Last week Slate ran an article that at first glance appears to be a step in the right direction -- Fat People Don't Need To Be Punished.  The author makes all the right noises about the failure of diets and punitive measures. Any of us can agree with this. But then there is this:

The brutal reality is that the reason a lot of adults are fat is that they were fat as children. Research shows that obese children are at least twice as likely to be fat adults as non-obese children. Children aren't generally recognized in our culture as fully capable decision-makers. It's widely acknowledged that the responsibility for keeping children from getting obese lies not with the children, but with the parents.

I have been thinking about this and the whole idea of prevention.



The action of stopping something from happening or arising. *

Now think about it -- does not prevention require that we know the cause in the first place? We know that the polio virus causes polio and developed a vaccine which then conveys immunity, or prevents the development of the disease. Knowing the cause, we could find the means for preventing it. Or knowing that being thrown from the car is a cause of automobile accident deaths, we devise means to keep that from happening, thereby preventing some of those deaths.

So how are parents to prevent their children from becoming obese? Weight is heritable to the same degree as height -- that is 70-80% of the variance is accounted for by genetics, which leaves a pretty small window for this prevention to occur. And try setting up a Google News alert for "obesity research" and every day you will find new reports of putative causes -- everything from premature birth to thinking you are fat have been cited as causative factors in obesity in just the last week.

Mayor Bloomberg believes supersized soft drinks causes obesity so he calls fr a ban on them. If he were correct, we would see a drop in the rate of obesity, but it is likely that not a single pound will be lost nor will a single person avoid obesity because of this measure. 

Now note the closing paragraph of the Slate piece:

A sane, rational approach to the health crisis stemming from poor nutrition and exercise would be to change the circumstances that make people fat. Americans aren't the fattest people on Earth because we are uniquely absent of will power, nor is there a reason to think that obesity is rising because American self-control is somehow mysteriously declining. It's an environmental issue; we live in a culture where the cheapest food has the most empty calories and exercise opportunities elude huge portions of society. If we changed those factors, it would go a long way to reducing the strain of diabetes and heart disease on our health system. 

So it must be cheap food and too little exercise which makes people fat. She states that as if it were proven fact. No doubt these are contributing factors for some people, but by themselves they are not the cause, else slender people in the same environment, eating cheap food and being sedentary, would also be fat. The variance in weight exists regardless of the environment. 

Or think about it this way -- there are illnesses correlated with height, both for taller than average and shorter than average people. But curiously no one is suggesting that parents take action to insure that their children either exceed or fall short of the average. We don't do that because we know that what we see are correlations, not causation. And modifying height won't alter the risk.

But then again, there is not a whole raft of negative cultural assumptions attached to height.

Just think about it.