Weighing in

There has been a back-and-forth between Megan McArdle and Marc Ambinder at the Atlantic. It began with 1) McArdle interview with Paul Campos, an obesity skeptic 2) More McArdle thoughts, 3) Ambinder's reply, 4) McArdle's third shot, 5) Ambinder's second reply, 6) Fallows' rather shallow addition.Whew. Think I got it all.

I am broadly sympathetic to McArdle, but not because I'm a libertarian and have any principled objection to government interference. It is because she emphasizes any individual person's lack of control over weight. I'd like to set aside the libertarianism v. government intervention side of the question, actually. It's pointless right now, because we do not know for sure what is causing the rise in obesity. Many people have theories, many of them are plausible, but the data are not in. Once a reason is actually agreed upon by most knowledgeable parties, then I would support a pragmatic approach - if a government approach could work without being offensively intrusive, I'd certainly support it.

I agree, however, with Ambinder and Fallows that people who want to argue that we have little conscious control over our eating (as I do) need to explain the variance in obesity from culture to culture, including and perhaps especially the recent change in our own culture. Campos, while convincing some other points, is particularly unconvincing on this (also unconvincing about why ill health might be correlated with severe obesity).

Ambinder and especially Fallows don't say nearly enough about the fact that we, as a society, are widely attempting to repeatedly force a solution that empirical evidence has shown again and again and again does not work. That is: reducing calories and increasing exercise. Such programs work in the short term, and over time they have a less than 5% success rate (less than 1% ten years out). So doctors and nurses and schools and the culture at large are urging a "solution" that has very unpleasant psychological and possibly physical side effects (the reduction in calories, that is -- exercise is good for you, it just is ineffective for weight loss) and that has virtually no chance of succeeding. WHen does the medical community or government in any other instance try to impose such an absolutely unworkable solution? What aren't more people calling attention to this? McArdle and Campos are also right to point out that it has not been convincingly shown that overeating is a cause of obesity, as opposed to, say, a correlation - perhaps fat tissue makes people have uncontrollable urges to eat, or accompanies some other phenomenon that causes eating, etc. We know that children eat a lot when they are growing, and malnutrition means you grow less tall, but we don't say that eating in itself causes height - we suspect other systems are at work regulating appetite and height. McArdle and Campos are also right to at least question whether obesity is a cause of its associated ill health problems, rather than a correlation.

Meanwhile, we stigmatize fat people. Not only are they considered unattractive, which has an absolutely enormous effect on all aspects of social life, but we now feel free to consider them weak-willed and self-indulgent and actually deserving of the stigma they receive. Thin people think that because they can control their own eating, obese people can control theirs. I was very glad to see McArdle out that this is almost certainly fallacious, a point with which I've had first-hand experience.

My eating used to be out of control and I was overweight. I would think about food all the time, think about how to get it, what I would eat, etc. When I was with people, I was unable to control my overeating, even though I knew people were judging me for it. Then I was diagnosed with an insulin problem (not diabetes) and began taking medication. Note: this medication did not increase my willpower, which is as good or as bad as it ever was. It did not increase my desire to do something about the problem, which believe me, was present all along, as it is for almost all fat people. It did not effect the rate at which I burn calories (alas). But all of a sudden, my urges were within my control. I still want the doughnut, but the urge is resistable. And I lost a huge amount of weight and kept it off - not with no effort, but with an effort I was suddenly capable of making. It is an extremely different thing for me to resist food now as it was before my insulin production was regulated. So when thin people believe that because they can resist urges to eat, so can anyone...they should think again. We seem to understand this happens with alcohol. I am not particularly predisposed to heavy drinking, but some people are. I have absolutely no problem drinking only when reasonable for me, not drinking to excess. It is easy for me to consciously control my drinking, much harder for others. And we seem to have no problem with the idea that some people are more predisposed than others to battle strong urges for alcohol. We do not assume all urges for alcohol are felt in the same way by everyone. We should note the same thing about obesity. After all, abstinence from alcohol as a treatment for alcoholism actually has a much higher success rate than reduction of calories for dieting.