Rethinking the War on Fat

Dieting is risky business. When examined over a 12 to 24-month timeframe from the commencement of a weight reduction effort, many dieters find they have actually gained weight. No one who has thought or written about weight loss would challenge that conclusion.

Therein lies the dilemma at the heart of the latest push to launch a universal anti-obesity public health message. Dissenters warn that making the war on fat a national priority will lead to increased dieting and more overweight individuals.

In other words, the campaign will create the very problem it is trying to solve.

Recent media coverage of the obesity epidemic has been alarming. The New York Post called it “Dying to Eat.” A somber New York Times warned “Death Rate from Obesity Gains Fast on Smoking.” One anti-fat champion, David B. Allison, told the media that obesity shaves five years off an individual’s expected life span and could “end” the steady rise in overall life expectancy that Western societies have witnessed in modern times.

But the anti-fat campaign was born in controversy. Experts at the Centers for Disease Control and Prevention (CDC) in Atlanta are divided over the scientific evidence. Not everyone agrees fat kills. At the end of April, a senior research scientist at the CDC reported no significant mortality risk from being overweight. That study questioning the wisdom of the obesity campaign was released in the Journal of the American Medical Association (JAMA) and received wide coverage in the media.

Thanks to Scientific American, it is possible for the general public to delve into this debate and come out with a good understanding of the issues. In its June issue, an article, “Obesity, An Overblown Epidemic?” by W. Wayt Gibbs, details the controversy. Katherine M. Flegal, the CDC researcher behind the April JAMA report, concluded that obesity in older people is “not a major factor” in their mortality. Among many findings, Flegal noted that body fat provides a “nutritional reserve” that makes the elderly “more resilient” when hospitalized. For the oldest group, her estimates of deaths from obesity are lower than the predictions made by the fat warriors.

Younger people, it is true, may suffer adversely from being overweight, but Flegal noted “their death rates are very low.”

One of the strengths of Flegal’s findings is that they are based on recent studies measuring height and weight from 1998 and 1994 and deaths up to 2000 from which she found that “even severe obesity failed to show up as a statistically significant mortality risk.” She speculates that recent improvements in medical care reduce mortality levels for obese persons and concludes that the mortality risk associated with fat drops as people age.

The fat warriors and their challengers reach sharply different conclusions. Allison, a professor at the University of Alabama, and other scientists who believe fat is a growing epidemic, have estimated that a group of 400,000 Americans will face significant effects on their longevity from fat. But Allison, according to Scientific American, admits that his warnings of adults losing between two and five years from their life expectancy are “just back-of-envelope, plausible scenarios.” His headline-grabbing statements were “never meant” to be “precise,” Allison hedges. The detail that grabbed the attention of reporters and the public has “no statistical analysis to back it up” reports Scientific American.

In the same issue of JAMA in which Flegal made the case for fat having a low impact on the life expectancies of the elderly, another CDC scientist, Edward W. Gregg, found that the prevalence of high blood pressure dropped by roughly half between 1960 and 2000. High blood pressure is still twice as common among the obese as among those who are lean. However, medicine can now successfully control it. Obese persons “now have better cardiovascular disease risk profiles than their leaner counterparts did 20 to 30 years ago,” Gregg’s study finds.

The trend regarding high cholesterol is similar. Gregg suggests that any increase in risk from obesity is more than compensated for by better treatment of high cholesterol and blood pressure.

These findings have been borne out in my own life. I developed high blood pressure in my 40s, but medicine has kept my readings within normal limits for two decades.

Gibbs’ article in Scientific American reports that dissent is growing and asserts that the government and medical authorities are “misleading the public about the consequences of rising body weights.” The critics include J. Eric Oliver, a political scientist at the University of Chicago, who believes “a relatively small group of scientists and doctors, many directly funded by the weight-loss industry… have inflated claims and distorted statistics.”

Allison, a leader in the war on fat, has disclosed payments from 148 companies in the drug and diet industries. The article in Scientific American certainly makes a reader suspicious of the extravagant claims of impending death made by the fat warriors.

What irks the critics most is the fact that the campaign against fat promotes the diet industry. Many of us, in our own diets, have discovered the tendency of weight loss efforts to have the opposite effect. Returning to old eating habits after a diet often leads to a net weight gain. Thus someone who goes from 180 pounds to 170 pounds ends up weighing 190. The diet triggers responses that lead to added weight. Any fast weight loss involves starving the body, and the feelings of hunger, suppressed for a time, lead to overeating after dieting.

The diet industry avoids asking Americans if they are sure they really want to lose weight. Successful weight loss over the long run is only possible with a fundamental change of habits. There is nothing intuitive about this process. It requires exercise and new eating habits. The anti-fat campaign exaggerates the risks of being fat, but also the feasibility of long term weight loss.

I speak from experience. My weight spiraled out of control and I faced a severe loss in mobility. I couldn’t walk three blocks on an errand without stopping to rest. And it was a vicious cycle—the less I moved, the weaker I became.

I finally brought my weight under control by drastically changing my eating habits—almost no pasta and bread, no fried foods, salad dressing without olive oil—combined with a dramatic increase in physical activity with the help of a trainer. For me, success has really been about a personality change as much as a new lifestyle.

The pernicious effect of body fascism in the gay community makes weight control a particularly freighted issue. More generally in society, the newly invigorated campaign against fat aims to convert a private issue into a social rule—being thin is not only desirable but a matter of life and death.

The analysis presented in Scientific American suggests that greater respect for the privacy of individuals’ choice and more attention to the findings of medical science will produce better results. Steven Blair of the Cooper Institute, a preventive medicine organization in Dallas, says we have to stop shouting obesity is “bad for you and that fat people are evil and weak-willed and that the world would be lovely if we all lost weight.”

Yet, unhappily Blair said he hasn’t seen “much evidence that this is happening.”