Fat land : how Americans became the fattest people in the world (16 page)

There is another factor driving the D.C. poor toward obesity as well, one rarely talked about in public health circles, let alone in the mainstream media. It is what might be called the pain of poverty. As Stephanie Mencimer, a reporter for the Washington City Paper who spent several months talking to poor, obese D.C. resi-

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dents, put it: "The adolescents who started appearing in D.C. hospitals with diabetes four years ago were born almost exactly at the beginning of the last big noninfectious inner-city epidemic. Crack cocaine changed the inner city and its residents in profound ways. Even those poor families that weren't succumbing to the ravages of drug addiction were touched by its side effects: unrelenting violence, the disappearance of vast numbers of men into the criminal justice system, and the emptying out of the neighborhoods." Mencimer cites Dr. Gloria WilderBraithwaite of the Georgetown Mobile Pediatric Clinic: "It's tiresome being poor. Living in the cocoon of obesity is a very comfortable thing to do."

Much of that cocoon has been built especially for the poor by the fast-food industry, which for the past twenty years has emphasized development of the inner-city consumer. As various critics have duly noted in recent years, the push began in the early 1970s, when nascent chains were looking for markets to complement their growing lock on suburban customers. Fortunately for the companies, the federal government — through the newly created Small Business Administration (SBA) — had gone into the loan-making business, with a special emphasis on urban redevelopment. In particular, the agency wanted to empower minority entrepreneurs by guaranteeing loans for new businesses. The consequent gold rush went beyond anyone's wildest expectations. By 1979 the SBA had guaranteed eighteen thousand franchise loans, with fast-food outlets a leading beneficiary. Many of those franchises flopped, with the American taxpayer left to eat the remaining unpaid loans, but many of these new outlets thrived. That drove the policy forward, even through twelve years of Reagan and Bush, both of whom ran ostensibly anti-SBA administrations. In 1996, according to a study by the conservative Heritage Foundation, the policy was still in high gear. That year the SBA guaranteed almost $1 billion in new franchise loans, with more — six hundred — going to the fast-food segment than any other. No wonder that, by the late 1990s, one in four fast-food burgers was purchased by a consumer in the inner city.

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That many of these new consumers were teenagers was no chance phenomenon. McDonald's had already laid the groundwork for their allegiance in the mid-1970s, when it introduced the Happy Meal. The concept was pioneered by a little-known Kansas City ad executive named Bob Bernstein, who had noticed that parents increasingly were bringing their children along with them to McDonald's — and then sharing their own meals instead of buying one for Junior. That, Bernstein recalls, presented both a problem and an opportunity. "We knew that kids would want — demand — their own meals if one was available." Bernstein then got an idea for what would eventually become the Happy Meal formula — "putting at least ten things on the bag that a kid could read" — from his own child, whom he observed reading the cereal box every morning. "It was very simple. I asked him why he read the box, and he said, 'Dad, it's just something to do while I eat breakfast.'" As any contemporary parent knows, the Happy Meal became one of the company's most enduring (if annoying) success stories.

But for McDonald's it was not enough simply to cue young children when they were small and then rely on adult advertising to keep them as loyal customers later on. By the mid-1980s, with the value meal concept at competing fast-food chains chipping away at the core McDonald's audience, the company decided it needed a new strategy to capture and retain "tweens," or pre-teens. This it did by forcing its advertising agencies to come up with new ways to measure the impact of youth advertising. The effort was so important that, in March 1986, the company sent its head media buyer, Karen Dixon-Ware, to reprimand the entire Media Research Club of Chicago. Bad Nielsen and Arbitron numbers on children would no longer be tolerated, Dixon-Ware told the stunned audience. Attributing fluctuations in children's viewing habits to "simply the fickleness of children," she lectured, "is a cop-out." The agencies had better find a way to get "tween" viewers' attention or risk losing the McDonald's account.

The reaction to the speech was immediate and industry-wide.

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Arbitron and Nielsen rating systems and the viewer diaries they are based upon were retooled to better capture demographic data on children's viewing patterns. The new data convinced McDonald's and its imitators to allocate more money for tween-centric ads. Soon there was so much money for youth advertising that entire new ad agencies were formed simply to handle the "Saturday a.m. buy." Corporate identities were remade, or "tweened." Pizza Hut changed its longtime jingle "Pizza Hut and nothing more" to "More rock 'n' roll, more fun." As its marketing director, Humphrey Kadaner, explained to Advertising Age, the change was "targeted specifically to kids." Attracting a host of other junk-food purveyors, such ads eventually became the dominant background noise of all morning programming for children. As a team of Columbia University researchers reported, by 1993, 41 percent of all Saturday morning kid show ads were for high-fat foods. What was once a time for children to get a few laughs on a non-school day had become a time to indoctrinate them on the benefits of grease, salt, and ever increasing amounts of sugar. About this the Federal Trade Commission and the Federal Communications Commission, the two regulatory agencies that might have buffered the tween revolution, said nothing and did nothing. One reason for that inactivity — or at least one often cited as a justification for inaction — was a lack of hard, empirical data about fast-food consumption and its relationship to increased energy intake. In other words, does using fast-food restaurants frequently result in a child — or anyone — consuming more calories over time? On this issue the obesity establishment, the nexus of advocacy, scientific, and policy organizations focused on the issue, has been strangely quiet. Or quiescent. In its leading journals of the past decade one can count on two hands the number of articles studying fast food. Part of the reason is pragmatic; with limited funds and endless battles to fight, groups like the North American Association for the Study of Obesity (NAASO) and the International Association for the Study of Obesity (IASO) see a fight with McDonald's as ultimately unproductive.

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("What, are we going to convince them to stop selling french fries?" one member told me at a recent NAASO convention.) There is also a kind of institutional pragmatism at work; many makers of candy, soft drinks, and other less than desirable products often support the promotion of health and fitness.

But in 2001 a group of epidemiologists from the University of Minnesota broke with conventional wisdom and published an in-depth report on the association between fast-food use and caloric intake. Studying almost 5000 adolescent students in thirty-one urban secondary schools, the researchers tracked their use of fast-food restaurants through daily dietary diaries. The results were striking. A boy who never ate at a fast-food restaurant during the school week averaged a daily calorie count of 1952; one who ate fast food one to two times a week (as did more than half of all the children in the study) consumed an average of 2192 calories a day; while those who ate fast food three times or more a week (one fifth of the studied) consumed an amazing 2752 calories a day. "Fast food restaurant use was positively associated with intake of total energy, percent energy from fat, daily servings of soft drinks . . . and was inversely associated with daily servings of fruit, vegetables, and milk," the researchers concluded. Worse, they added, "eating habits established in adolescence, including preference for and reliance on fast food, may place them at future risk for higher fat and energy intake as they move into young adulthood, a developmental period that is high risk for increased sedentary behaviors and excess weight gain."

By the mid-1990s another grim example of obesity among the poor appeared in Appalachia, traditionally ground zero in the war against undernutrition in America. There, studying elementary school children in a low-income township in eastern Kentucky, the anthropologist Deborah Crooks was astonished to find stunting and obesity not just present but prevalent. Among her subjects, 13 percent of girls were stunted — they were shorter than 95 percent of all other U.S. children in their age group; 33 percent of all children were significantly overweight; and 13 percent

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of the children were obese — 21 percent of the boys and 9 percent of the girls.

A sensitive, elegant writer who had originally been attracted to the study of nutrition through an interest in impoverished Third World populations, Crooks drew from her work three important conclusions: One, that poor children in the United States often face the same evolutionary nutritional pressures as those in newly industrializing nations, where traditional diets are displaced by high-fat diets and where, as in the United States, laborsaving technology reduces physical activity. Second, Crooks found that "height and weight are cumulative measures of growth ... reflecting a sum total of environmental experience over time." Last, and perhaps most important, Crooks concluded that while stunting might be partly explained by individual household conditions — income, illness, education, and marital status — obesity "may be more of a community-related phenomenon." A town's physical and economic infrastructures — safe playgrounds, access to high-quality, low-cost food, and transportation to recreation facilities — were the real determinants of physical activity levels, and, hence, weight. "Given that as a nation, we are trying to improve public health by promoting more healthful behaviors," she concluded, "this research indicates that nutrition education efforts might benefit from a greater focus on children.... These efforts should also address the particular concerns of communities and families in poverty."

Poverty. Class. Income. Over and over, these emerged as the key determinants of obesity and weight-related disease. True, there was a new trend that saw significant numbers of the middle and upper middle class also experiencing huge weight gains. But the basic numbers were — and are — clear and consistent; the largest concentrations of the obese, regardless of race, ethnicity, and gender, reside in the poorest sectors of the nation — among the chronically impoverished (from Appalachia to the rural South), among the working poor (from L.A. barrios to New York's Little

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Puerto Rico), and among what might be called the structurally poor (from Detroit's housing projects to reservation-tied Native Americans). Here is the definitive Handbook on Obesity: "In heterogeneous and affluent societies like the United States, there is a strong inverse correlation of social class and obesity." From the Annals of Epidemiology: "In white girls ... both TV viewing and obesity were strongly inversely associated with household income as well as with parental education." And, again, from the Handbook, this time from the leading international epidemiologists on the subject: "The increase in the prevalence of obesity occurred in all income groups but was relatively largest in the poorest groups. In 1974 the women with the highest income were heaviest whereas in 1989 the women with the middle income were the heaviest. There were strong positive correlations [with obesity] between family income in the poorest and middle-income families."

Yet in America of the 1990s class seemed to be the last thing on the minds of most public intellectuals dealing with obesity. Instead, the tendency of many in the academy was to fetishize or "postmodernize" the problem. To trivialize it. A good example

— and a bad diet — can be found in Richard Klein's 1996 Eat Fat. In it, Klein, a professor of French at Cornell University who has struggled with weight gain for most of his life, proposed that people simply stop trying to avoid fat and instead, as his title suggests, indulge in it with wild abandon. "Believe me, it isn't easy

— today, in our culture, with all the messages coming down to eat no fat, less fat, low or lite fat, [or] to eat fat free," Klein writes. "But this is a postmodern diet book. What it's proposing is something like an anti-diet. Try this for six weeks: EAT FAT."

Then, after 242 pages of postmodern navel-gazing, Klein, confronted with a modern reality, is forced to completely reverse his own prescription. In a hastily written postscript he confesses: "With the sort of irony that reinforces my belief in the unconscious, as I was writing this book, I was confronted in my personal life with a drama surrounding fat, which contradicts my

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book's conclusions. My mother had become so fat that it pressed on her lungs while she slept ... fat was her greatest enemy. How could I tell my mother to EAT FAT? I had to admit that under these circumstances, the most responsible thing I could do as a son was to say to my mother, EAT RICE." Ms. Klein promptly lost twenty pounds, and her once life-threatening case of sleep apnea abated.

Yet Klein's postmodern musings — and the fact that they were so fondly received by the tittering masses in the humanities — are a perfect reflection of how the media of the 1990s tended to interpret obesity — namely, as everything but a class and medical issue.

Consider the reaction to a 1995 study by a group of University of Arizona researchers, published in the journal Human Organization. Looking for evidence that black girls and white girls viewed their bodies in "dramatically different ways," the group documented that while 90 percent of white junior high and high school girls voiced "some dissatisfaction" with their weight, a full 70 percent of African American girls were "satisfied" with their bodies. Although one reading of this might reasonably be that black girls had come uncritically to accept — and even celebrate — a condition that would one day almost certainly lead to a variety of serious medical problems, the mainstream press, almost without exception, chose a different angle: to celebrate the "good news." As Newsweek proclaimed, "After decades of preaching black is beautiful, black parents and educators have gotten across the message of self-respect. Indeed, black teens grow up equating a full figure with health and fertility." News-week's journalist, Michelle Ingrassia, was so happy about this that she went out to find a fifteen-year-old black male from Harlem to co-sign the celebration. "You got be real fat for me to notice," the young man said. This, Ingrassia concluded, was because other new studies had indicated something even more celebratory — that "black men send some of the strongest signals for black girls to be fat."