The War on Ice Cream Eating – a Parable

Things you can tell by looking at a fat personFirst let me say that I’ve missed you all.  Last week there was a decided lack of blogging because I managed to hurt my neck in a way that made me unable to use my right arm.  I’m on the road to recovery now but there were some really scary days and I’m very luck to have an amazing care network here in Austin to help me (thanks to Dr. Robin and Dave for their incredible help!), though I would expect that a ranty blog about my inability to get health insurance because of my size is probably just around the corner. But not today…

We talk on this blog a lot about how almost nobody succeeds at weight loss long term, and why that is.  Today I want to talk about the rationale that we are given for pursuing weight loss in the first place.  It’s a bit shaky when you realize that there is no study that shows that people who are able to maintain weight loss long term are healthier or stronger, and that almost every bit of “evidence” linking weight and health problems is correlational, not causational.  Often the suggestion is that if enough studies show a correlation between size and health problems, we can safely assume that size causes the health problems and that changing someone size will cure health problems.  Since weight and health are such charged subjects, let’s look at this through some other lenses.

The problem with correlational research is that it only shows that things happen at the same time, it does nothing to prove that one thing causes the other, and that’s where the trouble starts.

Many studies show a link between increased ice cream eating and increased murders.  All I can definitively say from this is that ice cream eating and murders often happen at the same time. I cannot say that ice cream eating causes murders.  I cannot say that murders cause ice cream consumption.  If more murders take place I can’t say that there is an ice cream epidemic.

Since all I know is that there is a correlational link, I must acknowledge that it’s possible that the ice cream eating causes murders, that murders cause ice cream eating, that they are unrelated, or that they are both caused by a third factor.

Let’s say that the latter is true –  that the cause of both issues is heat – when people get hot they tend to eat more ice cream, or become cranky and murder people.

But let’s say I don’t know that, and I assume that since there is so much evidence linking ice cream and murders, I can assume that eating ice cream causes murders.  So I start a War on Ice Cream Eating!  I lobby to get ice cream off the shelves, to get everyone to look at people who eat ice cream as horrible people who deserve to be shamed.  I work tirelessly to get ice cream out of schools and away from our kids.

Not only is this misguided, if the truth is that when people are hot they either eat ice cream to cool off or they murder someone, by taking ice cream off the shelves I may actually increase the murder rate.  And that’s why assuming cause from correlation is a bad idea.

Men who have male pattern baldness also have a higher risk of heart issues. The reason for that is that the same hormones responsible for male pattern baldness are responsible for increased risk of heart issues.  But let’s say I assume that the baldness causes the heart issues.  So I start a War on Baldness!  I work with companies that claim they can grow hair and inform the public that bald men who aren’t using Rogaine or joining the Hair Club for Men are increasing all of our health care premiums.  I create workplace incentive programs where men who are showing signs of balding are fined thousands of dollars unless they join “voluntary’ hair regrowth lunch meetings.  I suggest that bald men may be unfit parents since it’s possible that they may be more likely to raise bald children.  I pour millions into programs that give out toupees to bald men.  By treating one of the results instead of the cause I can take attention away from treating the actual issue and increase heart issues in bald men, or delay treatment that is actually shown to help the heart issues because I’m busy trying to treat the wrong thing. And that’s why assuming cause from correlation is a bad idea.

Large bodies have been correlated with some health problems.  Let’s say that I assume that body size causes those health problems.  So I start a war on obesity.  I direct all public health efforts toward trying to figure out how to make people thin, I direct public health messaging to be about how fat people need to become thin to be health.  Doctors start to tell fat people that becoming thin is the way to prevent these diseases, even though thin people get them too.  By doing so I direct attention and treatment away from actual healthcare interventions and toward body size interventions, rolling the dice that changing body size will lead to health and blaming fat people if it doesn’t work.  And that’s why assuming cause from correlation is a bad idea.

For more fun with correlation, check out this article!

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21 thoughts on “The War on Ice Cream Eating – a Parable

  1. Not to put too fine a point on it, but there are also studies showing that people from different socioeconomic groups are more at risk for certain health problems, and the same is true for certain ethnic backgrounds compared to other ethnic backgrounds of the same financial & educational status. There are complex factors including the legacy of oppression that contributes to this, but the upshot is that you don’t tell people who are struggling with health problems to stop being poor in order to fix the issue (OK, maybe part of society does say that). Changing that status significantly, while not impossible, is also very difficult. The focus is on making healthy lifestyle choices to the best of your ability wherever you are.

    I feel like with fat, too, there are so many factors that go into this, so many studies that talk about risks of obesity in children linked to many things. Your genetic heritage, in utero experiences, infant experiences, environmental exposures, how you were raised, all of these may indicate some children are more likely to become fat. My parents were smokers and I was formula fed, and you can find studies that show that these both put me at risk. Yet people just assume as soon as you hit a certain age in childhood that all it takes is eating a little bit less and moving a little bit more to make you thin. And after you’ve tried strict dieting for years and you are even unhealthier from the weight cycling, and you decide to take charge of your health by actually taking charge of your health, people will only equate becoming healthy with losing weight.


  2. A friend of mine had serious problems with her knees six years ago, and the doctor recommended she should try to lose weight immediately because – he said – the weight was what caused the problem. She did it – she joined Weight Watchers (aaargh. I’m not a fan, but for her, it worked), and she lost (and, more amazingly, kept off) 25 kilogram, nearly 4 stone. The doc was very pleased with her and concluded she needed no further treatment. Needless to say: the aches came back, got worse (although she kept off the weight), she went to see another doc, and last November, she had her first knee replacement surgery, the other knee is to follow this year; her new doc told her she has hereditary osteoarthrosis. HAD it been detected and treated six years before, he says, she would not have been in need of surgery for at least another 10 years. Duh. and this happened here in Germany where healthcare is usually excellent! Makes me mad to think of it!

  3. I often wonder how they determine anything as “Obesity Related.” Is it just because one is obese and has that particular condition? I mean I have type 2 diabetes, diagnosed in my 50s-I am obese, hence my diabetes is “Obesity Related”–the Drs all say so. My mother, now 80 has always been thin, she was diagnosed with diabetes in her 50s–not “Obesity Related.” I could go on, my very thin father has CHF, type 2, and has developed dementia. Not “Obesity Related” If I developed any of these conditions I would be told to lose weight and it would be considered “Obesity Related.” How do they determine if something is hereditary, genetic, or even environmental? That is why I am so skeptical of their stats about the cost of obesity, the loss of productivity, etc. How do they make the determination?

    1. Obesity related illnesses do seem to be diagnosed as ‘having while being fat/obese’.

      My sister told me recently she has knee problems because her knees are at a slight angle (which may or may not be hereditary) but if I went to the doctor with the same problem it would be because of my size. My mother and my grandmother (her mother) both take/took tablets for what is very possibly GERD, I was given exactly the same tablets for what appears to be the same symptoms, mine is due to my weight apparently.

      I spent most of my life with mild back pain which is now very not mild, but mine is caused by the size of my body and not apparently by the fact I have a chest that suggests the boob fairy was stalking me during my teen years. I finally got one simple exercise and an explanation for why my back muscles lock so painfully but I’ve had over a decades worth of lose weight you’ll feel better. Hell I even got that for my sinus infection which left me feeling lethargic and has had a significant impact on my health and fitness due to me not having the energy to go out so my muscles are less capable of supporting my body.

      All because the diagnose was put down to obesity. I want my evidence based health care. (I do now have a doctor that checks my actual symptoms and at least on the NHS I wasn’t paying for crappy treatment.)

      1. “…boob fairy was stalking me…” I just about snorted my coffee out my nose at that one! I, too, was stalked by the boob fairy. My sister likes to say that I took all the boobs, for she has very little… I may have to introduce this boob fairy stalking bit–although, knowing her, she may disagree and say I kidnapped the fairy.

        Our body shapes are VERY different, however we have many of the same ailments. Due to her height and my lack thereof, we often have things diagnosed differently. I think we overall have about the same amount of mass, she’s just distributed over a taller “distance.” Oh, and she’s had several children where I have not–some of her ailments have been brushed off as being due to pregnancy/having given birth, where mine are due to being overweight. Hmm.

        Anyhoo, both of us have similar degenerative disc/sciatica problems in our lower back, I just have the additional fun of the back pain caused by the girls. Whereas my sis does a lot of Yoga and acupuncture for her pain, I go to physical therapy and when not in PT I get time with a personal trainer integrated at my PT locale for additional strength, flexibility training.

        We once tried to do yoga together–she now understands that certain poses are difficult when one has the rack o’ doom.

        1. I think our side of the family is catnip for the boob fairy, my mum and both sisters are very busty – my aunt (mum’s sis) and my cousins seem to have been mostly missed over, mind you the height fairy skipped most of us too, I’m 5 foot 2 and my cousins are shorter

      2. Obesity related illnesses do seem to be diagnosed as ‘having while being fat/obese’.

        Agreed. I’m clinically obese, and I have chronic hip pain. The hip pain started with puberty — when I had a BMI in the low 20s — and is pretty clearly caused by nerve damage due to a progressive endocrine/autoimmune illness.


        I’ve had numerous health care providers list it on my charts as a “side effect” of my weight.

        1. Kind of makes you want to grab the file and write “EVIDENCE BASED CARE, DUMBASS!” in it, doesn’t it?

          I had a shock at my annual physical. The physician opened the file and told me that with my history of gestational diabetes it was time to watch for signs of pre-diabetes. I have had three pregnancies, with people freaking out right and left over how I was going to explodeanddie and insisting on testing for this and that, and never, not once, have I ever had even a borderline positive result for GD. But somebody at this group practice wrote “GESTATIONAL DIABETES” in the section of the summary page where ongoing concerns are supposed to go. After my last pregnancy was over, no less, or I would have heard about it earlier.

          Guess what size I am. Go on. Guess.


  4. And now I have visions of starting an ice cream speakeasy. All the best murderers would be there, of course. Them, and all the fat people who don’t want to give up joint pain and sinus infections.

    When they come through the doors, I’ll greet them with a hearty ‘Howdy, suckers!’ and a couple torch songs. Then I’ll start of the newbies with the easy stuff, soft-serve vanilla, maybe. The regulars will go for the hard stuff: mocha almond fudge, peppermint ripple, or passionfruit sorbet.

    Every once in a while, the cops will raid the place, but they’ll never manage to completely shut me down.

    And they can have my ice cream when they pry it from my cold, dead waffle cone.

    1. Ever read “The Good Humor Man”? There’s a speakeasy that offers nothing but super-rich “forbidden” foods. Being caught eating things like ice cream is punishable by cancellation of health insurance – without which most people cannot have children. Because they have no body fat. Ironically enough, one of the characters in the book regains her fertility because she’s patronizing the speakeasy.

  5. Excellent article, as usual. By the way, Ragen, I’m sorry you were injured last week but I’m glad you’re feeling better!

  6. Dang. I was hoping that the light posting schedule was because you were having a fabulous time in Austin. How disappointing to find out the real reason.

  7. Thanks for the great examples of ridiculous correlations. one of my favorites is the one that tops the list for heart disease. The vast majority of people with heart disease speak English. If the same logic were applied to this correlation as that applied to body size, speaking English must be penalized and speaking Japanese encouraged. Except that there is actually scientifically valid evidence that native Japanese speakers have lower levels of heart disease than people in English speaking countries.

    Or maybe it is simply a matter of geographical location. There is valid evidence that the longer a Japanese immigrant lives in USA the higher their risk of heart disease. Perhaps we should all move to Asia. Or better yet, Africa where the vast majority of the population are very slender and the prevalence of “developed world diseases” is exceptionally low.

    There is far more evidence to support the above proposals than there is for the recommending weight loss as a means of improve health. However, I don’t hear any medical authority endorsing extinction of the English language or mass emigration. The current weight loss paradigm is so flawed it cannot possibly be considered “evidence-based medicine”.

  8. Wonderful column, Ragen. Thanks for the good time. I hope you recover completely immediately and if it hurts to write/type, don’t. We can wait.

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