Monday, May 17, 2010

Fat Panic as Front-Page News (Again)

EXECUTIVE SUMMARY: An article in my local newspaper reporting on the most recent of a long series of studies analyzing data from a large national survey of U.S. children's health has managed to reduce that study's findings to boilerplate obesity-scare rhetoric. The study's author, Gopal Singh, has found that lots and lots of things contribute to a region's, or demographic group's, relative prevalence of childhood obesity, and a lot of those things have to do with economic inequality. But the newspaper article ignores these larger, systemic aspects of public health and seems to promote constant vigilance over children's diet, lifestyle and body size as The Answer to the Childhood Obesity Epidemic. I don't think that's the answer, because dieting for weight loss --- i.e., chronic low-level undernutrition --- is also very bad for people, and it's especially dangerous for children, who are not yet done building the bodies they're going to have to live in for the rest of their lives.

This article in today's Kansas City Star is a pretty good (and by "good" I mean "aggravating") example of the above formula (i.e., fat panic as front-page news).

Let's start with the title: "Study reveals soaring obesity rates among girls." I like those two verbs --- "soaring" obesity rates! It seems like every obesity-related news story uses some kind of dramatic, exciting action verb like that --- soaring, skyrocketing, ballooning, exploding --- or, more rarely, an adjective that conjures similar images of rapid expansion or upward motion, like "stratospheric." And then there's "reveals." While "reveal" is a perfectly good word for talking about research findings --- being a synonym for "show," "demonstrate," "present," etc. --- it also has connotations that whatever is revealed had been hidden, as opposed to merely there waiting for someone to call attention to it. This idea of a menace lurking insidiously under our noses is a staple of alarmist journalism, and has often been used before in equally panicky stories about an Obesity Epidemic.

The study they're talking about is this article in this month's Archives of Pediatric and Adolescent Medicine, which looks at the prevalence of obesity (BMI at or above the 95th percentile for the child's age) and overweight (BMI between 85th and 95th percentiles) among children all over the US in 2003 and 2007, as determined by parents' responses to a nationwide telephone survey about their children's health conducted in both of those years.

The article is actually one of several, all based on different statistical analyses of the same survey data. The lead author of all these studies, Dr. Gopal Singh, is looking at all sorts of different structural and demographic factors for things that correlate to greater rates of obesity within certain groups of people: things like whether people live in walkable communities, how poor they are, their race* and ethnicity, what kind of food they can afford/have time to prepare, how much crime there is in their neighborhoods, whether there are parks nearby, etc.

Here is ScienceDaily's summation of Dr. Singh's most recent findings:
The geographic patterns in childhood obesity are similar to those observed among adult populations, the authors note. Several Southern states -- including Mississippi, Georgia, Kentucky, Louisiana and Tennessee -- were in the top one-fifth of both childhood and adult obesity rates in 2007. For both adults and children, obesity rates were highest in the Southern region and lowest in the Western region.

"Individual, household and neighborhood social and built environmental characteristics accounted for 45 and 42 percent of the state variance in childhood obesity and overweight, respectively," the authors write. "Prevention programs for reducing disparities in childhood obesity should not only include behavioral interventions aimed at reducing children's physical inactivity levels and limiting their television viewing and recreational screen time but also should include social policy measures aimed at improving the broader social and physical environments that create obesogenic conditions that put children at risk for poor diet, physical inactivity and other sedentary activities," they conclude.
(Semantic aside: I love how merely not engaging in physical activity is deemed a "sedentary activit[y]" in its own right in that last sentence. I had no idea you could be so busy not doing something!)

Anyway, one of the weirder things Dr. Singh found in his comparison of the 2003 and 2007 National Children's Health Survey data was two states whose childhood obesity-prevalence numbers almost doubled in those four years. Those states were Arizona and Kansas, with 2007 rates 90.9% and 91.4% higher than their respective rates in 2003.

Also, this increase (which is humongous when compared with the national increase of just 10% over the same period) was only observed in girls. Boys' rates of overweight and obesity did not change significantly between 2003 and 2007.

One thing that has definitely changed between the early and late '00s is the level of sheer panic that's crept into people's attitudes about weight; where maybe before, you might know your child was overweight, and maybe you worried a little about how much weight they might continue to gain once they stopped growing and their metabolism slowed down (or, alternatively, you didn't worry at all because they were still growing!) whereas now, being even a little bit overweight is seen as a life-threatening condition. (You think I exaggerate? Read this. And this. And this. And this. And this. And also, this entire blog).

The study's design protects it somewhat from undue influence of parental attitudes about their children's weight because the parents are not asked whether their child is overweight or obese; they're just asked the child's height and weight (along with, obviously, their age). There's still some room for parental interpretation, in that the parents might have an imperfect notion of what their children actually weigh, and some overly-worried, perfectionist parents might overestimate the weight of a healthy child they're convinced is too chubby. (Or, alternatively, more parents might be actively monitoring their children's weight, due to scaremongering awareness campaigns about Childhood Obesity, and thus more kids who are overweight are having their weights accurately reported). Girls would be particularly prone to this sort of thing, since thinness is so highly prized in girls, and the size of a girl's body is frequently a subject of contention between that girl and her controlling, abusive, judgmental or over-involved parents.

Those factors are more or less constant throughout society, though, and tend --- especially the parental-perfectionism one --- to be concentrated in the demographic categories that didn't see much of an increase in girlhood obesity: white, middle- and upper-class families. The abstract of this other study of the same data makes it clear that most of the increase was seen in poorer children of color.

In general, the groups of people seeing the sharpest increases in childhood obesity over the past four years were the same groups within which obesity is especially prevalent: this is stated explicitly in a study Singh, along with coauthors Michael D. Kogan and Mohammad Siahpush (Kogan, but not Siahpush, is also a coauthor of the state-by-state study) conducted last year, finding that "[s]ocial inequalities in obesity and overweight prevalence increased because of more rapid increases in prevalence among children in lower socioeconomic groups."

However, there is very little discussion of social, economic or policy implications of this research in the Star article; when one social factors do come up is typically in the context of laws mandating certain behaviors at the individual level, rather than addressing any of these underlying systemic inequalities:
Nobody knows why for sure, but girls in Kansas have been gaining weight at an alarming rate.

From 2003 to 2007, the percentage of Kansas girls 10 to 17 years old who were obese nearly doubled, a new federal study shows.
Most of the increase in obesity in Kansas may have been among girls who were below high school age, [study author Gopal Singh] said.

About one in three children in the United States is now considered overweight or obese, which is raising concerns about their future health and even their longevity. Many children already are developing diabetes or showing early signs of heart disease that typically are found in adults.

First lady Michelle Obama recently initiated the "Let's Move" campaign against childhood obesity. A government report last week offered 70 recommendations, including healthier food at schools and getting children to exercise more, to combat weight gain.

People who are obese are well above normal weight and have large amounts of body fat. Obesity is usually measured by a calculation based on height and weight called the body mass index, or BMI.

For example, a 12-year-old girl who is 5 feet tall would be considered to be a healthy weight at 110 pounds and obese at 130 pounds.

Singh's study found wide variations in obesity rates among states, even after accounting for ethnic and economic differences.

Kids in Kansas, for example, were twice as likely to be obese as kids in Oregon, which had the lowest obesity rate.

Differences in the availability of parks and playgrounds and in state policies promoting healthy weight among children may play a role, Singh said.

State policies could be a factor in Kansas, said Sarah Hampl, a pediatrician who directs weight management services at Children's Mercy Hospital.

She pointed to a 2009 report by the Trust for America's Health that noted which states had nutrition standards for foods available to children at school or policies for measuring students' BMIs.

"Notably, Kansas was one of the only states in the nation that doesn't have this kind of legislation," Hampl said.
So, while the article does allude to some of the social and environmental factors Singh found accounted for some of the state and regional variation --- it mentions the issue of access to safe outdoor spaces --- it gives more emphasis to solutions addressing children's behavior: restrict what kinds of foods they can get at school, regularly weigh them, etc.

I was particularly distressed to see Dr. Hampl's suggestion that Kansas's lack of school BMI-monitoring policies might explain the state's "alarming" increase in childhood obesity rates appearing just a few inches below Dr. Singh's claim that most of the newly obese or overweight girls in his study are probably preteens; the last thing girls need right as they're going through puberty is some adult scrutinizing their bodies and warning them not to gain any more weight!

*While there is certainly a big role for systemic, economic racism in explaining why people in some racial and ethnic categories tend to be both fatter and less healthy than people in others --- African-Americans, Latin@s and Native Americans are all much likelier than white Anglo-Americans to be poor, unable to afford enough food, and to live in food deserts --- another factor might just be variation in average body type among different ethnic groups. Urocyon has several eye-opening posts about how her body type, which she shares with her relatives and with lots of other people, living and historical, with Cherokee/Tutelo heritage, has been deemed ugly, fat and dangerously unhealthy throughout her life because it doesn't match the thin, willowy ideal of beauty and health that, while it might be unrealistic for most white, European women, too, is even further removed from the actual bodies of most women of color.


Anonymous said...

Excellent post.

Yep, it's depressingly predictable. So much easier to point to individual problems which can be solved through increased control over the problem individuals. :(

I have been interested in the geographical groupings, as well. Not only does pointing at horribly obese Southerners (adults and kids) reinforce classism and regional bias, from my own experience I find it very interesting indeed that the folks judged most obese are clustered in Oklahoma and Arkansas, and in areas from which an awful lot of people ended up in those places. And in which a lot of their relatives still live. I mean, Oklahoma ought to be a tip-off that some racist standards might be involved, right there; it's hard not to have some Native ancestry (mostly from the "fat" Southeast) there. I mean, 7.9% of the population listed themselves as Cherokee on the Census, and that's not even counting the other 38 federally recognized nations. Along with all the state recognized, unenrolled, and earlier "passing" people (both huge groups).

My own experiences tally pretty well with Billy Brady's:
In a 55 acre housing tract of scattered former Navy duplexes; perhaps 250 people; over 90% of those I asked said they, too, were "part-Indian". For all that our racist system cared they were probably considered "white". I knew better. I know better.

They hailed from Oklahoma, Tennessee, Arkansas, Texas, Georgia, Arizona, New Jersey and many other places. I knew them to be "just like us": part-Indian.

That 90%+ sample had some class bias built in, for people from socioeconomic backgrounds which make them consider the military as a good career and educational option. I do not find this coincidental, either, especially coming from an area which provides a disproportionate amount of cannon fodder.

Yeah, sometimes I feel like a broken record when this kind of thing comes up. But it's hard not to see this kind of thing as the next step in forced assimilation: you will starve yourself in a futile effort to look the way we think you should. And now you should also starve your obviously inferior children. :(

Anonymous said...

Oops, I had a brain fart while re-skimming that piece. For "people from socioeconomic backgrounds which make them consider the military as a good career and educational option", read "people living in a housing project converted from military housing". Not that I'd be surprised if a decent percentage had also been in the military at some point. :-|

wriggles said...

But it's hard not to see this kind of thing as the next step in forced assimilation: you will starve yourself in a futile effort to look the way we think you should. And now you should also starve your obviously inferior children.

I'm glad I'm not the only one noticing this effect of cultural supremacy dissemination creep.

It's funny how when you begin to squeeze something unpleasant out from certain places, if the force of it remains intact; it just comes out someplace else.

Hey, is that like physics or something?

Trabb's Boy said...

This was a really brilliant article. I really hope to find more about the links between increasing poverty and increasing BMI. The American middle class is disappearing, and those falling into poverty are dealing with enormous amounts of stress as well as food deserts, lack of safe green spaces, lack of time to fuss over food choices, etc. It would not surprise me at all to see some real causation there.

Amanda said...

Urocyon: Yep and that's me - fat descendent of people from both Oklahoma and Arkansas who were Indian descended "whites" and whole family is fatexcept few random people.

Meowser said...

Okay. So if this "huge increase in child obesity" really does exist, why is it a one-gender phenomenon, O Scientific Ones? (Not to mention one that bypasses more affluent whites, like you said.)

I think a lot of the stuff you point to is probably true; girls are concern-trolled more about their weight than boys are, so they would be judged to be fatter at lower levels of BMI, or even likely to have their weight overestimated. (They could have actually weighed and measured the kids themselves and done away with that possibility, but noooo, that would have been too easy.)

But haven't any of the Scientific Ones stopped to think about the fact that dieting and self-imposed food restriction is rampant among young girls, and has become even more so as the Great Fatty Panic of the Aughties (not auties!) has built to a five-alarm shriek? And that dieting/food restriction not only trashes metabolism but also represses height (and therefore increases BMI)? And of course, the ill effects of doing so would more negatively impact people with a genetic tendency to gain a lot of weight.

But gods forbid we should tell girls not to diet. Anything but that, right?

Lindsay said...

Yeah, Meowser, the only-girls-are-getting-fatter thing is the main reason why I thought it was probably a change in parents' weight-monitoring behavior rather than an actual increase in the girls' size. (That, and that fact that four years is a very short time for a major demographic change like that to take place!)

I also wish they could have taken actual measurements rather than rely on parents' estimates of their children's weight; my guess is that the gender gap would probably diminish if they'd done that.

And, yes, I also totally agree with you that disordered eating poses more of a threat to preadolescent girls in my book than obesity does.

Lindsay said...


Whoa, it didn't even occur to me that a lot of the officially "white" people in the Southeast (and south-eastern Midwest, which is what I'd consider Arkansas, Oklahoma and Missouri) might have significant Native ancestry.

Now that you mention it, though, it is obvious, considering the historical significance of Oklahoma, especially...