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Posts Tagged ‘Obesity’

Eat, Drink & Be Merry

We recently discussed the apparent contradiction between the facts that America is fatter than ever and people are living longer than ever. BMI is the determining factor in declaring Americans overweight.

However, the theory which says America should be suffering health problems and increased mortality because of increased obesity is quite wrong.

So why are death rates dropping and people living longer? Something must be wrong with the model — it’s pretty hard to quarrel with the data as being inadequate. Certainly the increased incidence of obesity should have produced something by this time (it started 30 years ago).

In case you have been living in a cave or something, there are several serious flaws with the BMI which make it unsuitable for determining health. A new German study by Matthias Lenz of the Faculty of Mathematics, Computer Science, and Natural Sciences of the University of Hamburg and his co-authors present these and other results in the current issue of Deutsches Ärtzeblatt International:

The Süddeutsche Zeitung published an advance notice of the report (http://www.sueddeutsche.de/gesundheit/140/489526/text/), which shows that overweight does not increase death rates, although obesity does increase them by 20%. As people grow older, obesity makes less and less difference.

For coronary heart disease, overweight increases risk by about 20% and obesity increases it by about 50%. On the other hand, a larger BMI is associated with a lower risk of bone and hip fracture.

In relation to cancer, the overall death rate among extremely obese men (BMI above 40) is no higher than among those of normal weight. Men who are overweight even have a 7% lower death rate. No significant association was found in women.

According to the authors’ analysis, overall mortality is unchanged by overweight, but increased by 20% by obesity, while extreme obesity raises it by up to 200%.

Futurepundit raises a few interesting points:

What I’m expecting: Genetic testing might show us what our relative risks are for a large variety of diseases and this knowledge could push us toward different ideal weights depending on which diseases we have the greater risks for. Also, some people are probably genetically better adapted to carrying more weight.

Note that you have other options for slowing bone decay aside from carrying more weight around. Exercise, better food, and a combination of vitamin D and vitamin K might cut bone fracture risks with age.

Weight studies are problematic because weight can vary due to muscle mass as well (albeit less often). Also, people can lose weight during the early stages of an illness before they even know they are sick. How well did the researchers adjust for these factors?

According to the CDC:

BMI is a fairly reliable indicator of body fatness for most people.

In light of this new study, will the CDC change it stance on using BMI data as a way of reliably gauging the health of Americans?

If the BMI chart is based on an illogical formula concocted over 200 years ago and can only give a general assessment of obesity in a population while failing on an individual level, why is it still in use by the government?

The answer is because government loves to create problems for which it is the solution. Pay close attention to what is happening here because this is a pattern that repeats over and over again.

We would not bet on it because it is not the first time nanny staters in the government have used bogus data to justify their agendas regardless of scientific truth, nor will it be the last. Rather than letting those busybodies get you down, learn how to eat your way to happiness. Being drunk and gassy is one recent formula for living a long life, although can easily be a life of bachelorhood if you are not careful to find the right wine/broccoli balance.

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There are many sad tales appearing on the internet which present people who are angry because they feel mistreated by their insurance company. Those personal anecdotes are designed to raise an individual’s ire and natural desire to do something about it. The reader may notice that conveniently attached to such stories are mentions of a solution to the problem: healthcare reform as being debated into law by Congress.

The setup seems almost too easy. David, the little man (or woman, or child, or family) gets beaten on by a Goliath (big insurance company) who treats them as mere numbers in a soulless quest for ever increasing profit, only to have Congress and others swoop in to save the day. Someone should create a comic book about that story because it would be entertaining – and fictional.

Yes, we are cynical and skeptical at heart and are willing to wager that many of our readers who come across such saccharine tales of heartache also immediately think “what are they selling?“. Being cynical and skeptical to a degree one notch below annoying is a trait commonly found in scientists because it is an important part of the scientific process. Not all of you are like that (yet), so for those of you who are new to all this, buckle up and hang on for an interesting ride.

Why would insurance companies do silly things, like deny coverage to an unusually heavy baby, if the bad publicity is so damaging to their reputation?

The answer is because insurance companies use statistical tables to make decisions, and anyone caught at the tail end will have a rough time. Here is the most interesting quote from the story of baby Alex Lange:

The frustrated parents said their child was the odd infant out in a cruel numbers game. A chart by the Centers for Disease Control and Prevention used by insurers puts Alex in the 99th percentile for weight and height for babies his age.

The BMI chart is an example of flawed statistics being used, but it is also not entirely inaccurate for a population wide assessment. In general, someone who has a BMI above 30 is far more likely to be unhealthy than to be an athlete. The problem is for those in the middle, in between normal and obese, who are merely considered overweight.

One flaw in the system is that while most people in the obese range are unhealthy, the same cannot be said for those in the overweight range. Pay close attention the next time you are at the park or the gym to those chunky guys who can outrun you. In fact, someone with low body fat who is athletic in that range between casual Frisbee player and professional athlete can often be classified as overweight.

Insurance companies can get away with using the BMI to classify people into broad categories, which then affects their premiums or if they are eligible for insurance at all because the government continues to use it, even though it is flawed. According to the CDC:

BMI is a fairly reliable indicator of body fatness for most people.

If the BMI chart is based on an illogical formula concocted over 200 years ago and can only give a general assessment of obesity in a population while failing on an individual level, why is it still in use by the government?

The answer is because government loves to create problems for which it is the solution. Pay close attention to what is happening here because this is a pattern that repeats over and over again.

First, the CDC called more than one million people between 2006 and 2008 and collected their information. The fact that the data are suspect because people routinely lie about their height and weight should be obvious even to a non-scientist. Second, after the data was gathered and processed, a conclusion was reached:

Experts believe there are several reasons for the differences. People with lower incomes often have less access to medical care, exercise facilities and more expensive, healthier food. In many places, minorities are disproportionately poor.

“Poverty is a very strong driver of obesity,” said Kelly Brownell, director of Yale University’s Rudd Center for Food Policy and Obesity

The differences being referred to are the differences between the African-American communities and other communities in terms of obesity. We already know the reason for those differences, and it is the reason the BMI chart is racist. So, where does that conclusion lead to?

The only way to deal with our “obesity epidemic” is to address the “poverty epidemic” — of course, as measured by yet another government psuedo-science statistic called the “poverty line”. And how do we deal with that? You guessed it, create more entitlement programs, programs to be run by the very same government that is funding the study, a study based on a statistical measure that is meaningless, where the statistics are unreliable and unverifiable but all point to the same convenient conclusion — the government needs more of your money.

And the media will now happily play along, running b-roll footage of some fat dude at Disney shoving ice cream in his pie hole or a fat mother and her fat kids waddling along through Frontierland, their butts bouncing up and down, as they stroll through the theme park in too-tight shorts and too-short t-shirts.

Laugh if you want but this is the same government that wants to ration your health care. Guess what? Fat people move to the back of the line under such a government-run health care system. Still laughing?

Although baby Alex Lange’s story inspires outrage, it is the insurance company taking all the heat, rather than the government. If the government banned the use of the BMI chart because of its flaws the insurance companies would be forced to evaluate everyone on an individual basis leading to fairer premiums. Individualized healthcare is one result of a market based system because a fair market needs to distinguish between a healthy 200 lb. person and a 200 lb. couch potato. Currently, they are both considered equally risky to insure and such a system does not foster individual responsibility.

People are even angrier today according to newspapers because a report which concluded that the healthcare reform bill recently approved by the senate finance committee would end up costing everyone more money is false – at least according to certain members of Congress and economist from MIT.

After an insurance industry report said that premiums would rise sharply with the passage of comprehensive health care legislation, Jon Gruber, a health care economist at the Massachusetts Institute of Technology, said he evaluated the report Monday at the request of Senate Democrats and found it deeply flawed.

Coming from a prestigious academic institution does not guarantee that Jon Gruber is telling the truth but it does lend him a lot of credibility, so he will be taken seriously. We are skeptics and our site is geared towards teaching non-scientists, so how can a non-expert determine if someone with fancy credentials is telling the truth when what they are saying goes against logic and common sense?

In this instance the answer is amazingly simple.

Mr. Gruber, who helped Massachusetts with its effort to provide universal health insurance coverage, said that the industry report failed to take into account administrative overhead costs that he said will “fall enormously” once insurance polices are sold through new government-regulated marketplaces, or exchanges.

We need to examine the situation in Massachusetts since they implemented universal health insurance in a way very similar to the proposals in the Baucus bill. Depending on how the situation turned out, it will either serve as a model for the current bills in Congress or a dire warning against them and will establish the reader establish Mr. Gruber’s real level of credibility.

The Wall Street Journal talks about the situation in Massachusetts (and other states, so go read the whole thing):

Guaranteed issue alone, the argument goes, results in slightly more expensive premiums, which drives healthier individuals out of the risk pool, which in turn further drives up premiums. The end result is that many healthy people opt out, leaving a small pool of sick individuals with very high premiums. An individual mandate, however, would spread those premium costs across a larger, healthier population, thus keeping premium costs down.

The experience of Massachusetts, which implemented an individual mandate in 2007, suggests otherwise. Health-insurance premiums in the Bay State have risen significantly faster than the national average, according to the Commonwealth Fund, a nonprofit health foundation. At an average of $13,788, the state’s family plans are now the nation’s most expensive. Meanwhile, insurance companies are planning additional double-digit hikes, “prompting many employers to reduce benefits and shift additional costs to workers” according to the Boston Globe.

And health-care costs have continued to grow rapidly. According to a Rand Corporation study this year, the growth now exceeds state GDP by 8%. The Boston Globe recently reported that state health-insurance commissioners are now worried that medical spending could push both employers and patients into bankruptcy, and may even threaten the system’s continued existence.

That certainly paints a cheery picture. There is more wonderful news from The Boston Globe:

The state’s major health insurers plan to raise premiums by about 10 percent next year, prompting many employers to reduce benefits and shift additional costs to workers.

Increases will range from 7 to 12 percent, capping a decade of consecutive double-digit premium increases, according to a Globe survey of the state’s top health insurers. Actual rates for 2010 will depend on the size of the employer and the type of coverage, with small businesses and individuals expected to be hit hardest. Overall, premiums are more than twice as high as they were 10 years ago.

The higher insurance costs undermine a key tenet of the state’s landmark health care law passed two years ago, as well as President Obama’s effort to overhaul health care. In addition to mandating insurance for most residents, the Massachusetts bill sought to rein in health care costs.

The failure of the Massachusetts system is far from hidden. Who is Jon Gruber hoping to fool by flashing his academic pedigree? Is the general population reading the news so incapable of examining the issues in any depth such that Mr. Gruber can brag about the wonderful state of universal health insurance in Massachusetts without the rubes bothering to check and see how things actually turned out?

Many newspapers and other outlets reporting on this situation are in favor of universal healthcare becoming law, damn the facts, and so reports on the subject tend to be biased by omission of key details which would entirely change the outcome of the story. The real anger is by citizens who are frustrated at being ignored by their elected officials and maligned by some members of the media.

When a layperson expounds about a subject in a way that it is clear they are out of their depth, we excuse the ignorance or quickly sniff out the agenda. However, we must hang our heads in shame when a fellow scientist abuses their position of trust and respect to mislead the general public. Jonathan Gruber’s motivation for lying is not important, simply because such lying is unacceptable. Studying science is about shedding light on the world’s mysteries, and so we have fulfilled our responsibility by illuminating this situation with sunlight, the best disinfectant.

Exit question: What are you going to do about it?

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If the members of the American medical establishment were to have a collective find-yourself-standing-naked-in-Times-Square-type nightmare, this might be it. They spend 30 years ridiculing Robert Atkins, author of the phenomenally-best-selling ”Dr. Atkins’ Diet Revolution” and ”Dr. Atkins’ New Diet Revolution,” accusing the Manhattan doctor of quackery and fraud, only to discover that the unrepentant Atkins was right all along. Or maybe it’s this: they find that their very own dietary recommendations — eat less fat and more carbohydrates — are the cause of the rampaging epidemic of obesity in America. Or, just possibly this: they find out both of the above are true.

The worst part about the way other respected people in the medical community treated Dr. Atkins is in the way they acted contemptuously towards scientific principles.

In fact, when the American Medical Association released its scathing critique of Atkins’s diet in March 1973, it acknowledged that the diet probably worked, but expressed little interest in why.

The prevailing theory, that eating more carbohydrates and fewer fats was better for health, was itself a new and untested hypothesis at one point.

The alternative hypothesis also comes with an implication that is worth considering for a moment, because it’s a whopper, and it may indeed be an obstacle to its acceptance. If the alternative hypothesis is right — still a big ”if” — then it strongly suggests that the ongoing epidemic of obesity in America and elsewhere is not, as we are constantly told, due simply to a collective lack of will power and a failure to exercise. Rather it occurred, as Atkins has been saying (along with Barry Sears, author of ”The Zone’‘), because the public health authorities told us unwittingly, but with the best of intentions, to eat precisely those foods that would make us fat, and we did. We ate more fat-free carbohydrates, which, in turn, made us hungrier and then heavier. Put simply, if the alternative hypothesis is right, then a low-fat diet is not by definition a healthy diet. In practice, such a diet cannot help being high in carbohydrates, and that can lead to obesity, and perhaps even heart disease.

Given the spectacular failure of such low fat, high carb diets to cause people to lose weight and improve their health, the medical community should have been more open to other ideas. More importantly, Dr. Atkins’ hypothesis proved correct and was easily verified after only a few years on the market.

Here is how the nonsense got started:

It was Ancel Keys, paradoxically, who introduced the low-fat-is-good-health dogma in the 50’s with his theory that dietary fat raises cholesterol levels and gives you heart disease. Over the next two decades, however, the scientific evidence supporting this theory remained stubbornly ambiguous. The case was eventually settled not by new science but by politics. It began in January 1977, when a Senate committee led by George McGovern published its ”Dietary Goals for the United States,” advising that Americans significantly curb their fat intake to abate an epidemic of ”killer diseases” supposedly sweeping the country. It peaked in late 1984, when the National Institutes of Health officially recommended that all Americans over the age of 2 eat less fat. By that time, fat had become ”this greasy killer” in the memorable words of the Center for Science in the Public Interest, and the model American breakfast of eggs and bacon was well on its way to becoming a bowl of Special K with low-fat milk, a glass of orange juice and toast, hold the butter — a dubious feast of refined carbohydrates.

The Center for Science in the Public Interest advocates neither science nor anything in the public’s interest until today. We will cover that in a future post.

According to Katherine Flegal, an epidemiologist at the National Center for Health Statistics, the percentage of obese Americans stayed relatively constant through the 1960’s and 1970’s at 13 percent to 14 percent and then shot up by 8 percentage points in the 1980’s. By the end of that decade, nearly one in four Americans was obese. That steep rise, which is consistent through all segments of American society and which continued unabated through the 1990’s, is the singular feature of the epidemic. Any theory that tries to explain obesity in America has to account for that.

Some scientists blame fast food, sedentary lives, and genes designed to store food as fat for the obesity epidemic.

This theory makes perfect sense and plays to our puritanical prejudice that fat, fast food and television are innately damaging to our humanity. But there are two catches. First, to buy this logic is to accept that the copious negative reinforcement that accompanies obesity — both socially and physically — is easily overcome by the constant bombardment of food advertising and the lure of a supersize bargain meal. And second, as Flegal points out, little data exist to support any of this. Certainly none of it explains what changed so significantly to start the epidemic. Fast-food consumption, for example, continued to grow steadily through the 70’s and 80’s, but it did not take a sudden leap, as obesity did.

Examining genetics reveals an important clue to the truth:

It is also undeniable, note students of Endocrinology 101, that mankind never evolved to eat a diet high in starches or sugars. ”Grain products and concentrated sugars were essentially absent from human nutrition until the invention of agriculture,” Ludwig says, ”which was only 10,000 years ago.” This is discussed frequently in the anthropology texts but is mostly absent from the obesity literature, with the prominent exception of the low-carbohydrate-diet books.

As our regular readers are aware, smart people easily support stupid ideas, all the more so if the new idea on the scene challenges their preconceived conception of what’s right.

The glycemic-index concept and the idea that starches can be absorbed into the blood even faster than sugar emerged in the late 70’s, but again had no influence on public health recommendations, because of the attendant controversies. To wit: if you bought the glycemic-index concept, then you had to accept that the starches we were supposed to be eating 6 to 11 times a day were, once swallowed, physiologically indistinguishable from sugars. This made them seem considerably less than wholesome. Rather than accept this possibility, the policy makers simply allowed sugar and corn syrup to elude the vilification that befell dietary fat. After all, they are fat-free.

David Ludwig, M.D., Ph.D., the Harvard endocrinologist, runs a pediatric obesity clinic.

He does not recommend the Atkins diet because he says he believes such a very low carbohydrate approach is unnecessarily restrictive; instead, he tells his patients to effectively replace refined carbohydrates and starches with vegetables, legumes and fruit. This makes a low-glycemic-index diet consistent with dietary common sense, albeit in a higher-fat kind of way. His clinic now has a nine-month waiting list.

Note the common themes prevailing here which are evident in other areas, and which will continue to pop up again and again:

  • Government stepping in with ambiguous evidence in an effort to provide a solution to a problem which may not exist. Government bureaucracy increases to handle this new “problem”, which requires increasing tax revenue.
  • Smart, very educated people unable to see past the end of their noses, even when doing so means accepting common sense.
  • The “experts” offer all sorts of advice which revolve around the idea that John Smith, typical citizen, cannot be held responsible for his actions. For example, “it’s not your lack of self control that’s making you fat, just blame the fast food industry for making food too cheap and delicious”.

Replacing individual responsibility with reliance on government is something which has been going on this country for several decades, and is coming to a head over the recent universal government healthcare bill. The only cure is for citizens to pay attention and to remain ever vigilant against encroaching tyranny.

Many experts do not see cradle to grave reliance on government as a flaw, but as a desirable goal. They truly believe that the average American is a moron unable to handle serious decisions, perhaps slightly smarter than cabbage. It is that brand of “we know what’s best for you” elitism which may bear the greatest responsibility for the obesity epidemic.

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The Center for Disease Control released new data for 2007 (based on 90% of all USA death certificiates) showing that mortality rates dropped again (by over 2%) to 760/100,000 population. It’s been dropping for the past 8 years, and viewed longer term is half of what it was 60 years ago. Interestingly death rates from heart disease dropped a staggering 5% and even cancer dropped 2%.

We consider that factual information to be good news, yet we are faced with a contradiction here because America is fatter than ever.

We are told to be prepared for an epidemic of diabetes, high blood pressure, elevated blood lipids because of this. Every doc has seen blood sugar drop, blood pressure lowered, lipids come down in people with any/all of the above when they are able to lose a significant amount of weight.

However, the theory which says America should be suffering health problems and increased mortality because of increased obesity is quite wrong.

So why are death rates dropping and people living longer? Something must be wrong with the model — it’s pretty hard to quarrel with the data as being inadequate. Certainly the increased incidence of obesity should have produced something by this time (it started 30 years ago).

It is an interesting question, and a few ideas are proposed. This is not an exhaustive list by any means.

  • People may be in engaging in more/ higher quality exercise.
  • Fewer people are regular smokers.
  • Better, more well informed doctors.
  • Better drugs on the market.

We are not the only ones to notice the bogus nature of the BMI, and some other people have proposed alternatives based on the fact that a group of people of equal height and weight can have very different mortality rates.

Also, when taking into account people who are skinny because they smoke a lot, there is still no indication that being overweight increases mortality.

Linking, for the first time, causes of death to specific weights, they report that overweight people have a lower death rate because they are much less likely to die from a grab bag of diseases that includes Alzheimer’s and Parkinson’s, infections and lung disease. And that lower risk is not counteracted by increased risks of dying from any other disease, including cancer, diabetes or heart disease.

The BMI is bogus. It bears repeating again and again because we still live in a system which judges your health, and thereby your insurance premiums based on this nonsense. Private insurance companies can be mandated to change this by Congress but the CDC and others enjoy the convenience provided by simply using national BMI data.

If the government is using statistically invalid data to judge the health of Americans, can we trust them with actually running the healthcare system? Why should we trust a proposed system of hugely increased cost and responsibilities by officials who can’t bother getting the basic things right?

Many public officials have been holding town hall meetings recently to try and sell the proposed healthcare legislation to the public. Take a few moments and read this compilation of important questions which need to be answered by the President and Congress before any healthcare reform bill gets voted into law.

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Can Exercise Make You Fatter?

Consider this an exercise on the laws of unintended consequences.

Vigorous physical activity for at least 45 minutes will strengthen a person’s cardiovascular system and burn calories. It will also make that person hungry. When combined with the general tendency to overestimate calories burned during exercise and to underestimate calories in food defeat is all but guaranteed.

For example, burning 300 calories during an hour’s worth of exercising and eating a delicious 600 calorie muffin as a post workout reward is a net gain. On an average day in which a person exercises more, they eat more.

Weight training builds muscle, and a pound of muscle consumes more calories than a pound of fat but not enough to make much of a difference.

According to calculations published in the journal Obesity Research by a Columbia University team in 2001, a pound of muscle burns approximately six calories a day in a resting body, compared with the two calories that a pound of fat burns. Which means that after you work out hard enough to convert, say, 10 lb. of fat to muscle — a major achievement — you would be able to eat only an extra 40 calories per day, about the amount in a teaspoon of butter, before beginning to gain weight.

The human body is an exquisitely regulated machine which has certain homeostatic goals in mind and works ruthlessly to achieve them. To truly win this war an individual needs to fight against themselves and it is very difficult to do so.

Arm yourself with data about how many calories are really being burned for various types of workout  routines and durations. Know the approximate caloric count of your favorite snack foods, like those sugar free muffins at the local bakery.

Plan ahead and be aware of your body’s inclinations. If you are going to be hungry after an energetic workout be sure and have a low calorie and healthy snack immediately available. For a post exercise meal, choose your dining partners carefully.

Good luck.

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Speaking at APA’s 117th Annual Convention, Steven Blair, PED, called Americans’ physical inactivity “the biggest public health problem of the 21st century.”

Quick, raise your hand if you snickered when you read the word biggest because you were picturing just how big and fat Americans are. Now take your raised hand and slap yourself across the face for being so insensitive.

We kid.

Really though, there are surely much bigger global problems relating to health, especially in regards to disease control, access to clean water, nutritional deficiencies, etc.

Research has shown approximately 25 percent to 35 percent of American adults are inactive, Blair said, meaning that they have sedentary jobs, no regular physical activity program and are generally inactive around the house or yard. “This amounts to 40 million to 50 million people exposed to the hazard of inactivity,” Blair said in an interview.

Putting the hyperbole aside, it is an often accepted and mistaken bit of common knowledge that weight can determine a person’s health. Many young men and women diet and exercise with the goal of changing their weight to a particular amount, and are occasionally briefly successful. Others do not exercise, or do so rarely, but are not considered overweight so it is assumed that they are healthy.

One follow-up study of 40,842 longitudinal study participants showed poor fitness level accounted for about 16 percent of all deaths in both men and women. The percentage was calculated by estimating the number of deaths that would have been avoided if people had spent 30 minutes a day walking.

The reality is that everyone should make it a goal to be physically active to at least a moderate level. Cardiovascular exercises in particular seem to be strongly correlated with longevity and better health, physical and mental,  well into old age. Most people should stay away from exercise extremes such as marathon running because the damage incurred (to the joints, for example) and risk of injury are not worth the health benefits.

Blair also highlighted the benefits of exercise on the mind, referring to recent emerging evidence that activity delays the mind’s decline and is good for brain health overall.

Diet alone cannot make a person healthy. Appetite control is regulated in a complex way by the body, and is very difficult to fight against for any reasonable period of time. Should you be one of those people with a slow metabolism and a hearty appetite, make sure you put extra time and effort into exercising.

Obviously, since this was presented at an APA function there was a role in all this for psychologists.

“I believe psychologists can help develop better lifestyle change interventions to help people be more active via the Internet and other technological methods.”

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When women eat with men or in mixed gender groups they tend to choose food with significantly lower caloric value than would if dining alone or exclusively with other women. The study, conducted by Meredith Young, a PhD candidate at McMaster University, has an explanation:

The diet industry targets female consumers and product advertisements typically depict very slim models rather than average-sized or overweight female models, she says, so food choices appear to be weighed against how other perceive them. In other words, smaller, healthier portions are seen as more feminine, and women might believe that if they eat less they will be considered more attractive to men.”It is possible that small food portions signal attractiveness, and women conform, whether consciously or unconsciously, to small meals in order to be seen as more attractive,” says Young.

Men eat what they want regardless of whom they are dining with.

As for men’s food selections, the study showed that men were neither substantially affected by the number of nor the gender of their dining companions.

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