By Michael Smith
A recent article in Village, ‘Obesity obeisance’ (June 2015) suggested Ireland was in the manipulated throes of a spurious fatness ‘epidemic’ contrived by industry machination, junk science and twenty-first-century angst.
The article was an example of truthiness, a righteous gloss on truthfulness – minus the core ‘truth’ element; and thankfully a number of Village readers were enraged. Normally Village publishes nothing nutritional except articles that vilify obesity and its purveyors.
One of the points of journalism is, where relevant, to draw attention to the science; and not to succumb to crackpot minority opinions ungrounded in the scientific method. Journalism can with ease distinguish peer-reviewed science from junk science; and denying an obesity epidemic has little academic substance. It is not journalism to publish the disproved views of cancer/smoking link-deniers, of creationists or of climate-change deniers. Obesity deniers should draw our opprobrium no less.
Interestingly a representative of the ambassador of one of the great culinary civilisations wrote to the magazine letting it be known his excellency would like to talk to the piece’s author; and arrangements were made. Why ambassadors do not make more focused contact about real issues is unclear.
The stakes are high. 23 per cent of Irish people are obese (ie with a body mass index in excess of 30), but Ireland is actually set to become Europe’s most obese country by 2030, rivalled only by Uzbekistan, according to figures presented by the World Health Organisation as part of their 2015 Modelling Obesity Project.
The proportion of obese Irish men is expected to increase from 26% to 48%, with the number of men classified as either overweight or obese rising from 74% to 89%. Obesity in women will jump from 23% to 57% with the number of women classified as either overweight or obese rising from 57% to 85% by 2030. In the US for reference currently two thirds of women and three quarters of men are overweight or obese, and the figures there are rising.
Professor Donal O’Shea, co-chair of the Royal College of Physicians of Ireland, sees all this as “a much bigger health crisis than what cholera was back in the 1800s and HIV/AIDS was back in the 80s and 90s”. Minister for Health Leo Varadkar admits that obesity has become a “major personal and public-health problem”, and has called for the issue to be treated “as seriously as we treated tobacco in the past”.
The Village article questioned whether being fat was really that detrimental to our health and suggested there were moral, social and economic influences (no less) rendering our understanding of obesity (wait for it) “inaccurate at best, or worse still, enormously harmful to many people’s lives”.
No such fear.
The article started by looking at the baseline unit of measurement for obesity that the World Health Organization uses: the Body Mass Index or “BMI”, a simple mathematical formula that places people of different heights and weights on a single integrated scale, but one which, the piece notes, “was never intended to be a measure of individual health yet despite this it has formed the basis for almost every public policy and study on issues of weight and obesity written in the modern era”.
It is alleged a body called the International Obesity Task Force (IOTF) – scandalously funded by big drug companies looking to sell weight-loss drugs – drafted a report for the WHO using data provided by US health insurance giant Met Life. The report led to the “ideal”, “healthy” weight for an individual dropping by 15-20 pounds.
The BMI formula itself does not account for things like muscle mass and bone density. Rugby-player, Cian Healy, according to the index (and the article), registers as obese.
Certainly BMI is an unreliable indicator for individuals but the point the author missed is that it is not unreliable for populations: there is no reason to think that, if a population’s BMI rises, weight will fail to rise under any of the other established indexes, such as ‘the Body Shape Index’.
The author seems to miss the entire point. Public policy is addressed to populations not individuals.
BMI remains a useful gauge of how society is progressing over time and of how it is faring relative to other countries that use the same measure.
“Where BMI is really useful is for measuring trends in large populations”, according to Dr David Haslam, chairman of Britain’s National Obesity Forum. The author’s mistake is basic.
In America, the author goes on, the country thought of as leading the way in weight gain and rising obesity levels, the majority of people, according to a study from the International Journal of Obesity, have only experienced a moderate weight gain of approximately 3-5Kg. That’s only an extra 10 calories a day in their diet, a Big Mac every two months, he declares.
It’s not quite clear what he means. He notably fails to say what time period he is considering. No matter. His topic is obesity. As already stated, in the US currently two thirds of women and three quarters of men are overweight or obese. According to the Trust for America’s Health, in 1990, the US obesity rate was 12 percent. By 2005 it almost doubled, with 23 percent of Americans considered obese. Five years later, it was 35.7 percent.
Worse, a report by CDC in 2012 estimated 42 percent of Americans would be obese by 2030. America, the science and the figures show, is obese and getting obeser.
It therefore matters not, in proving the scale of the obesity problem, that a particular Journal over an unspecified period noted the majority of people only gained 3-5kg, even if – presumably unbeknown to the author – it is probable they will put on even more weight over a further (perhaps even specified) period.
The author proceeds to look at a 2013 study published by The Journal of the American Medical Association which reviewed nearly three million subjects from more than a dozen countries and found the ‘obesity paradox’ – that adults categorised as overweight, and most of those declared obese actually had a lower risk of mortality than so-called thin or normal weight individuals.
For example for average-height men, 5 feet 10 inches, those who weigh between 129 and 174 pounds have a higher mortality risk than those who weigh between 175 and 243 pounds.
But the study was criticised by Walter Willett of the Harvard School of Public Health, who called it a “pile of rubbish . . . No one should waste their time reading it”. Soon after it was published, the dean of Harvard Medical School, Jeffrey Scott Flier, convened a panel of experts to discuss it at Harvard. The panel members stated that it contained several methodological errors. For example, panelist Frank Hu said that its selection criteria “ruled out high-quality studies of 6 million people” and that these studies, combined with those actually included in the review, showed that the highest survival rates are in people of normal weight.
The author goes on: “throughout the terrors of our recent obesity ‘epidemic’, life expectancy in western countries has risen, not fallen, despite the many life-threatening health conditions supposedly caused by obesity. The correlations between higher weight and greater health risk are threadbare, only significant at the extremes, severely underweight or morbidly obese”.
This doesn’t even offer rudimentary logical appeal. It is undermined comprehensively by the argument that life expectancy would have risen even more without the impediment of prevalent obesity.
But, he notes, in any event that there’s almost no evidence that turning a fat individual into a slim individual improves overall health. He claims, in argumentation likely to appeal to right-on progressives, that this is mostly due to the fact that – despite claims of omnipresent miracle diets and exercise programs – sustained, long-term weight loss is something we currently, according to the evidence, do not know how to achieve.
A former finance director of Weight Watchers, claimed the brand was successful because “the 84% [who can’t keep the weight off] keep coming back. That’s where your business comes from”.
That may be so. But it is a further injunction against becoming obese and in no way belies the dangers, or existence, of the epidemic. It does not help him with his argument that obesity is not a problem.
He notes that the global market for “weight management services” is expected to reach $650.9bn this year and huge corporate conglomerates control both the “healthy” and “unhealthy” markets. Nestlé sells traditionally fattening foods but also owns US diet company, Jenny Craig. The current CEO of Weight Watchers used to be, CEO of Cadbury America.
Again this suggests nothing but that there are malign forces facilitating the epidemic.
His final gambit is that there is a growing body of research beginning to question the calorie as an indicator of food’s weight-producing propensity. Harmful chemicals known as endocrine disruptors may create biological pathways to obesity independent of caloric metabolism.
This may go to the cause, but again it does not go to the existence, of the obesity epidemic.
In any event fashion, science (and Jamie Oliver) are pointing to sugar as the major source of contemporary obesity. There are nine calories in one cube (0.1 oz) of granulated sugar. You’d need to walk two minutes to burn nine calories. But people rarely do.
As Michael Gibney, Professor of Food and Health at UCD pointed out in a recent Irish Times column the problem of obesity (like it must be said, that of climate change) is highly complex.
Even with a body of evidence from several disciplines, the answers are neither straightforward nor are they necessarily known.
There is a clear need to integrate what scientific evidence we have. Because of its complexity, helping people with obesity requires a multi-pronged approach. What works for those who are somewhat overweight may not be appropriate for the very obese. The causes of, and solutions to, obesity are complex. Even for experts.
Obesity’s existence and prevalence; and the increase in that prevalence, are clear. At least to experts. •