Saturday, January 7, 2006

previous entry | main | next entry | TrackBack (0)

January's Books of the Month

This month's general interest book is by my colleague Eric Oliver -- Fat Politics: the Real Story Behind America’s Obesity Epidemic. The real story, according to Oliver, is that there is no such thing as an obesity epidemic -- rather, this appears to be a whopping case of medical experts confusing correlation with causation.

This write-up in the U of C Chronicle does a fair job of providing a precis:

Oliver contends there is no scientific evidence to suggest that people who are currently classified as “overweight” and even most Americans who qualify as “obese” are under any direct threat from their body weight.

Oliver explains that this is partly because the current standards of what is “overweight” and “obese” are defined at very low levels—George Bush is technically “overweight,” while Arnold Schwarzenegger is “obese.” But it also is because most people confuse body weight with the real sources of health and well-being—diet and exercise, he says.

In most cases, the relationship between fat and disease is simply an association, says Oliver. People who are overweight may also have heart disease, for instance, but there is no proof that being overweight causes the heart disease.

“There are only a few medical conditions that have been shown convincingly to be caused by excess body fat, such as osteoarthritis of weight bearing joints and uterine cancer, which comes from higher estrogen levels in heavier women, although this can be treated medically without weight loss,” he says. “For most medical conditions, it is diet, exercise and genetics that are the real causes. Weight is merely an associated symptom.”

Yet Americans continue to be told that they need to lose weight, Oliver believes, partly because weight is so much easier to measure than diet and exercise. It also is because of American values that consider overweight a sign of sloth and thinness a mark of social status, he says. “But the most important factor,” Oliver argues, “behind America’s ‘obesity epidemic’ is the weight loss industry and public health establishment.”

Read the whole thing -- Oliver's deconstruction of the body mass index (BMI) as the basic metric for determining obesity is particularly useful. The one mystery that remains for me is why powerful economic sectors -- like processed food services and restaurant owners -- haven't fought harder against the obesity myth.

Oh, yes, in case you were wondering, Eric didn't write this as a massive justification for his own body tpe -- he's quite svelte.

The international relations book is Michael Mandelbaum's The Case for Goliath: How America Acts as the World’s Government in the Twenty-First Century. There's a book excerpt in the January/February 2006 issue of Foreign Policy in which Mandelbaum spells out his basic hypothesis:

The gap between what the world says about American power and what it fails to do about it is the single most striking feature of 21st-century international relations. The explanation for this gap is twofold. First, the charges most frequently leveled at America are false. The United States does not endanger other countries, nor does it invariably act without regard to the interests and wishes of others. Second, far from menacing the rest of the world, the United States plays a uniquely positive global role. The governments of most other countries understand that, although they have powerful reasons not to say so explicitly....

To be sure, the United States did not deliberately set out to become the world’s government. The services it provides originated during the Cold War as part of its struggle with the Soviet Union, and America has continued, adapted, and in some cases expanded them in the post-Cold War era. Nor do Americans think of their country as the world’s government. Rather, it conducts, in their view, a series of policies designed to further American interests. In this respect they are correct, but these policies serve the interests of others as well. The alternative to the role the United States plays in the world is not better global governance, but less of it—and that would make the world a far more dangerous and less prosperous place. Never in human history has one country done so much for so many others, and received so little appreciation for its efforts....

If a global plebiscite concerning America’s role in the world were held by secret ballot, most foreign-policy officials in other countries would vote in favor of continuing it. Though the Chinese object to the U.S. military role as Taiwan’s protector, they value the effect that American military deployments in East Asia have in preventing Japan from pursuing more robust military policies. But others will not declare their support for America’s global role. Acknowledging it would risk raising the question of why those who take advantage of the services America provides do not pay more for them. It would risk, that is, other countries’ capacities to continue as free riders, which is an arrangement no government will lightly abandon.

In the end, however, what other nations do or do not say about the United States will not be crucial to whether, or for how long, the United States continues to function as the world’s government. That will depend on the willingness of the American public, the ultimate arbiter of American foreign policy, to sustain the costs involved. In the near future, America’s role in the world will have to compete for public funds with the rising costs of domestic entitlement programs. It is Social Security and Medicare, not the rise of China or the kind of coalition that defeated powerful empires in the past, that pose the greatest threat to America’s role as the world’s government.

Mandelbaum's thesis is, in many ways, an updating an old warhorse in international relations scholarship, hegemonic stability theory (HST).

The funny thing about HST is that almost no one in the discipline would claim to buy the whole argument. Realists don't buy it because the theory posits that a hegemonic actor provides global public goods even though it knows that other states, by free riding off those goods, will catch up in terms of relative power. Liberals don't buy it because the evidence that international regimes collapse when a hegemon is in decline turns out to be pretty meager. Constructivists don't buy it because the root of the theory is a state's material power and not its power over norms is what drives the model. Rationalists don't buy the hegemon's motivations -- why provide public goods and tolerate free riding when an actor can coerce others into chipping in?

That said, the model is still around when academics talk about policy, because at some level there's a ring of truth to it. It's the difference between pure theory and policy-relevant scholarship -- which is a topic too big for this blog post.

posted by Dan on 01.07.06 at 10:32 AM


Body weight standards are an imprecise gauge of health, and of course weight doesn't cause many diseases. Being overweight, as the author stated, is a symptom.

But because that symptom is so evident in the American population, Americans' diets and activity levels need to change if they want to be healthy.

posted by: b. phillips on 01.07.06 at 10:32 AM [permalink]

"The also have released faulty estimates about the amount of deaths attributable to obesity,"

Surely he isn't talking about that recent study that found that people who were heavier lived longer. It's since been debunked because the sample had included alot of people who were thin because of terminal illness.

“For most medical conditions, it is diet, exercise and genetics that are the real causes. Weight is merely an associated symptom.”

Yes, well of course, but he is being pedantic here. Being overweight is a sign of poor diet and lack of exercise. There's no such thing as a "mere" symptom. One only needs to visit a college campus and notice the enormous number of young people with middle-aged physiques to understand that things have indeed changed.

posted by: rakehell on 01.07.06 at 10:32 AM [permalink]

To me, there is a worrying causality problem in the Chronicle's article, and maybe in the book if the article is faithful to it.

- Paragraph 1 contests the statement S1 = "it is scientifically proven that being overweight or obese threatens your health".

- Paragraph 2 contests the statement S2 = "people designated as overweight or obese are indeed overweight or obese, according to scientific indicators."

When I read those two §s consecutively, I get the impression that S1 is wrong because S2 is wrong. Well, I would agree that S2 is, indeed, flawed, because the Body Mass Indicator is an old and inefficient indicator from the 70s. Yet this does not weaken S1 at *all*.

New indicators have shown up: the spatial distribution of grease on the body is now taken in account, and abdominal fat has been identified as much more dangerous than fat located elsewhere on the body. These indicators produce less aberrant classifications, yet the causal equivalence "obesity = threat" stays untouched.

My conclusion is that contesting obesity indicators does not automatically brings me to invalidate the relationship between fat and increased health hazard -- quite the reverse! In that sense, the article is critically wrong in its deductions, in my humble and tired opinion.

posted by: François/phnk on 01.07.06 at 10:32 AM [permalink]

of course 'fat' is more of a symptom than a cause in most cases, but that doesn't change it's value as an ruler against which to measure well being since, one, it's very difficult to be 'fat' if one has a healthy diet, and two, fat people tend not to get exercise and lack of exercise is a cause of poor health. Type 2 diabetes is perfect example: people with type 2 tend to be fat because they eat 'bad' food and do not exercise; the bad food and lack of exercise is what's causing the diabetes but being fat is a good indicator of something being wrong and that's why it's completely legitimate to link fat with poor health.

posted by: saintsimon on 01.07.06 at 10:32 AM [permalink]

While it's true that there are few direct medical risks from being overweight, a large number of common risk factors correlate directly with weight. So, e.g., if you are hypertensive, if you have high cholesterol, if your father was chubby and died of a heart attack at an early age, or if you are diabetic, you should lose weight. If, on the other hand, you are none-of-the-above, and you are OK on diet and exercise, your weight doesn't matter.

posted by: Matt on 01.07.06 at 10:32 AM [permalink]

"Deconstructing" BMI seems to be a bit of attacking a straw-man, since it is clearly a "rule-of-thumb" type indicator, even if it may be overemphasized in popular culture (media) usage; but that's true of most things in the media. The whole issue of cause and effect may be aside the point anyway; the "merely associated symptom" of weight may be a very direct and easily measurable indicator for the average person to use to manage their overall day to day health, so why discourage people from paying attention to it? In any case, I'll continue to consult an MD for my health issues, not a political scientist.

posted by: tom on 01.07.06 at 10:32 AM [permalink]

Type 2 diabetes is perfect example: people with type 2 tend to be fat because they eat 'bad' food and do not exercise; the bad food and lack of exercise is what's causing the diabetes but being fat is a good indicator of something being wrong and that's why it's completely legitimate to link fat with poor health.

I thought of the case of diabetes immediately as well. Then I was astonished to read in the Times today that about one in every eight adult New Yorkers is a diabetic. Eric's a smart guy, but (not having seen it) I hope the book isn't an exercise in getting it right but missing the bigger point.

The one mystery that remains for me is why powerful economic sectors -- like processed food services and restaurant owners -- haven't fought harder against the obesity myth.

This isn't a mystery at all, because there's no conflict. Processed foot services are happy to provide all kinds of basically bad-for-you stuff in the name of diet fads -- low carb or low-fat or high protein or anything you like in highly-processed junk form.

posted by: Kieran on 01.07.06 at 10:32 AM [permalink]

A downside to blogging about two unrelated books in one blog entry is that the comments become harder to follow. I have a few comments on Mandelbaum's Foreign Policy article.

I think that the Nation Intelligence Council paper by G. John Ikenberry does a better job of analyzing the ways in which countries can respond to American hegemony. The only response Mandelbaum considers is for other nations to form an alliance to balance (or overwhelm) America's power. But other nations have a variety of responses which can make things easier or more difficult for the United States.

For example, Zapatero's victory in the 2004 Spanish elections certainly wasn't good news for the United States. Aznar thought that close cooperation with the United States would bring Spain sufficient benefits to justify the cost; Spanish voters didn't buy it. And that's one problem with Mandelbaum's focus on what foreign policy officials in other nations think (or, more precisely, what Mandelbaum speculates that they think). In a democracy, it's often what the voters think that counts.

posted by: Kenneth Almquist on 01.07.06 at 10:32 AM [permalink]

About Michael Mandelbaum's book: "Rationalists don't buy the hegemon's motivations -- why provide public goods and tolerate free riding when an actor can coerce others into chipping in? "

The obvious reason is that the public goods being provided are extremely beneficial to the factions controlling the hegemon's behavior.

posted by: Barry on 01.07.06 at 10:32 AM [permalink]

I think the criticism of Oliver should go farther than noting that that being overweight is an indicator of poor diet and insufficient exercise. most people know that 'overweight' means too high of a bodyfat percentage, and those with lots of muscle, like arnold, aren't included. (of course, steroids cause health problems too.) There are few 'conclusive' proofs in many of the diseases that kill people in rich countries. there are too many factors, the time frame is too long, and you can't force a group of people to do whatever you want to experiment on for 30 years. But there is a lot of evidence that excess bodyfat is unhealthy, however much the evidence is poorly transmitted to the public.

posted by: yoyo on 01.07.06 at 10:32 AM [permalink]


Please recognize that voting for Zapatero was not necessarily a vote against U.S. hegemony. True Zapatero promised to pull Spanish troops from Iraq, but to my knowledge he has never suggested actively opposing the U.S.-led coalition outside of the highest level diplomacy. Thus if you're going to mind-read the Spanish, the most you can assert is that they voted against Spanish involvement in the Iraq war. (BTW, let's also recognize that a vote for Merkel wasn't necessarily a vote for U.S. hegemony, rather at most an acknowledgement that a little more rapprochement with the U.S. wouldn't be bad.)

Which I think underlines Mandelbaum's thesis: other nations aren't happy with Pres. Bush's version of U.S. hegemony, but they don't seem to be so unhappy that they're directly opposing it. They are using other strategies to engage and influence U.S. power, as Ikenberry does illustrate.

Of course Ikenberry also suggests that the other major powers are evolving their strategies. Which should caution anyone who thinks more U.S. unilateralism or isolationism would be good.

posted by: kwo on 01.07.06 at 10:32 AM [permalink]

Post a Comment:


Email Address:



Remember your info?