Tuesday, August 27, 2013

Obesity epidemic or obesity polemic

Earlier this year, a well-respected academic, Kathy Flegal, from the US National Center for Health Statistics, published a study that distilled all the research on overweight and mortality. It captured the research of 97 studies on almost 3 million people and 270,000 deaths so it gave a pretty good indication of the effect of excess body fat and your chance of early death.

So, being overweight will slice years off your life, right? No. And that wasn’t the answer most were expecting, nor was it the answer you want if you spend your life trying to scare people into losing weight.

If you are officially overweight, as measured by BMI 25-29.9, then you have a lower mortality rate than if you are lean, was the conclusion of the analysis. It’s only once you get into the official obesity level (BMI > 30) do you start to shorten your life. Not the impression you normally get, is it?

Forget respect, just get angry
The results did not please another very well-respected academic, Walter Willet from the Harvard School of Public Health. “This study is a pile of rubbish, and no-one should waste their time reading it” he said in an interview. He seemed to think it was giving the wrong impression and those carrying a few extra kilos may not see any reason to lose weight.
He felt that the public message would get confused, doctors wouldn’t encourage the mildly chubby to change their ways, and that the food industry at large could justifiably use the data to their advantage. In turn, the biostatisticians, turned the heat on Willet, stating that the conclusion was plausible. An editorial in the famous science journal Nature stated that public health authorities should stop trying to simplify messages if the message wasn’t simple. We’ve made that mistake before with the “Eat less fat” campaign 20 years ago.

Extra fat may not be a problem
This wasn’t the first study to show that being overweight doesn’t cause a health calamity. It is thought that carrying a little extra weight helps older people especially to survive intermittent medical problems and surgery that effects appetite. Put simply, if you have extra fat it becomes reserve energy for when you are sick and not eating. I have previously written that being overweight doesn’t mean that you are unhealthy. You might be one of the healthiest, fittest and best looking people in your town.

Is obesity a disease?
Personally, on a completely non-scientific level, I find it difficult to reason that if I now choose not to exercise, eat pizza daily, and spend 25 hours a week watching cook-offs and sing-offs on telly that I have now contracted a disease. It seems to me that I have just made a stupid decision, and stupid decision-making doesn’t usually respond to medical intervention.

On 17 June the American Medial Association (AMA) said that obesity is not a disease, partly because it is hard to diagnose. A public health problem maybe, but not a disease. If it is defined as a disease, then people might just assume that it is totally out of their control and they are going to wait for a medical solution.

Is obesity an epidemic?
Then it got political, and after strong lobbying, two days later the AMA decided that obesity was a disease. Not only that, it was an “epidemic”.

My Taber’s Cyclopedic Medical Dictionary defines an epidemic as an “infectious disease or condition that attacks many people at the same time in the same geographical area”. It isn’t infectious, and its onset has been gradual over 60 years. Does it fit the definition of an epidemic? Words like epidemic are used (much like the word “toxic”) to scare people, including politicians, so people take notice and provide research funds.

**Who to blame for the disease?
As you would expect, there was a big debate after the AMA came out with their final decision. Who can you blame for this disease? Will the disease be covered by medical insurance? If I get the disease, can I blame family members for giving it to me? Or anyone selling French Fries? Most diseases are cured by time, medication or surgery. Although surgery can help some with obesity, most are “incurable”.

My brain can’t classify obesity as a disease and neither can David Katz from the Yale Prevention Research Centre. On the other hand, being classified as a disease may just stimulate some government action. As long as it isn’t another silly public weight loss campaign.

Not my fault; it’s my doctor’s fault
In Australia, an obese bloke recently successfully sued his doctor because he didn’t “treat” his obesity with surgery. His claim was then overturned on appeal.

I’m sure there is more to this case than we know, but will this tactic become popular? Should we determine what/who caused someone’s excess body fat and then what/who is responsible for its disappearance? Once that is established, let’s engage a lawyer.

What does it all mean?
It seems to me that we continue to cast the public as a victim, and when you accept your position as a victim, then you can give up hope and begin to rely on outside agencies for a solution. Ignore the fact that these agencies don’t have a solution for obesity.

Only a fool will suggest that there is a solution. Sadly, there are many fools who proclaim they have a simple solution, from bans to taxes to plain bullying. It is widely accepted that any diminution in a population’s body size will require a combination of environmental change, food industry change, encouragement to be active from birth, health education and self-responsibility. It is that last part that no-one wants to mention, yet it may be the most effective.

But when was the last time you heard someone say: “Yes, it is my fault; I accept total responsibility” ?