You're a Web-surfin', Limbaugh-listenin', Temptation Island-watchin', Biggie Fries-gorgin', plant-your-ass-in-the-Pathfinder-and-watch-the-gridlock desk jockey. You're an American. And you're fat. At least, 64.5 percent of you are.
You probably knew that -- you're just trying not to think about it too much, just as you have a vague inkling that all that flab clinging to your hips is bad for you. Still, let's run through the risk list just for fun: gout, stroke, incontinence, cancer, and obstructive sleep apnea. And those are just the exotic ailments. The real bariatric bogeymen are heart disease, which kills roughly one million people a year, and diabetes, which currently afflicts at least 6 percent of Americans. Have I mentioned that diabetes can rot your limbs? "It doesn't get worse than diabetes," says Susan Ivey, a physician and UC Berkeley professor of public health. "We're talking about kidney failure; we're talking about getting your leg cut off due to gangrene and circulatory problems. It's really bad."
Americans possess a certain fatalism when it comes to obesity. After all, we know we're getting fatter, and we know it seriously compromises our health, productivity, and quality of life, but it seems such a fait accompli that there's not much we can do about it. Yet according to medical researchers and public health professionals, a growing consensus has emerged that obesity is the single worst national health problem, and federal officials are embarking upon a massive new spree in obesity-related medical research.
The exact amount of money set aside by the government for such research is virtually impossible to determine, since so many inquiries overlap into diabetes or cardiovascular research. But one figure is particularly telling. In 1996, just 337 research projects funded by the National Institutes of Health mentioned obesity in their abstracts; this year, more than 1,400 projects did so. Earlier this year, the NIH created a new Obesity Task Force to tackle the problem in the years ahead. "In most people's minds, it's become the nation's leading health problem," says UC Berkeley Associate Dean for Research Tom Boyce, who adds that Cal intends to hire more faculty members specializing in obesity and nutrition.
But just because we're spending more money doesn't necessarily mean we're spending it wisely. Indeed, since the social causes of obesity are plainly evident -- the changing nature of employment, the ubiquity of fast food, the idiot box in the center of your living room -- one might be forgiven for wondering why we're studying it at all.
For example, Kaiser researchers Patricia Elmer and Victor Stephens got $7.3 million in government funds this year to launch, as their press release put it, "a major new study that tackles one of the hardest aspects of weight loss -- keeping off lost weight." What's their great new idea? They propose to find out if people will be better at sticking to their diets if they log onto a Web site that records how much weight they lost and how much exercise they did. All that, for just $7 million! Of course, study participants also will be able to download little nuggets of inspiring information whenever they're feeling hopeless, and if they forget to log on they'll receive nagging little e-mail notes reminding them to stick to their schedule. Maybe that's why they call it spam.
Meanwhile, Patricia Crawford, the codirector of UC Berkeley's Center for Weight and Health, is spending $209,387 in government money to find out if high-school kids who drink soda pop during the school day get fatter than kids who don't. I'm gonna save Crawford a lot of time and effort by answering her query right now. Ahem. The answer is ... yes, they do. I'll take a cut of that $209,387 now -- does forty grand sound reasonable?
Okay, I'm being an ass, but maybe I'm just suffering from media-inspired disease fatigue. Clearly obesity is a genuine and pervasive public threat, but perhaps we've all just lost the sense of perspective to fully appreciate it. Over the past two decades, we've been subjected to a dizzying array of ratings-driven, hysterical alarms about the next great disease du jour: asthma, autism, osteoporosis. And beyond the facile dramas of local news broadcasts, the very process of establishing national public health priorities is increasingly driven not just by scientific data, but also by that strange animal known as "public awareness," a universe populated by congressional whims, advocacy groups, and celebrity ailments. Ronald Reagan never spoke the word AIDS aloud until Rock Hudson died of it. Once a Christopher Reeve falls on his head, or a Michael J. Fox testifies about Parkinson's disease, suddenly public pressure for more research is brought to bear. Perhaps the most extreme example of this phenomenon happened right after 9/11, when someone sent anthrax letters to Toms Daschle and Brokaw. A few months after this eerie spectacle, the Bush administration announced its intention to spend $11 billion preparing the nation's public health system. Although bioterror preparation may inadvertently leave us better equipped to deal with likelier threats such as dengue fever, the Bush initiative was clearly driven more by headlines and the hysteria of the moment than by sober reflection.
"There's this disease, and then two months later there's another disease," UC Berkeley's Boyce says. "But the difference is that obesity is much more like smoking than autism. Smoking is a long-term, damaging habit that affects not just lung cancer but cervical cancer and all sorts of pulmonary disease. Smoking isn't going to go away five or ten years from now. Obesity is the same kind of phenomenon; it's a long-term health problem."
And as with smoking, making a dent in the obesity problem will require an enormous expenditure of will, both personal and political. The nation is fat because American workers are sedentary, and American consumers are driven by advertising to snarf fatty foods and watch TV. Only a national public awareness and prevention campaign on the scale of the government's mammoth antismoking campaign can reverse these consumption patterns and encourage healthier lifestyles. This ain't rocket science, but officials with the NIH -- indeed, virtually the entire diet industry -- seem bent on treating it as such.
This year, for example, the NIH gave 352 grants to scientists conducting research that involves leptin, a protein that plays a critical role in appetite regulation. Scientists in Melbourne, Australia, are developing a drug that speeds up the body's metabolism and reduces its capacity to store fat. Roche Pharmaceuticals market Xenical, a drug that inhibits the intestines from absorbing fat -- and can give you a nice dose of diarrhea as a side effect. Merck Research Laboratories have experimented with drugs that mimic insulin to trick the body into reducing weight gain. South African scientists are even looking into the possibilities of the Hoodia, a squat cactus found in the Kalahari desert that reduces the sensation of hunger when eaten; if the plant can be turned into a marketable drug, the 100,000 bushmen of the region could be transformed into instant millionaires. And who can forget fen-phen, the phony fat pill that killed around three hundred people before the Food and Drug Administration took it off the market in 1997?
All these quests for a quick fix are just getting in the way of the obvious solution we already have. "Pouring money into NIH projects around research is a flawed approach, and money should emphasize public health work instead," says Tony Iton, the Alameda County health officer. "This investigation into the genetics of obesity is probably misguided, probably because what's happening is pretty elementary. People should be investing in the political will to adopt these policies, rather than investing money in research that is self-evident."
In the case of tobacco, research did help confirm long-held suspicions about the dangers of smoking, but more importantly it created momentum for a government commitment to mount a vast legal and public-relations campaign to reduce smoking and save untold millions of people from lung cancer and emphysema. With obesity, we already know that being overweight is unhealthy. The question then becomes how to convince a public seemingly bent on gorging itself to death in front of the boob tube -- which means countering billions of dollars spent on advertising by the processed food industry. It won't be easy; crippled budget deficits have forced school districts around the country to sell cafeteria floor space to Taco Bell kiosks and Pepsi vending machines, for example. In this fight, Crawford's research could actually make a difference; kicking soda machines out of schools will require a host of weapons, including "scientific" research that tells us what we already know, but must gussy up in fancy language to give politicians the courage to confront the fat enablers.
Making fun of Crawford's work is good for a quick laugh, but, frankly, she's on the side of the angels here. Only prevention and public awareness can turn the obesity problem around, and it may not be as impossible as it sounds. Once upon a time, Big Tobacco and Smith & Wesson looked unbeatable. But a determined commitment gradually eroded their influence and changed the way we look at smokes and guns. If we're going to do the same for obesity, we have to apply the same determination, not more federally financed R&D in search of the next panacea in a pill. Because as long as society searches for a solution you can put in your mouth, it's probably looking in the wrong place.
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