The girth of a nation

Americans are way too fat -- right? Well, maybe not. A controversial new book claims that our diet-crazed culture is buying into a big lie.

Published June 29, 2004 9:30PM (EDT)

It's summer, and across America people are grilling hamburgers but eschewing the buns; they're vacuuming up every crumb of information about how Kate Hudson lost her baby weight, and how Mary-Kate Olsen has finally copped to her anorexia. The South Beach diet continues to sizzle; pasta companies are going under; and still we're bombarded with stories about class-action suits against McDonald's and news of how obesity is threatening to gobble our country's youth whole. But a new book wants to blow holes in our fixation with weight. According to "The Obesity Myth: Why America's Obsession With Weight Is Hazardous to Your Health," we are all being duped, not only about the concept that weight consciousness will lead to better health, but about the notion that being overweight is such a big problem anyway.

Paul Campos, a professor of law at the University of Colorado, argues passionately that the idea that America is in the midst of an obesity epidemic is false. He says that we're willing to buy into the notion of a national fat emergency because the medical profession and the media feed us misleading information about the connections between weight and health risks such as hypertension, cancer and heart disease. Campos says that what the studies actually show -- before they have been garbled by an "anorexic" media -- is that improved health is possible with a moderate amount of increased physical activity, regardless of our weight. But that message gets lost in the fever-pitch of fad diets, ever-shrinking government definitions of what it means to be overweight, and cultural discrimination against people who fail to meet the unrealistic and unnecessary standards for slimness.

Salon spoke with Campos from his Colorado home about Jennifer Aniston's body mass index, Dr. Phil's near-obesity, and how we should worry more about the increased weight of automobiles than our own extra pounds.

You're a lawyer. How did you get interested in the medical profession's obsession with weight loss?

I was speaking at a conference on the Clinton impeachment and I started looking at the media coverage of the Lewinsky scandal and was struck by how frequently the media referred to Monica Lewinsky's weight. I was particularly struck by the frequent use of the word "zaftig." Then Andrew Morton's book "Monica's Story" came out, and I was just astonished to read about the forthcomingness of Monica about her weight anxieties and Bill's and Linda Tripp's. It turned out that the bulk of what Monica and Tripp talked about was weight! There was this tremendous opprobrium that fell on Monica and Bill and Hillary for not having superthin bodies. Hillary particularly was constantly upbraided for having thick calves. I'm not sure what she was supposed to do about her calves.

But then even more scandalous was what I discovered through talking to lots of sociologists and people involved in the research end of all this. I discovered the tremendously exaggerated quality of the claims about how obesity -- as defined by government standards -- was being regarded as an epidemic that has direct correlation to health. I discovered what I consider to be a large cultural hysteria about how we're on the verge of a public health calamity. And what is essentially a social, cultural and political concern has been transformed into a medical issue. And that ridiculous notion ends up being transmuted into the claim that it's only doctors who can be approved to speak authoritatively on it. And not just doctors -- weight-loss doctors, who run weight-loss clinics and are benefiting from the hysteria.

Do you base your argument on what you found in studies, or have you also reported out this hysteria by talking to people in the weight-loss field?

I started out by reading studies and again and again ran into the same phenomenon: There was this disjunctive experience of reading the data and not being able to understand how conclusions about the correlation between weight and health stemmed from this data. I soon found people who were willing to say flat-out, "The reason you're having that experience is because those conclusions don't flow from that data."

I asked a very prominent epidemiologist at the CDC [Centers for Disease Control] about the latest study that came out in March, claiming that 400,000 deaths a year are a result of poor diet and a lack of activity level. I asked her how accurate that number was, and off the record -- because she wants to keep her job -- she said, "I think it's pretty accurate with a margin of error plus or minus 400,000 deaths a year."

The whole thing makes as much sense as reefer madness or hysteria over satanic ritual abuse in our day-care centers. People can look back at eugenics or something and say that that was ridiculous. Nevertheless, if they see something about an obesity epidemic on the front page of the New York Times and you ask them to consider the possibility that it's not true, they'll say how can you possibly question it when the NIH [National Institutes of Health] and CDC are telling you that it's true?

What is your reaction to the commonly held belief that there is a direct connection between obesity and ill health?

Something which ought to cause tremendous skepticism but hasn't is when you hear there is an epidemic of obesity in the U.S. According to official government standards, you're overweight if your BMI [body mass index] is over 25, which is 64.5 percent of the population on the basis of available data. Then there are the people at Harvard Medical School who think everyone should have a BMI of under 22 when 80 percent of the population is at 22 or higher. So according to all of them, the large majority of the population weighs too much. But there should be suspicion about the claim that there is a strong causal link between heart disease, hypertension, cancer -- and weight. Because these diseases are less prevalent and less fatal than they were even recently. Cancer rates continue to fall. Americans are much healthier now and have a longer life expectancy than they ever had before.

Studies about the causal relationship between these diseases and obesity fail to take into account a host of other factors, including socioeconomic status, activity levels, fitness levels, dieting, weight cycling, and diet-drug use, which all have an impact. If you take those factors into account you see how weak the argument is that a certain level of BMI is in and of itself causing heart disease, hypertension or cancer.

What about Type 2 diabetes?

Diabetes is a separate and special case because in the case of Type 2 diabetes, there is a strong correlation between weight and the condition.

But the big killers are heart disease and cancer, and there is a weak correlation between an increased BMI and those diseases. The level of physical fitness that needs to be maintained to see health improvements is the equivalent of a half-hour walk every day. And people who are profoundly sedentary -- without regard to weight -- are at greater risk than obese people with that level of fitness, who are very healthy, regardless of how much they weigh.

But isn't the idea of physical fitness -- walking a half-hour a day -- related to losing weight?

The evidence is very powerful that improved health among people who go from being sedentary to active is not due to weight loss, because for most people, increased physical activity does not produce significant long-term weight loss. And people who lose a lot of weight don't get any benefit over people who lose a little weight, so the benefit of weight loss by itself is medically nonexistent. But the good news is you don't have to become thinner to enjoy significantly improved health.

And you argue that the people telling us that we can get thinner aren't necessarily living by their own imposed guidelines?

I was at this Time/ABC obesity summit three weeks ago and [Secretary of Health and Human Services] Tommy Thompson is talking about how terrible this epidemic of obesity is -- and he's not a slim guy. He's definitely obese by the standards he wants to impose. I was the lone dissenter, and there are tons of people out there questioning the war on obesity but they didn't invite any of them. They invited only the pain in the ass lawyer who's more easy to dismiss, because I'm not a medical professional. But one of the things I said is that all these people -- most of them men -- are overweight, or even obese by their own definitions.

I've really reached a wall of ideological incomprehension: How is it that people whose own bodies literally embody a refutation of their claim can keep getting up and haranguing us for being obese? What would people say if Tommy Thompson got up and lit up a big old fatty and then told all of us how terrible marijuana is? I assume people would say that doesn't seem to make a lot of sense! But literally no one ever says, "Well, wait a second, Mr. Secretary ... how much do you weigh?" A central component of the whole obesity myth is that people could weigh significantly less if they wanted to, but these people at the forefront of the war on fat don't.

Okay, so how much do you weigh?

I weigh 165 and I am 5-foot-8. I am probably overweight by government definitions right now because I had lunch, but I was not overweight this morning. I have the same BMI -- slightly less -- than George W. Bush. We are both extremely healthy, extremely active people who are not typed as fat or even overweight, culturally speaking. But we're overweight according to standard definitions because we have a BMI over 22.

But then, a 127-pound woman of average height will be overweight if the people who want to lower the BMI for the definition of average weight to less than 22 get their way. [Harvard professor of epidemiology and nutrition] Walter Willett says most people would be healthier if they had a BMI below 22. It's as if he said most people would be healthier if they were more than 6 feet tall. It makes exactly as much sense. I think he's typical of this culture of anorexic people telling Americans how to think about their health.

What do you mean when you refer to people like Willet as anorexic?

I think these people have an anorexic ideation, to use a technical term. That means that their mind frame is similar to that of a person who is diagnosed as anorexic. One of the things that's true in this country is that the same kind of ideation -- the same perceptual tendencies, same ideological orientation toward issues of weight -- are found among many, many more people than the number of people who are technically diagnosed as having an eating disorder.

The line between having an eating disorder and eating-disordered thinking is very fuzzy. If you're obsessed with being thin, if you have major control issues, if you're obsessed with the idea that fat is bad and thin is good, if you place foods in good and bad categories, if you have an unrealistic body image and you think of yourself as fat -- all that stuff is classic eating-disordered ideation. It's so normalized now that people don't even notice it.

What's happening is the institutionalization of this kind of ideation in the form of these government standards. I am not trying to be provocative here -- this is what I actually think. Policies on this issue are strongly influenced by anorexic ideation. The NIH, the surgeon general, the official government public health agencies -- in terms of definitions, in terms of advice about what people should be striving to achieve, in terms of the demonization, and the pathologizing of most of the range of normal body mass variation -- they have turned most human bodies into diseased bodies by coming up with this very bizarre notion of what constitutes a normal body.

How much of the obsession with weight loss has to do with people wanting to be healthier and how much has to do with people wanting to look like Jennifer Aniston?

There is overwhelming evidence that the latter consideration is vastly more important to people. As for Jennifer Aniston, she has a BMI of 18.3. Her husband -- the hunky Brad Pitt -- has a BMI of 27.5. For Jennifer Aniston to have the same BMI index as her husband she'd have to weight about 55 pounds more than she does now. That highlights the extent to which we put a premium on extreme slenderness as the sexually desirable ideal for women. Brad Pitt could be fairly described as a large individual. He appears to be in excellent shape. Largeness in men is considered quite desirable while extreme slenderness is what's supposed to be sexually attractive in women.

Wait. How do you know Jennifer Aniston and Brad Pitt's BMIs?

You can look up their height and weight on the Internet. And by the way, Jennifer Aniston is not extremely slender for a female celebrity, when you compare her to Gwyneth or Madonna who have BMIs of 16. Dr. Phil's BMI is 29.5. He's almost obese! I just discovered that he's 6-foot-4 and weighs 240. He's way at the very top of the overweight range and that's Dr. Phil -- America's big weight-loss guru.

So what is your gut reaction if I mention the word "Atkins"?

My reaction is that P.T. Barnum is spinning in his grave because he can't get in on this stuff.

It's safe to say that there is no more thoroughly investigated question in medicine than what happens when people restrict caloric intake for purposes of reducing weight: They lose the weight and gain it back again. It is absolutely amazing how impervious to evidence people are on these questions. It would be absurd at this point to ask whether cigarette smoking causes lung cancer. It's been investigated. Yes. It does. What happens if you have 100 people on Atkins is 95 of them one year later weigh as much or more than they did when they started. But there is something worse about Atkins, because low-carb dieting cuts aerobic endurance and since fitness level is vastly more important to health than weight, a diet that cuts fitness levels is perverse.

What about gastric bypass surgery?

Gastric bypass was first done back in the '60s, but it fell out of favor because it produced severe complications -- like death -- and there was no good data on long-term benefits. But it started coming back in a big way in the mid-'90s because of these laparoscopic procedures. They said the new surgery was much better than the old one. But what that meant was that it was much easier for surgeons. What happens inside the patients' bodies and the long-term consequences seem to be the same. There was a paper presented at the American College of Surgeons in Chicago that said in 60,000 gastric bypass surgeries, 1.9 percent were fatal within 30 days. This was in people who had surgery since 1990. And the rehospitalization rate was 20 to 30 percent. People claim that there was a higher mortality rate because these were morbidly obese people who were on the verge of death anyway. But most of these operations were on healthy women in their 20s for whom the regular risk of dying within the next year is one in 1,500. If 2 percent are dying after these operations, that's a massively increased mortality rate.

Who's most to blame for the weight hysteria you describe?

This is a society and a country fundamentally obsessed with weight loss and fundamentally eating disordered, and when those two things are in place everything else feeds into it. That's the reason people can sell 5 million dieting books even though dieting doesn't work. This kind of cultural hysteria gives us images of thinness that are wildly unrealistic but imbued with tremendous cultural power. There's no way to simply fix it. It's like saying -- and this is a dangerous but useful analogy -- what can you do about gender oppression? What can you do about racism? You can't implement one plan that is going to fix the culture, but I do think a very important first step is to recognize the existence of dissent.

Because I'm not saying it's not possible that the diet doctors are right. I'm just saying it's possible they're wrong. And if that's not investigated, they are just getting a free ride.

Your book points out that the rates of dieting continue to skyrocket even while the country's average weight had risen. Why?

The connection is causal. Dieting makes people heavier than they would be otherwise. There are a lot of studies where if you take two cohorts of people of the same initial weight and compare people who diet and people who don't, in the long term people who diet weigh more than the people who don't.

You argue in the book that all of this has to do with a culture of overconsumption.

Overconsumption in America is closely equated with class: The higher up you go the more you consume. The only area in which consumption is inversely related to class is caloric overconsumption. So the American elite project anxiety about the fact that they're massively overconsuming economically and materially through a disgust for fat, lower-class people.

America is just too big. We throw our weight around, our cars are too big, our shopping malls are too big, our houses are too big. Our anxiety about fat is our anxiety about our own bigness. But it's a projection that is so inappropriate when our cars weigh 700 pounds more than they did 15 years ago -- which is politically and economically and environmentally far more troubling than the fact that our bodies on average weigh eight pounds more than they used to 15 years ago.

By Rebecca Traister

Rebecca Traister writes for Salon. She is the author of "Big Girls Don't Cry: The Election that Changed Everything for American Women" (Free Press). Follow @rtraister on Twitter.

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