Two-thirds are overweight, and we're still debating?
The prevalence of obesity has increased in every corner of the world. Fully two-thirds of adults are overweight or obese, and rates in children have more than tripled in the last 30 years. Obesity, diabetes and a cascade of other diseases are affected by styles of modern living, in particular poor diet and physical inactivity. Permitting the status quo invites disease, disability and suffering beyond what healthcare systems can handle.
It is sad that we debate this issue at all, but it is part of a predictable cultural script. The media strive to present two sides of every issue, even if one side is held by only a few people. Enter the contrarian -- the press needs someone to disagree. Some questioned Newton's law of gravity long after it was clear he was right. Today a handful of people claim that global warming is a myth and that cigarettes do not cause lung cancer. The contrarians make themselves even more newsworthy by adding in conspiracy claims that profits or fame drive their opponents and that some "establishment" suppresses the truth.
One can always, always find contrary studies, even in cases such as obesity, in which a large and compelling body of scientific evidence shows that it is a prevalent, growing and dangerous global health problem. When a great many studies are done, some will show negative results by chance alone or by virtue of weak methods.
So we continue debating whether obesity increases risk for medical, social and economic disadvantage, distracting us from a more important question -- what can be done? You and I do agree on a key issue -- that treating obesity is costly and difficult. The problem screams out to be prevented, leading to a conclusion we both embrace -- diet and physical activity must be improved. This conclusion is easily reached. The real challenge is to identify ways to stimulate these changes on a massive scale. More on this later in the week.
I agree with you that there is a pervasive stigma directed at overweight individuals and that the bias and outright discrimination it generates should cease. I stand shoulder to shoulder with you in fighting for this end. Studies have shown clear patterns of discrimination aimed at overweight people in employment, education and healthcare. My colleagues and I hear a continuous stream of heartbreaking stories from people teased and bullied as children - the damage lasts a lifetime.
I have heard you say that fighting obesity by definition fights obese individuals and hence contributes to the stigma. We must prevent this, I agree, but we can fight a disease while protecting those who have it. There are many parallels. We deplore AIDS as a disease but have compassion for those who contract it. We can battle depression, alcoholism and cancer but fight for the rights of those who suffer. People with weight problems deserve kindness, compassion and the same civility afforded all citizens. The nation seeks to reduce rates of cancer, depression, alcoholism and AIDS and must take a similar stance with obesity.
Kelly D. Brownell, PhD is a professor of psychology, epidemiology and public health at Yale University, where he serves as director of the Rudd Center for Food Policy and Obesity.
Homosexuality was once a 'disease' too
The history of medicine is littered with examples of imaginary diseases and arbitrarily defined pathologies. One need not refer to such once eminently respectable fields of academic research as phrenology or eugenics when more contemporary examples come so readily to mind. Consider that a generation ago the medical world's consensus view was that same-sex attraction was a serious mental illness that cried out for effective "treatment." This is merely one example of how socially marginal people are stigmatized by being defined as sick or crazy or otherwise defective.
Now "obesity" (defined by our public health authorities as a body mass index of 30 or higher) has been transformed into a disease. In fact, except at statistical extremes, the correlation between weight and health risk is weak or nonexistent. The vast majority of Americans who the government defines as weighing too much have, on average, as good or better health than the scientifically baseless "normal weight" category of BMI 18.5 to 24.9. This is confirmed by the overwhelming bulk of the epidemiological evidence. The studies that find a strong correlation between increasing weight and health risk are the true outliers - and they produce these correlations by highly dubious statistical methods, such as by excluding 90% of the deaths in their studies.
The current claims about what long-term consequences increasing average body mass has for public health are, almost word for word, the same claims American public health authorities were making in the 1950s, when the New York Times featured stories with headlines such as "Overweight: America's Number One Health Problem." And indeed by current definitions, 45% of the American populace was either overweight or obese in 1960.
It should be unnecessary to point out that all those predictions turned out to be not merely wrong but represented the precise opposite of what has since happened. Life expectancy and overall health are far better now than they were 50 years ago, while rates of heart disease, stroke, cancer and almost all the other diseases for which body fat is being blamed have plunged. (Diabetes is to some extent an exception, but even the CDC's own data fail to show that diabetes rates have risen over the last 20 years.)
As for discrimination, I admire the work you've done documenting the astonishing levels of prejudice and bigotry people (and especially white women) who aren't thin face in this culture, but one does not combat stigma effectively by continuing to advocate the search for a final solution to the continued existence of the stigmatized group.
After all, there are plenty of well-meaning, sincere people in our culture who have great compassion for those among their fellow citizens who suffer from the "disease" of same-sex attraction. And they are eager to help.
I note, too, that biological sex is a far better predictor of mortality risk than fatness, and that castration extends life expectancy in large mammals. Thus, unlike the "obesity epidemic" there is a ready solution to the "masculinity epidemic" - but perhaps some diseases aren't worth curing.
Paul Campos is a professor of law at the University of Colorado, and a syndicated columnist for Scripps Howard News Service. His most recent book is "The Obesity Myth: Why America's Obsession with Weight is Hazardous to Your Health."