A diet of hysteria
A new book suggests that the panic about obesity has been super-sized.
The UK House of Commons health select committee has produced a damning report on the growing problem of obesity, and the government’s failure to deal with it.(1)
The report says that obesity levels have risen rapidly in the past few years. Obesity is defined as a body mass index (BMI) of 30 or more – BMI being a ratio of weight to height. Obesity levels have risen fivefold in the past 25 years. And if action isn’t taken, we are told, many children will die before their parents do. The media fanfare that accompanied the launch focused on the shocking death of a three-year-old girl who ‘choked on her own fat’. (2)
The report suggests that more government intervention is required to prevent a tidal wave of death and illness – junk food advertising to children should be stopped, children should be weighed annually, and a cabinet committee should be set up to coordinate action.
But amid all this hysteria, a bit of scepticism is required. This obesity ‘epidemic’ has taken off at a time when more and more people have tried low-fat diets and government health campaigns are becoming ubiquitous. Far from doing nothing, governments spend a lot of time telling us to eat less. And being fat isn’t exactly fashionable today – quite the reverse. Yet average weight continues to rise.
Has this led to a tidal wave of ill-health? Not at all. Life expectancy continues to rise – and we are currently obsessed by a pensions crisis caused by the fact that more of us are living into our dotage.
Paul Campos’ The Obesity Myth is an interesting new contribution to the debate. As a professor of law, Campos takes a legal approach to the obesity question – presenting the case against being overweight, before then demolishing it.
The school of thought which demands something be done about obesity is based on a four-step argument, says Campos:
- There is a correlation between being overweight and suffering ill-health.
- This ill-health is caused by excess weight.
- Losing weight will cure this disease.
- Dieting is the appropriate strategy for doing this.
Various studies have shown a relationship between weight and ill-health. However, that relationship is far more complicated than we have been led to believe. Far from ‘fat is bad, thin is good’, the studies tend to show that a broad range of normal weights show very little difference in health outcomes.
Even BMIs in the low 30s, defined as obese, show very little change in mortality. Moreover, negative health effects are seen at both ends. As Campos notes, being underweight by five pounds seems to be as dangerous as being overweight by 75 pounds. However, there is a clear and rising level of association between extreme obesity and premature mortality.
Which brings us to point two – is the fat to blame? One problem with the most widely cited studies is that they generally fail to control for the other things that may be associated with being fat. Very obese people tend not to exercise and are frequently poor, and they spend a disproportionate amount of time dieting. When fitness is taken into account, most of the excess mortality disappears.
Research by Steven Blair at the Cooper Institute in Texas shows that fat people who are also fit (and by this he means taking the equivalent of five half-hour walks per week, not marathon-running) have better prospects than thin people who do no exercise. When fat people are given better diets and take more exercise, their prognosis improves dramatically, even though they may lose no weight at all – to the extent that cholesterol and blood pressure normalise and drug treatment for diabetes can frequently be stopped.
So eating better and exercising more would seem to be good for you, but not because they help you to lose weight. Obesity appears to be irrelevant.
However, for 50 years there has been a campaign to make us lose substantial amounts of weight. Bizarrely, there is almost no evidence that losing weight improves health prospects; many reports suggest that intentional weight loss makes things worse, particularly if the weight is put back on later.
As the editors of the New England Journal of Medicine wrote in 1998: ‘Until we have better data about the risks of being overweight and the benefits and risks of losing weight, we should remember that the cure for obesity may be worse than the condition.’ (3)
In fact, 90 per cent of dieters put the weight back on later. This could be an indication of mass weakness and a ‘toxic environment’ – or it could just indicate that other factors, like a genetic predisposition to be a certain shape, are very strong. This ‘yo-yo’ dieting has long been thought to have health risks of its own. In 1966, a US government report entitled ‘Obesity and Health’ warned that ‘the frequent weight gains and losses indulged in by many obese patients who practice what one writer calls the “rhythm method of girth control” may be actually more harmful than maintenance of a steady weight at a high level’. (4)
There is also a logical fallacy at work. Taking a fat person and making him thin does not give him any of the other qualities that thin people have, which might lie behind any health advantages. Campos uses this analogy: if bald men die younger than men with a full head of hair because they have more testosterone in their bodies, giving them a hair transplant won’t help, because putting hair on their heads doesn’t get to the root of the problem.
The campaign to make us all diet has been an abject failure. If the efficacy of dieting as a cure for health problems was assessed in the same way as a new drug or vaccine, it would have been taken off the market years ago as ineffective, unnecessarily burdensome and potentially dangerous.
The upshot of these health campaigns is what Campos calls ‘chronic restrained living’. Even if everything that obesity researchers say is true, he asks, ‘Is the prospect of a year or two of extra life worth several decades of daily denial?’ Nor is this an extra couple of years of life in your teens or twenties, but a couple of extra years of old age.
Campos rightly describes the obesity hysteria as a ‘moral panic’. However, his explanation of why the obesity panic has come about seems much weaker. He sees it as a kind of middle-class guilt, where doubts about the excessive consumption in modern American society are transformed into an obsession with personal consumption. Yet Campos also seems to accept that American society is recklessly consuming too much:
‘We may drive environmentally insane SUVs that dump untold tons of hydrocarbons into the atmosphere; we may consume a vastly disproportionate share of the world’s diminishing natural resources…but at least we don’t eat that extra cookie when it’s offered to us.’
Moreover, while Campos nails dieting effectively, he fails to criticise the almost equally strong drive to get us to exercise more. Is pounding the streets day in, day out, worth it for the few extra months we might gain from it? Why are we so obsessed with avoiding death rather than getting on with life? Exercising regularly can make us feel better, and dieting to look or feel better has its place, too – but that has nothing to do with health.
While it has many faults, The Obesity Myth is a very important riposte at a time when we are drowning in a sea of irrationality relating to food and health. In the developed world, the war against food shortage and ill-health has been won. The obesity panic could yet snatch defeat from the jaws of victory.
(1) Obesity, House of Commons Health Committee, 27 May 2004 (.pdf format, 880kb)
(2) Three-year-old dies from obesity, BBC News, 27 May 2004
(3) Quoted in Big Fat Lies, by Glenn Gaesser, Gürse Books, 2002
(4) Quoted in Big Fat Lies, by Glenn Gaesser, Gürse Books, 2002
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