The following article is complete and unadulterated with link to its original source. (It’s not news to you, Dear Reader, but you may know someone who needs to hear it. And it proves that the science of fat will eventually outpace the fear of fat… even in newspapers.)
Is there really an obesity epidemic? Or has it been created?
Published: Monday, December 17, 2012, 10:00 AM Updated: Monday, December 17, 2012, 6:10 PM
Are there really more fat people in our society today? Or is it that fat people are disproportionately represented in polls, because they have landlines and are home to answer the phone, while younger, active people are out and using cell phones?
Is there really an epidemic of obesity – or has it been falsely created by the pharmaceutical industry?
These are some the provocative questions and theories presented by Paul Ernsberger, who has a Ph.D. in nutrition and has been teaching at Case Western Reserve University’s medical school since 1989.
“We do not have an obesity epidemic,” he says plainly. “While there has been an increase in people’s weight, about half of it is due to increased honesty – because people are now telling the truth about their weight, while they were more modest about it in the past.”
Ernsberger is a research scientist, and he makes statements that fly in the face of nearly all reported research on the topic of obesity, which state that the majority of Americans – two-thirds – are overweight or obese.
For one thing, he posits that the idea of an “epidemic” of obesity has been created by the media, based on faulty assumptions from questionable research, or a desire for eye-catching headlines.
Weight is also a personal issue for Ernsberger. When he was a young adult, the 6’1″ Ernsberger says he was of “average weight.” Now 56, with a lung condition that he says is not connected to obesity, but which makes exercise difficult if not impossible, he is significantly overweight.
In a lecture at the monthly Science Caf meeting at the Market Garden Brewery in Ohio City last week, he showed PowerPoint slides of Brad Pitt and Arnold Schwarzenegger, saying that according to the Body Mass Index method of measurement, they would be considered overweight or obese.
But he never mentioned his own weight – on purpose, he says later.
“I don’t address it unless someone asks,” he says. No one in the audience of about 150 people asked him about it in during the question and answer period, though some talked about it with each other afterward and wondered why he didn’t.
When he has mentioned his own weight issue, he says, “It can really backfire,” and it becomes a distraction.
But, that aside, he proposes that being overweight, even obese, isn’t as bad for your health as headlines would have you believe – or as predictive of mortality. Smoking is much more dangerous, and a habit that some people keep partly to avoid gaining weight, he points out.
Too often, people look at others who are fat and make assumptions about their habits, Ernsberger says.
“In fact, weight is almost as heritable as height,” he says. “Identical twins weigh within a few pounds of each other. And yes, physical inactivity and imprudent diets affect weight, but so do medical illness, psychiatric illness and social determinants, such as poverty.”
So judgment about others’ weight – or our own – is misplaced and unproductive, he says.
Focusing on a few key healthful habits is much more important, Ernsberger says – which includes eating lots of fruits and vegetables, getting some physical activity each day, and diligently taking medications that you have been prescribed, especially those for high blood pressure and cholesterol.
All this flies is contrary to what people have heard and read for the past two decades – that obesity started becoming a public health problem in the 1980s, and has snowballed since then. Stories have noted that obesity “threatens to bankrupt the U.S. economy” and “threatens the foundations of our society.”
Just this past week, the United Health Foundation nonprofit released a report saying that in 1990, Ohio reported an obesity rate of 11.3 percent, while in 2012, the rate had more than doubled to 29.7 percent of the population. Those obesity numbers were self-reported, and the report notes that the real number of obese people is likely higher.
Mortality, says Ernsberger, depends more on your habits than your weight, and fatness depends mostly on your genes.
“Most people have not gained weight – [Americans] have added only 20 pounds in the last 20 years on average,” he says. “These relatively small gains have pushed many people into the overweight and obese categories.”
He points to BMI as being a measurement of obesity that can be flawed, and that has skewed the numbers. Other experts too have pointed out that muscular people– like Pitt and Schwarzenegger, for example — have BMIs that would put them in the obese category, based on what they weigh in relation to their height. Yet insurance companies mostly use BMI in their calculations of whether the insured person is overweight.
Calorie-counting is another thing that Ernsberger points to as being mostly futile. “You can gain one pound per year by eating 10 extra calories a day – which could be 3 M & Ms, or one sip of soda. Or you could burn 10 calories fewer per day by taking 200 fewer steps.”
No one can count calories to within significant degrees of accuracy, he says, so it’s rather a pointless practice.
His main point, says Ernsberger, is this: “I’m not saying you can be healthy at any size. I am saying you can improve your health at any size. The relationship between weight and health is not absolute.”
It’s far better for doctors to tell their patients that, than to merely tell them, “Lose weight,” he says, adding that that’s not just unhelpful advice, but too often, doctors won’t prescribe, say, high blood pressure medicine to an overweight person while they will to a normal-weight or thin patient.
So, to what does he attribute the idea of an “obesity epidemic?”
It all goes back to the pharmaceutical industry in the 1990s, Ernsberger says, which is what started the “hysteria.”
“Large pharmaceutical companies were working on diet pills – dexfenfluramine and orlistat,” he says. “They were expecting millions of dollars of sales and they wanted to build up the markets for this. So they had to promote the concept that obesity is a serious medical condition, so that doctors could prescribe medication for it.”
Companies “spent several hundred million dollars in physician education, and the doctors who ran weight loss clinics began to talk about the dangers of obesity. They started putting out press releases, but you couldn’t tell, because they came from organizations like the American Dietetic Association and the American Heart Association.”
Then, he says, weight-loss companies piggy-backed on all this.”
How does he know?
“A lot of information about this — about ghost-written articles in medical journals and such – came out because of the lawsuits that came out of the fen-phen deaths.” (Fen-Phen combined two obesity-treating drugs and was withdrawn from the market in 1997 because it was associated with a higher-than-normal incidence rate of heart valve disease, and some deaths).
The media immediately responded to the reports of an obesity crisis with far more stories about the issue, he said.
There also have been alarming reports over the years about the rise in Type II diabetes, and its emergence in young children – previously unprecedented.
But Ernsberger has an explanation for that. “(Type II) diabetes in children has an extremely low incidence,” he says, “with less than 5 in 100,000 children affected.
“And for adults, blood sugar levels haven’t changed all that much. Back in the 1980s, though, only 1/4 of the people who had diabetes knew it. We’ve changed the definition now by making the guidelines stricter. ”
He puts it this way: “You can almost entirely explain the increase in diabetes by two things: the increase in the Hispanic population in the U.S., because diabetes is more common among Hispanic people, and the increased detection for treatment.”
Also, he says, “Type II diabetes is almost an entirely genetic disease. If one twin has it, for example, there’s a 95 percent chance that the other twin has it. It isn’t caused by obesity – obesity is a symptom of early diabetes.”
The most important takeaway, he tells audience like the one Monday night, is not to focus on losing a lot of weight. “Our biology conspires against weight loss,” he says, because our bodies respond to an intake of fewer calories by becoming more efficient.
That is demoralizing, and it makes weight loss – or keeping weight off – difficult, if not impossible for most people.
Instead, he says, making changes in your behavior – eating more fruit and vegetables, exercise – and if you want to lose weight, just think about losing 5 percent of your body weight.
The first five percent of weight loss has the most impact on health, he explains, because the fat lost is the fat that surrounds our internal organs – the most dangerous fat from a health standpoint.
As a medical school instructor– who has tenure – Ernsberger says his positions are not as controversial as one might think.
“The only flack I get is from people who derive their livelihood from providing weight loss services,” he says. “I am providing weight realities in a dietetic society.
“Telling people they should be skinny is not working.”