With tremendous media fanfare last year, Julie Gerberding, director of the Centers for Disease Control and Prevention, and Health and Human Services Secretary Tommy Thompson announced that overweight and obesity had killed 400,000 Americans in 2000. The CDC paper making this claim, led by Gerberding and published in the Journal of the American Medical Association, laid the foundation for billions of dollars in government and industry initiatives and an aggressive new national advertising campaign to combat what she called a "tragic and unacceptable" health crisis.
But it has finally been exposed for what it is: a grossly exaggerated and fabricated scare campaign.
This anti-obesity campaign has proven, however, to be an incredibly successful marketing effort, popular with an enormous throng of financial and political interests all rushing to use the "obesity crisis" to sell various weight loss treatments, anti-obesity initiatives for schools and communities, expanded governmental programs and regulations, and obesity research. It also made the obesity crisis one of the past year's top media stories. With so many vested interests behind the crisis, not surprisingly, the public has largely yet to get the truth from mainstream media.
A new CDC analysis has just come out which found that overweight and obesity may actually have been associated with only 25,815 extra deaths in 2000. That 400,000 figure was off by 374,185 deaths -- or 1450%!
As Emily Litelle, Gilda Radner's spinsterly media analyst on Saturday Night Live, might have said about the obesity scare: "Oh, never mind."
No longer can anyone claim obesity is a major killer. Obesity doesn't appear at all in the actual causes of death in the U.S. according to the 2002 National Vital Statistics Report. But it's become popular to look for bad behaviors to blame for contributing to premature deaths. So, the CDC has recently taken to estimating the relative risks of deaths attributed to various lifestyle behaviors. Based on their 2000 figures, overweight and obesity would now rank 7th -- after motor vehicle accidents (at 43,000 deaths) and firearms (at 29,000 deaths) -- and be blamed for a mere 2% to 3% of all "preventable" deaths.
This new analysis, led by Katherine Flegal, a senior research scientist with the CDC's National Center for Health Statistics, and co-authored by David Williamson, Barry Graubard and Mitchell Gail, "is careful, it is sound, it is science at its best," said Deb Burgard, Ph.D., a psychologist in Los Altos specializing in weight and eating disorders. Unlike the Gerberding report, it used more recent and solid data that included actual measurements on people nationally representative of today's population. It also employed more sophisticated and unbiased modeling that accounted for a number of risk factors, including aging, the single biggest risk factor in death.
For years, multiple experts within the scientific community, including some of the most esteemed health statistics experts from other branches of the CDC, have been speaking out about the lack of credibility in the CDC's death claims. They rebuked its methodology last year in two professional journals: the August issue of the American Journal of Epidemiology and the September issue of the American Journal of Public Health. Even the editors of the New England Journal of Medicine, which originally published the paper claiming 300,000 deaths due to overweight and obesity, said its claims were not only "derived from weak or incomplete data, but it is also called into question by the methodological difficulties....[Other factors may] account for more than 100 percent of deaths -- a nonsensical result."
We've been so sold on the belief that being fat is deadly, that the scant media coverage this new analysis has thus far received is mostly incredulous or downplayed. So here are a few facts from this new analysis that you're not likely to hear.
Lower deaths (lives saved) associated with being "overweight" (BMI 25-30) = 86,094
Yes, you're reading that right. Being overweight is actually associated with reduced mortality rates. Being well nourished is healthful. In fact, looking at the data on nonsmokers, ages 29-59, those who are "overweight" or "obese" (BMI 30-35) have 66 to 77% of the mortality risk of government-approved "normal" bodies (BMI 18.5-25). For an average 5'4" woman, that means weighing 145 to 205 pounds is the least risky; for someone 5'11", the lowest risks are at 172 to 247 pounds.
But being underweight, even after accounting for smoking or illness, is 25% more dangerous than being "normal" weight. And it's considerably more dangerous when compared to either "overweight" or "obese" (BMI 30-35): 89% to 62%, respectively. After the age of 60, being underweight becomes especially hazardous and is the riskiest of all: almost 200% greater risks than those associated with "normal" weights, 266% greater than "overweight," 145% more than "obese" (BMI 30-35), and even 29% more than the most extreme obesity (BMI >35). In contrast, obesity only reaches the same risks as underweight among younger ages (25 to 59 years) at the uppermost extremes of BMIs over 35, which represents a mere 8.3% of the population. That's a far cry from the government's claim that 66% of us are "too fat."
While the dangers of underweight are significant, they've been largely ignored while the risks of overweight have been greatly overstated. The findings of Flegal and colleagues are nothing new, most of us just haven't heard the facts before. Of all the body weight studies published in the last half century, about 75% find weight to be irrelevant to health and mortality except at the extremes of BMI, according to Glenn Gaesser of the University of Virginia. A 1996 study by researchers at the National Center for Health Statistics, for instance, analyzed more than 23 long-term prospective epidemiological studies involving more than 600,000 people and found a wide range of weights had equally low mortalities, but notable risks associated with thinness (BMIs under 21), leading them to conclude: "Attention to the health risks of underweight is needed, and body weight recommendations for optimum longevity need to be considered in light of these risks."
What is particularly comical are the expressions of incredulity about Flegal's analysis, even by Gerberding who told CBS News: "There's absolutely no question that obesity is a major public health concern of this country." Yet, for more than fifty years, her own agency has reported that health and life expectancies continue to improve ... as we've gotten fatter for generations.
There is a notable caveat about this new study which also addresses lingering fears about the dangers of extreme obesity. Although this analysis used much better data and a more accurate computer model, it is still a statistical analysis. As such, it can look for associations to "estimate ... numbers of excess deaths associated with different levels of body weight, but the associations are not necessarily causal," Flegal wrote. "Other factors associated with body weight... might be responsible for some or all of the apparent associations of weight with mortality."
So, even while extremely high BMIs may be associated with health problems or increased mortalities, that still doesn't mean that fatness is the cause. According to a 2003 report by the Surgeon General, "obesity" is significantly higher among minorities, poor women and those with lower levels of education. Lower educational and employment opportunities, poverty, negative social environment and discrimination, increased levels of stress and feelings of hopelessness and isolation, and less access to preventative health services all add to their health risks. A recent CDC Morbidity & Mortality Weekly Report noted that minorities "bear a disproportionate burden of disease, injury and premature death." There is overwhelming evidence that disadvantaged people in our country receive poorer health care, according to M. Gregg Bloche in a recent NEJM. "Obese people have been forced out of jobs, paid higher insurance premiums, or been denied medical coverage because of their weight," he wrote.
As Paul Ernsberger and Richard Koletsky wrote in a recent Journal of Social Issues: "Obese patients often lack full access to medical services owing in part to social stigma and low self-esteem, which impair self-care activities, and the bias of health professionals. These barriers, along with the prevalence of poverty among the obese, may contribute to the association of obesity with poor health." Additionally, Ernsberger noted that if everyone simply had access to preventative health care and high blood pressures were controlled, it would "likely eradicate the increased risks 'associated' with obesity."
The most healthful thing we can all take away from this new analysis is a sense of relief and wellbeing. Being fat isn't a death sentence. After years of being told most of us are diseased and threatened that we're going to die because we're fat, it's no wonder we all feel constantly anxious about our weight and health. The stress of that alone is anything but healthful. Feeling healthier, taking to heart the positive reality that fat people can be healthy, means they're more likely to be healthier and a whole lot happier.