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December 17, 2007

Obama on obesity

Meowser takes exception to a recent comment by Barack Obama's claim during a recent Democratic debate that that "[i]f we could go back to the obesity rates of 1980 we could save the Medicare system a trillion dollars."

In this election season, Meowser has some questions about how far this crop of Democrats is willing to go to control obesity:

[W]e have an election coming up next year, and strictly from a fat perspective, I worry about who is going to replace [Bush]. When I found out Barack Obama (much like Hillary Clinton, who has made similar remarks in the past) wanted to disappear me solely because of my weight in order to save the government money, I had to ask: Just how far are they willing to go to make that a reality?

I find this rhetoric offensive. The United States government really is disappearing untold numbers of people, and not because they're fat. (Cf. Stephen Grey's Ghost Plane, an outstanding book that I plan to review soon.)    

Meowser continues:

But I still think I have a right to know just how much agency they are willing to remove from people—and especially fatasses like myself—in the name of "health care cost containment." You'd think the Democrats would be all about personal agency and individual freedom. They damn well ought to be. But I'm afraid that when it comes to nosing around in people's body autonomy, they're just as guilty as the people they want to replace; they just want to nose around in a different part of our bodies, that's all.

Here are some questions I'd love to see asked during Presidential debates (and not just of Democrats):

"Do you believe in reducing the number of fat people by any means necessary? What if people really make an effort to exercise and 'eat right' but are still 'obese'? Do you favor requiring them to have bariatric surgery, or putting them in weight-reduction prisons, or having a police state in which people get their homes broken into and their pantries cleaned out and forced at gunpoint to work out until they drop, or being barred from all restaurants and grocery stores and all public places until they slim down? How far are you willing to go?"

Who said anything about stripping people of agency, let alone disappearing anyone?

If politicians are making hateful or false statements about fat people, they deserve to be called out on their prejudice. However, Meowser hasn't offered any evidence that Obama or Clinton is doing any such thing. She's railing at Obama for an empirical claim about the relationship between health care costs and obesity, and assailing Clinton because she voted for nutrition grants and exercise promotion.

These candidates haven't said anything about people who are already fat needing to diet, much less to disappear. Clinton's bill was aimed at promoting healthy lifestyles across the board. We don't know what Obama has in mind, but we shouldn't assume that he's calling on anyone to diet. He was talking about reducing obesity rates to what we saw in the 1980s through prevention. That could mean preventing obesity through healthy school lunches, phys ed, and grants for bike paths.

As far as health policy is concerned, it would be a mistake to fixate on obesity itself as the primary threat. The rapidly increasing prevalence of obesity is just one very visible symptom of much more widespread public health problems, including poor nutrition and insufficient excercise.

Experts disagree about the extent to which excess body fat itself causes health problems
However, there's no doubt that high calorie, low nutrient diets will eventually cause weight gain in a large percentage of the population. We know that poor nutrition and inactivity are harmful, even to those who don't gain weight. What isn't showing up on your abs may very well be collecting in your arteries.

So, the increasing prevalence of obesity is genuinely worrisome, if only because it appears to be linked to deteriorating diets and declining activity levels on a societal level. Weight isn't a good indicator of individual health. However, it is troubling to see entire populations getting heavier, at younger ages.

Clearly, the answer isn't to identify people who weigh "too much" and harangue them to lose weight.  If individual bootstrapping worked, the burgeoning diet and fitness industries would have already addressed the problem one consumer at a time.

We often talk about obesity as if fat people have a problem and everyone else is A-OK. That's a dangerous form of self-delusion. We're ignoring the ways in which our entire society has become less healthy since the 1980s. As a society we're driving more and sleeping less. We're awash in high fructose corn syrup because we subsidize too many Iowa corn farmers. Schools are shortening recess and cutting out PE while adding vending machines to generate badly-needed revenue.

Politicians should be encouraged to talk about public health issues. Their health policies should be judged on their merits. If Obama and Clinton are scheming to deprive fat people of their agency, let's see the evidence.

[NB: I don't want to hear any hateful comments about weight or body shape. Take that bullshit somewhere else.]

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Comments

There's "disappearing" people as in wanting them to be invisible, like blacks on 1950s TV; and then there's the "disappearing" of throwing from people from planes into the south Atlantic. Meowser mixed up her imagery, and let her anger paint it in unnecessarily lurid colors. Nevertheless, she has a very valid point. I've had it with politicians scapegoating certain parts of the population. And I've had it with the so-called "personal responsibility" rhetoric, which translates to: "get your own act together, America, and leave me and my corporate contributors the hell alone." And unless Obama is talking about declining obesity rates in the context of proposals that actually address the serious and systemic problems we're facing, that's the way I'm going to be inclined to take these statements.

Obama is talking about prevention in the context of his health care plan. He doesn't talk about state-sponsored dieting in there, AFAIK, but he does talk about access to regular medical care--which could help prevent and treat many common contributors to weight gain, such as poorly controlled diabetes. FTR, I think Obama's plan is weaker than those proposed by Clinton and Edwards--but there's no particular reason to conclude that he's scapegoating fat people.

Well, except for the fact that he's parroting language used by people who *are* scapegoating fat people, in that he's singling them out as an expensive-to-treat group that's costing us money. Which, again, is rich coming from a smoker.

He's also talking about a return to the obesity rates of 1980. Great. But how does he propose to get us there? Prevention is well and good, but prevention shouldn't focus simply on body fat, but rather on health. And for those people who are already fat, if they don't get in line and lose weight, what is the proposed solution? Denial of treatment until they comply? Further scapegoating?

"BTW, people: when Meowser says that Obama is disappearing people like her, she is not referring to black sites or Guantanamo. She's referring to the kind of thing that Republicans do when they gripe that if only black people didn't vote, they'd win more."

Sorry, no dice. Read her entire post.

"Do you favor requiring them to have bariatric surgery, or putting them in weight-reduction prisons, or having a police state in which people get their homes broken into and their pantries cleaned out and forced at gunpoint to work out until they drop, or being barred from all restaurants and grocery stores and all public places until they slim down?
...
And having someone holding the highest office in the land who would rather kill me than treat me like a human being is not going to do wonders for mine."

I like to read what people actually write, not what I wishfully imagine they had said.

There is a good post that could be written on the topic; she wrote a lousy one.

I didn't know obama smoked. That IS ludicrous coming from him, then.

I think I find the idea that anyone points this out offensive. I cost less to live here and take care of than my sister? I was offended when the airlines made patrons pay twice the price after a certain body weight was topped.

People are large, medium and small.

Obesity is not even a factor in some cultures (and maybe not a word)
What we or some here consider obese is considered affluence in other cultures.
Some of those cultures experience much better health than their American counterparts. Body size aside.
Full disclosure: I am a size seven. My sister was NOT. Once she asked me if I was ashamed to be seen with her. It's appalling to single out a group of people for their body size just as it is to single them out for skin color or any other reason.
Many hurtful things were said to my sister over the course of her lifetime. Not in front of me.
I think she would consider it hurtful to have pointed out that she is more expensive to treat; especially considering that she had excellent healthcare coverage all of her life and rarely used it. Where can I collect for those unused sick days, Obama??
Should blacks be considered more expensive to treat because of sickle cell anemia??
Should we stop treating inmates because it doesn't matter if they spread aids to those on death row?
As a society we're all working towards equality, or, are we??
People are born as ectomorphs and endomorphs. Pre-disposed to large or small.
Some weight issues are health-related.
Sometimes I wonder if there shouldn't even BE a finger pointed at weight.
It struck me as HOW DARE the airlines decide how large a person can be? How dare we decide that someone is bigger than they should be?
And then folks are struggling all their lives to 'look right' when they may be already looking 'right' for them.
Tons of 'fat' people live long, fruitful lives ....

Never trust a skinny chef. Just kidding that last part.

Yes, Obama smokes which means he can never make any statements about preventative health care.

Edwards is a rich bazillionaire and his house is too large so he cannot tell us about lawyers or two americas or the poor.

Al Gore has a big electric bill so he is the cause of global warming which is a hoax anyway and we shouldn't listen to him.

Nancy Pelosi should be taking a hybrid VW bus to travel to/from California.

Jessica Valenti has tits and needs to wear a burqha before she tells us about feminism.

Anything else?

good point, whatever. I didn't mean it 'that' way.

I know plenty of smokers who have lived long and fruitful lives, as well.
Which is NOT what you're saying ... LOL.
It's just the whole subject: Why?
It's like they're saying that fat people can help it while others with health problems CAN'T?
Like fat can be prevented.
I agree with Lindsay that it doesn't seem like obama or hillary are disappearing 'fat' people.
I'm stating that fat may not even necessarily BE a health issue and that I can see where it's offensive that it's pointed out that it costs more to care for them. I think that's what was pointed out.
It costs tons to care for many different obligations as decent citizens.
I hate war but I don't object to keeping Arlington pristine.

Sorry if I'm not making sense to you.
We have an obligation to EACH person to care for them as we would like to be cared for.
Singling out statistics to 'imply' that one group is more responsible for megabuck rates when we ALL KNOW it's the pharmaceutical companies, insurance and some so-called doctors is not the solution.
NOT to mention the outright Medicare and Medicaid fraud.
BILLIONS. Way more than fat people I bet.
just sayin...

>It's like they're saying that fat people can help it while others with health problems CAN'T?

Nobody is saying that.

>I'm stating that fat may not even necessarily BE a health issue and that I can see where it's offensive that it's pointed out that it costs more to care for them.

Obesity causes health problems. Every overweight person not in deep denial knows this. Avoiding the subject is not doing anyone a favor.

>Singling out statistics to 'imply' that one group is more responsible for megabuck rates when we ALL KNOW it's the pharmaceutical companies, insurance and some so-called doctors is not the solution.
NOT to mention the outright Medicare and Medicaid fraud.

Here's the false dichotomy at work again. Situation A causes problems. Situations B,C, and D cause enormously larger problems. Therefore, someway, somehow, somesomething, situation A causes less problems or the problems don't matter as much.

Voxy - Ditto to everything you said. Very eloquently put.

zuzu - Thank you for your leadership.

whatever - no, there's absolutely nothing worse that being fat, and if you're a smoker, a druggie or a serial killer it doesn't matter. You're still superior to fat people and you should tell them all the time how much you think they suck for being fat at you. Oh, and mention you find them really unattractive while you're at it - fat people never hear that and it will be quite the eye-opener!

Dock Miles - see answer to whatever. I think the two of you really should get together over a cup of expresso at a outdoor cafe to point and laugh loudly at fat people walking by. Then they'll finally get over their denial and lose the weight. It's for their health, right? And there's nothing too cruel when it's in the name of health. And the little children. Don't forget about the little children!

lindsay, thanks for this post.

my reaction to obama's statement was - okay, that's great, so what are you going to do to cut corn subsidies? i liked cass's wish list, but i would move the corn subsidies to number 1, because our farm policy has a much larger impact on the overall health of our country than the entire collective choices of individuals.

I can't decide which group of people are more annoying - those who talk about how opressed they are for being fat or those who talk about how oppressed they are for their polyamory.

I think it goes to Dock's point about the false dichotomy. I don't need to decide which one is MORE annoying, they're both a bunch of narcissistic jerks who like to throw pity-parties for themselves on the internet, for an audience.

And this is coming from a dude who was 90 pounds overweight and never suffered any sort of "discrimination" or "oppression" for it aside from the occasional snide comment from my mom.

Now, obviously Obama didn't get to go into any sort of specifics and I agree that his comments sounded way to general, but its pretty obvious he was talking about preventative health care to combat the idea that a health care plan will be "too expensive" and require us to all pay 120% of our income in taxes. And no, preventative health care does not mean refusing to treat overweight people (my doctor never refused to treat me, though he did say unless I was planning on trying out for the Patriots I should probably try to lose some weight). It could mean things like the trans-fat ban, or more accurate nutritional information requirements, more P.E. in schools, more public education on nutrition, greater access to excercise facilities, etc.

I mean, fuck, he could just say, "The government will pay for anyone who wants to join Weight Watchers and get a gym membership." That would be something. It might not be the best thing, and I can think of about thirty different reasons why its a bad idea, but the point is that it isn't rounding people up and putting them in concentration camps.

It's too bad one can't look realistically at what he said. It is the truth. I have hope for policies which stop subsidizing corn and starts subsidizing vegetables, so people can afford to eat them, put physical education back in the schools and get kids off the couch or from in front of the computer.

One really can't argue with the statement, whether it be politically correct or not it, it is the truth. We are an obese nation. It cost us a lot of money.

I do know it is extremely risky for a physician to do surgery on an obese individual so docs have the right to decline surgery on obese individuals, and it should not be unethical to refuse to treat a patient who is of sound mind and of average education but continues to be consistently non-complaint. There is only so much
a physician can do, at some point it becomes the personal responsibility of the individual.

Gosh Rose, you must have been hallucinating into your iPhone again. Or perhaps you can show me where I said anything that comes out in any way shape or form like the words you put into my mouth.

I know that shouting and battling strawpeople is a favored tactic of some, and it seems to work in way too many places. But over here on the reality based blogosphere may I ask you write about what I wrote and not about what you want me to have written?

>I think the two of you really should get together over a cup of expresso at a outdoor cafe to point and laugh loudly at fat people walking by.

Hey, if you insist. (btw, went with Yo Momma because it's classic -- feel free to substitute Yo Bro, Yo Daddy, Yo Schnauzer, etc. etc. etc.)

What Cooper said. Obesity is a problem in our country. That doesn't mean fat people need to die or be shipped off to concentration camps, or that they should be made fun of or treated poorly. It doesn't mean that fat people are *the* problem and we'd be better off if we shot them all into the sun.

That said, lowering obesity rates is a good thing and it's hardly persecution to point that out. Obesity rates are rising for a reason and it should be very possible to fight that, figure out the reasons and reverse them to some degree.

Which, again, is rich coming from a smoker.

FWIW, smokers on average have lower lifetime health costs than non. That's because the ones who get cancer tend to die quickly before other long-term, more expensive conditions, set in. Non-smokers are more likely to live to a ripe old age, at which point they require YEARS of expensive medical care.

--It's too bad one can't look realistically at what he said. It is the truth.--

It certainly is. We need more straight talk like this, not less. He's not serious about a "trillion" dollars.

I say this as someone who could stand to lose 40 pounds, which I'll surely do, beginning with the New Year, at 00:01 am.

In most private insurance plans, including the one that I participate in, smokers pay higher premium. That's fair. I think that it would also be fair to charge those who are overweight higher premium.

Most people, like me, do not carry the extra pounds do to any physical issue. We're overweight because we choose not to eat or drink in moderation.

Those who have family in Europe, as I do, can compare the average size of their own relatives with those in the USA. Guess who's fatter? That goes double for any Asian-Americans who have family back in Japan, Korea, or wherever.

If the average American lost 15 pounds --which does not seem too damned hard to me -- what would the health care implications be? Pretty good, I think.

And that lost 4,500,000,000 pounds just might have some impact on the amount of energy we use.
The newer models of the 747 hold 467 people. That would be up to 7000 fewer pounds on every flight, assuming all the passengers were less fat Americans.

Again, good job, Obama. Those who complain about your comments should quit typing and lay off the Big Macs for five minutes.


When Obama starts talking about dismantling ADM, and depriving Iowa agribusiness of massive corn subsidies, I'll take the rest of his ranting seriously.

A false positive in the typepad comment spam filter.

>When Obama starts talking about dismantling ADM, and depriving Iowa agribusiness of massive corn subsidies, I'll take the rest of his ranting seriously.

Issue A is a rilly serious business. Issue B is something I don't care about.

Therefore, somehow, someway, somesomething, that Issue A isn't mentioned makes issue B irrelevant.

Get that down and never make the mistake again and I'll take your rants ... well, I won't have to point out logical fallacies in them.

There is actually a lesser stupidity here underneath the larger one of accusing Obama of wanting to "disappear" fat people.

And the stupidity is this: "If we have national healthcare, government will ban (insert unhealthy thing here) to save healthcare dollars."

It's a nanny state myth something easily destroyed by looking at the foods available in Britain, France and Canada.

Canada has universal single-payer health insurance. We also have a wider selection of chocolate than americans, a fetish for double sugar double cream coffee and donuts, and a little dish we like to call "Poutine" made of french fries, cheese curds and gravy. And there's currently no call to ban these. We pay more for cigarettes and alcohol, but they aren't _banned_. Has Britain closed all the fish and chip shops? Banned the Deep-Fried Mars Bar? Killed Cadbury? Has France banned the use of cream sauces or closed the wineries?

To say that government will ban popular items that are bad for us to save healthcare dollars misses three important facts:
1: Corporations that make these foods have powerful lobbies and a great deal of influence.
2: A party likely would not survive an election doing something deeply unpopular to affect so many people with little direct result.
3: Ultimately, it's the taxpayer's dollars that deal with system costs, all gov't needs to do is raise taxes or user fees to recover the costs.

>To say that government will ban popular items that are bad for us to save healthcare dollars

Um, please point out who has suggested this anywhere anyhow anywho.

(PS: There's no "F" in Ox)

That was certainly at least implied by the whole "reduced personal agency" line of reasoning.

Which is where and how? (NOT spam, Typepad you stupid shit.)

Try again.

In the original post by Meowser. You know, the post we are all discussing?

You should consider reading it.

I did read some of it. Then decided life was too short. If that's the source -- pfffft. You may be discussing the post. I'm more interested in exactly what Obama said and the larger issue of obesity in America.

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