Fat so? Be fit-fat

Worth A Look, Healthcare & Welfare, Frontier Centre

In some ways, it was a very bad summer for the war on obesity, at least for those who care about evidence-based public policy. In mid-July, for instance, U.S. Health Secretary Tommy Thompson made obesity eligible for Medicare coverage. Two years earlier, the IRS, under pressure from the American Obesity Association, funded mainly by the pharmaceutical industry, declared obesity a disease for tax purposes.

While making up a disease called obesity is useful both to pharmaceutical giants such as Johnson and Johnson, who have invested significantly in anti-obesity drugs, and to the food Gestapo, who now can argue for more control over what people eat, no scientific evidence shows obesity to be a recognizable disease such as cancer or heart disease. For instance, real diseases such as cancer and heart disease have clinically defined symptoms and agreed treatment regimes. Obesity has neither.

Closely following Mr. Thompson’s move was a new junk science study in the Journal of the American Medical Association that claimed to show a link between soft drink consumption and Type 2 diabetes in women. Though hyped by certain scientifically challenged members of the media as establishing a diabetes-soft drink connection, on closer examination the study actually established nothing of the kind. For instance, there was no association between regular consumption of soft drinks and type 2 diabetes. The only soft drink association with diabetes that was found was with women who significantly increased their soft drink intake during the study. Indeed, even though the study found associations between low protein, smoking, physical activity, low cereal consumption and type 2 diabetes, these were ignored in favour of the soft drink-diabetes hypothesis.

Despite these setbacks in good public policy, three recent developments just might show that the war on fat is losing its hold on the media and the public’s imagination. First, a careful statistical analysis of American weights from 1991 to the present from the U.S. National Center for Health Statistics casts a good deal of doubt on claims of an obesity epidemic. The analysis shows that the weight of thin Americans has stayed constant over this period. As one moves up the scale, there has been some additional weight gain, but only in the range of six to seven pounds. Only when one comes to the clinically obese has there been a significant weight increase of 25 to 30 pounds. While there are more obese people (Body Mass Index above 30), the average weight of the U.S. population has increased by only seven to 10 pounds over the past 13 years. In fact, most people in the population have weights that vary within a 10-pound range in any given year.

Second, a recent Journal of the American Medical Association article on the relationship between physical fitness, BMI and coronary disease in women finds that one of the important keys to cardiovascular health appears to be fitness, not fatness. The study followed 906 women, all of whom had had a coronary angiograph measuring blockage in their heart arteries. Of the women studied, 76% were overweight and 41% were obese. What the study discovered over its four-year period was that neither BMI nor abdominal waist measurements were significantly associated with coronary artery disease. As the authors note, “Our data support previous studies showing that functional capacity [fitness] appears to be more important than BMI for all-cause and CV mortality, especially in women.”

Yet, despite the clear benefits of fitness, even in overweight individuals, physical activity rarely has a significant place in the War on Fat policy menu.

This finding supports the work of such people as Steven Blair, who has consistently argued that the actively obese — the “fit-fat” — have lower disease and mortality rates than normal weight individuals who are sedentary. It also contradicts the public health message that individuals will maximize their health and longevity by maintaining ideal BMI’s of 18 to 20. As several long-term studies have shown, those with the longest lifespans have BMIs of 26 to 28 — the overweight — while those with BMI’s of 18 to 20 had shorter lives than those with BMIs of 34 to 36 — the obese. Indeed, in a series of 11 studies by the International Collaborative Group, not a single study showed a positive association between obesity and premature mortality. Many of the studies, in fact, showed the longest-lived were those with above-average weights.

The third reason for hope, particularly in Canada, is a recent University of Toronto conference (The Politics of Obesity) jointly organized by the Centre for Girls’ and Women’s Health and Physical Activity and the Centre for Sport Policy Studies. Unlike this summer’s huge American Obesity Summit, a joint production of Time magazine and ABC News, which never met a junk-science study nor a draconian policy fix to the so-called fat problem that it didn’t like, the U of T conference evidenced a healthy dose of skepticism about the alleged connection between obesity and ill health and the “science” of the BMI.

Though including the obligatory epidemiologist who claimed (wrongly) that there was a definite connection between obesity and ill health, the star of the conference was University of Colorado professor Paul Campos, who showed not just how untrue the claims about obesity and premature mortality are, but how the health benefits of losing weight fail to outweigh the health costs of doing so.

The critical reaction in Toronto to the junk science obesity claims, coupled with the new research questioning the fat-ill- health/premature death connection, suggests Canada’s appetite for a crusade against fat might be quite limited. After all, sometimes an ounce of prevention is not worth a pound of cure. Let’s just hope that our prevention-obsessed health care establishment is listening.