THE MYTH OF THE FAT SUBURBANITES

Summary
from The Thoreau Institute
April 1, 2002

Despite claims by anti-sprawl, anti-auto activists, the nation's
recent "obesity epidemic" has nothing to do with the suburbs. It is
not even certain that there is such an epidemic, since the only
evidence for it is unverified telephone surveys whose results differ
greatly from actual measurements of American weights.

But given that some Americans are overweight, the available evidence
indicates that obesity is found more in the supposedly walkable
cities than in the supposedly auto-dependent suburbs. For example,
Hispanics and African-Americans, who tend to be concentrated in the
cities, are much more likely to be obese than non-Hispanic whites,
who tend to live in the suburbs. This suggests that obesity is
associated more with low income levels than with geography.

Studies also indicate that the amount of exercise Americans get has
not changed in decades. If obesity is increasing, then, it is due to
changes in diet, not to changes in physical activity resulting from
too much driving or pedestrian-unfriendly environments.

It is not surprising that anti-sprawl activists would leap onto the
anti-fat bandwagon with specious claims that suburbs cause obesity.
Public health officials, however, should not delude themselves into
thinking that endorsements of the smart-growth planning fad will do
anything to reduce obesity or promote health.

Reviewing Obesity Data

The suburbs "encourage sedentary living habits" that have led to an
epidemic of obesity, say anti-sprawl public-health officials. Since
the "health care burden" of obesity can "conservatively" be estimated
to be "more than $100 billion," we need to promote exercise by
rebuilding the suburbs into denser, less auto-friendly areas.

These quotes are from page 9 of the study by Centers for Disease
Control (CDC) employees that was published by the SprawlWatch
Clearinghouse (http://www.sprawlwatch.org/health.pdf). As noted in
the Vanishing Automobile Update #22
(http://www.ti.org/vaupdate22.html), the report's speculative claims
are not supported by any evidence associating obesity with the
suburbs or physical fitness with New Urban design.

Since update #22, I have reviewed more data and studies on obesity in
America. The basic source for the claim that there is an obesity
epidemic is a CDC study concluding that the share of Americans who
are obese has increased from 12 percent in 1991 to 18 percent in 1998
(http://www.cdc.gov/nccdphp/dnpa/obesity-epidemic.htm) and more than
19 percent in 2000
(http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/index.htm).

The CDC defines "obese" as having a body-mass index (BMI) of 30 or
more. "Overweight" is a body-mass index of 25 or more. BMI for adults
is calculated by dividing a persons weight in kilograms by the square
of their height in meters. For those who are not yet metricized,
multiply your weight in pounds by 703 and divide by the square of
your height in inches. Or use the CDC's BMI calculator
(http://www.cdc.gov/nccdphp/dnpa/bmi/calc-bmi.htm), which works in
either English or metric units.

Without naming any names, if you are a balding researcher who is
5-feet, 7-inches tall and weigh 159 pounds, your BMI is a marginally
satisfactory 24.9. However, if you creep up to 160 pounds, you fall
into the overweight category with a BMI of 25.1. This means that our
hypothetical researcher probably shouldn't have the Valrhona
chocolate mousse that everyone else is enjoying for dessert tonight.

CDC breakdowns of obesity levels by state show some rather alarming
trends. In my home state of Oregon, for example, less than 15 percent
of adults were considered obese in 1995, but by 2000 more than 20
percent were obese.

Some states were even worse: Georgia obesity rates more than doubled,
from less than 10 percent to more than 20 percent, between 1991 and
1999. Obesity increased in every state during that time period, with
the greatest increases in the South and Midwest. (See the complete
data series at
http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/index.htm.)

Surgeon General David Satcher has called the obesity epidemic a
"crisis" because obesity supposedly kills 325,000 Americans a year
and adds $117 billion to annual health care costs
(http://www.surgeongeneral.gov/topics/obesity/calltoaction/CalltoAction.pdf).

Why Are We Fat?

What happened between 1990 and 2000 that would explain this sudden
ballooning of the American public? I can think of three things.

First, the explanation for just about every demographic trend in
modern America: baby boomers. Perhaps they got older, exercised less,
but kept eating. The problem with this is that the most fattened
adult age class is 19- to 29-year-olds. Children are also supposedly
getting fatter as well.

The second explanation for increased obesity rates is more
compelling: The declining unemployment and rising incomes of the
1990s. As Paul Fussell observes in his 1983 book, "Class," obesity is
in large part a class phenomenon. One hundred years ago, it was
fashionable among the wealthy to have a paunch, and men's clothes
were even designed to emphasize one. This is what led to the popular
notion of wealthy people as "fat cats."

Today, of course, the middle and upper classes prefer to be
fashionably thin, but working class people tend to be overweight. As
CDC researchers point out, "lower economic status . . . is associated
with obesity"
(http://jama.ama-assn.org/issues/v282n16/abs/joc91119.html). Just as
weight indicated wealth a century ago, it indicates security today.
The booming 90s saw unemployment rates at near-record lows, enabling
more people to earn enough money to feed their families enough to
become overweight.

A close look at the obesity statistics supports this notion.
According to CDC data, obesity is growing fastest among Hispanics.
CDC data also indicate that the most obese children are
African-American girls, 17 percent of whom are overweight compared to
less than 12 percent of other groups. A study from the New Jersey
University of Medicine finds that 22 percent of Hispanic and black
children are likely to be overweight compared with only 12 percent of
non-Hispanic white children
(http://jama.ama-assn.org/issues/v286n22/abs/jbr10287.html).

If there is an obesity epidemic, then, it may merely reflect a
healthy economy that has provided jobs for low-income people. If so,
then one sure cure for the epidemic would be a good, long recession.
Policies aimed at such a recession make as much sense as trying to
cure congestion by stopping new highway construction and putting
barriers in existing roads -- which, of course, are the policies
recommended by anti-sprawl forces.

Is There Really an Obesity Epidemic?

The third explanation is that the numbers are simply wrong. They are
based on a random telephone survey of people's heights and weights
done by state health officials and coordinated by the CDC. Only 21
states participated in the survey in 1985. By 1990, all but 5 (mostly
unpopulated) states reported in, and all joined by by 1994.

How accurate is a telephone survey? Without naming any specific
genders, a lot of people I know won't even tell their husbands how
much they weigh, much less a complete stranger calling on the phone.
At the same time, people in a completely different gender tend to
overstate their height. (Our hypothetical researcher would like
everyone to know that he is really 5-feet, 7.5 inches tall, but
modestly used 5-feet-7 for the purposes of this article.)

Because so many people understate their weight and/or overstate their
height, CDC researchers assume that actual obesity rates are much
higher than are revealed by their telephone surveys. Indeed, they
point out that real measurements of large numbers of Americans reveal
much higher rates of obesity -- 22 percent -- than any of the
telephone surveys, which recorded no higher rates than 12 percent
(http://jama.ama-assn.org/issues/v282n16/abs/joc91119.html).

Thus, the obesity epidemic may really be a truthfulness epidemic.
Perhaps interviewers in recent years prodded interviewees a bit
harder to get more accurate results. Or perhaps people are more
willing to admit they are overweight because so many popular writers
blame obesity on McDonalds, Coca-Cola, Frito-Lay, and other food
makers rather than the overweight people themselves (see below).

Stephen Milloy, who publishes the junkscience.com web site, calls
these numbers "unadulterated junk science" since the data collected
by telephone were never verified
(http://www.foxnews.com/story/0,2933,40759,00.html). Milloy suggests
that reports of a fat epidemic are coming from bureaucrats and
academic researchers who simply want to expand their budgets and
power.

Is Obesity a Crisis?

Milloy also cites an editorial from the New England Journal of
Medicine questioning the surgeon general's claims that obesity causes
325,000 deaths or more per year -- and, by implication, the claim
that the health costs of obesity are more than $100 billion per year.
"That figure is by no means well established," says the Journal,
adding that "Most of the evidence is either indirect or derived from
(studies with) serious methodological flaws."

More than one recent study has found that weight is less important to
health as you get older
(http://jama.ama-assn.org/issues/v281n16/abs/joc81271.html). Our
hypothetical researcher, whose 50th birthday is in exactly six
months, will be reassured to know, for example, that people over 50
can have BMIs as high as 32 and not suffer any greater mortality than
people with BMIs under 25. Researchers add that, unless such people
have heart disease, diabetes, or some other obesity-related disease,
asking them to diet "might unjustifiably decrease their perceived
quality of life."

What about the Suburbs?

Yet it remains true that some Americans are obese and that severe
obesity is associated with heart disease, diabetes, and other health
problems. To what extent is that obesity caused by the suburbs?

The detailed data suggest that, if anything, cities are more obese
than the suburbs. While many minorities are moving to the suburbs,
Hispanics and blacks remain concentrated in cities and the suburbs
remain largely white. It appears that location tends to be less
important than income.

The SprawlWatch report still insists that the "built environment"
contributes to obesity because it encourages auto driving rather than
walking or cycling. But another finding of the CDC telephone survey
is that the amount of physical activity Americans undertake has NOT
changed substantially in the last decade
(http://www.cdc.gov/nccdphp/dnpa/obesity-epidemic.htm).

In fact, says another report, "the activity levels of Americans
appear to have changed little, if at all, from the 1970s to the
1990s" (http://www.cspinet.org/reports/obesity.pdf). This indicates
that auto driving and the built environment have nothing to do with
recent changes in obesity rates.

Despite this finding, the report's authors recommend that "cities,
zoning authorities, and urban planners" should "modify zoning
requirements, designate downtown areas as pedestrian malls and
automobile-free zones, and modify residential neighborhoods,
workplaces, and shopping centers to promote physical activity." Among
the other recommendations are to "Designate an annual National
'No-TV' Week," restrict advertising on high-calorie foods on
children's television, tax high-calorie or high-fat foods, and
subsidize low-calorie nutritious foods.

These and twenty-six other recommendations are made with absolutely
no assessment of their efficacy. Before elected officials and
government bureaucrats start implementing such policies, they should
find out whether they will work or whether they will do more harm
than good.

Anti-sprawl activists are also quick to note that children today are
less likely to walk to school and more likely to have their parents
drive them. But this isn't a suburban phenomenon either. Before 1980,
80 percent of American schoolchildren walked to school. By 1990, less
than a third did.

Yet 57 percent of American families didn't move to the suburbs during
the 1980s. Instead, something else must explain this change.

The answer seems to be milk cartons -- specifically, the "missing
children" campaign that crested in the 1980s. This media-generated
panic turned out to be phony -- the vast majority of the "kidnapped"
children had been taken by one of their family members in a custody
dispute. Yet CDC Dr. William Dietz believes that "parental fear about
kidnapping" is one of the major reasons why children today get less
exercise than they did twenty years ago. (Dietz was quoted on
"California Reports," a public radio program aired by California
public radio stations on November 30, 2001.)

Who Is to Blame?

Eric Schlosser, author of "Fast Food Nation," has a different take on
the sprawl and obesity. He argues that fast-food restaurants such as
McDonalds were "a catalyst" to sprawl. And he also blames those
fast-food restaurants for the obesity epidemic, claiming that the
price paid for fast food fails to account for the "real price" of the
meal, mainly the social cost of obesity.

Schlosser's view is underscored by George Washington University law
Professor John Banzhaf, who takes credit for helping "come up with
the idea of suing tobacco companies as a way of shifting the cost of
smoking from the nonsmokers to the smokers." Now he argues that the
oft-cited $100 billion cost of obesity is partly paid "by people who
maintain a healthy weight in the form of higher taxes and health
insurance" (http://www.foxnews.com/story/0,2933,43958,00.html).
Banzhaf is urging people to sue food companies for imposing those
costs on society.

This is a difficult case for lawyers to make because, in contrast to
smoking, fatty foods produce no "second-hand fat." It will be hard to
prove that a particular food contributed to obesity; that obesity
caused a particular health problem; and that that health problem
imposes costs on people who don't suffer from it. If seriously obese
people don't live as long as thinner people, it is possible that the
health costs they impose on society are actually lower, not higher,
than average.

So some nutritionists go beyond Banzhaf and advocate suing food
companies just for selling people fatty foods. The ironically named
Marion Nestle, a nutrition professor at New York University and
author of the forthcoming book, "Food Politics: How the Food Industry
Manipulates What We Eat to the Detriment of Our Health," observes
that "The function of the food industry is to get people to eat more,
not less"
(http://abcnews.go.com/sections/us/DailyNews/obesityblame020122.html).

"There's a lot of people who benefit from people being fat and sick,"
Nestle claims. "So the response to the food industry should be very
similar to what happened with the tobacco companies," meaning that
food companies should be sued for making people fat
(http://www.foxnews.com/story/0,2933,43749,00.html).

This is a common theme of the anti-corporate, pro-government
movement: People are so easily manipulated by advertising that they
need government regulation to protect them from things they shouldn't
do. Anti-fat activists argue, for example, that vending machines
should be banned from schools so that students aren't given the
opportunity to buy junk food
(http://abcnews.go.com/sections/GMA/GoodMorningAmerica/GMA011029Junk_food_kids.html).


Indeed, many food activists want to demonize fatty foods just as
tobacco has been demonized. "I want to get to the point where people
are in the hallway and see a vending machine and say, 'That's bad,
that shouldn't be there,' in the same way as if they saw a cigarette
vending machine," says Tom Farley of the Tulane University School of
Public Health and Tropical Medicine
(http://abcnews.go.com/sections/us/DailyNews/obesityblame020122.html).

A different attitude is taken by Michael Pollan in his recent book,
"Botany of Desire." Pollan is no friend to the food industry and
makes it clear that he opposes genetically manipulated foods. He also
notes that refined sugar is a recent phenomenon: A little more than a
century ago, few people could afford most sweets.

But he tries to imagine what it was like the first time someone
tasted honey or some other sugar. The closest he can come is to
recall his one-year-old son's reaction when he tasted his birthday
cake -- the first time he was treated to a sweet. A look of
wonderment came over his face, as if to say, "Why didn't you tell me
there was something like this in the world? I am going to dedicate
the rest of my life to getting more of it." And, Pollan notes, "he
pretty much has."

Pollan's son was too young to be manipulated by advertising or the
food industry. The lesson is that diet and physical activity are
matters of self discipline (or, in the case of children, parental
discipline). Fast-food restaurants and other parts of the food
industry sell things that people want, and the industry is subject to
enormous selection pressures filtering out things that people don't
want. The health-food and weight-loss segments of the industry are
each multi-billion dollar industries in their own right.

Nor is there any evidence at all that physical activity and healthy
weights are influenced by the built environment, as claimed by sprawl
opponents. Indeed, if there is an obesity epidemic, it is hitting
urban populations more than suburbanites and it is caused more by
eating habits and incomes, not by changes in physical activity and
the built environment.
_________________________________________________________

Randal O'Toole                      The Thoreau Institute
rot@ti.org                              http://www.ti.org

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