually much more complicated than just “75 million Americans may have something called metabolic syndrome. How Big Pharma turned obesity into a disease – then invented the drugs to cure it.”
This is the part I want to say something about, though:
Diet and exercise? It’s easy to recommend, and it’s good in theory, but there’s surprisingly little proof that lifestyle intervention actually works as a weight-loss strategy. In the late 1990s, the Centers for Disease Control and Prevention initiated its Diabetes Prevention Program, a $174 million study hoping to prove that behavioral changes can induce weight loss. To make the point, the program went to extremes. The 3,000 participants received gym memberships and personal trainers, had their food provided, and were coached with daily phone calls from nutritionists – all for two years or more. After all that hand-holding, patients lost an average of 7 percent of their body weight.
The CDC hailed the study as proof that diet and exercise work, but it just as readily proves the opposite. After all, how likely is the average American to stick with – let alone be able to afford – such an intensive program?
Two or more years to lose on average seven percent of your body weight. If you’re a three hundred pound person, your gym membership and your personal trainer and your food and your nutrition coach lost you about 21 pounds. Over two years or more. A three hundred pound person who’s ideal weight is around 150 would need at least seven years to lose that weight, assuming the CDC’s plan doesn’t lead to plateaus. I’m with the Wired writer. Who can afford that? You’re basically limiting weight loss to the wealthy, who are, by and large, not obese anyway.
Never mind that there’s nothing here about whether those people were able to keep the weight off once they didn’t have the CDC paying for the gym and personal trainers and providing food and a nutrition coach.
It’s basically admitting, without being upfront, that thinness is a class marker, reliably available only to the wealthy.
But the other thing I wanted to address is how whiplash-inducing it is to hear “Oh my god, you have the death fat! You must lose weight immediately!!!!!!” and then to hear that even studies touted as proof that diet and exercise work take a long time. I think that’s where the needs of the commercial weight-loss industry dangerously obscure the medical realities, even to the point where medical professionals somehow think that “needing” to drastically lose weight means that you should be able to lose weight drastically and, if you’re not, that you’re lying or just not trying hard enough.
I have mixed feelings about turning obesity into “metabolic syndrome” but when I think of the potential it has to turn the tone of the discussion away from moral panic and toward medical issues, I kind don’t mind it.