Confused? It may help to know the first NEJM position has been the conclusion of scientific studies published in that journal dating back years, conducted by the worlds top obesity researchers. Meanwhile, the second NEJM position was merely a commentary by editors of the journal who have never published a single paper on obesity, and who essentially ignored the magazines own findings.
Indeed, it even ignored the findings of the lead study, by June Stevens and others, in that very issue!
Editors Jerome Kassirer and Marcia Angell, although both M.D.s, actually devoted little space to medicine at all, preferring politically correct platitudes such as that "doctors should do their part to help end discrimination against overweight people." So much for doctors as healers; lets make them propagandists, instead. And false propagandists as well, to judge from the Kassirer-Angell editorial.
For example, they claim that "as weight increases, so does mortality, but only modestly." Really? Insurance actuarial studies for literally over a century have shown a powerful association between fatter bodies and shorter, more sickly lives. The largest and most detailed of these is the Stevens study, comprising over 300,000 men and women.
It concluded, "Excess body weight increases the risk of death from any cause and from cardiovascular disease in adults between 30 and 74 years of age." Longest life was associated with the leanest bodies, specifically those with body mass index (BMI) between 19 and 22. (The higher the BMI, the heavier the person is for their height. To determine your BMI, multiply your weight by 705, then divide by your height in inches, then divide again by your height in inches or Calculate your BMI to see if you are obese.) What the scores mean:
- 24 or under: Minimal health risk
- 25-29: Low to moderate risk
- 30 or over: High risk
For example, the Stevens study found that men averaging six feet tall whose ages were only 30 to 44 and were just 16 pounds overweight increased their chance of death by 50 percent. This is a BMI of just 23.8.
"Im sorry to tell you," Stevens told one reporter, "its the very lean weight that is associated with the best survival rate."
Apparently a 50 percent increase in death of young men is only "modest" to Kassirer and Angell. They said you have little to worry about until your BMI reaches 27 or 28.
Even if we accept that assertion, we must consider the context. A third of all Americans were already above that level by 1994-95, meaning at least 30 to 40 pounds overweight. Meanwhile, this portion keeps getting bigger because Americans keep widening at what appears to be an accelerating rate. In 1977-78, "only" a fifth of Americans were above that level. "Americans are getting so fat that its incredible," commented Stevens to the New York Times.
By comparison, the EPA passive smoking report estimated a lifetime increase in lung cancer deaths of only 17 percent, yet it became the basis for sweeping federal and state regulations on indoor smoking. Moreover, the size of the group effected by passive smoking was tiny. The EPA estimated only 3,000 extra lung cancer deaths per year.
So something that shortens the lives of 3,000 Americans a year is a massive public health threat, while something that prematurely knocks off 60 million Americans isnt worth breaking a sweat.
Probably at least a fourth of us are at a BMI of 29 or above. This is a mere 30-40 extra pounds on a 55" woman. Yet this more than doubled a womans chance of death the 16-year measuring period in the Nurses Health Study, published three years ago in yes the NEJM. Only 15 to 20 extra pounds greatly increased the risk of adult-onset diabetes, hypertension, and heart disease.
A huge study of Harvard male alumni produced similar results, as did an earlier American Cancer Society one.
How does obesity kill? Its all right there in years of NEJM studies. Last year it published one showing that women merely 44 pounds overweight fully double their risk of breast cancer. Another journal reported that those same extra 44 pounds of weight increases a womans chance of blood-clot related stroke by 2.5 times. These strokes kill more women than breast cancer.
Studies in the NEJM and elsewhere have also correlated obesity with myriad cancers, coronary heart disease, hypertension, diabetes, and stroke.
The Stevens study also states, "The relative risk associated with greater body weight is higher among younger subjects." Bizarrely, Kassirer and Angell say its somehow reassuring that the obesity risk "declines steadily with age until about 74 years, after which there appears to be no" increased rate of death. This stands on its head the accepted public health position that causes costing the most years of lost life deserve the most attention.
In any case, the "reprieve" after age 74 applies only to women. For men 75-84, Stevens found a doubling in the risk of death for those of BMIs of 32 or greater. Its just that women so heavily outnumbered men in this category that the combined overall death rate was average.
If the NEJM editors really understood modesty, they would have assigned obesity experts to write the commentary. At the very least, they should have stuck to medicine, leaving "fat acceptance" rhetoric for political magazines and the fat advocacy groups.
Read Michael Fumentos additional work on obesity.