In Defense of the Anti-Obesity Movement - Part II

Posted on May 24, 2009
Filed Under Cardiology Topics, Obesity and rationing |

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The “Obesity Paradox,” and How to Manage It

In Part I of this important and insightful meditation, we saw the many reasons why it is so critically important for anyone (such as DrRich) who supports the President’s healthcare reform plan (whatever that plan may turn out to be) to stand foresquare behind the demonization of the obese.

But unfortunately, the vitally important anti-obesity platform of healthcare reform is under assault. The fat-is-bad firmament - created by the concentrated exertions of the American College of Cardiology, the American Heart Association, the National Institutes of Health, the fashion and beauty industries, sundry weight-loss conglomerates, the popular media, and countless other engines of public opinion - is threatened by a growing body of evidence, created by a few misguided scientists, which suggests that obesity may not be quite as bad a thing as we are all led to believe. Like an expanding pool of molten rock hidden just beneath an apparently placid landscape, this expanding evidence poses a threat to the anti-obesity movement, and therefore to healthcare reform. It must be dealt with.

And we need to deal with this threat now, while it is still relatively hidden, and before it bursts through to the surface where it would do much damage. Fortunately - in contrast to an actual volcano - we have the tools to tamp the threat down before it becomes manifest.

Before DrRich explains how this can be accomplished, let us take a brief look at some of that counterproductive evidence itself, to illustrate the seriousness of the problem. The evidence, when one begins to look for it, is disturbingly broad and consistent. DrRich will not attempt a comprehensive review of that evidence here, but instead will merely attempt to impart a sense of the threat we are dealing with:

1) We must begin by noting that a substantial part of the “obesity epidemic” that has become manifest over the past decade can be accounted for by a change in the definition of obesity. When the CDC changed that definition in 1997, as many as 30 million Americans who had been of normal weight suddenly found themselves to be obese, or at least overweight, and all without gaining a pound. Enemies of the anti-obesity movement will not be above exploiting this inconvenient truth to their own ends.

2) In 2002, a report in the Journal of the American College of Cardiology examined almost 10,000 consecutive patients who had angioplasty and/or stenting for coronary artery disease, and found that those who were overweight or obese had fewer complications and a lower 1-year mortality than those who were thin or of normal weight. Several more recent studies claim to have shown the same thing.

3) A 2007 report in the Journal of the American Medical Association showed that overweight people who were physically fit had a lower risk of death than normal-weight people who were sedentary.

4) A 2007 report by the National Bureau of Economic Research noted that while Americans were growing fatter, other changes in health behavior (such as reduced smoking and better management of cholesterol and hypertension) more than offset any increase in health risk posed by the population’s increase in obesity.

5) And just last week, a meta-analysis in the Journal of the American College of Cardiology concluded that while obesity itself increases the risk of heart disease, obese people who develop that heart disease have significantly better survival than thin or normal-weight people who develop the same kind of heart disease.

Some cardiologists have already termed this growing line of evidence, i.e., the general observation that at least in some situations obese cardiac patients fare better than thin ones, as “The Obesity Paradox.” Anyone who understands the importance of the anti-obesity movement should be alarmed.

Just on the face of it, we can see that while such evidence could easily be painted by our enemies as “a little fat is OK,” the opposite is actually true. As we all know, the chief aim of healthcare reform (despite all the palaver about providing universal access and improving quality) is to reduce costs. So what could be worse than a condition like obesity, which a) increases the incidence of heart disease, but b) once heart disease develops, prevents an early (and relatively inexpensive) demise?

The actual incidence of a disease, of course, is pretty neutral to our goal of reducing healthcare costs. What is important is the expense and duration of the disease once it develops. (Indeed, to reduce long-term healthcare costs, a very prevalent disease that kills very quickly would be just about ideal.) Since few medical conditions are more expensive to manage chronically than heart disease, the best thing for our healthcare system and our society would be for those who develop heart disease to just go ahead and make a rapid departure from the scene. So in this light, what this recent evidence shows is that obesity - because it increases the incidence of non-fatal (i.e., chronic) heart disease - far from being more benign than we thought, is instead much worse than we believed.

Beyond these obvious cost implications of the “Obesity Paradox” (i.e., the general idea that obesity may not be as dangerous as we have thought), is the much deeper problem that any new science that undermines the anti-obesity movement threatens to undermine a major pillar of healthcare reform. DrRich described this important aspect of the anti-obesity movement at length in his prior post, but to summarize: Successful anathematization of the obese will establish an important precedent that is needed by our central authorities as they set out to restrict, control and tax all the other human behaviors they decide may cause an increase in healthcare expenditures (which is to say, nearly all other human behaviors). While establishing this precedent would certainly be possible with some group other than the obese, so much effort and time has been invested in dehumanizing fat people that it would be more than a shame to have to abandon that huge investment, and start all over to demonize some other subset of our population.

We’re talking about healthcare reform here, so time is of the essence. Thus, what is needed is a means of suppressing a more general awareness of the Obesity Paradox. It is fortunate, therefore, that we have at hand a very serviceable model for achieving this end.

That model, as DrRich has pointed out, is Man-Made Global Warming. By the simple expediency of issuing a formal declaration that Man-Made Global Warming is real and is too important to argue about, all further debate over global warming (whether it is occurring, and more importantly, whether it is man-made) has been cut off; those who persist in challenging it have been decreed as outliers, heretics and kooks. To so effectively stifle further scientific scrutiny, a great council of hand-picked environmental scientists was assembled to review the body of admitted evidence on global warming, and to formally divide that evidence into orthodoxy (the study of which is holy) and heresy (the study of which is damned), and to declare the era of scientific revelation on the matter to be ended, and the science settled.  And while the extensive document that council produced itself contains much that would make one question the actual magnitude of global warming, and especially whether it is actually man-made, the Executive Summary (a sort of catechism produced for general consumption by the Global Warming hierarchy) nicely provides us with what we really need to know, and accordingly is the only part of the document that is ever reported or discussed publicly or in polite company. In this manner, and with the full cooperation of the media, Man-Made Global Warming has been rendered a done deal.

DrRich merely points out that if further scientific exposition and debate of global warming can be officially cut off, ostensibly (and remarkably) with the blessing of the scientists themselves, then the same can certainly be accomplished with obesity.

It would be a simple matter to assemble another great, Council-of-Nicaea-like, body of respected and unassailable experts on obesity and preventive medicine - from government, academia, sympathetic consumer groups, and the numerous industries whose success depends on the existence of lots of fat people desperately wanting to lose weight - to ruminate over all the evidence, and produce their own sacred document declaring, once and for all, that obesity is very, very bad (and so is anyone who says otherwise); and further, that it is morally wrong to waste any more time or money studying whether obesity is a health hazard, and heretofore the only permissible research will be aimed at studying how to prevent and treat it.

That should do it.

Selling such an Obesity Creed should be even easier than selling global warming. Fat people, unlike the apparently rising seas and melting ice caps, are all around us and readily visible to everyone. Many times each day our encounters with them will induce real and visceral reactions - our pity over their personal health plights, our disgust over their manifest inability to exhibit any self control whatsoever, and our indignation that their obvious gluttony and sloth is costing us so much money. Obesity as a threat to humanity will be a much more concrete, much less abstract, tool for focusing a general righteous anger than global warming can ever be.

So how to combat the growing problem of the Obesity Paradox is not the problem - we can combat it by promulgating an Obesity Creed. The problem is to recognize that there is indeed a threat to the anti-obesity movement, that the threat comes in the form of an expanding body of scientific evidence, and that time is of the essence. If we are to have the kind of healthcare reform our leaders visualize, we need to recognize the threat and deal with it now, while it is still in its early stages, and before it enters the general public consciousness.

DrRich is very pleased to have been able to assist in this matter, and at this critical juncture, to help eliminate a grave threat to healthcare reform. But heck, that’s what DrRich is here for.

Comments

11 Responses to “In Defense of the Anti-Obesity Movement - Part II”

  1. Alberto on May 24th, 2009 11:55 am

    I think how you reported point 5 is very misleading. Are you citing the review by Carl J. Lavie?

    I like his conclusion in his 2003 paper:

    These facts, however, do not discount the need for more vigorous efforts at obesity prevention and intervention, which may go a long way to prevent these diseases and prevent the morbid complications recognized centuries ago by Hippocrates.

  2. DrRich on May 24th, 2009 12:50 pm

    Alberto,

    I don’t think it’s misleading at all. Lavie gave an interview to Heartwire regarding this article, in which he said,

    “First, obesity is a very strong risk factor and increases all types of heart disease, but second, once you get heart disease, the obese patients do better. . .In fact, if you have obese patients with congestive heart failure or coronary heart disease or other heart disorders, those patients actually have a pretty good prognosis if they are treated well.”

    Lavie went on to point out that “there is solid evidence to suggest that being overweight or obese may improve survival, not just in heart failure, but also in diseases like hypertension, coronary artery disease, and peripheral artery disease.”

    So, while perhaps in an earlier paper Lavie may give the obligatory nod to the need to remain svelte, and even refers to Hippocrates in doing so, I’m afraid his more recent publication does indeed add weight to the Obesity Paradox Heresy.

    And once the Obesity Creed is formalized, I’m willing to bet his name will be on the list of those whom the Inquisitors will consider people of interest. At that time, if he wishes to remain a medical researcher in good standing, it is likely he will be given every chance to recant.

    Rich

  3. tante on May 24th, 2009 5:26 pm

    Don’t worry. If fat people can’t be made to be appear to be the cause of high health-care costs due to their potential to develop maladies, you can continue to demonize them by manipulating the numbers: Just count the billions of dollars spent annually on weight-loss products, bariatric surgery, diet plans and anti-fat drugs as part of the overall costs of health care.

    All of that money is squandered by fat people! It’s wasted, since they never lose weight, anyway.

    All you have to do then is figure out how to cover up what fear of fatness actually contributes to the economy.

  4. Jerry Foundel on May 25th, 2009 10:27 am

    I think the most compelleing data are from Kalantar-Zadeh at UCLA who refers to this using the term “reverse epidemiology”

  5. DrRich on May 25th, 2009 10:50 am

    Jerry,

    Yes, Kalantar-Zadeh definitely will need to be placed on the list for “re-education” as well. He may prove to be a tough nut to crack, but our leaders have drugs for that.

    Rich

  6. BobC49 on May 25th, 2009 2:42 pm

    If our country’s new direction is to demonize the obese we should consider basing our income tax rates on the person’s BMI. In order to maximize the humiliation, we will have to organize a yearly weigh-in in the public square. This will be useful for entertainment as well as instilling fear into the populace. The way television is going these days I can see opportunities for reality TV. Since we are moving closer and closer to fully tax funded healthcare, the BMI based tax rate is a natural fit. Of course muscular people will be unfairly hit with higher taxes. Maybe we’ll have to have a deduction for how many concrete blocks you can balance. Any accidents will make for better TV ratings.

  7. DrRich on May 26th, 2009 11:25 am

    BobC49,

    Yes, once we establish once and for all that obesity (and the obese) are bad, the possibilities become endless.

    Rich

  8. PB on May 27th, 2009 1:01 am

    I think the most compelleing data are from Kalantar-Zadeh at UCLA who refers to this using the term “reverse epidemiology”

  9. paulie on May 30th, 2009 12:29 am

    The situation is even worse than you describe. Numerous observational studies have determined that people with higher BMI survive longer on dialysis, thus consuming more health care dollars as well as more calories and carbon credits. In fact, there is a dose-response relationship - the obese survive longer than the merely overweight, who in turn outlive those of “normal” weight. To address this intolerable situation, I offer a modest proposal for an interventional trial - which hopefully will determine that forced weight loss in obese dialysis patients will result in their earlier demise…

  10. obesity definition on November 23rd, 2009 10:03 am

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  11. bridget on January 22nd, 2010 11:23 am

    A MAJOR portion that most people are not contributing to the factor of obesity is the lack of movement + what we eat. As a society we depend on our car to go everywhere. If we were an European society, they walk everywhere and have been compared and done studies as to why they are trim and can eat alot and not gain the weight. Because in America we do not walk to school, to work, to the playground. There are not safe sidewalks or proper crosswalks. We depend on an autocentric way of life. Follow our blog about how to change that…we believe in changing obesity before it becomes an epodemic! http://srfandassociates.blogspot.com/

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