Greetings From Fat-Land

The Washington Post reports on obesity in rural Kentucky and misses the point.

Read more of Daniel Engber’s columns on the science and politics of obesity.

Is obesity Kentucky’s real problem?

Here’s the setup for Wil Haygood’s A1 featurette in Monday’s Washington Post: A veteran journalist heads into the Appalachian foothills and stops at Manchester, Ky., where more than half of the adult population is obese. It’s a community plagued by Type 2 diabetes and hypertension, he explains, yet one that remains “a friendly town where little thought is given to what the health crisis might mean for its own future.”

Haygood goes on to describe these deep-fried-lotus eaters in the wistful voice of a literary tourist. His article, “Kentucky Town of Manchester Illustrates National Obesity Crisis,” reads like a slender cosmopolitan’s postcard from Fat-Land, ticking off stories of his time among the lard-butts:

Half a dozen little kids are standing in line at the McDonald’s. Four are clearly overweight. A man and two kids emerge from a pickup, heading into the Arby’s. The man is huge, the little girl is not, the little boy is. A little boy, overweight, balances his tray at the Wendy’s. A burger. Big fries. Big soda.

Big deal. I can’t figure out what these unremarkable tableaux—which Haygood calls “Manchester moments”—are supposed to illustrate. Does the author mean to suggest that some (but not all) kids are overweight? That little boys are eating French fries and drinking soda? That fathers have resorted to carting their children around in pickup trucks, and that those children might or might not be fat?

A picture is worth a thousand calories, I suppose. Haygood’s article is so preoccupied with the sight of gorging teenagers that he barely takes note of the other factors at play in Kentucky’s public-health emergency. Instead, he tosses off a bit of homespun wisdom courtesy of Manchester’s own anti-obesity campaigners. A pharmacist—the town’s “hard-boiled realist”—tells him “there is a feeling of ‘clean your plate’ in many of the homes around here. You don’t throw food away.” Then we hear from “the budding scholar,” a local girl training for a Ph.D. in kinesiology. What has she learned, after two years of studying her community? “I hate to sound simplistic, but it is a lack of physical activity as well as poor eating habits,” she says.

The real problem, in Haygood’s telling, is that these Manchester simpletons may be too simple even to acknowledge their own simple problems. (Or too afraid. He quotes the kinesiologist: “It’s a fear of knowing. A fear of knowing the truth.”) Thus we meet the Robinsons—an obese handyman named Scott and his oversize daughters, Carlin and Britney. These people are hugely fat, yet they refuse to step onto a scale. “I don’t remember the last time I weighed myself,” says Scott. “Why in the world would I wanna do that?” asks Carlin. Meanwhile, Britney won’t talk to her sister about weight issues, for fear of making her feel bad.

If you think that’s outrageous—fat people who won’t weigh themselves and don’t want to call one another fat—then wait until you hear this: According to Haygood, the Robinson family has arranged their living space in such a way that they never have to confront their own bodies. “There are no full-length mirrors in the front rooms of their home that might reveal a full image of anyone,” he writes. Got that? These people—these fat, fat people—have no full-length mirrors … in the front rooms … of their home. They’re either so oblivious of their problems, or in such denial, that they’ve stashed every last one of their full-length mirrors in the back.

In short, the fat, friendly folk of Manchester are leading America’s march toward a public-health disaster, and they’re whistling all the way.

It’s worth pointing out that the Robinsons are almost certainly better off—happier, healthier—by virtue of their indifference to the obesity crisis. A doctor might advise the family to eat better and get more exercise, but Britney and Carlin aren’t going to benefit from daily weigh-ins or a Hall of Mirrors in the foyer. In fact, plenty of evidence suggests that the people who are most distraught over their own weight status tend to suffer the most from obesity-related health issues. (That’s one reason why the effects are worst among young, white women—for whom the stigma of being overweight is highest.)

But when it comes to public health, Haygood’s essay isn’t merely condescending. It’s a distraction. The health crisis in Manchester and the surrounding Clay County would seem to have more to do with income and education than body size. We learn at the top of the article that more than half of the county’s residents are obese and that it ranks dead last in the state for overall health status. The implication, of course, is that A causes B. But consider a second statistic, which Haygood holds off mentioning until the story’s 59th paragraph: The median income in Clay County is $16,000 less than the national average, and fewer than half of the adults have graduated from high school.

Most of people in this community are obese, many are poor, and most never finished the 12th grade. So which of these qualities is most likely to account for the health problems in the community? Obesity may be associated with heart disease and diabetes, but so is poverty. All things being equal, you don’t want to be fat or poor. But if you compare these risk factors directly, it turns out that poverty is the more dangerous condition, by a wide margin. That is to say, it’s much better to be rich and fat than poor and thin. (Here’s a rule of thumb: It’s not your ass that’s the problem; it’s your class.)

Instead of considering the health effects of deprivation, though, Haygood harps on the town’s charming folkways. What does the Robinson clan have to say about exercise? “We also could use a bicycle trail,” says Scott. “Of course, we growed up riding our bicycles in the street.” Now Scott’s daughter Britney faces the burden of having “growed up” online. We learn that her emotional pain has led her to overeat and hide away in her bedroom, “where she spends hours on her computer” every day.

God have mercy. A 20-year-old woman is sitting for long stretches in front of a monitor? Sounds like she might be developing the skills for getting a job in the digital economy. Is now the time to mention that every single one of my colleagues—and almost everyone else I know—spends most of their daylight hours staring at a screen? Here’s a postcard from the nation’s media capital: Most of us are college-educated and middle-class. And we’re feeling just fine.

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