The ongoing obesity debate at the Atlantic has been great. I particularly enjoyed Megan McArdles last offering.

An important point, however, needs to be made. Everyone in the conversation seemed to accept that obesity itself is a health problem. On a superficial level this is clearly true – most fat people don’t want to be fat, therefore being fat is a problem. Yet, I don’t think this what most anti-obesity advocates have in mind. They cite the link between obesity and other health problems, most notably type II diabetes.

If obesity were the problem, however, then large volume liposuction would be the cure. People have too much fat? No problem ,we just remove the fat.  All better now. Except, it doesn’t work that way. Liposuction has not shown significant health benefits.

This is an important piece of evidence, especially when we note that surgically removing a malignant tumor does do wonders for the patient. Indeed, surgically clearing a person’s arteries of accumulated plaque can stop an otherwise fatal heart attack.

When body tissue is the problem, removing it is the cure.

This doesn’t work with fat and so its likely that being fat is not the underlying problem. Just as taking a cough suppressant doesn’t make the flu go away, cutting away fat doesn’t make obesity related health problems go away.

Personally, I am sympathetic to the notion that obesity may often be a symptom of hyperinsulinemia which in turn is a pre-diabetic condition. The evidence, however, is mixed. There is some recent research that that suggests some obesity and type-II diabetes are autoimmune in origin.

In any case we should not approach this as if the problem was people getting fat, any more than we should approach bird flu as if the problem were people coughing all the time. There is some underlying disease that appears related to obesity and to affect long term health. If the core disease is some part of the diabetes process then we should work to understand it and arrest it. If the core problem is not diabetes related then we need to find out what it is.

What we don’t need to do is expend a lot of moral outrage over national fatness when we are not even sure what the causes and consequences of obesity are.