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The Obesity Myth

Posted by medconsumers on December 1, 2004

The Obesity Myth: Why America’s Obsession with Weight is Hazardous to Your Health (Penguin Group New York: 2004) by Paul Campos

The obesity myth, according to author Paul Campos, is based on three claims: that excess weight causes illness and early death; that losing weight improves health and extends life; and that we know how to make fat people thin. The book is well armed with footnotes to support his argument that the public has gotten a skewed view of the research from the media and from obesity specialists, who are largely funded by the $50 billion a year weight loss industry.

The author is not saying that weight is entirely irrelevant to good health. (It is, he says, unhealthy to be at each extreme, morbidly obese and extremely thin.) Instead, he lays out a convincing case for how the adverse health effects of excess weight have been grossly exaggerated. Take heart disease, for example. Most cardiologists will tell you that excess weight is right up there after smoking as a major risk factor for heart attack.

Yet the nation’s heart disease death rate has been steadily declining since the 1960s and continues to decline even after the upsurge in the number of overweight and obese Americans that began in the 1980s. Contrary to conventional medical wisdom, many fat people have none of the risk factors—-high blood sugar levels, high blood pressure and high cholesterol—-associated with illness and early death. Excess weight increases the risk of heart disease, at most, by 1-5%, says Campos, and some studies even suggest obesity is a protection against vascular disease.

By now, the extremely high failure rate of all diets is well known, and Campos, a professor of law at the University of Colorado and a syndicated columnist, reminds us of the well publicized deaths and injuries associated with diet drugs. One popular over-the-counter weight loss drug, for example, had a now withdrawn ingredient proven to cause strokes in young women.

Still, the “get thin, live longer” message drives many people to diet and drugs with the idea that the benefits of losing weight clearly outweigh the risks. Unfortunately, numerous studies suggest otherwise. For example, The New York Times reported this in 2002: “Dr. Jules Hirsch, an obesity researcher at Rockefeller University [in New York City] provided evidence from studies conducted by others that followed thousands of people for years, keeping track of who lost weight, who kept it off, who become ill and who died. Repeatedly, investigators reported that fat people who lost weight and kept it off had more heart disease and a higher death rate than people whose weight never changed.”

Campos’s book is filled with references to this type of research that is largely overlooked because of its inconvenient findings. And why don’t we hear about the health risks of yo-yo dieting (weight cycling)? Could it be that there are industries from—-women’s magazines to weight loss clinics—that would go down the tubes if word gets out? One reason why the public gets a distorted view of the adverse health effects of obesity, says Campos, is the focus on weight by most researchers who ignore other factors that create ill health in fat people, such as sedentary lifestyle, poor diet, dieting-induced weight fluctuations, diet drug use, poverty, lack of access to and discrimination in health care, and social discrimination.

That a fat person can be healthy and physically fit has been demonstrated in the work of Steven Blair and colleagues at the Cooper Institute in Dallas, who have conducted a study of over 70,000 people and followed them for more than 20 years. Unlike other researchers who either ignore the role of physical activity or allow study participants to self-report activity levels, the Cooper Institute conducted regular treadmill testing throughout their study. Campos says that this study showed that obese, not merely overweight, people who engage in at least moderate levels of physical activity show half the death rate of sedentary people of ideal weight.

America is on the verge of an obesity-induced Type 2 diabetes epidemic, we are told, but Campos pokes holes in this contention. Here, he relies on the work of Paul Ernsberger, professor at the Case Western Reserve University School of Medicine, who is well versed in the obesity research and a critic of how the findings are portrayed to the public. “Actually, there is no hard data that says blood sugar levels are rising,” according to Dr. Ernsberger, who points to telephone surveys as the source for this purported rising incidence of Type 2 diabetes. Aggressive educational programs aimed at testing are one reason why many people report themselves as diabetics in telephone surveys, according to Dr. Ernsberger, who explained that doctors often tell people they are “borderline diabetics” or to “watch out for diabetes,” and this has led some people to think they already have the condition. Not incidentally, the definition of Type 2 diabetes was changed from a fasting blood sugar of 140 to a blood sugar of 126. Overnight, millions of Americans became diabetics.

The book’s parting words of advice–stop obsessing about weight. “The prosecutors in the case against fat aren’t completely wrong: They’ve just indicted the wrong parties. Americans are too sedentary. We do eat too much junk that isn’t good for us, because it’s quick and cheap and easier than the alternative of spending the time and money to prepare food that is both good for us and satisfies our cravings. A rational public health policy would focus on those issues, not on weight, which isn’t the problem, any more than diets and diet drugs would be the solution, even if they actually made people thin (thin people with bad health habits are no healthier than fat people with the same habits).”

Reviewed by Maryann Napoli, Center for Medical Consumers © 2004

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