Tonight in the State of the Union, President Obama gave Michelle Obama credit for lower childhood obesity. This is not so cut and dried as it might sound. Australian scholar Michael Gard points out in his new book, The End of the Obesity Epidemic, that over the last decade obesity rates among both adults and children have leveled off or declined all over the world, including in the United States. In 1998 35 million Americans went to bed a so-called “healthy weight” and woke up fat thanks to a commission of scientists with ties to weight loss programs and drugs who successfully lobbied to have what is considered a “healthy” weight lowered (creating 25 million new potential clients in the process.)
But try to calmly enter this information into the discussion and you’ll often find yourself shouted down by people yelling – I see fat people everywhere and I didn’t before! 65% of people are fat! I see fat people everywhere and they are all [fill in the blank with a stereotype]! This may be a good time to remember that observation, while part of the scientific method, is not science in itself, here’s why:
First, there’s Confirmation Bias - that people tend to favor information that confirms their preconceptions or hypotheses, regardless of whether or not the information is true. They also tend to interpret ambiguous results as supporting their point of view. Everyone is subject to this, including me, researchers are taught to be aware of it. (Interestingly, this is why it took me so long to choose a Behavior Centered Health approach – I was certain that I had to lose weight to be healthy and it took a while for the facts that were staring me in the face to set in). Back to our world overrun with fatties… we must accept the possibility that it’s not that there are a ton more fatties, or that every fatty fits into some stereotypes (and let’s be clear that the problem here is stereotyping and not fat people), but rather that confirmation bias is driving society to seek out evidence to support their conclusion and ignore that which does not. Similarly, when someone posts a comment on one of my dance videos saying how lazy I am they are ignoring the evidence in front of them because they are letting their confirmation bias run away unchecked, or because they are a jackass. Actually, the two aren’t mutually exclusive. At any rate, this is something that we all have to be aware of – especially if we are reviewing and interpreting data.
The second issue is frame of reference. I’ve heard more than one doctor say “I know that obesity causes health problems, every obese person I see has health problems!” Well, you’re a doctor – do a lot of people stop by your office to say that they feel great? When a friend of mine suggested that there are fat people without binge eating disorder a therapist specializing in binge eating disorder told her that “It’s my experience that someone that size probably has binge eating disorder”. Perhaps that’s because her experience is with fat people coming to her to deal with binge eating disorder. It’s like a podiatrist saying that every person with feet has foot problems. If all you’ve got is a hammer, every problem can start to look like a nail.
Next we have sample size. Maybe you saw a fat person eating McDonalds – this does not a statistically significant sample size make, though that person has every right to eat whatever he or she wants. Similarly, if you, or your sister in law’s best friend’s nanny’s aunt, lost weight and kept it off for 5 years then you are a statistical anomaly, if you were on TV the bottom of the screen would read “Results Not Typical”, you are not proof that weight loss works for the majority or even the minority of people.
The next thing to think about is meaning. Even if it’s true that there are tons more fat people than there used to be, do we know (and I’m not talking about “everybody knows”, I’m talking about evidence-based knowing) why it’s happening or what it means? We are also taller than we used to be but nobody’s freaking out about the tallness epidemic. The hysteria around obesity and its healthcare costs (which, despite popular opinion, have been shown to be way overblown) has somehow made it ok to skip the steps where we look dispassionately at why a phenomenon happens and what it means and instead we’ve jumped right to “We’re gonna die! Quick, shame the fatties!!!”.
Finally, we have to look deeper. I heard someone say the other day that they were at a hospital and most of the people there were fat, thus proving that fat people are less healthy. All of the issues from above apply but let’s look deeper. According to research out of Yale, in this culture fat people have a more than 50% chance that when we go to the doctor, she or he will view us, and treat us, as if we are awkward, unattractive, lazy, weak-willed, and unlikely to comply with treatment. Even when fat people do go to the doctor they are often humiliated and receive sub-par care. Without so much as touching us, let alone using proper diagnostics, doctors diagnose us as fat, give us a treatment protocol of weight loss and send us on our way (People have relayed having been prescribed weight loss without even being touched by their doctor for sudden onset intense back pain that turned out to be ruptured discs, abdominal pain that turned out to be a cancer, and abdominal pain that turned out to be gallstones that required emergency surgery). So, many fat people have horrible experiences that lead to them to avoiding the doctor, and when we go we often get subpar treatment. Both of these things can lead to us not getting proper early intervention, thus even if the scenario is true, finding us in the hospital for situations that a thin person may have had solved by their doctor in its early stages because they were listened to with more respect and given a treatment plan based on proper diagnostics. You can’t just accept things at face value if you want to get to the truth. It helps to ask yourself: Is this statement true? If it is true what might it mean? What is might be causing this?
Observation can be powerful but we have to be careful about drawing large scale conclusions based only on what we can see. This is something that researchers struggle mightily with. You know how when you paint a room the painting is easy but the set up is a pain – all that taping and prepping, laying down the tarp, etc.? That’s how setting up research is – actually performing the research is the easy part. The difficult part is in setting it up – making sure that you have a statistically significant sample size, making sure it can be extrapolated to the population of interest, deciding what variables to control for and how to control for them etc. Good researchers go to great pains to do this well, and they always state their limitations so it’s foolish to think that we can look around and get information that’s just as good or better.
