Reflections on the AMA Decision – Part 2

July 4th, 2013 by MorganDowney Leave a reply »


One of the more curious comments on the AMA decision came from Hank Cardello of the Hudson Institute. Hank (with whom I have broken bread a couple of times) is a former food industry executive who believes that the food industry can basically down-shift the calories in the marketplace, resulting in lower obesity rates. Writing in Forbes Magazine, Why the AMA’s Obesity Ruling is Bad Medicine, Hank appears offended that doctors went off to decide what is a disease without checking first with the food industry. If they had, Hank would have told them how declaring obesity a disease gives health activists and policymaker a “new blunt instrument to use against the food industry.” Those crazy folks will now revive calls for Twinkie taxes, soda cup size bans and restrictions on full-fat pizza. Writes Hank,“These newly ignited brushfires, fanned and fed by social media and zealous lawmakers, could cost the food and restaurant industries enormous time and money to fight. If the activists were to claim that the industries are selling products that worsen a disease called obesity, they would have no choice but to lawyer up and defend themselves. As the decades-long tobacco wars proved, this would only greatly delay getting both parties to come to an equitable agreement.”

Whoa! Hank! Take a breath! Walk around the block.

First, numerous authorities have recognized obesity as a disease. It has been in the International Classification of Diseases for at least 20 years. The Social Security Administration, Food and Drug Administration, National Institutes of Health, Internal Revenue Service have described obesity as a disease for about 10 years or so. So, it isn’t new. If the ‘health activists’ will now ‘use’ it, where have they been? Do you really want to draw a parallel between the food industry and the tobacco industry? I don’t think it is apt and I would think you wouldn’t either.

But Hank presses on predicting (threatening?) that the food industry will now back off creating more healthy foods because they are being demonized “as purveyors of disease.” Well, it didn’t take any time to throw in the towel on the food industry meeting consumer demands for healthier alternatives! That was quick. Was the industry looking for a way out? It certainly feels that way since there is nothing really new in the AMA policy.

But it is next part of Hank’s paper that is embarrassing. It is like being at a party with a friend who starts to say something really unfortunate. You know it is too late to stop them. So, Hank goes on,

“Labeling obesity as a disease also ignores the almost taboo subject of personal responsibility. Describing obesity as purely a disease overlooks the complex role of a person’s psychological profile and attitudes. A study led by Angela Sutin of the National Institutes of Health highlighted that the most disciplined consumers had lower rates of obesity while larger weight gains were linked to personality factors such as impulsiveness, low conscientiousness, and a willingness to take risks. The authors concluded that any obesity solution must address these psychological factors, which general practitioners cannot.”

Well, I guess ‘personal responsibility’ isn’t so taboo after all. Never too late to call obese people damaged in the head. Persons with obesity have been called worse but trying to rope in a researcher from NIH for support was novel.

A few things are wrong with Hank’s description of this paper. First, it appears the study sample had many more ‘normal’ weight participants than the general population (45% to 31%) which might affect the outcomes. Second, Sutin and her co-authors acknowledge the possibility of reverse causation, i.e. that excess weight and the health and stigma attendant thereto can affect personality development. Hank ignores this. Third, while Hank is trying to say these overweight/obese customers can’t control themselves, Sutin points out, “Individuals high on Neuroticism, in particular the impulsiveness facet, and low on Conscientiousness have elevated triglycerides, hypertension, and clinically elevated levels of inflammation, even after controlling for differences in adiposity. Abnormal weight may be one mechanism that partially mediates the relationship between personality and these health outcomes.” (Emphasis added.) Sutin’s paper concludes, “The cognitive, emotional, and behavioral patterns associated with personality traits likely contribute to unhealthy weight and difficulties in weight management. Identifying the personality traits associated with obesity may help to elucidate the role of personality traits in disease progression.” Whoops! Did she just call obesity a disease?

This paper was published in 2011. To pull it out, Hank had to skip over 2 of her papers published earlier this year which have produced some dramatic and unexpected findings.

In the first 2013 paper, she and her colleagues found that individuals who rated high on impulsiveness and lacked discipline or low conscientiousness had high circulating levels of leptin, which plays a critical role in regulating body weight, even after controlling for body mass index, waist circumference or inflammatory markers.

Sutin’s second 2013 paper, “I Know Not To, but I Can’t Help It: Weight Gain and Changes In Impulsivity Related Personality Traits,” has much greater implications. In this study, Sutin and colleagues picked up where the 2011 study left off. They looked to see whether weight gain or loss of 10% or more led to personality changes, specifically impulsiveness and deliberation. They found that, compared to participants to stayed weight-stable, those who gained weight became more impulsive. Those who did not gain weight showed a predicted loss in impulsiveness. Then came the surprise. Contrary to their hypothesis, weight gain was also associated with increases in deliberation. That is, with gaining weight, subjects became more thoughtful before acting. This was especially strong among younger participants. The authors considered that, as participants gained weight, they bought into the American stereotypes about persons with obesity. So they saw themselves as more impulsive even as they were increasing in deliberativeness. They had no change in self-discipline. The authors speculate further, “A second possibility is that physiological mechanisms associated with weight gain could contribute to the relation between weight gain and changes in personality. For example, overweight and obese individuals tend to have higher levels of inflammation and chronic inflammation may reduce the ability to effectively regulate emotions and control behavior.”

Sutin et al suggest more research to help identify how considerations of personality traits can enhance interventions. For example, information on healthy lifestyles may be less useful for some than information on emotional aspects of impulsivity.

Finally, Hank concludes that the ‘disease’ label will be a crutch and cause people to stop making lifestyle changes and probably backslide. Why do these pundits make such negative generalizations about 2/3 of the population? Has the food industry decided just to insult its customers? You may want to see what happened with Michael Jefferies, the head of the head of Abercrombie & Fitch who said he did not want fat customers in his store. Donny Deutsch, advertising executive and TV personality, recently called him “disgusting” and “vile.” or University of New Mexico professor Geoffrey Miller who said he did not want students with obesity to apply to his Ph.D. program. He is being investigated by his university.

Oh, if only we would just leave obesity in the hands of the benevolent food industry!

Remember, those are the folks who are re-introducing Twinkie’s to America’s stores.


The same folks who have brought us  tennis superstar Maria Sharapova whole line of candy called, Sugarpova. (Get it?) See picture above.


And let’s not forget Sonic’s new 1,700 calorie peanut butter and bacon milk shake.

Sonic" peanut butter and bacon milk shake

Oh, and then there is Safeway’s leadership to shift the costs of health insurance onto overweight and obese employees based on dubious representation of their program and Kroger’s and Safeway’s efforts to derail front of package calorie labeling in supermarkets. Yeah, let’s all follow those guys.


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