Getting obesity wrong
Obesity is what sociologists might term a "wicked" problem. That is, it is a second-order scourge of the modern world, and one whose solutions are always stapled to a set of often contrasting beliefs and values that ascribe to society a certain conception of the good and just. So many of our political debates are over these issues, none of them trivial, but all of them being contested on the terrain of a society that has already figured out how to solve or mitigate the hard problems. A hard problem is a brick and mortar problem: war, clean water, life expectancy, access to justice and housing. The stakes are incredibly high. (There are, of course, gradients: access to equal housing and clean water remain problems).
What makes obesity a wicked problem is that it is not inextricably linked to the basic struggle for civilization. It exists because the civilization exists. And so, having recognized it as a thing, our politicians and experts seek out ways to frame solutions in a way that make sense to most people. In doing this they inevitably bump up against the social and class differences that define the way we look at complex problems. Citing the sociologists Horst Rittel and Melvin Webber, Michael Shellenberger and Ted Norhaus note that these problems seem irreducibly complex because one person's solution automatically becomes another person's problem, so extreme is our polarization.
An essay in their new journal, Breakthrough, by Helen Lee, takes on some of the more established beliefs of those public health activists who've made obesity their prime target. Liberal activists should read it. It's uncomfortable because it suggests that our beliefs do not comport with the science, and our preferred solutions are tied to a conception of the good life, rather than a realistic appraisal of how life is actually lived.
Experts took the wrong lessons from the smoking campaign. What worked more than pressure on the tobacco companies was the culture-wide effort to de-normalize smoking. It became unacceptable; people's interest in it waned.
Lung cancer is often a death sentence. But obesity is not. It costs a lot of money, but obese people can live long lives because doctors can treat the symptoms of the condition. Here, Lee ignores the quality of life associated with obese individuals — unhappier marriages, more broken families, much higher rates of depression — but her point is well considered.
The background for fighting obesity became dependent on victims and enemies. Innocent kids were the victims and evil food corporations were the enemies.
So: Poor people and kids lack the resources to be healthy. That's the narrative. Corporations, social justice groups, and health advocacy groups rapidly rallied around this explanation (really, just a framework). But the science doesn't back it up. Food deserts are not common. In fact, access to cheap, healthy food in inner-city America is plentiful. Highlight on cheap: The cheapness of it may contribute to its lack of nutritional content, but far fewer people are going hungry. (One person's problem is another person's solution). Further, outcomes for people with obesity are strongly correlated with poverty, so much so that it is impossible to isolate obesity as a causative or symptomatic.
Helen Lee suggests that instead of assuming that poor people have no agency, that they fewer access to resources, and that they cannot shape the world around them, policy-makers would be better off finding ways to reinforce healthy choices, rather than to punish unhealthy ones, or to treat a group of people as automatons who can't stop eating their Butterfingers.
Lee is not suggesting that government get out of the way, or that many of the initiatives being tested in schools and cities shouldn't be attempted. In fact, based on her logic, the easiest way to reduce obesity (and especially negative outcomes associated with it) would be reduce the number of poor people. To do that requires significant financial investment in health care, housing, jobs, parenting assistance, pre-natal care and even direct income transfers.