Bill Maher has been a political commentator that has fascinated me over the years. When I was younger, I did not care as much for Maher's comedic style or content. As I became older, I have come to appreciate Maher as a comedian. One reason is that as I became more libertarian, I better understood the nuances of this world and was able to understand where Maher was coming from. Another factor is that the mainstream Left has moved much more to the Left in the past decade. While Maher identifies more with the Left, he has on multiple occasions called out the Left for abandoning its more traditional roots (e.g., freedom of speech, tolerance) and buying into inane, crazy ideas that would have been considered extreme only a few years ago.
What makes Maher special is that he is one of the only political commentators that self-identifies as a liberal and is willing to stand up to the crazier elements that exist within the U.S. Left. Maher's criticisms are those that I find myself agreeing with much more than I am disagreeing these days. Look no further than last week's episode of Real Time with Bill Maher where he lambasted the fat acceptance movement (see below). Maher did not hold any punches back. He said that body positivity is used to mean "I'm perfect the way I am because I'm me." He called it "Orwellian how often positivity is used to describe what is not healthy." Maher went as far to say that "If you are participating in this joyful celebration of gluttony that goes on now, you have blood on your hands, full stop."
I want to get into why Maher is right about the calamity that we face with the high amounts of obesity in this country. But first, I want to preface by saying that the obese should not be shamed. I would not simply argue that from a moral stance of human decency, but also as a public health stance. Shame is not an effective public health strategy. When was the last time you changed your mind on something because someone berated you and made you feel awful for existing? Don't all raise your hands at once.
The truth is that shaming does not work (e.g., Ho et al., 2015; Costa and Kahn, 2013). Shaming did not get skeptical people to wear face masks in 2020 or get hesitant people to get the COVID vaccine in 2021. Shaming does not work as a strategy for smoking cessation or getting someone to stop drinking. Shaming did not work as a tactic during the heyday of the HIV/AIDS epidemic in the 1980s. Shaming is more than merely ineffective. If anything, shaming can make things worse. The Canadian Medical Association Journal shows how shaming worsened health outcomes for HIV, obesity, and fetal alcohol syndrome (Duong, 2021). A study from the University of California-Los Angeles (UCLA) shows that shame makes smokers more likely to smoke (Cortland et al., 2020).
Why does shame prove to generally be ineffective in a public health context? To quote neurologist Caroline Leaf, "Shame is a very negative emotion that challenges a person's identity and tends to make people feel defensive or aggressive, or make them withdraw to protect themselves. Shame essentially tells someone they are bad, as opposed to making them feel that they may be doing something that will have negative consequences." That explains why more often than not, shaming people in a public health context leads them to hide or not disclose their behavior. Shame is not the way to go in terms of public health. It is not going to incentivize healthier behaviors. But what about obesity? The question on this topic is not whether shame should be used, but the debate has become whether we should normalize and make obesity an acceptable life choice on a societal level.
Those who are activists for fat acceptance (see below), they think that stigmatizing fat is the problem. A 2021 article from Cosmopolitan tried to depict obesity as healthy, which is amusing considering that the satire website Babylon Bee satirized the idea a few months earlier. In spite of what fat acceptance activists would argue, my issues with obesity have nothing to do with fatphobia, thin privilege, or whichever term that the woke like to use to deflect criticism. As we will see shortly, obesity has significant, negative impacts on physical health.
I can imagine a criticism along the lines of "the Body Mass Index (BMI) is not perfect, ergo obesity is not an issue." That argument is half-right: the BMI is not a perfect measurement. For example, muscle weighs more than fat. A wide receiver for a football team who is all muscle could be considered under the BMI. On the flip side, you can take it in the other extreme direction with unhealthy thinness, whether that is bulimia or anorexia. At the same time, the BMI is still a good proxy for metabolic health.
The idea of "healthy at every size" is a myth. The truth of the matter is that there is a large evidence base showing that health issues are linked to obesity. There is a reason for that. A meta-analysis of 72 cohort studies from the BMJ showed that indices of central fatness (including BMI) are significantly associated with a higher all-cause mortality risk (Jayedi et al., 2020). And here is an older meta-analysis of 97 studies from Journal of the American Medical Association saying the same thing (Flegal et al., 2013).
Maher is right to point out that one of the first things that you do when visiting the doctor is stepping on the scale and getting your weight checked. A list from the National Institutes for Health (NIH) shows how obesity elevates the risk for multiple diseases, including type 2 diabetes, heart disease, stroke, sleep apnea, metabolic syndrome, fatty liver disease, osteoarthritis, gallstones, cancer, and kidney disease. In 2019, the New York Times said that "poor diet is the leading cause of mortality in the United States."
If you need a more contemporary example, let us examine COVID and obesity. If you have a problem walking up a few stairs, imagine how an upper respiratory disease such as COVID could wreak havoc on your health. We do not have to imagine. The CDC says that obesity can triple your likelihood of being hospitalized from COVID and that the obese are 1.42 times more likely to have severe COVID if hospitalized. The British Medical Journal found that those who were physical active were much less likely to be hospitalized from COVID (Sallis et al., 2021). Obesity was second only to age as the largest factor in COVID morbidity, according to a 2022 study from The Lancet. If more people took care of their personal health, fewer would have died in this pandemic.
You are probably wondering why I care about the topic of obesity. My political philosophy leads me to believe that as long as you are not hurting, harming, or directly affecting anyone with your personal decisions, I do not care what you do. That is the nonaggression axiom in a nutshell. If you want your diet to consist of McDonald's, Twinkies, and a whole array of processed foods, that is your dietary choice. If you want to be vegetarian or vegan, go for it. If you decide to drink raw milk or eat genetically modified foods, that is "your body, your choice." I have applied this philosophy to more than dietary choices. I believe that it applies to freedom of speech, freedom of religion, owning a firearm, marrying whichever consenting adult (or adults) you would like, selling your own organs for cash, and a whole host of choices.
I care about this issue for two reasons. The first reason is just because I believe you have the freedom to do something does not mean I personally agree with certain life choices. I can believe that an adult can get married to whatever consenting adult they want, but I do not believe that polygamy is a good idea. The same goes for having children before getting married. Regular exercise, a sound diet, and good sleep are still three essential components of a healthy lifestyle. Keeping alcoholic consumption within moderation is healthier than binge drinking. Winston Churchill might have smoked multiple cigars a day and made it to his eighties, but daily cigar smoking is not a healthy habit. The less you smoke, the better. To quote Maher again, "No one pretended there was positivity in smoking. You're not a freedom fighter because you want to keep eating donuts." As already illustrated, being obese does not make for a healthy lifestyle.
This leads to the second reason why I care. We have a major problem because fatness is not fitness. According to the CDC, 41.9 percent of Americans are obese and 73.6 percent are overweight. When a large portion of the population decides to partake in unhealthy decisions, those decisions lead to poorer health outcomes. Those poorer outcomes result in increased demand for healthcare services, as we see with a U.S. study (Cawley et al., 2021), as well as a Danish study showing that obese people have about double the healthcare costs that non-obese people have (Spanggaard et al., 2022). What happens when you drive up the demand for a good or service? The price of that good or service increases. That is the Law of Demand. In other words, the society-level perpetuation of obesity affects me because millions of obese people needing more healthcare services skyrockets the healthcare costs for me and every other American who decides to live healthily enough to not be obese.
Here is some food for thought on the economic costs. A report from Research Triangle Institute (RTI) International shows the global impact of obesity. Some economic costs in the RTI report include increased absenteeism, reduced productivity while at work, early retirement. This RTI report, by the way, found that obesity-attributable diseases killed cause five million deaths and 160 million disability-adjusted life years globally. In its report, the World Bank adds the costs of significantly increased mortality, increased disabilities, and reduced length of disability-free healthy living across the life cycle. The Milken Institute found in its 2020 study that in 2016, chronic diseases driven by obesity in the U.S. cost $480.7 billion in direct health care costs and $1.24 trillion in indirect costs due to loss of economic productivity. This total cost of $1.7 trillion was the equivalent of 9 percent of the U.S. GDP.
Bill Maher is right in that there is an unfortunate trend of "rewriting science to fit ideology or just to fit what you want reality to be." We have seen it with anti-vaxxers, lockdown lovers, and those who despise genetically modified food, to name a few. We should not ignore overwhelming evidence about the economic and health costs of obesity simply because it is inconvenient or difficult to hear. It does not do anyone any favors to sugar-coat the truth (or food for that matter).
Up until a few years ago, it was indisputable that obesity came with considerable health and economic costs. Yet fat celebration is what we get for a society that indulges in self-entitlement, feeling good for its own sake, emotional fragility, and thinking that life should be a piece of cake. Guess what? Life has always been a struggle. As Maher pointed out, cake was delicious in 1969 and yet people somehow had better impulse control. It takes time and effort to go and exercise. It takes discipline to follow a diet or exercise regiment. It takes impulse control to not eat compulsively, smoke, or drink too much alcohol. The whole premise behind personal development is that you are not fine just the way you are and there is always room for self-improvement. It should not matter if there is more processed food or if more people sit at a desk for eight hours at work. Anything worthwhile in life takes time, patience, effort, and discipline. Healthy habits, discipline, self-control, and prudence used to be considered values, but not in a country where self-gratification is more important than self-improvement.
Framing it in terms of discrimination and social justice while telling people they are "fine just the way they are" does not help the obese. When you tell people they are "fine just the way they are" and those people buy into fat acceptance, they are 85 percent less likely to lose weight, according to research from the Obesity Society (Muttarak, 2018). Rather than embolden the obese to live happier, healthier lives, the cognitive dissonance behind fat positivity makes matters worse.
Maher was spot-on by saying that we have reached the point where acceptance became enabling. I remember watching Family Guy in 2005 when it satirized the fat positivity movement with the episode The Fat Guy Strangler (see clip above). Times are so upside-down that satire has become reality less than twenty years after the release of that episode. There was a time when we used to at least try to be fit and healthy and society praised those who succeeded. To paraphrase Maher, our society has devolved to the point where letting yourself is a point of pride and improving upon yourself (in this case, with fitness) is being vilified.
What we should be doing is being respectful of obese individuals while encouraging them to make necessary life changes to be healthier. One should find a healthy self-acceptance that does not glorify obesity or shame fitness. Yet multiple industries, including food, health, and clothing, have a cash cow by making more money off of people who are obese. The media is not catastrophizing it when it should be. Obesity has many negative implications for public health and the economy at large, plain and simple. We should act more healthily like our lives depend on it because in terms of longevity and quality of life, our lives do depend on it. To quote Maher one last time, when we as a society are "lying about it and making excuses, it is psychologically telling ourselves that letting ourselves go is the best we can do." A society that propagates the lie that "all shapes are healthy" does so at its own peril.
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