Worth Its Weight in Debate
In the midst of the federally declared obesity epidemic, Paul Campos is savoring a plate of seared ahi tuna in ginger-garlic marinade, a neat mound of white rice and a bed of gently sauteed spinach accompanied by sourdough bread and real butter.
He looks slim enough -- but is quick to point out that at 5-foot-8 and 165 pounds, he is officially “overweight” according to the National Institutes of Health, the World Health Organization and a slew of scientists and doctors.
For the record:
12:00 a.m. July 24, 2004 For The Record
Los Angeles Times Saturday July 24, 2004 Home Edition Main News Part A Page 2 National Desk 2 inches; 68 words Type of Material: Correction
Obesity risks -- A chart accompanying an article in Friday’s Section A about scientists and others who think the health risks from being overweight are overblown mislabeled the increased risk for heart disease and diabetes associated with obesity. The chart should have indicated a 27.6 times greater risk for diabetes and a 3.6 times greater risk for heart disease, not 3.6 for diabetes and 27.6 for heart disease.
Does he care? Not a bit. He snorts at the notion of a fat “crisis,” that a little spare tire could be hurting him. He sips away at his full-calorie Bavarian beer and mulls the offerings on the dessert menu.
“Junk science,” he says. “That’s the real epidemic.”
Campos and a minority of other scholars and researchers are challenging the science behind ever-more-shrill pronouncements on the hazards of heft. They want to stop the obesity feeding frenzy.
Two-thirds of us are now deemed overweight, with half of those classified as obese, according to the government. In March, the U.S. Centers for Disease Control and Prevention said obesity was killing at least 400,000 Americans a year, almost as many as the 435,000 death toll from tobacco.
Obesity skeptics say this is the latest in a long string of exaggerations.
“There’s this tremendous cultural hysteria about this issue which is really not justified at all by the scientific and medical literature,” said Campos, a University of Colorado law professor and author of “The Obesity Myth.” “P.T. Barnum -- wherever he now may be -- must be furious with the notion that he can’t get in on this thing.”
Campos and others contend that study after study -- including those of 1.8 million Norwegians and 115,195 Massachusetts nurses -- have found that people who were overweight had a lower risk of death than those who were lean. Some studies (such as one of 9,228 middle-aged and elderly Israeli men) have reported that people who intentionally lost weight died sooner than those who stayed fat.
Mainstream obesity researchers object strenuously to this analysis, and say the skeptics are quibbling, misreading the data or cherry-picking medical facts.
They say that hundreds of studies show beyond reasonable doubt that there is a link between obesity and unhealthy conditions such as high blood pressure, diabetes, heart disease and certain cancers, as well as a higher overall risk of death.
“There are hundreds of people who’ve spent their careers studying obesity,” said James Hill, director of the center for human nutrition at the University of Colorado in Denver. “And if there’s one thing everyone agrees on, it’s that obesity has negative health consequences.”
Fat wasn’t always public enemy No. 1. In the 19th century, “Fat Men’s Clubs” thrived and girls wore padding to mimic the voluptuous 200-pound stage star Lillian Russell. When the government drafted its first nutrition guides in the early 20th century, malnourishment was the threat of the moment.
But fashions changed -- even Lillian Russell took to dieting -- and doctors started to frown on fatness. In 1943, the Metropolitan Life Insurance Co. published a list of “ideal weights” in actuarial tables. As early as the 1950s, government officials proclaimed a crisis and issued calls for a slimmer America.
Through much of this time, Americans gained weight in a drip-wise manner. But in the last two decades, national data revealed an especially sharp rise in body weight. Today’s average American adult is 7 to 10 pounds heavier than in 1990, tipping the scales at 180 pounds for a 5-foot, 9-inch man and 154 pounds for a 5-foot, 4-inch woman.
Our plumpness status is measured using an estimate of body fat called body mass index -- a person’s weight in pounds multiplied by 703, divided by the square of one’s height in inches. People are classed as obese if their BMI is 30 or above -- a cutoff chosen because studies suggest that health risks are significantly heightened beyond this point. They are overweight if they have a BMI of 25 or above.
Until 1998, this overweight threshold was 27, but as the studies on health risks piled up, the National Institutes of Health lowered the cutoff to that already in use by the World Health Organization. Overnight, about 30 million Americans became unacceptably big.
It would seem reasonable that scientists and doctors could at least agree on the basics -- such as whether the nation as a whole was really ballooning in size. But even this point is up for debate.
Jeffrey Friedman, an obesity geneticist at Rockefeller University, said the apparent weight rise of Americans was in large part an illusion. Very fat people have certainly gotten a lot fatter, he said, presumably because their genes make them especially prone to gain weight in today’s food- and leisure-rich environment. Nearly everyone else has stayed more or less the same, or gained just a few pounds.
The perceived national obesity crisis is actually a problem for a narrow group of people, he said. Targeting the entire population with an exercise-and-eat-less public health campaign won’t solve the problem.
USC sociology professor Barry Glassner sees something familiar about the obesity epidemic he reads about daily. It reminds him of headlines about flesh-eating bacteria and satanic preschool molestation -- topics explored in his 2000 book “The Culture of Fear: Why Americans are Afraid of the Wrong Things.”
“From the hysteria from government officials and the media, one could easily get the impression that gaining a few pounds is the equivalent of taking up smoking or removing the seat belts from your car,” he said.
The current obesity flap, he said, is one more example of what sociologists like to term a “moral panic.” Obesity is the ghoul du jour -- and predictably, our reaction is over the top.
Toying with his spinach at the Daily Grill on La Cienega Boulevard, Campos proposed that making obesity a disease was a handy way to justify people’s aesthetic distaste for fat people.
“People who would not have been considered fat in any other time and place are considered fat in this culture and are bombarded with all this nonsense about how they’ve got to do something about their pathological bodies,” he said with a fork-shaking table thump.
If Campos sometimes gets testy, it is partly because he has tasted the turmoil of gaining weight and losing it, then gaining and losing it again.
As a child, he was considered stocky. As a teen, he embarked on his first diet after a girlfriend told him he could stand to lose a little heft -- and shed 35 pounds in less than four months through a regimen of jogging, self-denial and Tab.
In his 30s, going through a divorce, he purposefully lost 25 more pounds through jogging, starving himself all day, and then dining at night on Entenmann’s chocolate doughnuts -- a strategy, he notes, that was hardly healthy but not very different from that of many dieters.
Yet again, the fat slowly nudged back on, 6 to 8 pounds of it each year. In 1999, when he began writing “The Obesity Myth,” he weighed 215 pounds.
By 2001, he’d lost 67 pounds.
Campos is frank about these experiences and his anxiety that his 9-year-old daughter will inherit his physiology. He fears she will face the same anti-fat bias that pushed him down a road of distress and yo-yo dieting.
“I don’t want to personalize this issue, but [I] realize at some level it would be dishonest not to talk about my own experience,” he said.
Linda Bacon, associate researcher of nutrition at UC Davis, also wrestled for years with her weight -- dieting, eating poorly, feeling miserable. Today, she has concluded that prejudice against fat has mortally shaded the science of obesity.
“I’m really kind of appalled,” she said. “There’s a lot of instances in our field where the cultural bias is so strong that people don’t even look at the data they’re gathering.”
Like many areas of medical research, obesity science has a problem: People cannot be studied like lab rats.
You can’t feed people fattening or slim-line chow, then track them for years under highly controlled circumstances. Instead, scientists must draw many of their conclusions from the science of epidemiology -- the study of large, free-living groups.
Such studies are often muddied by the complications of real life. Anyone who wants a fight about obesity has plenty of contradictory reports to fling about and interminable opportunities for scrapping over interpretation and methodology.
Obesity skeptics say there is ample evidence that overweight and obese people live longer than the thin.
For example, a 1984 population study of Norwegians reported that people who were moderately overweight (with a BMI of 26 to 28) and even obese (with a BMI of 34 to 36) lived longer on average than the ideally lean (with a BMI of 18 to 20).
A 2000 study, of nearly 8,000 Europeans, reported that thin men (with a BMI of less than 18.5) had twice the rate of death as overweight men during the course of the study.
Maybe being plump is healthier because it provides energy reserves in times of sickness, said Glenn Gaesser, associate professor of exercise physiology at the University of Virginia and author of an iconoclastic 1996 book, “Big Fat Lies.”
Skeptics also think there is evidence that dieting is an unhealthy thing to do. For instance, some population studies have reported that people who deliberately lost weight lived no longer than if they’d stayed fat -- or, in some studies, they died even sooner.
If weight loss is unhealthy, reasons might include heart muscle damage and increased risk of fracture due to bone loss, said CDC epidemiologist David Williamson.
Alternatively, perhaps many of the people who managed to lose weight were in the early stages of a serious illness, Williamson said.
What drives the skeptics craziest of all is what they term the tweaking of data to exaggerate the risks from extra weight. They say such shaky methodology pervades the body weight literature.
The most egregious recent example of this, they say, was the CDC’s pronouncement in March that obesity was killing 400,000 Americans a year. The study, which was used in the kickoff of a federal anti-obesity campaign, came up with its estimate by taking the death risk of young people who were obese and applying it to the whole population.
But a variety of scientists, including some at the CDC itself, later took issue with the study. One of them, Stanton Glantz, a professor of medicine at UC San Francisco, said the methodology made no sense because the death risk from obesity for young people was known to be high, and the risk for the elderly was tiny. The result was a highly inflated death estimate.
Dr. James Marks, one of the CDC authors, said the methodology was sound and had been used in other studies.
Dr. Walter Willett, a professor of epidemiology and nutrition at Harvard School of Public Health, said that being overweight and obese clearly raises health risks -- and risk of death .
One 1995 study of 115,195 nurses said the risk of death rose 60% in even slightly overweight women, although the results have been sharply contested by obesity skeptics, such as Campos, who accuse the researchers of statistical “hanky panky.”
Some studies show that being overweight causes a five- to tenfold increase in diabetes risk compared with someone really lean, Willett said. Being obese triples the risk of coronary heart disease and endometrial cancer; it doubles the risk of hypertension and stroke.
Losing even a little weight leads to significant improvements in blood fats, blood pressure and blood sugar control.
“Every 10 years we get somebody like this who comes along and thinks they’ve discovered fatal problems in the relationship between body mass index and mortality,” Willett said. “But it’s always somebody who doesn’t understand medicine and human disease processes and epidemiology.”
Even with this abyss of disagreement there are some areas where both sides agree. Diets work very poorly: Most people can lose only about 10% of their body weight, and most tend to gain back their weight over time.
Exercise improves health, no matter what you weigh.
Steven Blair, president of the Cooper Institute, a nonprofit research and education foundation in Dallas, says exercise is by far the most important factor in long-term health. He has monitored thousands of men and women for decades -- and showed that a person’s performance on a treadmill test at the study’s start was a better predictor of later health than was body weight.
“It’s better to be fat and fit than be lean and unfit,” he said.
“People are shouting from the rooftops about the hazards of obesity and by and large are focusing on diet to deal with the problem. And I just ask a simple-minded country boy question: How well are these strategies serving us?”
After two hours of meaty talk about fat, science and popular culture, Campos skips dessert, drains the last drops of beer from his glass and quits the Daily Grill for the quarter-mile trek along La Cienega to his car.
He walks briskly: He runs 30 miles a week these days and is in pretty good shape.
He won’t deny that it felt good reveling in the compliments of co-workers as the pounds melted off -- although he says he won’t be surprised if in a few years he’s a lot heavier.
To his right, the lights of the Beverly Center beckon, its stores with sylph-like mannequins. High above his head shines a billboard advertisement for vodka, adorned with a sexy blond model, not an ounce of surplus lard on her tight, toned torso.