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Friday, Jun 17, 2005

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Fat versus fiction

Vivienne Parry

The moral panic about the obesity epidemicwas always hard to swallow. Now, a newstudy says we may have been wrong all along.

THERE IS an epidemic of obesity. We are all going prematurely to hell in a heavily reinforced handcart, the victims of our own self-indulgence and laziness. And a tsunami of diabetes, osteoarthritis, heart disease and cancers is about to hit us. Bring on the lettuce leaves and 10 km runs.

That is the orthodoxy, but a number of scholars are now accusing obesity researchers, the media and public health officials of exaggeration. This week sees the publication of yet another of these dissenting views. "The Obesity Epidemic: science, morality and ideology (Routledge 2005)" is the work of two Australian academics, Michael Gard and Jan Wright, experts in physical education and education respectively. I can hear the sniffs of disapproval already.

They are outside the medical community, but that does not mean they have nothing of value to say. Scientists talk about fat as if it had a clear cause. Too much energy in and not enough out. The reality, these authors claim, is that there are many aspects of both the causes and the consequences of being overweight or obese which are not explained by this simplistic model.

The authors do not dispute that the proportion of those who are obese in the population has roughly doubled in the United States and many parts of Europe since 1980. Nor do they dispute the increase in cases of Type 2 diabetes. In the U.S., 55 per cent of adults with diabetes are obese, compared with 31 per cent in the general population, which surely links obesity and diabetes.

It is said that 365,000 Americans die prematurely each year because of obesity. This figure became written in stone almost as soon as it appeared in 1999. But it was derived from 10-year-old data, taken in part from self-reported weights and heights. In April, research published in the Journal of the American Medical Association by Katherine Flegal, a scientist at the Centres for Disease Control, which used newer data, showed that it is far from certain that there is measurable excess mortality among obese or moderately overweight Americans.

Many will say that this is because of better drug treatments. But 30 per cent to 50 per cent of prescription drugs are not taken as directed, and many lower income Americans do not have health insurance and cannot afford drugs, so this does not ring true. If it was, one would think the pharmaceutical industry would have been shouting it from the rooftops, yet Ms. Flegal's findings did not make the front pages like the 1999 study. But given that the $46 billion weight loss industry is dependent on scaring stouter citizens, that is hardly surprising.

You could regard all this in the same vein as global warming dissent — to be trashed either because you think it wrong, or think there is truth to the argument but it shouldn't be made because it encourages complacency.

But Mr. Gard and Mr. Wright have some points on the ideology surrounding obesity and also the way body mass index (weight divided by the square of height) is used as a measure. In the past, only those whose BMI was in excess of 30 were deemed overweight or obese. That value has now been changed to 25 and above, exploding the number of obese people, labelling them as "abnormal" and in need of medical treatment.

This arbitrary definition of fatties vs thinnies has meant constant exhortation to get to your "ideal weight," within the magic 20-24 BMI band. Since there are naturally a range of weights within a population, many are trying to achieve the impossible. When they fail, they are told they are "weak-willed".

We are right to be concerned about the rising levels of Type 2 diabetes but should we be worrying about the health futures of people with a BMI of 26 or 28 who are taking regular exercise? Probably not, but we will continue to tell these people that they are porky slobs who ought to try harder. In doing so, it is likely that we are condemning them to the sort of yo-yo dieting that results in weight gain, not weight loss.

- Guardian Newspapers Limited 2005

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