In fact, being a man these days seems, well, an awful lot like being a woman. For men, more than ever, looks count. Check out the magazines where modern-day Adonises sell everything from cars to cologne. Manly men used to be burly and soft, but now it’s all about a pumped-up low-fat physique.
Men eye the washboard abdominals in the ads and think that maybe, with enough dieting and time in the gym, they too could trim the fat and get “buff.” The average guy, of course, can no more shape his torso into the media image than the average gal can. But the fantasy is very captivating.
This turning of the tables is not without consequences. Men are catching up with women in body dissatisfaction, acquiring problems formerly associated with women: eating disorders, body obsessions, low physical self-esteem. In fact, Cornell researchers recently found that men and women are similarly dissatisfied with their weight (though women are more likely to want to lose weight and men have more mixed desires, including the desire for increased muscle definition).
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This sure isn’t what I have in mind when I advocate for gender equity!
There is nothing objectively attractive about thinness. Our cultural beauty standards are a reflection of political and economic interests. When you buy into them, you support commercial interests and the status quo and undermine the health and well-being of all of us as individuals. Chapter 8 helps you opt out.
8. The “You Can Trust the Experts” Myth
When solid scientific evidence is considered, the ideas in this book are not particularly heretical, nor even new. Why do they differ so much from what is more commonly promoted by health “experts”? Why is it that these views have not found their way into the beliefs of the public or even to a significant portion of the scientific community? Why are so many intelligent and compassionate people invested in reifying an old paradigm that not only doesn’t work, but exacerbates people’s difficulty with weight regulation and wreaks havoc with their self-esteem?
I suspect it is because our views have been shaped by our own personal experiences of managing our weight within a cultural context marked by an obsession with thinness and a belief that success can be achieved through that thinness. No individual can escape the influence of culture. Scientists and health care practitioners are subject to the same bias against fat and are exposed to the same unrealistic images of bodies and relentless pressure to “purchase beauty” that we all experience in our culture. They are also subject to intense pressure from people desperate for solutions and may feel a strong need to cling to something, even if it’s baseless, rather than acknowledge that they just don’t have an answer.
The weight-loss industry, of course, has a multibillion-dollar interest in promoting the view that “overweight” is dangerous and unattractive and that weight can be controlled by dietary manipulation, drugs, or other consciously applied techniques, and we can’t ignore the tremendous influence they have had in fueling our cultural hysteria about weight. Body-conscious Americans spent over $58 billion last year to lose weight, and that number is expected to continue to balloon.
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We wouldn’t be spending that kind of money if we thought we had such limited ability to lose weight. Clearly, it pays for the weight-loss industry to have us believe that losing weight is, with a little help from them, not all that hard. Weight-loss advertisements give the impression that losing fat and keeping it off is easy. The people in these ads are having fun and look great, especially compared to the way they used to look before they signed up for the program, or ordered the “natural” herbal weight-loss pills, or bought the diet book.
It also pays for the weight-loss industry to have us believe that weight has negative health consequences, as is evident from the enormous resources that the pharmaceutical industry has put behind research that exaggerates the health risks associated with weight. Knoll Pharmaceuticals, for example, offers funding to those who “advance the understanding of obesity as a major health problem,”
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as they explicitly state in a call for proposals. After mobilizing concern about obesity, they can profit by selling the cure.
Exaggerated claims regarding the dangers of obesity are in fact at the cornerstone of efforts to get Food and Drug Administration approval for long-term use of weight-loss drugs known to be hazardous. When defending themselves against lawsuits, the pharmaceutical companies justify sales with the argument that obesity is so dangerous that it overshadows the dangers of their drugs.
Exaggeration of obesity’s dangers similarly benefits physicians, for whom there is a tremendous market in promoting various weight-loss methods, particularly surgery. It mobilizes patients to use their services—and helps secure insurance coverage. Health practitioners are among the most insidious players in this fat-hating drama, as they have legitimized the cultural mandate for thinness by reframing it as a health concern. Bariatric surgery poses a particularly egregious example. Ironically, as Eric Oliver astutely points out, bariatric surgeons actually
create
disease, by damaging a healthy organ, and justify this practice by asserting an imaginary disease, obesity.
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The government has played a particularly potent role in propagating this cultural hysteria. It was unlikely a mere coincidence that the article
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wrongly attributing 400,000 deaths to overweight and obesity appeared in
JAMA
just days before Julie Gerberding, the director of the CDC, was to appear before Congress to request increased funding. The report was prepared not by the CDC’s top experts on the subject but by Gerberding herself, who holds no particular expertise in obesity, and other researchers attached to her office. Gerberding, of course, cited the paper in her testimony.
The
Wall Street Journal
and
Science
magazine both noted that anonymous sources within the CDC were concerned that the report had been influenced by political pressure to make the results consistent with CDC’s public health policy.
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The report was so blatantly problematic that even conventional obesity researchers questioned its methodology and conclusions, suggesting that a political agenda to exaggerate the risk of obesity had trumped scientific concerns. A host of reasons were expressed, among them that the authors added an arbitrary number of deaths from poor nutrition to the obesity category. The following
JAMA
issue featured several contentious letters. The criticism prompted an internal review and the CDC was eventually forced by a Freedom of Information Act request to post the results of this review on its Web site. The updated information was eventually published in
JAMA
and, as discussed earlier, reduced the estimate for excess deaths a whopping 94 percent.
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Lest people actually allow the data to inform practice, the CDC’s next step was to issue a disclaimer to state health agencies stating that “despite the recent controversy in the media about how many deaths are related to obesity in the United States, the simple fact remains: obesity can be deadly.” Apparently the CDC doesn’t want the evidence to distract us from continuing to impose baseless policy.
Also problematic is that those who determine public policy and federal grant funding are almost always simultaneously on the pay-rolls of weight-loss and/or pharmaceutical companies, thus presenting a conflict of interest. Government panels favor economic interests over health interests whenever they identify obesity as a major public health threat, define obesity at low standards, promote unsuccessful treatments, or minimize the dangers of various treatments.
For instance, at least seven of the nine members on the National Institute of Health’s (NIH) Obesity Task Force were directors of weight-loss clinics,
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and most had multiple financial relationships with private industry.
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Thanks to this task force, one magical night in June of 1998 twenty-nine million Americans went to bed with average figures and woke up fat. They woke up with a presumed increased risk of type 2 diabetes, hypertension, and atherosclerosis and a government prescription for weight loss. Of course, nobody gained a pound. The task force had simply lowered obesity standards,
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a change which was obviously favorable for private industry.
The research presented in their report did not support the value of lowering the standards.
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Indeed, the only relevant peer-reviewed research they cited in their report, a review of studies on the association between BMI and mortality,
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suggested that
raising
the standards would be a more astute application of the science. The review didn’t find a statistically significant relationship between BMI and mortality until BMIs in excess of 40 (yet they set the cutoff for overweight at 25 and for obesity at 30)!
The Politics of “Evidence-Based Science”
I was a PhD candidate at the time the BMI standards were lowered. My mentor was a member of the NIH Obesity Task Force. When I expressed my surprise at the standards being lowered, she encouraged me, as an academic exercise, to conduct a review and make recommendations as if I were sitting in her place on the task force.
A careful review confirmed my suspicions: There was significant evidence in support of
raising
the standards, not lowering them. I presented my review to my mentor, who laughed and congratulated me on my insightful analysis.
I asked the obvious question of why the NIH Obesity Task Force recommended lowering the standards in the absence of supporting data. I paraphrase her response: “We were pressured to make the standards conform to those already accepted by the World Health Organization.”
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In other words, this decision was made for political reasons, not because it was supported by science or for the betterment of public health.
Trace the origins back further and it becomes even more disturbing. The World Health Organization report that helped to establish a BMI of 25 as the cutoff for overweight was predominately drafted by the International Obesity Task Force (IOTF).
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On the surface, IOTF appears to be a scientific organization. However, probe a little and you find that IOTF receives much of its funding from Hoffman-La Roche (makers of the weight-loss drug Xenical) and Abbott Laboratories (makers of the weight-loss drug Meridia). Their primary mission is to lobby governments and advance an agenda that is consistent with the platform of the pharmaceutical industry. Indeed, many outsiders describe them as no more than a front group for the pharmaceutical industry.
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In other words, private industry is writing public health policy.
Over the years I’ve been privy to rumors of a lot of dirty secrets among obesity researchers. There are way too many stories circulating about research results being suppressed when they are unfavorable to industry, industry writing papers under the name of prominent academics, bogus numbers being reported by researchers and government agencies, “scientific organizations” that front for private industry. . . .
Knowing many of the players and the pressure many of us feel from our universities to make ourselves known and bring in grant money, and given my own personal experiences of being tempted by potential conflicts of interest, it doesn’t take a leap of faith to believe those rumors are true. Indeed, evidence is accumulating, and many exposés have already been written.
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Examine the key players in the two major organizations for obesity researchers, The Obesity Society and the American Obesity Association (which recently folded), and you will not find a single officeholder who does not have some financial tie to a pharmaceutical or weight-loss company. Indeed, I cannot think of one obesity researcher, other than myself and the government researchers that are prohibited from these relationships, with a policy of refusing industry money.
Eric Oliver calls this a “health-industrial complex,” built on a “symbiotic relationship between health researchers, government bureaucrats, and drug companies,”
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and he and health writer Thomas Moore describe the interlocking relationships.
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Drug companies sponsor the research that defines health issues and fund the researchers who sit on government panels; government agencies rely on researchers to provide the data to support their funding requests; and drug companies rely on health advisories issued by government agencies to promote and justify their products. Everyone benefits from reinforcing the same (fearmongering) message.
While the very nature of these relationships is problematic and true corruption exists to some extent, I also believe that it is unlikely many of the people promoting the obesity myths are acting consciously to mislead us, and I am not suggesting all of those holding conflicts of interest are dishonest or part of a conspiracy. Indeed, I believe that most are well-intentioned. Rather, the myths about obesity are so much a part of our culture, and the penalty for questioning them so high, that assumptions are not even recognized, let alone challenged. Many obesity warmongerers are sincere in their belief that fat leads to death and disease. And for those concerned about Americans’ health, the “obesity epidemic” is a convenient, attention-getting way to highlight problems with nutrition or activity habits.