Rabid Reader: 'Fat Land' and U.S. Supersizing Americans keep getting fatter, and now there are new findings about the health dangers that come with obesity. NPR's Karen Grigsby Bates explores the issues behind Americans' expanding waistline with Greg Critser, author of Fat Land: How Americans Became the Fattest People in the World.

Rabid Reader: 'Fat Land' and U.S. Supersizing

Book Chronicles America's Battle with Obesity and Fast Food

Rabid Reader: 'Fat Land' and U.S. Supersizing

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Cover for Greg Critser's book Fat Land: How Americans Became the Fattest People in the World (Mariner Books 2004) hide caption

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Author Greg Critser shows off the contents of his refrigerator in his Los Angeles-area home -- a few guilty pleasures, but mostly healthy, whole foods and not a lot of processed food products. Karen Grigsby Bates, NPR hide caption

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Karen Grigsby Bates, NPR

Americans keep getting fatter, and now there are new findings about the health dangers that come with obesity. NPR's Karen Grigsby Bates explores the issues behind Americans' expanding waistline with Greg Critser, author of Fat Land: How Americans Became the Fattest People in the World.

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Below, an excerpt from Fat Land:

I've always wanted to steal Abbie Hoffman's subversive exhortation to rebel, and the paperback publication of Fat Land seems a fitting occasion to do so. That is because Fat Land was and is intended not to please the intellectual palate but, rather, to disturb it.

It apparently has done just that. Along with praise from across the political spectrum, Fat Land has also drawn its share of critics, from touchy international food companies to the nation's dour food police. Then there was Vanity Fair, which occupies its own niche in the great American circus. Its editors promptly proclaimed that "reading this book will take ten pounds right off you." A reader on Amazon.com even proclaimed that I -- I, Greg Critser! -- could "save millions." Still, many missed the littleknown fact that I was also the first to come up with a solution to global warming, a path to world peace, and a cure for cancer.

One thing is certain. Fat Land has taken off with a loud bang that just keeps on repeating, which makes it sound like what happens to you after eating at McDonald's but really says something about the world that Fat Land both reflects and provokes. Upon publication, a number of news events dramatized its main themes. New studies appearing in major medical journals, for example, showed that the rate of overweight and obesity was continuing its climb, edging from 60 to 65 percent of the population. Other journal reports proclaimed that the Atkins diet, which I drub, was in reality a better diet than the traditional low-fat diet, while still others showed that those who lost weight on Atkins usually regained it after a year. Interest in weight loss, to say the least, was at an all-time high.

The biggest action was in the courts. In New York, four teenagers from the Bronx sued the McDonald's Corporation for causing their obesity, citing, in their complaint, that "said products were hazardous or detrimental to an extent beyond which was contemplated or understood by the reasonable or ordinary consumer." Among the court documents supporting the case was Fat Land. Obviously their attorney had not read the whole book; if he had, he might have lost the extra weight between his ears that impaired his common sense.

Speaking of McDonald's, the fast food industry itself is being reshaped by the obesity epidemic. According to the Potato Processors'Association, sales of French fries have fallen over the past year by 10 percent, the largest single drop in the last fifty years. Just as the media storm over fat blossomed, McDonald's announced one of its most unprofitable quarters ever, causing it to close hundreds of stores and, eventually, to oust its CEO and name a new one. At the core of the giant's woes were poor service, overexpansion, and -- the very nightmare of its marketing department -- the growing notion that supersizing was becoming, as a number of college-age girls told me, "totally disgusting."

Since then, excoriated by study after study showing how supersizing has adversely affected the nation's collective corpus, Mc-Donald's has continued to supersize, of course. At my local McD's, 42 ounces of Coke -- about one-quarter of an average child's daily calorie requirements -- now can be had for 49 cents.

To be fair, the geniuses at McDonald's and other fast food firms have made some changes for the good. It is now possible, for example, to get a bag of fresh fruit with a Happy Meal instead of fries. And the company has promised to use (slightly) more healthful oils, eliminating artery-clogging trans fats. But one wonders about even these moves. The former, most marketing folk say, was a move taken not out of health concerns but, rather, as simply another selling opportunity. As one fast food consultant explained of the new fruit option, "It's basically a way to veto the vetoer. If there's one member of the family who brings up health issues, it's a way for the others to shout him down. It's pure genius." As for the trans fat change, many believe this was simply a way to head off lawsuits and an inevitable ban on the substance by the federal government. Either way, you can now use a credit card to eat at the Golden Arches.

But let's cut the clown a break, shall we? Obesity counts many enabling bedfellows, one of which, the federal government, seems to have finally awakened, or at least rolled over in its sleep. Secretary of Health and Human Services Tommy Thompson is the most notable example. Thompson has taken a leading role in using the obesity issue as a way to access prevention of chronic diseases, funding a series of community-based efforts to educate children and parents about the subject. Unfortunately, the Bush administration has had other priorities this past year, and the president has at best given the subject lip service. He has also allotted little in the way of public money for it.

What about the surgeon general? After all, it was the clarion call by President Clinton's Dr. David Satcher that prompted much of our current focus on obesity. Sad I am to report that President Bush's man, the charming and very polished Dr. Richard Carmona, seems hopelessly muddled in the morass of conservative D.C. culture. Although he has undertaken a number of educational initiatives on obesity, he is fundamentally unwilling -- or unable -- to use his bully pulpit equally on all. While he likes to sound the personal-responsibility trumpet whenever the president's advisers deem fit, when it comes to corporate responsibility, well, that's another matter -- that's "divisive."

I know this preface to the mariner books edition because I was on a speaking program at the conservative American Enterprise Institute (AEI) with Carmona. He graciously acknowledged and even praised Fat Land ("I'm a huge fan!"), but when I asked him directly, "Is there any time during the school day when a twelve-year-old child should be given access to a twenty-ounce cola?" Carmona punted, saying, "There are a lot of things that children shouldn't be exposed to, like they shouldn't be exposed to racing cars or drugs, but we can't be in the business of regulating everything..."

No, not everything, but, as my nine-year-old nephew Christopher said, "Jumbo Pepsi? That's a no-brainer."

Then again, Carmona and I were at a conservative event, and the unfortunate response of most conservatives to the obesity issue has been stunningly banal, if I may use that oxymoron. In general, they have reacted to the problem by spending time, money, and energy to deny that the obesity epidemic exists at all. An example: According to AEI and a recent Chamber of Commerce study, fast food advertising aimed at kids doesn't cause obesity. (No, it causes them to buy fast food, one element in causing obesity.)

The fact that obesity is rooted among the poor? Well, that means we should "reform the food-stamp program" (not a bad idea, but so predictable). National liberals have not been much better, spending most of their time bad-mouthing milk and advocating fat taxes, which is apparently a recreational activity at the increasingly vitriolic Center for Science in the Public Interest. Enter the post–Fat Land arena of community politics, however, and you get a different, much more vibrant picture of possible solutions.

In school districts from Los Angeles to New York, with many Midwestern stops in between, parents, physicians, and students of all political stripes have banded together to stop the sale of soft drinks in schools. Others are working to expand traditional physical education programs or to create whole new ones. Still other groups are pressuring the USDA school lunch program to diversify its offerings, beginning a long overdue shift preface to the mariner books edition from the era of pizza, chicken nuggets, and cheesy mac to one of more healthful, less processed alternatives. At the local level, parental responsibility now includes the task of holding corporations responsible for the foods foisted on children, an important new permutation of the old notion of in loco parentis.

It is heartening that almost all of the new activism centers on children and obesity prevention, rather than on adults and weight loss. The former is not only practical but increasingly supported by science as well; the latter remains clouded by boomer narcissism and scientific doubt.

Consider two different articles in a recent issue of the influential Obesity Research. In the first, "Fetal Origins of Obesity," researchers from Harvard Medical School looked at the growing field of in utero and early infancy programming -- the notion that what happens, nutritionally and otherwise, to the expectant mother and, later, to the newborn, has profound consequences in predicting chronic illness. The scholars found a complex but clear series of connections between maternal health and the offspring's fatness in later life. Children born underweight have a substantial risk of central obesity (big stomachs, the worst kind of fat) as adults, while children born too big risk greater overall fatness as adults.

Either way, Emily Oken and Matthew Gillman concluded, "Prevention of obesity starting in childhood is critical and can have lifelong, perhaps multigenerational, impact." Even the pediatric medical establishment has awakened. In August of 2003, the influential American Academy of Pediatrics released its first policy statement on how physicians should deal with the issue of childhood overweight, a refreshing development from an organization that for too long dealt with the issue by saying that parents should simply wait for their kids to grow out of their chubbiness.

The second Obesity Research report, on the other hand, shows how far we are from understanding, let alone treating, adult obesity. In an article entitled "Are We Addicted to Food?" a group of researchers from the National Institutes of Health looked at preface to the mariner books edition all the research making the claim that certain foods may be addictive. They found some evidence that low concentrations of dopamine, a brain chemical, may respond to the sight and smell of food in an addictive manner for some obese people. They may not be able to control their eating the way the rest of us can. Still, the findings remain far too unclear and preliminary to support any national policy. "Do we have enough evidence from neurofunctional and other studies to [begin to suspect] that human obesity is predominantly an addictive disorder characterized by compulsive eating?" the scholars ask. They conclude, "We cannot say for sure as yet."

In other words, we ought to focus resources on prevention and children.

And, perhaps, on diversifying our food supply. One of Fat Land's main themes is the connection between agricultural policies that promoted an oversupply of fat and sugar and the rise of obesity. In essence, calories -- often the wrong kind of calories -- became too cheap. But on this issue there has been no movement. Instead, the Bush administration, perhaps in a bit of preelection maneuvering to shore up the farm-state vote, pledged $800 billion in crop subsidies -- mainly for corn and soybeans -- over the next ten years. The Big Gulp and Jumbo Fries -- they're here to stay. Suffice it to say that we are not exactly on the verge of shifting some crop subsidies from corn to, say, olive-growing, which not only would be more healthful but would also make us less dependent on foreign oil.

Internationally, Fat Land appeared at a time fraught with jingoism at home and anti-Americanism abroad. It was published after 9-11 and before the war on Iraq. To some, the obesity epidemic was nothing short of Imperial America getting its just deserts, definitely no pun intended. The British writer Salman Rushdie had set the notion rolling in early 2002, noting in a New York Times editorial that "American patriotism, obesity, emotionality, self-centeredness: these are the crucial issues."

Rough words, but there is, I am afraid, something to them. In millennial preface to the mariner books edition America we eat and act, however unconsciously, in an increasingly imperial manner. The satisfaction of appetite is everything; criticism is greeted with a Springeresque smirk. The British recognize this posture all too well; it bodes poorly. Indeed, it pays to remember that the first modern fad diet -- William Banting's low-carbohydrate regimen -- appeared in 1863, at the peak of Great Britian's imperial power. Is obesity a sign of encroaching imperial ruin?

Abroad, many others saw the issue, and the book, not as a way to bash America but as a genuine warning signal to their own consumerist societies. In the United Kingdom I was called everything from a "moralist" to an "anti-fat crusader" -- approvingly. Health authorities there are just now wrestling with what to do about obesity. The BBC has banned the use of its cartoon characters for fast food advertising. And Parliament is considering a law restricting portion sizes, something that would make Dr. Carmona and the folks at AEI very queasy indeed.

Even France got into the act. The French, still the leanest of all European peoples, were responding to the fact that -- quelle horreur! -- 10 percent of its people are now obese. Between-meal snacking, fast food consumption, and sales of convenience foods are all up, particularly among kids in big cities. This has fueled no end of features and editorials about childhood eating patterns. Le Monde even ran a front-page cartoon of a fat child sitting in front of a television as he eats, while his parents look on and say, "He eats whatever he wants."

Not only did the French government issue a series of wideranging, very specific directives on how to deal with the issue (something the United States has yet to do), it also began what it called a national sizing campaign. The entire country is now being remeasured to make sure that a size six remains a true size six. Although the effort was launched by the clothing industry to better understand the modern French physiognomy, the campaign has also become a way to remind the populace of their true size.

Still, if the exact meaning of the obesity epidemic remains unclear to those who ponder such things, the consequences of it are more certain than ever before. Some stunning numbers: According to the Centers for Disease Control, of all babies born in 2000, one-third will become diabetic sometime in their lives unless they begin eating a lot better and getting a lot more exercise. One-half of the children in New York City are overweight, and of all Latinos in that city, one-eighth are already type 2 diabetics. States from California and Texas to Indiana and Arkansas report similar rates.

There are already signs that some people have come to view this trend fatalistically. The brilliant UCLA scholar Jared Diamond has even opined, quite seriously, that what we are seeing is accelerated evolution. The type 2 diabetes epidemic we are now witnessing among first- and second-generation Latinos (and in Mexico and South America), he says, may simply be nature's way of getting rid of populations that still carry the so-called thrifty gene -- a gene that is no longer necessary for survival in modern societies of abundance. At the very least, then, Fat Land's original prediction that obesity "might" break our health care system seems optimistic. Many public health epidemiologists now count that inevitability in years, not decades.

Meanwhile, the food industry is spending more than ever to get its names and products in front of children. Just this past summer, Coca Cola was caught using "consultants" to funnel money to Boys Clubs, which were required to use the money to buy Frozen Coke at their local Burger King; the scheme was intended to falsely drive up Coke's numbers and get Burger King to buy more Frozen Coke. There's more fun: Research by Texas A&M shows that companies like Kraft and Coke spent $15 billion on child-oriented ads last year, compared with $12.8 billion in 1998. There is now a Barbie doll dressed as a happy McDonald's counterperson.

Moreover, the new tack by food marketers seeks to supplant or subvert parental influence at every turn possible. Such is the intent, under the guise of convenience, of such foods as Ore Ida's blue French fries, Eastern Foods' purple pizzas, and ConAgra's Kid Cuisine, which features TV dinners like the Sandwich Builder -- a hamburger meal with a patty shaped like a house and cookies that look like bricks. I wonder if they taste like a house as well.

My fretting over all of this is not to suggest that we should pass laws to limit what food makers can say, as long as what they say and do is hygienically sound. Like it or not, these excesses come with the whole package of modern consumer capitalism, and I detect no mass movement roiling to get rid of that. The point is that such foods have a corrosive effect on the modern American family. They separate children from eating with their parents and catapult them, early on, into the realm of unsupervised -- and seemingly endless -- consumption. The key to change lies to some extent in the regulatory power of the state but also in the choices, political and individual, we make. Read on for more, and remember, if no one buys blue French fries, blue French fries will soon disappear.

And good riddance, I say.

Copyright 2004 Greg Critser. All Rights Reserved

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