Fixing obesity is not complicated

I recently spoke at a symposium on nutrition and public health at the Tuck School of Business at my alma mater in beautiful Hanover, N.H., Dartmouth College. Among others on the panel with me was Richard Starmann, the former head of corporate communications for McDonald’s. Those with even a modest number of Katz-column frequent flyer miles can readily guess how often he and I agreed.

One point Mr. Starmann made, more than once, was that rampant obesity and related chronic disease was enormously, intractably complicated and would require diverse efforts, a great deal of private sector innovation, minimal government intercession, lots of time, lots of money, and many conferences, committees and panels such as the one we were on to fix. I had trouble deciding where to start disagreeing with this one.

For one thing, if you have ever served on a committee, you likely know as well as I that the surest way to never fix something is to convene a whole lot of committees and panels to explore every possible way of disagreeing. Just look at our Congress.

But more importantly: Obesity is not complicated. And neither is fixing it. Hard, yes; complicated, no!

Before I make that case — emphatically — a brief pause to note the essentials of informed compassion. Yes, it is absolutely true that some people eat well and exercise, and are heavy anyway. Yes, it is absolutely true that two people can eat and exercise the same, and one gets fat and the other stays thin due to variations in genetics and metabolism. Yes, it is absolutely true that some people gain weight very easily, and find it shockingly hard to lose. Yes, it is absolutely true that the quality of calories matters, along with the quantity. Yes, it is absolutely true that factors other than calories in/calories out may influence weight and certainly health, including such candidates as the microflora of our intestinal tracts, exposure to hormones, GMOs, and more.

But on the other hand, once we contend effectively with the fact that we eat way too many calories, that “junk” is perceived as a legitimate food group, and that we spend egregiously too much time on our backsides rather than our feet — we might reasonably address only the remaining fraction of the obesity epidemic with other considerations. I am quite confident that residual fraction would be very small.

Which leads back to: We can fix obesity, and it isn’t complicated.

As a culture, we are drowning in calories of mostly very dubious quality, and drowning in an excess of labor-saving technology. I have compared obesity to drowning before, but want to dive more deeply today into the implications for fixing what ails us.

Let’s imagine, first, if we treated drowning the way we treat obesity. Imagine if we had company executives on panels telling us why we can’t really do anything about it today, because it is so enormously complicated. Imagine if we felt we needed panels and committees to do anything about epidemic drowning. Such arguments could be made, of course.

For, you see, drowning is complicated. There is individual variability — some people can hold their breath longer than others. Not all water is the same — there are variations in density, salinity, and temperature. There are factors other than the water — such as why you fell in in the first place, use or neglect of personal flotation devices, and social context. There are factors in the water other than water, from rocks, to nets, to sharks.

The argument could be made that anything like a lifeguard is an abuse of authority and an imposition on personal autonomy, because the prevention of drowning should derive from personal and parental responsibility.

The argument could be made that fences around pools hint at the heavy hand of tyranny, barring our free ambulation and trampling our civil liberties.

We would, if drowning were treated like obesity, call for more personal responsibility, but make no societal effort to impart the power required to take responsibility. In other words, we wouldn’t actually teach anyone how to swim (just as we make almost no systematic effort to teach people to “swim” in a sea of calories and technology).

Were we to treat drowning more like obesity, we would have whole industries devoted to talking people into the choices most likely to harm them — and profiting from those choices. One imagines a sign, courtesy of some highly-paid Madison Avenue consultants: “Awesome rip current: Swim here, and we’ll throw in a free beach towel! (If you ever make it out of the water…)”

If we treated swimming and eating more alike, we would very willfully goad even the youngest children into acts of peril. An announcer near that unfenced pool would call out: “Jump right in, there’s a toy at the bottom of the deep end! And don’t worry, the pool water is fortified with chlorine — part of a healthy lifestyle!”

I could go on, but you get the idea. But you also, I trust, have reservations. As you recognize that treating drowning like obesity would be ludicrous, you must be reflecting on why drowning isn’t like obesity. I’ve done plenty of just such reflecting myself, and here’s my conclusion: time.

The distinction between drowning in water, and how we contend with it, and drowning in calories and sedentariness, is the cause-and-effect timeline. In the case of water, drowning happens more or less immediately, and there is no opportunity to dispute the trajectory from cause to effect. In the case of obesity, there is no immediacy; the drowning takes place over months to years to decades. It’s a bit blurry.

Really, that’s it. If you disagree, tell me the flaw — I promise to listen.

We have the time perception of our ancestors, contending with the immediate threats of predation and violence on the savannas of our origins. We are poorly equipped to perceive calamitous cause-and-effect when it plays out in slow motion. One imagines viewing ourselves through the medium of time-lapse photography, and suddenly seeing the obvious: We topple into the briny, obesigenic depths of modern culture, and emerge obese. Cause and effect on vivid display, no committees required.

Consider how differently we would feel about junk food if it caused obesity or diabetes immediately, rather than slowly. Imagine if you drank a soda, and your waist circumference instantly increased by two inches. It likely will — it’s just a matter of time.

We generally deal effectively with cause-and-effect catastrophes that have the “advantage” of immediacy. One obvious exception comes to mind: gun violence. If the “pool lobby” were to address drowning the way the gun lobby addresses gun violence, the solution would somehow be more pools, fewer fences, and no lifeguards. But that will have to be a rant for another day, so let’s not go down that rabbit hole.

Instead, let’s flip the comparison for a moment. What if saw beyond our Paleolithic perceptions of temporality, recognized the cause-and-effect of epidemic obesity and chronic disease, and treated the scenario just like drowning?

We would, indeed, rely on parental vigilance and responsibility — but not invoke them as an excuse to neglect the counterparts of fences and lifeguards. We would impede, not encourage, children’s access to potentially harmful foods. We would avoid promoting the most dangerous exposures to the most vulnerable people.

We would recognize that just as swimming must be taught, so must swimming rather than drowning in the modern food supply and sea of technology. We would teach these skills systematically and at every opportunity, and do all we could to safeguard those who lack such skills until they acquire them. Swimming is not a matter of willpower; it’s a matter of skill-power. So, too, is eating well and being active in a world that all too routinely washes away opportunities for both.

Your “eye for resemblances” is likely as good as mine, so I leave a full inventory of all the anti-obesity analogues to defenses against drowning to your imagination. They are, of course, there for us: analogues to lifeguards, fences, swimming lessons, warnings against riptides, beach closures, personal responsibility and vigilance, public policies, regulations and restrictions, and a general pattern of conscientious concern by the body politic for the fate of individual bodies.

The only real distinction between drowning in water and drowning in calories related to causality is time. One hurts us immediately, the other hurts us slowly. The other important distinction is magnitude. People do, of course, drown, and it’s tragic when it happens. But obesity and chronic disease affect orders of magnitude more of us, and our children, and rob from us orders of magnitude more years of life, and life in years.

No one with a modicum of sense or a vestige of decency would stand near a pool, watch children topple in one after another, and wring their hands over the dreadfully complicated problem and the need for innumerable committees to contend with it.

We are drowning in copious quantities of poor-quality (even willfully addictive) calories, and labor-saving technologies all too often invented in the absence of need. We have run out of time to see that this is like the other kind of drowning, a clear-cut case of calamitous cause-and-effect, albeit in slower motion, playing out over an extended timeline.

We could fix obesity. It’s hard, because profit and cultural inertia oppose change. But it’s not complicated. (And maybe it isn’t even as hard as we tend to think.)

As we look out at an expanse of bodies sinking beneath the waves of aggressively-marketed junk and pervasive inactivity, wring our hands and contemplate forming more committees — I can’t help but think we’ve gone right off the deep end.

David L. Katz is the founding director, Yale-Griffin Prevention Research Center

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  • buzzkillerjsmith

    Disclaimer: Our host Kevin, who does a wonderful job and to whom we all must be grateful, gives an open forum to all. He does not peer-review the posts.

    If we could fix obesity easily we would have done so by now. Anyone can see the foolishness here.

    Quite simply, this post has no merit. Dr. K., likely a very nice gentleman, is another out-of-touch happyhappyjoyjoy fellow with little knowledge of the real world and of the fundamentally tragic nature of human existence. Ignore him.

    • Daniel

      Dr Katz does distinguish between simple/complex and easy/hard. He points out that fixing the obesity problem is hard (but not complex).

      • Marian Parrott

        I’m not even so sure about that. I only need to lose thirty pounds, but find that at age 59 the pounds will just not come off. I never eat at Mickey D’s. eat chips, donuts, cookies, etc yet I struggle with my weight. My job leaves me little time to exercise but I do manage to get in 30 minutes of cardio most days. So either I am genetically programmed to be this weight at this age ( photos of my late grandmothesr tend to confirm that) or I am missing something.

        • Chiked

          Unless you were a pro athlete, 30 mins of cardio is great. Are you drinking enough water, do you snack at night, how much sleep do you get, stay away from sugar (high fructose foods) foods.

        • adh1729

          Do you cook everything yourself? (Includes making your own ketchup, soup, salad dressing and buying no processed food whatsoever?)
          Do you eat/drink MSG or aspartame in any form? If you eat meat, does it come from factory-farmed animals?

        • Suzi Q 38

          I used to think that too.
          I am 57.
          It took me about a year to lose about 40 pounds.

          I took a hard look about what I put in my mouth.
          I logged every meal onto “My”
          I allowed myself 1500 calories a day, and exercised 45 minutes -hour 5 days a week.

          I skipped or limited foods made with sugar, flour, oil/butter, and salt.

          I brought my tennis shoes to work so that I could walk during lunch. One of my students is from China and he and his wife teach me Tai Chi once a week for stretching.

          I have had my health issues, so I only exercise about 45 minutes a day, 4-5 days a week.

          My grandmother was heavy, too, but it doesn’t mean that I have to be, and neither do you.

          I went from a size 14 or 16 to a size 6 or 8.

          My BP went down, and I no longer have asthma.

          Do you long in your food? This will keep you accountable and you can see the calories, carbs, salts, sugars, etc. that are going into your body with each fat laden meal.

          I quit going out to dinner because I could not control how it was prepared. I save restaurants for the special occasions, once or twice a month. I try to share meals.

          No more processed foods. I try to buy and eat fresh foods.

        • Daniel

          The body needs to use up its glycogen stores before it will start using fat. That happens after about 30 minutes of moderate to intense activity. So if you stop exercising at 30 minutes, you’re stopping just when your body was about to start using fat as fuel.

          • Suzi Q 38

            Are you saying that she needs to up her workout time to an hour a day?
            I say that if that is true, she also needs to look into the food she eats.

          • adh1729

            Intense exercise (“interval training”) is an option to consider seriously. I have been doing it for several months now. Need to work into it slowly and carefully, and stretch.

          • Daniel

            For people who are gaining weight, the first step is to stop gaining weight. Diet and activity levels must balance each other out.

            Once weight is stable, losing weight is a matter of eating less or exercising more (or both). Eating less can leave stores of fat behind. Exercise has that 30 minute barrier at uncomfortable intensity levels.

            While drowning isn’t a very good analogy for obesity, swimming (or water aerobics) is a good exercise solution. It’s easy on the joints. Discomfort is mostly from muscle exhaustion, not temperature regulation issues (sweating). Water provides resistance, which helps increase exercise intensity and maintain muscle mass.

          • Guest

            Controlling diet and exercise will, in principle, work for anyone who wants to maintain or lose weight. However, there are some people for whom it will not work. They likely have metabolic issues that they should see their doctor about.

          • Suzi Q 38

            I just fell over. I agree with everything you said.
            If is a choice of what you want to do or eat at any given moment. Everyone has cravings. I choose to go to bed early with a glass of water instead of eating another meal. Choice.
            I don’t want the government in my business of what i can buy or not buy.

          • M.K. Caloundra

            We recently adopted a senior dog who is overweight and has bad joints, Daniel. Your advice about water exercise is exactly what our vet told me! As a result, El Guapo the Fat Yellow Lab is on a high-protein low-cal diet and does laps with me in the pool every morning. LOL.

      • buzzkillerjsmith

        A distinction without a difference. Common among foolish urbanites.

        • Daniel

          Consider alcohol and tobacco. Quitting either is really simple. (Just stop using the stuff. Or stop buying it so it won’t be around to be used.) But lots of people can’t seem to manage it, for whatever reasons that have to do with the brain’s reward circuitry. There are even programs that involve 11 more steps than are actually required.

          • adh1729

            We have a new generation of children. How will we keep them from becoming addicts? That is really where it’s at.
            I have no cravings for tobacco at all; I have never smoked. Simple.

          • Tim873

            “We have a new generation of children. How will we keep them from becoming addicts?”

            Remove them from their fat parents and raise them in health gulags cum work camps. There are no fat children in North Korea, after all! That should be a teachable moment for us all.

          • adh1729

            I would instead propose that the fat parents wise up and raise their children differently from the way that they themselves were raised.

          • LaurieMann

            It took my Dad about 40 years to finally stop smoking, and I’m very proud that he was finally able to do so. Tobacco is only bad and it’s extremely addictive. The “just stop” is simplistic advice – it’s not easy to “just stop” an addictive drug like nicotine. It’s better that people never start, but as it’s a cash crop in America, and there would be a massive black market if tobacco was made illegal, it’s better to allow it but restrict and tax it. The same should be true of pot, but that’s another argument.

            Light drinkers tend to live longer than non-drinkers or heavy drinkers, so alcohol is NOT “only bad.” But, it can be addictive for some people and deadly in heavy amounts. Alcohol is a huge gray area.

            Food is necessary for life, so it’s mostly good. It’s understanding to eat the right food in the right amounts, combined with exercise. Many skinny people are unhealthy, but they are not automatically assumed to be so. Some fat people are healthy and many live to be quite old, despite the fact they are assumed to be unhealthy.

            I’m a fat person from a long line of fat people and I have high BP & cholesterol, both of which are controlled by better diet, activity and drugs. I walk 2-4 miles a day, sometimes more. I will probably always be fat, but I’m working on being less so.

          • Daniel

            [[ Tobacco is... extremely addictive... "just stop" is simplistic advice - it's not easy to "just stop"... ]]

            That’s the point. Complex is not necessarily hard. Simple is not necessarily easy.

            I smoked before, and quit. Quitting really is as simple as just stopping. The problem for many people isn’t lack of willpower to quit. It’s too much willpower to keep smoking. Smokers have driven extraordinary distances through rain, snow, and hail to pay exorbitant amounts of money for a cigarette.

          • Suzi Q 38

            “I’m a fat person from a long line of fat people and I have high BP & cholesterol, both of which are controlled by better diet, activity and drugs. I walk 2-4 miles a day, sometimes more. I will probably always be fat, but I’m working on being less so.”

            You don’t know that.
            If you were only fed fruits, veggies, and a little chicken or fish everyday, you would be thinner.

            If you add exercise, and it would come off faster.
            Two to four miles a day is great, but if you are eating too many carbs you are not going to lose weight.

            RE-train yourself to eat healthier foods.

            When I lost 40 pounds, my BP and cholesterol improved. My asthma went away entirely.

            How many times a week do you go out to eat?
            Do you eat a little junk food everyday?
            Doing this will “kill” any weight loss program.

          • LaurieMann

            I’ve lost about 50 pounds over 17 years. Last year, I lost and gained 20 pounds (mostly lost due to illness, and gained due to shifting medications, menopause and really craving carbs). I hadn’t had asthma in a long time, but did have trouble this spring. I prefer extremely slow, long term loss. I still enjoy eating, I’m just working on reasonably eating less.

          • Suzi Q 38

            “Food is necessary for life, so it’s mostly good. It’s understanding to eat the right food in the right amounts, combined with exercise. Many skinny people are unhealthy, but they are not automatically assumed to be so. Some fat people are healthy and many live to be quite old, despite the fact they are assumed to be unhealthy.”

            Not all foods are mostly good. You can always point to the “extremes,” the anorexics that appear on TV. I can always point out the documentaries about the “The heaviest people in the world”

            Generally being overweight is not good for you, me or millions of others.

            I was visiting China over a decade ago.
            They as a group are thinner. Why is that?
            Is it all genes? Maybe not. They were taking pictures of the two obese women in our tour group. Rude, yes, but they could not understand why they were so fat.
            I was heavy at the time, and so was my friend. We wanted to ride a rickshaw, and the man pulling us was fairly small and thin. He had to work so hard, that I gave him a huge tip. The guy was sweating up a “storm.” We were just too big for our builds.
            I realized that I needed to do something about it.

            I have a friend that is very thin, but not anorexic. You should have seen what her plate looked like at the potluck gathering.
            She had very small portions of several foods.
            In other words, she controlled not only what she ate, but how much. There was a lot of white plate showing on her meal.

            I came to realize that my genes were not the problem. It was me.
            I had to change.

            I enrolled in a diabetic workshop that involved learning about carbs and other foods.
            The class was 6 hours long. It helped me a great deal.

          • Guest

            “I was visiting China over a decade ago.
            They as a group are thinner. Why is that?”

            China’s gross national income per capita is just $4,940 per annum, and they don’t have food stamps. I imagine that helps.

          • Suzi Q 38

            Good one.
            They don’t have food stamps, so they work for their food and other things.
            If they did have food stamps, they would limit the foods to fresh, inexpensive foods.
            Not the “Buy anything you want, even if it is a rib eye steak mentality.”

          • LaurieMann

            I’d also point out that Chinese people harass fat people. A large friend went there and was not treated well. People do not deserve harassment.

          • Suzi Q 38

            You are right about that.
            I met a new friend on the trip that was about 275 or 300 pounds. It was sad. People were running up to her and taking pictures of her as if she were famous. They could not believe her size.
            The would follow us and take pictures of her rear end. We would have to chase the people away.
            After a few days of this, she sadly would stay on the bus.

          • Tim873

            So we should really just wire fat peoples’ jaws shut, and provide them only a limited-calorie fluid for nutrition. That’s the easy answer. Freedom, shmeedom. Who cares, when there are fat people to ensmallen.

          • Suzi Q 38

            First tax the sodas, next wire the jaws shut or take the innocent children away from their fat parents. What next?

          • Chiked

            “But lots of people can’t seem to manage it, for whatever reasons that have to do with the brain’s reward circuitry”

            Really! Everyone says that but yet when people get locked up in prison and have no access to alcohol and tobacco, they seem to get over it. Hmmm I wonder why. Maybe it’s because it is REALLY SIMPLE.

    • adh1729

      “If we could fix obesity easily we would have done so by now”: we haven’t even tried. “We have not yet begun to fight.” See my post above. I didn’t even get into the issue of artificial food additives that cause obesity, independent of calorie intake.
      We abolished the housewife, got hooked to the processed/fast food/pop industry that loves us so much and cares so much about our health — and we wonder why we have an obesity problem? The power to tax is the power to destroy. We could tax soda pop and fast food into oblivion, if we cared enough.

      • Suzi Q 38

        Another TAX. Ho hum.
        Just what we need.

        I am kidding.

        • adh1729

          we could cut taxes in other ways

          • Suzi Q 38

            How about we not add them at all?
            Every tax measure is deemed important.
            I think that they should have less taxes, not burden us with more.

      • Tim873

        “artificial food additives that cause obesity, independent of calorie intake”

        So if we were to give these magical “artificial food additives that cause obesity, independent of calorie intake” to starving Africans, they’d all get fat regardless of of the fact that they’re barely taking in enough calories to survive?


        • adh1729

          You have the brain of a bull, based on the way that you replied to my (correct) information.
          Dietary glutamate (MSG) intake correlates with obesity, after controlling for calorie intake. That information came from studies done in the Orient; not studies done on starving Africans.
          If you want to reconcile the Oriental study with the fact that people have starved to death in Africa, feel free to use your (hopefully human) brain. I refuse to help an opinionated idi0t.

    • LaurieMann

      That’s not true. We could very easily fix gun deaths – and how’s that been working?

      Fixing obesity is much harder than the author is willing to admit, and drowning is a terribly analogy. It’s a long term problem involving individual behavior, individual genetics, individual activity levels and interactions with society (money, food availability…)

      • Suzi Q 38

        Money?? For what? the fresh veggies at the farmer’s market?
        Veggies and fruits are cheaper than meats.

        • LaurieMann

          My basic problem is fruits & vegetables taste bad to me and carbs taste good. I’m working on this. I do add chick peas to more dishes as I know they’re good for me and they don’t taste bad. Tend to eat more chicken and fish and less meat. Have done the food diary on and off for years.

          • Suzi Q 38

            Yes. Now you are getting what the culprit is.
            Carbs are not forbidden, but they must be limited.
            I used to eat a whole bowl of rice.
            Now, 1/2 cup has to be enough, or not at all.
            Ditto for pasta, noodles or breads. I rarely eat pizza. The carbs, fats, and sodium alone are way to much for one meal.

            In order to truly be committed to losing weight and keeping it off, a food diary is a must.

            It will make you more aware of how much and what you are eating that is destroying your weight loss progress.

            If I have eaten too much (more than 1500 calories per day) and I am hungry, I go to the gym or else I go to bed early.

          • Cyndee Malowitz

            LaurieMann – try to focus on eating 60 grams of protein per day – don’t count calories or carbs. You’ll probably feel too full to consume many carbs or calories. Stay away from high fructose corn syrup – interesting studies on why that substance packs on pounds. Good luck.

        • Kristy Sokoloski

          Fruits and veggies cheaper than meat? Hmm, not around here they aren’t.

          • Suzi Q 38

            I figured out that the best places to go were the ethnic markets, if you have them.
            I used to go to the Farmer’s Market at the swap meet. The swap meet had about 6 different vendors there. I would go later, at about 12:30 or 1:00 PM, so that I could find a close parking space and get the markdown veggies and fruits.

            There is another store in my neighborhood called “the Farmer’s Market.” It is huge. Full of every vegetable and fruit imaginable. I would dare to say that restaurant food buyers would go to a place like this. I bought tiny zucchini, round yellow, and round green squash. They were baby little things, and delicious. 99 cents a pound. The broccoli was 69 cents a pound. There were 2 varieties of green beans (one regular, and long). A huge bag of spinach was $2.99. This bag was 10 times the size of the regular small salad kit bags.

            Most fruits and veggies are cheaper than meats, with the exception of chicken.
            I can find whole chickens for 89 cents a pound.
            I can bake one, and it will last my husband and i 2-3 meals. The first night is chicken breast and veggies, the second night is tacos, the third meal is either chicken soup, chicken salad or a chopped chicken with a little mayo and onions sandwich.

            Here in California we have an abundance of fruits and veggies. We have the 99 Market, which is Asian. We have a long list of latin grocery stores. An arabic family owns the biggest Farmer’s Market in our city.
            I have left Von’s and Ralph’s for these stores long ago. Their vegetables are not only expensive, but they are not as fresh.

          • Kristy Sokoloski

            In my area to buy a mango is $1 a pound. To buy two packages of berries such as strawberries when there is a good deal is 2 for $5. I love the idea of the Farmer’s Markets but it is located in an area that not everyone can access. Also, most of them only take cash. At least this one as of last I heard does. As for the ethnic stores I wish I could say they were cheaper than the supermarket, but my mom and I have found them to be more expensive. If they would lower the prices of fruits and veggies then it would be more accessible. As for chicken being the cheapest meat, hmm, I have seen some packages of it selling at about $4 a pound. That’s not cheap to someone who is on a very tight budget.

          • Tim873

            So you can buy an ENTIRE POUND of chicken for four dollars at your
            (very expensive!) shoppe, but that’s TOO EXPENSIVE, so your
            dole-bludging fatty boom-bahs go buy a QUARTER-POUNDer hamburger for the
            same price?

            Is it ROCKET SCIENCE to point out to these morbidly
            obese welfare queens that they could buy A FULL POUND of chicken even at
            the most expensive shoppes for the same price it would be to buy a
            QUARTER of the same amount of meat at a fast food joint?

          • Suzi Q 38

            I can buy an entire chicken for about $3.00 or $3.50. If I want convenience, I go to Costco and buy one of their fresh roasted chickens for $4.99.
            do you have a Costco in your area?

            Yesterday I bought a miniature watermelon for 50 cents, a bunch of asparagus for 99 cents, a small box of blueberries for 69 cents, and a huge orange for 50 cents. I like to try the fruit before I commit to buying more.
            Sorry your area is so expensive. Do you live in a large city? That may have something to do with it.

          • M.K. Caloundra

            A lot of poor neighborhoods don’t have many fruit & veg stores, that’s for sure. But whether that’s because there’s some conspiracy to deny poor people the health benefits of fruit & veg, or it’s because the residents of those particular neighborhoods aren’t interested in buying fruit and veg, is a good question. If they were as happy to spend their money on fruit and veg as on fast food, you’d think someone would open up fruit and veg stores in all the inner city ghettos and make a fortune, yes?

  • Guest

    If I wanted to drown in liberal Puffington Host bull pucky, I’d be there rather than here. Gah.

  • Guest

    One demographic more prone to obesity than most is female food-stamp recipients. Why don’t you start there, test your “cure” on them, and then get back to us with how it works. It’ll probably work just about as well as gun bans in places like Chicago (i.e. not at all), but you need to test it on a subset before you impose it on an entire nation of over 300 million free citizens. GO!

    • adh1729

      You bring up food stamp recipients. Excellent observation. Let’s have food stamps pay for vegetables, fruits, fish, nuts, skim milk; let’s forbid that food stamps pay for any processed or junk food, sweetened drink, ice cream, margarine, etc. We’ll see how it goes. Lots of fun seeing how the food industry goes crazy while the government deliberates where to draw the line.
      Why should our tax dollars go to subsidize obesity?

      • Suzi Q 38

        I agree.

    • Chiked

      He would but people like you would not even agree to limit soda sizes.

      • Suzi Q 38

        After we agree to limit the soda sizes, then what next??
        A ban on alcoholic beverages and their sizes?
        I don’t think there should be a ban.

        • Chiked

          Sure….and that is why fixing obesity has become complicated. No one wants to do anything. So let’s sit on our big behinds and wait for the problem to go away.

          • Suzi Q 38

            Not really.
            Maybe your behind is big, but mine isn’t by choice.
            I don’t drink sodas, but if I did, I can decide if I want 17 oz or not.
            A stupid law shouldn’t be making the decision for me.
            I would rather my 89 year-old mother saying “no,”
            rather than the mayor.

            People have to “police” themselves rather than the government making decisions for us.

            People choose to put food in their mouths.
            What foods and drinks is up to them.

            THEY are the ones that need to get off their behinds and quit eating calorie laden foods and drinks.

          • birchpoint5

            That is all well and good to say, but then don’t expect society to pay the bill for all the medical complications from obesity. I would guess that you are against the ACA, as am I, but people would take your argument and use it to support us paying for others bad choices.

          • M.K. Caloundra

            “don’t expect society to pay the bill for all the medical complications from obesity” … “paying for others bad choices”

            Any country with socialized healthcare pays for the sinners as well as the saints. AIDS, sexually transmitted diseases, alcohol and other drug related problems, skydiving and other “extreme sports” related injuries, skin cancer in sun-bathers or solarium users, accidents where cyclists weren’t wearing helmets or drivers weren’t wearing seatbelts, pedestrians who walk in front of buses while messing around on their iphones, asthma in children whose parents wouldn’t let them get pets…

            How many “bad choices” are you going to ban in the name of making socialized medicine more fair?

      • Tim873

        Ban soda altogether for food stamp recipients. Once all your bannings have eliminated all obesity in the welfare classes, proving you were right all along, then go ahead and roll it out for everyone else.

        • Chiked

          Please remove your right wing filter.

          • Tim873

            Your ideas are so wonderful though, why don’t you want welfare recipients to get full advantage from them right away? Why do you want them to stay fat. Why do you hate poor people so.

  • Daniel

    Drowning is a poor analogy for obesity. In addition to the time and magnitude issues, each incident of drowning tends to be isolated from the others. However, with obesity, there are many interacting factors. There are activity levels; food intake; food companies making (non) foods that promote obesity; individual variation in metabolism; drugs that alter metabolism; etc. The numerous factors, and their interactions, which contribute to the obesity epidemic, make it complicated, at the society level.

    At the individual level, however, dealing with obesity can be much more direct. One problem is it can require lifestyle changes that many people are not willing to make. (Consider all the wasted gym memberships… And the time wasted hawking for parking…)

    • Suzi Q 38

      I love my gym membership.
      It is nice to have a place to go to exercise when the weather is too hot or too cold.
      I have met a lot of people there, too.

      I met a woman that was 350 pounds when I went for a work out in the pool. She said that she was “stuck” there because the trainers forgot to come back and get her. She couldn’t get out of the pool by herself.

      I told her that she should also try the recumbent bike.
      She gave me so many excuses as to why she didn’t want to do that. A treadmill workout was out of the question.

      I told her that it was great that she came to the gym.
      It beats sitting home by herself and eating junk.

      She agreed.

      I never saw her again.

      • Daniel

        That’s a really sad story.

        • Suzi Q 38

          I would have to agree, except that she told me how her life was.

          Her husband had died, and her daughter wasn’t speaking to her.

          She slowly packed on the pounds.

          One day, she couldn’t walk very far without being in a lot of pain.

          She kept junk food in her house.
          The junk food tasted good, and she admitted that she made a habit of eating desserts and sweets everyday.

          She made me realize that one of the ways to make a fat person thin is to love h/her.

          Even if it does not envolve another person.
          Maybe she just needs to love herself.

  • DavidBehar

    From Yale.

    Worthless, left wing, hate America propaganda until proven otherwise. Most evil ideas have come from Europe, and Yale University has been their vector to infect his country, including his call for tyrannical government control. I supported its audit by the Feds, and would go further to ban it from any public funding.

    Yale was founded by Harvard dissidents who thought Harvard was not pious enough. They have had their moral superiority since the 1700′s. This article is no exception.

    • RenegadeRN

      Wow! Hate much? I fail to see how your diatribe contributed to this topic.

  • ValPas

    What a great analogy! Drowning in water is like a slow drowning in excess calories and lassitude. Your oxygen intake is insufficient to fuel your body. You can’t move your muscles well enough to get out of the dire situation, etc., etc. And the poor are the worst victims, because they seem to have less access to healthy sources of food and exercise. Certainly, some of that behavior is a matter of choice, but so is drug addiction, and we try to control that!

  • Fred Ickenham

    Analogies for easily understood problems are invoked when the argument is too weak to swim on its own……voila! this drowning analogy.
    The ACA makes “providers” responsible/accountable for patient behavior. Doing so requires a certain suspension of disbelief, against all lifelong evidence. This is just one of the glaring weaknesses of its strategy. Since its designers are certaintly bright enough to see these
    critical vulnerabilities, and have included them, it appears to merely be a doomed interim step on the way to Single Payor. If we do this, we need to do it the way Germany, the Swiss etc have done so, with regard to tort changes, and limits on insurance company profiteering, or it too will fail.

  • sparklingsoul

    I attended a lecture on obesity and carbohydrate intake at Stanford six months ago. The panel included an obesity researcher and a famous food writer. I asked, “What is the difference in caloric intake between obese and non-obese people?” They answered, quite defensively, that no one knows, because it would be very hard to run a clinical trial that could control for all the other variables. The accused me of being judgemental of overweight people.

    If an obesity researcher/expert at STANFORD can not even answer this basic question about caloric intake, then what are all the obesity researchers doing with their time and money??? We should know at this point whether heavy people and thin people consume the same number of calories or not. Without this information, we cannot move forward in this debate.

    • Suzi Q 38

      I agree. God forbid we make individuals accountable for their own eating habits and choices.
      I have to take a break now. I am going to “down” an 18 oz. glass of Coke, with ice. Is that allowed? After all, I have celebrated my 18TH birthday a few decades ago.
      My son, who lives in NYC and is a democrat, is not here to chastise or “police” me. He graduated from Berkeley, along with his sister. They get after me needlessly for this and other things that I still have the right to do.

      Pretty soon you know I won’t have to make any decisions.

      Also, the mayor of NYC s not here to charge me the extra tax for my poor decision.

      Excuse me while I take a break…..mmmm nothing like the fizz of Coke.

      • M.K. Caloundra

        I will join you in your break, Suzi. I don’t like fizzy drinks, but I’m about to run over to Starbucks for my summer favorite, an Iced White Chocolate Mocha (Venti): 20 sinful ounces, 610 calories, 220 of them from fat, containing a lovely 80g of sugar. Mmmmmm! Cheers ;-)

  • sparklingsoul

    Whatever the reason for overeating, people’s appetites are working against them. Research into safe appetite depressants is obviously something that would benefit many, many people.

    • Kristy Sokoloski

      Yes, but then after a time like happens in many cases the body will become used to being on the medication and then the medication will stop working for them. What then?

  • Dorothygreen

    Some folks, including myself, have left the obesity related analogies and the AGMs (attention getting mechanisms -sin tax, nanny state ) about government “doing something” in the dust of our exercise. The studies are in, pounds are still being added, diabetes is still increasing etc. There are volunteer and community efforts throughout the country trying to make change. They need help. It’s time for the “wee folk” aka ” we the people” to act collectively: vegans and Paleos, anyone who respects their bodies and doesn’t want income taxes raised to pay for the care of those who become addicted to sugar, fat and salt.

    The Academic world, the Medical Industrial Complex as well as Big Ag and Big Food will continue to profit without action – more kinds of sugary cereal, smaller bottles coke at greater cost, more studies, more bariatric surgery, more drugs. More ways to keep the status quo.

    I agree the fix is not so hard. We have two well tested models, one to reform our eating culture, and the other to reform our health care.

    For our health care – the Swiss system – this is different from a single payer which is not a fit for the US. We have some of its elements in the ACA. But the mandate on employers to pay for health premiums hurts everyone. We can have insurance, but for profit for essential service must be outlawed,. One major difference between the Swiss population adn the US is our obesity rate – 9% compared to 34%. So, in order for any health care model to work we must reform our eating culture.

    For our eating culture it is the tobacco model. It worked. Take this model to the beginning – the farm bill – subsidize vegetables instead of Big Ag products, limit what can be purchased with food stamps, good jobs in small farms – through an excise tax on sugar, refined grains, heat and chemical processed oils, added sodium (call it RISK, after all they are the greatest risk factors for chronic disease- greater than tobacco smoking) – and with the money to educate, educate, educate. The excise tax would probably pay for Medicaid if the proposed increase in tobacco tax could pay for head start.

    It is good that you all got up and exercised together in your conference, Dr Katz, but it doesn’t sound like you discussed anything that comes close to what could save people’s lives from unhealthy food addiction and from the middle drowning in unsustainable health care costs – it’s not just Medicare and it is certainly now a global issue because the US is exporting its SAD.

    After you said “obesity is easy to fix”, you say “It’s hard, because profit and cultural inertia oppose change”. So, does this prevent you from going beyond the discussion and developing a plan to fix our health care and our eating culture? I have just offered a plan. I can even expand it with details. Take this to your committee. Folks in the comment section have offered suggestions consistent with this plan. Our President tells us if we don’t move our Congressional representations off their comfy corporate padded duffs, nothing will change. We need doctors like you who will not just say it is because of profit that it is hard to fix but who will champion a revolution and push back hard against the Bigs.

    • Kristy Sokoloski

      You can limit as much as you want when it comes to purchasing with food stamps all you want, but that is not going to stop the people from eating things that are not healthy. They will find a way to continue to get those things no matter what. Just like with the issue of tobacco. No matter what it costs you will still continue to have people that will find a way to continue smoking even though it’s very bad as well. Also, a lot of people in this country will not agree to pay more in taxes on anything period. That’s why what Mayor Bloomberg tried to do with the ban there in NYC when it came to the size of sodas did not get passed in to law. He of course appealed and we’ll see what the outcome shall be.

      • M.K. Caloundra

        Sin taxes are very regressive: they hurt those on low incomes much more than they do those who are better off.

        If sin taxes worked the way they were meant to (i.e. the more something hurts you financially, the less likely you’ll be to do it), then low-income Americans would be the LEAST likely to smoke cigarettes. Instead, they smoke at a greater rate than high-income Americans. And sin taxes mean that they, out of their paltry incomes, are giving money to the government that they could be spending on other things to their own benefit. Every dollar the State takes away from a poor person in sin tax, it spends 60-70 cents of that dollar collecting, processing and redistributing it, and then puts maybe 30 cents into the kitty to care for… poor people. The same poor people they just stole a dollar off. Churn like this benefits only the already well-off bureaucrats, at the expense of the less fortunate.

    • M.K. Caloundra

      Sin taxes on “bad” foods don’t work. The Danes just repealed theirs.


      “The suggestions to tax foods for public health reasons are misguided at best and may be counterproductive at worst. Not only do such taxes not work, especially when they choose the wrong foods to tax, they can become expensive liabilities for the businesses forced to become tax collectors on the government’s behalf.”

      So declared the government of Denmark in announcing that it was repealing its year-old tax on fatty foods.

      The law didn’t reduce fat consumption. “Since the introduction of the new tax the demand for butter has risen,” Lars Aarup, head of analysis for the Danish retail chain FDB, told the Journal. And Danes are not eating less cheese, just lower-quality varieties.

      The law did, however, reduce employment. The Journal reports…

      [ "Danes Say “Cheese” as Fat Tax Is Repealed" for full article]

  • Lara

    Itsa great piece and I like the analogy to drowning, but I disagree- I
    think it’s very complicated, mostly because education programs, even the
    most intensive, so far seem to be ineffective. The reality is that classes about how to eat are not necessarily analogous to swimming
    lessons and in fact, eating is not analogous to swimming. We need to
    eat to live and and we have all of the history of the human evolution working against us- we are made to gain weight, not loose it. We don’t
    need to swim to live (at least most of us don’t) and we are not
    evolutionarily programmed to drown. So in a society filled with
    immediate access to extremely low cost, highly processed, high sugar,
    high fat foods, and sedentary lifestyle, lessons in eating well seem not
    to be enough to change the trajectory for most people. That’s not to
    say we shouldn’t try and I think the author makes an excellent argument for the work that I do, which is teach parents of young children about the
    importance of instilling healthy habits early.

  • Lynda Schwemmer

    It seems to me that the analogy fails a bit when you realize that you are assuming that education will cause people to give up foods they enjoy for foods they may enjoy less, which can need more effort to prepare and may cost more. Drowning in calories is fun–to a point. Drowning in water? Not so much.

  • usvietnamvet

    Yes there are “simple” answers to a majority of obesity but there are people who have MEDICAL conditions for them losing weight is complex. The under treatment of pain issues in this country is another reason for obesity. I know. I have TOS, RSD, CPS and other painful conditions related to my military service. When my pain is treated adequately my wight goes down because I can move. When it’s not my weight goes up in spite of my not eating junk. I’ve been put in the hospital to reduce my weight and all the “starving” did was screw up my metabolism more then it already was. I gained almost 40 lbs under these “experts”. 40 lbs that took me moths to get rid of. I never had a problem with my weight until after my injury in the military. I was athletic when I was younger. Competitive swimming, running, hurdles, parachuting, climbing mountains. lifting weights, etc. I finally got treatment for my pain issues and was losing weight UNTIL the VAMC system decided to lower my pain meds by 50%. Now my weight is a constant struggle. And many of the medications they replaced my pain meds with cause weight gain. Many of us are damned if we do and damned if we don’t. . I hate when people just assume you’re heavy because you’re a pig. And with companies putting more and more junk in our food (the milk industry wants to put aspartame in our milk and not label it!. One has to wonder why especially since many people are allergic to aspartame) The unhealthy foods that surround us is astounding and yet our government refuses to LABEL things. We grow an extensive garden every year so that I have access to healthy non GMO foods. We also can and freeze. I eat very limited meats (again only eating Kosher butchered meat with no antibiotics). One has to wonder why our government doesn’t want to pass good labeling laws and they must take some of the blame for the obesity in this country. Also what happened to the physical eduction programs in schools? We need to lengthen the school day and add 2 hours of phys ed. There are solutions but I don’t think they are simple.

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