The Obesity Gap

On Sept. 12, 2001, according to Greg Critser's "Fat Land," one of the few news stories to break through the coverage of the previous day's attacks "was one about the latest obesity statistics (the national rate had jumped again -- to 26 percent)." Overweight will kill far more Americans each year than any terrorist would dare dream of taking out, and Critser is rightly incensed about the death toll racked up by cardiovascular disease, hypertension and especially diabetes, along with all the other fat-related illnesses.

Still, it has taken a while for the true proportions of the epidemic to penetrate my own consciousness, and to shock me it took a number like 26 percent (and that's just the obese; about half of us are merely "overweight," at least enough that health problems start to kick in). Sure, most of the people I know want to lose a few pounds, but none of them are actually obese or even significantly overweight. There's a guy from the University of Colorado's Health Sciences Center, a physiologist named James O. Hill, who's been running around pronouncing that "almost all Americans will be overweight by 2050," but from my little urban corner of the world, the fattening of the land has been nearly invisible.

That's Critser's point. Obesity, he points out, is a condition that "disproportionately plagues the poor and the working poor," while public discussion and policymaking on the topic get steered by the middle and upper classes. A health journalist, Critser decided he needed to lose 40 pounds a few years ago. To do so he enlisted a competent doctor, the prescription weight-loss medication Meridia, jogs in a congenial neighborhood park, a wife who cooked him healthy food, and access to plenty of information. "And money," he adds. "And time." He lost the weight, but "the more I contemplated my success, the more I came to see it not as a triumph of the will, but as a triumph of my economic and social class."

By contrast, he covered the opening of a Krispy Kreme doughnut store in Van Nuys, Calif., a largely working-class Latino area, for Harper's magazine in 1999. The store manager explained to him, "We're looking for bigger families ... Yeah, bigger in size," meaning, I suppose, that Van Nuys residents have more kids, as most Latino families tend to do, but also that they're likely to be heavier than non-Hispanic whites. African-Americans are more likely to be overweight than either group. And the poorer you are, the more likely you are to be obese.

The association of fat with a lower social status is probably intuitive for most Americans, but so far that has mostly been treated as a cruel stereotype of the overweight, representatives of whom have gone on TV talk shows to tearfully protest that they are not "lazy" or "low class." The innovation Critser brings to the literature of obesity is to take what turns out to be a valid perception after all -- working-class and underclass people are more likely to be fat -- and pull a switcheroo. Rather than regard class status as a stigma unfairly affixed to fat people, he presents fat as a health liability unjustly foisted on the poor and insufficiently addressed by the affluent.

It's a refreshing argument and often quite persuasive. Critser also traces some developments in international trade, agriculture, social customs, marketing and food sciences that, he maintains, have conspired to boost the calorie content of the average American's diet. High-fructose corn syrup, a sweetener that fosters diabetes, and palm oil, said to enjoy many "molecular similarities to lard," have become pervasive in prepared foods since the 1970s, and they are two of the nastiest, most fattening concoctions known to man. The portion of the average American's food dollar spent on meals obtained away from home jumped from 25 percent to 40 percent between 1970 and 1996. Restaurant food not only tends to be higher in calories (it adds 197 more per day, to be precise), it also comes in increasingly humongous portions, especially if you supersize your order. A regular serving of McDonald's French fries contained 200 calories in 1960; now it has 610. Then there are the between-meal snacks and the sedentary lifestyle.