DebraSY

Obesity Public Policy: Let’s Just Call it Confusitarian

In Weight-Loss Maintenance on April 15, 2011 at 12:20 pm

Thank you to Anonymous blog reader KX for submitting the following two-part essay for my consideration.  Amitai Etzioni on Obesity Public Policy Part One  and Part Two.   Do not be intimidated, my gentle readers.  In PDF form, part one, before notes, is only three-and-a-half pages and part two is two-and-a-half.

I read the essay(s) before reading the author’s bio (silly, ignorant me), but as I read I could tell that he’s an outsider to our issue.  He clearly doesn’t understand or divide out the players the way we might, or as I have.  He has absorbed our issue as any intelligent, disinterested person might and then proposed public policy recommendations in keeping with his particular theory and area of expertise. 

Amitai Etzioni is a respected public policy scholar who has been a senior advisor to the white house and held university professorships at some of this country’s most prestigious institutions (Columbia, Harvard, George Washington).  He’s been president of the American Sociological Association and the International Society for the Advancement of Socio-Economics.  In 1990, he founded the Communitarian Network, a not-for-profit organization dedicated to “shoring up the moral, social and political foundations of society.”  (The group also calls itself nonpartisan, but Etzioni’s jabs at Libertarianism would seem to betray that claim.)  He’s the author of more than 30 books, none on obesity from what I can tell.

In other words, he is the “guru” of a respected theory/platform, “responsive communitarianism,” and in this two-part essay, he applies his theory to obesity public policy.  It is worth a look from us, because it is most certainly getting a look from powers that can influence our lives.

The first half of part one is very hard reading.  He lays a foundation of assumptions:  Fat is BAAAAD!  Fat is expensive.  Fat kills.  His sources are ones that we in the fray have refuted or countered with alternative sources many times over.

Then he seems to double back.  Beginning with his Criterion II and continuing in III, he notes that even though fat is bad, interventions that focus on lifestyle changes don’t work.  Moreover, public health campaigns that push lifestyle changes fuel discrimination, stigmatization and may prompt eating disorders and result in other psychological consequences. They also hurt poor people more than the rich.  Way to go, man!  In part Two, we will learn how we might refocus public policy along a “Responsive Communitarian” line.

It turns out that Responsive Communitarianism would lead us to have our public policies promote exercise.  While I might agree with that, his justification is tortured.  He claims that exercise is more effective at reducing BMI than diet or diet combined with exercise, and uses a lame study as support – exercisers maintained a five-and-a-half-pound loss, whereas people who combined diet and exercise only maintained a four-and-a-half-pound loss. Yeesh.  Beyond that he states the obvious benefits of exercise. 

He then says a “communitarian” approach would focus on children. (Ack!   Danger!  Most of us know this kind of focus, combined with careless language, could lead to a bully problem for fat kids.)  Better food and PE in the schools would be in order and in keeping with his theory, as would other social reforms.  In the end, however, an obesity public policy might just be too expensive.  Etzioni concludes: 

Obesity is a serious health problem, but a rather intractable one. It requires costly interventions that will generate little gain as long as the focus is on reducing caloric intake through encouraging individuals to change their eating habits. Much more focus should be given to (a) caloric expenditure (exercise); (b) on parenting and children, as opposed to adult lifestyle changes; and (c) on societal rather than on personal factors. In addition, much more attention should be paid to the adverse side effects of dieting. Finally, the merit of making obesity reduction a high-ranking public health drive should be weighed against the value of other campaigns.

Those last two sentences give me heart.  An intelligent outsider can see something that has been obvious to those of us dealing with the issue, but has eluded many “experts.”  Most of the rest of the essay(s) read(s) as same-old-same-old to me.

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  1. Cynical Me can’t help but wonder why this ‘communitariat’ approach doesn’t include a teeny-tiny intervention against the corporations who are putting crap in the food …?

    *considers writing the Prof a little bitty note*

  2. Thanks for the links! I used to be on Etzioni’s mailing list many moons ago. Will be interesting to read these.

  3. Debra, thanks for these great links. The other articles in the issue where Etzioni’s appears are also helpful, to get a better look at puplic policy that is more balanced than what one typically finds. I have to wonder, though, why you suggest that the author takes “jabs” at Libertarianism. In a different article or in his books, I assume? Because, here, in the two part article, he is simply laying out a carefully reasoned argument based on a specific social philosophy, which exists as a model on an imaginary continuum, which one may envision, and the libertarianism of which he writes is little “l”, as in the political philosophy that emphasizes a hands off of the economic side of social issues to let the FREE MARKET regulate people’s choices and actions, rather than the big “L” libertarianism of the said-named political party (and he also briefly critiques the other forms of communitarianism–closer to pure socialist policy, for instance–not to “jab” them, but to better illustrate his position on the continuum.) Small point, maybe, but I hate to see Etzioni’s integrity unfairly criticized (if that is indeed the case) when I observe so much integrity in the specific argument he constructs in this case. In spite of its limitations and potential flaws, of course.

    His article is less about obesity and social consequences or causes, but instead focuses on the theoretical application of responsive communitarianism to public policy. I read it as a demonstrative-type piece that provides an example of how his social/philosophical position could be applied, in a practical sense, to a social issue. These kinds of arguments are always tricky. Mostly because they must, by necessity, start with premises that must be open to question during ongoing discourse, and because the use of research examples must be very limited for the sake of the argument itself. From this perspective, the specific research he uses in his examples, therefore, may be less important than the overall structure of the arguement and the selection of research that avoids market-driven bias. As we see on your blog, Debra, for example, we can all pull up scads of contradictory research reports, and cherry pick those that go along with our own biases. The author seems to have chosen research that appears reasonable to him, probably based on some communitarian criteria that attempts to exclude market-driven bias as much as possible.

    All in all, I find the article’s conclusions to be very consistent with its prevailing argument(s), which are well reasoned and logical, especially in this day of wildly unchallenged claims. The original premises, with which he begins, are what would be most open to question in an ongoing discourse with the author–for example, does his position conflate causality with correlation when writing about “obesity-related diseases” (different from saying obesity causes disease) or does he indicate there are significant problems with making those kinds of assumptions. All in all, the author is the kind of writer I would enjoy taking the time to argue with (and talk with about different kinds of obesity) because he seems to be open to reaching better understanding of social issues…how else would he become so keen on stressing all the potential harm in advocating calorie restrictive diets, for instance, and on suggesting caution about making anti-obesity a public health priority? His is not an opinion piece, but an actual example of reasoned discourse. Amazingly rare in blog land, and highly unlikely to be found in popular media.

    I like the way he questions accepted “wisdom” of the culture, especially about consequences of weight loss to lower BMIs, the questionable safety and effectiveness of dieting through caloric restriction, and so forth. And I would love to see more about the kinds of public policies that would advance his “more exercise” advocacy (more available!) for more people–because he is definately not suggesting that appeals to personal responsibility are helpful or effective (unless significant changes in social policy, such as increased equality of access, also occur). Would he for instance advocate that communities provide more public swimming pools, increased safety in neighborhoods (protection for children so they can play outside without fear), increased availability of free gym memberships, with free or low cost physical therapy, along with all the other aspects that make increased exercise POSSIBLE on a day to day basis? Nowadays, we tend to think of “gym memberships”, I fear, as something that implies “working out” but I love the idea of using public monies to build more YMCA-style gyms (with pools, basketball courts, etc) that would be available for families and children to PLAY together at, free or very low cost, along with the time to play.

    Oh, gosh, I better end here or it will clear become, as my son claimed recently, “another rant”. Sigh.

    I’m old fashioned, I guess, and still believe there is a difference between an argument (YAY) and a rant. Triple sigh.

  4. On the other hand.

    There is something very unsettling, now that I reread the conclusion, about the author’s use of the passive voice.

    “…attention should be paid…”

    And I am compelled to ask: BY WHOM?

    My critical eye is slipping. (What an image!)

    Didn’t the main character in “Death of A Salesman” say something quite similar, lo these many years past? LOL.

    Yet. Why do I hear the character’s plea as so much more profound?

  5. The good: The guy starts out from the absolute WORST set of common assumptions and yet arrives at the place we’d want him to be. The bad: He has a certain “objective” authority that may advance the assumptions more than the conclusions.

    I don’t know whether I’m put off by the passive voice here. There are so many people/entities who need to pay attention — scientists, clinicians, dieters, public policy makers — to cast the sentence in the active voice might not provide the intended clarity. I don’t think he’s trying to neuter himself with the passive voice, though that is interesting that his words parrot literature’s classic demoralized/defeated character. Interesting catch on your part, Hopeful.

    With regard to his jabs at libertarianism, from part II: “Even a libertarian may acknowledge that we cannot choose our parents.” That smacks on condescension to me. I substitute in my own political party in the sentence and feel like I’m being manipulated. There are better ways to express finding common ground.

    • Nice summary! Concise. Not my strength.

      Yeah. Looking at that statement I can see why it would seem like a jab; still, I like that it recalls a libertarian-style position that comes close to viewing children as property of their parents to do with almost whatever they may, such as feed them crap day after day, and crap may still be the best they can provide, or employ a wide variety of cruel acts in the name of discipline, etc, in contrast to an extreme communist position that might simply advocate for removal of children from isolated family settings at birth, to be brought up by the state. On the one hand, the *free market* dictates what they eat, and on the other…

      Oh. Never. Mind. 🙂 I see I’m reaching for a whole other ball of sh*t.

      You are fun to talk with.

  6. This is my problem with the proposed emphasis on “caloric expenditure.” It’s assuming that increased activity levels inevitably lead to decreased weight. A very lovely woman on the Web has been chronicling the beginning stages of training for a triathlon, and she hasn’t lost a pound. Going from nothing to daily multiple-mile treadmill extravaganzas, and not a single pound. Thank God she’s into FA and is training for the love of it, but even she admitted a bit of (short-lived, I hope) confusion and frustration.

    Increased exercise works for some people. Me, for example. If I stick to my exercise regimen I can cheat eating-wise and still be okay. (For now, we’ll see what happens as I age.) For others (anecdotal evidence from friends of mine), exercise doesn’t do squat and the only thing that works is caloric restriction so severe my hair is graying just thinking about it. In short, with the issue so complex and personal how can there ever be one nationally-recognized formula or strategy at all? (Even assuming that the goal of getting people thinner for its own sake is valid, which it isn’t.)

    Also, if his cited study demonstrates only a one-pound maintenance difference between exercisers and exercisers/dieters…hahahahahahahahaha!!! One pound. Gee, I gain and lose a pound about twenty times during my menstrual cycle.

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