Obesity

Obesity is a condition in which the natural energy reserve of humans or other mammals, which is stored in fat tissue, is expanded far beyond usual levels to the point where it impairs health. Obesity in wild animals is relatively rare, but it is common in domestic animals like pigs and household pets who may be overfed and underexercised. In humans it is considered a major challenge to health.

Controversies

There is continuous debate over obesity, at several levels. While scientific evidence for particular risks and treatments is fairly firm, the evidence informing debates on exact causation, social impact and necessary policy responses is much less clear-cut. In the area of policy and public debate, statistics demonstrating correlations are typically misinterpreted as demonstrating causation, a fallacy known as the spurious relationship. As much of the data is open to interpretation, there have been many "experts" taking positions, as well as policy pressure groups, influencing the debate from various angles.

Related Topics:
Scientific evidence - Correlation - Causation - Spurious relationship

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Medicalisation of obesity

Controversy exists as to whether the concept of "obesity" is a valid one. Critics assert that physically active people are healthier than the sedentary regardless of their body weight. The focus on weight and body mass is fed, in their view, by a diet promotion industry, drug companies, and segments of the medical profession for profit purposes, by promoting a vision that equates health with slenderness, and makes extreme slenderness of a sort that is quite difficult for most people to achieve an ideal. In The Obesity Myth, Paul Campos writes that:

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:... (F)rom the perspective of a profit-maximising medical and pharmaceutical industry, the ideal disease would be one that never killed those who suffered from it, that could not be treated effectively, and that doctors and their patients would nevertheless insist on treating anyway. Luckily for it, the American health care industry has discovered (or rather invented) just such a disease. It is called "obesity". Basically, obesity research in America is funded by the diet and drug industry — that is, the economic actors who have the most to gain from the conclusion that being fat is a disease that requires aggressive treatment. Many researchers have direct financial relationships with the companies whose products they are evaluating.{{mn|Campos|10}}

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More militant "fat acceptors" reject any attempt to present obesity as a problem: Conventional wisdom, assuming obesity to be a health problem, is to be considered a prejudice, directly equivalent to the medicalisation of homosexuality in the 19th century, and the consequent persecution of this minority.

Related Topics:
Prejudice - Homosexuality

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Causes of obesity

Conventional wisdom holds that obesity is caused by over-indulgence in fatty or sugary foods, portrayed as either a failure of will power or a species of addiction. Various specialists strongly oppose this view. For example, Professor Thomas Sanders of King's College London emphasises the need for balance between activity and consumption:

Related Topics:
Addiction - King's College London

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:In trials, there is no evidence suggesting that reducing fat intake has an effect on obesity. As long as your expenditure equals what you eat, you won't put on weight, regardless of how high the fat content is in your diet (The Times, London, 10 March 2004).

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Health effects of obesity

Opposing Campos are voices such as Greg Critser, who writes in Fat Land that the statistics such campaigners use are based on a selective sample of research data — a selection designed to emphasise obesity co-factors such as poor fitness, rather than obesity itself. Critser notes that advocates of the Obesity Myth position typically rely heavily on a study by Dr. Steven Blair at the Cooper Institute, Texas, which showed that fit, fat subjects were healthier than unfit, skinny subjects:

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:... Taking out the fitness variable and looking at body weight only, Blair admitted: "Men with a BMI of >30 were generally less physically fit and had more unfavorable risk factors than men in the lower BMI groups". Lower weight men had higher good cholesterol, lower bad cholesterol, and higher treadmill times than fatter men. "The highest death rate," he added, "was observed among those men in the highest BMI category and correspondingly lower death rates were observed in each subsequently lower BMI category." And when one looks at the difference between low fit men in all categories — which one might think would be most useful since most obese people are not fit — Blair's upbeat message fades: Normal weight nonfit men had an age-adjusted death rate (the number of excess deaths in the studied group) of 52.1; unfit fat men had the higher rate of 62.1. More: Unfit lean men were half as likely to have a history of hypertension than unfit fat men. In the real world, even according to Blairism, the fat are more likely to die early — and to live precariously — than the lean.{{mn|Critser|11}}

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Medical responses to obesity

Conventional wisdom recommends that the obese adopt strategies to lose weight in order to mitigate the health risks associated with obesity. There is controversy both over what those strategies realistically include, and also whether such a goal does actually result in better health outcomes.

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Weight reduction strategies include dietary changes, exercise regimes, weight loss drugs, and surgical interventions (see Therapy, above, for complete list). Of these, "miracle diets" are most contested, with several studies suggesting that short-term weight loss typically results in metabolic adjustments leading to weight gain in the longer term.

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Prevalence and public interest

What qualifies a medical condition as a matter of public interest, rather than a private health issue between doctor and patient, are its social costs. The estimation or measurement of the social cost of obesity is an extraordinarily hazardous statistical task, for two separate reasons.

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Firstly, the collation of evidence concerning the prevalence of obesity, or especially changing rates of prevalence, is open to several types of distortion. In the case of the UK, for one example, uninterpreted public health statistics may contradict the common belief that obesity is reaching epidemic proportions http://www.spiked-online.com/Articles/0000000CA8D9.htm. More generally, average weight increases with age — so a population with an increasing proportion of older people will have a higher average weight, regardless of changes to diet or activity.

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Secondly, since obesity is the correlate of a long list of factors which have significant health consequences in their own right, there may be no fact of the matter about which costs to attribute to obesity per se, and which are more properly costed to these co-factors. For one example, the proven relationship between obesity and low social status means that any group of obese persons' health outcomes will be significantly lowered by their average access to medical care, as a socioeconomic class, which will be, on average, lower than that of any non-obese control group.

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Researchers from the U.S. Centers of Disease Control and Prevention in Atlanta{{mn|Mokdad|12}} reported that approximately 400,000 US deaths annually were associated with poor diet and little exercise, and that if the trend continued, this would be 500,000 in 2005, overtaking smoking as the leading cause of death. These statistics are fiercely contested http://server1.consumerfreedom.com/article_detail.cfm/article/141, and error was admitted by the CDC in November 2004 http://www.cbsnews.com/stories/2004/11/24/health/main657636.shtml. In particular, studies of this nature are normally unable to distinguish causes of death, so include many accidental deaths, murders etc., which ought not to be costed to obesity.

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Canada and Europe are generally considered to be somewhat behind the United States in the trend towards overweight, with the rest of the world mixed. Some nations like Egypt and Mexico have also suffered from greatly increasing rates of obesity.

Related Topics:
Canada - Europe - Egypt - Mexico

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In March 2005 the International Obesity Task Force, a global coalition of obesity scientists and research centres advising the European Union, estimated that Finland, Germany, Greece, Cyprus, the Czech Republic, Slovakia, and Malta have exceeded the United States figure of 67% for overweight or obese males. The task force estimated in 2003 that about 200m of the 350m adults living in what is now the European Union may be overweight or obese http://www.guardian.co.uk/medicine/story/0,11381,1438700,00.html.

Related Topics:
International Obesity Task Force - Finland - Germany - Greece - Cyprus - Czech Republic - Slovakia - Malta - United States - Males - European Union

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Policy responses to obesity

On top of controversies about the causes of obesity, and about its precise health implications, come policy controversies about the correct policy approach to obesity. The main debate is between "personal responsibility" advocates, who resist regulatory attempts to intervene in citizen's private dietary habits, and "public interest" advocates, who promote regulations, on the same public health grounds as the restrictions applied to tobacco products. In the U.S., a recent bout in this controversy involves the so-called Cheeseburger Bill, an attempt to indemnify food industry businesses from frivolous law suits by obese clients.

Related Topics:
Policy - Cheeseburger Bill

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"Personal responsibility" advocates work on the basis that, as the microbiologist Rene Dubos once said, health ought not to be considered an end in itself, but "the condition best suited to reach goals that each individual formulates for himself" http://www.spiked-online.com/Articles/0000000CA7A4.htm. Any other definition permits authorities to curtail the autonomy of the self-determining individual, imposing quantity over quality of life onto them, undermining their civil liberties. As much as principled doctors, personal responsibility arguments have also been offered by food producer lobbies. In 1961, for example, as President John F Kennedy raised concerns about a lack of fitness in American society, a spokesman for the U.S. Dairy industry, Frank R. Neu, wrote advertorials warning We May Be Sitting Ourselves To Death http://www.theatlantic.com/issues/61nov/neu.htm. Not food regulation, but personal exercising, is moved as the solution.

Related Topics:
Microbiologist - Rene Dubos - John F Kennedy - Advertorial

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The "public interest" advocate John Banzhaf has found a way to harness personal responsibility arguments to the public interest side of the debate in the U.S., via recent changes http://banzhaf.net/docs/fatrates to HMO regulations which enable health insurance providers to differentiate between obese and regular customers in their pricing. The "public interest" objective is that obese people will have to pay extra for their health maintenance, bringing "personal responsibility" to bear on their consumption choices. This new tactic is controversial itself — if a causal link pertains from low social status to obesity (see above), the net effect will be increased costs for low income members of HMOs, particularly ethnic minorities, and reduced costs for slim, middle class white members.

Related Topics:
John Banzhaf - HMO - Above

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On July 16, 2004, the U.S. Department of Health and Human Services officially classified obesity as a disease. Speaking to a Senate committee, Tommy Thompson, the Secretary of Health and Human Services, stated that Medicare would cover obesity-related health problems. However, reimbursement would not be given if a treatment was not proven to be effective.

Related Topics:
July 16 - 2004 - Tommy Thompson

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