Tuesday, May 24, 2005

An interview with Michael Gard

Australian physical education academic Michael Gard is the co-author, with Jan Wright, of The Obesity Epidemic: Science, Morality and Ideology. I talked to him about the book which was published in April 2005.

Why did you decide to write the book - why now?

I was doing my PhD with Jan Wright who was my supervisor at the University of Woolangong. I was actually doing research into another interest of mine, professional dance. We just got talking about it, from 1999 to 2000, when the talk about obesity really got started.

By about 2001, I realised there was something in it. I had been doing some analysis on the side into some of the major claims made about obesity such as declining physical activity levels. Over a period of time, I kept coming across statements like "Of course we have no proof, but we know that physical activity is going down" in the scientific literature. It occured to me that there was something in that, something to be pursued.

What I found was a recurring theme, particularly with an issue like how much people are eating. It always struck me that not only was there nothing like academic consensus about that issue but there's actually a strong line of longitudinal studies showing that people are eating less and less. In a sense, that strikes me as common sense. Particularly middle class westerners are eating less and eating better than certainly my grandmother's or my grandfather's generation.

I thought that was a very interesting point - how the data doesn't match the assumptions behind much of the discussion. Even when the data says the exact opposite, it is assumed that the energy in/energy out model must apply somehow.

Yes. I realised around 2002 when we started sending out proposals for the book that there was a lot of mileage in this. To be honest, the thing that really got me going was this kind of demonisation of children. We don't get into it, and I wish I had said more about it in the book. For example, the argument that children are getting less physically active: I would say that, and I'm talking anecdotally like everyone else I suppose, the idea that young women are less physically active today than my mother's generation just seems to me to be an absolute non-starter. So, I suppose there were all these kinds of disconnects that I was getting.

Why is obesity an issue now? Has it always been an issue, but it's just in a new form? Or has it really exploded, as it seems to have, in the last five years - and if so, why?

It's a convergence of factors. There have been people talking about a crisis of obesity for a number of decades. I didn't do any research on this, but I kind of charted the sharp rise in comment about it from about the mid-90s. Let's be honest, some of the statistics around obesity are quite startling particularly in the last 15 years or so. But it occurred to me that there was something in that, that the spike in the last 15 years could not be explained by general moral decline. I think the medical and scientific community have been banging on about this for about 15 years and finally they've got people to listen. The term 'obesity epidemic' has been around for quite a while but it's only these last three years where it's taken off.

This connects with an area study which we don't talk about a lot called the sociology of health. We have entered a period of history where it is now okay for governments and institutions like medicine to presume to give advice about very intimate things about our lives, such as parenting practices, how much time we spend watching the telly and stuff like that. It always been around but it's connected with this whole self-help age that we live in, everybody has advice for how we should live.

People have become kind of numb to it, they just expect experts to tell us how to live. In Australia, the last federal election saw both parties focus on child issues. I participated in a current affairs programme for the ABC (Australian Broadcasting Corporation) where the guy running the show basically dubbed it 'The Kids Election'. Both parties seemed to be driving very hard on that kind of stuff: childcare, obesity, sport, single mothers etc.

A lot of people will say it's fair enough to talk about our health all the time. What's the harm in the government telling us about the latest medical advice etc? What are the negative consequences of that kind of outlook?

There's one very obvious one: the connection between being overweight and poor health is very weak. When we talk about an obesity epidemic, we are talking about people with a BMI of above 25. What I say, and what a number of people say, if you have a BMI of 25, 26, or 27 - which I do - you are not necessarily diseased. In fact, you're very unlikely to be diseased.

This is the crazy thing about it. We have now got to the stage in the scientific literature where they talk about being overweight as being a diseased state. The line between have a BMI of 26, 27, 28 and suffering from a lifestyle illness is just very, very complicated and hard to establish. So, we are talking about millions and millions of people who are being included in this statistic who aren't sick, and who are probably going to die from something quite unrelated to being overweight. Same goes for people who are moderately obese.

Of all the things we could be talking about, we have included millions and millions of people in Western countries who are going to live average lengths of time and live average deaths. We're spending all this time telling them to exercise more and lose weight when it's very doubtful whether dropping your weight from a BMI of 31 to 28 will help you live any longer. Nobody has ever proved that. Not only has no-one ever proved that, they've never come within a bull's roar of trying to establish it, never mind prove it.

It's a very perverse thing that this obesity epidemic is happening, life expectancies continue to rise inexorably because all the main reasons that people used to die in the past are disappearing.

It will be interesting to see, given that some of these people have predicted that life expectancies in the West will start to drift downwards now, because I haven't heard anybody outside of obesity studies seriously suggest that. The people who study life expectancy for a living confidently say we will be having average life spans of 100 by the end of the century. So someone's wrong about this.

Indeed. How can you have a pensions crisis and an obesity crisis at the same time? The two things do seem to be entirely contradictory.

There is some crazy research in this area where they try to calculate how much overweight and obesity is costing us. Like I say in the book, it's all stick and no carrot, it's all downside. Well, I assume that if, en masse, we started to die ten years earlier, that would be some kind of economic bonanza.

When I was reading through the book, what I found was a very interesting, sceptical look at a lot of this data, but it was only towards the end that I got a sense of what you thought yourself. You talk about the 'social construction' of obesity and you also talk about 'stories', like at the start of the book you talk about the 'story of progress' versus the 'story of decline'. Isn't there a danger with a social constructionist outlook that you end up saying that there are lots of these different stories around, and they're all equally valid? Does it lapse into relativism or do you think you've still made a strong point about the way the world is?

No, I don't go along with that at all, really. It was more a case in this book of not wanting to stick my neck out too far before having really looked into it. The point I try to get to towards the end is that, in terms of obesity, I'm inclined to think that we need to trust our instincts in some ways. For example, I think we need to trust people's general scepticism about this and that maybe it's not the huge problem that some in the scientific community think it is.

But, by the same token, I tried to be a little bit upfront about this and say "If you are seriously suggesting that we are in the midst of an epidemic which is about 30 years old, then what is it about our society that has changed in the last 30 years?" One possible line of argument might be, and I think it has some legs, that deregulation and the late 20th century form of capitalism... you have poverty, deregulated labour markets and obesity. There's been some very striking research in relation to poverty and obesity in America. I'm wondering whether or not this focus on indivduals doesn't obscure some very important and fruitful debates about the macro.

At the end of the day, look at the kinds of things that governments are suggesting, for example in Australia they've just brought in this rule that schools can get extra money if they have compulsory after-school physical activity. It's not going to make any difference to anybody's health and long-term body weight - it just isn't. The idea that you can program kids and that they then become physically active for the rest of their life... it doesn't work that way. At the very least, we can say that money is being poured into programmes that will have no effect.

I don't want to throw the baby out with the bathwater. I do think there are some interesting things being done with the design of suburbs. I've just read an interesting book by a group of guys in America who have basically looked at urban design and health. Decentralised cities mean that there is just no way lots of people can exercise and avoid using cars unless they try really, really hard. In smaller cities, you had hubs where you could eat and see a movie and go to the bank and all that sort of stuff. Whereas now, all the shops are in one place and all the restaurants are in another place, particularly in America with that hyper-decentralised approach to urban design. That seems to me to be important work.

But I do think that once you try to go down that route, as I try to say at the end of the book, we're talking about big issues like capitalism versus regulated economies. We are immediately in ideological terrain. What we try to say is that we shouldn't avoid that. What science tends to do is say that if the problem is ideological, we'll stay clear, not realising of course that the ideological wake of what they say is just obscured, it's not that it's understated. What I say is let's get this debate out in the open, let's talk about big ideological questions.

At the moment, we have a Conservative government in Australia. They've just won a fourth term. While they've just unveiled some fairly radical free market policies in terms of labour regulation and the like, they are becoming increasingly pro-active in the lives of families. They're becoming increasingly activist in parenting and the like.

That's very interesting. We've just had a Labour government elected for a third term, and we associate those policies with Tony Blair because he's the one seen to enact them. It doesn't seem to matter much the hue of the government, there's a trend across the western world for a free market policy at the macro level, but an increasingly interventionist policy in the private sphere, particularly in relation to health.

I was listening to Bea Campbell talking tonight on the radio about Tony Blair's policies to manage unruly youth. For example, banning the wearing of sweaters with hoods in shopping centres, that kind of thing. There is an interesting literature that is emerging now which is kind of connecting left and right in some interesting ways. From the conservative, they're saying 'Why aren't leftists jumping up and down about this stuff? Why aren't they saying something about this invasion of private life which seems to be all the rage now?' For conservatives, it is in some respects their home territory, they traditionally argued for low intervention in all spheres of life.

The Obesity Epidemic is published by Routledge.