The Obesity "Crisis"

Spurlock writes:

The United States is the fattest nation on earth. Sixty-five percen of American adults are overweight; 30 percent are obese. According to the American Obesity Association, 127 million are overweight, 60 million Americans are obese and 9 million are "severely obese." In the decade between 1991 and 2001, obesity figures ballooned along with our own figures: from 12 percent of us being obese in 1991 to 21 percent in 2001. Almost double. In ten years. (p. 10)

It's important to note before debunking this that Americans have, on average, put on eight to ten extra pounds over the last 25 years. It's also important to note that in spite of that, we're healthier than we've ever been in the history of the country.

Now to the debunking. A huge part of the "ballooning" Spurlock speaks of has nothing to do with overeating. It's due to the fact that in 1998, the U.S. government redefined what it meant to be obese. The Centers for Disease Countrol lowered the bar. One magic night in 1998, then, 29 million Americans went to bed of "normal" weight, and woke up "overweight" -- without ever gaining a pound. Millions more went to bed "overweight," and woke up "obese." That's not the fault of McDonalds or Frito lay, or Baskin-Robins. It's the result of an alarmist government moving the goalposts to manufacture hysteria. My favorite quote comes from a Washington Post, written shortly after the decision...

"… 97 million adults -- nearly 55 percent of the U.S. population -- would be considered overweight, placing them at increased risk of such health problems as diabetes, elevated blood cholesterol, heart disease, stroke and high blood pressure."

Of course, none of these people's risk for these conditions increased overnight. The government merely drew a largely arbitrary line, and announced that one side of that line would now be healthy, and the other side wouldn't.

Of course, all of these statistics flow from the Body Mass Index, or BMI. BMI is by and large a completely arbitrary measure of health. It doesn't account for age, sex, gender, body type, or ethnicity. It also doesn't distinguish between fat tissue and muscle tissue (the latter is more dense). By now, you've probably heard about how big, muscle-bound athletes are classified as "obese" by the government. By BMI standards, more than half the NBA is obese or overweight. But in fact, any person who works out regularly is likely to fall into the "overweight" or "obese" categories. According to the government, for example, Johnny Depp is overweight. And Tom Cruise is obese. If your build is similar to theirs, you're probably obese or overweight, too (if you're wondering, the government considers me obsese, too -- here's a recent picture). Should give you an idea of how specious a tool the BMI really is.

Look at it this way: Muscle mass is denser than fat mass. If you've ever started a regular workout regimen after a few months of inactivity, you'll know that your weight tends to go up, not down, after the first few weeks. You're building muscle. Which means if ten people of normal build who don't exercise joined a gym, their collective BMI would go up, not down. But they'd be adding to the overweight-obesity statistics.

On it's own website, the Centers for Disease Control writes:

Two people can have the same BMI, but a different percent body fat. A bodybuilder with a large muscle mass and a low percent body fat may have the same BMI as a person who has more body fat because BMI is calculated using weight and height only.

[...]

This is a good reminder that BMI is only one piece of a person's health profile. It is important to talk with your doctor about other measures and risk factors. (e.g., waist circumference, smoking, physical activity level, and diet.)

The CDC's accompanying table shows a sketch of an obviously flabby man and obviously very fit man and admits that according to the government's method of calculating obesity, there is no difference between them. Remember, when people like S purlock say things like "127 million Americans are overweight," this is how they're arriving at those figures.

If the CDC advises against using BMI as the sole indicator of overall health on an individual level, why are we using BMI and only BMI to gauge the overall health of the nation? And why are people like Spurlock throwing these numbers around in an effort to influence public policy?

Spurlock mentions the American Obesity Association. For someone so skeptical of the motivations of corporations, I'm surprised he didn't do a bit more research on AOA.

Just last week, the Seattle Times ran a report on how and why the BMI was lowered in 1998. Guess who was behind it? the American Obesity Association. And a plethora of nutrition activists, drug companies, and professional scolds who had a stake in getting the government to call more of its citizens fat. Writes the Times:

In May 1995, the National Institutes of Health (NIH) asked 24 experts to write guidelines for diagnosing and treating obesity. The expert panel officially defined obesity as a BMI of 30 or higher, and overweight as a BMI above 25 and below 30. The panel, which included the pharmacologist who created the phen-fen combo, was criticized for its ties to the drug and weight-loss industries.

[...]

At the hearings, Interneuron presented data showing an obesity pandemic and said desperate measures were required to stop it from prematurely killing 300,000 Americans a year.

That controversial figure came from weight-loss experts and researchers who used epidemiological data from decades-old health studies to build the case that excess body fat was a crisis more urgent than even AIDS.

[...]

Also at the hearing was a newly formed group, the American Obesity Association, which built a case for treating obesity as a chronic disease. Funded largely by drug companies, including two involved with Redux, the association was headed by Dr. Richard Atkinson, an internist who advocated gastric bypass for severe obesity and who later founded a company to test for what he believed might be an "obesity virus."

At the hearing, the association positioned itself as a patient-advocacy organization, though it offered no patients to testify for the drug.

There is some evidence that extreme, morbid obesity is on the rise, though it still affects a realtively small percentage of the population. No one is advocating morbid obesity, here. But the idea that we as a nation putting on pounds, and spiraling toward a health care catastrophe just isn't supported by the facts. And when you read somewhere where it seems to be, odds are, the facts you're reading were manufactured and pushed by agents with a financial stake in promoting the hype, agents like the American Obesity Association. Even the Center for Science in the Public Interest, whom Spurlock consults thoughout the book and which is always eager to hype the obesity "threat," doubts the integrity of AOA. Center for Consumer Freedom (disclosure: a food industry-funded group) sheds light on AOA here.

NOTE: A commenter points out that my link to Tom Cruise pointed to a lookalike photo. Here's a picture of Tom Cruise. Not that it does much to undermine the point.

Comments

[Kevin B. O'Reilly]

http://www.cato.org/people/images/hires/balko-hires.jpg

I guess Atkins isn't working for your fat ass!

[Brock Tice]

I'm no fan of Morgan Spurlock, but as a biomedical engineer I can tell you that the more you weigh, discounting those that exercise quite frequently, the more health problems you will have.

You don't have to look around too much these days to see people that are obviously overweight due to fat, not muscle. I'm still a few points over a 'safe' BMI of 25, but I'm getting my numbers closer. I used to be a lot heavier.

Learning (in my studies as a biomedical engineer) about all of the health problems associated with overweight scared me into doing something. I also now exercise several times a week.

Is Spurlock exaggertaing and possibly nuts? Sure. However, don't discount the problems with overweight and obesity because of one crackpot.

[Van]

Spurlock certainly exagerates, but I think you're being overly dismissive of BMI and what it tries to do. As you mentioned, morbid obesity seems to be the only level that has very obvious direct links between weight and disease. It seems that being "overweight" or "obese" in itselt does not directly cause a huge jump in disease. What does cause disease, and what are very strongly correlated to "overweight" or "obese" BMI levels (because let's face it, a very small percentage of the US populace is anywhere near NBA player or Tom Cruise fitness levels)are poor eating habits and lack of exercise. And while perhaps the BMI rhetoric has become overblown, there's a good chance some of this hysteria is having a positive effect on American habits. Would, for example, McDonald's have introduced salads to their menu without the growing obesity controversy of the last few years? Possibly, but unlikely. I really have no idea whether there has been a positive effect on exercise habits, but I certainly can't imagine a negative one. I guess my point is, some positive effects have come out of BMI, and off-hand I can't think of any negative ones.

And finally, the quote, "It's also important to note that in spite of that, we're healthier than we've ever been in the history of the country." Exactly, in spite of weight gains--ie, we would be even healthier without the weight gains. Drugs and medical science are great, but so is simple behavioral prevention. And a lot cheaper too.

[Radley Balko]

Sorry, but that's just not true. People who are underweight actually die early at the same rate as people who are morbidly obese.

And the latest research from the CDC shows that there are no significant health risks associated with a BMI of 25 to 35. In fact, there are heath *benefits* to modest overweight (25 to 30). People in this range are least likely to die before average life expectancy.

This uggests that the "ideal" weight is quite a bit higher than what the government says it is.

[monty]

That isn't a picture of Tom Cruise. It's a look alike.

http://www.splitting-images.com/tom_cruise.html

[josh]

"You don't have to look around too much these days to see people that are obviously overweight due to fat, not muscle."

I totally disagree with this statement. If we've put on an average of 8 to ten pounds in the past 25 years, and the fitness boom has certainly come within the past 25 years, I don't think you can speculate how much of that weight gain is due to fat and how much is due to muscle. I wish I had data on the number of people who lift weights today as compared to 25 years ago. Anyway, of course there are fat people today, but neither you nor I can speculate without data that there are more fat people today (per capita) than there have been in the past.

[joh]

so fat people on little trolleys with a oxygen mask that I saw 3 times in american supermarkets during my visit, but never once in europe in my entire life, are normal healthy people, your government just gives them the wrong label???

25 years ago, the wholly different standard of living made getting fat a lot harder than now, hence the fitness boom.

You guys got kids that can't get out of bed without help, dude!

[Brian Hawkins]

Any serious health professional or scientist that studies obesity will acknowlege the limits of the BMI. The reason so many studies are based on it is because the data collection is super easy: you just have to record a subject's height and weight off of their medical charts.

Measuring something more appropriate and accurate--such as skin impedence for body composition--takes considerably more time and effort. Especially if you're doing a proper prospective study with 20,000+ people.

From a researcher's perspective, I can appreciate the "quick and dirty approach"...it can be valuable for asking big questions that help you zero in on smaller, more definite ones. So epidemiological data based on BMI isn't a bad *starting point* for addressing questions of the form "Does obesity lead to increased risk of...?" But eventually, you have to confirm your data through more rigorous means.

The problem now is that far too much policy and far too much hysteria is being based on data that is--at best--preliminary.

[Van]

No, I'm pretty sure you can speculate what is fat and what is muscle. All you have to do is look at the people around you. Presuming the subject in question is not wearing a ski parka, the differences between two men of identical height, one 200 lb of mostly muscle the other 200 lb of mostly fat should become readily apparent after even a cursory glance.

As a side note, I recently finished a trip through Europe, and while over there a friend asked me the biggest single difference between Americans and Europeans. At the time I couldn't think of anything, mostly because I felt there were few unversial (continental?) aspects that held from country to country. However, once I flew into Dallas/Fort Worth Airport and started wandering around the terminal on my layover, it struck me: Americans are fatter. I wasn't looking for it, or even thinking about the question, the observation just flew out at me.

[G Eugene]

Two reasons for the US population getting fatter:

1) 40 years ago everyone smoked like a chimney. Smoking 3 packs a day will curb your appetite. Probably the reason Euro's are thinner.

2) The baby boomers are aging, and as people age they get fat. We were put on this Earth to gain weight. It's in our DNA. Those that didn't put on weight perished in the many famines that afflicted the planet until recently.

[Adam M]

The FDA changing it's guidelines is seemingly not a case of people becoming "overweight" or dangerously obese overnight so much as a slow-moving government bureaucracy languidly chewing over the research and finally issuing an updated guideline for what constitutes a healthy body mass after several years of research further clarified the issue.

That stated, Morgan Spurlock and the brand of "dogma + one reference" pseudoscience he represents must be stopped before he reaches his 17th minute.

[KEVIN B OREILLY]

For some reason, the [/sarcasm] tag I added to my post above didn't show up. Anyway, no offense intended Radley -- just a bad joke.

[R. Kirby]

You write as if CDC's adjustment of the definition of obesity were completely arbitrary. A bureaucratic slight of hand.
What if it represented new research that identified health problems at lower BMI's?

[Radley Balko]

R. Kirby -- Did you read the Seattle Times piece? The BMI was lowered after pressure from pharmaceutical companies who had diet drugs in the pipeline.

[R. Kirby]

So the article points on in detail the industry ties of the NIH expert group on obesity.
But little was said about the data they looked at, or if their conclusions were warrented.
The presence of industry ties certainly makes one think twice about claims. But the adjustment of BMI might still represent sound medical thinking.

[francisco velasquez]

...You are kidding yourself if you don't think obesity is serious health risk in this country. You obviously have it out for Spurlock for some strange reason, but just automatically argueing the oposite of anything put forth is stupid.

[Sarah]

BMI is a measurement for people in a sedentary lifestyle, defined as less than three instances of cardiovascular intensive exercise per week. Many people take a kick boxing class twice a week and think of themselves as active, but their muscles have more atrophy period than toning period.

Criticizing BMI as being a bad measure for athletes is like saying a career aptitude test designed for adults would not be effective on children--you're right, but what's your point?

Also, think about what you're implying about the larger body of data. If the data on obesity were collected by more accurate means like a fat caliper or a full body scan, all outliers would enter into the equation, your athletes with abnormally high muscle mass for the population would be included, and people with small frames, underdeveloped muscles and a lot of fat would be included too. Is it not just as likely that the accuracy of the test on the individual basis won't change the obvious general trend?

[Bmi Kalkulator]

Obesity is a major health risk, but measuring it using BMI is just plain stupid. A friend of my weights in at about 110kg.. 7% bodyfat.. According to bmi he's overweight.. poor fella :)

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