Interventions That Don't Involve Belittling the Obese

VelveteenAmbush - [original thread]

Both sides of this perennial Reddit debate are shit.

On the one hand, yes, obesity is a health crisis, is physically disgusting, affects people around you negatively in many contexts, should not be normalized, usually involves a heavy element of self neglect, and is clearly aberrational if one can see more than a generation into the past. We shouldn't celebrate fatness, euphemize it, pretend it's consistent with a healthy life, or attempt to convince ourselves that obesity is attractive (a futile struggle if ever there was one).

On the other hand, those of us who are disgusted by obesity often go way too far in condemning it, reducing it to purely a moral failing, promoting empirical falsehoods like "it's just calories in versus calories out" (as though metabolic syndrome and insulin resistance and glycemic load - or even just appetite-based homeostasis - just do not exist) or "just exercise" (surprisingly scant evidence that promoting exercise is an effective intervention), ignoring that different people appear to have genuinely different inborn propensities to gain weight, and generally seeming to focus all of their effort on shaming and abusing fat without any attention to whether this is likely to be productive or just to further sap fat people's motivation and make them even more miserable.

Nor is my latter set of complaints apace with general liberal distractionism like we see with certain other issues, such as pretending that homelessness can be solved with ever more low-income housing, that crime can be solved by spending ever more money on social workers, that poverty can be solved with ever more handouts. I recognize the impulse to link them, but the factor that sets apart a more productive approach to obesity is that there are genuinely more productive approaches we could take, that there is a lot of low-hanging fruit that we could harvest, if the anti-fat activists weren't quite so obsessed with hating fat people to the exclusion of all else.

To wit:

  • We could stop promoting counterproductive dietary advice that basically consists of "eat all the bread, stuff yourself with simple carbs, avoid eating fat and fill your low-fat foods with sugar so it doesn't taste like cardboard" (I vividly recall the "food pyramid" in elementary school, in which the base of the pyramid was "10-12 servings of grain per day" and meats and fat were treated like poison, and public health advice seemingly has not advanced in the decades since). Eating a high-protein, high-fiber and high-fat diet is very effective at avoiding glycemic load, metabolic syndrome, insulin resistance and diabetes. It isn't necessarily a cure once someone has progressed down that spiral of morbidity, but it is effective at preventing the spiral in the first place. I am sure that future generations will look back on dietary advice of 1970 through the present with the same horror that we look back on the era of leaded gasoline.

  • We could ban sugary soda, or at least strongly nudge people away from it, because it is effectively poison. I find it particularly frustrating that the anti-fat activists I've argued with seem adamantly opposed to this type of intervention. But of course we ban other foods that are dangerous. Trans fats are largely a thing of the past, and good riddance. You can't sell a burger that is full of lead, even to a consenting adult, even if you disclose the lead content, even if you get them to sign a waiver first. The first letter of the FDA is dedicated to regulating this kind of thing!

  • We could acknowledge that fruit juices are approximately equivalent to sugary soda in terms of being effectively poison if you are going to drink more than 4-8oz at a time.

  • We could promote (even pay for!) surgical interventions like gastric bypass, banding, etc. that are empirically proven to enable lasting weight loss.

  • We could research weight loss drugs with a fraction of the fervor that we research treatments for cancer and the like, since the aggregate health toll of obesity is certainly orders of magnitude higher than that of cancer.

  • We could stop suggesting exercise for obese people. Exercise is generally healthy but it evidence is scant that it causes substantial and sustainable weight loss, especially after someone is obese. It's also very difficult for someone who is already obese to exercise safely; their joints are in a lot of peril even with standard daily activity, let alone trying to go for a long distance run. Even aside from physical danger, attempting weight loss via intense exercise is extremely counterproductive. The Biggest Loser was a catastrophe for its participants, and all advice that proceeds along similar lines will be similarly catastrophic.

So, my challenge for people who are lining up to condemn fat people but who like to think of themselves as engaged in something other than literal bullying for its own sake: Prove it! What kind of interventions would you favor that don't involve belittling the obese? Have you given any thought at all to that question? If you've posted about this topic in the past, can you link to a comment where you've approached the problem from that angle, or is everything you post just a bunch of anti-fat invective?

For what it's worth, neither I nor anyone in my family is or has ever been obese, this is not a matter of self interest.