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On "Weighing Obesity"



 
 
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Old September 23rd, 2003, 08:04 AM
Steve Chaney, aka Papa Gunnykins ®
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Default On "Weighing Obesity"

http://www.techcentralstation.com/082103B.html

On "Weighing Obesity"

By Michael Fumento Published 08/21/2003

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?

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."

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."

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."

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"

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

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-numbing 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.

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!"

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 person 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?

Michael Fumento (fumento(at)pobox.com) is a senior fellow at the Hudson
Institute in Washington, D.C. and a syndicated health/science columnist
with the Scripps Howard News syndicate, and author of The Fat of the Land
(Viking, 1997).

******

-- Steve
º¤º°`°º¤ø,¸¸,ø¤º°`°º¤º
Steve Chaney

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