"There are three kinds of lies:
lies, damned lies, and statistics."
Benjamin Disraeli
The researchers behind the recently published New England Journal of Medicine study claiming to document "the spread of obesity in a large social network over 32 years" have apparently never heard of Disraeli's comment on statistics (popularized by Mark Twain)
-- or have conveniently forgotten it in their eagerness to use
statistical analyses and a nifty Social Network Image Animator to
purportedly track "the person-to-person spread of obesity."
And
the media, in parroting the study's claims to have documented the
"social contagion" of obesity, are fueling the war on fat people by
uncritically reporting that "obesity" is contagious.
What can we expect next? Quarantine? Apartheid?
Nicholas A. Christakis, M.D., Ph.D., M.P.H. and James H. Fowler, Ph.D. were researching the "social spread of obesity" as they mined a portion of the almost 60 years' worth of data collected in the Framingham (Massachusetts) Heart Study.
In almost all of the nine media reports of this research I found in a
quick web search, there was no differentiation between physical/medical
contagion (the spread of a disease) and social contagion (the spread of
ideas and behavior).
The research is being reported in a biased manner, which I'll go
into in a minute. But I suppose that's only to be expected, since the
research was biased to begin with.
The researchers started -- and apparently ended -- with assumptions
that fatness is always unhealthy and undesirable, weight loss is always
healthy and desirable, and that permanent, safe weight loss is
achievable. None of those assumptions is empirically supported, and
each has been debunked in research documented in books ranging from Glenn Gaesser, Ph.D.'s Big Fat Lies: The Truth About Your Weight and Your Health to Fat Politics by J. Eric Oliver, Ph.D. and Rethinking Thin: The New Science of Weight Loss and the Myths and Realities of Dieting by New York Times science reporter Gina Kolata.
What the Christakis-Fowler research actually shows is the social
contagion of fat hatred, especially in regard to the way it's being
disseminated and reported.
For example, in my admittedly non-random sample of media reports,
the research was consistently reported as indicating that the body mass
index of "friends"
(no gender indicated) influences each other. (Yes, they
confused correlation with causality. That seems to be standard in
"obesity" research.) Every photo or video or audio clip purportedly
illustrating that "obesity" is socially contagious among friends
featured women. (Women who joined Weight Watchers, in at least two instances -- making me wonder if the diet industry rather than the National Institute of Aging might
be the real funder of the study. The exception being the
headless-torso-photos so typical of fat-related journalism, in which
gender can't be determined.) But the original study found that the
so-called "influence" of friends in regard to BMI only existed in male same-sex friendships.
Among
friends of the same sex, a man had a 100%...increase in the chance of
becoming obese if his male friend became obese, whereas the
female-to-female spread of obesity was not significant...
Yet
not one of the media outlets reported this fact. Indeed, by
illustrating their stories with female friends, they falsely implied
that the friends-make-friends-obese "connection" was true of
female-female friendships. Which I find particularly egregious given
that women are more preoccupied by -- and penalized for -- fatness than
are men, and have a higher incidence of eating disorders.
(You know, somebody ought to point out to Rush Limbaugh than
this new study could be used to blame him and his body-mass cohort for
the so-called "obesity epidemic." That might make an -- ahem --
interesting show topic.)
But in the media's haste to keep the "war on obesity" flaming --
fueling it in part by their own prejudices and assumptions about fat --
they're missing a far more important story, in my opinion. No, not "why
did the New England Journal of Medicine publish this p.o.s. in
the first place?" (although that's a good question), but "what effect
is this research having on fat people?"
Because the fat people (and their allies) who know the truth about
the "myths and realities of dieting" are horrified. And many are
scared.
They (we) see this study being used to justify more intrusive
public health programs and actions. More fat children being removed
from their homes to "save" them from their allegedly fattening parents.
(Well, maybe not "allegedly" fattening, since "obesity" has been shown
to be highly heritable, a fact the social-contagion-study researchers
discount.) More shunning of fat kids and adults, more job and academic
and social discrimination.
Indeed, I see the justification and agenda for this study in the reseacrhers' conclusion that
The
spread of obesity in social networks appears to be a factor in the
obesity epidemic. Yet the relevance of social influence also suggests
that it may be possible to harness this same force to slow the spread
of obesity....medical and public health interventions might be more cost-effective than initially supposed, since health improvements in one person might spread to others. [Assumes thinness and/or weight loss equals good health.]....This highlights the necessity of approaching obesity not only as a clinical problem but also as a public health problem. (Emphases mine)
More
money for public health initiatives! (And those whose salaries depend
on them.) More money for weight loss treatments, especially
group-focused interventions! (Never mind that Weight Watchers, for
instance, has been offering dieting-based groups for more than 40
years, with no demonstrable effect on the nation's waistline except,
possibly, to expand it through the yo-yo-dieting weight-loss-and-regain
effect.)
The first reports of this study indicating "obesity is contagious"
(reports assuming, of course, that "obesity" is a terrible thing)
brought chilling visions of quarantine, apartheid, and even lynching to
some minds. Including mine.
When my husband came across a report of the study online, he emailed
the link to me. He thought it was funny and couldn't imagine anyone
taking it seriously. "Yeah, you laugh until they put me in a boxcar and
send me to Fat Land," I told him. (That was before I learned the
strongest "effects" of this so-called contagion were male to male.) My
husband's reaction? "Well, you know where the gun is." That's a
Southern male response for you.
Here's a sampling of the way this research was reported. As you
read, keep in mind that the "friends" effect was only for male same-sex
friendships, and the average amount of weight a friend gained when his
male friend was "obese" was only 5 pounds.
Time magazine (Laura Blue):
Obesity Is Contagious, Study Finds
Wondering
why your waistline is expanding? Have a look at those of your friends.
Your close friends can influence your weight even more than genes or
your family members, according to new research appearing in the July 26
issue of The New England Journal of Medicine.
NPR Morning Edition (Allison Aubrey):
Are Your Friends Making You Fat?
A new study suggests that your best friend's weight may be very
influential in determining whether you'll gain or lose weight over the
years.
NewScientist.com
Is obesity contagious? (Roxanne Khamsi):
They
say it's not what you know but who you know. A new study suggests that
this aphorism might hold true when it comes to your body weight.
MSNBC.com (Reuters):
Your best friend could be making you fat
If your BFF gets obese, study says you're likely to follow suit
Could your best friend make you fat?
Researchers who have studied "networks" of obesity think so; they
found that if someone's friend becomes obese, that person's chances of
becoming obese increase by more than half.
BBC News (no attribution):
Obesity 'contagious', experts say
Having a friend, sibling or spouse who is overweight raises a person's risk of being obese too, US researchers say
The New York Times (Gina Kolata*):
Find Yourself Packing It On? Blame Friends
Obesity
can spread from person to person, much like a virus, researchers are
reporting today. When one person gains weight, close friends tend to
gain weight, too.
*Yes, that Gina Kolata, the author of the recently published book Rethinking Thin, who has apparently dissociated the contents of her book, including her ending plea that we "lay off the beleaguered fat people."
CBSNews.com Couric & Co (Dr. Jonathan LaPook):
Is Obesity Contagious?
...If one of a pair of mutual friends BECOMES obese (defined as Body Mass Index, or BMI >= 30) then the risk of the other becoming obese increases by 171%!
My Way News (Alicia Chang):
Study: Obesity is 'Socially Contagious'
If
your friends and family get fat, chances are you will, too, researchers
report in a startling new study that suggests obesity is "socially
contagious" and can spread easily from person to person.
Each
of these stories, of course, leads with the "friends can make you fat"
claim, but fails to clarify that the friendship "contagion" was only
significant in male same-sex relationships. Of the nine articles I
read, only one, by WebMD, clearly stated in the headline or lead paragraph that the contagion wasn't "about viruses or germs." But WebMD reporter Miranda Hitti still reported the friendship-obesity claims without clarifying that they applied to male same-sex friendships only.
This might be an example of the assumption of male privilege by the
male researchers -- findings applying only to men being reported as if
they were true of men and women both. I have a hard time imagining that
findings applying only to women wouldn't be clearly indicated as such.
I suspect the consistent failure of reporters to clarify the friendship
gender issue stems from their not having read the original research and
relying instead on a press release that spins the research in the
direction most likely to fuel the war on "obesity."
Here are some more gems from the media reports:
The study's authors suggest that obesity isn't just spreading; rather, it may be contagious between people, like a common cold. (Time; emphasis mine)
Confuses social contagion and physical contagion.
"You
are what you eat isn't the end of the story," says study co-author
James Fowler, a political scientist at UC San Diego. "You are what you
and your friends eat." (Time)
Erroneous
assumption that fatness is simply and directly related to the amount
and type of food ingested. Fat people can eat healthily and still be
fat, just as some thin people can eat unhealthily and still be thin.
Having fat friends makes being fat seem more acceptable. (Time)
Assumes fat bodies are "unacceptable."
Working on your weight? Enlist your social network.
"If you're going on a diet, then you want to convince them to go on
a diet. If you want to start to run or to change your exercise
behavior, you also want to encourage your friends to engage in those
behaviors," says Fowler. (WebMD)
Like no one
has ever thought of this before. Well, maybe men aren't as likely to
make dieting a social or group activity as women are. Or maybe Fowler,
being a political scientist rather than a clinician, doesn't know beans
about the history of dieting. Or of Weight Watchers and TOPS (Take Off Pounds Sensibly) and Overeaters Anonymous and other weight-oriented groups.
If
the new research is correct [well, thanks for that "if"], it may say
that something in the environment seeded what some call an obesity
epidemic, making a few people gain weight. Then social networks let the obesity spread rapidly. (New York Times; emphasis and sarcasm mine)
Maybe
to stop this rapid spread of "obesity" they should train people to yell
"Fat! Fat!" when they spot an "obese" person, and "drop and roll" if
they get too close. Or they could create fatbreaks -- you know, places
that are inaccessible to fat people and thus could stop the spread. Oh,
wait -- there are plenty of those places already, and they apparently
haven't had an effect upon the conflagration.
It may also mean that the way to avoid becoming fat is to avoid having fat friends. (New York Times)
That's
the take-home message being blared by the media, even though the
researchers claim it's not their intention. (Just what we need, more
isolation, discrimination, and shaming. After all, discrimination and
stress have great effects on health -- oh, wait. No, they don't.) Of
course this statement, just as every other media report as well as the
original journal article, confuses correlation with causality.
Almost all the media reported the study uncritically. Only the New York Times, My Way and BBC News
articles (among those I reviewed) included comments from other
scientists that could be considered mildly cautious about the study,
but those remarks were buried at the end of the articles and were
nowhere near as critical as the research warranted.
Other problems with the study:
- The data was reported as if it applied to all Americans and all
social classes, even though it was a non-random sampling of a white
middle-class community. (The NewScientist.com article actually reports that Christakis and Fowler say the study "might mean that the problem of obesity
[a phrase reminiscient of "The ________ Problem"....fill in the blank
with the population of your choice] could spread more quickly through
small towns -- where social networks tend to overlap more than in big
cities." [Emphasis mine.] Maybe we should stamp out small towns. Or
rigorously police them to make sure the fatties stay away from the
thinnies.
- The "friends" and family members included in the study were
only those whose names the Framingham Heart Study (FHS) participants
had given to the FHS researchers when asked for emergency contacts --
and of those people, only ones who were also participating in the heart
study were included in the "social contagion" analyses. Christakis and
Fowler apparently excluded any "friends" or family members who were not
also in the FHS, because weight data weren't available for those people.
- Using BMI as an indicator of "obesity" is inherently
problematic especially for men (for whom the only "friendship" effects
were found, remember), because the BMI formula doesn't discriminate
between muscle and adipose tissue. Muscular men could be identified as
"obese" even though their body fat percentage might be within "ideal"
range.
It appears that Christakis and Fowler pulled social data from a
study not intended for that purpose, tossed it into a statistical
program, and looked for patterns that fit their preconceived notions --
err, hypotheses.
That reminds me of the scene from the film A Beautiful Mind in which Russell Crowe shows Jennifer Connelly
how he could find any image she named in the stars. Given enough data
(or a starry night), you can find find all sorts of patterns and assign
the meaning to them you wish.
In the BBC News article, Christakis says "It's not that obese or
non-obese people simply find other similar people to hang out with."
[Actually, the researchers claim this isn't the case, but I suspect
it's just one of the constellations they wanted to see in the data.
It's not at all clear in the journal article that their data disprove
this.]
"Rather, there is a direct, causal
relationship.[Correlation does not equal causality. Twinkle, twinkle,
little star...] What appears to be happening is that a person becoming
obese most likely causes a change of norms about what counts as an
appropriate body size.
"People come to think that it is OK to be bigger since those around them are bigger, and this sensibility spreads." [Horrors.]
So there's another take-home message from the researchers: size
acceptance -- or, heaven forbid, fat acceptance -- is dangerous because
it can seduce others into fatness.
Of course,it is true that those who recognize natural
diversity in body size and champion size -- even FAT -- acceptance
might, yes, influence others to stop food restriction and other
unhealthy weight loss practices. And that might result in those
individuals' regaining any lost weight -- although they'd eventually
regain anyway, since there is no diet or drug or exercise or medical
"treatment" proven to result in permanent, safe weight loss. Size/fat
acceptance just helps them understand that the failure lies in the diet
(or other intervention), rather than the individual.
But is that dangerous? I think it's most threatening to those whose
livelihoods are dependent on the notion that fatness is a killer
disease that must be eradicated.
Earlier today I shipped a box of books published by my publishing company, Pearlsong Press,
to the young woman who will be our first writing intern this fall. I
wanted her to become acquainted not only with the books and authors,
but with the company's mission and vision of publishing only books that
promote (or at least do not contradict) size acceptance and Health At
Every Size, the weight-neutral approach to well-being.
The first books I published, in 2004, were Pat Ballard's
short story collection and romance novels featuring plus-sized
heroines. (Or, as I like to put it, books in which the fat chick gets
the guy.) Romance novels might seem like lightweight armor in the war
against fat people, but I think it's important that people be able to
see positive images of themselves in the world around them. I'm old
enough to remember when there were no African American people on
television in any role except servants. It was a big deal when Diahann Carrol became the first black woman to star as a professional woman on television, in the show Julia. It's almost as rare today to see fat women portrayed positively in television, film, and literature. (I'm talking fat, here, not Bridget-Jones-chubby .... although even that, too, is rare.)
Anyway, as the postal clerk weighed the book package this afternoon
she went through her usual litany, asking me if the box contained any
liquid, flammable, or hazardous material.
"Just dangerous ideas," I said.
UPDATE 7/30/2007: Sandy Swzarc has an excellent post on the study and its "virtual reality" at her Junkfood Science blog.
She points out that although the NEJM reported the authors had no conflicts of interest, in fact Christakis is on the Robert Wood Johnson Scholars in Health Policy Program at Harvard, which is a program of the Robert Wood Johnson Foundation. The RWJF is the largest organization in the world funding policies against "obesity." (See my April 4, 2007 post about the foundation funding the war on fat kids here.) And they call that "no conflict of interest"...?
