Fat Nation: A History of Obesity in America

by Jonathan Engel

The diet and weight-loss industry is worth $66 billion – billion!! The estimated annual health care costs of obesity-related illness are 190 billion or nearly 21% of annual medical spending in the United States. But how did we get here? Is this a battle we can’t win? What changes need to be made in order to scale back the incidence of obesity in the US, and, indeed, around the world? Here, Jonathan Engel reviews the sources of the problem and offers the science behind our modern propensity toward obesity. He offers a plan for helping address the problem, but admits that it is, indeed, an uphill battle. Nevertheless, given the magnitude of the costs in years of life and vigor lost, it is a battle worth fighting.

Fat Nation is a social history of obesity in the United States since the second World War. In confronting this familiar topic from a historical perspective, Jonathan Engel attempts to show that obesity is a symptom of complex changes that have transpired over the past half century to our food, our living habits, our life patterns, our built environments, and our social interactions. He offers readers solid grounding in the known science underlying obesity (genetic set points, complex endocrine feedback loops, neurochemical messengering) but then makes the novel argument that obesity is a result of the interaction of our genes with our environment. That is, our bodies have always been programmed to become obese, but until recently never had the opportunity to do so. Now, with cheap calories ubiquitous (particularly in the form of sucrose), unwalkable physical spaces, deteriorating rituals and norms surrounding eating, and the withering of cooking skills, nearly every American daily confronts the challenge of not putting on weight. Given the outcomes, though, for those who are obese, Engel encourages us to address the problems and offers suggestions to help remedy the problem.

Genres: Nonfiction, Health, History

266 pages, Kindle Edition

Published November 30, 2018

Reviews

[Katy Miller · Rating 4 out of 5]

Great analysis, although he misses a few key points

Pros: excellent summary of the obesity epidemic and the systemic changes we will need to combat it. He nicely summarizes the medical information on obesity, albeit with some sensationalism (I am a physician so feel qualified to make that assessment). I especially liked his descriptions of recommended policy changes, which I think are outstanding and demonstrate a good grasp on the political landscape as well as the science.

Cons: I took issue with some of the language he uses describing poverty, including inferring that people in poverty bear some blame for "bad choices" (although he also acknowledged systemic inequities). The fat acceptance movement is dismissed as an after thought not worthy of consideration, rather than a movement that has brought up valuable objections to diet culture. Finally, a writer as good as this should not have to resort to referring to feminists as "man hating," but here we are. Involving a few more female editors in the writing process might strengthen furniture books.

[Sarah · Rating 3 out of 5]

I appreciated much of the first half of this book. Engel provides excellent historical information surrounding how the food industry and the lifestyles of Americans have changed over time to create environments that do not promote health. He also provides thoughtful strategies for change. My rating, however, is lowered due to his approach to the discussion of poor health and weight in America. As a weight bias researcher, I can see his bias oozing out of every chapter of the book. Engel is wildly pro-thin, in a way that distracts from his pro-health messaging. Although I was glad to see him acknowledge the impact of weight-based stigma and discrimination (as well as other forms of stigma and discrimination) on body weight, I did not feel an appreciation for this impact throughout the book. Engel mis-represented the fat acceptance movement and focused heavily on discussion of how to "live thin" rather than "live healthy". If it is true that our bodies will have a natural set point that is incredibly difficult to change, wouldn't it be more productive to discuss the strategies outlined in the book as strategies to improve health? Engel discusses excellent health promotion strategies in the second half of the book, but couches them within a discussion of thinness, rather than a discussion of health. When body weight and health are conflated, motivation to continue to engage in healthy behaviours, regardless of changes in body weight, wanes significantly. Engaging in the strategies for health promotion, as outlined in this book, for the sake of health (and independent of weight) is a more worthwhile endeavour.

[Sam · Rating 4 out of 5]

The book gives a detailed informational treatment of obesity in the United States, in language accessible to non-professionals. It is as no-nonsense as anything I've found, clarifying for example the fact that energy and nutrition are largely separate concerns. I found value in its related explanation of why fad diets based on macronutrient distribution (rather than scaling energy input and output) fail in the long run (b/c they aren't sustainable lifestyle modification).

The latter third or so addresses policy, relating the task to the campaign to regulate tobacco and inform the public of its health risks. Unfortunately it seems the author pulls punches regarding the fact that the analogous industry is not simply negligent but malicious in their behavior.

If I have any real gripe with the book, it has to be the occasional promotion of "set point" myths. But this is a minor point in the text, so I will leave this criticism proportional.

[Valerie Sherman · Rating 4 out of 5]

A good overview of a lot of subjects that other authors go into more deeply. I gained new insights, but sometimes the author would discuss a subject at length without spending enough time tying it into the obesity epidemic (or how to fix it). For example, he goes into a loving history of the women's lib movement but seems to imply that this increased obesity, while ignoring obvious potential solutions (hey, maybe men could cook at home more, too). Same with the chapter on smoking - goes too deeply into the history of smoking regulations and not enough into how it's specifically comparable to obesity- and food-related regulations.

[Mary · Rating 3 out of 5]

Based on the description, I hoped to learn more about the ACTUAL history of obesity in America. That is, when did being overweight start to become not a sign of health, wealth, and beauty (as it was way back when) but a public health problem? How did people try to lose weight (diet-what kind? Exercise, drugs, etc.)? I was a bit disappointed in most of the book was about how excess weight is unhealthy (and damages joints, the heart, etc.), which I already knew, and only one chapter about the history of obesity.

[Elizabeth · Rating 3 out of 5]

This book was basically a short overview of the various theories about obesity, health, and dieting. It was a fine amalgamation of the information, but seemed a bit preachy and holier-than-thou at times, which wasn't my favorite.

[Susan · Rating 5 out of 5]

Very interesting book. The historical perspective is very thought-provoking. It touched on a lot of topics not usually covered by diet books. I would recommend reading it.

[Remi · Rating 4 out of 5]

We basically need go change our culture and society if we want to end the obesity epidemic because our bodies were meant to put on weight and keep it.