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Back on the Obesity Beat

I left for vacation on July 24. Just two days later, a story broke that made me wish I could ditch the family and return to blogging, if only for a few hours. When I checked my email, I saw that at least a half-dozen readers had sent me links to the story. (Thanks to all, by the way.)

You probably know the summary already. A study published in the New England Journal of Medicine found that obesity is spread through social networks -- that is, friends let friends become fat. Here's a snippet from Gina Kolata's report in the New York Times last Thursday:

[P]eople were most likely to become obese when a friend became obese. That increased a person's chances of becoming obese by 57 percent. There was no effect when a neighbor gained or lost weight, however, and family members had less influence than friends.

It did not even matter if the friend was hundreds of miles away, the influence remained. And the greatest influence of all was between close mutual friends. There, if one became obese, the other had a 171 percent increased chance of becoming obese, too.

I'm hardly an expert on research techniques, but the design of the study strikes me as ingenious. The authors went back through decades' worth of handwritten records in the Framingham Heart Study. Their goal was to find "alters," or people who were listed as close friends and relatives of the participants in the study itself. (I can't say this for certain, but I believe the friends' names were originally recorded to help the researchers find participants who have moved or dropped out of the study or in some other way become difficult to track.)

They started with about 5,000 Framingham participants and another 7,000 alters. They then built out social networks that included 38,611 individuals, or about 7.5 per participant.

Some bullet points:

  • Men make men fat: If a close male friend becomes obese, your odds of becoming obese increase 100 percent.
  • Women, conversely, are nearly immune to their best friends' obesity; their transmission rate is only 38 percent.
  • Opposite-sex friends don't affect each other's weight.
  • However, sisters have a much bigger influence on each other's weight than brothers: A woman is 67 percent more likely to become obese if a sister she's close to reaches that standard. For brothers, it's 44 percent. The effect only occurs if the siblings regard themselves as close; if you hate your family, they probably don't affect your obesity risk, aside from whatever propensity is built into your genetic hardware.
  • You'd think that spouses would have a dramatic influence on each other's weight. But your chance of becoming obese if your wife does is just 37 percent.
  • Neighbors don't have any measurable effect on obesity. The researchers didn't say this, but I'd guess it really depends on how much you like your neighbors. That's why Ned Flanders remains relatively slim despite the fact he lives next door to an obese person.
Because I was away, and getting almost all my news from a daily paper, I missed the chance to look at the various ways the media covered this story. However, Slate's William Saletan did what I couldn't, and came away unimpressed:
The upshot of the data is that if you find yourself caught in a fattening social network, you have three options. You can resist the fattening norm. You can try to reverse it. Or you can ditch your fat friends.

That doesn't sound very nice. The study's authors certainly don't want to say it. In talking to the press, the Post notes, they "cautioned that people should not ... stigmatize obese people." Likewise, an obesity expert from Yale warned the New York Times against "blaming obese people even more for things that are caused by a terrible environment." Fowler cautioned that studies "suggest that having more friends makes you healthier. So the last thing that you want to do is get rid of any of your friends." Christakis added, "We are not suggesting that people should sever ties with their overweight friends. But forming ties with underweight or normal weight friends may be beneficial to you."

Come on. Everything in the study belies these mealy-mouthed conclusions. To resist a fattening norm, you need willpower. To reverse it, you need to promote responsibility, which implies blame. You almost certainly need stigma. And realistically, to add normal or underweight friends to your circle, you have to relegate others who are overweight. That may be bad for your fat ex-friends, who will lose your friendship as well as your thinness. But it's fine for you, since you'll have just as many friends as before.

Interestingly, the call to maintain close friendships despite health risks would be ridiculed if we were talking about anything besides obesity. If you knew your 15-year-old daughter was hanging out with a group of girls who were sexually active, including several who'd become pregnant, wouldn't you be alarmed? Wouldn't you do anything in your power to get your daughter away from girls who considered unplanned, underage pregnancy the normal course of events?

What if your son was running with a group that included obvious drug users, or petty criminals, or guys who liked to get drunk and smash things up on a Saturday night?

You'd be considered negligent if you didn't intervene. You might switch schools, if that was affordable or feasible. You might even move to a new area. At a bare minimum, you'd push your kids into different activities, with different peers.

Please don't misunderstand: I'm not equating obesity with criminal or antisocial activity. But when we talk about obesity, we are talking about the potential for lifelong health problems.

Maybe it's better to look at this in terms of ambition and aspiration. If your best friends from high school, say, are all career-oriented, what are the odds that you'd be a slacker in a dead-end job? Pretty low, I'd think. You'd either find a different job or different friends.

Same with personal habits. If you're the only smoker in your social circle, wouldn't you feel some motivation to quit? But if, on the other hand, all your friends were smokers and you decided to quit, you know you'd have to make a hard decision regarding those friends of yours. Your only real chance to quit the habit is to quit (or at least modify) the relationships that encourage you to keep smoking.

This is all intuitive and validated by every single person's social history -- yours, mine, everyone's. I don't smoke or drink to excess, so I don't have any friends who do those things. The people I'm close to are all over the place in terms of weight, but everyone I can think of is health-conscious.

I assume social scientists would agree that interpersonal networks are key to normalizing behavior, good or bad. You can't choose your family, but you can choose your friends, as the saying goes. It's not a stretch to say you can choose your lifestyle and personal habits, as well.

That's not profound, of course, but it's the best I can do on my first day back.

Post-vacation blog meat

  • caffeine + exercise = lower risk of skin cancer. As a fan of both, I was way ahead of the curve on this one.
  • Just what the world needs: schizophrenic mice.
  • Don't bogart that joint -- a new study finds that the lung damage from a J is equal to that caused by chain-smoking five cigarettes. Obviously, the solution is to share the buzz.

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Welcome back
Hope you had a good trip, good to have you back blogging again.

I for one have missed my daily MPB fix.

by Mark57 on Jul 31, 2007 11:10 PM EDT   0 recs

Thanks!
It's great to be back.

by Lou Schuler on Aug 1, 2007 8:07 AM EDT to parent up   0 recs

Correlation vs. Causation
Hey, welcome back.

I haven't been following this study closely but I think it's interesting that yours is the first article I've seen that breaks out the results by gender. I have seen some articles that emphasize the sister connection, though (I guess since many articles of this type are written to a female audience that's not too surprising).

I feel like a lot of people are jumping the gun with respect to causation on this study, and are further speculating pretty freely on the mechanism of causation. I'm particularly amused that folks seem to think there are fat people anywhere in America who believe that being fat is acceptable in our culture, regardless of what their friends look like. I'm no sculpted hottie myself, but practically every overweight person I talk to at any length gets around to telling me how he or she needs to get into the gym or put down the potato chips (or both). Most people seem to be well aware of what the norms are and how they compare.

It seems a lot more likely to me that this is a matter of like attracts like, and the same general habits and environment effect people the same way to varying degrees. Someone will no doubt "go first" for whatever reason (his frame size, a medical condition, being a little bit older, a deep secret love for Ben & Jerry's, whatever), but I don't really believe that guy is dooming his buddies. (Yeah, the long-distance friend effect would suggest environment isn't the issue, but you're probably still dealing with people of similar social class and background, exposed to the same media, shopping and dining in the same type of businesses, etc.)

One interesting little anecdotal tidbit (which incidentally matches up with your anecdote about your health conscious but "all over the place in terms of weight" circle): most of my friends succumbed to ice hockey mania within a year or two of each other, normal-weight and obese folks alike. A couple years down the line the normal-weight folks are still normal-weight and the obese folks are still obese, despite a drastic increase in physical activity for all...Happily everyone's in better condition and having a good time.

by kimuchi on Aug 1, 2007 5:21 AM EDT   0 recs

All good points
I thought a lot about that very issue -- correlation vs. causation. Although the key phrase here is "became obese," there's no way to separate out all the variables you mentioned.

It's also important to note that the sample sizes here weren't particularly large. Even though they were dealing with close to 40,000 people altogether, the sample sizes in each particular category (such as brothers or sisters who were close to each other and became obese) might include fewer than 100 people. So even a 38 percent correlation, say, wouldn't be signficant in some categories.

Still, I think the findings make intuitive sense.

Getting back to anecdotes, I can remember my father's circle of friends back in the early '60s all being kind of proud of their beer bellies.

That's why I wasn't surprised about the stronger obesity correlations between males vs. females. With guys, and this goes back to watching my father and his friends, there's a pretty strong synchonization and normalization of lifestyles, particularly when it comes to TV, sports, and beer.

With women, I don't see it as much. Just looking at my wife's friends in her book club, there's a huge variety of weights and body shapes, but as far as I know they all work out. (As do most well-educated women I know.) The heaviest may work out more than the leanest. Most of them are probably near the bottom of their genetic weight range.

Just anecdotes, of course, but they show why this study got so much attention, and why it makes sense to me. We can't decode the correlation-causation question you raise with the data we have, but what we have at least gets the conversation started.

by Lou Schuler on Aug 1, 2007 8:23 AM EDT to parent up   0 recs

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