Friday, October 12, 2007

The Obesity Epidemic

MarkH, over at Denialism, posted an excellent article about obesity, related health risks, and issues that obscure the problem of obesity. Rather than pull out the best parts, I'm merely going to plug the entire article. Go read it, and the comments. The whole thread is a good read, raising important issues not only about the health risks of obesity, but the cultural and psychological issues that go along with it, and how few options we currently have for taking care of the problem. It's a great discussion. Head on over there.

Digg!

4 comments:

Ada said...

Althogh i am a big people i am not so intersted in reading such kind of information as you mentioned. i often chat with my friends on largefriends.com. In my opinion they can do what they like and their information is just giveing us a suggestion. whether we take it or not, the chioce is up to you. Anyway it is not so bad!

Anonymous said...

Disclaimers: I’m not overweight and I did believe that with a BMI > 30 I will be at an elevated risk of various “morbidities”, like heart failure when climbing to the third floor. I believe that some people eat too much and that many restaurants offer too large amounts of food. I hate the new “trend” of picking a little food from an overloaded dish and trashing the rest.
I didn’t post there because I have no affinities with a group populated with Coca-Cola bashers and “natural”-food believers that cross the border of vitalism.

I’m an occasional reader of Conspiracy Factory- and Junkfood science-blogs, and enjoy both of them, even if I disagree with the bloger. I usually did not post comments because English is not my first tongue. Now, I due it because the entry on denialism blog you link at, is in my opinion a particularly bad piece of science (that’s SB). In my view, it is mostly a “play with words”, in which “obesity” and “risk” are used in a vague manner in order to create the perception that “fat is harmful”, and to frame Sandy as a “crank”, or denier (like Holocaust- or global warming-cranks/deniers?).

After telling a sad story, MarkH presents his thoughts regarding the effects of obesity on the health of US citizens.

"The major reason for the increase in Type II diabetes rates is obesity and lack of exercise."

This sentence seems to suggest that “obesity” causes (is “reason of”) some diabetes. But, the linked abstracts show something else. In the light of those studies the above sentence means that the major “reason” for increased rates of Type II diabetes in the population is an increased rate of “overweight + obese” and/or sedentary people in the population, and that the rate of Type II diabetes in the subset of “overweight + obese” and/or sedentary people is higher than in the subset of slim and/or physically active people.
This is a statistic that I did not dispute although I’m very suspicious about statistics that use ill-defined categories like “normal”/“overweight” and than conclude that 25 points, or 102 cm mark the frontier between good and bad.
I expected from a scientist something better, especially when some paragraphs later he admits that BMI is not a good measure of “obesity”. And than for what reasons did he link to those studies?

"Disturbingly, younger and younger people are presenting with diseases often only seen with age, like type II diabetes and gout. This is unquestionably due to increasing rates of obesity in the US population."

The same vague insinuations; and I have to ask:
What’s the relationship between “increasing rates of obesity”, type II diabetes and gout? I thought that too high consumption of fat meat, sea food, tofu, beer, for example, may cause obesity and/or gout.
What is unquestionable?
Did MarkH claim that “obesity” in general is causing gout? Presumably not, but that excessive food consumption by some young people makes them obese and those higher rates of obesity in the “young people” category causes an increased rate of obesity in the US population, as compared to past statistics, and so on, and so on...

"Thus, it is with dismay, that I read Sandy Szwarc's blog Junkfood science, that seems to exist for the sole purpose of denying the health risks of obesity and of being overweight. Sandy, who is on CEI's staff, routinely writes about obesity as a health-scare, that is not harmful as doctors and health scientists suggest."

In my opinion it is dishonest to suggest that Junkfood science “seems to exist for the sole purpose of denying the health risks of obesity and of being overweight.” Actually, Sandy is writing mostly about scary obesity-related stories that find their way into the news. Or someone denies the “fact” that many news stories about obesity that are discussed in Sandy’s Blog are frightening? Well, not necessarily for him, or me, but reading “Weight Loss News” on Yahoo usually lets me with the impression that the articles are written in a sensationalist style with the purpose to create scare in some young minds, or pride in young, healthy, smart, symmetric ... slim people. I strongly suspect that most doctors didn’t consider “obesity” that harmful as those news-stories suggest. Again, what’s “obesity” and who are the “health scientists”?

- quotation -

"One already notes the intimation of a conspiracy in "obesity interests", but let's leave that aside for now."

I did not believe that healthy-food makers, dieteticians, drug makers, health-insurance companies, etc. conspire in propagating an obesity scare. They probably use scare, each of its own, as one of many propaganda tactics in order to sell their products/services, or justify imminent bankruptcy by shifting the blame on the public’s bad lifestyle. Than, there are a number of organizations that conduct coordinated and well planned propaganda campaigns, e.g., anti- animal fats, burgers, ice-cream, soda-drinks, trans-fats, but that’s not a conspiracy either, just indoctrination, as usual. I think that Sandy is simply emphasizing that there are many parties that promote the obesity scare.

"But what is this evidence that fat is harmful?"

Harmful without qualification, or in excess?

"For one, obesity is known to be a risk factor for hypertension and other morbidity in children (1,2,3,4,5,6) and increases the risk of diabetes (1,2,3,4,5,6) In adults obesity increases a number of cardiovascular and other morbidities (1,2,3,4) and the health burden of obesity is recognized as a critical public health problem (JAMA free full text) as well as a cause of decreased quality of life."

Here are these studies. All based on the same methodology, and BMI.
Should I remind the readers that after the publication of innumerable (questionable) studies showing that obesity is associated with many “morbidities”, a large, well controlled study could not reproduce those findings? And the conclusion: BMI is no longer good. That is not sound science. One would expect that after such findings the old work will be “frozen” until reevaluation and new investigations.
However, what’s remarkable in this paragraph is the misuse of the term “risk”. All studies asses the relationship obesity-morbidity as in “risk factor”. But MarkH calls obesity a “risk factor”, then something that increases “the risk”, and then, something that increases “morbidities”. A MD/PhD bearer should know the difference, and I’m confident that MarkH knows it. So, why deserve his readers such propagandistic tricks?
Even the headlines about ED a major risk for the health of men were less wrong, since one can imagine how the onset of ED leads to “broken hearts” and other morbidities in some men:).

And so on.... He ends including Sandy in the class of “cranks”. Someone argued that this is no personal attack, I would call it name calling, just framing.

"This constant denial of any negative consequence of obesity is irrational, contrary to the clinical evidence, and is, quite simply, just crankery. While some of Sandy's skeptical writings do hit the mark (the social-networking study of obesity on the Framingham study being a good example), I have to say she's more of a skeptic like Steven Milloy of Junkscience (who she links - there's a bad sign), also a CEI fellow, and noted global warming crank. While they have some capacity to recognize real nonsense, the central message is one denying the rational interpretation of the literature."

A rational interpretation of the literature in to not confound scientific “significance” with “significance” of a statistical test, or odds-ratios with causation; and refrain from hasty conclusions at least until evidence is presented that there is an important physical cause/mechanism, underlying the statistically significant results.

I’m wondering about the target-audience of denialism blog. I didn’t want to undermine the public’s confidence in doctors, but suggesting that they have such simple solutions as weight loss for preventing so many “morbidities” is dishonest.

Iant

The Factician said...

anon,

I'm mostly going to comment on your last paragraph, as it would take an entire blog post to deal with your entire comment. I don't think MarkH suggests there is a simple solution for weight loss. This is a very difficult problem. I suspect that weight loss itself is an intractable problem for the population as a whole. We should focus instead on preventing children from becoming overweight in the first place, to prevent the host of health problems that come with extra weight.

Dr.Chester Prof.Chatwin said...
This comment has been removed by a blog administrator.