The Obesity Epidemic: Science, Morality and Ideology [Paperback]

A sceptical look, by two Australians, at what we know and

(more especially) at what we don't know, about obesity. The authors believe "It ain't what folks don't know is the problem so much as what they think they know that ain't so." The central message could be phrased as that fatness doesn't matter as much as they try to make you think, but that would be oversimplifying it. There's nothing simple about this book. I started it thinking I knew a lot more about obesity than when I finished it.

The authors write elegantly with sharp wit, but even so it is rather heavy going because of the density of information and closely reasoned argument. Although it is an important book it it difficult to know who to recommend it too, maybe anybody in the health or education field who enjoys good writing and doesn't mind having their assumptions shaken.. It's not a self-help book for dieters.

The Australian perspective is interesting. Americans are still reeling from finding they are the world's fattest men (apart from some Pacific islanders) and the British are upset from finding that they are the least athletic white nation, with curling as their only Olympic gold. The skinny athletic Australians have managed to convince themselves that they are slothful overeaters

This book takes a look at a variety of obesity research with a fresh eye. It assumes nothing, and what is revealed with this unbiased eye will surprise and amaze most readers. As many know, diets don't work. This helps explain why. Fat people aren't fat due to gluttony. Exercise, while it may be good for people of all sizes, does not contribute much to body size except in extreme cases. Twin studies and meta-analyses are methodically reviewed. Much of what passes for facts or science in the public debate on obesity, is really more about morality and ideology. Well done!

"The Obesity Epidemic, Science, Morality and Ideology" is not light reading. The authors, university physical educators in Australia, have packed an enormous amount of research and thought into this volume. Their premises are:

1. The obesity epidemic has been hyped and blown out of proportion,

2. Scientific uncertainties have been papered over with unsupported assumptions.

3. The rush to `fix' the epidemic is likely to lead to policies which are unwise, unnecessary, wasteful and possibly counter-productive.

The authors state, "In short, the first danger that this book addresses is that talk of an `obesity epidemic' has the potential to do more harm than good." The second danger they address is that the public, journalists, scientists and other authors offer misguided explanations for the obesity epidemic. Their final and key point is that,"a scientific approach to the human body has not led, and is unlikely to lead, to more satisfactory ways of thinking about overweight and obesity." They give three reasons for this conclusion. First, "the science of overweight, obesity, health and the mediating role of exercise and diet are severely mired in controversy and contradiction...Second, it seems optimistic to suggest that the populace is on the verge of dispensing with their superstitions, fears and prejudices about body weight in favor of a more `mechanistic' or `scientific' way of thinking...Third, it is not at all clear how a more `mechanistic' or `scientific' view of weight and obesity would be a good thing." The following, dense nearly two hundred pages are written in support of their theses.

It isn't hard to find researchers who offer global prescriptions to control body weight; it isn't hard to find press accounts which hype this or that discovery or new information and it isn't hard to find dubious or misguided policy prescriptions. But the authors' real target is science itself. They feel that overweight and obesity just can't be viewed as a science at all and that biology, physics, have not been helpful and will not be helpful in the future. A big part of their gripe is the energy in/energy out formula just doesn't seem to work consistently in obesity studies.

In fact, a number of the authors' insights and observations should cause some serious thinking. But it is curious to note that, although the authors are university professors and although they must cite close to a thousand studies, there is not, as I can read it, one reference to the discovery of leptin, much less the influences of the host of neuropeptides, hormones and other neuroendocrine effects of adipose tissue. One must ask, "In all this research, did they never come across the information about grehlin, PYY 3-36, and other such influencers? If they did come across them, why not reference all that is going on? Where is any analysis, or even mention, of the effects of bariatric surgery on the understanding of the disease process we call obesity?

The authors argue that because science has not solved the complexities of body weight regulation today it never will. And furthermore, that even if it could, people's thinking about body weight would never change. Surely, this is too rigid thinking. It is like saying that because physics has not come up with a grand unifying theory today, all physics research is useless and it won't make any progress in the future. Or that because we can't cure Parksinson's disease now, we never will. This is unacceptable on its face. Also untrue is that people's perceptions and actions do not change. In the days before Prozac, depression was poorly understood and treated; after Prozac the public, health care professionals and others came to see that at least some depression was a neurochemical imbalance. The sudden swings in the public's eating habits, such as the low-carb phenomenon, is further testament to the power of the public to seek out and employ hopeful approaches to weight control.

If science cannot get us where we want to go, what can we do? The authors have two, very brief suggestions. First, we could just `get over' it (their words). Simply accept overweight and obesity and move on to something else. Second, and more interesting is their suggestion that what is needed is a "thorough engagement with issues such as economic disadvantage, the workings of capitalism, increasingly deregulated labour markets and the imperative for companies, particularly, but not only, those that sell food to be profitable." As they so well acknowledge, "This would mean that the fields of science, medicine and health developing and articulating positions that are overtly moral and ideological, a project which would mean changing the very nature of science itself."

These conclusions comprise the last paragraph of the book. It might have behooved the authors to spend a little more time discussing how capitalism causes obesity or the effects of labor market regulation but it seems like these were mere afterthoughts. Having led the reader to conclude that science is a dead end, the authors have no where to go. Other of us might be much more sanguine about the prospects that the science of obesity is developing at a rapid pace and if there is a lot of `noise' in the system because of different studies and interpretations, this is a good thing. A robust scientific enterprise is the only alternative which can give the public and policy makers accurate information to address the significant challenge which is obesity. Morgan Downey, Executive Director, American Obesity Association

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