Fat land : how Americans became the fattest people in the world (28 page)

Then, just as both groups: Corbin interview; Hayes interview; An independent narrative is found in "Meeting Minutes," April 1991, pp. 45-55, Box 13, PPCPF According to testimony by Warren Giese, "The AAPHERD [sic] people at the final meeting sat down and ... looked us all in the eye and said either you use the test that we scientists say is the test that is supposed to be used which included a skin foid test which this Council absolutely refused to accept and that started us off as to we would not use the test... the basic rupture was because AAPHERD was going to tell the President's Council either we use that test or else."

"wasn't ever in the business of making weight an issue": Hayes interview.

84 In one ad depicting: "Ad Council," Box 4, PPCPF The identification and reporting of overweight and obesity were part of the original council mission, as evidenced in the 1961 guide, published by the council, entitled Youth Physical Fitness: Suggested Elements of a School-Centered Program. The guide states (p. 7) that "health appraisal proce-

NOTES

dures should include . . . height and weight measurements, interpreted in terms of individual needs; pupils who are obviously obese, underweight or malnourished should be identified and referred to the medical authorities" (Box I, PPCPF). See also "A Special Note About Weight," in Bud Wilkenson, Official U.S. Physical Fitness Program (Washington, D.C.: President's Council, 1962), p. 7.

84 "As we saw it. . . body fat testing . . .": Corbin interview.

85 "We were basically shut out": Ibid. Also interview with Dr. Judy Young, president, AAHPERD.

"15-60 minutes of continuous aerobic activity": American College of Sports Medicine, "Position Stand on the Recommended Quantity and Quality of Exercise for Developing and Maintaining Fitness in Healthy Adults," 1978. For a thorough chronological review of the standards and their weakening, see also S. N. Blair, R. S. Paffen-barger, H. W. Kohl, and N. F. Gordon, "How much physical exercise is good for health?" Annual Review of Public Health, v. 13, 1992, pp. 99-126.

86 "Adequate exercise means vigorous exercise": J. N. Morris, R. Pollard, etal, "Vigorous exercise in leisure-time: protection against coronary heart disease," Lancet, December 6, 1980, pp. 1207-1210. Experts attributed this to the modern lifestyle: Only recently have hard population data emerged on this point. An outstanding recent work looking at the period 1982-1989 showed a substantial rise in the percentage of least strenuous jobs and a substantial drop in the percentage of most strenuous jobs. See Table One in Darius Lakda-walla and Tomas Philipson, "The Growth of Obesity and Technological Change" (Santa Monica: RAND Institute, 2001).

87 On both these accounts . . . Harvard . . . Cooper's: Ralph Paffen-barger, Jr., Alvin Wing, and Robert Hyde, "Physical activity as an index of heart attack risk in college alumni," American Journal of Epidemiology, v. 108, September 1978, pp. 161-175; Ralph Paf-fenbarger, Jr., et ai, "The association of changes in physical-activity level and other lifestyle characteristics with different mortality among men," New England Journal of Medicine, v. 328, February J 993> PP- 525-545; Steven N. Blair, Harold Kohl, Ralph S. Paffen-barger, Jr., et ai, "Physical fitness and all-cause mortality," Journal of the American Medical Association, v. 262, November 1989, pp. 2395-2401.

"If there is a causal relationship": Paffenbarger, Wing, and Hyde, "Physical Activity ..." p. 166.

88 "High intensity exercise affords little additional benefit": Robert

NOTES

DeBusk, Ulf Stenestrand, etai, "Training effects of long versus short bouts of exercise in healthy subjects," American Journal of Cardiology, v. 65, April 1990, pp. 1010-1013.

88 "A brisk walk of 30-60 minutes ...": Blair, Kohl, et al, "Physical Fitness and ...," p. 2400.

The American Heart Association was the first: Gerald Fletcher, Victor Froelicher, et al, "Exercise standards: a statement for health professionals from the American Heart Association," Circulation, v. 82, December 1990, p. 2307.

89 Even the authors of the Cooper and Harvard: Blair, Paffenbarger, et al, "How much physical exercise ..." p. 102.

In 1993 they seized control: Centers for Disease Control, American College of Sports Medicine, President's Council on Physical Fitness, Summary Statement: Workshop on Physical Activity and Public Health (Indianapolis: American College of Sports Medicine,

1993)-

After all, only six months before: Paffenbarger et al, "The Association of Changes ..." p. 544.

90 "was under tremendous pressure . ..": Interview with Walter Ettinger, M.D., Wake Forest University.

91 Consider what they wrote in the aftermath: Quoted in Paul Williams, "Relationship of distance run per week to coronary heart disease risk factors in 8283 male runners," Archives of Internal Medicine, v. 157, January 1997, p. 191.

93 The authors, led by Stanford's Robert F. DeBusk: DeBusk, Stenestrand, et al, "Training effects ..." p. 1010.

Peak oxygen intake: Ibid.

"multiple short bouts ... as a single long bout": Ibid., p. 1013.

"In contrast . . . increasing the overall daily . . .": Paul Williams,

"Physical fitness and activity as separate heart disease risk factors: a

meta-analysis," Medicine and Science in Sports and Exercise, 2001,

pp.754-761.

94 "Our data suggest that substantial health benefits ...": Williams, "Relationship of distance ..." p. 191.

"Formulating physical activity recommendations . . .": Williams, "Physical Fitness and Activity ..." p. 754.

"overall, there is a consistent inverse dose-response": Y. Antero Kesaniemi, Elliot Danforth, Jr., et al, "Dose-response issues concerning physical activity and health: an evidence-based symposium," Medicine and Science in Sports and Exercise, v. 33, supp., June 2001, P- S354-

NOTES

95 The ACSM itself recently published: Claude Bouchard, "Physical activity and health: introduction to the dose-response symposium," Medicine and Science in Sports and Exercise, v. 33, supp., June 2001, p. S348.

"current strategies have not been very successful . . .": Frank B. Hu, Joanne E. Manson, "Diet, lifestyle, and the risk of type 2 diabetes mellitus in women," New England Journal of Medicine, v. 345, September 2001, pp. 790-797, see especially Table 1. See also F. B. Hu, R. J. Sigal, et ai, "Walking compared with vigorous physical activity and risk of diabetes in women: a prospective study," Journal of the American Medical Association, v. 282, October 1999, pp. 1433-1439; M. J. Stampfer, F. B. Hu, J. E. Manson, E. B. Rimm, and W. C. Willett, "The primary prevention of coronary heart disease in women through diet and lifestyle," New England Journal of Medicine, v. 343, 2000, pp. 16-22; F. B. Hu, M. J. Stampfer, J. E. Manson, G. A. Colditz, and W. C. Willett, "Trends in the incidence of coronary heart disease and changes in diet, and lifestyle, in women," New England Journal of Medicine, v. 343, 2000, pp. 530-537. Noting that members of the Weight Registry: Transcripts of Proceedings: Dietary Guidelines Advisory Committee (Washington, D.C.: USDA), September 28, 1998, pp. 102-104.

"the assumption [is] that most people . . .": Bouchard, "Physical activity and health ..." p. S349.

The guidelines are promulgated every five years: Carol Davis and Etta Saltos, "Dietary Recommendations and How They Have Changed Over Time," in America's Eating Habits (Washington, D.C.: USDA/Economic Research Service), publication AIB-750, p. 45 for chart.

97 "At what weight-for-height ranges does minimum mortality . . .": R. Andres, D. Elahi, et ai, "Impact of age on weight goals," Annals of Internal Medicine, v. 103, 1985, pp. 1031-1033.

"the Metropolitan Life tables have erred . . .": Ibid., p. 1032. "We compared the body mass . ..": Ibid., p. 1031.

98 "systematic underestimate of the impact of obesity . ..": JoAnn Man-son, Meir Stampfer, Charles Hennekens, and Walter Willett, "Body weight and longevity: a reassessment," Journal of the American Medical Association, v. 257, 1987, pp. 353-358.

99 "few in the general U.S. population . . . excessive leanness": Ibid.,

p. 358. 100 "I can line up ten people . . .": Interview with Wayne Callaway.

"lets men off the hook too easily": Ibid. See also Transcripts ofPro-

NOTES

ceedings: Dietary Guidelines Advisory Committee, January 10, 1990, p. 212.

101 To Callaway, such a statement was "authoritarian": See also Transcripts of Proceedings, August 10, 1989, p. 97.

"But that concept still has to be conveyed . ..": Ibid., pp. 97-98. "Because if we look at certain subsegments . . .": Transcripts of Proceedings, August 5, 1989, p. no.

"By the time a woman gets to age sixty-five ...": Ibid., p. 106. "our views did not get a fair shake": Interview with Meir Stampfer.

102 "As far as I am concerned": Interview with Walter Willett.

As the New York Times put it: Denise Webb, "What Is a Healthful Diet?" New York Times, November 7, 1990, p. C3. For the next five years ... a broad swath: For an example, see "Weight, weight change, and coronary heart disease in women," Journal of the American Heart Association, v. 273, 1995, pp. 461-465, and citations therein.

"Based on published data, there appears to be no justification . . .": Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, iggs (Washington, D.C.: Human Nutrition Information Service, USDA).

103 "Fit, fat, and bald . . .": Quoted in Linda Villarosa, "New Fatness Guidelines Spur Debate on Fitness," New York Times, June 23, 1998, p.F 7 .

He has run, by his own estimate: Laura Beil, "Fatness, Fitness Can Coexist," Dallas Morning News, August 30, 1999, Health Section, p. 1. "We've got to get rid of this focus on weight": Quoted in Emma Thomas, "Study Finds Obese Exercisers Outlive Thin People Who Don't," Tulsa World/Associated Press, July 19, 2001. "Let's throw away all the scales . . .": Beil, "Fatness, Fitness . . ." "you can stay overweight and obese . . .": Thomas, "Study Finds Obese Exercisers ..."

The test starts at a speed of eighty-eight: Carolyn Barlow, Harold Kohl, Larry Gibbons, and Steven N. Blair, "Physical fitness, mortality and obesity," International Journal of Obesity, v. 19, supp. 4, I995,pp. S41-S44.

104 "inverse gradients of mortality . . . were similar for obese . . .": Ibid., p. S44.

"The health benefits of normal weights appear to be limited . . .": C. D. Lee, A. S. Jackson, and S. N. Blair, "U.S. weight guidelines: is it also important to consider cardiorespiratory fitness?" International Journal of Obesity, v. 22, supp. 2, 1998, pp. S2-S7.

NOTES

105 The media translation was predictable: Thomas, "Study Finds Obese Exercisers ..."

A book came out that was entitled: Judy Molnar and Bob Babbitt,

You Don't Have to Be Thin to Win (New York: Villard, 2000).

The New York Times even went so far: Jane E. Brody, "Fat but Fit: A

Myth About Obesity Is Slowly Being Debunked," New York Times,

October 24, 2000, p. D7.

Blair admitted: "Men with a BMI >30 . . .": Barlow, Kohl, Gibbons,

and Blair, "Physical fitness, mortality .. .," pp. S41-S42.

"The highest death rate": Ibid., p. S42.

And when one looks at the difference between: Ibid., see chart, p. S42.

106 "Men who were normal weight . . .": Lee, Jackson, and Blair, "U.S. weight guidelines: is it.. .," p. S4.

Of Blair's total universe of people, 8100: Ibid., chart, p. S5.

107 Alexander is also, at 5'8" and 260 pounds, "a big boy": Quoted in Foster Klug, "Being Fat Doesn't Mean He's Not Fit," Sunday Washington Times/ Associated Press, February 11, 2001.

"The most important risk factor for type 2 diabetes ...": Hu and Man-son, "Diet, lifestyle, and the risk of type 2 . . .," p. 795. "More than 61 percent. . .": Ibid.

the laboratory of so-called Syndrome X: Gerald Reaven, Syndrome X: Overcoming the Silent Killer That Can Give You a Heart Attack (New York: Simon & Schuster, 2000), pp. 47-60.

108 A pound of extra body weight: Interview with Dr. Michael Ellman, rheumatologist, University of Chicago, quoted in Jerry Adler, "Arthritis: What It Is, Why You Get It, and How to Stop the Pain," Newsweek, September 3, 2001, p. 44.

5. What Fat Is, What Fat Isn 't

In the popular press, the subject of class and fat has been obscured, at least for the past two decades, by identity politics. Not so in the academic press. In epidemiological literature, an abundance of data has been accumulated, and is routinely reported in the influential Annals of Epidemiology. So too in two professional journals, Obesity Research and International Journal of Obesity, as in the profession's bible, the Handbook of Obesity. A number of original works on the subject of anorexia, obesity, and eating disorders can be found on the Web sites of the Centers for Disease Control, the National Institute for Diabetes and Digestive and Kidney Disease, and the U.S. Surgeon General. On the anthropology of obesity I was fortunate to

NOTES

interview Deborah Crooks at the University of Kentucky at Lexington. On the subject of body image and body weight testing, James Whitehead at the University of North Dakota was of particular help. About the fat rights movement, Michael Fumento has written an engaging and informative book on the subject, The Fat of the Land (New York: Viking Penguin, 1997), well worth your time.

no At the very bottom end were households: See the chart in David Barboza, "Rampant Obesity, a Debilitating Reality for the Urban Poor," New York Times, December 26, 2000, p. D5. "The relationship of income and obesity . . .": Sue Y. Kimm, Eva Obarzanek, et al, "Race, socioeconomic status, and obesity in 9- to 10-year-old girls: the NHLBI growth and health study," Annals of Epidemiology, v. 6, 1996, pp. 272-273.

111 There, obesity has become the defining . . . : Stephanie Mencimer, "Hiding in Plain Sight," Washington City Paper, June 16, 2000, pp. 22-32.

112 "The adolescents . ..": Ibid., pp. 23-24.

"It's tiresome . . .": Ibid., p. 24; for a summary of research on poverty's impact on one's ability to solve life's problems, see also Faith McLellan, "Countering poverty's hindrance of neurodevelopment," Lancet, v. 359, 2002, p. 236.

Much of that cocoon: Michael Stamler, "SBA Loan Guarantees, Select Cities, 1982-2001," Report in Response to Memo from Greg Critser, Small Business Administration, February 21, 2001; Eric Schlosser, Fast Food Nation (Boston: Houghton Mifflin, 2001), pp.101-102.

No wonder that, by the late 1990s: A. M. Freedman, "Fast Food Chains Play Central Role in Diet of Inner-City Poor," Wall Street Journal, December 19, 1990, p. Al.

113 "We knew that kids would want . . .": Interview with Robert Bernstein.

The effort was so important that: Scott Hume, "Research Ignores Pre-teens: Big Mac Exec," Advertising Age, March 17, 1986, p. 28.

114 Pizza Hut changed: "Pizza Hut Targets Kids in Latest TV Push," Advertising Age, May 11, 1992, p. 4.

As a team of Columbia University researchers: Emily DeNitto, "Fast-Food Ads Come Under Fire," Marketing News, February 14, 1994, p. Si4; for an outstanding compendium of such studies, see the Web site for the Center for Science in the Public Interest, the leading advocacy group on the issue, at www.cspinet.org.

NOTES

115 But in 2001 a group of epidemiologists from the University of Minnesota: S. A. French, M. Story, et al, "Fast food restaurant use among adolescents: associations with nutrient intake, food choices and behavioral and psychosocial variables," International Journal of Obesity, v. 25, 2001, pp. 1823-1833.

"Fast food restaurant use was positively associated": Ibid., p. 1823. Worse, they added, "eating habits established in adolescence . . .": Ibid., p. 1832.

the anthropologist Deborah Crooks: Interview with Deborah Crooks; also, Deborah Crooks, "Child growth and nutritional status in a high-poverty community in eastern Kentucky," American Journal of Physical Anthropology, v. 109, 1999, pp. 129-142.

116 "height and weight are cumulative measures . . .": Ibid., p. 138. "Given that as a nation . . .": Ibid., p. 141.

117 "In heterogeneous and affluent . . .": Peter J. Brown and Vicki K. Bentley-Condit, "Culture, Evolution, and Obesity," Handbook of Obesity, ed. George Bray, Claude Bouchard, and W. P. T. James (New York: Marcel Dekker, 1998), p. 149.

"In white girls . . .": Kimm et al, "Race, socioeconomic status ..." p. 271. See also T. J. Parsons, C. Power, et al., "Childhood predictors of adult obesity: a systematic review," International Journal of Obesity, v. 23, supp. 8, November 1999, pp. SI-S71. Although the inverse correlation is strongest among women in developed nations, it cuts across a surprising range of gender, ethnic, and racial groups as well. The inverse relationship can also extend across generations, even when the individual occupies a higher social address. See Albert J. Strunkard, "Socioeconomic Status and Obesity," in The Origins and Consequences of Obesity (New York: Wiley, 1996), pp. 174-206. "The increase in the prevalence . . .": Seidell and Rissanden, "Worldwide Prevalence of Obesity," in The Origins and Consequences of Obesity, p. 87.

"Believe me, it isn't easy . . .": Richard Klein, Eat Fat (New York: Vintage, 1996), p. 17. "With the sort of irony . . .": Ibid., p. 243.

118 Looking for evidence that black girls: See Christian Lawrence and Mark Thelan, "Body image, dieting, and self-concept: their relation in African-American and Caucasian children," Journal of Clinical Child Psychology, v. 24, 1995, pp. 41-48.

As Newsweek proclaimed: Michelle Ingrassia, "The Body of the Beholder," Newsweek, April 24, 1995, pp. 66-67. "You got to be real fat for me to notice": Ibid., p. 67.

NOTES

119 "to eliminate a predominantly white Anglo Saxon": M. G. Melnyk and E. Weinstein, "Preventing obesity in black women by targeting adolescents: a literature review," Journal of the American Dietetic Association, v. 94, May 1994, pp. 536-540.

After adjusting for respondents' weight: Lawrence B. Rosenfeld, Stephanie C. Stewart, and Heather J. Stinnett, "Preferences for body type and body characteristics associated with attractive and unattractive bodies: Jackson and McGill revisited," Perceptual and Motor Skills, v. 89, 1999, pp. 459-470. "The importance of round buttocks . . .": Ibid., p. 468.

120 "Men and women, regardless of race .. .": Ibid., p. 464. "although it has been proposed that certain subcultures . . .": R. M. Rebeck, F. M. Cachelin, et al, "Body Size Preferences Across Ethnic Groups: Presented at the Annual Meeting of the North American Association for the Study of Obesity, 2000" (Los Angeles: Department of Psychology, California State University at Los Angeles), p. 2.

A report in the journal Clinical Pediatrics: B. A. Sisson, S. M. Franco, et al, "Bodyfat analysis and perception of body image," Clinical Pediatrics, v. 36, 1997, pp. 415-418.

121 "That's the big conundrum": Interview with Richard MacKenzie, quoted in Greg Critser, "Let Them Eat Fat," Harper's, March 2000, p. 42.

"The number of kids with eating disorders ...": Interview with Judith Stern, quoted in Ibid.

"Social stigma may serve to control obesity . . .": S. Averett and S. Korenman, "Black-white differences in social and economic consequences of obesity," International Journal of Obesity, v. 23, 1999, pp. 166-173. F° r an elaboration on this theme, see K. J. Flynn and M. Fitzgibbon, "Body images and obesity risk among black females: a review of the literature," Annals of Behavioral Medicine, v. 20, Winter 1998, pp. 13-24. The authors note: "Body images of black females may contribute to their high risk for obesity by inhibiting motivation for weight control."

122 "Ms. Lopez has a nice big muscled ...": Quoted in Greg Critser, "The Meridian Candidate," Worth, February 1999, p. 122.

"Being a black woman . . .": Erin J. Aubry, "Back Is Beautiful," Salon.com, July 15, 1998.

123 "Compulsive eating in women is a response ...": Susie Orbach, Fat Is a Feminist Issue (New York: Galahad Books, 1997), pp. 33-34, 23,25.

"Fat is a social disease . . .": Ibid., pp. 22-23.

NOTES

123 "An early and distinctive psychotherapy of middle class . . .": Joan Jacobs Brumberg, Fasting Girls (Cambridge, Massachusetts: Harvard University Press, 1988, rev. 2000), p. 3.

"The association's materials . . .": Ibid., pp. 19-20; see pp. 12-14 for Brumberg's own statistics; for a more recent statistical summation, which puts the rate of anorexia among adolescent and young adult women at .5 to 1 percent, see Susan Zelitch Yanofski, Obesity and Eating Disorders (Bethesda, Maryland: National Institute of Diabetes and Digestive and Kidney Diseases, 1997), p. 116. "a highly specific social address": Brumberg, Fasting Girls, p. 13.

124 "can legitimately be called a popular saint": Jennifer Egan, "Power Suffering," New York Times Magazine, May 16, 1999, p. 112. "parents sort of freak out": Interview with James R. Whitehead.

125 There were no effects ...: J. R. Whitehead and R. C. Ecklund, "Cognitive and Affective Outcomes of Skinfold Caliper Use in Middle School Physical Education: Presentation to 1997 Conference of the American College of Sports Medicine" (Grand Forks, North Dakota: Department of Health and Physical Education, University of North Dakota, 1997).

Similar studies: See, for example, Joseph E. Prusak III, James R. Whitehead, Ronald H. Brinkert, and Robert C. Ecklund, "The Effects of Fitness Testing on Social Physique Anxiety and Physical Self-Perception: Presentation to 2000 Conference of the American Alliance for Health, Physical Education, Recreation and Dance (AAHPERD)" (Grand Forks, North Dakota: Department of Health and Physical Education, University of North Dakota, 2000); and James R. Whitehead and Melissa A. Parker, "Fitness Tests as Opportunities for Cognitive Learning: An Experiment Using Skinfold Testing: 1992 AAHPERD Conference Presentation" (Grand Forks, North Dakota: Department of Health and Physical Education, University of North Dakota, 1992). On a related research question — does dieting cause psychological stress? — see M. L. Klem and M. Y. McGuire, "Psychological symptoms in individuals successful at long-term maintenance of weight loss," Health Psychology, v. 17, July 1998, pp. 336-345. "I don't come to that conclusion lightly": Whitehead interview. "I am convinced that the drug for treating . . .": Interview with Francine Kaufman.

126 The plant is the largest factory dedicated: Greg Critser, "Your Money and Your Life," Worth, March 2000, p. 116.

A recent advertisement for the drug Avandia: See advertising section, New England Journal of Medicine, v. 346, March 14, 2002, pp. 875-878.

NOTES

126 "These days, you've got to be in diabetes": Interview with James Kappel, public relations officer, Eli Lilly and Company. See also Critser, "Let Them Eat Fat," p. 44.

6. What the Extra Calories Do to You

In recent years, the amount of information about the medical consequences of obesity has exploded. Two journals, Obesity Research and the International Journal of Obesity, remain as the premier organs of the field. In addition, the Lancet, the New England Journal of Medicine, and the American Journal of Clinical Nutrition often publish obesity-related studies. Several lengthy interviews with Dr. Francine Kaufman, head of the children's diabetes clinic at Children's Hospital Los Angeles and president of the American Diabetes Association, helped me understand the real-world implications of those works. The journals Diabetes and Diabetologia were also important sources on the obesity-diabetes link. A recent book worth every bit of its price for its general wisdom on the subject is Gerald Reaven's Syndrome X (New York: Simon & Schuster, 2000).

Data about the connection among fast food, entrepreneurs, and government policy were provided by the Small Business Administration, which performed a special computer tabulation for me to measure the extent of SBA loan guarantees to inner-city fast-food franchisees. In this I was aided by Eric Schlosser's groundbreaking Fast Food Nation (Boston: Houghton Mifflin, 2001). In an interview, Robert Bernstein gave me a colorful account of the creation of Happy Meals.

On the subject of "third world peoples living in first world nutritional infrastructures," I was fortunate to have the cooperation of Professor Barry Bogin, whose work on the anthropology of human growth has raised the bar for everyone working in that field; his most recent book, The Growth of Humanity (New York: Wiley-Liss, 2001), has become required reading, particularly for anyone involved in nutritional policy-making. The metabolic consequences of fructose, though a relatively new subject, are covered in a number of professional journals, the American Journal of Clinical Nutrition chief among them; I was guided through that maze of work by Dr. Scott Connelly, whose recent book, Body Rx (New York: Putnam, 2001), takes up the subject and a number of other metabolic issues. The publications and Web site of the Center for Science in the Public Interest also offer substantive work on the subject.