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It’s interesting that a condition that a condition that’s "good for us" is wreaking havoc on insurers and government health care .
Every year, Americans grow fatter. Currently about 44 million Americans are considered obese, while fully two thirds are obese or overweight. Children are lumbering right behind their parents. By no coincidence, the fatter we become the stronger becomes the "fatlash" movement. It attempts to succeed where Big Tobacco failed, to convince us that what people have intrinsically known for centuries and what science has shown for decades is nothing but a Big Lie, what the late Sen. Joseph McCarthy called a "Conspiracy so immense." Yet for all the disinformation fatlashers have spewed, perhaps nothing has been as monstrous as the cherry-picked data and outright fabrications in Sandy Szwarc’s big fat series (10 pieces and over 25,000 words) "Weighing Obesity" that appeared in Tech Central Station from July 14-August 8.
Among the most blatantly false assertions:
It’s not just that being overweight is harmless; it’s actually good for you. The real health problem is trying to lose weight. It kills more than 150,000 Americans annually. We’re not growing fat nearly as fast as we’re told. The obesity epidemic is not caused by eating; indeed, we’re barely nibbling enough to survive. In short, tons of published research that’s been mounting for decades is all wrong. Instead of relying on it we must do as Szwarc does and get our information from obesity activists like Frances Berg; Glenn Gaesser; and Paul Campos; and groups like the National Association for the Advancement of Fat Acceptance; the Council on Size and Weight Discrimination; Largely Positive, and the former Body Image Task Force. Yes it, true: the doctors in Woody Allen’s Sleeper were right: Fudge is good for you. Granted, Szwarc’s message has tremendous appeal to the overweight and obese, which is why so many of them switch off their brains when they read fatlash material. Denying a problem is always easier than tackling it; and tackling obesity is extremely difficult. We live in a nation that loves to eat massive amounts of calorie-packed food while we sit mesmerized in front of the boob tube watching back-to-back sets of sitcom reruns and drink 64-ounce soft drinks. "Exercise," "good nutrition," "moderation," and "restraint" are all four-letter words. Formerly considered sins, "gluttony" and "sloth" are now the butt of jokes and advertising is filled with admonishments to eat till we practically burst.
So there are plenty of us to support a cottage industry catering to massive denial and delusion. Szwarc has done her job well. But if you’re obese, believe her and die.
This is no point-by-point rebuttal, but rather a discussion of a few of the most important issues raised in Szwarc’s Oxford English Dictionary-length propaganda feast. And it makes the point that she and the fatlashers in general are not only horribly wrong but that they darned well know it.
TO LENGTHEN THY LIFE, STUFF THY FACE? "The strongest scientific evidence indicates we’ll live longest and with the fewest health problems if we’re in the overweight range, especially as we get older," Szwarc claims. "In addition to longer life spans, fat people have lower rates of most cancers, respiratory diseases, and osteoporosis," she insists.
Is that why she looks so thin in her photo?
Thousands of years ago, Hippocrates recognized the correlation between overweight and sudden death.
In any event, wise people have known better than this for millennia. Over 2,000 years ago Hippocrates, the founder of western medicine, noted the correlation between being overweight and sudden death, and Benjamin Franklin observed in his Poor Richard’s Almanack: "To lengthen they life, lessen thy meals." All that’s changed since then is that know we have data to prove it and to show why. Earlier this year, the Journal of the American Medical Association (JAMA) reported that white men ages 20 to 30 with a Body Mass Index (BMI) greater than 45 lost 13 years of life compared with those with a BMI below 25. (A BMI over 25 is considered overweight, while one over 30 is considered obese.) The heavier women lost eight years. At the same time, the Annals of Internal Medicine reported six to seven years of lost life for obese 40-year-old nonsmokers, approximately the same premature mortality found in normal-weight smokers. So obesity can kill as readily as smoking.
An oft-cited 1995 New England Journal of Medicine (NEJM) analysis that followed the over 115,000 women of the Nurses’ Health Study over 19 years found, "Among women who had never smoked, the leanest women in the cohort (those with body-mass indexes below 19.0) had the lowest mortality, and even women with average weights had higher mortality. Mortality was lowest among women whose weights were below the range of recommended weights in the current U.S. guidelines." It concluded that, "The lowest mortality rate for U.S. middle-aged women is found at body weights at least 15 percent below the U.S. average for women of similar age."
In one major study that Szwarc comments upon, in the January 1, 1998 New NEJM, Dr. June Stevens of the University of North Carolina at Chapel Hill and her colleagues tracked over 300,000 men and women for 12 years. "I’m sorry to tell you," Stevens told reporters at the time, "But it’s the very lean weight that is associated with the best survival rate."
Some studies have found the risk of obesity to be on par with those of smoking.
Szwarc claims this study had the scientific community in an uproar because it was so flawed, although that same community continues to rely on it. "Reviewers were quick to condemn these inconsequential numbers," she writes. This is readily falsified; the NEJM tracks future citations of its articles and shows that over 60 medical journals have made use of the Stevens study. Moreover, other than the editorial in the same issue by two editors with no background in obesity, it’s hard to find medical journal mentions unfavorable to Stevens. Thus it’s understandable that Szwarc cited nothing but the editorial. Instead, she noted that some of the relative risks Stevens found were statistically significant but seemingly quite small, certainly under 2.0. (A relative risk of 1.0 means those in the theoretical risk group have no higher incidence than comparison subjects, a 2.0 means twice the incidence, and so on.) Further, she notes that "the National Cancer Institute has stated: ’In epidemiological research, relative risks of less than 2.0 are considered small and usually difficult to interpret. Such increases may be due to chance, statistical bias or effects of confounding factors that are sometimes not evident.’ In other words, the study’s conclusions were flimsy."
But what’s "flimsy" is Szwarc’s understanding of what epidemiologists call "statistical power." This means the lower the relative risk, the higher must be the number of participants in the trial for that risk to be meaningful. Sample size increases the precision of all statistical calculations. A study of 300,000 is huge, tremendously reducing the chance that a risk ratio below 2.0 is unimportant.
Moreover, even though Szwarc calls the Stevens study "The largest study ever conducted" on obesity, the very next year, the American Cancer Institute released a prospective study of over a million people. Its conclusion: "The risk of death from all causes, cardiovascular disease, cancer, or other diseases increases throughout the range of moderate and severe overweight for both men and women in all age groups."
Another way of determining the value of a relatively low relative risk is to look for a dose-response gradient. In our case, do the studies show that as fatness increases so does death at relatively the same degree? The answer with both of these studies and every one I cite in this article is yes. Finally on this subject, nothing provides better support than replication. If the Stevens study were the only one on the subject, her findings would be of limited use. Instead it was just one in an ongoing series, many of which had risk ratios far beyond 2.0. And all show that the fatter you are, the sooner you die.
According to the Centers for Disease Control and Prevention, obesity is associated with congestive heart failure; coronary heart disease; angina pectoris; stroke; cancer; high blood pressure; high blood cholesterol; type 2 (non-insulin dependent) diabetes; gallstones; gout; osteoarthritis; obstructive sleep apnea and other respiratory problems; complications of pregnancy (including birth defects); poor female reproductive health (such as menstrual irregularities, infertility, irregular ovulation); and poor bladder control.
It’s also costing the nation a fortune. Expenditures for medical conditions caused by being overweight or obese "account for 9.1 percent of total annual U.S. medical expenditures in 1998 and may be as high as $78.5 billion ($92.6 billion in 2002 dollars)," according to the journal Health Affairs. "Medicare and Medicaid finance approximately half of these costs," it noted. This makes a good response to the cry of fat activists that their excess adiposity is nobody’s business but their own.
OBESITY CURBS CANCER? "According to the National Research Council," Szwarc claims, obesity appears to protect against overall cancer deaths and against deaths from the specific cancers that are the leading causes of cancer death, such as premenopausal breast, lung, stomach and colon cancer in women, and lung and stomach cancer in men." She provides no citation because there is no such NRC report or statement. But countless other respected scientific bodies - private, governmental, and international have said exactly the opposite.
Szwarc does mention a study in the April 24, 2003 NEJM conducted by the American Cancer Society evaluating the risk of cancer and being overweight, but provides us her interpretation instead of theirs. The authors’ conclusion was that, "In both men and women, body-mass index was also significantly associated with higher rates of death due to cancer of the esophagus, colon and rectum, liver, gallbladder, pancreas, and kidney." Further, "Significant trends of increasing risk with higher body-mass-index values were observed for death from cancers of the stomach and prostate in men and for death from cancers of the breast, uterus, cervix, and ovary in women." They presented a table showing a statistically significant increase of risk for all cancers combined starting at a BMI of 30 and increasing as weight goes up. Szwarc pooh-poohs the increased risk as "negligible," which is easy when you’re healthy. But it’s a good bet those in the study who contracted cancer don’t feel that way. Those with a BMI of just 30 to 35 had a 41 percent increased chance of pancreatic cancer – a quick death sentence.
The study concluded that, "On the basis of associations observed in this study, we estimate that current patterns of overweight and obesity in the United States could account for 14 percent of all deaths from cancer in men and 20 percent of those in women."
If you’re extremely heavy, you probably have a set of these in your future. One study found the heaviest women had a four times higher rate of osteoarthritis.
Regarding osteoporosis, there is little data on the subject. It is understandable that carrying extra bulk can strengthen the bones, and some studies show this to be the case with those only moderately overweight. But try to find a physician who recommends becoming fat to preserve your bones rather than drinking extra milk or taking a calcium pill. Further, this applies only to adults. As the journal Nutrition Reviews pointed out last year, "Recent studies suggest that overweight and obesity in childhood and adolescence reduce bone mineral content below what would be predicted based on weight and are associated with an increase in incidence of childhood fractures." With childhood obesity increasing faster than adult obesity, and obese children generally cursed to become obese adults, body fat can hardly be said to protect against osteoporosis. It’s also that extra bulk that weakens the joints and causes terrible osteoarthritis rates among the obese. An April 2003 study found that those with the heaviest BMI had about four times the rate of osteoarthritis of the knee as those with the lightest.
ANOREXIA DEATHS, A TRULY INVISIBLE EPIDEMIC If overeating and hence being overweight is good for you, it would seem that undereating and being thin must be horrendous. That’s Szwarc’s claim in the segment, "The War on Fat’s Casualties", and in her final segment she asks why there are no splashy headlines such as, "If your dress size is under four, you have the highest risk of dying young!" and "Dieting quadruples your risk of dying early!"
It’s probably because Jayson Blair was fired.
Dieting advice, she says, had led to a devastating epidemic of eating disorders. That’s like saying that advising someone to exercise more leads to them trying to run 20 miles a day. The rise in eating disorders goes hand-in-hand with the rise in obesity, and as such is as much a consequence of the obesity epidemic as is the rise in type 2 diabetes.
Szwarc claims "10 to 15 percent of anorexics die of starvation or related problems, including heart or kidney failure, and another 2 to 5 percent commit suicide," quoting from a trade book that she’s so unfamiliar with that she lists the wrong co-authors. (She cites David Katz and Jerome Knittle, when it’s actually Victor Herbert and Jennel J. Subak-Sharpe.) Further, she writes, anorexics "Are 12 times more likely to die than the general population of similar ages, according to a study published in the New England Journal of Medicine, April 8, 1999. It’s estimated that in the United States alone as many as 150,000 die annually from eating disorders."
Christina Hoff Sommers punctured the 150,000 dead anorexics myth fully nine years ago.
Never mind that the more logical connection between eating disorders and premature deaths is probably that people with mental dispositions leading to eating disorders are bound to be disposed to having other problems, as well. The NEJM study gives only a rate of mortality among anorexics (the same the CDC uses), without saying how many there are. The 150,000 figure comes from no medical journal but rather tired old feminist mythology, once propagated by Gloria Steinem and Naomi Wolfe and punctured fully nine years ago by Christina Hoff Sommers of the American Enterprise Institute. Steinem and Wolfe admitted their errors. The only eating disorder virtually anybody dies of is anorexia, and the actual number of deaths from it? According to a published 2001 study, it’s about 145 annually. That makes Szwarc off only by a factor of 1,000. Do we really want to be taking health advice on such an important matter from somebody who trades in urban legends? Szwarc also cites an activist group to support her claim that, "Up to 10 million Americans suffer from eating disorders," even as the very NEJM study she cited put it at half that. Five million still sounds like a lot, until you realize how large the definition of "eating disorder" has become.
Eating disorders aside, Szwarc also claims in "Dying to be Thin" that science shows that being underweight is far more serious than being overweight. Numerous studies I have already cited show that those with extremely low BMIs actually live longest. There have been some published that do show the thinnest people had a higher death rate than those closer to average. But when the researchers take into account why this is happening, they find that the affect disappears once you account for people who are lean because of heavy smoking or disease. One such study in JAMA from a full decade ago was from the famous Harvard Alumni Health Study. It concluded: "After accounting for confounding by cigarette smoking and bias resulting from illness-related weight loss or inappropriate control for the biologic effects of obesity, we found no evidence of excess mortality among lean men. Indeed, lowest mortality was observed among men weighing, on average, 20% below the U.S. average for men of comparable age and height."
THE MYTH OF THE "300,000 MYTH" The effect of atherosclerosis on an artery over time.
Szwarc also pretends to shatter the "myth" that obesity kills 300,000 Americans a year, saying it began with a study back in 1993. That review indeed found 300,000 deaths attributable to "diet and activity patterns," which she dismisses in great part on the basis of her own previous biased presentation. "Those factors, as we’ve seen, don’t equal obesity," she says. Yet she admits, "It’s appeared in hundreds of studies since." Apparently obesity researchers seem to think it to be of some importance, even if a self-described "food editor and writer" such as Szwarc does not. Moreover, other studies have reached the same conclusion by other calculation. Thus the authors of a 1999 JAMA study did their own number-crunching and concluded: "The estimated number of annual deaths attributable to obesity among US adults is approximately 280,000 based on Hazard Ratios from all subjects and 325,000 based on Hazard Ratios from only nonsmokers and never-smokers." Consider, too, the aforementioned NEJM study from April finding 90,000 annual cancer deaths alone from obesity. Toss in stroke, diabetes, other diseases, and the biggest killer from obesity – heart disease – and you can easily reach that 300,000 figure.
Yet Szwarc denies even the heart disease connection, citing an unnamed "1989 JAMA review of almost 100 studies [that] found fatness is not a risk factor for atherosclerosis or coronary heart disease. I conducted a search on JAMA’s website search engine, alternatively using either "atherosclerois" or "coronary heart disease" for all of 1989 and found no such reference. But it would have been astonishing had it done so. Consider that the aforementioned analysis of the Nurses’ Health study found that, "Rates of death due to cardiovascular disease among the obese women (body-mass index, >29.0) were four times higher than those among the leanest women." There was almost a perfect correlation between weight and death, such that the women in the heaviest grouping were almost five times more likely to have died during the study than the thinnest women. A report from the Harvard Alumni Health Study found that among men younger than 65 the relative risk for death among those with a BMI of 33 or higher was about 3.5 times that of men with a BMI of 23 or lower.
OBESITY CAUSES BREAST CANCER, NOT DIETING Dieting doesn’t cause breast cancer, obesity does.
Indeed, it’s not body fat that kills says Szwarc; it’s trying to get rid of it that does. So-called "yo-yo" dieting (properly called "weight-cycling) can cause breast cancer she insists, citing the 1996 fatlash book, Big Fat Lies. Nobody recommends weight-cycling; that’s merely the path you put yourself on if you follow fad diets. But insert the terms "weight cycling" and "breast cancer" into PubMed and you’ll find only one human study that even discusses the issue. It concludes, "Temporary weight cycling (weight loss followed by weight gain) was not associated with [breast cancer] increased risk." Rather, "Weight gain clearly increased risk of postmenopausal breast cancer. These data lend further support to efforts aimed at helping women avoid weight gain as they age." The actual medical view of weight cycling as presented in JAMA is that, "Evidence is not sufficiently compelling to override the potential benefits of moderate weight loss in significantly obese patients. Therefore, obese individuals should not allow concerns about hazards of weight cycling to deter them from efforts to control their body weight."
Conversely, use the search terms "obesity" and "breast cancer" in PubMed and you’ll find an amazing 650 or so article citations. While there will always be dissenting studies among a pile this high, they provide overwhelming evidence that obesity, not weight cycling, is not only a major cause of breast cancer, it also makes tumors both harder to find and treat. It thus increases not only the likelihood of contracting breast cancer but of dying of it once diagnosed. One study concluded, "It appears that maintenance of non-obesity may be a more effective way of decreasing mortality from breast cancer than any other measure proposed to date," while another found "30-50% of breast cancer deaths among postmenopausal women in the US population [may be] attributable to overweight."
The April, 2003 NEJM obesity-cancer study found a remarkable (and terrible) correlation between increased weight and increased risk, such that women who were overweight but not obese had a 34 percent greater chance of death, moderately obese women had a 63 percent higher risk, and the heaviest category had over double the risk.
Still, "any port in a storm" as they say, so Szwarc pulls out yet another mind-numbingly response to "obesity kills" that was refuted at least as far back as 1997 because that’s when I refuted it in my book The Fat of the Land "It’s a strange epidemic," she says, "that finds those exposed to it living longer, healthier lives than ever before." By that reasoning, there was no AIDS epidemic. In 1980, the year before the AIDS epidemic began, U.S. life expectancy at birth was 73.7 years according to the U.S. Census Bureau. Yet by 1993, at the height of the epidemic, it was at 75.5 years. The simple explanation is that medical advances elsewhere, especially in reducing infant mortality which effects lifespan measurements the most, more than offset the deaths from AIDS and have more than offset the deaths from obesity.
Suffer the little children for the examples we adults have set, and the propaganda pumped out by the fatlashers.
Moreover, a 430-page National Center for Health Statistics report published this year detailed why Americans are living longer and better was accurately summarized as concluding, "But as Americans make gains in these areas, they are endangering their health by becoming overweight and failing to exercise." To Szwarc, nothing concerning the obesity epidemic or its harmfulness can go unchallenged. The epidemic itself, she says, is partly concocted. "In 1998, the rhetoric became more exigent, when NIH changed the definition of overweight from those with BMIs over 27, to those with BMIs of 25 or greater. That instantly deemed an estimated 29 million more Americans overweight and in need of weight loss." She doesn’t say that the definitional change applied only to "overweight," not obesity. Moreover, since the definition change has no impact on the long-term studies that now use a consistent definition of 25 for overweight and 30 for obesity. So whether looking at "overweight" or "obese," at adults or children, the rates truly are exploding. Since 1981 adult obesity has increased by 74 percent, while among children it’s increased by a horrifying 2.5 times. As is often the case with health problems, minorities suffer the most. A fourth of all Mexican-American children are now obese.
"BLAME ANYTHING AND ANYBODY BUT US!" Szwarc says we’re eating barely enough to survive, even as we grow fatter by the year. It must be witchcraft at work!
Even if we are getting fatter, it must be from some form of witchcraft because "A recent national study showed the median calorie intake for women in the United States is about 1,600 calories," Szwarc says. Since we should be taking in an average of about 2,200 calories there seems no other explanation for the girth of our nation than black magic. Szwarc doesn’t say, but her data for the 1,600 comes from a USDA publication based entirely on self-reporting. But probably every study ever done (and there have been plenty) comparing self-reported caloric consumption with observed consumption finds that everybody underreports, with fat people doing so the most. Some studies have found obese persons underreported their intake by one-half even as they overstated how much exercise they engaged in by 50 percent. More reliable is the USDA’s "availability data," which appeared in an article in that same small USDA publication but that somehow Szwarc missed. It found that there are now an all-time high of 3,900 calories available per American for consumption. Accounting for waste and spillage it says, we’re wolfing down about 2,750 calories on average daily or 550 more than USDA recommends for the average American diet. Once again, proof of supernatural forces at work is found wanting. As the report bluntly states: "A big jump in average calorie intake between 1985 and 2000 without a corresponding increase in the level of physical activity (calorie expenditure) is the prime factor behind America’s soaring rates of obesity and Type 2 diabetes."
So yes, fat cripples and kills. We are getting fatter by the nanosecond and non-fat Americans will soon fall behind Bohemian midgets as a minority group. It’s not genes or a virus or Voodoo that’s doing this; the explanation is simply too much food and too little exercise. But say one thing for the fatlash activists and their journalist mouthpieces, they’re singing a sweet Siren song that many fat people are dying to hear. The only question is, how many will die because they heard it?