Dire Wolf —
Remember when smoking was the greatest threat to the health and welfare of this nation, and the most respected public health organizations joined together with HBO to produce a series of documentaries to tackle the public health crisis of smoking?
Neither do I.
That’s because there has never been an issue that has galvanized the medical community and the media quite like the fatties.
Even today there’s barely a peep to be heard, as 15% of adults continue to smoke every day, according to the Centers for Disease Control and Prevention (CDC) in its 2012 National Health Interview Survey (PDF). Meanwhile, 18% of kids under 18 have smoked a cigarette in the last 30 days, according to the 2012 Youth Risk Behavior Surveillance System (PDF).
And yet, the CDC’s mortality statistics for smoking are mind-boggling:
Smoking is responsible for 129,000 deaths due to lung cancer deaths and 126,000 deaths due to heart disease. Obesity is responsible for just 112,000 deaths each year, according to the most recent and widely-accepted research.
Or what about the War on Alcohol, a lifestyle choice that kills 85,000 people each year (PDF). I commented on a few other connections in this previous post comparing media coverage of the negative health effects of alcohol versus obesity:
A recent study on the economic costs of alcohol consumption estimates that 79,000 of those deaths are due to binge drinking, while a 2003 study in the Journal of the American Medical Association suggests that 26.8% of adults who consume alcohol are binge drinkers. Of the 101 million Americans who consume alcohol, that means that approximately 27 million are binge drinkers who are responsible for 79,000 deaths, or 0.3% of binge drinkers either die or cause the death of others each year.
Compare that with the 33.8% of the population (~105.5 million Americans) who are obese. That means 0.1% of obese people die each year. This suggests that binge drinking is a deadlier “lifestyle choice” than obesity.
That post also contains research from the CDC study that estimates the costs of alcohol consumption at nearly $224 billion, divided between lost productivity ($161.3 billion), increased healthcare costs ($24.6 billion), criminal justice costs ($21.0 billion), and other ($16.7 billion). And alcohol, unlike obesity, is responsible for the deaths of hundreds of children each year.
For some reason, these public health crises warrant some attention, but nothing like the full-scale War on Fat declared in 2004. Yet, despite broadly-accepted research from the CDC which shows that obesity rates leveled off for women and children in 1999 and for men in 2004, the War continues to be justified as a fight against indefinitely rising rates of obesity.
The problem is that for a public health campaign to warrant funding, it helps to be perceived as a crisis. So anti-obesity advocates, like First Lady Michelle Obama, must continue making a strong case that obesity is the “greatest national security threat,” otherwise the federal government won’t make anti-obesity campaigns a fiscal priority for the Department of Health and Human Services budget (PDF), which includes programs such as the $226 million in Community Transformation Grants.
The CDC’s description sounds remarkably familiar to me:
This [Funding Opportunity Announcement] will support key evidence- and practice-based policy, environmental, programmatic and infrastructure changes, in small communities (populations less than 500,000), and tribes, including in rural and frontier areas, to achieve demonstrated progress in one or more the following five outcome measures outlined in the Affordable Care Act: 1) changes in weight, 2) changes in proper nutrition, 3) changes in physical activity, 4) changes in tobacco use prevalence, and 5) changes in emotional well-being and overall mental health, as well as other program-specific measures related to local CTIP performance monitoring and evaluation.
These Community Transformation Grants play a pivotal role in the HBO four-part documentary, Weight of the Nation, which has become the federal government’s latest attempt to persuade America that fatties will “crush the United States into oblivion.”
Now, don’t get me wrong, I’m all for havens of wellness and health, but WotN (as I shall henceforth refer to it) makes the case that these Community Transformation Grants are one of the solutions to the scourge of obesity.
Except there is no scourge.
Or at least no more of a scourge today than in 1999. And although obesity rates haven’t risen, we’re warned by public health officials and WotN that a tsunami of flesh is waiting at the other end of this decade. But actual, demonstrable evidence says otherwise.
This made me wonder if fading alarm bells were the motivation for several public and private healthcare organizations to join forces for an “unprecedented” public health campaign against a public health issue that is sounding less like a tsunami and more like a minor rise in the tide.
As more and more health organizations rally around obesity, other public health issues fall by the wayside, according to the New York Times:
Shortly after the first lady kicked off the “Let’s Move” program, the administration awarded more funds to fight obesity than tobacco through two big new money sources for preventive health. The funds, totaling $1.15 billion, came from economic stimulus and health care reform legislation. They still provided more than $200 million for tobacco-use prevention, but much more to grapple with obesity.
With billions invested in fighting our perceived national “weight problem,” WotN seemed intent on inciting the kind of panic that lead to the War on Fat in the first place. Worst of all, in their attempt to rekindle those fires, WotN cites quite a bit of good, solid research and evidence to bolster its case before poisoning the entire message by resorting to sensationalism, exaggeration, misdirection and flat out lies.
There’s a whole helluva a lot to unpack, so this will be an ongoing series that will explore each of the four episodes and the evidence presented. For now, I would simply like to offer an overview, and an example, of what is wrong with WotN.
Crack That Nut
So what the hell is this thing? What is this Weight of the Nation documentary all about?
I’ll let WotN describe itself:
Bringing together the nation’s leading research institutions, THE WEIGHT OF THE NATION is a presentation of HBO and the Institute of Medicine (IOM), in association with the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH), and in partnership with the Michael & Susan Dell Foundation and Kaiser Permanente.
The centerpiece of THE WEIGHT OF THE NATION campaign is the four-part documentary series, each featuring case studies, interviews with our nation’s leading experts, and individuals and their families struggling with obesity.
Sounds pretty impressive, no?
<sarcasm>Finally — finally — someone with the courage to say enough’s enough! After decades of struggling with this issue without any public health recommendations or answers or guidance on how to stop being so fat, somebody had the good sense to say something about all the fatties fattin’ it up across America.</sarcasm>
And this isn’t the East Podunk Health Clinic, folks… the CDC and the NIH are both mammoth federal agencies that impact the healthcare priorities of the federal government; Kaiser Permanente is the largest managed care organization in the United States; and the IOM, which the New York Times described as “the nation’s most esteemed and authoritative adviser on issues of health and medicine, and its reports can transform medical thinking around the world.”
As a result, amateur bariatricians, like Alec Baldwin, people have been citing WotN like it was produced, written and directed by God.
Except it wasn’t (obviously).
But who was responsible for the information included in the final version?
One would expect that with so much on the line, the CDC, NIH and IOM would have spared no expense on hiring the best and most experienced healthcare science documentarian money could buy.
Instead, Weight of the Nation chose Dan Chaykin.
Who is Dan Chaykin?
Dan Chaykin is the director of WotN, whose only previous work was in the adult entertainment industry, including Porn 101, Pornucopia: Going Down in the Valley, Katie Morgan’s Sex Quiz, Katie Morgan’s Sex Tips: Questions, Anyone?, Katie Morgan’s Sex Tips 2: Any More Questions?, Katie Morgan on Sex Toys, Katie on Demand, Katie Morgan: A Porn Star Revealed.
So, why did they choose Chaykin? Well, it turns out that two of the Executive Producers of WotN, John Hoffman and Sheila Nevins, were also producers for Chaykin’s in-depth (no pun intended) Katie Morgan series.
And yet, Hoffman and Nevins have both been involved with several HBO healthcare documentary series’, including The Addiction Project, which tackled the subject of substance addiction in a similar manner to WotN. Except with The Addiction Project, Hoffman’s team chose 23 different filmmakers who contributed to the project, all of whom had some background directing serious documentaries.
In fact, on Hoffman’s team included four additional members from the Katie Morgan series, including line producer Ellin Baumel, co-producer Sonia Dulay, editor Jennifer McGarrity, assistant editor Anne Allen,
After discovering this fact, I suddenly realized that all 278 minutes of WotN was nothing more than fat panic porn, pure and simple.
And the best example of this emphasis on sensationalism comes from the trailer for the series and a quote from Susan Combs, the Texas Comptroller of Public Accounts. In fact, Combs’ quote is repeated throughout the series, reminding people that obesity must be taken seriously. But the full quote is not revealed until the episode titled “Children in Crisis,” when Combs makes the case for fighting childhood obesity with a fiscal argument.
While describing the program she launched in Texas, Combs issues a series of hyperbolic claims to justify the campaign and the intense scrutiny of a nation. Among them, the infamous quote:
Obesity will crush the United States and we will fade in the rear view mirror in oblivion. We could have done something different, we should have done something different, and we lacked the moral fiber and love for our children to do the right thing.
That’s right… if your kids are fat, then you lack moral fiber and love for your children. And thanks to your indifference, your fat children will crush our nation into oblivion. Way to go, crappy parents!
You’ll notice, interestingly, that the trailer chops up Combs’ quote to make it even more intense.
But what’s awesome about this quote isn’t that it’s so over the top, it’s that Combs appears in the second segment to third segment to “prove” that we can successfully end obesity in children, if only we all had the moral fiber and love that Combs does.
The program Combs promotes, Texas Fitness Now (TFN), which provided grants $20 million in grants to Middle Schools throughout Texas for two years to support in-school physical education, nutrition and fitness program. To qualify, three-fourths of the school had to be “economically disadvantaged.”
According to WotN, Fitness Now is a model for other states to begin turning back obesity rates in children. WotN holds Combs up as a hard-scrabble innovator, who made the economic case for Fitness Now and has the results to prove it’s an idea worth spreading.
Except, they never actually say how Fitness Now affected obesity rates in Texas. But a January 2011 report submitted to the Texas Legislature from the Texas Education Agency does go into details (PDF).
It turns out that participants in TFN had statistically significant increases in the percentage of boys and girls who achieved what TFN referred to as the Healthy Fitness Zone, which included the following five measures: aerobic capacity, curl-ups, trunk lift, upper body strength and endurance, and flexibility.
But here’s the downer for those touting TFN as a solution to childhood obesity. The sixth measure, Body Composition (measure by percentage body fat or BMI) barely budged:
[N]one of the increases or decreases in the percentage of students in the HFZ on Body Composition could be attributed to anything other than chance for either boys or girls. That is, while descriptively there were primarily increases in the percentage of students in HFZ on Body Composition, these differences were not statistically higher in any case.
In other words, while more boys, and fewer girls, were in the “appropriate” body composition range after three years on the program, the differences never reached statistical significance. So, the changes, whether positive or negative, could not be attributed to TFN.
And yet, there’s Combs, lauding TFN as a successful anti-obesity campaign and excoriating the parents of fat children, all without a single shred of evidence that her plan worked to rescue the United States from obesity-induced oblivion.
However, if Combs, and WotN, chose to emphasize physical fitness over the size of our children, perhaps they’d have solid footing to claim success. Instead, WotN zeroes in on fat people only, and places all their chips on making Americans less fat.
After all, WotN chose this tagline:
But perhaps if WotN, and the agencies behind it, focused their attention on metrics other than weight, the success they seek might be possible.
Instead, WotN continues to emphasize weight loss as our number one goal. But in making that case, director Dan Chaykin had to manage the existing research literature which paints a complicated, nuanced story regarding fitness and health. And in the process, Chaykin downplays evidence that seems to support a Health at Every Size approach, while putting front and center everything he can to present weight loss as the only solution for improving the health of America.
This effort confuses the facts and makes finding a feasible path forward even more difficult. That’s why I settled on the following title for the series that I will be rolling out:
In the coming weeks and months, I will go through each episode and outline where WotN gets it right and where it resorts to panic porn and lazy thinking. Hopefully, this will provide an opposing viewpoint to a public health campaign that needs to be challenged on the facts.
I hope you’ll enjoy the perspective I share, and when you come across someone who believes WotN is solid science, you can direct them right here, where we explain what is solid and what is mush.