A few years ago the National Institutes of Health warned of a national obesity epidemic that threatened to shrink the average American lifespan for the first time. Despite heroic efforts by the nation's diet-exercise complex, things haven't improved much since.
In fact, we're fatter than ever. We're also living longer than ever. But there's still concern that obese Americans are sicker than they need to be because of their vulnerability to problems like heart disease and diabetes and that their excessive eating habits are causing excessive medical bills that are responsible for spiraling health costs.
There's always been a quiet backlash from those who argue that the fact that this generation is getting fatter is no more threatening - or evidence of either a moral failing or a public health problem - than the fact that the prior generation was taller than the one before it and that much of the issue is a lot of hooey.
All agree that being grossly obese creates medical problems, but that's a far cry from someone who weighs 25 pounds more than the government's standard. In their case, it may not matter.
"This viewpoint received a boost in August when The Archives of Internal Medicine reported that fully half of overweight adults and one-third of the obese had normal blood pressure, cholesterol, triglycerides and blood sugar -- indicating a normal risk for heart disease and diabetes, conditions supposedly caused by being fat" the New York Times reported.
That seems to suggest that half of those overweight and two-thirds of the obese have less benign test results that are worth worrying about.
But it also seems to puncture the public health domino theory, which basically argues that if we all get fat now, we'll all get sick later with chronic diseases that will cause us to die painfully and prematurely under conditions that will create an explosively expanding national medical bill. In short, the link between that supersized order of fries and our expensive health system is less direct than some have argued.
That's not just important for investors and customers of fast-food restaurants. It is also an oblique challenge to those who project that we could save a lot of money if we lived healthier lives and suggest that spending a few million dollars now on an anti-obesity campaign could result in saving billions on doctor and hospital bills tomorrow.
It is indicative of a recurring issue for those trying to affect change. In order to win widespread public attention, they define a public problem as pervasive (think of the data regularly presented to prove today's schoolchildren are illiterate morons). But doing so redefines the targeted behavior into a norm and people are less likely to change if they see themselves as part of the majority.
If, in fact, most of us are dangerously fat, the medical system will ultimately respond to our problem by coming up with remedies. In the meantime, let the good times roll while others focus on resolving the problem we are creating.
Ultimately, though, what we see here is the crisis in credibility that is now spreading from politics and the press to the health area. On a personal level, that makes it more difficult for each of us to know what rules to follow.
But it also casts a growing shadow over the basis for health reforms predicated on saving money by optimizing patient and provider behavior. At a time when we need a sharper definition, the rules are becoming increasingly gauzy.