Precautionary Tales

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Greg Critser, author of Fat Land: How Americans Became the Fattest People in the World

What has been the reaction in the UK to the book? Do people see the same problems here that they see in America?

The reaction to the book has been extremely positive. The reviews that have appeared so far, by some fairly trenchant critics, have been very positive, so I was encouraged by that, of course. As far as the basic thesis and the concern that the same epidemiology might prevail, clearly that's on the minds of a lot of British medical authorities, public health people, education people. So, what's happened with the book is that it's come at exactly the right time to bring a unified theory, if you will, to why people in Western cultures are becoming obese and particularly, it seems, in Anglo-Saxon cultures.

You call obesity a 'public health emergency'. Why do you think it is so important?

I don't think I've ever said the word emergency. It's a chronic disease epidemic as opposed to an infectious disease epidemic. The reason is fairly clear: if you are concerned about the health of children over their lifetime, obesity is probably the critical portal or window to prevent chronic disease. The most recent statistic to come up is troubling is that of all children in the United States born in the year 2000, the risk is that about a third will become diabetic at some time in their lives, and this is directly attributable to obesity, to excess weight.

Is this a problem that is going to affect anyone who is overweight or is it the case that you hit a certain threshold where these problems really start to kick in?

The threshold really is what we call a body mass index of 30. Body mass index is basically the sophisticated version of those old weight-for-height charts that you were raised with, and when you get above 30, the research is very clear that in terms of health problems, your risks go way up: for Type II diabetes, glucose intolerance, coronary heart disease, even things like asthma, osteo-arthritis and sleep apnea, go way up. And we're not just talking about the risk, the actual incidence of those conditions goes up. In other words, you're getting sick as a result of your excess fat, and as a result of the fat lifestyle that leads to being fat.

What's interesting about the book is that you pull together a lot of different factors. I wrote down a list of them, there's possibly 20 different things you mention. Are there one or two factors that are crucial, or are they all equally important?

I think there's two factors that probably are most important. One is the kind of co-dependent linkage between the modern parent, and convenience foods or fast foods. The word co-dependent I think is a good one because in the last 20 years, the two-income family has become the norm and so that time that a parent has to cook a decent meal at home and bring the family together round the table has decreased, and the stresses have increased. At the same time, access to, and the price of, convenience foods and fast foods - foods that pull the family away from the table and feed them increased calories for the same amount of money - those opportunities have gone way up and they've become very inexpensive. So, I would say it's that co-dependent relationship between the two, between fast food and eating away from home, and the requirements of the young parent, that is at the core of the increased caloric consumption. It's very hard to break that cycle. I think what it takes is a lot of things, but mainly a lot of willpower, by the modern parent, to insist on finding a way to eat together as a family at home, and eating simple foods cooked, not in an organic way or anything like that, but cooked in a healthy way, around the table, several times a week.

That, I think, is number one.

The second big factor is the expenditure of calories. What we have to realise is that, essentially, we are paid to be sedate. We have to pay money and time to get rid of calories. Really, it's a reversal of what, historically, human beings have had to do. And so, I think the second part of it is to realise that we need to consciously move vigorously for at least 45 minutes to an hour a day. People here are bombarded with this frankly bullshit from the Academy and from public health people saying if you just accumulate 20 or 30 minutes a day of moderate activity, that's enough. That is nonsense, and that is just academics and public health unwilling to be unpopular with people. The fact is that the modern lifestyle is so sedate and so calorically dense that anything less than 45 minutes to an hour of moderate to moderately vigorous activity per day, I mean continuous moments. You don't sweat streams of sweat, but you start to break a sweat. Anything less than that is probably not enough to insulate you from the consequences of the sedate lifestyle.

One of the things that struck me about the book is that you spend an entire chapter talking about this problem of exercise and public health advice. In this country, we seem to get nothing but advice about our health. In Britain, there is a bigger 'pinch of salt' taken, excuse the pun, with what the government says. Are people in America more likely to trust what the government says?

Hell, no. We just have less government. In terms of exercise recommendation, they all become part of the constant assault upon the public mind of health advice, that the media transposes and translates. I think what ultimately happens is that people become convinced of things that are not true or are the easier path. People have asked me for my advice and I'm saying, "If you think the advice is bullshit, it probably is - especially if it is comforting." The other thing I would say is that it might feel good temporarily to think that "I'm sick of what the government is telling me to do, what do they know anyway?" I think the data is fairly clear that if you want to participate fully in modern life and be healthy, and be able to take all those vacations when you're 60 years old like you're planning, you really need to consciously move vigorously every day. That is just the price of modern life.

I like to say that what we are learning as the middle class now, is what the rich, at least the rich who managed to live through being rich, found out a long time ago. That is: the price of living in a modern, abundant culture is twofold. One is restraint and moderation, conscious moderation even. And the second is being consciously vigorous everyday. The rich learned that a long time ago. Now the middle class really needs to learn that. And that is hard to do. As a middle class, we don't have all the buffers and niceties that the rich have. But in terms of the basic things that can make us unhealthy, we've got that now. We've got a lot of calories and a lot of leisure time, sedate time. We need to cognitively and aggressively deal with that.

One of the things we get taught as kids is that if you leave food on the plate, we should think about the poor people in Ethiopia. So, we're taught never to leave food then we go to a restaurant where they are giving us buckets of food and we try to eat all of it.

That's a wonderful example of what needs to change. If you want to prevent the next generation from becoming obese, I think that's where the focus should lie. I don't think value-added taxes and requiring people to lose weight in order to get their NHS appointment is the way to go. Once an adult is fat, the chances that he's ever going to get lean are slim, no pun intended. But with the children, we know it works. If very early on, the child is taught to eat a certain way, to eat with a certain structure, to not snack, really almost prevented from snacking, we know that child is going to go into teen and, later, adult life, as someone who has the ability to say 'no' to the constant temptations of modern life.

The only person I have ever heard of who leaves food on her plate is the Queen. Apparently, she only eats 10 percent of what's put in front of her.

The Queen's Diet! There's your book! That's the perfect thing. People are always pushing on her the easy way and the fat way, the most luxurious thing. And what has she learned to do to survive?

One thing I hadn't heard much about in this country is that early chapter on corn syrup and palm oil. First of all, hasn't all food got cheaper anyway? Secondly, you talk about the way that these products get metabolised. That's new science - isn't that still a little bit at the theoretical stage?

Yeah, and I think I present it that way - I have been criticised for this. But I think if you read those pages, I say preliminary investigations suggest. The reason I emphasised this is that this research on fructose as a special metabolic impact on the body goes back about 25 years. And for many years, it was actually British scientists that first brought it up. It's only been in the last five to seven years that it has started to be taken seriously by very mainstream scientists, both in the States and the UK and France. These are not quacks, these are chairs and professors of nutrition at major universities. What I am saying is that we need a fuller discussion of the enhanced use of sweeteners. I just point at fructose because (a) it is the main sweetener that we use. It's changed in the last 20 years and the availability of free fructose to the liver has increased. So I'm saying that given that, this seems to be one candidate to look at. What is interesting is that the head of the American National Association for the Advancement of Study of Obesity, NAASO, which is a big organisation for obesity science, which has traditionally focused on dietary fat rather than dietary carbohydrate, recently singled out high-fructose corn syrup as a key factor in the obesity epidemic. That focus on the special metabolic effects of fructose has really become part of mainstream science, now.

What are the main criticisms that you have come up against with the book? For example, by called America 'Fat Land' aren't you problematising the relationship with food even more, and maybe we should all just chill out about it?

Oh, I don't know. You could say that about anything. I'll tell you exactly what the criticism has been. One, that I'm too hard on parents, that I put too much blame on parents and I should focus more on blaming fast-food companies. And my point is, as a journalist, if you're going to assign responsibility, you have to do it all the way around. Secondly, people have said that I focus too much on personal responsibility, even though our environment is so toxic, how could I possibly do that? My point is that that's really all we've got. What I've seen is that the efforts that have succeeded, like getting soft drinks out of schools for example, usually start with families who have an awareness of the fact that they are getting fat and not eating right. They take it upon themselves to straighten themselves out and then realise it is hard to do that because of the soda that is being sold at schools. So, they start organising and they confront the school board, and they get the sodas out of the schools. My feeling is that if you wait around for government, for academics, or for professional political people, to start doing something about this for your kids, you're just going to see a huge fat kid. If you engage the issue yourself, and get some basic information, you can make some big changes.