Don’t miss Paul Campos’s commentary on overweight and obesity in today’s NYT. Responding to the latest report by Katherine Flegal of CDC and coworkers, Campos points out that
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.
The report by Flegal et al., published this week in JAMA, is a meta-analysis of 97 studies on body-mass index (BMI) and mortality. This new analysis found that mortality risks for the “overweight” (BMI 25-29.9) was 6% lower than that for “normal” BMI (18.5-24.9) individuals. And those in the “grade 1 obesity” category, with BMIs from 30 to 34.9, were at no higher risk of dying than those in the so-called normal range. Only those with BMIs of 35 and above were at elevated risk of dying, and then only by 29%.
In other words, people who are overweight or obese generally live longer than those who are in the normal range. Only extreme obesity is associated with an increased probability of early death.
Flegal and colleagues already demonstrated most of these findings using administrative data, in an article appearing in JAMA in 2005. There, they reported no excess mortality among people labeled “overweight” by BMI standards, and that about three-quarters of excess mortality among the “obese” was accounted for by those with BMIs above 35.
What’s notable about this week’s publication is that it has attracted the attention of some heavy hitters in the media. Pam Belluck covered the JAMA report for the NYT. Although her article seems more interested in propping up the myths about the dangers of fat than in conveying the main points of the new analysis, Belluck does acknowledge that some health professionals would like to see the definition of normal revised.
Dan Childs’s story for ABC News gives a clear picture of the findings, and allows the obesity warriors, like David Katz of Yale and Mitchell Roslin at Lenox Hill, to embarrass themselves — waving the “fat is bad” banner under which they do battle. MedPage Today gives the story straight up. In NPR’s story, another warrior, Walter Willett of Harvard, unabashedly promoting his own persistently fuzzy thinking, calls the Flegal article “rubbish” — but the reporter, Allison Aubrey, is too sharp to buy it from someone so deeply invested. She ends by suitably questioning the connections of BMI to risk.
Campos’s op-ed piece does the favor of translating the Flegal findings into everyday terms (and without the pointless provisos that burden the NYT’s supposed news story):
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.
Is the hysteria about overweight and obesity is over? I’m sure not. In today’s article, Campos — who was one of the first to explode the fiction of an obesity epidemic, with his 2002 book The Obesity Myth — reminds us of a crucial fact about public health:
Anyone familiar with history will not be surprised to learn that “facts” have been enlisted before to confirm the legitimacy of a cultural obsession and to advance the economic interests of those who profit from that obsession.
There’s too much at stake with the obesity epidemic for our culture’s power brokers to give it up so quickly. One day, some other aspect of modernity will emerge to inspire dread (and profits). In the meantime, we might at least hope to see some re-jiggering of the BMI boogeyman.