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Fat Land: How Americans Became the Fattest People in the World
By Greg Critser
Houghton Mifflin
224 pp $24

For all the clutter of conflicting studies surrounding the topic of obesity in the United States, nobody doubts the truth of Greg Critser's subtitle to his provocative new book, Fat Land. Except for the populations of a few Pacific Islands, Americans have indeed become the fattest people in the world. If from there the consensus breaks down, it is because our current obesity epidemic is rooted in everything from food politics and the disappearance of the family meal to an increasingly sedentary lifestyle. Make no mistake: This topic is a minefield, and the search for a patch of safe ground to stand on is a challenge, even for as nimble a writer as Critser.

The author proposes two important reasons for the advent of the home of the free, home of the fat: the successful design and distribution of food that is plentiful, cheap, and, above all, fast; and the new view of overindulgence as acceptable. Both trends have come home to roost in a time-strapped America that is increasingly stratified by income.

"The mom of a generation previous," Critser writes, "had the time to cook a complete meal, insist that everyone show up to eat it, and then wrestle each child's food issues into an acceptable family standard. The new parent had no time for such unpleasantness."

Critser argues that the American Baby Boom generation was culturally primed for the colonization it experienced at the hands of the industrial producers and packagers of food. He quotes sociologist Edward Shorter as observing that, unlike Europeans who emphasize the importance of the extended family, Americans seek freedom from extended family involvement, most often viewed as "meddling." A more sexually permissive age, meanwhile, changed American's view of children. No longer an inevitable consequence of family life, children became the family's sole reason for existence. "As a result," writes Critser, "the American child commanded disproportionate 'respect' -- he wasn't to be hurried too quickly into the pain of adulthood. Rather, he was to be mollified with the tremendous bounty of the new nation. And the nation's greatest bounty was food, glorious food."

The emergence of identity politics had an effect as well. Feminists, looking at the newly reported incidence of eating disorders, made fat acceptance a political issue. A generation of mothers, seeking to spare their daughters the pain of being ashamed of their never-to-be-Barbie bodies, worked on de-linking body image from self-esteem. Unfortunately, those outmoded social stigmas may have served to control obesity among some women. "If so," Critser quotes an obesity researcher as reluctantly concluding, "the physical and emotional effect of greater pressure to be thin must be weighed against health risks associated with overweight and obesity."

And those risks are not marginal. The main problem with being obese is not its effect on self-esteem or its relationship to eating disorders. The chief concern is that obesity eventually destroys healthy bodies. The connection between obesity and cardiovascular problems is well-documented. But Critser also chronicles in agonizing detail the effect on the body of Type 2 diabetes and points out the biochemical linkage between the surging incidence of obesity in America and the new epidemic of diabetes.

Type 2 diabetes is now understood to be a result of a condition called "insulin resistance." Insulin is a hormone, secreted by the pancreas, that enables muscle cells to absorb nutrients in the form of glucose -- or sugar -- from the bloodstream. Insulin resistance blocks the actions of insulin, resulting in undernourished cells and harmful levels of sugar circulating in the bloodstream. What causes insulin resistance is the subject of heated debate. While it's clear that insulin resistance is closely linked with obesity, researchers are still debating whether it is an effect of obesity, or its cause.

While Critser delicately tries to avoid getting caught in the crossfire of the "Great American Debate" on dietary fat, he seems to be edging to the conclusion that as a society we're seriously overindulging in carbohydrates. "Increasingly," he writes, "scholars believe that the modern way of eating also causes enhanced insulin resistance. Frequent, high-energy snacking stimulates the pancreas to over-secrete insulin, thereby exposing the liver to longer, uninterrupted bombardment by the hormone."

Critser finds safer ground when he turns his attention to exercise, the most effective treatment of obesity and its related health ailments. But even here, there are conflicting studies. Over the last two decades, he points out, there has been a gradual softening of the exercise standards promoted by public health officials.

From the Kennedy-era insistence on physical vigor, we retreated to Bill Clinton's jogs to McDonald's. "Prior to the 1990s," Critser writes, "almost every organization that was in the business of making public health recommendations agreed on several things. One, that exercise should consist of 15 to 60 minutes of continuous aerobic activity,' three to five days a week." Implicit in this was a key assumption: that the more you exercise, the more benefits you get. This is called the "dose-response effect" -- the larger the dose, the greater the effect.

In the 1990s, however, several researchers produced theories that even limited periods of moderate exertion -- like brisk walking -- can produce extraordinary benefits and that increased levels of exertion might produce diminishing returns. Perhaps desperate to spark indolent Americans into any kind of physical activity at all, some health experts may have been grabbing at dubious research. More recent studies seem to ratify the dose-response effect and the superior benefits of vigorous daily exercise.

Throughout his book, Critser has wicked fun dissecting the lies affluent Americans tell themselves in their quest to justify eating more (and exercising less) than they should, but he turns serious when he is analyzing the effect of the American diet on its two most vulnerable populations: the poor and the young. In the United States, the poorer you are, the more likely you are to be obese. Mass production has flooded the market with cheap, fast, and dangerously unhealthy food.

As incomes decline and time is more pinched, home-cooked meals are becoming a relic, while cash-strapped school districts offer their students a lunchtime repast of Pizza Hut pizzas and Pepsi. Mandatory gym periods have long since disappeared from most of the nation's public schools, and most health clubs are not recruiting members in low-income neighborhoods.

American children's health, already compromised by a surfeit of sedentary activities, is further undermined by widespread parental intolerance of even the mildest form of social sanction attached to the issue of weight. The stakes are significant. Critser quotes a study finding that a kindergartner's weight is likely to predict obesity later in life.

Greg Critser has written an important book. While this topic requires any researcher to forge a path through a jungle of conflicting nutritional information and health prescriptions, Critser doesn't lose focus on this fundamental reality: Ultimately, the culture of obesity cannot flourish without our consent. As one obesity researcher in Fat Land puts it, what we must do, is "take back control of the table."

-- John Raeside is a freelance writer and editor living in Oakland, California.

First published June 11, 2003
Last updated November 30, 2007
Copyright © 2003 Consumer Health Interactive