Why the Washington Post decided to devote space to libertarian crankery from the Pacific Research Institute, I'll never know, but today's op-ed from Sally Pipes on the evils of governmental interference in diet is a bit much.
The way I see it, obesity cranks recycle 3 arguments over and over. It usually goes: (1) BMIs don't fit everyone (2) the stupid government has arbitrarily changed the definition of overweight to make more people fat and (3) exercise is all that matters anyway and overweight doesn't hurt you.
First, we have BMI's are inaccurate:
The standard metric for this measurement is a person's body-mass index, or BMI -- the ratio of one's height to one's weight. But at best, BMI is a rough tool that does not take into account an individual's body type. A six-foot-two athlete who weighs 210 pounds would be classified as "obese" according to BMI charts -- despite his 32-inch waistline, 17-inch biceps and his less than 6 percent actual body fat.
If you believe the BMI tables, most of the best players in the NBA and NFL are "overweight," including superstar athletes Kobe Bryant and Tom Brady.
Many Hollywood heartthrobs also qualify as fatties -- Brad Pitt, Matt Damon, Tom Cruise and George Clooney, to name a few.
Once you read this you know you're going to see the standard idiotic attacks on science from someone defending the food industry or obesity itself. Why is BMI used? It is a indirect measure of adiposity. It is not perfect, and sadly, there is no perfect way to measure and track total body fat easily. BMI is an approximation, but on average a pretty good one.
Now, the obesity cranks love to throw out this red herring, usually it's Arnold Schwarzenegger, but whatever. Is anyone really confused by this? Certainly I doubt that professional athletes and body builders are losing sleep because their BMIs aren't ideal. BMI is an indicator for the average schmo and not professional athletes and body builders. No one is confused about this, and if anything it hurts their case as it suggests overweight statistics are being brought down by healthy athletic people. No one thinks the BMI is perfect, but until we develop a better indirect measure of adiposity that can be easily tracked in individuals (or an easy direct measure) we shouldn't let the perfect ruin the good.
Next, this endless refrain from people who are full of it:
What's more, the acceptable BMI continues to be ratcheted downward -- transforming those who were considered perfectly healthy yesterday into "overweight" and "obese" today.
Before 1998, a "healthy" BMI was anything less than 27. Then, suddenly, the government changed the "healthy" number to anything less than 25. Overnight, more than 25 million people who were previously considered to be a healthy or normal weight were reclassified as overweight. Looked at another way, the government artificially manufactured an obesity crisis by moving the BMI goal posts.
The Govmint! The Govmint! It's a conspiracy! For one her first statement is completely incorrect. Obesity has always been > 30, and still the number of obese has been increasing based on this threshold. Therefore it would be very difficult to manufacture an obesity crisis by keeping the BMI threshold for obesity the same!
Further, the "government" said anything less than 27 was healthy? Whom do you mean? The NIH? Or the CDC? Which "government" are you talking about? One group of government researchers convinced the government researchers in the CDC in 1998 to stop using 27 as a measurement of overweight so they would fit with everyone else who had always used 25. It's no great conspiracy, they were sick of the definition being different across different evil government groups. Further this only changed the definition of overweight from the CDC, not obesity nor the definition for overweight being > 25 that many other gov'mint researchers had used for a long time.
Now, the third nonsense argument - that exercise is all that matters and overweight isn't that bad - I'm not even going to go into extensively as I've harped on it so much already. Remember, it's about primary vs. secondary prevention. Overweight and obesity get you by giving you diabetes, hypertension, and dyslipidemia. These conditions, however, can be largely controlled with drugs which will largely abrogate overweight/obesity's effects on mortality. The goal though is primary prevention - preventing the co-morbidities in the from occurring at all. This is superior to secondary prevention - prevention of increased mortality through pharmaceuticals. The irony is the cranks are using the success of medicine at preventing harm from obesity to criticize medicine for trying to keep us healthy in the first place!
Instead I'll just jump to a paragraph I found so cranky, I almost plotzed:
While we may not always like the choices others might make, it is essential that we all have the freedom to choose for ourselves. Once we accept the idea that the Nanny State should step in when it's "for our own good," we've taken a very big step down the road to something like the scene painted in George Orwell's "1984" -- when citizens wake each day to mandatory exercise classes on the Telescreen.
Holy persecution batman, I think we have ourselves a crank! That was pretty fast - usually I have to read more than one article from someone before they so perfectly fulfill the crank criteria. Pipes, however, has managed in record speed. Considering this is coming from the libertarians I guess I shouldn't be surprised. But damn! That was some high-speed crankery.
What is most tragic about this article, however, is that she takes a study with an important holiday message about obesity, and only mentions it in passing, rather than describing its very relevant message to all of you eaters out there. She mentions in her first sentence, "it should come as no surprise that the average American gains about one pound between Thanksgiving and New Year's, according to the National Institutes of Health. That pound a year really adds up over the decades."
It really does add up, because the study showed that not only do you gain a pound a year over the holidays (and about 10% of people gain 5 pounds!), you don't lose that weight throughout the year. The result is that for many people weight gain occurs in discrete steps of over-consumption rather than steady accumulation. It used to be the harvest feast was followed by a winter lull in food availability - no more. You get stuck with that extra turkey for life. There's a holiday message of joy, and a suggestion for a New Year resolution. Aim low, and try to get rid of those pounds you just added. In the long run, it might make a big difference. Primary prevention people. Get on it!
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There's some crankery there, but not nearly as much as you make out. Let's start with BMI. At a first approximation, mass varies with volume, which for similar shapes is proportional to the cube of height, but BMI divides only by the square. Thus, BMI is likely to be off not only for super-toned athletes but for any tall or short person. Obviously we're not idealized bags of constant-density material, so other factors such as bone density, muscle mass, and limb proportions matter too, but even in the world of easy-to-calculate approximations BMI sucks. Simple weight over height cubed immediately gives results that more closely approximate actual body-fat percentages and subjective evaluations of obesity.
Government changed the numbers? OK, that one really is stupid so I'll leave it alone.
That leaves us with exercise vs. diet, and I think you're exaggerating the opposing position a bit. Sally Pipes never says that being overweight doesn't hurt you, and all she says about exercise is this:
Is that untrue? Is it even "exercise doesn't matter" as you paraphrase? No, and no. It's merely saying that not everyone can stand to exercise every day and give up all of their favorite foods, and for those that feel they have to choose exercise alone seems to yield more benefits than diet restriction alone. That doesn't have anything to do with whether both exercise and diet restriction might be better than either alone, or whether being at one's ideal weight is better than being above it. It's a reasonable position, and it's also reasonable to say people who need to lose weight have every right to choose which lifestyle changes they will make to accomplish that. I don't generally have much good to say about libertarians, but at least I do them the courtesy of trashing their actual claims instead of something else that I made up for them.
If you want to make it your mission to debunk crankery, don't be a crank yourself. A dishonest paraphrase plus a false dilemma does not add up to a good debunking. I can't wait to see what verecundiam-filled retort I get for saying that.
At the risk of crankery, I have to say that I don't know about this whole thing with the BMI. I defer to your expertise as an MD on studies and generalities. I can only speak of my own experience. In the interest of full disclosure, my current BMI is 37 (6', 275, 36 yrs old) and that, I believe, is largely due to my sedentary lifestyle. I have an office job, which wears me out mentally, I'm exhausted by the end of the day, come home, cook, clean, deal with children stuff and then plop on the couch until bedtime. Weekends are for grocery shopping, cleaning the house well, taking care of errands I couldn't get to during the week and so on. Exercise is just not even on the radar. So, I'm well aware that I've crossed that threshold to unhealthy, even in my own mind. Yet, I smoke a pack a day and that has caused more issues than the weight. (asthma) My BP is consistently 120/60, cholesterol is perfect, and no, I don't take any medication for controlling either of those things and never have.
Thinking back to when I was younger though, I've always been chubby. I've been at least overweight, even when I did exercise and have an active lifestyle. The only time I was ever normal weight with a 23 BMI was when I was in college, starving myself for days on end and exercising my self into exhaustion. I felt and looked like shit and caught every cold that came down the pike. I felt better and was healthier at 190, a BMI of 26 and technically overweight. After looking at family photos, I've come to the conclusion that the only way I could ever have been thin is if I'd chosen to be born with completely different DNA--my parents, grandparents, and great-grandparents were and are all at the very least stocky--hardy peasant stock. Further, had I been born into a family with a bit more wealth, or had the opportunity to accumulate such, things might be different. When I have to donate plasma more weeks than not just for the $30 to buy groceries, veggies and healthy foods are not on the menu--too expensive and I can't stretch them far. Processed and nutritionally-bereft foods are cheaper and I can feed all 4 of us for less than $10 per meal. Keith and I eat one meal per day on most days so the kids can eat 3. Raman noodles and Hamburger Helper fill up the belly. We aren't even technically poor--lower middle class, actually, or working class and all of the people we know in our income bracket live pretty much the same way. So, as I said in the beginning, my experience is not in line with all this BMI stuff. As for when I get older--well, my great-grandparents lived into their 90s, my grandparents lived into their late 70's at least and 3 of the 4 are still alive. The one who passed away died of lung cancer, not weight-related problems. My grandfather is 81 and counting, my other grandfather is 85 and my other grandmother is 87. So...not so much with the dying young and neither of my parents' health problems are from overweight, but from genetic issues.
I'm surprised Pipes resisted the urge to invoke Hitler and the Nazis.
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This is a comment I've seen frequently and used myself many times (well... before I got addicted to exercise).
The truth of the matter is... this is an extremely lame excuse!
If you exercise this whole thing about being mentally exhausted tends to disappear. Exercise helps you eliminate stress as well as have much more energy for your other activities. It's worth the effort to give this a try for a 6 weeks just to prove what I'm saying is true (at that point you won't be able to give it up either!). I promise you your life will improve drastically with exercise.
That sounds great, Steve, but I don't think you should assume everyone will respond the same way to exercise. Not everyone gets addicted to the same things. I go through periods when I crave exercise, when I really feel it helps clear my head, etc. just as you say. I also go through periods - weeks or months at a time - when I dread it because of either the physical discomfort or the sheer boredom or because it means giving up the only hour I might have to myself that day. I still do it, but out of self-discipline and thinking about the future. Telling people that there's some immediate reward will just leave them disillusioned and even more demotivated when that turns out not to be true for them.
I agree with you except for the BMI thing - I'm muscular and busty and that gives me a BMI that I believe misrepresents my fitness level. While I'm not losing sleep over it, I am worried that some day I will have to pay more for health insurance because of it.
I never paraphrased any such thing. But the studies that are being used to suggest exercise are the most important variable are themselves affected by secondary prevention in the study groups.
There is a lot of confusion about BMI and the relationship between the thresholds and health. Let's be clear, it's about averages, and there will be individual cases that differ. If you have a body type that it does poorly with (I myself think I'm an exception), then fine. It's an estimate of adiposity that is predictive of problems.
Attacking it is attacking a red herring. We know the problems with this measure, there are people for whom it is a poor fit. They usually realize it is a poor fit. The point is to generally use it to identify people who have an excess of body fat, and it's a starting point, not an end point, for identifying a potential problem. So I'll defend it for the purposes of these studies, but to say that it is some absolute measure of health is committing the same error as Pipes in this article. No one really does. We can all figure out when it's absurd in the individual case.
Further, there is no "reasonable position" being espoused by Pipes in this article. She's alleging conspiracies, misinterpreting data, and finally suggesting that this is all part of some Orwellian plot to make us do calisthenics. If there is a better point to this article, I can not see it, other than to attack sensible public health interventions to decrease the impact of unhealthful foods in schools and recommendations for people to exercise restraint and healthy behavior. She attacks the science, makes idiotic allegations, and misrepresents facts. This is crankery, and she poses no defensible public health position, just a silly critique of attempts to educate people to do the right thing.
As long as the government sticks to a goal to educate, and not mandate, then it's not too bad. We can easily predict, however, that politicians will abuse their power and begin to enact nutritional and exercising mandates for the citizens (for their own good, don't you see...)
Why would government do this? They don't own you or me, that would be slavery! If they stick to education, then yes fine, I'll take what they have to say. The government has no constitutional or moral right to limits my freedoms and liberties - even if I choose to engage in behaviors that may harm myself!
Now, if that sounds 'cranky' to you, tough beans. I will be as cranky as I can when I even suspect you begin to 'tread on me!' Actually, I found it odd that you labeled the libertarian as the cranky one. Seems to me the cranky ones are all those screaming that the sky is falling if my BMI is high. Sheesh! It's none of their business!
"Why would government do this? They don't own you or me, that would be slavery!"
Yeah, I'd say enforcing simple rules for the public at large to be healthier is the same as making us all slaves. Makes perfect sense. Actually somebody needs to start tearing down those sanitation grades at restaurants, please. A restaurant near me had all sorts of nightmarish food hazard qualities and was unfortunately shut down. How dare they? They've eliminated my *freedom of choice* by shutting down an unsafe restaurant that I could have eaten at. I am just so upset.
I think Mark's assessment of crankery in the article is fair. With just a quick read, I counted half-a-dozen instances of wingnut government conspiracy theory paranoia, carried to ridiculous extremes: "the government in our schools and kitchens", "the government deciding whether we should exercise or have an extra slice of apple pie".... :-P
Perhaps someone should warn Sally Pipes that the government is outfitting their Big Black Helicopters with extra rotors and heavy-duty winches. Those extra pounds won't keep you from being airlifted to the secret detainment centers, the locations of which are documented by directional reflective stickers on the backs of highway signage.
Jeff Darcy, My friend recently was denied health insurance because of a high BMI. She is obese and takes cholesterol lowering meds. She gets very little cholesterol in her diet and she generally eats very healthy (I've analyzed her diet). She also walks her dog every day for an hour at 4 a.m. I've counseled women who are skinny with a normal BMI and have high cholesterol.
Don't get me wrong, the BMI is a valuable tool to use in conjunction with other measurements. But I worry about people who have a poor BMI but have a strong heart and follow diet and exercise behaviors getting the run-around like my friend.
(great blog and excellent post by the way!)
Re: Rebecca,
It is unfortunate what the insurance companies will do to deny coverage. Their abuse of science and decency deserves more scorn than I can heap in a single blog.
Re: Stephen Starling,
Get back on your meds.
Yes, insurance companies suck in more ways than can be described. (What's wrong with national health insurance, again?) What I was getting at with my story, though, was the problem of economic injustices and how that plays out on this field as it does on every other. The health of the middle, working and lower classes is only going to get worse, not better. People eating crap food because they can't afford better is only going to get more prevalent, not less. As transportation costs go up, so will food, utilities, rents. People like me will be paying more to go work and have less to buy food than we do now. Wages have been stagnant for 20 yrs or more. We'll be paying out more, working two or three jobs just to keep things together. Without some serious changes, say rollbacks to the way things were for our parent's generation with strong unions, worker protections, social safety nets that actually gave an amount that people could survive on and the like, we will begin to see an even greater difference between the life expectancies of the rich and the poor than we do now.
Part of what makes this crankery so dangerous is that it gives us fat people a false sense that there is someone out there "looking out for us".
Is it frustrating to be a person who can run an easy five miles, do fifty push-ups, gets bored of doing sit-ups before she feels the burn, and can kick over her head, has a blood pressure of 110/50 and a resting heart rate of 65, and can do a peak-flow breath analysis of over 600...yet is in the same "risk catagory" as a 500-lbs person who hasn't left their bed for ten years when I go to get life-insurance?
YES!!
Does that mean that just because someone wants to appeal to our sense of that injustice, we have to buy into their idea that the scams of the food industry have nothing to do with the obesity problem?
NO!
The author of the article linked to is trying to tie people's sense that they might or might not have any control over weighing "too much" with some sort of idea that the food industry has no responsibility for marketing unhealthy foods, or even that they should not have to 'fess up to the content and impact that their foods have on health.
That's rediculous.
Some people are bigger than others. As a society, we often unjustly shame and berate heavy people who are heavy despite living a healthy life-style...why the hell should that fact let corporations off the hook?
They should have to honestly market their products. If they are unhealthy, they should be labled as such.
Sally Pipes is just taking advantage of a misplaced sense of defensivness. Either you are living the most healthy life you can or you are not. If you are, and you're heavy anyway, get over it. Tell people to take a hike with their guilt trip. But don't let some bought-and-paid-for crack-pot co-opt your issues.
The following is an anecdote on BMI with no intended ideological bent.
In the late 1980s, the Canadian Forces tried to use BMI as a fitness measure, in conjunction with aerobic and strength based fitness tests. All unit personnel were measured, and a consolidated BMI list was provided to the CO. If I remember correctly, at BMI 27 and higher, COs were to put personnel on remedial fitness training, and at BMI 30 and higher, COs were also required to issue a Recorded Warning. We found, however, that personnel in the 27 to 29.9 BMI bracket tended, with exceptions, to be in adequate physical shape, as borne out by the fitness test results. BMI 30+ was a good indicator of fitness problems, but that grouping did also include stocky, football player types who were in great shape. Ultimately, the CF dropped BMI as a fitness measure and went entirely with fitness testing.
The CDC used to use 27?
As someone who generally stays under 27, but has a hard time getting below 25.5, I like the sound of that.
-L