The flip-flop over fat
Philip J. Goscienski, M.D.
When the Centers for Disease Control and Prevention reported in April 2005 that being overweight or even moderately obese was, to paraphrase, no big deal, the national media rejoiced. Here was a controversy that would keep the news pot bubbling for weeks, if not longer. To physicians who have been waging the battle against obesity this was a credibility-cruncher. All our finger-wagging admonitions and threats of an early death have been misdirected: it was those skinny folks whose death rates were the highest. Even the American Association of Retired Persons noted that "being pleasingly plump may actually be good for you." (AARP Bulletin June 2005) If that's true, what's the point in trying to lose those few stubborn pounds?
We shouldn't be surprised at the reaction of the media or the AARP. If they represent a cross section of Americana two thirds of them are overweight and a third are obese. Those figures might be a little low for AARPers, whose youngest members are at least 50 years old and who are even more likely to be a little on the portly side. This had to be reassuring news.
It didn't take long for the CDC to try to explain the apparent contradiction. In a press conference on June 2nd Dr. Julie L. Geberding, CDC Director, stated flatly that there is a definite association between overweight, obesity and death, a fact that any physician in practice will agree with. The contrary study failed to note that it included persons who had lost weight because of chronic illness, a point that was not mentioned by most persons in the media.
Dr. Geberding pointed out that persons who are obese encounter a number of life-shortening conditions that include heart disease, high blood pressure, type 2 diabetes, kidney failure and several types of cancer. In addition, persons who are obese have breathing problems and sleep disturbances as well as problems with mobility and arthritis. The most striking examples are those who are morbidly obese and whose weight is 100 pounds or more than normal. For them, living to a ripe old age is not likely.
Connecting obesity to death rates is not as easy as it would seem. One reason is that the term obesity does not appear on death records that are the basis for tabulations. The kinds of statistics that formed the basis for the favorable report were derived indirectly from other data, a potential source for large errors. Health authorities encountered similar problems when they tried to associate smoking with higher rates of lung disease and death. It took 40 years to nail that one down.
What do you know from your own experience? Can you name a friend or relative who made it to the age of 90 years or more? Are there any obese folks in that group? Of course, they were already middle-aged when obesity rates were far lower than they are today and fewer American families had labor-saving devices, second cars or computers.
Is there a lesson in this? Studies that seem to contradict past experience are sometimes correct but it may be because the conditions were different, the population was too small, the study group was not a randomized one, or even that the group that sponsored the research had a financial interest in the results.
Philip J. Goscienski, M.D. is the author of Health Secrets of the Stone Age, Better Life Publishers 2005. Contact him at email@example.com.