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Thursday, August 01, 2002So say our senators and congressmen, who have heard the call of the CDC and the Department of Health and Human Services that we are a nation of gluttons and are determined to do something about it. Along with such truly weighty matters as a Department of Homeland Security, whether or not to go to war with Iraq, patent laws, and aid to low-income seniors for prescription drugs, they are also asked to consider this: “...the three senators are proposing spending as much as $217 million next year and additional money in future years on a variety of programs to encourage better nutrition and more physical activity. The money would go to the Institutes of Medicine, the Centers for Disease Control and Prevention and the Department of Health and Human Services to identify risk factors, analyze government food assistance programs and work with state governments on nutrition and exercise programs. At first glance, this seems innocuous. Nothing wrong with encouraging nutrition and exercise, or with making sure government sponsored food assistance programs offer healthy foods (shouldn’t they be doing that anyway?). But, do we really need the government this involved in our lives? That money would be better spent on, say, beefing up local health departments to deal with the threat of bioterrorism, or helping to finance immunizations for the poor. Besides, How Do You Define Fat? How many of those senators are themselves fat? And how many of those consider themselves fat? Often, fat is in the eye of the beholder. (I once had a partner whose chart notes described all women as “obese” if they weighed over 140 pounds. He never referred to a man as obese unless he had an obvious beer belly.) When researchers define obesity, they use the body mass index, a calculation using height and weight. It’s supposed to be more accurate than the life insurance charts that we used to use. A body mass index greater than 25 is considered overweight. However, even using that calculation, you’d be surprised to see who’s considered fat. (As usual, the Boston Globe makes it impossible to link directly to their story. Cut and paste this URL into your browser: http://www.boston.com/dailyglobe2/211/science/Who_you_calling_fat_+.shtml) Although it’s a more useful measure than the actuarial tables were, it still has it’s drawbacks. I’ve often had patients give up their diets and exercise programs in despair because they can’t achieve the final ten pounds that will take them to a BMI of less than 25, even though they have done splendidly with weight loss to that point. Just a ten or twenty pound weight loss can improve health, so it’s important not to get too fixated on an abstract number. If you feel good and exercise regularly, you’ll be doing all right even if your BMI tells you otherwise. And Ignore the NEJM: As if on cue, the lead paper in the New England Journal of Medicine is about obesity and the role it plays in heart failure: The researchers calculated that there was an increase in the risk of heart failure of 5 percent for men and 7 percent for women for each increment of 1 in the body-mass index... Or so says the result section of the not-so-helpful abstract of the paper, a statement which was duly copied in CNN’s report of the study. That sounds pretty impressive, but the abstract doesn’t tell us how many overweight subjects had heart failure compared to the non-obese. It only talks of rates of risk which can be misleading. In fact, the paper itself isn’t much clearer. It, too, never gives out the absolute numbers, preferring instead to deal with “person-year of follow-up” compared to numbers of heart failure cases. Even using these gymnastics, the final results aren’t all that impressive. For women of normal weight there was a 10-year cumulative age-adjusted incidence of heart failure of 3.4%. For overweight women (BMI 25.0- 29.9) it was 3.7%. For the obese (BMI > 30), it was 6.8%. Yes, it doubled, but the percentages are still pretty small. The figures for men are similar. Normal weight men had an incidence of 4.9% over ten years, overweight men had an incidence of 6.1% and the obese had an incidence of 10%. There is no doubt that being morbidly obese is detrimental to your health. It puts a strain on your joints, it probably strains your heart, and it batters your self esteem. But you don’t have to be a doctor to know that, and you certainly don’t have to have research projects to tell you that, either. Judging by this one, even when they try their hardest to prove it, they come up short. posted by Sydney on 8/01/2002 06:46:00 AM 0 comments 0 Comments: |
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