Bill Maher's Approach to Treating Obesity Makes for Better Comedy than Actual Problem-solving
No amount of writers' talent or on camera poise will change the fact that obesity is not as simple as everyone pretends it to be
It’s always easier to criticize performance than it is to perform. So where does that leave us with comedian and social commentator Bill Maher’s recent episode of “Real Time”? In it, he discussed America’s obesity epidemic while also attacking Ted Kyle, an advisor to the Obesity Society. After viewing the segment, I was left wondering if comedy is really difficult or if Maher is simply adept at criticizing things he only superficially understands.
I thought it would be worthwhile to discuss Maher’s reasoning regarding the obesity epidemic. For the record, I’m familiar with Bill Maher, I don’t watch his show, and I don’t take personal any of his comments, aside from his unfair and dismissive characterizations of Kyle. In his own defense to Maher’s remarks, Kyle stated, “You are an unrepentant bully for whom we have no time.”
Personally, I’m a little more brazen and happy to offer rebuttal in defense of a friend.
I’ll start by steelmanning a few of the points Maher touched upon. Primarily, the role of self-monitoring and vigilance in health. Every now and then, the notion of “personal responsibility” becomes an incendiary point in healthcare research; one group dismisses this as a toxic and malicious mindset, while the other upholds or validates the perspective.
I find myself generally leaning towards the latter group, but acknowledge the claims of the other. I study diet through the lens of public health, so I’m familiar with the literature that points out the associations between disease and environmental or demographic factors. If you are poor in America, odds are stacked against you for having a longer and healthier lifespan compared to someone who is not poor. Do both of a child’s parents struggle with obesity? Well, that child’s genes up the likelihood that they themselves will struggle with obesity. It’s simply a fact - the world in which we reside, much of it beyond our control, does play a role in our health.
But where I depart from outright dismissal of individual responsibility is what we are supposed to do about it. Even though the stacked deck may not be your fault, the only way to manage it will start with you, whether that’s making changes or seeking help to do so. We should exercise compassion for those in dire straits beyond their control, but the health of an individual is never in the hands of someone else, so like it or not, responsibility will always plays a role.
I also agree with Maher in how there is no amount of body positivity in the world that will correct the low-grade inflammatory state brought on by increasingly excessive body fat. Mantras and self-love are good, but are not going to counter basic biology. And yes, if you are going to promote “plus-size” models who take charge of their health and disregard weight reduction, it is hypocritical to criticize people like Adele who want to lose excess weight.
That’s about all I can say in defense of Maher. Perhaps the science of human health and the multitude of factors that contribute to it don’t make for entertaining television. No amount of writers' talent or on camera poise will change the fact that obesity is not as simple as everyone pretends it to be, a fact made obvious by Maher’s overly dramatic declaration about obesity and mortality:
“If you are participating in this joyful celebration of gluttony, you have blood on your hands. Full stop.”
No, no. It’s not “full stop”. But there’s only so much time to air a show, so I suppose at some point you just have to move on. Misunderstanding the scope of the science is one thing, but I took issue with Maher’s attacks on Ted Kyle.
At two points in the show Maher quoted Kyle, clearly intended as strawman fodder for cheap laughs. Maher mocked Kyle’s point about our lack of understanding when it comes to treating obesity because, as Kyle said “we don’t know precisely what the factors are that are causing it.”
Maher reads the line and pauses for effect while the audience and guests giggle, but betrays his misunderstanding of Kyle’s claim. Maher’s reasoning, as best as I can tell is, the problem is eating too much and not moving enough! I know this. Kyle knows this. Many who research the problem know this. But identifying the problem is not the same as offering a solution. So let me put it in alternative terms…
Weight loss is (relatively) easy. Maintaining weight loss is a hell of a lot harder by comparison.
We have lots of data that demonstrates the prevalence of weight recidivism - people follow diets, alone or in tandem with other lifestyle changes, but then gradually regain the weight. If your counterpoint is to say “Well just stick with the changes!” you’re neither helpful nor comprehending the challenge. Maher’s interested in science, so here are a few scientific points.
Obesity is heavily driven by subcortical dysregulation, the parts of your brain involved in complex, subconscious activities such as memory, hormone production, pleasure and other emotions. Subconscious cues require enormous effort to both identify and then manage.
As a person loses weight, those subconscious cues become more difficult to manage; constant hunger, difficulty assessing portion intake, triggers to eat in absence of hunger, etc. All of us are subject to prompts for action, so imagine constantly being prompted to eat. If you need further evidence of the power of these subconscious cues, look at the effects of medicines like semaglutide. Taking this medication results in significant, lasting weight loss, principally because of its influence on that subcortical region.
None of this touches on stressors, time availability, poorly established goals, limited finances, or waning motivation, all of which can ebb away a person’s will to carry on in the face of pushback. Please understand, I am not saying people are helpless, or that they can’t author better things in their life. I like will-power. I like motivation and inspiration. But these hit a comparatively limited audience. For broad change to occur, will and motivation need to be recognized as sparks, not the fuel that maintain the fire of good health. The fuels we need are evidence-based solutions. Nothing less will do.
Managing the obesity epidemic in the world of today is a complex task full of struggles. Maher mentioned at one point in his segment, “You don’t think it was a struggle for them? You think cake wasn’t delicious in 1969?” Admittedly, I laughed at this line.
Yes, it was a struggle for them. But the struggle is greater now, principally because our food production is exceedingly good at its job. More than ever, tasty, convenient, and cheap food that provides too much energy and fewer nutrients is easier to get your hands on. Cap this off with a world that requires less and less movement, and you start to see that, yes, cake was delicious in 1969, but it now costs half as much, is twice as big, tastes even more amazing, every corner sells it, and I can have somebody bring the cake to me (thanks a lot, DoorDash).
Population level obesity is simply not that easy to fix. We know people eat more and move less. How do you get everyone, with the unique factors that surround their lives, to maintain changes which counteract our environment and biology?
Ted Kyle understands this question, and respectfully, Bill Maher does not.