Fear of Fat, Fear of Fatness, or Both?

This, from The New York Times, came to me a while back and initially gave me a raised eyebrow.

Our Absurd Fear of Fat. Interestingly, the original working title is likely this: Our Imaginary Weight Problem: (http://www.nytimes.com/2013/01/03/opinion/our-imaginary-weight-problem.html). This tells me that the author, Paul Campos, changed his title in draft, not bothering to go back and change the automatic hyperlink that most blogging platforms will generate based on the original (I’ve been bitten myself).

Perhaps it’s neither here nor there, but it is an interesting insight into the author’s thinking. The final title is more ambiguous. Does he mean a fear of fatness? Fear of dietary fat? That one causes the other, but it doesn’t matter? I don’t know. Here’s his entry into the piece:

ACCORDING to the United States government, nearly 7 out of 10 American adults weigh too much. (In 2010, the Centers for Disease Control and Prevention categorized 74 percent of men and 65 percent of women as either overweight or obese.)

But a new meta-analysis of the relationship between weight and mortality risk, involving nearly three million subjects from more than a dozen countries, illustrates just how exaggerated and unscientific that claim is.

The meta-analysis, published this week in The Journal of the American Medical Association, reviewed data from nearly a hundred large epidemiological studies to determine the correlation between body mass and mortality risk. The results ought to stun anyone who assumes the definition of “normal” or “healthy” weight used by our public health authorities is actually supported by the medical literature.

The study, by Katherine M. Flegal and her associates at the C.D.C. and the National Institutes of Health, found that all adults categorized as overweight and most of those categorized as obese have a lower mortality risk than so-called normal-weight individuals. If the government were to redefine normal weight as one that doesn’t increase the risk of death, then about 130 million of the 165 million American adults currently categorized as overweight and obese would be re-categorized as normal weight instead.

To put some flesh on these statistical bones, the study found a 6 percent decrease in mortality risk among people classified as overweight and a 5 percent decrease in people classified as Grade 1 obese, the lowest level (most of the obese fall in this category). This means that average-height women — 5 feet 4 inches — who weigh between 108 and 145 pounds have a higher mortality risk than average-height women who weigh between 146 and 203 pounds. For average-height men — 5 feet 10 inches — those who weigh between 129 and 174 pounds have a higher mortality risk than those who weigh between 175 and 243 pounds.

Yep. We’ve all known overweight people who seem relatively healthy. My own hypothesis is that so long as it’s not totally overboard, overeating probably also correlates with higher quality essential nutrition and there’s likely a large grey area where full nutrition trumps body fat accumulation (and all the “anti-nutirents,” too). And this doesn’t even get into the distinction between relatively benign or, inert, sub-cutaneous fat vs visceral, adipose tissue fat around organs.

I was all set to blog this as somewhat of a question, food for thought, etc. It is and should be no surprise that in the general paleo paradigm, lots of people are abandoning the idea of being super lean and ripped, feeling fine with 10-20 “extra pounds.” It’s so age, gene, gender and lifestyle dependent it does seem rather absurd to hold everyone to that sort of standard.

…So I Googled around and this was the top hit critiquing the piece and I must say, it’s a very fine job by Dr. David Katz, MD: Fat, Fear, and the Truly Absurd: The Perils of Ping-Pong Science.

According to a widely circulated op-ed in yesterday’s New York Times by Paul Campos, a law professor at the University of Colorado with whom I don’t believe I have ever managed to agree on anything, our “fear” of fat — namely, epidemic obesity — is, in a word, absurd. Prof. Campos is the author of a book entitled The Obesity Myth, and has established something of a cottage industry for some time contending that the fuss we make about epidemic obesity is all some government-manufactured conspiracy theory, or a confabulation serving the interests of the weight-loss-pharmaceutical complex.

In this instance, the op-ed was reacting to a meta-analysis, published this week in JAMA, and itself the subject of extensive media attention, indicating that mortality rates go up as obesity gets severe, but that mild obesity and overweight are actually associated with lower overall mortality than so-called “healthy” weight. This study — debunked for important deficiencies by many leading scientists around the country, and with important limitations acknowledged by its own authors — was treated by Prof. Campos as if a third tablet on the summit of Mount Sinai.

We’ll get into the details of the meta-anlysis shortly, but first I’d like to say: Treating science like a ping-pong ball is what’s absurd, and what scares the hell out of me. Treating any one study as if its findings annihilate the gradual, hard-earned accumulation of evidence over decades is absurd, and scares the hell out of me. Iconoclasts who get lots of attention just by refuting the conventional wisdom, and who are occasionally and importantly right, but far more often wrong — are often rather absurd, and scare the hell out of me.

And so does the obesity epidemic. […]

The first, obvious limitation of this study is that it examined mortality (death) but not morbidity (illness). The Global Burden of Disease Study, recently published in The Lancet and sponsored by the World Health Organization, the World Bank, and the Bill and Melinda Gates Foundation, is widely acknowledged as one of the most comprehensive epidemiologic assessments in history. What it shows, among countries around the world, is that we are living longer, but sicker. Thanks to the cutting edge of biomedical advance, we can often forestall death; but high-tech medicine is not remotely as useful for cultivating health and vitality.

So, it’s no surprise that overweight and mild obesity do not increase mortality. They could cause an enormous burden of chronic disease and still not do so.

But why would overweight and mild obesity be associated with a lower rate of mortality, as the meta-analysis suggests? For one thing, when people get sick, they generally lose weight. The new study was in no way adjusted to exclude from the analysis people who were thin because they were sick. We have long had evidence that among older people, hanging onto weight is associated with better outcomes than losing weight.

And so on and on. I encourage you to read the whole debunking. He finishes:

We can, of course, become unduly focused on body weight. In fact, as a culture we do so routinely. Weight is not the issue; health is the issue. It is possible to be heavier and healthy, or thinner and sick. We should keep our eyes on the prize. And the new meta-analysis may suggest that the range of “normal” for weight could be expanded, although it by no means proves it.

But at the population level, epidemic obesity is incontrovertibly established as a clear and all-but-omnipresent danger. It is absurd to suggest otherwise. And it’s those who do so, who play ping-pong with science because of misguided bias or motivated self-interest — who threaten to forestall the societal action needed to turn this toxic tide — who frighten the hell out of me!

Nice job, Dr. Katz. I purposely didn’t look into your background or general recommendations, etc., fearing you might advocate veganism or some evil like that which would spoil it for me. I didn’t want to bias myself, because this is an excellent critique of a meta-analysis which ought to be seen as suspect in the first place. So, I remain ignorant as to your general recommendations.

Me? Easy: real food, home cooked. All of it.

Nonetheless. Good job, sir.

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  1. Gordon Shannon on January 21, 2013 at 18:13

    Google him.

    • Jd on January 21, 2013 at 18:27

      Please look into dr. Katz. He could be considered a less popular dr. Oz. several appearances on Oprah. He openly mocks Paleolithic ideas and sneers at people who pursue that type of diet.

      • Gordon Shannon on January 21, 2013 at 18:31

        It’s older, and I only assume this is the same guy, but it looks like he only rejects a certain kind of paleo (which, given that this was written in 2011, was under attack all over at the time):


        I only skim read it.

      • Richard Nikoley on January 21, 2013 at 18:59

        Well, see, now you know why I didn’t look. I know my own propensity for bias but that was a good deconstruction regardless of what he thinks otherwise.

        I’ll let him tell me why meat, fish, fowl, vegetables and fruit you cook at home to eat is a bad idea, if he wants.

      • Justin on January 21, 2013 at 19:49

        After you posted this, I read some of Katz’s work. The worst I can say about him is that he is at least somewhat against a high fat diet. He points to the Inuits short life span vs the Okinawans long life span as examples of how a low fat / high carb diet seems to work better overall. He seems to also say that paleo people have used that moniker to eat cheeseburgers / sausages / hot dogs. I cant say which paleo diet he means with those choices. He also is against a high meat diet because of its non sustainability.
        Despite those things, he is very much into eating natural / whole foods. He also points out he didnt score the Paleo diet poorly in the infamous US News survey.

      • Gabriella Kadar on January 22, 2013 at 17:40

        Grandma was right: eat real food (all homemade) and carry around a little bit of chub.

        Alarmingly, there are people who insist on maintaining a low body weight for whatever reason. The only problem: analysis of dietary choices (and loads of plaque on teeth) indicates a high of sugar consumption. Sugar is only energy it’s not nutrition. So these people could be doing better if they would exchange the brioche and baklava with something that actually provides a better profile nutrient/vitamin/mineral content. If you want thin, at least be healthy thin: eat quality foods.

        Just tasted some Hungarian apricot brandy (not sweet). It’s my empty calories.

      • Richard Nikoley on January 22, 2013 at 17:54

        Yep, and this is exactly why an animal-oriented Paleo diet works so well for so many. You can “under eat,” feel satisfied, and still get higher nutrition than people eating 1000 more kcal of crap, and without the load of bad.

  2. Galina L on January 21, 2013 at 19:20

    I am in the middle. The obesity in US is not a myth , but it is ridiculous and unrealistic to think that a person has to be “ripped” to be healthy.
    It is great if “real food” will make you healthy and at the reasonable weight, but it depends …

  3. tatertot on January 21, 2013 at 19:50

    I used to be really fat. Fatty Liver Disease, pre-diabetics, high bp, sleep apnea, high chol, gout, metabolic syndrome kinda guy.

    Found paleo/Mark’s Daily Apple and lost the excess weight, off all meds, very healthy now 2+ years later.

    Throughout my journey, I was scared to death of getting fat again. If I ate off-plan and put on 5lbs, I’d be super-strict zero-carb until I lost it all.

    Enter the Potato Diet. Now that I have a reset button, I am way more adventurous in my eating. I can play with macros and calories and see what happens long-term. If I don’t like where it’s going, I whip out the taters and I’m back to where I should be in a week.

    Here’s what I found out, though. Starch isn’t the devil. In fact, including it in copious amounts daily keeps my weight rock steady. No more 5 pound overnight bloat fests like I used to get.

    I find for me regarding weight, when I hit 175lbs, my sleep apnea is back and I need a CPAP to sleep. Under 170 and I sleep like a baby with no snoring whatsoever.

    • Kris on January 23, 2013 at 08:33

      tatertot, can you be more specific about how much starch you eat on a regular basis and which foods exactly? Do you eat any bread or pasta?

  4. Keoni Galt on January 21, 2013 at 20:15

    Prof. Campos is the author of a book entitled The Obesity Myth, and has established something of a cottage industry for some time contending that the fuss we make about epidemic obesity is all some government-manufactured conspiracy theory, or a confabulation serving the interests of the weight-loss-pharmaceutical complex.

    Theory? Hahahahahahaha

    This is the “wag the dog” argument. Whoever makes this argument, is actually telling the truth of the matter, but doing it from the frame of “anyone who believes this is a kook. a TRUTHER. A “conspiracy theorist.”

    Sound ludicrous? Let’s start with the “government-manufactured” USDA Food Pyramid.

    Prof. Campos = useful idiot.

  5. Jackie D on January 21, 2013 at 21:05

    Writers very rarely write their own headlines, and I guarantee that no writers are putting their own pieces into the New York Times’ content management system (several friends write for that paper). The headline is by an editor – no insight at all into the author’s mindset.

  6. Ulfric on January 22, 2013 at 04:01

    Only this ;
    “For one thing, when people get sick, they generally lose weight. The new study was in no way adjusted to exclude from the analysis people who were thin because they were sick.”

    In my own observations folk waste away to skin and bone before they die simply because they end up in a hospital ward where the staff keep them barely alive for a long long time. Very sad in my opinion.
    It’s not a study to be read and misunderstood by the masses.

  7. Joshua on January 22, 2013 at 06:38

    My current weight is 263. When I tell people that my goal is to lose 80 more pounds to get down to my goal weight of 183 (the upper bound for normal BMI) they look at me like I’m high.

    I’ve never weighed that much as an adult, so I don’t have any idea how I would look/feel at that weight, but I do acknowledge that I might not actually want to achieve that goal when I get close.

  8. Ed on January 22, 2013 at 10:55

    I figure waist size is more important than BMI. Shrug.

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