Watching Red Kerry on the box the other night I got a bit prickly over a report that the World Health Organisation was concentrating on obesity at the Health 2004 conference, “attended by representatives of the United Nations, the World Health Organisation, health ministers from Asian countries, non-government organisations, academics and health professionals.”
concern over the rising rate of obesity in the developed world would be discussed against the backdrop of proposals for a global strategy to be put to the World Health Assembly next month. …… “There is a pretty hot debate about how much control we should give the food industry – should we be regulating it, should we be regulating fast food advertising like we have with tobacco?”
Can someone explain to me where a bunch of overpaid, unelected so-called experts get to make policy about increased regulation based on extremely spurious evidence ? For instance;
< obese patients who have been put on very low-calorie diets subsequently display much higher rates of congestive heart failure than equally fat people who did not attempt to lose weight in the first place. The biggest evidentiary problem for those who insist there is a strong causal link between increasing weight and heart disease is that deaths from heart disease have been plunging at precisely the same time that obesity rates have been skyrocketing.
Even Australian politicians use unsupported ‘evidence’ to try and denigrate their opponents as Kate Lundy did in a Senate speech in 2003.
Incontrovertible evidence [my emphasis] shows that being overweight or obese is a serious risk to both physical and mental health. People who are excessively overweight have a significantly increased risk of suffering from heart disease, hypertension, stroke and diabetes, and certain types of cancer, including endometrial, ovarian, cervical and post-menopausal breast cancer in women, and prostrate cancer in men.
Obese individuals also show increased incidence of mental health problems, such as low self-esteem, negative body image self-concept, increased stress levels and poor socialisation ability.
The Australian Institute of Health and Welfare has stated that there is a direct positive relationship between degree of obesity, duration of obesity, and the relative risk of premature death. Estimates indicate that excess weight accounts for around 4.5% of all deaths in Australia. Further, trends show that the risk of premature death almost doubles at body mass indexes between 25 and 32, and at severe obesity levels, as measured by a body mass index of 40 or greater, there is a 12 fold risk of mortality in 25-35 year olds compared to lean individuals.
A recent story in the Guardian puts the idea that the BMI is the be all and end all to the obesity debate cannot be supported by large-scale epidemiological studies. Indeed a small study by the Menzies School of Health showed an inverse relationship between BMI and mortality.
The doctors and public health officials prosecuting the war on fat would have us believe that who is or isn’t fat is a scientific question that can be answered by consulting something as crude as a body mass index chart (the BMI is a simple mathematical formula that puts people of different heights and weights on a single integrated scale).
This, like so many other claims at the heart of the case against fat, is false. “Fat” is a cultural construct. According to the public health establishment’s current BMI definitions, Brad Pitt, Michael Jordan and Mel Gibson are all “overweight”, while Russell Crowe, George Clooney and baseball star Sammy Sosa are all “obese”.
According to America’s fat police, if your BMI is over 25, then you are “overweight”,full stop. Note also the radical difference between how our culture defines “fashionable” thinness for men and women. If Jennifer Aniston had the same BMI as her husband Brad Pitt, she would weigh approximately 55lb (nearly four stone) more than she does.
According to the latest BMI figures, 64.5% of American adults are either “overweight” (meaning they have a BMI of between 25 and 29.9) or “obese” (defined as a BMI of 30 or higher). Studies have found an association between even mild amounts of “overweight” and a significantly increased risk of premature death. For example, a highly publicised study published in the New England Journal of Medicine in 1995 found that women of average height who were as little as 12lb overweight had a 60% increased risk of mortality. A 1999 study published in the Journal of the American Medical Association estimated that overweight lead to around 300,000 premature deaths per year in America alone.
Meanwhile, the proportion of the population that maintains a dangerously high weight continues to climb: obesity in America has increased by more than 50% over the course of the past decade. If the authors of these studies are correct, America is facing a health crisis that, in the words of one anti-fat warrior, will make Aids look “like a bad case of the flu”.
The core belief of those prosecuting this case is that the BMI tables testify to a strong, predictable relationship between increasing weight and increasing mortality. That, after all, is what most people assume when they read that medical and public health authorities have determined a BMI of 25 or above is hazardous to a person’s health. This belief, however, is not supported by the available evidence.
A 1996 project undertaken by scientists at the National Centre for Health Statistics and Cornell University analysed the data from dozens of previous studies, involving a total of more than 600,000 subjects with up to a 30-year follow-up. Among non-smoking white men, the lowest mortality rate was found among those with a BMI between 23 and 29, which means that a large majority of the men who lived longest were “overweight” according to government guidelines. The mortality rate for white men in the supposedly ideal range of 19 to 21 was the same as that for those in the 29 to 31 range (most of whom would be defined now as “obese”).
The case against fat proceeds on the assumption that if a fat person becomes thin, that person will acquire the health characteristics of people who were thin in the first place. Although this assumption may seem like simple common sense, it is, like many commonsensical assumptions, quite dubious. If a person who is physiologically inclined to be fat loses weight, this does not transform that person into someone who is physiologically inclined to be thin. To understand the implications of this distinction, consider that bald men die sooner, on average, than hirsute men, probably because bald men have higher levels of testosterone, which appear to lower life expectancy. Given this, surely no one would conclude that giving a bald man hair implants would improve his prospects for long life.
The most extensive work of this sort has been carried out by Steven Blair and his colleagues at Dallas’s Cooper Institute, involving more than 70,000 people. What they have discovered is that, quite simply, when researchers take into account the activity levels and resulting fitness of the people being studied, body mass appears to have no relevance to health whatsoever. In Blair’s studies, obese people who engage in at least moderate levels of physical activity have around one half the mortality rate of sedentary people who maintain supposedly ideal weight levels.
Similarly, a 1999 Cooper Institute study involving 22,000 men found the highest death rate among sedentary men with waist measurements under 34 inches, while the lowest death rate was found among fit men with waist measurements of 40 inches or more. A 1995 Blair study found that improved fitness (ie, going from “unfit” to “fit”), with the latter requiring a level of exercise equivalent to going for a brisk half-hour walk four or five times per week, reduced subsequent mortality rates by 50%. As Blair himself puts it, Americans have “a misdirected obsession with weight and weight loss. The focus is all wrong. It’s fitness that is the key.”
So why is so much emphasis placed on ‘fatness’ rather than on ‘fitness’ ? Looked at from an economic point of view, the ‘diet’ industry – fitness programs, media (books, videos etc.), alternative medicines and most of all the pharmaceutical industry – all regard obesity as a gold mine.
…. from the perspective of a profit-maximising medical and pharmaceutical industry, the ideal disease would be one that never killed those who suffered from it, that could not be treated effectively, and that doctors and their patients would nevertheless insist on treating anyway. Luckily for it, the American health care industry has discovered (or rather invented) just such a disease. It is called “obesity”. Basically, obesity research in America is funded by the diet and drug industry – that is, the economic actors who have the most to gain from the conclusion that being fat is a disease that requires aggressive treatment. Many researchers have direct financial relationships with the companies whose products they are evaluating.
As I wrote here;
“the crux of the situation [is about] economic returns”. The pharmaceutical industry will continue to promulgate spurious ‘evidence’ that BMI is the only reliable indicator of obesity and drag the WHO (and impressionable politicians) into believing that a the focus should be on a couple of million fat westerners rather than a couple of BILLION poor people dying from malnutrition and malaria.
Authors declaration: BMI = 32.