Focusing on Weight May Be Hazardous to Your Health

This summer there was much rejoicing in the public health community over the recently announced falling obesity rate among preschoolers in many states, the first time in decades the rate has gone down.

“Although obesity remains epidemic, the tide has begun to turn for some kids in some states,” said Thomas Frieden, director of the Centers for Disease Control and Prevention (CDC), which had released the data. “While the changes are small, for the first time in a generation, they are going in the right direction.”

But for Paul Campos, a University of Colorado at Boulder law professor, concerns about obesity have been headed in the wrong direction for generations.

Campos, the author of the controversial 2004 book The Obesity Myth: Why America’s Obsession with Weight Is Hazardous to Your Health, has been a vocal critic of what he considers a self-defeating war on fat that has no basis in science and can have devastating consequences for women.

Campos argues that the health risks of obesity have been exaggerated by medical and public health professionals and the $50 billion a year weight-loss industry. Against a cacophony of voices calling attention to weight—from the CDC to First Lady Michelle Obama—he concludes that the health risks associated with body fat have been overblown, save for a small minority of people who are at the extremes of body weight.

Studies support the idea, says Campos, that a moderately active, moderately overweight person is likely to be healthier than someone who is thin but sedentary. He sees cardiovascular and metabolic fitness as more significant keys to health than a person’s body mass index (BMI).

Even if obesity carries risks, Campos argues, the solution is not to try to make fat people thin. In his view, the cycle of short-term weight loss, usually followed by weight regain, poses potentially serious health risks.

On Thursday, Campos will bring his critique of America’s obsession with weight to the School of Public Health, where he will deliver the 2013 William J. Bicknell Lecture. The lecture, titled The Obesity Epidemic: Is Focusing on Weight Hazardous to the Public’s Health? is free and open to the public and will be followed by a panel discussion on obesity that includes Frank Hu, a Harvard School of Public Health professor of nutrition and epidemiology, and Abigail Saguy, a UCLA associate professor of sociology and gender studies and author of What’s Wrong with Fat?

BU Today spoke with Campos about the hazards of fighting the war on weight.

BU Today: What was your reaction to the CDC’s childhood obesity findings?

Campos: Like most of these reports that come out about weight, I think it’s important to contextualize. Obesity among preschoolers, as an indicator, was just invented a few years ago by the CDC—not based in science, but just an arbitrary definition. Basically, they took the 95th percentile of the height-weight chart from the 1960s and 1970s and treated that as a definition of childhood obesity. So it’s kind of a made-up definition. And I have trouble seeing a decline in a made-up definition as a big deal.

In terms of context, rates of obesity and overweight have flattened out or declined all over the world. Much of the alarmism about obesity is based on projections that people were just going to get fatter and fatter, and it appears from the data over the last 10 to 12 years that this has just stopped. The alarmism in many ways has never been based on a sound scientific analysis, but on classic moral panic, in the sociological sense.

Where is that moral panic coming from?

There are several factors. One is a very straightforward economic one—there’s an enormous weight-loss industry in the United States. I don’t think most of this is really conscious at all—people’s economic interests just dovetail with beliefs. We have a very strong aesthetic preference for thinness in this society, and this gets medicalized. It becomes a sign of moral quality, essentially.

Another factor is that we have, in many ways, an eating-disordered culture in this country. Anorexia nervosa is rampant. If you look at the normal representation of a female body, it’s in the second percentile. That just feeds into this tremendous anxiety about weight.

There’s also a generalized anxiety about overconsumption, especially among the upper classes. Look at the popularity of the TV shows about hoarding—there’s a fascination with people consuming too much.

So there’s a social class element to this?

Absolutely. Obesity in our culture has become a marker for lower class status. This is something that makes people in higher economic status nervous. We think—who are these overweight people? Well, they’re people of color who are shopping at Walmart—and since we have a culture with a lot of downward mobility at present, that anxiety gets fueled by weight. It’s tied up with a lot of discriminatory beliefs and actions.

With women particularly, you have to get to extreme emaciation before you evoke a similar kind of revulsion from mainstream culture. Fatness is considered a respectable reason for scorn. We have this very stigmatizing culture surrounding weight.

If it’s so ingrained in our thinking, how do we fix it?

Well, first we have to give up on this phony notion that we somehow know how to make fat people thin. We don’t. Every discussion of this subject should start with an acknowledgment that we don’t know how to turn fat people into thin people.

I’m all for encouraging people of all sizes to be active and avoid eating-disordered behavior. Physical activity and nutrition are good things. What I’m not for is stigmatizing people and haranguing them about their weight. It doesn’t make them thinner, and it doesn’t make them healthier.

It’s like that old aphorism that defines insanity: Doing the same thing over and over again and expecting different results. That’s where we are with weight in this culture.

You are by training a law professor, not a health expert. What do you say to critics arguing that you lack the expertise to weigh in on weight?

I think what we’re talking about, when we talk about obesity, is a cultural phenomenon. That is, to refer to it as a health issue is already to engage in a kind of question-begging.

What academics from a whole bunch of disciplines have been criticizing is the idea of obesity and overweight, as it’s being defined, as a health issue. There’s a kind of language issue at the core of this. Obesity is a word that, by its very definition, pathologizes higher weight. Higher-than-average weight is being framed as a disease state. If the people who were authorized to speak on this are pathologizing weight to begin with, we have to ask: Should this be framed that way? I think it’s valuable to have people from a variety of disciplines talking about this issue. This is something that has many facets, health being one of them.

Health experts have criticized you for downplaying a serious public health problem. Why hasn’t your point of view gotten more traction?

Actually, there’s quite a vigorous debate within the health community on the question of how much is weight a causal factor in terms of health risk.

There are people who have criticized my work, but others who have been supportive of it. I think people mischaracterize what I say about the issue. I’m not saying obesity can’t pose a health risk for some people; it certainly can. I’m saying the cures that are being proposed are sometimes worse than the disease.

If the problem is that overweight people are more prone to disease than thin people, it does not mean the solution is to make people thinner. That can make the health consequences worse. There’s a debate right now because some people in the health community are beginning to grapple with the sort of crude and overly simplistic model that says, “If A has bad effects, then what we should be doing is getting rid of A.” It’s so much more complicated than that.

The 2013 William J. Bicknell Lecture in Public Health is Thursday, October 24, from 10 a.m. to noon at the School of Public Health Bakst Auditorium, 72 East Concord St. It is free and open to the public. The lectureship is named in honor of the late William J. Bicknell, founder and chair emeritus of the SPH international health department.

Lisa Chedekel can be reached at chedekel@bu.edu.