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The war on fat has reached the point where the systematic distortion of the evidence has become the norm, rather than the exception.

Are we all blind, then? What happend ?

Every day we hear assertions made every day by mainstream scientists and medical professionals, reputable healthcare organizations, public policy makers and, most of all, media in which correlations are used as proof of a cause. These are taken as facts, not because of any sound evidence, but because they seem intuitively correct and match what "everybody knows."

• Junk science: obesity causes approximately 300,000 deaths annually. ( see former page ).
  This data calculations assume that all excess mortality in obese people is due to their obesity.
  
  In fact there is a great deal of evidence that such factors are far more relevant to mortality than weight. Indeed, long-term studies conducted at Dallas' Cooper Institute, involving tens of thousands of subjects tracked for a decade or more, have concluded that all of the excess mortality associated with increasing weight is accounted for by activity levels, not weight. These studies show moderately active fat people have far lower mortality rates than thin sedentary people, and essentially the same mortality rates as thin active people. In other words, adding just one variable to the mix — activity levels — eliminates fat as a risk factor (the activity levels associated with optimum mortality rates are quite modest — a brisk daily half-hour walk will by itself put a person in these categories).
  
  Furthermore, the 300,000 deaths per year figure was derived without taking into account factors such as yo-yo dieting and diet drug use, both of which have been shown to have devastating effects on health. Nor were variables such as class — poor people die sooner than the well-off — and social discrimination, which has been shown to have a very negative impact on health, taken into account.
  
  
• For the 97 percent of the American population that has a body mass index of under 40 there is simply no connection whatsoever between body weight and early death. As researchers such as Steven Blair and Glen Gaesser have documented, fat people who are moderately active are just as healthy as thin people who are similarly active -- and they are far healthier than thin sedentary people.

  Indeed, numerous recent studies have demonstrated that, except at the statistical extreme, weight has no relevance to health, once factors such as exercise are taken into account

• Most, if not all, eating disorders start from dieting
  
  Over a third of "normal dieters" progress to pathological eating, a 1995 study published in the International Journal of Eating Disorders documented. For up to 4 percent of the population, according to the American Psychiatric Association, it takes the form of compulsive eating problems.The two most life-threatening eating disorders, focused on the quantity of food eaten, are anorexia nervosa and bulimia.

• No research studies are available to show the true benefits of long-term weight loss.1

  Short-term benefits of weight loss:

  • In one study patients with non-insulin dependent diabetes demonstrated lower risk for atherosclerosis through reduction of hypertension, hyperinsulinemia, and hyperlipidemia when placed on a 26 day program 2.
  • Studies have also shown that weight loss can lower the risk for hypertension and possibly diabetes mellitus, improve serum glucose control in diabetic clients, decrease blood pressure for hypertensive patients, and improve lipoprotein levels 3.
  • Since 95% of all individuals regain any lost weight within five years, it remains to be determined whether short-term benefits have any lasting effect on health.4

( 1 Gaesser, G. A. (1997). Big fat lies: The truth about your weight and health. New York: Fawcett Columbine.2 Angier, N. (1992, November, 22). Why so many ridicule the overweight. The New York Times, p. 38. 3Ponto, M. (1995). The relationship between obesity, dieting and eating disorders. Professional Nurse, 10(7), 422-425. 4 Fraser, L. (1997). Losing it: America's obsession with weight and the industry that feeds on it. New York: Dutton.)

• You can be very fat and very healthy.
  
  Astudy looked at participants with an average age of 57 who took part in a national cancer prevention study from 1982 through 1996. It found that among the healthiest subgroup of 100,000 people of normal body-mass index (BMI) there were 962 deaths among men per year. With women, this figure is even lower, 682 deaths per 100,000 women per year.

  Now, if we look at the figures for non-smokers who are healthy but significantly overweight, the relative risk factor for death is 2.6 times higher, which at the worse is about 2,600 deaths per 100,000 per year for males, and fewer for women who have high BMIs.

  What this means is that for an individual, the statistics are meaningless. You can be very fat and very healthy. The vast majority of heavy people won’t die prematurely based on this BMI analysis.
  
  One factor that negatively affects all weight groups is smoking, which increases the death risk across all body sizes.
  

• The Center for Consumer Freedom discussed how the three most commonly used statistics associated with the so-called obesity epidemic are all seriously flawed.
  
  
  • 1) that obesity causes 300,000 deaths per year. Already remarked in this page.
  • 2) that 61 percent of Americans are overweight or obese. the assertion that 61 percent of Americans are overweight or obese ignores the 1998 redefinition that took the counterintuitive step of judging men and women by the same standard, and that made 39 million Americans overweight overnight, including the very fit President of the United States.
  • 3) that the economic cost of obesity is $117 billion a year. Most food cops and nutrition zealots say it comes from the Surgeon General, but as CCF's testimony revealed, the original source is a study published in the March 1998 issue of the journal Obesity Research. Announcing the $117 billion figure, the Surgeon General cited this one article.
    
    The Obesity Research study has serious limitations, as the authors themselves admit
    
    The authors also define obesity incorrectly, writing: "The current estimate of the cost of obesity defines obesity as a BMI greater than or equal to 29." Obesity is actually defined as a BMI greater than or equal to 30. Thus the authors erroneously included the economic cost of individuals with a BMI between 29 and 30, which is more than 10 million Americans.

    Finally, the authors acknowledge that even if other data flaws were corrected, their methodology resulted in double or triple counting the costs of obesity
    

    We must also point out that Obesity Research is published by an organization with an interest in making the "obesity epidemic" seem as costly as possible. The North American Association for the Study of Obesity (NAASO) is funded primarily by pharmaceutical companies that would greatly benefit from official "disease" status being conferred on obesity so insurance plans will cover their anti-obesity drugs. Just before the $117 billion study was accepted for publication in the fall of 1997, the president of NAASO admitted: "most of our donations come from a number of pharmaceutical companies.
    
    
• The Growing Up Today Study (GUTS), is a databank of questionnaires about diet, lifestyle habits and health that were gathered from more than 16,000 children, 9 to 14 years of age. Their mothers are from the Nurses Health Study, the huge database of questionnaires gathered since 1976 from over 120,000 nurses.The study has the limitations inherent in population studies, but what makes these two studies from GUTS significant is that the researchers couldn't even find a connection between soda or snack (ice cream, candy, chips, sweet baked goods, etc.) consumption and weight among these kids after 3 years. In other words, fat children weren't eating more sweets than thin children.

  What the GUTS research, led by Allison Field, did find, however, was that regardless of their overweight status, children who dieted gained significantly more weight compared to children who never dieted. This confirms another study these same researchers released last October which found the BMIs of girls who were frequent dieters versus those who never or rarely dieted were nearly 4 entire BMI points higher. This was after they accounted for all the other factors that could have explained the differences, including physical activity, television watching, etc. The researchers concluded their data suggest that dieting is not only ineffective but in the long-run may actually promote weight gain. And, indeed, clinical studies have confirmed just that.

  Perhaps the most significant study to come out this month was the one that got the very least media attention. The results of the DONALD Study (Dortmund Nutritional Anthropometric Longitudinally Designed Study) were released from the Research Institute of Child Nutrition, Dortmund, Germany. This was a small cohort study on 228 nondieting children. The researchers themselves actually weighed the individual children and recorded their diets (the foods, amounts and eating occasions) at least ten times a year and followed them thusly for 17 years. They found that no identifiable dietary patterns during childhood or adolescence could explain their BMIs. While there were great differences in the children's diets, these differences were not related to their weights.

  The GUTS and DONALD studies join a profusion of other studies, both clinical and epidemiological, over the past fifty years demonstrating that fat children and adults as a population normally eat exactly the same as thin people. And regardless of their diets, children will still naturally grow up to be a wide range of heights and body weights. "Multiple researchers, using a variety of methodologies, have failed to find any meaningful or replicable differences in the caloric intake or eating patterns of the obese compared to the non-obese to explain obesity," concluded David Garner, Ph.D. and Susan Wooley, Ph.D., for example, in their review of some 500 studies on weight in Clinical Psychology Review.

  One of the country's foremost obesity researchers, Jeffrey M. Friedman, M.D., head of the Laboratory of Molecular Genetics at Rockefeller University explains that the commonly-held simplistic belief that obesity is just a matter of eating too much and/or not exercising enough is "at odds with substantial scientific evidence illuminating a precise and powerful biologic system." According to his research and that of numerous others, obesity is the result of differences in biology and metabolism, not behavior, diet or the environment. Through their own volition, people can control their weight long-term to a very small degree. Even voluntary physical exercise has minimal effect, according to Friedman and Glenn Gaesser, PhD., exercise physiologist and obesity researcher at the University of Virginia. So, while better access to foods can account for some of the increases seen in the average height and weight of all people in developed countries -- 7 to 10 pounds in the U.S. since 1980s -- it's genetics and not the environment that accounts for the largest proportion of the differences in size among people, Friedman explains.

  "The propensity to obesity is, to a significant extent, genetically determined," he says. Someone genetically predisposed to obesity "will become obese independent of their caloric intake" even when it's restricted to that of thin counterparts.
  
  

• New researchs argue the idea of fatal fatness .
  According to conventional wisdom, excess fat is an important cause of chronic disease, and the epidemic increase in obesity portends a coming health crisis.
  Four recent and forthcoming books by academic researchers argue that in fact the consequences of this trend for public health remain far less certain--and almost certainly less dire--than commonly suggested by obesity experts, government authorities and media reports.

After height, the body mass index is the second most heritable body feature - 30 - 70 % of body size can be genetic.

• The New Paradigm (Non-Diet Approach):
  
  
  

  The Old Paradigm (Conventional Approach)	The New Paradigm (Non-Diet Approach)
  Increased weight believed to be a risk factor for disease under voluntary control, and that losing weight may solve problems with other conditions. Heavier individuals have "out of control eating" and are sedentary. Thinness implies health	Body weight is reflection of multiple physical, emotional, and social influences
  Has evolved naturally out of the perceived need to achieve a lower body weight to reduce health risks.	Enforces culturally-bound expectations that thinness is required for beauty, success, and acceptance. Gives unrealistic and dangerous ideal for people to emulate, particularly women
  Individuals should not accept their weight if it is over "ideal".	Diversity in body size/shape needs to be accepted.
  The mind should override the body's signals for food needs in order to control body size.	. Individuals should eat in response to internal cues to hunger and satiety and should enjoy food.
  Exercise as a mode for weight loss	"Physical activity" terminology should replace "exercise", and includes many enjoyable activities besides regimented programs. Goal should NOT be weight loss

  
  
  
• Cancer and obesity.
  
  According to the authors of a new study published in the New England Journal of Medicine, "more than 90,000 deaths per year from cancer might be avoided if everyone in the adult population could maintain a body mass index (BMI) under 25.0 throughout life." Let us consider their evidence for this proposition. The American Cancer Society study from which the authors drew their data actually found the lowest cancer risk among "overweight" men (BMI 25 to 29.9). This fact was omitted from all the major media stories reporting on the study.

  Furthermore, among the "obese," (BMI 30 +) the increased risk of cancer death was negligible until subjects reached a BMI of 40 and above.
  
  Note that even if cancer was closely associated with increasing weight, it wouldn't necessarily follow that advocating weight loss would be the appropriate response.
  
  "Previous American Cancer Society studies have looked into whether intentional weight loss affects cancer risk," he says. "A 1995 ACS study found that an intentional weight loss among overweight women of one to 19 pounds was associated with a 24% to 62% higher risk of cancer mortality, as compared to equally overweight women who were weight-stable. And a 1999 ACS study found that intentional weight loss among men had no association with decreased cancer mortality. Indeed," he points out, "the 1999 ACS study noted a general association between increased cancer mortality and intentional weight loss."

  "Why have the authors of this latest ACS study not reported any data on intentional weight loss and cancer mortality rates?"
  

  Paul Ernsberger, an obesity researcher at Case Western Reserve University, points out that, even among the extremely obese, the association the study found between weight and cancer mortality was weak. "In a study of this type anything under a two-fold risk is suspect," he says, "especially given the huge number of subjects involved, and the questionable exclusion criteria the authors employed." For instance, the study excluded everyone who had lost ten or more pounds in the previous year, which means dieters were excluded far more often than non-dieters.

  Just as in the war on drugs, the war on fat has reached the point where the systematic distortion of the evidence has become the norm, rather than the exception. The strategies employed in these two wars are strikingly similar: Treat the most extreme cases as typical, ignore all contrary data (there are dozens of studies that indicate cancer mortality decreases with increasing weight), and recommend "solutions" that actually cause the problems they supposedly address. And, as in all wars, truth ends up being the first casualty.
  

• There are no data on fast food and obesity in children
  Shunning dietary fat seems to make sense, in a simplistic sort of way: fat makes you fat.
  Except the data simply doesn't support the link. As total fat consumption among American adults dropped from 1965, obesity rates soared.
  In children, the evidence is absent, as well. Cara Ebbeling, Ph.D., and colleagues at the Division of Endocrinology at Children's Hospital Boston questioned the relationship between dietary fat and fatness in the Aug. 10, 2002, issue of Lancet, noting: "Findings of epidemiological studies do not consistently show an association between dietary fat and adiposity in children and young adults."
  The science also doesn't conclusively support low-fat eating as being healthful for most people, as Gary Taubes' extensive thesis in Science magazine on March 30, 2001, documented. One example among a significant body of evidence against eating low fat is the clinical trials led by Laura A. Corr, M.D., Ph.D., published in European Heart Journal in 1997. Researchers found "little support for such [low-fat] recommendations and it may be that far more valuable messages for the dietary and non-dietary prevention of coronary heart disease are getting lost in the immoderate support of the low-fat diet." In the conclusions, Dr. Corr wrote: "Dietary advice to reduce saturated fat and cholesterol intake, even combined with intervention to reduce other risk factors, appears to be relatively ineffective for the primary prevention of coronary heart disease and has not been shown to reduce mortality."
  A study in the April 1997 American Journal of Clinical Nutrition by Dr. Jorgen Jeppesen and colleagues at the Stanford University School of Medicine demonstrated that low-fat diets in adult women were actually unhealthful, as they raised triglycerides, lowered good HDL-cholesterol, and worsened insulin resistance. Dr. Ronald Krauss, head of the AHA Nutrition Committee, admitted studies have found that for two-thirds of consumers low-fat diets increased the risk of heart disease or didn't help them. Since establishing their 2000 Dietary Guidelines, the AHA has recommended diets moderate in fat intake for healthy Americans.
  For children, there is evidence that restricting fat before age five could be dangerous, while there's little evidence it may be beneficial, said Bruce Watkins, Ph.D., professor of Lipid Chemistry and Metabolism at Purdue University.
  In a 1998 scientific review of all available information, researchers at Purdue concluded that dietary recommendations for adults had been inappropriately applied to children, who have different physiological and growth needs. Not only can low-fat diets retard growth and development, they said, but they may actually stimulate the enzyme that synthesizes cholesterol, which appears to be normally suppressed by high-fat diets. The American Academy of Pediatrics recommends 30 to 40 percent of calories in a normal child's diet should come from fat and there be no restriction in dietary fats before the age of two.
  It's becoming clearer that data simply doesn't link fat intake with a major impact on heart disease, most types of cancer, or weight.

• The genetic reality is that some of us have bodies that are naturally plumper than others. Such individuals are genetically designed to hold onto fat no matter how much they starve themselves
  
  The number of genes, markers and chromosomal regions that have been linked or associated with human obesity is now well above 200, Dr. Miina Ohman at the Departments of Molecular Medicine and Medical Genetics at the University of Helsinki, Finland, has reported.

• Fatness and genetic.
  
  In the August 2000 issue of Journal of Lipid Research, researchers from Israel, London, and Seattle summarized a number of studies that found "some genes are 'switched on' in response to specific environmental factors and remain continuously active." And these genes may not manifest themselves until years later or even subsequent generations.

  A gene currently receiving researchers' attention for its role in obesity is one that codes for lipoprotein lipase, an enzyme produced in fat cells that encourages the body to collect fat and move it into cells for storage. It's also the major enzyme that raises LDL-cholesterol, triglycerides, and lowers HDL-cholesterol. A 1997 meta-analysis of 14 studies, representing 15,000 subjects, in the International Journal of Clinical Laboratory Research not surprisingly linked activation of this gene with heart disease risk. Lipogenic enzymes are potential targets for new research and the future development of some extremely profitable drug therapies for obesity.

  Of particular note to individuals considering going on a diet or those promoting them, this gene appears to be activated by -- dieting. Researchers from Cedars-Sinai Medical Center, Los Angeles, in an April 12, 1990, New England Journal of Medicine study found that lipase levels rose 25 times normal in fat people and stayed elevated for 6 months, long after they'd stopped dieting. This activation is believed to be a reason why those who have dieted gain weight more easily than those who haven't and then have a harder time losing weight again, as the FDA's "Guide to Dieting" published in FDA Consumer, reported in 1991.

  Most diet enthusiasts would be shocked at the idea that dieting can actually cause genetic changes or trigger certain genes to make some of us fatter and endanger our health. But, this knowledge could help explain rising body weights seen during our recent diet-obsessed decades, despite lowered calorie and fat intake and unchanged physical activity levels. Those naturally plump aren't necessarily unhealthy, but compelling them to diet appears to contribute to their health risks.
  

  Why, in the face of a ponderous body of evidence to the contrary do they continue to spread fear about "bad" foods and the dangers of obesity, while espousing thinness, dieting and weight loss?
  
  
• The three major lifestyle factors determine a healthy life:
  • Smoking
  • Quality of diet
  • Physical activity
    
    What is a good diet?
    The first step to eating healthfully is to stop obsessing about it. There are no miracle foods, just as there are no forbidden foods.
    
    Common sense message: Eating the largest variety of foods possible, in moderation and without excluding any food or food group, is the diet that contributes to the healthiest and longest life.

    Fruits and Veggies. Those who don't eat many fruits and vegetables have the highest risks for heart disease, stroke, high blood pressure and cancers, there are hundreds of studies, all amazingly consistent, showing that those who eat the most fruits and vegetables -- a variety of deeply-colored selections -- have half the cancer rate for practically every type of cancer than those eating two or less servings a day.
    

    The third lifestyle factor

    When we're confronted with mountains of studies that show correlations between fatness and health problems, we've learned that doesn't prove cause. After weight-loss diets, which we've seen to be dangerous, the most critical factor most studies don't account for is ... [drum roll, please] ... physical activity or exercise. When fitness is taken into account, weight-related health problems almost always disappear.

    Being sedentary is an independent risk factor for poor health and high mortality, regardless of body weight.
    

    Most fat people have been deterred from active lives out of shame or fear of ridicule, and made to believe that it's pointless to exercise unless they lose weight.

    But weight loss isn't the end goal of exercise. At the American Enterprise Institute's June conference, "Obesity, Individual Responsibility and Public Policy," Gaesser said, "An abundance of epidemiological evidence shows a 20 to 70 percent reduction in all-cause mortality with increased fitness or physical activity, independent of BMI."
    
    In other words, it's much more important to be fit than trim.
    
    Yes, you can be fat and fit.
    
    Exercise does a body good

    • Lower mortality rates.
      Lower cardiovascular disease and high blood pressure
      Reduced triglyceride and HDL-cholesterol levels.
      Lower risks for colon cancer.
      Lower risks for type-2 diabetes,
      Fostered peak bone mass.
      Favorable changes in body fat distribution.
      Relief of symptoms of depression and anxiety.

  low-intensity exercise prevented the notable increases in unhealthy visceral fat seen in sedentary people (women proportionately accumulate twice the amount as men) and enabled them to lower levels by 8.6 percent after just eight months. Increasing the amount of exercise, not the intensity, saw the greatest benefits, according to Cris Slentz, Ph.D.

• Repeated long-term studies and reviews of existing studies in the Journal of the American Medical Association (JAMA) and the Archives of Internal Medicine have tried in vain to prove overweight a risk factor for premature death.

  In fact, the vast majority of studies find weight to be irrelevant to health and mortality, or that being overweight or obese actually appears to be healthier, offering the best prospects for long life.

• Some myths about fatness:
  
  
  • We know that fat people are less healthy than thin people because they are fat. Due to the effectiveness of the diet industry's propaganda, most people treat this assertion as being self-evidently true. In fact, there is no solid scientific basis for this claim.
    
    As the editors of no less an authority than the New England Journal of Medicine have pointed out, "the data linking overweight and death are limited, fragmentary, and often ambiguous." The most basic axiom of the scientific method is that demonstrating a correlation between A and B isn't the same thing as proving that A causes B, or vice versa. Yet, as the editors emphasize, this fundamental rule of scientific inquiry is violated again and again when the subject is the supposed health risks of fat.

    
    For example, we know that fat people are much more likely to be poor than thin people, and that being fat in America today makes a person fair game for the most brazen forms of discrimination. Both of these generalizations have long been true as regards African Americans - yet no rational person would suggest that poor health among black people is caused by their skin color, rather than by such factors as poverty and discrimination
    

  • We know that fat people would be as healthy as thin people if they lost weight. In the words of the editors of the New England Journal: "We simply do not know whether a person who loses 20 pounds will acquire the same reduced risk as a person who started out 20 pounds lighter .. . some (studies have) even suggested that weight loss increases mortality."
    
    
  • Fat people can choose to be thinner. Dieting to avoid getting fat makes exactly as much sense as smoking to avoid getting lung cancer.
    
    The diet advocates have continuously claimed that by eating less, and less fatty foods, we could all be slim. Americans listened. According to the U.S. Department of Agriculture (USDA) Center for Nutrition Policy and Promotion, total caloric intake, as well as total fat intake, steadily decreased from 1965 to 1990. During this period, obesity increased dramatically, Steven Blair, P.E.D., president of the Cooper Institute noted in a February 2002 Mayo Clinic Proceedings. "The prevalence of obesity," he concluded, "is unlikely to be due to increases in daily energy intake."

    We're not the only nation to realize that weight gain can't be explained simply by how much people eat. Between 1980 and 1991, the number of heavyweights in England doubled, while Britons were eating 10 percent fewer calories, according to their government.

  • Fat people are gluttons.

  Many fat people eat the same or less than thin and normal weight people. The Healthy Eating Index, the nation's report card on how Americans are eating, compiled by the U.S. Department of Agriculture Center for Nutrition Policy and Promotion, found little or no correlation between weight and caloric intake. Those with BMIs ("body mass index," a measure of weight relative to height currently used to categorize size) under 20 ("ideal" figures in the media) have similar calorie intakes as those greater than 30 (considered obese), as do people at all the BMIs in between.

  Multiple researchers, using a variety of methodologies, in the American Journal of Clinical Nutrition and the Journal of Applied Behavioral Analysis have failed to find any meaningful or replicable differences in the caloric intake or eating patterns of the obese compared to the non-obese to explain obesity.
  
  

• Eating disorders.
  
  Among the causes for them listed by the Eating Disorder Referral and Information Center of the International Eating Disorder Referral Organization and the American Academy of Pediatrics (AAP) are:

  · Cultural pressures that place extreme value on thinness and obtaining the perfect body.
  · Persistent messages encouraging dieting.
  · A history of being ridiculed because of size or weight.
  · Preoccupation with eating and weight.
  · Unrealistic expectations for achievement.
  
  By age 10, 81-percent of girls have disturbed eating -- are afraid to eat and feel guilty when they do.
  
  Young people resorting to unhealthy weight loss methods have stronger likelihoods of engaging in other problem behaviors such as drug and alcohol use, school delinquency, unprotected sex, and with suicide attempts, according to the University of Missouri.
  
  Anorexia is the third most common chronic illness among American teens, states the USDHHS Office on Women's Health. Bulimia is 20 times more common still, affecting 8 to 20 percent of young women, according to the AAP. Together they have the highest premature mortality rates of any psychiatric diagnosis, reported Dr. Pauline Powers, founding president of the Academy for Eating Disorders.

  Drs. Jerome Knittle and David Katz of Mount Sinai School of Medicine in Total Nutrition (St. Martin's Griffin, 1995) said 10 to 15 percent of anorexics die of starvation or related problems, including heart or kidney failure, and another 2 to 5 percent commit suicide. They're 12 times more likely to die than the general population of similar ages, according to a study published in the New England Journal of Medicine, April 8, 1999. It's estimated that in the United States alone as many as 150,000 die annually from eating disorders
  

  In March 2000. Americans spend somewhere between $30 and $60 billion on diets and weight-loss products each year.
  
  
• The Internal Revenue Service has just decided that being fat is a disease, and that therefore "obese" people will now be able to claim some weight-loss expenses as medical deductions.
  
  
  • The whole concept of "obesity" is based on the notion that, after adjusting for height, everyone's weight should vary no more than about 15 pounds from a theoretical ideal (the government claims your weight is a medical problem if you don't have a body mass index between 20 and 25, which for a woman of average height means weighing between 117 and 144 pounds). There is no scientific basis for this claim: basically, it's something the $50 billion-a-year American weight loss industry made up to justify pushing their fraudulent cures for an imaginary disease. Saying everybody should weigh within 15 pounds of an "ideal" weight is just as ridiculous as claiming that everybody should be between 5-foot-8 and 5-foot-11 tall.
    
    
  • Attempts to lose weight do far more damage to health than all but the most extreme levels of fatness. . In other words, the federal government has just created a multibillion-dollar-a-year subsidy for an industry that is actually creating the health problem it is claiming to cure.
    
    
  • At least 8 million Americans currently suffer from eating disorders. The best known of these, anorexia nervosa, has by some estimates a mortality rate of 20 percent. Declaring fat to be a disease will help ensure that many more Americans will quite literally starve themselves to death.
    
    Fat doesn't kill, but the prejudice and hysteria surrounding the subject certainly does. And the federal government's use of the tax code to further fuel that hysteria is only going to make a bad situation worse.
    
    
• Diet pills
  

  The evidence demonstrates that they don't work any better than dieting.
  
  And their side effects can be anything but healthy. Researchers at the National Institute of Mental Health found widely prescribed diet pills resulted in irreversible loss of brain nerve terminals, possibly resulting in depression, memory loss, cognitive and sleep problems, and psychiatric disorders, according to a Sept. 26, 1997, HHS press release.

• Weight Loss Surgeries (WLS )
  
  Sadly, most patients get their information from the media and those with vested interests in the surgery. If the evidence was better known, it's unlikely as many would rush to gamble with their lives in exchange for a remote chance to lose weight from a procedure that is:
  
  
  • Experimental, with very little research to support it.
  • Unlikely to make you much thinner in five years.
    
    Smith's group compiled medical research on WLS and found that "10 percent of patients don't lose any weight at all. ...Those more than 200 pounds overweight have only an 8 percent chance of getting down to [within 130 percent of their 'ideal' body weight ]. ... One in 10 loses the weight and keeps it off." The truest picture of the surgery's success and catastrophic complications isn't found in patients during the first few honeymoon years after their surgeries, she said, but after five or more years. But, just try to find them.
    
    A 1999 gastric bypass study that found only 7 percent of patients kept off all the weight they initially lost, only slightly higher than the stated success rate for dieting, which is 5 percent.
    
  • Unproven to be more effective than a diet.
  • The most dangerous surgery performed, besides open heart, regardless of whose numbers you believe.
    
    The 2000 Mayo Clinic study on gastric bypass reported that 20 to 25 percent of the patients developed life-threatening complications within five years, in addition to a 10 percent morbidity and mortality during the post-op period.
    
    The chances of dying from the surgery even before leaving the hospital "reliably range from 0.2 to 2 percent," said Ernsberger. Surgeons often give the lower numbers, he said, but "they exclude deaths they feel are unrelated to the surgery, which would appear to be almost all of the deaths they see."
    
    Long-term mortality data is especially hard to obtain. Analysis is complicated by the fact that many don't attribute deaths from long-term complications, such as liver cirrhosis, to the surgery, and usually categorize death as "due to obesity" or lump them into the "lost in follow-up" category, Ernsberger said. "The bottom line," he said, "is that NOT ONE randomized clinical trial has ever been reported that gives mortality data."
    
    risk of dying after these secondary operations is three times higher than for the initial surgery. More than one-third develop gallstones and nearly 30 percent of patients develop nutritional deficiencies that can result in anemia and bone disease, arthritis, compromised immune system and hair loss.

    Malabsorption operations also carry a notable risk for dumping syndrome, it said, which causes nausea, sweating, fainting, and diarrhea after eating. The more extensive the bypass the greater the risks for complications and nutritional deficiencies, stated WIN, and patients will "require close monitoring and life-long use of special foods, supplements and medications."

  • Permanent; you'll never be normal again.
    
    WLS causes nutritional deficiencies in nearly all patients.
    
    Most WLS survivors can only eat 500 to 1,100 calories a day for the rest of their lives, much of the nutrients in their foods aren't absorbed, and they must forever eliminate certain foods, such as meats, starches and dairy, from their diets because they can't be digested.
    
    Just like anyone else on a starvation diet, WLS survivors become obsessed with food. What's rarely mentioned is that WLS often leads to serious eating disorders.
    

In women with BMIs of 40 and above, their life expectancy is reduced by 5 years, Ernsberger said. "Yet these extremely obese women still have a longer life expectancy than normal-weight men."

• One of the most comprehensive analyses of the relationship between body weight and mortality ever published was done by researchers at the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics and Cornell University in 1996. Studying data on more than 600,000 men and women for 30 years, they found the lowest mortality for men was at BMIs 23 to 29, mostly weights considered overweight (by up to 50 pounds!) under current guidelines. They also found the highest mortality in BMIs under 23, comparable only to those who were the most extremely overweight. It was riskier to be slim than moderately obese. In women, a wider range of BMIs was perfectly healthy and mortality rates didn't begin to rise until BMIs reached 32 and beyond.

  Another study on women, led by Kevin Fontaine, Ph.D., of John Hopkins University, concurred that a broad range of weights were well-tolerated, and found mortality risks were actually lowest at a BMI around 34.

• Factors in weight gain:
  
  
  • Among such possible contributors are certain prescription meds, hormones, viruses, stress and fatigue
  • Dieting has a much more significant role in increasing body weights and in increasing health risks among fat people than is currently spoken of in our diet-obsessed culture. The link between dieting and obesity is well documented by sound research using a variety of methodologies, and by our nation's most reputable institutions and researchers.
  • Obesity's genetic component, ridiculed by many, has been determined to be the most significant, according to decades of sound study. The series discussed some of the research demonstrating the strong inheritability of obesity and the nearly 300 genes, markers and chromosomal regions that have already been linked to human obesity, and some of their possible triggers, such as starvation/dieting.

• Dieting
  
  Among girls who diet their risk for obesity is 3.24 times greater than for nondieters. Dieting among adults is similarly associated with an increased risk of long-term weight gain, according to studies by Allison Daee, R.D., and colleagues at the University of Missouri.
  The larger and more rapid the weight loss, the more profound and rapid the weight regain, according to research headed by Albert Stunkard, M.D., professor of psychiatry at the University of Pennsylvania School of Medicine and founder of the Weight and Eating Disorders Program.
  
  Dieting Builds Fat, our bodies are designed to adapt to stress. We stress our body by dieting and make it think it's nearing starvation, forcing it to break down fat to supply the energy we need for survival. Afterwards, as soon as the body's given any nourishment above starvation levels, it biologically reacts by putting on more fat, holding onto fat more vehemently, and conserving more of what we eat thereafter as fat.
  
  How can diets do all that? Diets appear to change a number of biological processes, and trigger fat-storing mechanisms, that are outside the dieter's control. Dieting does so especially intensely among those dieters genetically designed for survival during lean times. So, those with weight problems are not only most likely to diet, but also to suffer from the most detrimental physiological changes brought on by dieting.

  Multiple researchers have found that weight loss with dieting is at the expense of muscle mass and vital organs such as brain, heart, kidney and liver. In Clinical Nutrition and Dietetics (Prentice Hall, 1990), Frances Zeman, Ph.D., R.D., documented that skeletal muscle protein is broken down for energy at about 0.8 pound lean tissue per day during the first five to seven days of a low-calorie diet, and drops to a rate of about a quarter pound per day thereafter. The body then holds onto fat and eventually breaks it down at a much lower rate of 0.4 pound per day. Thus, up to 45 percent of weight loss from dieting comes not from losing fat but from the body cannibalizing its own muscle tissue, according to experts in Exercise and Sport Science Reviews (Academic Press, 1975).

  Worst of all, our diet-triggered survival propensities mean that weight then regained after dieting is preferentially as fat. Studies have shown it's largely gained as visceral fat around our organs and in the upper torso, which is associated with the greatest risk for heart disease, high blood pressure and type II diabetes. After dieting, especially repeated dieting, formerly fat people may look and weigh the same as naturally lean folks, but have high percentages of body fat -- technically they're still obese!

  Dieting completely alters fat metabolism, not just by changing the percentage and composition of body fat.

  As we've seen, it also hampers our ability to lose it again, and it raises insulin levels. (Insulin is the fat-building hormone, encouraging fat storage and resisting fat break down. High insulin levels prelude high blood pressure, abnormal blood cholesterol levels and atherosclerosis.)
  
  After dieting the lowered metabolism often doesn't return to its former level, so that with normal food intake the post-dieter quickly gains weight even more quickly than before. They documented studies finding people unable to eat more than 800 to 900 calories a day -- starvation levels, according to the World Health Organization -- after dieting, without gaining weight.
  A 1996 review of the National Weight Control Registry of successful long-term weight losers found that in order to maintain weight loss these people had to eat near semi-starvation levels, even though most were also exercising religiously. The average woman was eating 1,297 calories a day and the average man 1,725 calories, almost half of what would be considered normal for good health.
  
  What's been discovered to date concerning the causes of obesity leaves little doubt that it's much more complicated than it appears and considerable more research is needed.
  
  Even if obesity is a problem, many researchers question the concept that dieting or weight loss is the cure. Changing how someone looks on the outside will not change what's going on in the inside, nor will it change whatever health risk factors may be linked to his or her genes.

  Yet, obesity is the only condition we look to treat simply by changing appearances without addressing the physiological or genetic factors inside.

• Before the diet mania, the average American woman took in 3,000 to 5,000 calories a day; today that average woman eats less than 1,600 calories daily and is on some type of weight loss program, according to Frances Berg, M.S., in Women Afraid to Eat -- Breaking Free in Today's Weight-Obsessed World (Healthy Weight Network, 2000).

• Fat Epidemic.
  
  The science behind this hysteria merits examination:
  
  
  • First, during the recent period of growth in obesity in Western countries food intake decreased. Our reward is increased obesity.
    
    
  • Second, World Health Organization data show that the countries with the fattest children are Uzbekistan, Kiribati, Algeria and Egypt. These are all countries in which fast, 'sinful' foods are rare or non-existent. The rate of childhood obesity in the UK is about half that in many countries that are not afflicted with such 'dissolute' eating habits. The rate of childhood obesity in the USA is the same as that in Burkina Faso, one of the very poorest countries in the world. Thus the main premise of the anti-obesity lobbying is based on a fundamental misunderstanding. Dietary indulgence is not to blame for the rise in obesity. The indictment of fats, sugar, salt and fast foods is based on folklore, not science.

    Generations of nutrition research have done little to define what an ideal, healthy human diet is. Instead, this research has shown that the extraordinary diversity of humanity makes such a notion absurd. Rather than admit this simple truth, ideologically driven nutritionists insist that our very survival depends on making sweeping changes to our diet. It bears remembering, that a generation ago the same authorities were urging us to eat more meat, fat and dairy products. Then they were health foods. Now they are telling us that their last round of advice is killing us but that this time they've got it right.

    Even ignoring the poor science on which the anti-obesity initiative is based, there remains another daunting and well documented problem. The history of community-based nutritional improvement programs has been one of unrelenting and costly failure. All around the world, governments have tried every trick in the book, recruited legions of experts, and spent billions along the way. There is not a single case where the intervention has been a solid success. In contrast, there are many instances where the intervention made things worse.

    In the government's haste to save children from themselves, they will make them more fearful, more ignorant and more contemptuous of authority. Those who are overweight will suffer the consequences of being further stigmatized. Worse, the increased hysteria is likely to make them fatter, not thinner. There is sound evidence that chronic mild stress causes metabolic changes that promote weight gain. Our kids are fat and frightened. The government is about to make them fatter and more frightened.

• Professor argues 'obesity epidemic' is a myth

He says he was like the rest of us — until he started doing some research. The conclusion of the University of Chicago political scientist: The people with the most to gain from our constant obsession over our weight are the weight-loss industry and diet doctors.

"Based on the statistics, most of the charges saying that obesity caused various diseases or that obesity caused thousands of deaths were simply not supported," Oliver says in his book of his findings.

Oliver, an associate professor of political science at the University of Chicago, was traveling out of the country recently but took the time in an interview via e-mail to separate fat facts from fiction:

Chicago Tribune: In your book, you argue that America does not have an obesity epidemic. Most people would disagree with you.

Eric Oliver: No one would deny that Americans have gotten fatter over the past 30 years, but that's different from saying we have "an obesity epidemic." To say we have an obesity epidemic means that this weight gain is a threat to a large number of Americans or that it is a spreading disease. However, the scientific evidence is simply not there that most people who are either "overweight" or "obese" are in any danger directly from their weight.

The average American adult is between 8 to 12 pounds heavier today than in 1975. Because overweight and obesity are defined at such low levels, this small average weight gain has translated into large percentages of increase in the number of people considered "overweight" or "obese."

In your book, you argue that the perception that Americans have ballooned in size is largely a myth pushed by the weight-loss industry and diet doctors. Explain.

A small number of doctors and pseudo-scientific health organizations, like the International Obesity Task Force, have worked, with substantial financial backing of pharmaceutical companies and the diet industry, to lower the thresholds of what is considered "overweight" and "obese," even though there was no scientific basis for saying that someone with a BMI (body mass index) of 25 is at any risk because of their weight. They have also lobbied the government to get obesity considered a disease and to make certain weight-loss treatments tax deductible. Nearly every prominent obesity "expert" has been financed or supported in some way by the weight-loss industry.

How did our idea of a "healthy weight" change?

Until a report by the (National Institutes of Health) (authored largely by the groups mentioned above), "overweight" was a BMI greater the than 27 and "obese" was a BMI greater than 32. After the 1998 NIH report, suddenly tens of millions of Americans became "obese" even though they hadn't gained a pound. For example, George Bush and Michael Jordan are both overweight (under current standards) but nobody would say their weight is a problem.

Of course, at very high levels of weight (say over 300 pounds on most people), there are some health-related problems that come from weighing too much, such as osteoarthritis and some cancers, but that is a much smaller portion of the population. For most people who are technically overweight or even obese, there is no scientific evidence that their excess adipose tissue (i.e. fat) is an immediate danger.

In your book, you seem to be advocating that Americans should focus more on diet and exercise and less on the number on the scale.

Yes. There are two reasons why weight is a bad thing to focus on:

1. Studies have shown that people who are heavy and fit are far healthier than people who are thin and never exercise.

2. We do not have a safe or effective mechanism for most people to lose weight (if we did, you can bet most people would be using it). In the absence of such a mechanism, telling people that being thin is being healthy only encourages them to engage in dangerous behaviors like yo-yo dieting or taking dangerous weight-loss pills.

But isn't being overweight a bad thing in any case?

No. Many people are naturally heavy (my grandmother lived to be a vigorous 98 and was technically obese her whole life).

Telling us that we all need to be thin, particularly when most of our bodies resist losing weight, is simply setting most people up for feeling bad about themselves and engaging in dangerous weight loss techniques.

You also say the distaste with "fatness" has less to do with health and more to do with other issues.

In our culture, fatness is seen as a sign of being lazy, poor and of low status. Given the prejudice that we have against fat people, it is all too easy to also think that they must be sick.

Indeed, this is what I thought when I started this research. It was only after looking at the scientific evidence that I saw how my views on this were shaped more by my own prejudices than by any facts.

How would you describe your own weight and fitness level?

I'm 6 feet and 190 pounds, which makes me technically overweight although I have completed several triathlons and would be, by most accounts, considered very fit.

What was your reaction to Chicago Chicago's recently being named the "fattest city" by Men's Fitness magazine?

That distinction seems to go from city to city (Detroit, Philadelphia and Houston have all had it). Personally, I think it's a cheap way to sell magazines.

• Exercise to lose weight.
  
  One of the misconceptions about exercise
  • Most of us think we have to be thin to be in shape and see health benefits
  • We believe we have to sweat and burn or exercise isn't doing us any good
  • We're convinced fat people aren't exercising.
    
    It's all false.
    
    In the fight against the "obesity epidemic" we are inundated with diet and exercise programs. But when exercise is promoted primarily in terms of weight loss, and being "in shape" as defined solely as being thin, it can discourage people from making activity a life-long habit. For many the weight loss part can be elusive even when working out at the recommended healthful levels, and after a while they don't see the point. Thin people with no interest in losing weight think they're exempt from the need to exercise. It's hard for many of us to separate exercise from the goal of weight loss and to exercise simply for the health of it, but it's an important health message we can all benefit from.
    

    In fact, a just released 17-year study of almost 9,800 Americans found exercise and eating more was a better defense against heart disease deaths than exercise and restricting calories.
    ( http://www.hbns.org/news/exercise11-04-03.cfm)

• Graves riesgos de cirugía para eliminar obesidad [18_11_2005]
  
  CHICAGO - Las posibilidades de morir tras un año de ser operado de gastroplastia, una intervención quirúrgica para reducir la obesidad, son mucho más grandes de lo que se había pensado previamente, inclusive entre personas en la treintena y la cuarentena, indicó un estudio en que se analizaron más de 16.000 pacientes.

  Algunos estudios previos de personas entre su treintena y su cincuentena determinó que las tasas de mortalidad eran inferiores al uno por ciento.

  Sin embargo, en el estudio del gobierno estadounidense, que examinó personas entre los 35 y los 44 años de edad, más de un 5 por ciento de los hombres y casi un 3 por ciento de las mujeres habían fallecido antes del año. Tasas ligeramente más altas se registraron en pacientes de entre 45 y 54 años de edad.

  Entre pacientes de 65 a 74 años, casi un 13 por ciento de los hombres y un 6 por ciento de las mujeres habían fallecido.

  "El riesgo de muerte es muy superior a lo que se había informado", dijo el cirujano David Flum, de la universidad de Washington, quien lideró el estudio de los pacientes de Medicare, el sistema de salud público de Estados Unidos.

  El estudio involucró a 16.155 pacientes que fueron sometidos a gastroplastia entre 1997 y el 2002. Será publicado el miércoles en la revista especializada Journal of the American Medical Association.

  Los investigadores agruparon todas las muertes, sin diferenciar entre las causas. Pero entre las letales complicaciones de la gastroplastia figuran desnutrición, infección, y problemas de los intestinos y de la vesícula.

  Flum dijo que algunas investigaciones previas sobre la seguridad de ese tipo de operaciones consistían en "informes de los mejores cirujanos que dieron cuenta de los mejores resultados". En cambio el nuevo estudio es un análisis de un mundo más real, indicó. Según David Zingmond, uno de los autores del estudio, algunas personas consideran que la cirugía contra la obesidad es un recurso simplemente cosmético y, lamentablemente, descartan la posibilidad de que sufrirán complicaciones después de la intervención.

  La Sociedad de Cirugía del Estómago de Estados Unidos pronostica que se harán alrededor de 150.000 operaciones de ese tipo en el país durante el 2005,diez veces el número registrado en 1998.

• La mortalidad por cirugía de la obesidad en España es cinco veces superior a la de EE.UU., según la comparación entre dos estudios.
  
  La técnica del "bypass" gástrico es la más utilizada, con un 80% de casos. Sin embargo, las tasas de mortalidad y de complicaciones en el postoperatorio son unas de las más altas en cirugía.
  
  Una investigación que publica el último número de la revista de la Asociación Médica Americana (JAMA) analiza las operaciones de cirugía bariátrica que se realizaron en Estados Unidos entre 1998 y 2002. Y llegan a conclusiones sorprendentes si se comparan con España. La tasa de mortalidad estadounidense en esta cirugía se ha duplicado, pasa del 0,1 al 0,2%, cifra cinco veces inferior a la española. A mediados de 2004, la Agencia de Evaluación de Tecnologías Sanitarias, organismo dependiente del Instituto de Salud Carlos III, valoró las operaciones que se habían realizado entre 2000 y 2003. El resultado en estos cuatro años fue de 5.231 intervenciones y 57 fallecimientos, por lo que la tasa de mortalidad se situó en el 1,07%.

  El estudio español revelaba que la tasa de mortalidad en nuestro país era una de las más altas si se comparaban trabajos realizados en Suecia, Italia, Canadá y Estados Unidos.
  
  También advertía de que tanto el número de intervenciones realizadas como los índices de defunciones podrían estar estimados a la baja.

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