Wednesday, January 02, 2008


Or not.

Here is a fascinating article from Jacob Sullum at Reason, reviewing two new books out about obesity (see the links at the bottom for the books). Here are three excerpts from this fascinating article:
Gina Kolata says losing weight is nearly impossible. Brian Wansink says it’s easy. But they don’t really contradict each other, because they’re talking about different kinds of weight loss.
Although their new books offer very different messages for dieters, Kolata and Wansink share a suspicion of collectivist responses to the “obesity epidemic.” Both writers are intensely interested in the question of why people weigh as much as they do, but they do not leap from research findings to policy prescriptions aimed at making us thinner by restricting our choices. At a time when almost every discussion of weight in America seems to end with a list of things the government should do about it, their restraint is commendable....

Kolata’s discussion of obesity research suggests that false hope is not limited to people trying to lose weight. Scientists too are perpetually reaching for a weight loss key that always seems just beyond their fingertips: the right diet, the right drug, the right hormone.

Kolata’s main explanation for the failure of these efforts is that people are genetically programmed for a certain weight range, which varies widely from one individual to another. Twin studies indicate that genetic differences account for something like 70 percent of variation in weight. “The body’s metabolism speeds up or slows down to keep weight within a narrow range” of “20 to 30 pounds,” Kolata writes. While losing 20 or 30 pounds would count as success for most Americans whom the government considers overweight, it would be just a start for the study subjects on whom Kolata focuses.

The idea of predetermined weight ranges is consistent with much everyday experience: People tend to return to a particular weight after gaining a few pounds from holiday overeating, for example, or after losing pounds during an illness. It also jibes with the complaints of people who say they easily gain weight while friends can eat whatever they want and stay thin....

Despite their differences in tone and focus, Kolata and Wansink are equally unenthusiastic about proposals by fat warriors such as Yale obesity expert Kelly Brownell to reshape Americans by reshaping our “food environment” through propaganda, censorship, taxes, and regulation. Kolata says there’s no reason to think the government knows how to make people thinner. She notes that even well-funded, intensive efforts aimed at slimming down captive audiences of schoolchildren have produced disappointing results, making proposals such as restricting cereal commercials, banning soda machines from schools, and distributing federally funded fruit to students look even lamer.

Wansink, for his part, says labeling and education don’t make much of a difference, and “we cannot legislate or tax people into eating Brussels sprouts.”

I was one of the few physicians way back when "Big Tobacco" was being vilified, to point out to my collegues that smoking was a choice made by individuals and that teaching those individuals that they were simply the victims of evil businessmen who wanted them to get lung cancer would be non-productive. But it has become clear that the tobacco insanity--i.e., telling people they are not responsible for the choices they make and blaming business-- has opened the door to further absurdities, such as big government-types telling us what and how much to eat; that we must exercise; we must do this, we must do that blah blah blah.

Can the goal of these do-gooders be any clearer that this quote from a recent Mark Steyn blog post:
Bigshot eco-panjandrum lays down the law:
Hillman, senior fellow emeritus at the Policy Studies Institute, says carbon rationing is the only way to ensure that the world avoids the worst effects of climate change. And he says that the problems caused by burning fossil fuels are so serious that governments might have to implement rationing against the will of the people.

"When the chips are down I think democracy is a less important goal than is the protection of the planet from the death of life, the end of life on it," he says. "This has got to be imposed on people whether they like it or not."

Think about the implications of that last sentence, and understand exactly what kind of society Hillman--and by extension, the fat police--are advocating.

Of course, I constantly encourage individuals to be responsible in their personal choices -- but I never forget that it is their choice, not mine.

Notwithstanding the fact that there certainly are some people with physiological and biological defects which result in severe, morbid obesity requiring serious and long-term medical intervention; most run-of-the-mill obesity and overweight is a matter of genetic programming combined with personal lifestyle choices. I have nothing against people who want to lose weight to look and feel better. Go for it!

The underlying societal problem, it seems to me, is not obesity, per se; it is that. as we as a society increasingly demand that government take over health care insurance (e.g., medicare, medicaid, etc.) and pay for health care, we have opened the door to justifications to intrude on our everyday personal choices--like what to eat.

This is by far a greater threat to our individual liberty than anything ever written in the Patriot Act but there is hardly a word spoken against this sort of obscene violation of our personal freedom, and it is promoted relentlessly by the political left.

In 2004, Ed Hudgens, wrote an excellent essay on this very subject, which I have kept in my files:

In the mid-1990s I used to argue against the war on tobacco as follows: Supposedly 400,000 individuals die each year because of smoking. (It's closer to 200,000; the government fakes the numbers, but that's another story.) Since governments pick up many of the health-care costs of people who are sick from smoking, governments claim the right to wage a war on tobacco. But nearly as many individuals allegedly die from bad diets and lack of exercise. By this logic, it will only be a matter of time before you're limited to two Big Macs per month, potato chips are kept behind the counter and not sold to anyone under 18, and there's a five-day waiting period to buy Twinkies so government bureaucrats can check your medical records.

My reductio ad absurbum is one step closer to surrealist reality, thanks to Health and Human Services (HHS) Secretary Tommy Thompson who has now defined obesity under Medicare as a "disease." Thompson is on a jihad against extra pounds and expanding waistlines in this country. This change in the Medicare rules undermines freedom on four fronts.

First, lots of Americans have unhealthy eating habits. But obesity is not a "disease"; it is the result of poor choices and habits over which individuals have control. Yes, some might be more prone to binge on chips, chocolate or other tasty treats, but the difference between we humans and dumb animals is that we can control our appetites; we can develop the good habits and practices necessary to live healthy lives. To suggest otherwise is to suggest that we are not in control of ourselves and are not responsible for our actions and thus undeserving of freedom.

Second, by classifying obesity as a disease, Thompson has created a new, multi-billion-dollar government entitlement, without congressional approval, that will bloat an already monstrously obese Medicare program. Let's remember that when Medicare was created in 1965 the federal government estimated that it would cost $9 billion per year by 1990; instead it cost more than $66 billion that year. Today it costs about $275 billion with another $160 billion going to Medicaid to provide health care for the poor. And let's remember that in 2003, when the Bush administration proposed its new Medicare prescription drug benefit, it estimated the cost over the first decade at $400 billion. The ink of the president's signature on the legislation was barely dry when the administration announced that, oops, it had miscalculated; the cost would actually be $534 billion.

Third, this new entitlement removes a principal and powerful incentive for individuals to treat their bodies in a responsible manner. If individuals believe the government - read, their fellow taxpayers -- will pick up the tab for their poor dietary choices, paying for their Weight Watchers or Jenny Craig, their stomach-stapling surgery or clogged artery treatments, they will be less likely to take their health into their own hands.

Fourth, aggressive government diet controls cannot be far behind. With government paying the bill comes government control. As Medicare costs rose in past decades, the feds tried to save money by creating and forcing people into Health Maintenance Organizations that provide poor service, thus harming health. They also fine and even jail doctors for paperwork mistakes in Medicare filings, which are impossible to avoid because of the thousands of pages of incomprehensible Medicare regulations, thus driving many doctors, sick of being persecuted for curing patients, into early retirement.We now can expect the food fascists in this country -- those who want to restrict or ban foods of which they don't approve -- to join with the government - the guys with the guns - to make sure you only eat what they want you to eat.Obesity and poor health habits are certainly problems in this country. But the solution lies in true personal responsibility, a sense that one's life is so important and of such value that one would commit moral treason to one's self by allowing one's body to fall into disrepair.

A greater threat to the health of our country is the obese size of government, with Medicare the overweight poster child that illustrates the danger to the heart of our liberties. Our biggest problem is not with fat in our waistlines but, rather, in the heads of politicians who want to micromanage our lives. The lesson of HHS's classification of obesity as a "disease" is that the government should go on a diet, shedding hundreds of billions in needless spending, starting with the entire Medicare program.

Amen, brother. Or, should I say, "Amen, Big brother"?

The authors reviewed by Sullum suggest that:
Many of the health risks associated with obesity may be due to the poor diets and sedentary habits associated with fatness rather than the extra pounds per se. Kolata notes that it’s unclear whether exceeding the government’s recommended weight range is inherently hazardous or whether fat people who become thinner thereby become healthier. Yet scientists who point out such inconvenient facts can expect to be pilloried for failing to toe the party line. Kolata describes the dismay of two researchers at the U.S. Centers for Disease Control and Prevention, Katherine Flegal and David Williamson, at the anger they provoked from their colleagues by suggesting that the death toll the government had attributed to excessive weight was greatly exaggerated.

Most of you probably don't remember how the Center for Disease Control rapidly backpedaled on its OBESITY = DEATH meme back in 2005 when some interesting data came to light. What researchers found was that being UNDERWEIGHT is associated with more deaths than being OVERWEIGHT. Here's the scoop on that:
Apart from this huge downward revision in the numbers of people supposedly dying from fat, there are several things in this study which signal the end of any legitimate linkage between obesity and premature death. First, for the merely overweight with BMI's from 25-30 there is no excess mortality. In fact, being overweight was "associated with a slight reduction in mortality relative to the normal weight category." Being overweight not only does not lead to premature death, something that dozens of other studies from around the world have been saying for the last 30 years, but it also carries less risk from premature death than being "normal" weight. In other words the overweight=early death "fact" proclaimed by the public health community is simply not true.

Second, for individuals aged 25-59 the risks of premature death from being underweight are substantially greater than those of being overweight and they are also slightly greater than those of being obese. For those aged 60-69 the risk of dying from being underweight is much higher than from being even significantly obese, that is with a BMI > 35. Again, the total number of premature deaths due to obesity is 25, 814, while the mortality attributable to being underweight is 37, 746. If anything this points to an epidemic of not fat but thin caused death.Third, the increased mortality risks from obesity were concentrated in a small sub-section of the population, the morbidly obese (BMI>35), who comprise only 8% of Americans. Yet the obesity hysteria of the public health establishment consistently tells us that 65% of Americans are overweight and headed to an early death.

Fourth even the 25,814 deaths per year from obesity needs to be taken not just with a grain of salt but with enough to keep Chicago's streets ice-free for an entire winter. That's because the results are in many cases not statistically significant, though the authors don't mention this. For example, in the 25-59 year old group the confidence interval for increased risk for the obese with BMI's up to 35 is 0.84-1.72, meaning that we can't be confident that even for this group there is any increased risk of early death. The same is true for those with BMI's up to 30. Moreover, the RR figure -- the Relative Risk for dying from obesity - is, in the authors' words, "in the range of 1-2." This means that there is at the very best a very weak association -- notice, not a causal connection -- between obesity and death.

This is definitely NOT good news for the intrusive nannies who want to control what other people eat; nor is it good news for the a$$holes who hope to cash in on the current fast food victimhood trend.

Many obsessive dieters and exercisers that I have met over the years have firmly believed that they had discovered the secret of eternal life. They are encouraged in this belief by the gurus of thin and their legions. How sad for them to discover that death still patiently awaits them, even though they are thin and buff.

Which reminds me of several scenes from Woody Allen's classic 1973 movie, Sleeper:
Dr. Melik: [T]his morning for breakfast, uh, he requested something called wheat germ, organic honey, and tiger's milk.
Doctor: Oh yes. Those are the charmed substances that some years ago were thought to contain life preserving properties.
Dr. Melik: You mean there was no deep fat? No steak, or cream pies, or hot fudge?
Doctor: Those were thought to be unhealthy. Precisely the opposite of what we now know to be true.

And, my favorite:
Dr. Orva: You must understand that everyone you know in the past has been dead nearly two hundred years.
Miles Monroe: But they all ate organic rice!

No comments: