Been awhile since I’ve done a Bamboo review, but I spent a little over four hours, in bits and chunks, watching the HBO documentary made in conjunction with the CDC, the IOM, and the NIH called “The Weight of the Nation“. Four hours seems like a long time, but the issue of obesity, nutrition and exercise is—as readers are no doubt aware—a complex issue that really needs to be looked at in depth. The first episode explored the surprisingly diverse negative health effects of the systemic lifestyle shifts towards more calories/less exercise that have overtaken this country in the past decade. It also put beyond a shadow of any real doubt that a high fat-to-other-tissue ratio on the body is a discrete problem, and even if you moderate the effects by having a health lifestyle, the fat itself throws your metabolism processes out of whack and helps set the stage for diabetes. I didn’t know that, so that was interesting. The second episode, and the one that got the most negative press from fat activists before the documentary was even released, focused on the concept of weight loss and dieting. I’ll return to that one in a minute, because I also had concerns going in and found they were largely unnecessary. The third episode focused on prevention in children, because the research demonstrates that the root of lifelong weight and nutrition problems is set in childhood, and if you can emerge from childhood with good health habits, you’re exponentially more likely to carry them on throughout your life. The fourth episode focused on the various social structures that have created this problem, though let’s be clear that throughout the documentary, the filmmakers are very careful to avoid lambasting fat people as individuals and instead the entire focus is on this as the result of social changes. Which makes sense, since the argument that Americans suddenly got weak-willed in illogical, and the evidence that this is a result of social change is overwhelming.
Before I went in, my biggest concern was that weight loss would be positioned as the solution to our epidemic of heart disease, diabetes, and other nutrition-related problems. After all, the second episode was focused on weight loss and dieting. The problem is that evidence shows that the vast majority of people who diet lose weight and then gain it all back. Even though a person who is obese stands to prevent or decrease the symptoms of various nutrition-related illnesses by losing weight—which is why doctors concentrate on it—as a public health initiative, the focus on weight loss is a non-starter. It’s like trying to cure an STD epidemic only by treating people after they get ill, but to make it even worse, only doing so with drugs that work 5% of the time. That’s not going to work. Indeed, prior to the airing of this documentary, that was the biggest concern touted by fat activists, that weight loss would be presented as a solution when it’s not.
Having now actually watched the documentary, I would say that they actually did a really great job of using the public interest in weight loss to draw people into a discussion about prevention, but without leaving people who are obese and suffering without any hope of improvement. The majority of the second episode focused on why dieting was bad and why weight loss is nearly impossible, and much of it sounded quite a bit like what you’d read from an evidence-based fat activist website. They didn’t pull their punches, but instead were brutally honest in showing how much of a sacrifice it is to lose a whole bunch of weight and to keep it off. The section on gastric bypass emphasized how dangerous the surgery is and followed a man who had complications. Two of the women profiled who lost more than 100 pounds a piece and kept it off were followed, so you could see the excessive amount of calorie control and exercise they had to endure to maintain. (One woman subsists on 1100 calories a day, which is about 2/3 of what she’s probably be able to eat if she hadn’t gained and then lost a bunch of weight.) A ton of people were asked how many times they had lost a bunch of weight and regained it all. The diet industry was singled out as a major villain, with one expert witheringly pointing out that their business model is based on yo-yo dieting. Yes, they provided information on what people have successfully done to lose weight and keep it off, but they didn’t softball it, but made it incredibly clear that while it’s not impossible, it’s really hard, and functionally impossible for people who can’t make the time for it. Most importantly, they laid out the science of why losing weight and keeping it off is so difficult, which is that getting fat resets your metabolism and you can’t go back. So, for instance, if you gain and then lose a bunch of weight, you have to eat fewer calories and exercise more to maintain that weight than someone who weighs as much as you but never gained in the first place. Once you realize that, you realize why dieting doesn’t work and lifestyle changes are nearly impossible to maintain.
In other words, I felt like they pulled something of a bait-and-switch, but for a good cause. They lure the audience in with the promise of discourse about weight loss, something Americans obsess over, and then make an argument for why our obsession with weight loss isn’t the answer. Which sets the audience up to be more invested in the next two episodes, which focus strictly on what created this problem and what we need to do to fix it.
The answer throughout is always, always that it’s a systemic problem and not the fault of individuals. The filmmakers and the experts they consult are extremely invested in making it clear that they don’t hold individuals making “bad” choices accountable for this. Repeatedly, for instance, they point out that a person’s BMI is surprisingly predictable based on nothing more than a zip code, which I thought was a nice, clear-cut way to get the audience out of the “personal responsibility” framework of utter meaninglessness, and move them towards the “collective responsibility” framework that actually suggests solutions. From there, we’re treated to two episodes where food marketers, agriculture subsidies, conservative politicians, increasing work loads, and underfunded schools and communities are targeted as the cause of the problem. I was particularly interested in the emphasis on how overworked Americans are, which is an aspect that a lot of other writers on this issue don’t look at. One in four Americans doesn’t get any physical activity at all, and the reason pegged in this documentary is their jobs—between commuting to and from work and sitting at a desk all day, people just don’t have time. Turns out that stress is a major factor in developing obesity, because being stressed out tends to override a lot of brain functions that prevent overeating. One expert talks witheringly of how stupid the concept of “free will” really is, and how it’s a distraction from the real issues, which are that our society pressures you at every turn to eat more and exercise less.
I want to praise the filmmakers for not falling into the trap that many programs and writings on obesity do, which is to dehumanize and objectify fat people. Part of this is time; with four hours to spare, there’s lots of time to really get to know the subjects as whole people with jobs and families and lives. But it’s also a matter of conscientiousness. It’s clear that it was important to the filmmakers to get the voices of fat people into the film, and to get a diversity of such voices—all ages, classes, and races. Nor were fat people constrained to the role of subjects; many of the experts consulted or shown working were themselves fat, and no big deal was made of this. The filmmakers also made a point of not desexualizing fat people, which is a common and unfortunate trope elsewhere. Wedding photos, dates with spouses, that sort of thing: They did a good job at not turning fat people into a desexualized Other, but really put an emphasis on, for lack of a better term, normality. The documentary also made sure to interview a variety of experts, instead of just positioning white guys as the only real authority. The result of these choices was a real feel for how our health care problems related to nutrition and exercise are collective problems, and made the note of optimism that the documentary ended on feel earned.