TCS Daily

A Matter of Health

By Sandy Szwarc - August 11, 2003 12:00 AM

People either loved it or they hated it. Either way, the recent 10-part series on obesity was a success. It got people thinking - I hope more critically -- about the current beliefs surrounding weight and dieting.


The series set out to be an empirical, evidence-based, investigation on obesity which would reveal the findings even if they went against every tenet popular today.  Although the information presented merely hinted at the overwhelming body of research along these lines, it offered a viewpoint not found in mainstream media.


So, the first main accusation made by dissenters -- that this series was biased - is, in a sense, correct. It was meant to be. Part of the misunderstanding, I suspect, is because there wasn't an introduction to the series. The series wasn't about telling us what we already know and hear at every turn. Its goal was to reveal the information we don't hear, the other side. And, it was to examine the underlying reasons for obesity, demonstrated by the bulk of the soundest evidence, that go far beyond the myths that have become popularized.


Huge numbers of you welcomed this. The series resulted in a tremendous outpouring of gratitude and support from consumers, clinicians and researchers. I thank all of you who took the time to write. I sincerely hope it has helped those who've been hurt in this war on obesity.


This series was also one people loved to hate!


The other complaints about this series were that it denied the law of thermodynamics and "excused" obesity. The law of thermodynamics is used to justify the greatest myth about obesity: "Fat people are gluttons and sloths." In the war against obesity the negative blame messages about fat people have become continually more extreme: "Fat people eat too much bad -- processed, sugary, fatty, junk -- food. Fat is deadly. Most Americans are fat and must diet or by 2050 everyone will be obese!"


·        Sure, we can find people fat because they are gluttons and sloths. But the bulk of clinical and epidemiological studies have found that is not the case for many, if not most, fat people.


·        Sure, some people, especially at the most extremes of obesity, suffer health problems because of their weight. But the soundest studies have found that for most people being overweight has nothing to do with poor health, fatness isn't a disease, and most fat people can be perfectly healthy.


·        Sure, we may find a few people who have successfully maintained long-term dieted weight loss. But multiple expert reviews of all existing research have found that is not true for nearly 99 percent of people and that weight loss doesn't improve their health, but actually puts them at up to several hundred percent higher risks for cancer, heart disease and all-cause mortality.


·        Sure, some people become morbidly obese. But CDC statistics reveal they're rare and don't represent all fatness in cause and risks; most people are unable to reach similar weights even if dieting efforts are abandoned.


If the simplistic myths about obesity were true, they would hold true in every person and found in every study. They simply don't. There are clearly other significant factors to body weights not being acknowledged. Why do we cling to unsound premises? Scientists know when sound studies using various methodologies disprove a hypothesis, that's significant: It's time to go back to the drawing board. It is probably the most important part of the scientific process. Yet, it's the one most ignored today by those who cling to myths about food, health, and the environment. Their scary stories never seem to die no matter how many times they're disproven. It's especially the case with obesity.


This series and this issue touched on the most deeply held and profitable beliefs in our society. It demonstrated just how fiercely entrenched the obsession with thinness and fear of fat is today. Fat people are hated; even by a surprising number of fat people! We label them and blame their fatness for all sorts of things. Most of us­ don't think of ourselves as prejudiced, perhaps we've been sold like everyone else on the myths about fat people. But we all -- public policy makers, healthcare providers, scientists, and consumers -- have been guilty of neglecting to apply the same critical thinking to obesity that we apply to debunking other unsound ideas. We've closed our eyes, ears and hearts to the evidence and are missing invaluable insights that can help us identify the real problems and most valid answers. Until we can get past that, we will never learn the whole truth. Even worse, just like following the precautionary principle, by our failure to act we will be partly responsible for the escalation of tragic unintended consequences.


The Law of Thermodynamics


The ability to retain fat is a human adaptation to the prevalence of famine and starvation in human history; hence there are varying degrees of genetic fat traits in most of us. Science has long recognized that this fat-retention response is also triggered by exposure to starvation any time in one's life -- in utero, early childhood, adolescence or adulthood. With later nourishment, people become fat. Clinically, we see it in those born with low birth weights to undernourished mothers, be it inner city, minority, teen, or smoking mothers. We see it in immigrants from hunger-ridden countries and those who are emerging from poverty in underdeveloped regions. And, we see it in millions of Americans who've dieted.


Conversely, the world is full of examples of famine and starvation, proof that everyone can and will lose weight when they eat fewer calories than they burn. The Law of Thermodynamics applies to fat people just as it does everyone else; this series didn't deny that. They can lose weight if they sufficiently restrict their calories -- the problem is that for many of them, that means starvation level diets. And to continue losing weight, or to maintain body weights unnaturally low for them, many people must subsist on progressively fewer and fewer calories (like 800) for the rest of their lives. Those who believe there are no excuses for fatness dismiss this. Yet, the effects of starvation and malnutrition are well known and thoroughly documented: it jeopardizes health and well being, puts people at great risk for disease, and shortens their lives. Like fat people, most young girls and women today are watching their weight and even when not dieting are eating insufficient calories (averaging 1,600 or less) and nutrients for good health...and are already suffering nutritional deficiencies.


The moment malnutrition is advocated, which has well-known dangers, as a solution for fatness, for which the dangers are speculative, it proves that the war on obesity is about appearances not health.


The focus on health has fallen by the wayside in our cultural obsession with thinness and abhorrence of fat. An unfortunate profit motive is also undeniably afoot. Our priorities and public policies should be based on ensuring good health for all Americans, not advancing a fashion trend.


No excuse for fatness


Critics upholding popular wisdom also scoff at other reasons for fatness. But researchers are increasingly recognizing the role of multiple factors in weight gain.


·        Among such possible contributors are certain prescription meds, hormones, viruses, stress and fatigue.


·        Dieting has a much more significant role in increasing body weights and in increasing health risks among fat people than is currently spoken of in our diet-obsessed culture. Yes, dieting makes us fat. Although diet advocates mock such a notion, the link between dieting and obesity is well documented by sound research using a variety of methodologies, and by our nation's most reputable institutions and researchers. The health risks brought on by dieting, as with starvation, have been similarly chronicled in the awesome comprehensive reviews of the research by Garner and Wooley, Berg, Gaesser, Ernsberger, and the 1992 NIH consensus conference on dieting mentioned in this series.


·        Obesity's genetic component, ridiculed by many, has been determined to be the most significant, according to decades of sound study. It's especially spurned by those looking to blame fat people, foods or our toxic environment, as well as by some fat people wanting to be slim. The series discussed some of the research demonstrating the strong inheritability of obesity and the nearly 300 genes, markers and chromosomal regions that have already been linked to human obesity, and some of their possible triggers, such as starvation/dieting.


I find it curious that scientifically-minded people can accept the genetic component when it comes to individual differences in every physical attribute -- skin and eye color, hair texture and color, facial features, muscle build, eyesight, cardiovascular disease risk, allergies, height -- but not fatness.


Reexamining the War on Obesity


The aversion to accepting, or even considering, that the war on obesity has not been benign, and that we should stop and reevaluate if we're on the right track, is similarly puzzling. Clearly some 40 years of pushing the popular mythologies and the dieting solution hasn't worked. We're getting fatter. Screaming more hysterically, or penalizing and blaming fat people or bad foods -- which is the current itinerary -- isn't going to change that. Even worse, the relentless harping -- "we're all too fat, fat is bad, fat kills, we have to be thin, we must diet and lose weight" -- has caused profound harm. Since the war on obesity, discrimination against fat people has escalated; young women and girls most affected by this obsession have poor body images and self esteem and are now so terrified of fat and food almost all of them are inappropriately dieting and resorting to increasingly unhealthy and dangerous efforts to lose weight; there's been an escalation of malnutrition problems, low birth weight babies, smoking and suicides among desperate weight-worriers; and eating disorders now afflict 10 million Americans each year. As compassionate people, let alone scientific professionals, we cannot dismiss the consequences of this negative and misguided agenda.


We have an obligation to do sound risk analyses. Not only is encouraging thinness and weight loss harmful, losing weight for healthy fat people has not been proven to improve health or to be the best way to mitigate health problems in most others, even if it did work.  The fact that other things as simple as exercise reduce or eliminate most health problems popularly attributed to obesity, without the harmful side effects, should give us cause to pause.  There isn't sound evidence to support current recommended ideal weights.  A bulk of studies has found we'll actually live longer and healthier lives at weights considerably higher than recommended. The largest body of evidence even calls into serious question the entire premise that fat is deadly. If that were true, then the "epidemic" increases in adult obesity should have had a negative impact on life expectancies. That's simply not been the case. As we've grown larger, longevity has increased, with the most notable improvement in diseases supposedly linked to obesity. If Darwin was correct -- and I think the consensus of the scientific community believes he was -- since we're living longer and getting fatter, fat cannot be an entirely bad attribute.


That's unless Darwin, like genetics, doesn't apply to fat people, either.


© 2003 Sandy Szwarc. All rights reserved.


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