The Obesity Gap
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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.
As you might guess, "Fat Land" is packed with numbers, and while much of this is familiar stuff, some of the studies Critser digs up are fascinating. People, including children 5 and older, eat more food when presented with more of it, which pretty much dispenses with the notion that the body just naturally knows when it has had enough. On the contrary, natural selection has designed many of us to eat as much as we can get, as insurance against future deprivation. In fast-food restaurants, we eat more food when we get larger amounts of it at discount prices, and simply knowing that a greater variety of high-calorie snack foods has been made available to us apparently spurs us on to consume vast quantities of them. Critser debunks the idea that brief bouts of moderate exercise during the course of the day can make you as fit as sustained periods of vigorous activity, and that it's healthy to gain a few pounds as you get older.
But the really interesting and provocative aspect of Critser's book concerns class and poverty, which he insists several times are the "key determinants of obesity and weight-related disease." That's a strong-enough assertion for a magazine article, but he doesn't take it far in this slender book. He speculates a bit about why blacks and Latinos are more prone to overweight, but he doesn't really talk to any of them -- not, for example, a customer amid the crowd packing that new Krispy Kreme store -- about how they feel about eating and exercise, whether they're aware of how deadly obesity can be, whether they try to diet and exercise and, if not, why not. For a champion of the dispossessed, he doesn't seem to want to have much contact with them.
Instead, beyond delivering a well-earned indictment of corporate junk-food mongers, Critser expends a lot of his ire on "baby boomers," a group he blames for creating a social climate in which fat has flourished. The guy is a journalist, so he knows how to pick his straw men; you can get a lot of mileage out of boomer bashing, even with boomers themselves. But Critser's conception of just who these rascals are is hazy and contradictory. Boomers, he says, are elitist and individualistic, overly permissive when it comes to both their kids and themselves, and full of crackpot notions. He blames them for California's pioneering 1979 ballot measure, Prop. 13, which cut property taxes and drastically reduced education expenditures, and for Title IX of the federal Education Amendments of 1972, which mandated that equal money be spent on boys' and girls' physical education programs in schools.
But Prop. 13 was largely supported by older white Californians (the state is rich in retirees) who resented having their (admittedly draconian) property taxes spent on educating the increasing nonwhite kids in the state's schools. If it was a "generational temper tantrum," as Critser says, it wasn't boomers who pitched the fit. And the connection between Title IX and any decline in school P.E. programs seems pretty dodgy to me; all Critser has to support it is the grousing of some school administrators in a Department of Education survey, a fairly predictable bureaucratic response to change. Anyway, the point of Title IX was to spread around the P.E. resources and benefits to more of the students; what could be more elitist than the old-style boys-only programs that focused most of the schools' time and money on a handful of the most athletic children? Critser implies here that the old emphasis on "group participation and peak performance" in competitive team sports somehow produces more fit students, but later he praises P.E. programs that allow kids to choose the activities they prefer -- a far more sensible approach in a world where many prefer cycling or hiking to soccer.
Given his tendency to slant the story, I'm not sure I can trust Critser when he accuses upper- and middle-class critics of putting the kibosh on anti-obesity programs for kids because of overblown fears they will trigger eating disorders. He's right that the threat from obesity dwarfs that from anorexia and its ilk, which he calls "legitimate (and also epidemiologically small) health issues." But it's bizarre to claim that the medical system has been "skewed" so far in "favor" of anorexia that it has produced safe, effective drugs for eating disorders while the cause of weight loss has comparatively languished. Could the lack of anti-obesity drugs be due to the fact that it's simply a lot harder to medicate against the tens of thousands of years of evolution that have built our bodies to efficiently store fuel than it is to correct a mental illness that drives people to starve themselves? I'm willing to bet a year's supply of Big Macs that more is spent on research into how to slim us all down than on how to fatten up a few teenage girls.
Still, "Fat Land" is a lively book with more than a few worthwhile points to make, and you can't help but appreciate a writer who comes up with a line like "In the early 1990s supersize had met Super Mario with a vengeance." At the very least, it has taught me to think twice before I say the words "I'll have the Super Value Combo" the next time I step up to the concession stand at the movies. By now I really ought to know that if I do, I'm going to eat the whole thing.
Laura Miller is Salon's New York editorial director.