I See Fat People, They Are Everywhere

Tonight in the State of the Union, President Obama gave Michelle Obama credit for lowering childhood obesity.  This is not so cut and dried as it might sound.  Australian scholar Michael Gard points out in his new book, The End of the Obesity Epidemic, that over the last decade obesity rates among both adults and children have leveled off or declined all over the world, including in the United States. In 1998 35 million Americans went to bed a so-called “healthy weight” and woke up fat thanks to a commission of scientists with ties to weight loss programs and drugs who successfully lobbied to have what is considered a “healthy” weight lowered (creating 25 million new potential clients in the process.)

But try to calmly enter this information into the discussion and you’ll often find yourself  shouted down by people yelling – I see fat people everywhere and I didn’t before! 65% of people are fat!  I see fat people everywhere and they are all [fill in the blank with a stereotype]!    This may be a good time to remember that observation, while part of the scientific method, is not science in itself, here’s why:

First, there’s Confirmation Bias –  that people tend to favor information that confirms their preconceptions or hypotheses, regardless of whether or not the information is true. They also tend to interpret ambiguous results as supporting their point of view.  Everyone is subject to this, including me, researchers are taught to be aware of it.  (Interestingly, this is why it took me so long to choose a Behavior Centered Health approach – I was certain that I had to lose weight to be healthy and it took a while for the facts that were staring me in the face to set in).  Back to our world overrun with fatties… we must accept the possibility that it’s not that there are a ton more fatties, or that every fatty fits into some stereotypes (and let’s be clear that the problem here is stereotyping and not fat people), but rather that confirmation bias is driving society to seek out evidence to support their conclusion and ignore that which does not.  Similarly, when someone posts a comment on one of my dance videos saying how lazy I am they are ignoring the evidence in front of them because they are letting their confirmation bias run away unchecked, or because they are a jackass.  Actually, the two aren’t mutually exclusive.  At any rate, this is something that we all have to be aware of – especially if we are reviewing and interpreting data.

The second issue is frame of reference. I’ve heard more than one doctor say “I know that obesity causes health problems, every obese person I see has health problems!”  Well, you’re a doctor – do a lot of people stop by your office to say that they feel great?  When  a friend of mine suggested that there are fat people without binge eating disorder a therapist specializing in binge eating disorder told her that “It’s my experience that someone that size probably has binge eating disorder”.  Perhaps that’s because her experience is with fat people coming to her to deal with binge eating disorder.  It’s like a podiatrist saying that every person with feet has foot problems.  If all you’ve got is a hammer, every problem can start to look like a nail.

Next we have sample size.  Maybe you saw a fat person eating McDonalds – this does not a statistically significant sample size make, though that person has every right to eat whatever he or she wants.  Similarly, if you, or your sister in law’s best friend’s nanny’s aunt, lost weight and kept it off for 5 years then you are a statistical anomaly, if you were on TV the bottom of the screen would read “Results Not Typical”, you are not proof that weight loss works for the majority or even the minority of people.

The next thing to think about is meaning.  Even if it’s true that there are tons more fat people than there used to be, do we know (and I’m not talking  about “everybody knows”, I’m talking about evidence-based knowing) why it’s happening or what it means?  We are also taller than we used to be but nobody’s freaking out about the tallness epidemic.  The hysteria around obesity and its healthcare costs (which, despite popular opinion, have been shown to be way overblown) has somehow made it ok to skip the steps where we look dispassionately at why a phenomenon happens and what it means and instead we’ve jumped right to  “We’re gonna die! Quick, shame the fatties!!!”.

Finally, we have to look deeper.  I heard someone say the other day that they were at a hospital and most of the people there were fat, thus proving that fat people are less healthy.  All of the issues from above apply but let’s look deeper.  According to research out of Yale, in this culture fat people have a more than 50% chance that when we go to the doctor, she or he will view us, and treat us, as if we are awkward, unattractive, lazy, weak-willed,  and unlikely to comply with treatment. Even when fat people do go to the doctor they are often humiliated and receive sub-par care.  Without so much as touching us, let alone using proper diagnostics, doctors diagnose us as fat, give us a treatment protocol of weight loss and send us on our way (People have relayed having been prescribed weight loss without even being touched by their doctor for sudden onset intense back pain that turned out to be ruptured discs, abdominal pain that turned out to be a cancer, and abdominal pain that turned out to be gallstones that required emergency surgery).  So, many fat people have horrible experiences that lead to them to avoiding the doctor, and when we go we often get subpar treatment.  Both of these things can lead to us not getting proper early intervention, thus even if the scenario is true,  finding us in the hospital for situations that a thin person may have had solved by their doctor in its early stages because they were listened to with more respect and given a treatment plan based on proper diagnostics.  You can’t just accept things  at face value if you want to get to the truth.  It helps to ask yourself:  Is this statement true?  If it is true what might it mean?  What is might be causing this?

Observation can be powerful but we have to be careful about drawing large scale conclusions based only on what we can see.  This is something that researchers struggle mightily with.  You know how when you paint a room the painting is easy but the set up is a pain – all that taping and prepping, laying down the tarp, etc.?  That’s how setting up research is – actually performing the research is the easy part. The difficult part is in setting it up – making sure that you have a statistically significant sample size, making sure it can be extrapolated to the population of interest, deciding what variables to control for and how to control for them etc.  Good researchers go to great pains to do this well, and they always state their limitations so it’s foolish to think that we can look around and get information that’s just as good or better.

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36 thoughts on “I See Fat People, They Are Everywhere

  1. well written, as always.

    in addition to confirmation bias, there is also a phenomenon called “frequency illusion”, in which something which has recently come to one’s attention suddenly seems to appear with high frequency shortly afterwards. buy a white smartcar, suddenly you see smartcars, and especially white ones, everywhere. read an article about fatties, whoa: it’s an obesity epidemic. and these days you can’t avoid articles about obesity even if you try.

    1. I was just thinking about this. I remember applying for a job in a town called Montgomery… suddenly I was seeing the word/name Montgomery in tons of places. It iwas on my mind and I was drawn to notice it more often.

    2. I thought the same thing. People are seeing more fat people because they are hyper-aware about OMGFATZ! It doesn’t necessarily mean more fat people. Add to that how our perception of what constitutes as “fat” is being skewed further and further and voila. Congratulations, it’s an epidemic. Snake oil peddlers rejoice.

    3. Fat people must hide when I’m around because all I ever see are thin people. Of course, being tall as well as fat, everyone else tends to be short and thin by comparison… it’s rare to see people not only taller, but fatter.

      Guess if you’re short and thin, you compare body sizes that way so everyone else is bigger and fatter.

  2. Also, who asked these people to fix supposed “problems” anyway? Someone grocery shopping or otherwise minding their own business is not a target. Even the patient…need help for the problem, not the “lifestyle choice”.

  3. My favorite confirmation bias jackasses are the “I know this one fat person who eats her feelings, therefore all fat people have emotional problems”/”everybody knows all fat people ever do is sit on their couches eating cheetos because they’re lonely and need psychological help” jackasses. (And their “compassionate”, “helpful” offshoot — the “I’m just trying to be helpful because you won’t be able to lose weight until you deal with your issues” jackasses.) They seem literally unaware that they don’t know enough about the details of all fat people’s lives (or possibly any) to believe this.

    I understand why it happens — because if they can’t figure out where a fat person’s life “went wrong” in comparison to theirs, it could happen to them. What I have more trouble understanding is why they can’t understand what they’re doing even when directly questioned about the basis for their assumptions.

    1. I’ve heard both compulsive gambling and perpetration of abuse (against children) attributed to “the obesity epidemic” by armchair experts on another board. [rolleyes]

        1. It was basically along the lines of I walk by this video gambling parlor a lot and there are all these fat people in there who can barely fit on the stools OMFG!

          Yeah? I walk through my local park all the time and see fat people walking dogs, riding bicycles, etc. It really is all about perception.

          Oh, and the genius who claimed we were all likely child abusers decided on this correlation because her fat sister-in-law is mean to her own kids a lot. :/

  4. And let us never forget Mr. Twistie’s doctor recently diagnosing his pneumonia as heartburn from all the overeating he was doing… except that Mr. Twistie was having trouble breathing and had no appetite because he had freaking pneumonia.

    But with one glance, the doctor could ignore my husband’s entire medical history (the one he’s been in charge of for the past two years!) and say heartburn.

    I may be jumping to conclusions, here, but I suspect he was confirming a bias or two on that one.

  5. Reblogged this on Sly Fawkes and commented:
    If not for my stupid piece of crap loser thyroid gland, I would probably never go to the doctor at all. But because I have the worst endocrine system in the entire universe, I am stuck going to the doctor every few months.
    I’m pissed off right now because I was just diagnosed with diabetes, and forget the fact that this is hereditary on my mother’s side of the family and I dodged the bullet until I was nearly 50. It’s obviously my fault because I’m fat.
    At this moment I see stupid people, they are everywhere.

  6. I was thinking about your mention of Pres Obama giving credit to his lady for reducing childhood obesity…. hmmmm I know that in our school, kids are not eating the school program lunch as much. They are choosing the ala carte line and buying better tasting food. Granted, it isn’t fried, but there’s no limit (except money in the account) for how many slices of pizza or cheeseburgers they can buy. I think the overall trend in body size as stabalizing has more to do with a movement of consumers to look for more local, fresh and hormone free foods when they can. Also, groceries are expensive!!! We aren’t eating less red meat and fresh foods at my house because we are on diets.. it’s because our grocery budget doesn’t go as far. AND we are crankier, more tired and edgy becuase of it… and we’ve all lost a bit of size…. except me… my meds keep me fluffy

  7. I don’t have her book in front of me, but I’m pretty sure some of the studies cited by Linda Bacon (in 2010) already pointed out that weight in the U.S. was leveling off. Wouldn’t those studies have preceded any “healthy eating” programs put out there by the current Administration? (Well, maybe those studies didn’t specifically mention children. I’m not sure.)

      1. Q. How can you tell when a politician’s lying?

        A. His/her lips are moving.

        THANK YOU!! I’ll be here all week! Be sure and tip your server! :p

  8. Thank you for such a sanity restoring post! I was yelling at my television when he said that!! Well written & well thought out post, as usual!!!

  9. I call myself @BMIFraud for a good reason. Most people believe in an obesity epidemic because of percentages reported in articles and in the news. Rates of adult obesity are highly exaggerated. And if you observe at a local venue, childhood obesity is actually uncommon. This reminds me of the story about the emperor who wore no clothes but no one seemed to notice.

    1. You make an excellent point. I was just in a full-to-capacity elementary school lunchroom a couple of hours ago and don’t remember noticing one obese kid. I’m sure there may have been a few, but the vast majority were not. (And, I might add, I could count on both hands the number of kids who had bought the school lunch.) Certainly no visible “epidemic”.

  10. Thinking about the media and the fat hysteria reminded me of a story I heard years ago, but now I can’t find it.

    The gist of the story is that two reporters began reporting every crime in a town and everyone freaked out because their nice safe town was suddenly overrun with criminals.

    No actual change in the crime rate, everyone was just hearing about crimes.

    If there were a way to stop the media frenzy around fat, I suspect a lot of the other crap would eventually fade away.

    Unfortunately with so much money at stake, that isn’t going to happen.

    I spent some time a year or so ago looking through old family photos that went back to the turn of the century. None of those people were skinny by today’s standards. I felt so much better about my body after that.

    1. It’s true. I remember when I moved to a smaller city years ago, the citizens were up in arms over a reported 33% increase in murders in the city.

      If you listened further, that meant the number had gone from 9 to 12. Not happy news, but not really worthy of the ZOMG! 33% MORE MURDERS!!! press it was getting.

      Perhaps if the media (and the First Lady) would stop trying to convince us there’s a fat epidemic…

  11. I did an informal ‘study’ in my little down in Cambridgeshire, UK. I counted the number of fat people I saw in 5 minutes, walking past the cafe I was sat in. I counted 3, out of about 40 people who passed. All three were elderly. It was school chucking-out time and I did not see one fat teenager, although I am sure they exist. I saw a couple of overweight but not fat, middle-aged people. No fat children or babies.

    When you actually count people although it is pretty subjective (a big coat can look like fat when it isn’t) and you can’t tell a person’s weight by looking (some people ‘carry’ their fat more elegantly), it’s interesting how relatively few fat people there actually are in a typical English town. The official statistics back this up.

    There have always been some fat people, even after the war in Britain, when they had rationing, some people’s metabolisms still managed to make them fat. But fatness like a lot of things, seems more common when you’re looking for it – like when I was trying for a baby, everyone was pushing a pram, or so it seemed. Now I’m fat, I notice ‘my kind’ a lot more than I used to.

  12. As you’ve noted: “Even if it’s true that there are tons more fat people than there used to be, do we know (and I’m not talking about “everybody knows”, I’m talking about evidence-based knowing) why it’s happening or what it means?”

    A question very well-put. Animals in the wild and laboratory animals are also fatter now. But that’s almost never brought up, and when it is, there’s a new round of hand-wringing speculation as to the “cause”. And that’s just more noise, really.

    It won’t surprise me when we discover that fatness carries a real benefit. That which is regarded as Adversity often does that. Noise obscures the guidance which can be derived from a place of calm. The various media, though, thrive on chatter. Sigh.

    1. seriously? animals in the wild are fatter now than they used to be? i hadn’t heard that. are we talking rats, mice, pigeons? they are affected by human food supplies, so it wouldn’t surprise me a whole lot. but, say, deer would. do you have a link to some cites?

      1. I don’t have a link to the study, but I remember reading somewhere that marmosets, of all things, got fatter at around the same time as people did. Crazy, right?!

  13. “I see fat people everywhere and I didn’t before!”

    All that means is that *something* is making you aware of fat people, so you notice them more than you did before.

    I just bought a Hyundai Santa Fe a few months ago. Guess what? It’s like every other car on the road is a Santa Fe! Those suckers are everywhere! That means a zillion Hyundai SUVs sold right at the end of October in my town. I didn’t notice so many of them before, so they must not have been on the road. Right?

  14. The “I see fat people” phenomenon is evident in the comments of a New York Times article today about childhood obesity. http://www.nytimes.com/2014/01/30/science/obesity-takes-hold-early-in-life-study-finds.html

    Also out in force is the “medical degree from POOMA University” crowd. Everyone has the answer — charge parents of fat children with child abuse, send the kids to fat camp, eliminate carbs, eliminate meat, eliminate dairy, use “common sense” calories in-calories out, ramp up the shaming and social pressure. Voila! Problem solved.

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