Investigation  

How Fat Are We?

by Randal O'Toole

America's obesity "crisis" is not the result of fast food, but of fast and loose manipulation of evidence.

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A few years ago, at a Liberty editors' conference, Bill Bradford asked, "Now that the tobacco case is just about settled, what will lawyers and left-wing activists demonize next?" Several people guessed fattening food; I suggested instead, automobiles.

Soon after, Al Gore declared war on sprawl and the automobile. A Sierra Club lawsuit stopped all highway construction in Atlanta and Congress passed legislation that gives more funding to mass transit systems that carry less than 2% of American travel than to highway systems that carry nearly 90%.

Yet the war on fattening foods was not far behind. Recent announcements by the surgeon general and Centers for Disease Control and Prevention have proclaimed an "obesity epidemic." Nutritional activists urge people to sue fast-food restaurants and food manufacturers for making them fat. At least one such lawsuit has already been filed. They also want government to regulate food advertising aimed at children, tax high-calorie foods, and subsidize nutritious low-calorie foods.

The anti-fat and anti-automobile campaigns have even converged. Anti-auto and anti-suburb urban planners claim that suburbs and automobiles are a public health menace because they encourage people to get fat rather than exercise. They recommend a dose of high-density housing and auto-free downtowns. Yet the data show that inner-city residents tend to be more obese than those in the suburbs.

In fact, there are no clear data showing that there is an obesity epidemic at all. The only evidence for it is unverified telephone surveys whose results differ from actual measurements of American weights.

The basic source for the claim that there is an obesity epidemic is an annual CDC survey indicating that the share of Americans who are obese has increased from 12% in 1991 to more than 19% in 2000. The CDC defines "obese" as having a body-mass index (BMI) of 30 or more. "Overweight" is a body-mass index of 25 or more. BMI for adults is calculated by dividing a person's weight in kilograms by the square of their height in meters. For those who are not yet metricized, multiply your weight in pounds by 703 and divide by the square of your height in inches.

Without naming any names, if you are a balding researcher who is 5 feet 7 inches tall and weighs 159 pounds, your BMI is a marginally satisfactory 24.9. However, if you creep up to 160 pounds, you fall into the overweight category with a BMI of 25.1. Sadly, this means that our hypothetical researcher probably shouldn't have the Valrhona chocolate mousse that everyone else is enjoying for dessert tonight.

Some people have questioned the CDC's method of measuring obesity, pointing out that by CDC definitions, most NFL football players would be considered obese. While it is true that the body-mass index fails to measure fat vs. other kinds of body materials, there are even more significant sources of error in the CDC's surveys.

If you believe the CDC surveys, breakdowns of obesity levels by state show some rather alarming trends. In my home state of Oregon, for example, less than 15% of adults were considered obese in 1995, but by 2000 more than 20% were obese.

Some states are even worse: Georgia's obesity rates more than doubled between 1991 and 1999, from less than 10% to more than 20%. Obesity increased in every state during that time period, with the greatest increases in the South and Midwest. Surgeon General David Satcher has called the obesity epidemic a "crisis" because obesity supposedly kills 325,000 Americans a year and adds $117 billion to annual health care costs.

What happened between 1990 and 2000 that would explain this sudden ballooning of the American public? The popular explanation is that people are eating fattier foods and exercising less. However, I can think of three other explanations that make more sense.

First, the explanation for just about every demographic trend in modern America: baby boomers. Perhaps they got older, exercised less, but kept eating. The problem with this is that the CDC claims that the most fattened adult age class is 19- to 29-year-olds and that children are also getting fatter.

A second explanation for increased obesity rates can be found in the declining unemployment and rising incomes of the 1990s. As Paul Fussell observes in his 1983 book, "Class," obesity is in large part a class phenomenon. One hundred years ago, it was fashionable among the wealthy to have a paunch, and men's clothes were even designed to emphasize one. This is what led to the popular notion of wealthy people as "fat cats."

Today, of course, the middle and upper classes prefer to be fashionably thin, but working class people tend to be overweight. CDC researchers agree that "lower economic status . . . is associated with obesity." Just as weight indicated wealth a century ago, it indicates security today. Perhaps the booming '90s saw unemployment rates at near-record lows, enabling more people to earn enough money to feed their families enough to become overweight, without acquiring the upper-class aversion to fat.

A close look at the obesity statistics supports this notion. According to CDC data, obesity is growing fastest among Hispanics. CDC data also indicate that the most obese children are African-American girls, 17% of whom are overweight compared to less than 12% of other groups. A study from the New Jersey University of Medicine finds that 22% of Hispanic and black children are likely to be overweight compared with only 12% of non-Hispanic white children.

If there is an obesity epidemic, then, it may merely reflect a healthy economy that has provided enough jobs to bring low-income people out of poverty and into obesity. If so, then one sure cure for the epidemic would be a good, long recession. Policies aimed at such a recession would make as much sense as trying to cure congestion by stopping new highway construction and putting barriers in existing roads — which, of course, are the policies recommended by anti-sprawl forces.

The best explanation is that the numbers are simply wrong. They are based on a random telephone survey of people's heights and weights done by state health officials and coordinated by the CDC. Only 21 states participated in the survey in 1985. By 1990, all but five (mostly thinly populated) states reported in, and all joined by 1994.

How accurate is a telephone survey? Without naming any specific genders, a lot of people I know won't even tell their husbands how much they weigh, much less a complete stranger calling on the phone. At the same time, people of a completely different gender tend to overstate their height. (Our hypothetical researcher would like everyone to know that he is really 5 feet, 7.5 inches tall, but modestly used 5 foot 7 for the purposes of this article.)

Because so many people understate their weight or overstate their height, CDC researchers assume that actual obesity rates are much higher than are revealed by their telephone surveys. Indeed, they point out that real measurements of large numbers of Americans reveal much higher rates of obesity — 22% — than any of the telephone surveys, which so far have never recorded rates as high as 20%.

Thus, the obesity epidemic may really be a truthfulness epidemic. Perhaps interviewers in recent years prodded interviewees a bit harder to get more accurate results. Or perhaps people are more willing to admit they are overweight because so many popular writers blame obesity on McDonalds, Coca-Cola, Frito-Lay, and other food makers rather than the overweight people themselves.

Stephen Milloy, who publishes the junkscience.com website, calls these numbers "unadulterated junk science" since the data collected by telephone were never verified. Milloy suggests that reports of a fat epidemic are coming from bureaucrats and academic researchers who simply want to expand their budgets and power.

I downloaded data from the ominously named Behavioral Risk Factors Surveillance System, the annual poll that the Centers for Disease Control claims is "the world's largest telephone survey." The CDC and state public health agencies contact close to 200,000 people a year and ask them hundreds of nosy questions about their health and opinions.

The CDC brags that the survey has had major influences on public policy. For example, it says, the survey's finding that most people think second-hand smoke is dangerous convinced the Oregon legislature to ban workplace smoking. Whether second-hand smoke really is dangerous seems to be beside the point.

Using the downloaded data for 2000, I compared BMI with income, education, and race. The average BMI of all the people surveyed (at least, all those who gave their weights and heights) was 26.4, and 20.4% of them were obese. The first table confirms that BMI is strongly correlated with household income: the lower the income, the higher the BMI and the higher the obesity rate.

Household Income	Average BMI	Percent Obese
<10,000	27.3	27.5%
10,000–14,999	27.2	25.7%
15,000–19,999	26.8	24.0%
20,000–24,999	26.7	23.1%
25,000–34,999	26.5	21.1%
35,000–49,999	26.5	20.8%
50,000–74,999	26.3	18.6%
75,000+	25.7	15.1%

BMI is also correlated with education: the lower the education, the higher the BMI and the higher the obesity rate. The only exception is the category of people with no education. This is probably heavily stocked with recent immigrants, as 38% of this category is Hispanic compared with 8% of the total.

Education	Average BMI	Percent Obese
None	27.4	25.2%
Grade 1–8	27.6	28.3%
Grade 9–11	27.2	26.2%
Grade 12	26.7	22.3%
College 1–3	26.4	20.6%
College grad	25.7	15.4%

Asians (including Pacific islanders) have the lowest BMIs, followed by non-Hispanic whites, Hispanics, Native Americans, and blacks. "Other" is somewhere in the middle.

Race	Average BMI	Percent Obese
Black	28.2	31.6%
Native American	27.8	29.1%
Hispanic	26.9	22.7%
Other	26.8	22.6%
Non-Hispanic White	26.2	19.2%
Asian-Pacific	24.3	8.3%

BMI is also correlated with age: BMIs and obesity rates peak in the 50–59 age category and fall with decreasing and increasing age away from that category. This tends to support the baby boomer hypothesis.

Age	Average BMI	Obesity Rate
<30	25.0	14.3%
30–39	26.4	20.0%
40–49	26.8	22.6%
50–59	27.4	25.5%
60–69	27.2	24.3%
70+	25.8	16.0%

Stephen Milloy cites an editorial from The New England Journal of Medicine questioning the surgeon general's claims that obesity causes 325,000 deaths or more per year — and, by implication, the claim that the health costs of obesity are more than $100 billion per year. "That figure is by no means well established," says the Journal, adding, "Most of the evidence is either indirect or derived from [studies with] serious methodological flaws."

More than one recent study has found that weight is less important to health as you get older. Our hypothetical researcher, whose 50th birthday is imminent, will be reassured to know, for example, that people over 50 can have BMIs as high as 32 and not suffer any greater mortality than people with BMIs under 25. Researchers add that, unless such people have heart disease, diabetes, or some other obesity-related disease, asking them to diet "might unjustifiably decrease their perceived quality of life."

CDC and other nutritional researchers have a strong incentive to claim that we are suffering from an obesity epidemic, for such claims are likely to lead Congress to direct more research and other funds to them. Yet these claims are hardly new. "Overweight is so common that it constitutes a national health problem of the first order," said the Metropolitan Life Insurance Company in 1942. In 1952, the director of the National Institutes of Health declared that obesity was the nation's primary health problem.

Yet it remains true that some Americans are obese and that severe obesity is associated with heart disease, diabetes, and other health problems. To what extent do the suburbs cause that obesity?

The detailed data suggest that, if anything, people living in cities are more obese than than those living in suburbs. While many minorities are moving to the suburbs, Hispanics and blacks remain concentrated in cities and the suburbs remain heavily white. It appears that location tends to be less important than income.

A report from an anti-auto group SprawlWatch insists that the "built environment" contributes to obesity because it encourages auto driving rather than walking or cycling. But another finding of the CDC telephone survey is that the amount of physical activity Americans undertake has not changed substantially in the last decade.

In fact, says another report, "the activity levels of Americans appear to have changed little, if at all, from the 1970s to the 1990s." This indicates that increased driving and the built environment have nothing to do with any recent changes in obesity rates.

Despite this finding, the report's authors recommend that "cities, zoning authorities, and urban planners" should "modify zoning requirements, designate downtown areas as pedestrian malls and automobile-free zones, and modify residential neighborhoods, workplaces, and shopping centers to promote physical activity." Among the other recommendations are to "Designate an annual National 'No-TV' Week," restrict advertising of high-calorie foods on children's television, tax high-calorie or high-fat foods, and subsidize low-calorie nutritious foods.

These and 26 other recommendations are made with absolutely no assessment of their efficacy. Before elected officials and government bureaucrats start implementing such policies, they should find out whether they will work or whether they will do more harm than good.

Anti-sprawl activists are also quick to note that children today are less likely to walk to school and more likely to have their parents drive them. But this isn't a suburban phenomenon either. Before 1980, 80% of American schoolchildren walked to school. By 1990, less than a third did.

Yet 57% of American families didn't move to the suburbs during the 1980s. Instead, something else must explain this change.

The answer seems to be milk cartons — specifically, the "missing children" campaign that crested in the 1980s. This media-generated panic turned out to be phony — the vast majority of the "kidnapped" children had been taken by one of their family members in a custody dispute. Yet CDC Dr. William Dietz believes that "parental fear about kidnapping" is one of the major reasons why children today get less exercise than they did 20 years ago.

Eric Schlosser, author of "Fast Food Nation," has a different take on sprawl and obesity. He argues that fast-food restaurants such as McDonalds were "a catalyst" to sprawl. And he also blames those fast-food restaurants for the obesity epidemic, claiming that the price paid for fast food fails to account for the "real price" of the meal, mainly the social cost of obesity.

Schlosser's view is underscored by George Washington University law professor John Banzhaf, who takes credit for helping "come up with the idea of suing tobacco companies as a way of shifting the cost of smoking from the nonsmokers to the smokers." Now he argues that the oft-cited $100 billion cost of obesity is partly paid "by people who maintain a healthy weight in the form of higher taxes and health insurance." Banzhaf is urging people to sue food companies for imposing those costs on society.

This is a difficult case for lawyers to make because, in contrast to smoking, fatty foods produce no "second-hand fat." It will be hard to prove that a particular food contributed to obesity, that obesity caused a particular health problem, and that that health problem imposes costs on people who don't suffer from it. And if seriously obese people do in fact die younger than thinner people, it is possible that the health costs they impose on society are actually lower, not higher, than average.

So some nutritionists go beyond Banzhaf and advocate suing food companies just for selling people fatty foods. The ironically named Marion Nestle, a nutrition professor at New York University and author of the forthcoming book, "Food Politics: How the Food Industry Manipulates What We Eat to the Detriment of Our Health," observes that "The function of the food industry is to get people to eat more, not less."

"There's a lot of people who benefit from people being fat and sick," Nestle claims elsewhere. "So the response to the food industry should be very similar to what happened with the tobacco companies," meaning that food companies should be sued for making people fat.

This is a common theme of the anti-corporate, pro-government movement: people are so easily manipulated by advertising that they need government regulation to protect them from things they shouldn't do. Anti-fat activists argue, for example, that vending machines should be banned from schools so that students aren't given the opportunity to buy junk food.

Indeed, many food activists want to demonize fatty foods just as tobacco has been demonized. "I want to get to the point where people are in the hallway and see a vending machine and say, 'That's bad, that shouldn't be there,' in the same way as if they saw a cigarette vending machine," says Tom Farley of the Tulane University School of Public Health and Tropical Medicine.

In fact, Newsday columnist Meredith Berkman recently filed one of the first anti-fat lawsuits against the manufacturer of a snack food called Pirate's Booty. In December, 2001, the Good Housekeeping Institute tested Pirate's Booty, which is basically flavored puffed rice, and found that it contained three times as much fat as the label stated. The manufacturer, Robert's American Gourmet Foods, blamed the problem on a change in its manufacturing process and immediately recalled the product from store shelves.

Nearly four months after the recall, Berkman filed a $50 million class-action lawsuit against Robert's Foods, claiming "emotional distress" and nutritional damage because she had fed Pirate's Booty to her daughter. The complaint claims to represent all consumers who ruined their diets and had to spend more time at the gym because they ate mislabeled Pirate's Booty.

Of course, manufacturers should not mislabel the nutritional content of packaged foods. But in a broader general sense, can McDonalds hamburgers, Hostess Twinkies, and Ben and Jerry's ice cream be blamed for making people fat?

Frank Zappa once promised, "there will come a time when you won't even be ashamed if you are fat." If the left has its way, we will reach that time not because we no longer find fat to be aesthetically repugnant but because we can blame fat on giant corporations instead of ourselves.

Michael Pollan takes a different attitude in his recent book, "Botany of Desire." Pollan is no friend to the food industry and makes it clear that he opposes, for example, genetically manipulated foods. He also notes that refined sugar is a recent phenomenon: a little more than a century ago, few people could afford most sweets.

But he tries to imagine what it was like the first time in prehistory that someone tasted honey or some other sugar. The closest he can come is to recall his 1-year-old son's reaction when he tasted his birthday cake; the first time he was treated to a sweet. A look of wonderment came over his face, as if to say, "Why didn't you tell me there was something like this in the world? I am going to dedicate the rest of my life to getting more of it." And, Pollan notes, "he pretty much has."

Pollan's son was too young to be manipulated by advertising or the food industry. The lesson is that diet and physical activity are matters of self-discipline (or, in the case of children, parental discipline). Fast-food restaurants and other parts of the food industry sell things that people want, and the industry is subject to enormous selection pressures filtering out things that people don't want. The health-food and weight-loss segments of the industry are each multi-billion dollar industries in their own right.

To the extent that it is a real problem, obesity is a personal problem, not a social problem. Lawsuits won't solve it, nor will taxes on fat, subsidies to low-fat foods, censorship of advertising, or restrictions on auto driving. The government should stay out of our kitchens, supermarkets, and restaurants.

© Copyright 2008, Liberty Foundation

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