QUACKING LIKE A DUCK

(This is one of those extra-special read-it-all-before-bitching posts. Reading comprehension is important here.)

Matt Roth wrote a Baffler piece nearly a decade ago that stands as one of the best things I've ever read ("Living the Delayed Life with Amway"). Unfortunately it's not online, but it details the struggling freelancer's personal experience with Amway – the notorious "direct marketing" company that was the Next Big Thing in the 80s/90s and has been criticized for its cultishness and uncanny resemblance to a pyramid scheme. While the FTC has ruled that it is legitimate, as the majority of its revenue comes from the sale of products rather than from member fees, Roth makes a compelling point: if Amway isn't a scam, why does it feel so much like one?

This is an elegantly restated version of the Duck Test idiom ("If it walks like a duck…) Our perceptions are not always 100% correct but if something meets all of the criteria for being a scam, you're safer assuming it is than to assume the opposite.

The introductory analogy complete, this is the part of the post wherein I bring up the actual topic. If the recent surge in interest, academic and popular, in "fat studies" – research purporting to show that mainstream medicine's conclusion that obesity is unhealthy, or that obesity is even a condition, is wrong – is not basic science denialism along the lines of anti-vaccine theories, climate change denial, or "creation science", then why does it have all of the characteristics of denialism?

STOP. Here are some things I'm not talking about here: fat shaming, stigmas about weight, the media-driven obsession with thinness, or any other aspect of size/weight/appearance as a social phenomenon. Neither am I suggesting that people should/shouldn't lose weight, or gain weight, or anything else. My point is simply that the supposed evidence underlying the idea that the current medical consensus (obesity = bad for one's health) is wrong has all of the trappings of an argument that in another context would readily be identified as total bullshit.

First, it is based largely on a selective or distorted interpretation of evidence. Recently an article flew around the internet with eye-catching titles like "Overweight People Live Longer". It is based on a study published in the Journal of the AMA. The sole finding of the article is that BMI (Body Mass Index) has a small positive effect on lifespan, irrespective of cause of death (so the sample included, for example, people who died in accidents). But for the past 20 years, Fat Activists have been telling us that BMI is a load of crap. Why is BMI suddenly a valid measure of weight/health/obesity? Oh, because the results of the study are telling you what you want to hear. Cool.

Second, it makes wild assumptions backed by scant, shoddy evidence and ignores mountains of evidence to the contrary. The idea that people cannot lose weight, or cannot keep it off after it is lost, is supported by one or two dubious studies. The converse – that healthy weight loss is possible and can be maintained – is supported by decades of research. Why is the one study that supports your argument the only one worth considering?

Third, it borrows heavily from the climate denial/anti-vaccine movements in its belittling of "so-called experts". This recent Guardian (UK) column illustrates the point nicely. Did you know that doctors are not to be trusted? That they're just a bunch of know-it-alls whose opinions are no better than yours? Beware the "beady eye of a disapproving GP" who doles out the "type of medical finger-wagging (Academy of Medical Royal Colleges) advocates." The National Health Service has a plan to "pester patients about their weight in every encounter," which is not what doctors should do (in the opinion of people like the author who seem convinced that obesity is not inversely related to overall health and longevity).

Fourth, there's a conspiracy. From the same article:

AoMRC's proposals are not about health promotion, but contribute to a narrative of blame, punishment, prejudice, stigma and anti-fat scapegoating that is horribly familiar. The only thing that looks healthy in this context is the twinkle in the eye of the diet industry CEOs, who are laughing all the way to the bank.

Ah, yes. The diet pill industry, and the pharmaceutical industry in general. These are the same people who are pushing all those unnecessary polio vaccines on your kids for profit. Aside from the fact that this makes no sense – pharma would make money by encouraging doctors to keep patients obese/unhealthy so they'll be stuck on more meds, and certainly the trillion-dollar pharmaceutical industry can outgun the "diet industry CEOs" – why is the Fat Activist not equally skeptical of the role of the trillion dollar junk food industry? Surely it's in McDonald's interest to push the idea that eating garbage is not detrimental to health. I guess skepticism only works in one direction.

This is not to say that Fat Activists, as they self-label, make no valid arguments or, to reiterate, are not entirely correct about the social dimensions of obesity. But their overriding problem is that the attempt to uncouple obesity and health/well-being/longevity has the same goal as that of global warming deniers: to convince you that the vast majority of evidence, as well as the medical and scientific consensus, is wrong. The only way to make it look wrong is to engage in the same tired rhetorical tricks and logical fallacies that have underlain quackery and denialism for centuries. Something that bears such a striking resemblance to bullshit should be treated as such until conclusively proven otherwise.

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82 Responses to “QUACKING LIKE A DUCK”

  1. negative 1 Says:

    @Ellie —
    I'll save you some of the trouble of recreating your argument and agree with you to some extent. I just want to highlight one thing in my original post that it looked like you were quoting — that BMI is easy to calculate. You can find it on the internet. Easy things to find reasonable goals help everyone.
    Like I said, yes the muscle/fat thing is a paradox but I just don't see that many people who are so muscular that they're throwing off the curve, and that number decreases the further you go up the age scale. For every muscle-bound 60 year old who has a 7% bodyfat make-up throwing off the BMI curve, I bet you can find like 1,000 or so in hoverounds who got that way by being too heavy for their joints.

  2. Both Sides Do It Says:

    "Now I am convinced that you are Hershel from the Walking Dead!
    – Georgia, Farmer, mid-sixties."

    Left out "badass".

  3. bb in GA Says:

    @sluggo and BSDI

    I don't mess w/ zombies and I once got beat up by a girl (she was 12 and I was about 8).

    My 'badass' merit badge was recalled.

    //bb

  4. ladiesbane Says:

    If the real conversation here was supposed to be about why it's cool to question, ignore, or deny some sorts of science but not others, I would say it comes down to values.

    Consider stem cell research and gene therapy. Most of my liberal friends are fine with these things, because they imagine positive outcomes such as diseases cured and birth defects prevented. Yet these same liberals freak out about seeds genetically modified to be blight resistant, cloning, food irradiation, and other scientific advances. They may not always be able to explain the science behind it, but they know from experience that Monsanto is not a non-profit agency trying to find a way for grain to remain wholesome during transit to the refugees in central Africa. So, values.

    We also have seen that the public is a guinea pig for drug companies, that conventional wisdom (what it means to quack like a duck) changes over time, that most issues have not been utterly finalized for all time — if they were, why are there still studies being done? If you wait long enough or read widely enough, there is a scientist somewhere who sounds good and says stuff that jibes with your own experience and beliefs. Even if you are not ignoring the peer-reviewed journals to choose stuff from the John Birch Lending Library, this is true for certain issues.

    If you are not a scientist yourself, you are taking what scientists say on faith, and most people find the science that matches what they already believe. It's the same with religion: good people find scripture to support being good, and evil people find holy authority for their evil.

    The important thing is for people to learn how to check themselves for rationalizations and wishful thinking. Learn how to apply Occam's Razor. Test things that sound attractive as well as things which sound awful. Try to cultivate common sense, or what used to be called "thinking about it for a bloody minute". And above all, be honest.

    Unfortunately, asking "what do I know and how do I know it?" leads honest people to admit they can't be truly certain of much. We just do our best to make sense of the world.

  5. Xynzee Says:

    Ed,

    Effectively people are – dare I say it – "sinful". I chose that word as it goes beyond "lazy", but is a wanton disregard what is right.

    People do not want to change, stop what they're doing, to over come an unhealthy practice. So will look for signs in their environment that affirm their choices.

    So a person cheating on their spouse will find things to justify it (they're cold, distant, old, wrinkly, fat, etc etc) rather than putting in the hard yards to rekindle the spark.
    Someone selling meth will say it puts food on the table or whatever.
    People who want to smoke pot will ignore the research and tell you about all of "benefits" (food, fibre). Bullshit, you don't care about the planet, you just want to get high.
    People would rather believe/tell a lie than know/speak the truth.
    People would rather say it's "not their concern" or "they had it coming" rather than taking a principled stand on something.

    The list is endless. To recap people will believe and look for things in their environment to support their world view because otherwise they have to admit they're wrong. If they admit they're wrong, then they will have to change their behaviour to stop what they enjoy doing or admit they're not perfect.

    Change requires effort.

  6. bb in GA Says:

    @ladiesbane

    Huzzahs and Amen…

    I think a major problem in addition to your observations is the politicization of science. We've always had it as you can read any history of scientific inquiry that there were political/social/and or religious agenda being worked.

    In this media drenched age the level has been jacked wide open where we have issues of great public import being propagandized by every damn body.

    We are expected to make policy decisions and laws through our representatives on subjects where we are thoroughly 'lay people.'

    Cue the hired guns from whatever lobbying or interest group and 'fire for effect.'

    //bb

  7. eau Says:

    I reckon we could pretty accurately calculate the BMI of the individual participants of this conversation based purely on the enthusiasm with which they attack the worth of measuring BMI.

  8. Xynzee Says:

    @ladies (& bb):

    A highly accurate analysis of the point Ed was trying to make.

  9. Nan Says:

    You guys do realize skinny people die, too, don't you?

  10. Andrew Says:

    "You guys do realize skinny people die, too, don't you?"

    If I go, I'm taking you with me.

  11. sluggo Says:

    @Nan,

    But until the day they die, they will still expect my fat ass to lift heavy shit for them.

  12. Jak the Yak Says:

    Being too skinny is just as bad as being too fat. I think that the healthy range of weight is probably larger than the socially acceptable range of weight. I do think that our culture has an unhealthy obsession with thinness, but that this exacerbates the existing problem with lots of people being overweight to an unhealthy extent, rather than just to an un-cosmetic extent.

    I don't like people ignoring science. I don't hate GMOs or modern pharmaceuticals per se, but like any technology can be abused, and the profit motive isn't doing a great job of checking that. Quite the opposite. Diet pills are bad, companies who'd rather you stay sick but treatable forever rather than cure you are bad, and saturating farmland with millions of gallons of Roundup is bad. These are all things that can be accomplished with the same technology which could also cure cancer, end hunger, and help people be as healthy as possible in general…so it's not the technology, nor the actual research that I dislike or distrust, it's those who stand to make a buck.

  13. wetcasements Says:

    "The eat-less-exercise-more meme is 'way too smug and simple-minded."

    And yet, I can guarantee you that if a person eats-less-and-exercises-more for _a prolonged period_, he or she will lose weight.

    That's simple-minded, but it's also true. Why do you also think it's "smug"?

  14. ladiesbane Says:

    @bb: thanks, and I agree about the politicization of science. The part that really scares me is how polarized people can get over ideas they don't understand very well. Taking sides based on feeling is the opposite of science, and once you start advancing your position based on feelings, you stifle honest thought. Especially when those feelings *are* relevant to the problem.

    Fat is a really divisive issue, which makes this both a very good and very bad example. Kind of like abortion, another topic with an extremely high emotional index. The science is nigh irrelevant to most people's decision-making on the subject. Forcing another human to stay pregnant against her will can't be done in a free society, but on the other hand, baaaaabies. Most people are too squeamish to approach the boundaries of the issue, and too emotionally convicted to want to. Possibly afraid it will change their minds, or make their decisions harder. There is more to the abortion debate than just science. And there is more to the topic of obesity than the medical aspect.

  15. Jim B Says:

    My only question, When the population of the world became so fit? Did more healthy people stop dying? did the overweight people regain their health? A few odd statistics, not the numbers that you want. I'm 67, I've lived longer then 2/3 of the people in the world. And if you will notice, past 65 is becoming rarer. Is that because they are "healthier". If we are healthier, why are there not more of us then of previous generations. I am over 65 because of more likley, different genetics. Not better food, not better health care, nor "cleaner" enviroment. But simple genetics.
    But I will say, those with a smaller BMI number are dying sooner in the hospitals, then those with high numbers. Something to do about recovery ability.

  16. Drewbear Says:

    Disclosure: I'm 5'10" and weight about 380 pounds. There are now people automatically dismissing everything I'm about to say as biased. Congratulations on that, by the way. Note that I don't have diabetes, my cholesterol is great, my blood pressure is actually better than average, and my only chronic health concerns are entirely unrelated to my weight.

    To all the people who say "calories in, calories out" is the only/best way to do it: Yes, that's insanely oversimplifying it. A few years back, when I was desperately poor, I had to severely restrict my food intake and stop using my car (couldn't afford gas), so I walked everywhere. I lost 50# in 3 months. I was also constantly starving, constantly dizzy, and so weak and lacking in energy that when I walked someplace I would have to take rests about every 100 feet. Not because I was winded, mind you, but because I felt like I was going to collapse from weakness.

    As soon as I could afford food again, I regained 75 pounds in 2 months. I was actually eating LESS than I was before the poverty/starvation occurred, but my body was still in starvation mode and it totally f***ed my metabolism to the point that everything I ate was turned straight into fat.

    Additionally, I have to take a daily medication which has as its primary side effect "weight gain". I have steadily gained up to between 1-5 pounds a month every since I went on it.

    Would I like to lose weight? Sure! Would my doctor like me to lose weight? Sure! But the physical and mental costs of what would be necessary to do so would be more dangerous and damaging to my health than staying fat is.

    Also, multiple studies, including ones by the NIH, have shown that SUSTAINED weight loss, defined as maintaining it for a minimum of 5 years, is incredibly rare. Someone may lose a bunch of weight in the 3 months to a year, but typically regain most/all of it over time. They found that the most "successful" weight-loss program for sustained weight loss (5 years or more) was Weight Watchers, which resulted in an average weight loss of 5%. Yes, that's right: a 200# person losing and keeping off 10 pounds was the best average outcome.

    Frankly, if you want to fix the "obesity epidemic" (which is an entirely problematic designation, since it equates obesity with contagious disease and I have yet to see some catch fatness off of me) is to prevent people from getting fat in the first place. Congratulations to those of you who have lost weight and kept it off, but you're freaks. In a good way, but you do NOT represent the average person or overall populace when it comes to the lasting success of weight loss.

  17. Drewbear Says:

    As a side note: fat people are constantly attacked for using their own experiences as support for their arguments (as I expect I will be here), but keep in mind that people talking about their successful weight loss are just making anecdotes as well. If you want to claim that your personal experience means that everyone can do it, then I get to use my personal experience to say, no, not everyone can do it. You don't get to have it both ways.

  18. Pat Says:

    Wow. Last week you blogged about parenting, and this week you're blogging about whether there are health consequences to being fat? You're a braver man than I am, Gunga Ed, Gunga Ed. You're a braver man than I am….

  19. Alan Says:

    Okay, I wasn't going to leave a comment, but after a day of mulling it over I just can't help myself.

    There seems to be a subtext here that anybody who challenges the conventional medical wisdom is some kind of nut. And while it's far easier to paint caricatures with a broad brush, those strokes obscure a lot of details, some of which are sometimes important.

    Conventional wisdom is that an individual is "overweight" or "obese" if s/he has a BMI in excess of 25 or 30, respectively. That conventional wisdom has been adopted not just by the uninformed masses and the collective knowledge of Wikipedia, but also by many or most general medical practitioners.

    And that conventional wisdom is wrong. C'mon, Ed, you do CrossFit; just look at the dudes on the podium after last year's games. Froning (5"10, 195) and Panchik (5'9, 190) are "overweight," while Chan (5'10, 210) is "obese." Yeah, what a lard-ass.

    Commenting on the fact that BMI is an inaccurate measure of obesity at the individual level is not a rejection of science. Rather, it's a criticism of the intellectual laziness of those who refuse to acknowledge the limitations of applying an (admittedly useful) epidemiological tool on an individual level.

    That's not to say that all criticism of the conventional wisdom is well-reasoned or well-founded. You can find lunatics, connivers, and well-meaning idiots on any side of any discussion. And while evocation of conspiracies is almost always a sign that somebody falls into one of the aforementioned categories, asking questions about motivation does not make one a conspiracy theorist.

    So, long story even longer: yes, there are "fat studies" types who fit right in with the birthers, the anti-vaccine types, or the climate change deniers. But that doesn't change the fact that the correlation between morbidity and body weight (as well as fat percentage, diet, and activity level) is complicated, and tends to be oversimplified.

  20. quixote Says:

    I've had the same incredulous reaction as Ed to some of the fat positivity I've seen. The puzzling thing to me was the rejection of the concept that there is a difference between what was once called stoutness and what the medical profession calls morbidly obese. I mean, there is a difference. Why deny it? As far as I could tell, it was mainly due to the quite justifiable rejection of all the social BS laid on fat people. The rejection just hits more than the target.

    But what I really jumped into comments for was to add a biologist's perspective to the calories-in:calories-out argument. Every aspect of digestion, assimilation, storage, and metabolism is under precise control and every step has its genetic component. In some extreme cases, regulation can be skewed so far toward storage that there is not enough circulating glucose to sustain metabolic functions. Fat is deposited while the person is literally starving.

    We aren't all made alike. Before assuming that "all it takes is not overeating," don't eat for a day or two and then tell yourself to skip the next meal. That's how it is for some people. Drewbear's comment earlier describes somebody with a storage-oriented system.

  21. Julie Says:

    I have to disagree with this statement: "The idea that people cannot lose weight, or cannot keep it off after it is lost, is supported by one or two dubious studies. The converse – that healthy weight loss is possible and can be maintained – is supported by decades of research." There are actually many studies that show that most people who lose weight will gain some or all (or additional weight) back–especially those studies that follow weight-losers for several years.

    I wish that more American doctors would adopt the Edmonton Obesity Staging system that is described on Arya Sharma's blog. It grades obesity according to bmi plus risk factors such as high blood pressure, blood sugar, cholesterol etc, and does not recommend targeted obesity treatment for those in the lowest (fat but healthy) category.

    Another problem that results from focusing so much on weight, is that doctors tend not to ask thinner people about their eating/exercise behaviors even though they could be very unhealthy. At least, that has been my personal experience as someone who has been both fat and thin.

  22. blahedo Says:

    In the news just this week: https://www.nlm.nih.gov/medlineplus/news/fullstory_134667.html

    Short version: Americans are ingesting less calories but getting fatter anyway.

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