Reader Kerri alerted me to a new program in Ontario which calls for higher taxes on “junk food” and warning graphics on food that “lacks nutritional value” as a way to fight obesity. You can read the article here [Trigger warning: Fat Bashing, conflating weight and health, many bad things etc.] I think that this article is representative of all of the mistakes that are being made in this area so I’m going to answer it bit by bit. The (potentially triggering) quotes from the article are in block quotes, you can skip them and you’ll still understand the blog.
Physicians in Ontario are approaching the issue of obesity with renewed determination, calling for higher taxes on junk food and graphic warnings on food with no nutritional value. “We need to treat obesity like the public health epidemic that it is,” Doug Weir, president of the Ontario Medical Association, said at a news conference Tuesday.
Obesity, as currently defined, is the end result of a mathematical equation – weight in pounds times 703 divided by height in inches squared. Obesity is a ratio of weight and height, it is not a health diagnosis, it is a body size. We’re also taller than we’ve ever been but physicians in Ontario are not attacking the “tallness epidemic”. Healthcare treats health conditions, not body size.
The only way that you can call body size a health epidemic is if you are willing to ignore all of the evidence that shows that there are healthy fat people and unhealthy thin people, and that people of all sizes get the diseases that are correlated with obesity, and ignoring a bunch of evidence doesn’t sound to me like something that a group of physicians should be doing.
The proposed anti-obesity measures– touted by the OMA as some of the most aggressive to be suggested in Canada– include changes to legislation and the availability of junk food.
Being “Anti-obesity” means that the Ontario Medical Association supports the eradication of fat people with or without our consent. I think that Medical groups should concern themselves with helping people of all sizes have options for health and healthcare, not trying to make us all the same size, or eradicating people of a particular size.
Among the proposed measures, the OMA suggests:
- Limiting the marketing of sugary and fatty food to children
- Placing information about obesity-related health risks on high-sugar and high-fat foods
- Restricting access to junk food at sports complexes, and other recreational venues that children regularly frequent
Even if we assume for a moment that a junk food tax will cut down on eating junk food, unless these doctors believe that these foods are healthy for thin people who eat them and don’t get fat, but unhealthy for fat people, then the mention of obesity here is completely superfluous to any actual health message, and serves only to create stigma against fat people. The words “obesity-related” are misleading. What they mean is that these diseases have been correlated with obesity (meaning that they sometimes happen at the same time but are not proven to be caused by obesity. This is observable since there are fat people who don’t have these diseases and there are thin people who do. Murders and ice cream eating are also correlated – for a series of Augusts there were more murders and more ice cream eaten. Using the OMA’s approach, we would remove ice cream from store shelves and expect the murder rate to go down. Without causation we don’t know if changing one thing will affect the other at all.
Health doesn’t need body size as a middle man. In fact, it’s dangerous. It gives thin people the message that they are healthy as long as they don’t get fat and tells fat people that they can’t be healthy unless they get thin. That’s not what the evidence tells us at all.
Speaking of evidence, I’ve not seen any convincing evidence that this type of messaging on food has any measurable outcome on public health. I’m pretty concerned at the number of “anti-obesity” interventions that are passed off as public health interventions that have no evidence-basis. This is how people become non-consenting victims of experimental medicine.
There is some evidence that I think Team Tax-the-Fatties is not taking into account:
Peter Muennig from Columbia University found that the stress of stigma and shame were correlated with the same diseases with which obesity is correlated. Muennig’s research also found that women who were concerned about their weight had more mental and physical illnesses than those who were fine with their size, regardless of their weight. So telling people to be concerned about their weight may be, in and of itself, dangerous to their health.
Shame and stigma create all kinds of problems. For example, when doctors shame fat people for their weight, it leads to fat people not going to the doctor, they miss out on preventative care and end up not getting treatment until an issue is very advanced (which gives them even less time to wade through doctors who ignore their actual health issues and just tell them to lose weight, and some of them will die before they are able to obtain actual evidence-based healthcare.). When we shame people for getting sick, then they are too embarrassed to get the treatment they need. We will never know how much shame and stigma affects fat people until we stop shaming and stigmatizing them.
From the comments: “if there was a new tax, charge it to the obese people”
This is a major consequence of health campaigns that focus on body size. It encourages weight stigma and bullying including making it seem rational to some people to actually tax people based on a loose combination of how they look.
All of this mess could be avoided if public health work was focused around creating access – to a variety of foods, safe movement options, and evidence-based, stigma and shame free healthcare; and if public health messaging was about giving evidence-based information, about healthy behaviors rather than patting yourself on the back for creating the program that most aggressively stigmatizes a group of people for whom stigmatization may already be having negative health consequences.
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I remember on NPR one time they were discussing a tax on sugary beverages in America. A man called in and complained, “I’m thin, and I run marathons, so why should I have to pay a tax on soda?” The guest who supported the tax replied simply, “Drinking soda increases the risk of heart disease in thin people, too.” The man replied, “Well, I don’t drink that much soda.” To which the guest replied, “Well, then the tax won’t affect you that much.”
I haven’t completely decided how I feel about a soda tax. I suspect that it won’t have a major impact on public health. I did, however, appreciate how the guest on NPR who supported the tax clarified that drinking lots of soda is bad for most people, regardless of weight. I think that when we introduce obesity into the discussion, it just misleads everyone.
I just want to note that this is NOT a new program in Ontario. It was a ridiculous proposal for a program made by the OMA at a recent attention-seeking press conference. I don’t think anyone in Ontario would actually support a ridiculous proposition like this not just because it’s faulty reasoning but also think of the regulation involved- preposterous!
BTW, the OMA is not exactly the most highly regarded medical body in Ontario and in my experience most physicians and politicians don’t pay much attention to them.
Thanks, Jewel! I was appalled by the article as well, but not sure how seriously to take it.
I will be forwarding your article to the OMA, though, Ragen! Can’t hurt!
I really would like to see junk food being more expensive and healthy food costing less. But not to teach people about obesity. I just think it’s horribly wrong when people (who are generally minorities living in the inner city) have little or no access to fresh fruits and vegetables. I watched Food, Inc. and literally cried when a family would not buy pears for their child because they thought they were too expensive whereas a dollar fast food burger was a good meal. Something is wrong, but it has nothing to do with obesity.
This is exactly how I feel. Eating junk food is not, in of itself, a sin. Heck, I eat some from time to time and LOVE it. But, I agree with AB. It’s tragic when people can only afford a mega bottle of pop (that’s what we call “soda” here in Canada) and don’t have the money for fresh fruits and veg.
Linking obesity to overeating, particularly of junk food, is a total red herring and a perfect example of junk science. Shame on the OMA!
And to the same [lousy] effect, I somehow doubt that the Surgeon General’s warnings on cigarette packs really deter people from smoking. Who doesn’t already know that smoking’s bad for you? Who takes those warnings seriously?
*chuckle* I know women who try to grab the ones which state smoking reduces sperm count… and men who pick ones about effects on women’s fertility. Those messages (in the UK at least) are something of a running joke. You can even get stickers with jokes on them, to cover the health warnings.
Right on Ragen, Love the ice cream and murders that go up in Aug. How true!!! My question is who gets to determine what is junk food? My grandkids have been so brainwashed in school that when they come home from school they tell me I give them junk food. Like PB&J…corn…What Corn? They said it was unhealthy because it wasnt a green vegie. It is bad!!
The next time you’re up here in the SF Bay Area, you might want to lay some of this on the Richmond Progressive Alliance, which just failed to pass a soda tax which a city councilman, and a former chief cardiologist at Kaiser Permanente’s Richmond Medical Center, advertised all over the place in terms of the number of fat kids in Richmond.