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    Peggy wrote: Don t Feed the Humans! The medical establishment s ridiculous definition of overweight is unhealthy. Paul Campos, The New
    Message 1 of 1 , Nov 27, 2007
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      Peggy <naafa_pr@...> wrote:
      Don't Feed the Humans!

      The medical establishment's ridiculous definition of "overweight" is
      unhealthy.

      Paul Campos, The New Republic Published: Tuesday, November 27, 2007

      The reaction of America's leading "obesity" experts to the latest
      study on the issue demonstrates yet again that our current
      definition of the word "overweight" makes no sense. Walter Willett
      of the Harvard School of Public Health's fumed that the new findings
      were "rubbish." His colleague JoAnn Manson found the study, authored
      by Katherine Flegal and others, and published in the prestigious
      Journal of the American Medical Association, "very puzzling." After
      all, for "overweight" people to be healthier than "healthy weight"
      people just doesn't seem logically or linguistically possible.

      How did we get into this mess? First, the relevant definitions:
      According to public health authorities in America and around the
      world, people are "overweight" if they have a body mass index
      between 25 and 30 (for a 5'4" woman this is between 145 and 173
      pounds; a 5'10" man fits the category if he weighs between 174 and
      208 pounds).

      A decade ago, when I began to study the relationship between weight
      and health, I was struck by the almost total lack of medical
      justification for labeling people in this weight range "overweight."
      Since then, the situation has become considerably more absurd. It's
      possible to have reasonable disagreements about the extent to
      which "obesity" (defined as a BMI of 30 or higher) is an independent
      contributor to ill-health and mortality risk. After all,
      epidemiology is a crude science, and the correlations between ill
      health and body weight among very fat people are inevitably open to
      multiple interpretations.

      For example, suppose one follows two groups, each made up of 5,000
      people, for ten years. People in the first group are at their
      supposed "ideal weight" for their height, while people in the second
      group are "obese." After a decade, twenty people in the first group
      and thirty in the second have died of heart disease. Statistically,
      this means the fat people had a 50% increased risk of dying from
      heart disease than the thin people did. (This is typical of the
      sorts of risk ratios associated with obesity, and an example of how
      a handful of extra deaths, in the context of a tiny baseline risk,
      makes for scary-sounding headlines about obesity "raising the risk
      of a fatal heart attack by 50%.") Does that mean the ten extra heart
      disease deaths were caused by fatness? Far from it. Perhaps the fat
      people were, on average, poorer; more stressed; more prone to diet
      and therefore to weight cycle; more likely to use diet drugs, many
      of which have been linked to cardiovascular disease; more sedentary;
      more discriminated against by the health care system and by society
      in general; and so on. Long-term observational studies of this sort
      can never control for more than a few of these sort of confounding
      variables, making it difficult to determine the extent to which, if
      at all, a particular correlation between a risk factor and a health
      outcome is causal.

      But all this involves a very different question from that at the
      center of the controversy over whether being "overweight" is
      unhealthy. Flegal's study has provided yet another rigorous
      demonstration of the fact that, if anything, people in
      the "overweight" category have, on average, better overall health
      and lower mortality rates than people in the absurdly
      mislabeled "healthy weight" category.

      Flegal and her colleagues found that, for a whole range of diseases,
      from Alzheimer's and Parkinson's to infectious illness and most of
      the major respiratory ailments, "overweight" people face a lower
      mortality risk than "healthy weight" persons. In addition, they
      found no difference between the two groups in mortality risk from
      heart disease or cancer (the nation's two biggest killers, and ones
      that many people tend to associate with being overweight). Thus, the
      relative mortality risk, and by extension the overall health,
      of "overweight" Americans appears to be better than that of "healthy
      weight" people.

      In the context of America's war on fat, the fact that being
      called "overweight" makes no medical or scientific sense is hardly a
      trivial point. How do our anti-fat warriors deal with this
      inconvenient truth?

      Three rationalizations are getting prominent play. First, obesity
      researchers point out that while being overweight doesn't correlate
      with increased health risk, being obese does, and "overweight"
      people are closer to being "obese" than "healthy weight." "You
      should not take heart in the idea that if you are only overweight
      you are OK...because people gain weight as they age in this
      country," said Robert Kushner, a professor of medicine at
      Northwestern. The problem with this argument is that, statistically
      speaking, people who are even slightly "underweight" face greatly
      increased health risks. Consider two women of average height, who
      weigh 110 and 150 pounds, respectively. The former "ideal weight"
      woman is roughly ten pounds away from a lower weight level that
      correlates with a doubling of her mortality risk, while the
      latter "overweight" woman would have to gain more than 100 pounds to
      move into a similar risk category. And while people generally gain
      weight in middle age, they usually begin to lose weight once they've
      reached retirement age--and nearly 80% of all deaths take place
      among people 65 and older. (Indeed, high weight has almost no
      correlation--or even a negative correlation--with mortality risk
      among the elderly, while weight loss has a very strong positive
      correlation, even when one controls for weight loss caused by
      eventually fatal illnesses). Given these facts, it seems odd to
      focus on the possibility of an "overweight" woman gaining 100 pounds
      rather than a thin woman losing ten.

      Second, researchers talk about "quality of life." After all, life
      expectancy isn't everything. As Manson says, "health extends far
      beyond mortality rates." According to a New York Times story, Manson
      is concerned that excess weight makes it difficult for people to
      move around, and therefore impairs their quality of life. That's
      part of "the big picture in terms of health outcomes," Manson says.
      The notion that an average-height woman who weighs between 146 and
      175 pounds is going to find it difficult to move about is as good an
      example as one could hope to find of what eating disorder experts
      call "anorexic ideation." Here again, we see how an argument which
      may make sense when talking about extremely fat people is
      transferred onto people who are "fat" only in the sense that they
      don't conform to a radical preference for extreme thinness--a
      preference which is one of the key explanations for why we're
      saddled with a scientifically bogus definition of what constitutes
      a "healthy weight."

      Finally, as a senior government scientist told me last
      week, "There's this new argument going around that says overweight
      people are living longer because they're going to the doctor more
      often and are therefore getting better medical care." The scientist
      emphasized that, in a culture where access to medical care is
      closely linked to socio-economic status, and in which socio-economic
      status is inversely related to increasing body mass, this argument
      is, to put it politely, highly implausible.

      Still, when the entire public health establishment has put its stamp
      of approval on a definition, those who have staked their
      professional reputations on the accuracy of that definition aren't
      going to be deterred by something like, well, evidence. Predictably,
      Willett, who has been perhaps the most prominent proponent of the
      idea that people ought to try to maintain very low weights, was
      outraged by the latest refutation of his theories: "It's just
      ludicrous to say there is no increased risk of mortality from being
      overweight," he told The Washington Post.

      What's actually ludicrous is that Occam's razor has yet to be
      employed to explain the "very puzzling" result that, once
      again, "overweight" people have been found to enjoy better health
      than "healthy weight" people. The definition of "overweight"
      promulgated by Willett, Manson, and their colleagues makes no sense.
      Many "puzzling" results cease to puzzle when one stops abusing the
      English language.

      Paul Campos is a professor of law at the University of Colorado-
      Boulder. (Peggy's note: Paul is also on NAAFA's Advisory Board!)

      http://www.tnr.com/politics/story.html?id=b9d157fe-5673-4e7f-bd21-
      1c08d7543ef1



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