April 19, 2010

Marc Ambinder would like you to conceptualize obesity as social inequity.

"Think of a kid. A working class kid. Maybe he's black or Hispanic, or pale while."

Pale while... what? Pale while being white, I presume.

"She or he is standing inside a very dark room, so you can't seem [sic] her or him. Then she walks out the door. Suddenly, cymbals start to crash and the child becomes afraid and experiences stress; an unending inner monologue begins urging the kid to 'eat, eat, eat'; think of arrows sending pulses to the child's brain insisting that they consume more and more; think of a table of food in front of the kid, who has a few bucks to spend and can only buy the cheapest stuff; this new room is also a 360-degree high definition media experience, with television commercials tempting the kid by linking toys to the food on the table; think about the parents... where are the parents? They're at work; both of them; two incomes are needed to maintain a standard of living. Think of self-hatred and self-reinforcing stigma. The kid lives 24/7 outside the dark room, and grows up. Unless his or her genetic code has a lucky guanine where others have an adenine, there's a good chance — soon to be a better than even chance — that the kid will be fat or obese by the time he or she is in the second decade of life."

Ambinder is making an argument. It's an argument about the unfairness of obesity, an argument designed to justify new government policies and spending. Ambinder is disconnecting obesity from individual responsibility and tying it to race and disparities in wealth. After the quoted material above, he declares that "the social inequity is apparent." But where did that quoted material come from? His fervid brain? Ambinder is not being scientific. He's operating in a literary mode. Who is this kid, this he or she, in this abstract place in the world, this "very dark room"? He or she is an empty vessel, defenselessly filling up with information that pours in — from where? Ambinder is fumbling with the tools of the literary author. But he's no Charles Dickens. His literary character isn't a David Copperfield, but a nonentity, scarcely recognizable as human. Yet Ambinder calls upon us to identify or empathize with him. Or her. The methods and explanations of science and good journalism are needed, but Ambinder doesn't bother.

Meanwhile, the solution he found for his own obesity was bariatric surgery. Abdominal surgery fits snugly with the idea of obesity as the result of social and economic forces playing upon helpless humans (though Ambinder himself was not economically deprived in life). In calling us to make obesity the government's business, Ambinder says "It will involve some money, but not all that much." But do you feel confident that the government will not force insurance companies to cover bariatric surgery and spread the cost to all of us? Somehow I don't. I see big emotional manipulation pushing the democratic majority to take responsibility for every overeater in America and beneficently fund the scarily invasive procedure.

Ironically, after the drastic surgery, you only lose weight because you eat less. All it does is disable you from eating more by removing your stomach. It's based on the idea that you can't be expected to eat less on will and choice alone. You can't handle freedom. You need to be physically incapacitated. And, sadly, there are many people who need medical procedures that are in no way substitutes for things they could do for themselves. When health care is rationed — and it will be rationedsomething will need to be withheld. Do you think it is possible that some people will be asked to go without heart surgery or hip replacement surgery while others get their stomachs removed so they can't eat so much? I certainly do, and I think writing — flabby writing — like Ambinder's is mushing up minds so that's what the democratic majority will clamor for.

123 comments:

c3 said...

Prof;
But do you feel confident that the government will not force insurance companies to cover bariatric surgery and spread the cost to all of us?

I hate to break it to you but all major insurance companies and Medicare cover bariatric surgery (but generally you're above a BMI of 35).

They all generally require that you've demonstrated some medically supervised effort to lose weight; that a psychologist/psychiatrist has said you're "appropriate" for the surgery; that you've had counselling by a nutritionist for post op diet and that you're medically stable for the surgery.

Randy said...

Do you think it is possible that some people will be asked to go without heart and hip replacement surgery while others get their stomachs removed so they can't eat so much? I certainly do, and I think writing — flabby writing — like Ambinder's is mushing up minds so that's what the deomocratic majority will clamor for.

And I think you're right.

Quayle said...

I blame the parents.

This kind of evidence makes it clear that the government must take children out of the home.

And the earlier the better, in the name of equality.

miller said...

You make a good point about bariatric surgery. I have a friend who's had it and he's lost weight, but he has friends who've had the surgery and have not lost weight because they found ways to keep or increase their caloric intake in spite of only being able to eat smaller amounts.

It's not the stomach that's at fault. It's the brain.

Maybe we can get implants in the brain to control us better. For our own good. And the children.

c3 said...

As of 2002 (so old data) we were already spending 2 billion per year on bariatric surgery. However, it does lower health costs over the following five years

Comrade X said...

the thing about obamacare is that it makes everyone's private behavior everyone else's business.

Ignorance is Bliss said...

...who has a few bucks to spend and can only buy the cheapest stuff...

That's good, since the cheap stuff, like carrots and celery, are far healthier then the expensive stuff, like fast food or junk food. And if you're really strapped for cash, you could always eat less.

El Pollo Real said...

From the NYT article you linked:

In the current U.S. debate over health care reform, “rationing” has become a dirty word. Meeting last month with five governors, President Obama urged them to avoid using the term, apparently for fear of evoking the hostile response that sank the Clintons’ attempt to achieve reform.

That sort of linguistic manipulation that nobody seems to care about concerns me.

themightypuck said...

And, sadly, there are many people who need medical procedures that are in no way substitutes for things they could do for themselves.

Is this true? Or is the problem that it is hard for us to tell the people who can but don't from the people who can't?

Ann Althouse said...

"I hate to break it to you but all major insurance companies and Medicare cover bariatric surgery..."

There is a difference between some companies covering it and all companies being required to cover it (and everyone being required to buy that kind of comprehensive coverage).

Also, as noted by another commenter, there is the issue of how fat you need to be to qualify for coverage. Ambinder wasn't that obese.

c3 said...

PS All healthcare systems ration

paul a'barge said...

Ambinder == porky pig.

Snort snort, Ambinder. Snort snort.

Palladian said...

Yeah, too bad there's not a surgery to starve away his flabby writing. I was only able to tolerate that stupid blob of metaphors until the cymbals crashed.

It mystifies me that people associate being fat with cheap junk food. I got fat on French food, Italian food and booze. It also mystifies me that people assume that one becomes fat because of poor impulse control rather than the conscious decision to carry more weight in exchange for engaging in a pleasurable activity like eating mounds of delicious food. When I want to lose weight, I lose weight. What's the problem?

Oh, I forgot. We're all public utilities now (tax revenue producers). When the government feels that we are "out of control" and need maintenance, we're going to be expected to get it.

New "Hussein" Ham said...

Marc Ambinder just wants to cut off black people's food stamps. He's using "obesity" as a code word for "fat black people."

Everybody knows these code words. Obesity is the new black.

He's a fucking racist.

Paul Zrimsek said...

We all expected this, didn't we? Maybe not quite this fast, but we expected it.

At least they can bend the cost curve by having Ambinder stand on it.

Seven Machos said...

I love this country. I love it. Millions of people are starving around the world right now. The history of humankind has been strife, poverty, and constant worries about food sources.

And here we are, in the United States of America, so goddamn rich and blessed and powerful, that we clamor about the socioeconomic problem of fatness.

Get on a treadmill, Armbinder. Lift some weights. Eat a balanced diet. It's real easy.

New "Hussein" Ham said...

Althouse: "Ambinder wasn't that obese."

What the hell does that mean?

Isn't that like saying "she wasn't that pregnant."

You are either obese, or you are morbidly obese. Or you are not.

You can be "not that fat" but it is impossible to be "not that obese."

edutcher said...

The next oppressed minority for the Demos to champion.

You can't stop being black or female (not sure about homosexual, the data's a little fuzzy), but you can sure as Hell stop being fat. It's called self-discipline and it's what the Demos really hate because, if you impose a little self-discipline in your life, you won't need anything they have to offer.

And, before anybody makes some snide remark, I was about 50 pounds overweight and I dropped down to 125, so I have the right to call it this way.

c3 said...

Ambinder == porky pig.

Snort snort, Ambinder. Snort snort.


Paul resorts to elegant, pure reason as the discussion unfolds.

New "Hussein" Ham said...

Marc Ambinder is in fact a fat fatty who possesses no self-control whatsoever.

And he's butt ugly. And a moron, to boot.

His parents should not have been allowed to procreate. We need better Eugenics laws in this country.

Thank God that Barack Obama is expanding abortion access, so the government can eliminate these fatties before they kill Gaia by consuming way more than their fair share of the Earth's resources.

Seven Machos said...

I don't see my father very often but every time I have, he always remarks that I haven't gotten the family belly yet. Just wait until you are in your twenties, he said. And then it was my thirties.

I don't have the heart to tell him that it's not hereditary or determined -- that anyone who sits on their ass all day and eats one or two large, fat-filled meals and never exercises will be disgusting and fat.

New "Hussein" Ham said...

"Ironically, after the drastic surgery, you only lose weight because you eat less."

It is by design.

Fatty McFatso's like Marc Ambinder just can't let an entire pizza go uneaten. And so they pay doctors tie off their stomachs and tell them that if they try to eat they'll kill themselves.

So, they stop finally eating.

It's up to them at that point to develop the self-control their stupid fucking parents failed to teach them as children. Or, they die.

That simple.

What Ambinder is advocating is having the government FORCE this solution onto everyone else he deems too "obese" by his arbitrary calculation.

He wants bariatric surgery to not be optional. That's his ultimate goal.

He - like all good little fascists - wants it to be mandatory.

He wants not just to have us pay to have his stomach tied off, he wants to tie off your trachea also.

If he can't have the pizza ... nobody can.

AJ Lynch said...

Cool. Now that the libs like Ambinder have proposed great ideas like Obamacare, stopping global warming, preventing all accidental deaths except in nasty mines, inequitable education, acne, stuttering, being short or unathletic or ugly or all three, being socially awkward, let's make everyone skinny!!

Yikes I just realized - this idea of Ambinder's could put Trooper's wife's store out of business! So they will need a stimulus package!

Trooper York said...

More hate for the chubby.

We will be dressing Gabby Sidibe for her appearance on Saturday Night Live this weekend.

I will leave you with Jeremy's favorite quote.

Elliott A said...

There are large swaths of our inner cities where there are no supermarkets and the people have no way to get to them. These kids grow up on junk food because that is the available food. Once the grow up and get fat, the rest is a never ending cycle of health care overuse.

There are many other souls who have no self control and could eat healthy diets if they weren't so lazy. Fortunately, Obamacare takes care of this problem. Since Doctors' reimbursement will be tied to the overall outcomes of their patients, they will quickly drop the non compliant ones. The lazy ones will have to get with the program if they want to have a doctor. Nowhere in the 2000+ pages of the healthcare bill is there a mandate for doctors to see certain patients. They will simply say that they can no longer help them and dismiss them.

Trooper York said...

AJ, trust me buddy, I am not worried.

Seven Machos said...

There are large swaths of our inner cities where there are no supermarkets and the people have no way to get to them. These kids grow up on junk food because that is the available food.

This is absolute bullshit. My wife makes this exact argument when we are in cabs going through the (slowly gentrifying) Cabrini Green area. But what she and you need to realize is that cities are, by definition, dense areas. Yeah, there's a lot of crap convenience stores. There's also a Whole Foods and several supermarkets that sell everything within a four-block radius.

Kirstin said...

Grrr. Can't people wake up an hour early and go for a walk? Or just walk in place in front of the television if their neighborhood is unsafe?

I'm hoping that the "Let's Move" campaign will fix things.

Seven Machos said...

And another thing. I would wager that if you took a thousand poor people here who live in housing projects in Chicago and compared them to a thousand middle-class people in Joplin, Missouri, the Chicago people would be in relatively better physical condition.

This is not an inner-city problem and it's not a problem that has to do with poor people. It's a problem that derives from our fabulous extravagance of riches. It's not really even a problem.

Ann Althouse said...

"people assume that one becomes fat because of poor impulse control rather than the conscious decision to carry more weight in exchange for engaging in a pleasurable activity like eating mounds of delicious food"

And once you get your stomach removed, you never again get to make that choice. What does that do your mental health, knowing that you can't splurge and eat a glorious meal, ever again? And now there will be treatments for that mental health problem.

I'm suddenly reminded of female genital mutilation... Getting your stomach removed is like that, isn't it? Like choosing it, at least. You don't trust your impulses, so you have a major body part removed.

Old Dad said...

Uncle Obama,

Keep out of my kitchen and keep your hands off my esophagus.

Or something like that. There was once a time when Ambinder would have been (metaphorically speaking) tarred and feathered for such blithering idiocy. His bleating would have been incomprehensible to my parents who would have assumed that he was simple minded or insane. My mother would have ordered us not to stare at the poor thing. It's late afternoon in America, and damn near midnight for American "journalism." Hope that gives Chrissy Matthews and Joe Klein a thrill or two.

Elliott A said...

@Seven Machos

Have you ever been in North Philadelphia?

You have to make distinctions between the people who are truly needy and those who are true parasites on the rest of us. There is nowhere to buy food in North Philadelphia, for miles, except the fast food places.

I have not been commenting for the last few months, so you may not realize that I am somewhat to the right of Atilla the Hun. Just reminding that there are no absolutes in matters such as this and that we must be judicious in choosing whom we take out back and shoot.

Seven Machos said...

We need Fat People Studies in our universities, Althouse.

WV: pinesses

AJ Lynch said...

Trooper:

You have the nerve to doubt the ideas of the great liberals can succeed??!!

Also, are you doing a betting pool to see how many yards of cloth you need for Gabby?

Seven Machos said...

Elliott -- I see the point. I read that Detroit proper has one grocery store. One.

I have never been to Philadelphia (which is a little shocking to me). In most cities, there is good public transportation and it's easy to travel to another neighborhood to buy food and this problem is simply not confined to the poor.

themightypuck said...

What is wrong with just fixing the problems in front of you without getting all ideological. I realize it can lead to bad outcomes (like throwing Japanese Americans in internment camps or creating housing projects) but by and large it has worked out pretty well for us.

ricpic said...

I just had an epiphany: the Left is all about self-pity.

Lefties are filled with self-pity and...what's the word?..project that weakness onto everybody else. Ooh, those poor little fat kids, they can't, they can't, THEY CAN'T. They're helpless and hopeless and most of all they're overwhelmed by the big bad world and they MUST be helped.

Explains the whole mishegas.

Gosh I'm brilliant.

Palladian said...

The incessant drive to "normalize" fat people is just like the drive to electroshock the gay out of homosexuals back in the day.

"We're going to remove your stomach so you no longer sin, so you no longer disgust us."

"We're going to give you a lobotomy, and perhaps remove your testicles, so you are no longer troubled by evil impulses."

Trooper York said...

Now, now AJ. Don't take a page out of the blogger lady's book and try to bait me.

I am trying to be nicer these days.

Hal Dall, MD said...

30 years ago I was apprised by a fellow med student that being anti-smoking was a sign of my elitist/upper-class bias against the working class. She insisted that social conditions almost forced such people to smoke, and that trying to make them quit was some sort of class warfare! (all news to me the son of a nonsmoking union factory worker).

This sophistry camouflages irresponsibility as victimhood; "It's not my fault-it's all ______'s fault!" (fill in the blank with a favorite villain).

themightypuck said...

@Palladian.

Except there are interventions that work vis a vis fat.

Gabriel Hanna said...

I've often heard that junk food is cheaper, but my own experience is that is false. I live, I think, 300 miles from the nearest Whole Foods, but if you buy fresh vegetables and meat at Safeway or the equivalent you will spend far less on food.

The reason people buy junk food is because they don't have to cook it. Anything that you cook yourself is cheaper. My wife and I buy only raw meat and vegetables, and we spend about as much on food for a week as if we went to dinner once.

Meade said...

Bariatric surgery, dieting, and liposuction, aren't the only ways to lose weight.

Cigarettes.

Think about it: smokers often weigh an average of 4 to 10 pounds less than their non-smoking peers.

Smoking increases metabolism, causing the body to burn more calories.

The President of the United States (and my lefty neighbor) smokes. Shouldn't you?

AJ Lynch said...

Elliott:

In north Philly in the late 1970's or ealier, the first supermarket was opened [with govt assistance] to attack this alleged problem. It was in Progress Plaza - remember Leon Sullivan.

Well, that store failed and several others have followed it and they also failed. News flash for you - People buy what they want to eat. You can't force feed them what you think is nutritious.

Lastly, obesity, like the tendency to smoke, is related to socio-economic factors for some reason. Poorer people seem far more likely to smoke and/or be obese. Drive thru any poor neighborhood and then compare it to an affluent one. The evidence will be right in front of your eyes.

Pogo said...

"We're all public utilities now (tax revenue producers). "

Palladian, that's beautiful.

Obamacare doesn't give two shits about obesity. It's just one more way for them to have power over their subjects, to move them about like blocks of wood.

What I and others predicted is coming to pass.

Every single aspect of your lives can now be controlled, for it falls under public health and safety.

Where you live and drive("Smart growth,forcing people into high density housing), what you eat, who your doctor is, etc.

Recreation warrants control. Rock climbing is dangerous!

From there, control over what you watch on TV/internet/movies will demand federal interference, because the right ideas affect health (smoking, violence, etc.).

What you read affects mental health, certainly. So out go Tea Party posts.

themightypuck said...

@Hall Dal,

But they came around. People are innately conservative and very focused on ingroups and outgroups. The trick is to find a way. This happened with cigarettes. Not so much with booze. Hopefully it will happen with obesity. There are plenty of cultures where obesity is rarer than in the USA so it can happen. The problem is part of the solution is peer pressure and when it is OK to be fat, more people will be fat.

AJ Lynch said...

Trooper:

What you have something against a nice honest game of chance?

bagoh20 said...

Politically, it's unlikely people will be asked to go without much of any medical procedure. They will simply be asked to wait for it until they stop asking.

reader_iam said...

New kid moved into the neighborhood recently. The other day, he and my son were playing outside and when I checked on them, the other kid asked for a drink. So I went back inside and brought out a couple of glasses of water. The other kid politely thanked me (mine just grabbed his and took off, the cretin!) and then said, "You must be a water mom, not a juice mom."

LOL.

/OT (Except, in a way, it's really not, not entirely.)

David said...
This comment has been removed by the author.
AJ Lynch said...

Reader:

That reminds me. We played little league in the 1950's and 1960's. Our uniforms were wool I swear. Half the time, the playground water fountains did not work so you had to hope your coach brought a big jug of water. My point is none of us died or dropped from the heat.

Nowadays, when I coach little league or watch a game, the parents are shoving fruit and gatorade into the players' mouths every other inning. Could that be part of the obesity epidemic?

themightypuck said...

Haha. When I was a kid anything with sugar was the holy grail. Now, when I'm parched after working or playing outside, water is the holy grail. And ice cold beer. Nothing beats an ice cold beer.

David said...

C3 said" "They all generally require that you've demonstrated some medically supervised effort to lose weight; that a psychologist/psychiatrist has said you're "appropriate" for the surgery; that you've had counselling by a nutritionist for post op diet and that you're medically stable for the surgery."

Presently few of these preconditions are covered by most insurances. Think that will change?

Irene said...

@Meade: LOL!

Gabriel Hanna said...
This comment has been removed by the author.
Meade said...

@Irene: Shhh...
;-)

jayne_cobb said...

The secret to losing weight is to live on $25-30 a week in food while simultaneously training for a marathon.

You'll be back at high school weight in no time.

reader_iam said...

Meade and Irene:

As I was saying.

; )

Irene said...

@reader_iam: Haha. I remember that comment well.

AJ Lynch said...

Good one Reader. You solved obesity, state and fed budgets in one fell swooping comment!

Meade said...

Hear, hear reader!

Pogo said...

reader, when the tobacco companies got sued in the state of Minnesota over (in part) the increased health costs that smoking brought to the state, the court ruled that RJR et al could not present to the jury the data showing that smoking led to decreased costs because people died earlier.

themightypuck said...

@Pogo. I remember being kind of outraged at that. Although I understood why it was a pointless argument. You need more than logic to win arguments.

reader_iam said...

There's a reason why we have two hands: One is for wanking and the other is for pointing elsewhere. The various gifts of coordination are what it comes down to.

Pogo said...

@ themightypuck
I was actally surprised they couldn't show the data, given the 'smoking costs MN money' argument.

I don't recall exactly why they couldn't say 'No it doesn't' except that the court thought it was gross or somesuch.

@reader
Heh.
Brings new meaning to the phrase "OTOH".

Eric said...

the thing about obamacare is that it makes everyone's private behavior everyone else's business.

That's the best principled objection to socializing health care. It creates all sorts of minorities for the rest of us to scold - smokers, fatties, skydivers, drinkers, sunbathers, sailors, football players, etc.

There's enough variety in peoples' hobbies and vices that what you like to do is probably not enjoyed by most of your fellow citizens. Socialized medicine makes it in their interest to outlaw pretty much everything you do after work. The equation becomes "If we could just stop people from doing X, we would be able to afford to build Y more hospitals."

reader_iam said...

Pogo: Had you not responded so quickly, I would have deleted my original comment and re-posted it without the word "elsewhere," which construction is what I really intended. Instead, I'll leave up the original, for posterity--

and as reminder to myself, re: my own use of OTOH.

; )

William said...

Most of my life I have been a compulsive jogger. My life is flawed with a lot of obvious symbolism. I jogged because I wanted to run away from my problems. My fitness, just as much as the fatness of the obese, is the outward manifestation of neurosis. Fitness, fatness are markers of how you play the cards; they are not of themselves winning or losing hands. Still though, fit neurotics get to contemplate the misery of their lives for an extra ten or twenty years.....I think the drug company that develops an effective appetite suppressant will make more money than the one that cures cancer. And if you leave the profit motive intact they will find such a suppressant. People wish to be rich and beautiful much more than they wish to be wise and fit.

c3 said...

David;
Presently few of these preconditions are covered by most insurances. Think that will change?

I don't understand the questions. The criteria that Medicare uses are similar to the criteria that most insurance companies use. The core criteria:
1) BMI over 40 with or without co-morbidity. Some have it lower if significant co-morbidity 9i.e. diabetes)
2) demonstrated efforts to lose weights (generally requires medical supervision)
3) medical clearence
4) surgery by a surgeon trained in the procedures
5) pre-op clearence
6)other criteria are added/vary by insurance company

Average charge for the surgery;
15,000 to 30,000.

Meade,
Cigarettes aren't very good weight loss measures in the short run, ask Jacki Gleason. But in the long run...

Joe Giles said...

Don't for the life of me understand why some think that once BIGGOVT starts to coerce your waistline that it won't move up or down from there.

howzerdo said...

Althouse: I'm with you.

My husband has had four surgeries in the past year (just got home from the hospital yesterday after #4). They weren't related to bariatric surgery (they were to repair incisional ventral hernias from an old gall bladder surgery and he had a lot of complications after the first two).

So I have spent the past year sitting in colo-rectal and plastic surgery offices. (His repairs required a team.) The plastic surgeon shares offices with bariatric surgery, and I estimate that about 75% of the plastic surgeon's patients come from bariatric surgery.

There was always a long wait before appointments, and I overheard many patients discussing insurance. (This was not a HIPAA violation, patients openly discussed their situations with other patients while waiting.) The majority of patients seemed to be on Medicaid.

It was clear that there is a bustling business in both bariatric surgery, and in removing excess skin afterwards. It seems way more popular than breast implants and face lifts. Patients have the initial gastric bypass or lapband, and then procedure after procedure to pretty things up. Then, sometimes they get incisional hernias and those have to be repaired.

The majority of patients were morbidly obese, and some had mobility issues as a result, but frankly, after witnessing my husband's ordeal over the past year (he had four surgeries because he had no other options), I can't imagine why someone would have elective surgery.

I know the patients have to go through a lot of screening, but (this is even more anecdotal, n=1) a friend of mine who had a lapband procedure a couple of years ago jumped those hurdles with relative ease. She hasn't had plastic surgery, since her lapband hasn't been all that successful (she lost maybe 40 pounds but wanted to lose hundreds). She learned how to stretch it (and a couple of times had to go to the ER to have saline removed and loosen things up).

I find it disturbing that bariatric surgery is encouraged, applauded and has now become perfectly ordinary.

Revenant said...

The problem with having the government fight obesity is that we don't actually know of a way to fight obesity.

Yeah, yeah, "eat less and exercise more". We know that. But now try getting people to actually DO that; see how much success you have.

Seven Machos said...

Rev -- I bet Kim Jong Il has a few tips.

jamboree said...

I know two women who had different types of gastric bypass surgery - one stapling, and one with some kind of rubber mechanisms.

Both lost the weight. Both were thrilled and experienced big positive life changes.

Then several years down the line both got infections, blood poisoning due to complications and almost died. One also had trouble with her pregnancy.

But as her dad ruefully acknowledged - there wouldn't be a baby at all if she hadn't had the surgery because the guy never woud have married her. (True. She met him in Church btw.)

People are superficial and evil even when they think they aren't.

WV: die duc(t) Hah.

Pogo said...

@Rev: "we don't actually know of a way to fight obesity."

Well, Cuba, China, and the USSR figured it out.

All you need to do is have communism destroy the economy, and then people starve. Problem solved!

There are medical articles I have posted here before extolling the virtues of the 'reduced cardiovascular events' brought about in Cuba by their nation's financial collapse in the 1990s.

Pogo said...

Here it is:

"Key points:

• During the economic crisis Cuba experienced in the 1990s, energy intake per capita gradually decreased to 1863 kcal/d (7820 kJ/d) and the proportion of physically active adults increased from 30% to 67%. These changes affected the whole population and were sustained for almost 5 years.

• The result was widespread modest weight loss (4–5 kg, or 5%–6% of body weight) and a decline in all-cause mortality and rates of death from diabetes and cardiovascular disease.

Countries such as Canada and the United States, where more than half the population is either overweight or obese, could benefit from health policies whose aim is population-wide weight loss.

Paco Wové said...

Canadians. Figures.

lucid said...

nice images.

Lynne said...

I would like to point out that bariatric surgery is not "having your stomach removed," as the Professor has twice stated. Various techniques are used to reduce the amount of food the stomach can hold and process or effectively reduce the size of the stomach itself, but the stomach is NOT removed. Complete removal of the stomach is generally only used in cases of stomach cancer.
Sloppy writing is just as bad as flabby writing sometimes.

Jason said...

I agree with Ann: The blog post doesn't make a lot of sense. But his full-length article he wrote for the Atlantic that he linked to was excellent.

Cut the man some slack, guys.

Lisa said...

Bariatric surgery does not only force you to eat less. Part of your intestines are removed causing malabsorption. Even the food that you do eat is not absorbed as it was prior. Furthermore, the surgery changes the hormones produced by the stomach and you are no longer dealing with constant eat eat eat signals from your body.

Balfegor said...

Ambinder is making an argument. It's an argument about the unfairness of obesity, an argument designed to justify new government policies and spending.

It's hilarious that the conception of obesity as a form of social inequality, a signifier of the underprivileged, is so often used as a justification for exerting totalitarian control over them.

Imagine if the same logic were applied against poverty generally -- the solution wouldn't be to give them money (they'll only spend it on drink and fatty foods -- haha), but to direct every aspect of their lives, to tell them where to work, where to live, how to spend their leisure time. There's a little of this in some public school reform efforts, where well-meaning reformers wish to expand school-time to take up more and more of the childrens' time, and leave no time for corrupting influences from friends and family. And it's not that one cannot see the logic of stamping out the "culture of poverty" by such brute force methods. It's just that it would be totalitarian. And it's still totalitarian when one pursues totalitarian ends by softer means. Nudges rather than jackboots.

Robert said...

Are we at the first point in history where poor people are in danger from too much food?

Der Hahn said...

One thing I've noticed while reading comments on posts about dieting, obesity, weight loss, and food on a number of blogs is that a certain group of people are absolutely convinced that there are good magic foods and bad magic foods.

Good magic foods cause you to eat less and lose weight.

Bad magic foods (and food ingredients) cause you to eat more and become obese.

The funny thing about these foods is that 'good' foods are almost universally what bo-bo foodies eat (arugala, anyone?), and the 'bad' foods are usually associated with Wal-Mart and McD's.

k said...

I'm tired of the fast food/ junk food argument.

Yes, a burger with special sauce and double cheese and bacon or whatever is high-calorie. But no one forces you to order that. I usually get a salad, the fruit snack (used to be apples, walnuts, and yogurt dip), and an unsweet tea. I forego the salad dressing or use it minimally. So yeah. I ate fast food. But I didn't break the calorie bank to do it. And it's cheap.

If I can do it, so can anyone.

Pogo said...

k said..."So yeah. I ate fast food. But I didn't break the calorie bank to do it. And it's cheap.
If I can do it, so can anyone.
"

Clearly, the federal government needs to force people to do what k does.

Brian said...

Bariatric surgery is major surgery, whether it's lap-band or gastric bypass. It's not to be taken lightly (pun not intended). A disturbingly high percentage of people have died from it. It makes sense then to have a strict criteria for who can get the surgery.

I know a couple who started losing weight together, and have managed to lose a lot of weight with diet changes and exercise. It's a lot healthier to lose the weight gradually. It requires though the will to change your lifestyle.

If you can get started and maintain a diet and exercise routine, it's a lot easier than getting over complications of surgery.

c3 said...

Hamie;
Althouse: "Ambinder wasn't that obese."

What the hell does that mean?

Isn't that like saying "she wasn't that pregnant."

You are either obese, or you are morbidly obese. Or you are not.


Uh no

Its basic math. Graph here, and formula here

k*thy said...

Ambinder is speaking through his own experience and not from a trained medical, scientific or a reporter standpoint. We’re getting, essentially, an insider’s perspective of the food battles through the eyes and mind of one obese person’s experience. While his solution to his experience is his own, he seems to really be looking at a larger public health issue. He’s not saying that the solution is in drastic bariatric surgeries for everyone – but using public health strategies, which involve much more lower monetary investments.

I guess I’m not quite as troubled by his writing, as I hear these kind of personal stories quite often. It’s difficult to convey one’s own perspective to someone who doesn’t share that same experience. Almost impossible, actually. The best you can hope for is for the reader or listener to just accept it.

AJ Lynch said...

Ambinder is young and he could have spent $1,200 for a good quality recumbent bike and watched DVD's while he exercised. He would have lost weight gradually and gotten in better shape.

Instead, he was lazy and sought a magic bullet so he had his insurance company spend $15,000 or $25,000 for his high-risk major surgery and now he is a high-risk, high cost medical claim for the rest of his life.

So, tell me Marc - which of these options should Obamacare & the taxpayers cover ?

CrankyProfessor said...

It’s difficult to convey one’s own perspective to someone who doesn’t share that same experience. Almost impossible, actually. The best you can hope for is for the reader or listener to just accept it.

I accept it as his perspective - but that doesn't mean he's honest with himself or correct in his policy recommendation! Government by personal perspective is a disaster.

Roux said...

I think it's much harder to control weight today because everything (snacks, soft drinks, etc...) are so readily available. The food industry has made it so easy for us to stuff our faces. Of course it's our fault not theirs.

Fred4Pres said...

Pale, white and fat is no way to go through life.

Lisa said...

There is an underlying assumption that fat people are lazy and if they wanted to lose the weight they could. That's not true.

Once you are obese, it is very difficult to lose significant amounts of weight. Study after study has shown one diet and exercise regime after another that fail to drop more than 20 pounds for most of the participants. Few are able to keep that weight off even continuing with the plan. And twenty pounds for someone who is 100 or 200 pounds overweight is not enough.

The best thing is to ensure you never do get fat... because once you are, it is nearly impossible to become 'thin'.

Pogo said...

Just move to Cuba.
Weight loss is guaranteed.

The workers paradise!

Balfegor said...

Ambinder's 10 ways to beat obesity are equally idiotic. Teach kids to cook? Makes sense to me. Ever since I learned to make coffee cake from Bisquick, eggs, bacon, biscuits, waffles, cheesecake, pizza, pork barbeque, .... I've never had to worry about my weight or over eating.

Here, I've got a better one! Subsidise exactly the kind of midrise mixed use mass transit development I like. Down with cars! Haha.

There are people who seriously propose this kind of policy, as a solution to American obesity (e.g. by comparison to Japan or Europe, where people walk more, and are generally thinner), but it doesn't really work. I have about an hour's worth of walking every day (about half an hour to work, and half an hour or so back), and it certainly doesn't make me thin. I suppose I might be even fatter, if I didn't have it, but at the least, walkable transit-oriented development won't make Americans thin.

I suspect the cross-cultural difference is, contra Ambinder's suggestion that we should change the stigma against obesity, simply that the stigma against fat-ness kicks in much, much earlier than in does in the US -- that is, a normal weight White American might (at least in Korea or Japan) be treated as almost grossly obese. If we dial up shaming, taunting, and smug, smug self-satisfaction up to 11, I think that is, unfortunately, more likely to work than all these well-meaning policies. Part of it, to be honest, may also just be that if the taunts start earlier (in the progression to fat-ness), it's easier for the taunt-ee to change diet and lifestyle. It's not quite so easy if you wait until you're 250 pounds, or rather, if the stigma doesn't kick in until you're 250 pounds.

orbicularioculi said...

I don't believe this government intervention into every aspect of our lives is ever going to end until we SHOUT "stop this bullshit" and get out of my life.

Of course, in order to do this, we are going to have to replace all of the statist politicians and their bureaucratic minions interfering with our day to day existence.

This will begin in November and I hope it is the beginning of a New American Revolution for Liberty and a return to self responsibility.

DADvocate said...

If we dial up shaming, taunting, and smug, smug self-satisfaction up to 11, I think that is, unfortunately, more likely to work than all these well-meaning policies.

Probably so. In my family growing up there were strong biases against fatness. I guess this originated with my parents although we never referred to it as anything other than "fat."

Indeed, last week I was visiting my 85 year old mother, who is a very sweet woman, and she mentioned that someone was "fat."

Due this, growing up anyone of us kids who was a little heavy was called fat and worked hard to be skinny. Personally, I was painfully skinny (5' 11" and 128 lbs entering the 8th grade) and never suffered from fatness until past age 50. I'm getting close to skinny again now. None of my siblings has ever been close to obese.

Edgehopper said...

Ann, you're only worried that the government will fund bariatric surgery?

What I worry about is that the government will effectively force bariatric surgery--by, say, passing laws prohibiting fat people from finding employment or getting health coverage (now that they control the health care industry, they can do that). One of Ambinder's commenters wants to fire any teacher with a BMI over 27. Britain already fires fat teachers while burning fat children in effigy.

And the worst effect on freedom you see is financial?

Balfegor said...

Britain already fires fat teachers while burning fat children in effigy.

Oh good heavens, are they going to airbrush Lord Salisbury's embonpoint out of the old photographs too? Though I suppose they don't teach the Victorian age anymore -- not enough Nazis in it, and too much patriotism.

AJ Lynch said...

Balfegor said:

"If we dial up shaming, taunting, and smug, smug self-satisfaction up to 11, I think that is, unfortunately, more likely to work than all these well-meaning policies."

Watch it- you may run afoul of the new bullying laws we will soon see enacted.

Shanna said...

You can be "not that fat" but it is impossible to be "not that obese."

When “obese” runs the gamut from 60 pounds overweight to 500 pounds overweight, you kinda can.

There are large swaths of our inner cities where there are no supermarkets and the people have no way to get to them. These kids grow up on junk food because that is the available food. Once the grow up and get fat, the rest is a never ending cycle of health care overuse.

This always comes up but this is a TINY portion of the poor in general. And if you are really interested in getting fresh foods, you can, even if you are poor or in an inner city. Not to mention that you can get frozen veggies and fruits as well. Junk food is overused because it’s easy.

Anthony said...

I noticed that Mike Huckabee, who had the surgery and has been an evangelist of sorts for bariatric surgery, has started putting on the weight again. They say the stomach eventually expands again.

Smilin' Jack said...

And if you are really interested in getting fresh foods, you can, even if you are poor or in an inner city.

If the poor wanted apples and oranges instead of twinkies and nachos, inner city bodegas would carry apples and oranges instead of twinkies and nachos. They're in business to make money; they sell what their customers want, not what they're supposed to want.

This whole thing goes in cycles anyway. When people get tired of the campaign to end obesity in America, politicians will start yet another campaign to end hunger in America.

JorgXMcKie said...

The major reason Detroit has no [chain] grocery stores is in very small part due to the difficulty of getting permits for any business and almost entirely due to the fact that it's all but impossible to keep theft down enough to make a profit.

Those kinds of stores are too large to successfully 'police' both patron and employee theft, and if you raised prices high enough to make a profit you'd either run off all your paying customers or get hammered for 'gouging'.

A good chunk of this is due to the local culture, since small, family run stores can make it, mostly.

Sad, but there it is.

Oligonicella said...

Seven Machos --

"I would wager that if you took a thousand poor people here who live in housing projects in Chicago and compared them to a thousand middle-class people in Joplin, Missouri, the Chicago people would be in relatively better physical condition."

I got a cool grand I'll put on that bet. Selection must be random middle-class.

Oligonicella said...

c3 --

"Its basic math. Graph here, and formula here."

BMI ain't a good tool. Weight's a lot more than a friggin' chart powered by a simplistic formula. When I was 205 and 6'1", I ran a damned stunt show. Hardly in the middle of overweight.

"The medical establishment has generally acknowledged some shortcomings of BMI. Because the BMI is dependent only upon weight and height, it makes simplistic assumptions about distribution of muscle and bone mass, and thus may overestimate adiposity on those with more lean body mass (e.g. athletes) while underestimating adiposity on those with less lean body mass (e.g. the elderly)."

BarryD said...

I was an obese smoker in a mound of debt.

Correlation does not imply causation. I suspect that one finds many fat smokers in poor neighborhoods for parallel reasons. The same attitudes, behaviors, decisions and desires that lead one to be self-sufficient economically, are the ones that help someone to quit smoking, and get into good physical shape. The attitudes that lead one to financial bankruptcy are those that lead one to physical and emotional bankruptcy.

Do I have a really easy one-step answer? No. It's hard to change habits. But then again, what is life about, anyway?

Meeting challenges is part of the meaning of life. By making everyone the "victim", this pernicious "liberal" worldview is attacking the very meaning of our lives. I am quite serious about this.

DADvocate said...

When people get tired of the campaign to end obesity in America, politicians will start yet another campaign to end hunger in America.

Don't you know 1 out of 8 people in the U.S. struggle hunger? You cold hearted beast!! That's why we're so fat!!

Alex Curylo said...

"a certain group of people are absolutely convinced that there are good magic foods and bad magic foods. Good magic foods cause you to eat less and lose weight."

Actually, there's no magic involved. You can demonstrate the lack of magic yourself with a skinny kid and a fat kid. Feed them both a heaping bowl of Sugar Frosted Chocolate Bombs™ and watch what happens: The skinny kid will be bouncing off the walls like he just did half a dozen rails, the fat kid will be slow and sleepy and just that little bit fatter.

This is insulin resistance at work. If you're not insulin resistant, extra food goes to energy. If you are insulin resistant, extra food goes to fat. You start out insulin resistant if your mother was, and you lose it as you get older.

So for many people, and the obese in particular, why yes there are "good magic foods", they're ones with lower glycemic indexes; and why yes there are bad magic foods too, they're the ones with high glycemic indexes. And containing fructose. Fructose PLUS high glycemic index ingredients, that's the real disaster.

If you're eating the good magic foods, most of your calories turn to glucose and go to the brain. You're full. You eat less.

If you're eating the bad magic foods, most of your calories get swallowed up by fat tissue. Glucose doesn't get to the brain. You keep feeling hungry because YOU ARE STILL HUNGRY.

Try this experiment to see if you're one of the people this applies to. Eat a meal of butter prawns with no bread or other side carbs and only water as a drink. Probably can't get down 500 calories worth without feeling full, can you? Now try eating potato chips and drinking soda pop. You can probably mow your way through 3000-4000 calories easy and still be set for more, can't you?

And that is the *real* problem for most obese people, they eat too much starch and fructose. What skinny people call self-discipline is actually putting themselves into a semi-starvation state. Well why yes that will work with sufficient masochism, but not too damn likely to maintain it for long.

Reducing your glycemic index, on the other hand, that really does work like magic to lose weight while feeling fully satiated and not exercising. Some people just have to cut out the chips and pop, some people need to get rid of flour-based products, some people have to go all but completely carnivore as if they were Type 1 diabetic and insulin haven't been invented yet. But for every person that tends to gain weight if they don't work at keeping it off, there is some level of lower carbohydrate consumption that works for you; cut out the most highly processed grains and starches first, plus anything with fructose in it, and work your way down from there. Almost everybody -- not me, but I'm REALLY hypoglycaemic -- can stop by the time they're down to nothing starchier than peas and carrots.

El Pollo Real said...

Armbinder posts his 10 recommended solutions for the problem here.

His odd notion of stigma: let's rechannel that stigma we feel against fat people torwards the evil food companies!

k*thy said...

I accept it as his perspective - but that doesn't mean he's honest with himself or correct in his policy recommendation!

His description actually pretty consistent with others’ suffering from compulsion. Why wouldn’t the conversation include experiences of those who lived it? They were there, they might have some ideas on how to get out.

Government by personal perspective is a disaster.

Our personal perspectives shape our opinions and decisions, Cranky, like who and what to vote for. Like in a democracy.

A lot of the public health policies that could address some of this would revolve around agricultural subsidies and zoning policies. Not all that intrusive,I don't think.

AJ Lynch said...

El Pollo:

#10 is "End food deserts" and he uses an Indian reservation as an example. Are the residents of these Indian reservations actually confined to such places? So they can't re-locate?

It reminds me of Sam Kinnison's "move to the food!" comedy routine.

Barry Kearns said...

Elliott A said...

Have you ever been in North Philadelphia?

You have to make distinctions between the people who are truly needy and those who are true parasites on the rest of us. There is nowhere to buy food in North Philadelphia, for miles, except the fast food places.
4/19/10 7:32 PM


I don't believe you. Even a few moments browsing with Google Maps across North Philadelphia zoomed in a bit with the search term "supermarket" shows no areas where anyone is living where you have to go "miles" to buy food other than fast food places.

There is, of course, an easy way to see which of our two positions more closely resembles reality.

You could give us an exact intersection in North Philadelphia that you were talking about, and then plot a circle from there with a two mile radius. Then everyone else can use Google Maps to come up with a sorted list of supermarkets that are within that radius, from closest to farthest.

Perhaps a few other search terms like "grocery store" can be applied. You know, places other than fast food where food can be purchased. The places that you contend don't exist for miles around.

wv: wingn

Were you just wingn it, Elliott?

Meade said...

DADvocate said...
Don't you know 1 out of 8 people in the U.S. struggle hunger? You cold hearted beast!! That's why we're so fat!!

But it's true: many obese children and obese adults are fat because they are hungry. Their bodies are hungry for nutrients that their diets are not providing. So they eat more - more nutrient deficient foods which make them fatter.

Here is one approach that works for most people, an approach that requires absolutely no government intervention.

Balfegor said...

Are the residents of these Indian reservations actually confined to such places? So they can't re-locate?

If they try, Andrew Jackson will rise from his grave and come down on them like the wolf on the fold.

El Pollo Real said...

Meade wrote: Here is one approach that works for most people, an approach that requires absolutely no government intervention.

I agree with your approach Meade, but how to "let it happen" as opposed to "implement" it.
You're talking not just about choices but of lifelong habits. One answer is to instill them by intergenerational transfer, i.e., good parenting. Paradoxically perhaps, our government should do even less to do more as suggested here.

Jason said...

Ambinder thinks we can help end obesity by teaching kids how to cook. Good idea. I took home ec in 8th grade. We learned how to cook.

We cooked rice krispie treats and malasadas (balls of deep fried batter dusted with sugar - a popular dessert in Hawaii.)

Paul said...

Hal Dall, MD said...She insisted that social conditions almost forced such people to smoke, and that trying to make them quit was some sort of class warfare!

This reminds me of those lefty arguments that the fact that there are so many liquor stores in poor neighborhoods is a form of oppression--as if someone other then the customer is subsidizing them. Also the theory that African Americans drink malt liquor and fruit-flavored brandies and smoke menthol cigarettes because they're "marketed" to them.

Paul said...

I need to lose 20 pounds but I figure it'll be easier next year after President Obama liquidates the kulaks and collectivizes the farms.

Paul said...

Seven Machos said...We need Fat People Studies in our universities, Althouse.

I love it. Makes as much sense as anything else these days.

Eric said...

Oh good heavens, are they going to airbrush Lord Salisbury's embonpoint out of the old photographs too?

Outstanding. I love new (to me) words.

sushil said...

As we continue to grapple with Obesity, a question that is not getting too much attention is the role Alternative systems of medicine like Ayurveda can play in controlling / curing Obesity. A system based on Nature can not be all that bad :-)