Obesity: A Health crisis or a moral one?

[Quinlan]

This is an interesting interview with Paul Campos, author of "The Obesity Myth".

http://meganmcardle.theatlantic.com/archives/2009/07/americas_moral_panic_over_obes.php

He makes some interesting points:

The correlations between higher weight and greater health risk are weak except at statistical extremes. The extent to which those correlations are causal is poorly established. There is literally not a shred of evidence that turning fat people into thin people improves their health. And the reason there's no evidence is that there's no way to do it.

It's good to encourage people of all sizes to be active and avoiding eating disordered behavior (like dieting), but this isn't because lifestyle changes will make fat people thin people. They won't.

Obesity is defined completely arbitrarily as a body mass index of 30 or higher (175 pounds for an average height woman). Now body mass follows more or less a normal distribution, whiich means if the the mean body weight is in the mid to high 20s, which it has been for many decades now, then tens of millions of people will have BMIs just below and just above the magic 30 line. So if the average weight of the population goes up by ten pounds, tens of millions of people who were just under the line will now be just over it.

This might be meaningful if there was any evidence that people who have BMIs in the low 30s have different average health than people with BMIs in the high 20s, but they don't. At all. So the "obesity epidemic" is 100% a product of tens of millions of people having their BMIs creep over an arbitrary line. It's exactly as sensible as declaring that people who are 5'11 are healthy but people who are 6'1" are sick.

Adding to the absurdity of all this, people with BMIs in the mid to high 20s actually have the best overall health and longest life expectancy -- ,more so than those in the so-called "normal" BMI range.

Now lets talk about excess health care costs. if you look at the study, nearly half of the excess health care costs associated with being fat are from higher rates of drug prescription. But why are fat people being prescribed more drugs than thin ones? Largely, because they have the "disease" of being fat, which is then treated directly and indirectly by prescription drugs!

For instance, statins. Statins are a multi-billion dollar business, but there's very little statistical evidence that they benefit the vast majority of people to whom they're prescribed. Basically the only people who have lower CVD [cardiovascular disease] mortality after taking statins are middle-aged men with a history of CVD.

But the heavier than average are prescribed statins at higher rates simply because they're heavier than average, even though there's no evidence this is beneficial for them. And of course this doesn't touch on the costs of all the treatments for "obesity" itself, which are uniformly ineffective.

It's conceivable that through some massive policy interventions you might be able to reduce the population's average BMI from 27 to 25 or something like that. But what would be the point? There aren't any health differences to speak of for people between BMIs of about 20 and 35, so undertaking the public health equivalent of the Apollo program to reduce the populace's average BMI by a unit or two (and again I will emphasize that we don't actually know if we could do even that) is an incredible waste of public health resources

Here's an idea: Stop harrassing people about their weight. Because it appears that focusing on the idea that being fat actually makes people fatter. At least there's an extremely strong correlation there. I bet if we stopped demonizing fatness people would actually be a bit thinner. They'd certainly be happier and healthier

Of course. People aren't dumb. They do the experiment, the experiment doesn't work in the vast majority of cases, so they quit until they get desperate again. Or (llke the upper West Side women) they stay on a permanent restricted lifestyle that the vast majority of people don't have the combination of willpower and social privilege to maintain. There's an important class angle here. Thinness is a sign of social status, and is to some extent a product of it, which is one reason -- probably the main reason -- why it's so prized, especially among women.

What do you think?

 

[mallory knox]

I am not a health professional but I agree with most of it, I wouldn

 

[bamf]

I think being significantly overweight and obesity are a problem, but I agree with the author that it's not as huge of a threat as we make it.

The fact of the matter remains however that people are heavier and more people are gaining more weight faster than have previous generations of people. This is a health concern. Being significantly overweight or even obese is unhealthy. It puts undo stress on the immune system, cardiovascular system, and skeletal system just to name a few.

With that being said, making everyone thin (which is probably impossible) wouldn't solve the problem. Dramatic weightloss is dangerous, no matter how much a person weighs. Weight loss should be done gradually, and through fitness and healthier eating choices, not diets.

People have to realize not everyone is made to weigh the same. We are genetically different and there will be frail and skinny people and big and somewhat heavy people who both are healthy. Not every fat person is unhealthy and not every skinny person is physically fit. There are a number of factors that determine our "natural" weight including heredity, genetics, and metabolism.

Dieting (as in eating less, not eating healthier) is usually followed by binging and weight gain. A lot of diets fail in the long run and can actually be very unhealthy. A "diet" for one 300lbs person could be completely wrong for another 300lbs person. Dieting doesn't change genetics or metabolism.

If people made healthier eating choices, exercised moderately, and realized that some people are naturally larger than others and are still healthy, the whole obesity craze might be over.

 

[mallory knox]

I agree, and agree with the kerouac quote too...

 

[Quinlan]

I think any focus on weight is counter-productive, as it leads to otherwise healthy people in the overweight and obese weight range to damage their health (through dieting) and it gives a false sense of security to unhealthy people in the "healthy" weight range.

How often do you hear people say " I can eat all I want and still stay trim because I have a fast metabolism"? These people could very well be killing their organs with internal fat but because they're skinny on the outside they think they're perfect.

The goal is obviously health and wellbeing, but the way of getting there is through good eating and exercise regardless of whether you lose weight or not. Weight should be removed from the equation entirely, people of all sizes should look after themselves and can live healthy lives. The focus on weight rather than overall health and wellbeing, is discouraging, unrealistic and leads to damaging behaviour.

 

[BenW]

The BMI is complete bullshit right off the bat, it was never intended to be used for what it currently is.
So, yeah.

 

[Faye]

What about diabetes, heart disease, etc? How can being obese not be unhealthy?

 

[bamf]

What about diabetes, heart disease, etc? How can being obese not be unhealthy?

Yeah, this is what I was thinking too on top of my post.

Being overweight/obese can be dangerous and decremental to a person's health (but by no means does this apply to everyone, people are naturally all different sizes).

 

[Quinlan]

What about diabetes, heart disease, etc? How can being obese not be unhealthy?

Correlation is not causation.

What we do know is that if an obese person eats right and exercises often then they are less likely to be afflicted by those illnesses than a "normal" weight person who doesn't.

Obesity is unhealthy. It causes heart disease, cancer, diabetes, hypertension, asthma, arthritis, impotence, depression, sleep apnea, deep vein thrombosis, and dementia.
THE TRUTH: Obesity has not been found to be the primary cause of any of these health problems. There is little evidence that adiposity (excess fat tissues) produces the claimed pathologies.

Studies have shown that people who are heavy and fit are far healthier than people who are thin and never exercise. Fat, active people have half the mortality rate of thin sedentary people, and the same mortality rate as thin active people.

http://www.bigfatfacts.com/

Therefore it is entirely possible for an obese person to exercise and eat well and live a long, healthy and happy life.

 

[Quinlan]

Being overweight/obese can be dangerous and decremental to a person's health (but by no means does this apply to everyone, people are naturally all different sizes).

Not exercising and eating right is what is dangerously unhealthy and that can be done by anyone of any size.

 

[arbygil]

Absolutely agree. Fat "prejudice" also does a number on the significantly overweight too. It is possible to be fat and fit, and it is possible to be thin and sick. I can't remember if I saw it on Dateline or another news show, but several years ago they featured a marathon runner who would be considered "obese" to "morbidly obese" but this fellow was 100% healthy. He ate healthy foods, trained well, and ran every day. But he had to be nearly 280. But his doctor did every test and he didn't have high cholesterol or any hint of heart disease.

The truth is, health can only be measured by the individual. Are you physically healthy? Are you active enough to do everything you want and need to do? If yes, then the scale doesn't really matter. Sumo wrestlers are morbidly obese, but they're extremely healthy folks. But when they *stop* training, they can sometimes run into many weight related issues.

Determining fitness based on appearance is prejudicial. But judging based on lifestyle makes more sense. There has to be a balance in everything we do, whether thin or fat. Everyone needs a healthy balance of proteins, carbohydrates, and fats, and limiting processed foods is really the healthiest option for everyone, regardless of size or shape. But to really know how healthy you should be, it's best to visit a doctor regularly and visit with a nutritionist to know what's best for your own body. We're all different, and it would stand to reason that we all have different health needs.

I actually had started a thread similar to this a bit ago - with a different question. But I was looking for a similar discussion.

 

[Azure_Knight]

Obesity is a health crisis; but it is not the only one, nor is it limited to a crisis of health. Obesity is as much a social problem as it is with health: how many fast food restaurants do you pass by when you drive to work (or anywhere else for that matter)? Bringing children up with the garbage that they serve instead of proportioned, healthy meals is one of the problems. Another is the selection of food by both children/parents. While genetics may play a role in obesity, I think that the majority of the obese population is not there because of only genetics. It has a great deal to do with choices and personal responsibility.

You could look at obesity as a moral choice, but there are limits to it. What if someone is obese because of their genetics? Aren't you discriminating against someone for a reason that they cannot help? I do think that it is morally wrong though if there are a few people who are being well fed while the rest of the country is literally starving. To a much lesser extent, I think that it is also wrong to not take care of your body (such as by eating too much). But that is a personal belief; as long as the person isn't wasting food (by eating two bites of everything and throwing the rest away), then I personally wouldn't say anything. It's their choice.

It may sound odd, but the situations surrounding what is perceived as excess is more important to me than the excess itself (in most cases).

 

[arbygil]

Agreed, Azure_Knight.

Something else to consider: Although it's not quite been proven, I think there's a link between extreme obesity and poorer states in the United States. When you're poor, you discover that processed foods are cheaper than real (whole) foods. It's cheaper to buy a month's worth of macaroni and processed cheese food and butter and milk and cheap cereal than it is to buy fruits, veggies, whole grains, organic meats, fish, and olive oil. I really do think there's a direct correlation between obesity and poverty in the United States.

Now, for the middle and upper class, I think other reasons may also come into play. But there are no simple answers.

There are many reasons for obesity, and the answers might not be as simple for an individual as "diet and exercise." I've seen many obese people try and fail diets multiple times - and their defeat is not for lack of trying or laziness, I can tell you that much.

 

[Quinlan]

Obesity is a health crisis; but it is not the only one, nor is it limited to a crisis of health. Obesity is as much a social problem as it is with health: how many fast food restaurants do you pass by when you drive to work (or anywhere else for that matter)? Bringing children up with the garbage that they serve instead of proportioned, healthy meals is one of the problems. Another is the selection of food by both children/parents.

Weight is an unnessary part of the equation here, those issues are concerning regardless of how fat the individuals are! If everyone was skinny but with clogged arteries would the health issue suddenly disappear? Weight doesn't even need to be considered.

While genetics may play a role in obesity, I think that the majority of the obese population is not there because of only genetics. It has a great deal to do with choices and personal responsibility.

This is yet to be proved, we don't have the knowledge to even try and understand the size of the genetic, social and economic mountains these people have to climb, starvation is a proven weightloss treatment, but everyone's will has a breaking point. You can never know untill you're in their shoes how high their mountain is to climb. You can make all the best choices and be completely responsible and live a happy lide and still be obese.

Unhealthy living is the problem, and people of everysize can live unhealthy lives. By focusing on Obesity we just make scapegoats, and excuse the behaviour of the unhealthy people of all the other sizes.

To a much lesser extent, I think that it is also wrong to not take care of your body (such as by eating too much).

People of all sizes can eat too much, just because some have fast metabolisms doesn't mean they aren't still abusing their organs internally.

 

[Quinlan]

There are many reasons for obesity, and the answers might not be as simple for an individual as "diet and exercise." I've seen many obese people try and fail diets multiple times - and their defeat is not for lack of trying or laziness, I can tell you that much.

And why do they give up? Because their goal is not health it's weight loss, because people are told you can't be big and healthy as well, when they fail to lose weight they give up, what they don't realise is that just because they aren't losing weight doesn't mean that they aren't dramatically improving their health on the inside.

The obsession on weight distracts and discourages people from the goal of overall good health.

 

[arbygil]

And why do they give up? Because their goal is not health it's weight loss, because people are told you can't be big and healthy as well, when they fail to lose weight they give up, what they don't realise is that just because they aren't losing weight doesn't mean that they aren't dramatically improving their health on the inside.

The obsession on weight distracts and discourages people from the goal of overall good health.

I absolutely agree.

Add to that another thing: You don't need to kill yourself to be healthy. Walking thirty minutes a day or twenty a day can add to one's overall health.
It's actually dangerous to have people over exert themselves too quickly. Dangerous, and a little pointless. If exercise is too painful, you're not going to continue it. Why not start out with yoga and healthy walking and stretching exercises, and then when you get a bit more energy try increasing the exercise regimen, if it's something you're shooting for. Rome wasn't built in a day, and neither were Romanesque bodies.

 

[Satya]

While I agree that body shapes confound the problem of defining obesity, I still think obesity is a growing problem in this country. Just because a person is fat does not mean they are less healthy than the general population, but the probability is that they are. Simply taking a walk through the local grocery store tells me how bad the problem of obesity is getting in this country. I'm by no means innocent as I'm in perhaps the worst physical shape of my life at present but I do think people have an individual duty to look out for their own well being and health.

 

[arbygil]

I don't think anyone's arguing against taking care of oneself, Satya, but the answer might not be as easy as "eat that, don't eat that, do this exercise, don't do that exercise." Everyone seems to have an idea of what "health" is, and everyone seems to have an answer...but if the same answer worked for every person, we wouldn't have obesity in this country. Some studies suggest that merely dieting can cause obesity (site third party, Slate Magazine, July 4, 2007), and when people were followed for an extended period of time after a significant weight loss, it was found that an overwhelmingly large percentage (95% or more) gained all their weight back, and then some. Diet and exercise are part of the solution, yes. But I think what needs to change is the approach itself.

What if we told folks that nothing is forbidden, as long as they added fruits and vegetables and whole foods into their diets? What if they were told that they could choose any exercise they wanted, and that it was a choice - and that if they skipped a day it was okay to do so? What if they had the freedom to own their bodies? What if they were told it's okay to be the person you are now, and you'll still be the person inside whether they're fat or thin?

What if thinking changed? What if they loved themselves enough to treat their bodies with respect now, and not their future selves?

Obesity, in my opinion, is more of a mind issue than a body issue. We self-sabotage because we think we're unworthy fat and we'll only be worthy thin. So if we're worthless now, we're going to treat ourselves as worthless and continually have a bad self-image. And it doesn't help when society continually tells us that we're "bad" or "lazy" or (god forbid) "American" if we don't lose weight.

This is what needs to happen in the United States for weight loss to be successful.

1. Americans need to stop being schizophrenic. We adhere to the Adonis ideal, but we have a MacDonalds on every corner. What's up with that? Let's kill the Ideal American Figure and see each other as ordinary. And then lets bulldoze or destroy one fast food chain for every ten miles of city (and replace it with a health food store!)

2. Exercise needs to be seen as a pleasure, not a punishment. We don't need to jog to be healthy, we can walk. We can do yoga. We can even meditate to keep our stress levels down.

3. Food needs to be viewed as food, not as a reward or a punishment.

4. Organic and whole, "real" foods need to be the same prices as processed junk, and processed junk should be taxed like cigarettes and booze.

5. Reward companies for making healthier food distribution choices (tax breaks, etc)

6. Clean up the environment so the foods we *Do* consume from the land have the most nutrients possible.

7. Start by making little changes, every day, with food choices and exercise choices. Make strides to enjoy who you are. Don't punish yourself because you're not someone else.

And so on, and so forth.

I could go on and on about this, but I'm going to stop now. All I'm saying is, it's not an easy answer. There are several key factors, and it's all intertwined with so many, many things. I know I was healthier in England because I walked everywhere, and because the food (at the time) had far fewer additives than American food has.

The American lifestyle is conducive to weight gain. Ask anyone who comes here from another country. But is it food quality, exercises quantity, genetics, or a combo of factors? That's the question we have to ask ourselves individually.

 

[Quinlan]

While I agree that body shapes confound the problem of defining obesity, I still think obesity is a growing problem in this country.

Is obesity the problem or is bad health the problem? Is the slight creep of average weight over an arbitrary line a problem in itself?

Just because a person is fat does not mean they are less healthy than the general population, but the probability is that they are.

The general population IS fat!

Being overweight is ideal in terms of life expectancy, obese and "normal/healthy" are equal and underweight people have the shortest life expectancy.

Simply taking a walk through the local grocery store tells me how bad the problem of obesity is getting in this country. I'm by no means innocent as I'm in perhaps the worst physical shape of my life at present but I do think people have an individual duty to look out for their own well being and health.

Now you're just heading into the realm of anecdote and personal bias/experience.

I do think people have an individual duty to look out for their own well being and health.

Does this not apply to people of ALL shapes and sizes? So why the obsession with the obese? You can be obese and still be looking after your well being and health (although fat hysteria makes wellbeing a heck of a lot harder for these people).

 

[Quinlan]

Down the rabbit hole we go:

Dr. Paul Ernsberger, of Case Western Reserve School of Medicine in Cleveland, Ohio, led a review of nearly 400 studies that was published in the Journal of Obesity and Weight Regulation in 1987 which corroborated these results. “The idea that fat strains the heart has no scientific basis,” he said. “As far as I can tell, the idea comes from diet books, not scientific books. Unfortunately, some doctors read diet books.”

This April, researchers at Cedars-Sinai Medical Center in Los Angeles reported their clinical study of 14,739 patients with coronary artery disease, that had been confirmed on tomography, who were followed for over three years. They found that “obese” and “overweight” patients were at significantly lower risks for cardiac death than “normal” weight patients.

http://junkfoodscience.blogspot.com/2006/11/obesity-paradox-1.html

“Both U.S. government and Swedish studies indicate that fatness is not associated with increased doctor visits, medical procedures or hospitalizations...Fat men took no more days of sick leave...and were no more likely to have work-limiting health conditions,” wrote Drs. Paul Ernsberger and Paul Haskew in The Journal of Obesity and Weight Regulations. Among those over age 60, “‘obese’ men and women are no more likely to suffer from chronic diseases than ‘average-weight’” persons.” But they are more likely to survive longer. (Yes, even when researchers have factored for weight loss that could be a symptom of late-stage cancer and other pre-existing illnesses that could make thinner groups appear less healthy.)

The Seven Country Study, for example, which has followed 13,000 men over the last 40 years, has found that the risks of dying from cancer and infections decrease with increasing weight. In long-term prospective studies, complications (like retinopathy) and mortality rates from type 2 diabetes are three times lower among heavier people. And people are much more likely to survive a hospitalization if they’re “overweight” than if they’re thin.

http://junkfoodscience.blogspot.com/2006/12/obesity-paradox-2-how-can-it-be.html

But research just published in the American Heart Journal found you are 2 1/2 times less likely to die of acute heart failure if you are obese when you’re hospitalized than if you are “normal weight!”

Actual mortality rates for the “normal” weight patients was 6.3 compared with 2.4 for the most “obese.” This is not a fluke finding, as the researchers specifically note that “prior studies on chronic heart failure have demonstrated that body mass index is inversely associated with mortality, the so-called obesity paradox.”

As “obesity” rates increase in our Nation, heart disease death rates have been dropping for more than five decades — a whopping 22.1% just between 1993 and 2003.

They described multiple major studies which have examined peoples’ weights 10 and 15 years prior to death and found that longstanding leanness, not fatness, was the greater risk and a predisposing factor for cancer, noting, “it appears that leanness predates the development of cancer.”

U.S. Centers for Disease Control and Prevention researchers in the June 2004 issue of the Journal of the American Medical Association reported that since 1999, the prevalence of obesity and extreme obesity, and hence any deaths “associated” with obesity and extreme obesity in our country, have increased in actual percentages only 0.1% and 0.4%, respectively, over the entire period (going from 30.5 to 30.6% and 4.7 to 5.1%). Significantly less than most people and probably most medical professionals realize.
By comparison, between 1999 and 2005, American deaths from bariatric surgeries have increased 607% (from an estimated 1,334 deaths in 1999 to 8,096 deaths in 2005, when about 176,000 surgeries were performed).

In a nutshell, the data showed that no higher measurement of body shape or size, or body composition, is predictive of higher risks of dying from all causes, compared to people with “healthy” numbers and model figures. Nor was there a net benefit of using BMI versus another measurement. The data also found that NONE of the 21 diseases popularly attributed to obesity — those “obesity-related” diseases, including: cardiovascular disease, cancers (colon cancer, breast cancer, esophageal cancer, uterine cancer, ovarian cancer, kidney cancer, or pancreatic cancer) and diabetes or kidney disease — are actually associated with excess deaths at any BMI category, including obese.

http://junkfoodscience.blogspot.com/2009/06/figure-flaw-paradox-does-it-really.html[FONT=&quot]

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She added, “We have seen over the years that it does not work to make people feel worse about their bodies. The data are striking — talking about weight, worrying too much about diet, focusing on it increases risk not only of eating disorders, but also of being overweight.” Instead, she suggests modeling and positive encouragement of healthy behavior like making better food choices and exercising — and unconditional love, regardless of weight.

http://www.newswise.com/articles/view/533543/?sc=dwhn