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Friday, April 29, 2005

The New York Times > Business > Study Aside, Fat-Fighting Industry Continues Mission

Substitute any cause for "obesity" and its related terms, and you arrive at my belief that "advocate" is a four-letter word.


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Study Aside, Fat-Fighting Industry Continues Mission
By GINA KOLATA

as the fat fever broken? Don't count on it.

After an article in a leading medical journal reported last week that people who are overweight, but not obese, have a lower risk of death than normal-size and skinny people, it might seem that pleasingly plump could finally become the socially accepted norm. But even the Centers for Disease Control, whose researchers helped conduct the journal study, continue to say that fighting fat remains a top public health priority.

And some social critics and medical researchers say that because there are so many groups with an entrenched interest in crusading against fat it is unlikely that the obesity epidemic will be declared over anytime soon.

"The operative term is moral panic," said Dr. Sander Gilman, a professor of liberal arts and science at Emory University. "There are moments when certain things become the focus of the society because they are believed to be a danger to the society. And it is believed that if you focus on it you will be able to avoid it or cure it."

No one disputes that obesity poses health risks that include diabetes, heart disease and sleep apnea. But based on the recently published research, those whose weight put them at a moderately greater risk of death turn out to be a narrowly defined group: people under age 70 with a body mass index of 35 or above. That group constitutes less than 16 percent of the population. (A person 5 feet six inches who weighs at least 217 pounds would fall into that category.)

Still, obesity researchers and the Centers for Disease Control say that it would be folly to ignore the fact that one-third of American adults are now officially obese - with body mass indexes of 30 or higher - and that another one-third are statistically overweight, meaning they have B.M.I.'s of 25 or higher. (For a five-foot six-inch person, a B.M.I. of 25 means weighing 155 pounds, while a B.M.I. of 30 means weighing 186.)

It is the increasing risk of conditions like heart disease and diabetes that come with higher weight that makes fighting fat a public health priority, according to Tom Skinner, a C.D.C. spokesman. "We would really be remiss if we didn't continue to mount a full-court press," he said.

But the idea of an epidemic, some critics say, is in the financial interest of weight loss centers, supplement makers, drug companies and purveyors of diet books and diet programs. And the alarm can also benefit many scientists, who get research grants to study the problem and who often serve as consultants to drug companies or run weight loss centers at their universities. A sense of crisis can also help government agencies get additional funds from Congress.

"Obesity works across the board - that's a big part of it, and that's what's fascinating about it, " said Dr. Eric Oliver, a University of Chicago political scientist who is writing a book on the politics of obesity. "If you are on the political right, obesity is indicative of moral failure," he said. "If you are on the left, it means rampaging global capitalism."

As for the obese themselves, a big question is not whether they tend to have higher blood pressure or elevated cholesterol levels or a greater incidence of diabetes - they do - but whether losing weight will cure them. Researchers disagree, in part because so few people lose weight and keep it off that it is difficult to know what would happen if they did.

One of the few long-term studies was a 10-year look in Sweden at about 1,200 people weighing more than 250 pounds on average. Half had stomach-reducing bariatric surgery and the rest tried, unsuccessfully, to lose weight on their own. The surgery patients lost substantial weight and kept most of it off. And they ended up with fewer cases of diabetes. But the weight loss helped only briefly with their blood pressure and cholesterol levels, which initially fell but then drifted back to and then above their pre-surgery levels.

In fact, epidemiologists say, while Americans are fatter than they used to be, they also are healthier by every measure than they were in the 1960's and 1970's, when the average body mass index was lower. In the ensuing years, even as the public has grown heavier -15 percent more, on average - heart disease rates have plummeted, cancer mortality has fallen, many fewer people smoke and death rates from auto accidents are down. People also live longer than back then, and when they do develop chronic illnesses, they tend to get them later in life.

But such data may be at odds with the "cultural resonance" of obesity, according to Dr. Abigail Saguy, a sociologist at U.C.L.A. "People don't like fatness. They don't like it for aesthetic reasons, and they don't like it for moral reasons."

Even the language used to describe obesity is judgmental, Dr. Saguy said. "Obesity is a health risk, like smoking, rather than a physical trait, like race," she said. "It assumes that people are to blame for their weight."

Jerry Gordon, a 52-year-old Philadelphia record producer, says he knows the stigma. Five feet four inches tall and 220 pounds, Mr. Gordon has struggled with his weight his whole life, trying countless diets. But the pounds always came back. For the past year he has been on a low-calorie diet as part of a clinical trial. At first, he dropped 45 pounds, but he has regained 9.

Mr. Gordon says he has felt the impact of the moral crusade. "People have become so self-righteous," he says. Friends and even casual acquaintances have offered advice.

"I get people saying, 'Hey, you ought to exercise more. You ought to go to the gym,' " Mr. Gordon said. "Do they think people will say, 'Gee, thanks for telling me I'm overweight - I didn't realize it?' "

A news conference in December 2001 had all the trappings of a major event. Dr. David Satcher, the surgeon general, announced that two-thirds of Americans were overweight or obese.

"Overweight and obesity may soon cause as much preventable disease and death as cigarette smoking," Dr. Satcher said, introducing a report, "A Call to Action to Prevent and Decrease Overweight and Obesity."

Dr. James Morone, a political science professor at Brown University, recalls that concerns about obesity were suddenly raised to the level of "crisis and obsession."

For years, the surgeon general's office had been the great force behind the anti-tobacco campaign, Dr. Morone observed. "In 2001, the tobacco settlements were in place. We'd gotten all the cultural mileage out of blaming tobacco for our sins. The surgeon general's report gave us a new sin and it resonated, it had a sense of truth."

Dr. Saguy, at U.C.L.A., takes a similar view.

"Things we didn't think were possible before the anti-tobacco movement became possible afterward," she said. Companies could be held liable for selling a legal, but unhealthy product. Social pressures could change the image of smoking from glamorous to pitiable or even despicable. Now, she said, the overweight are pitiable or despicable.

They are also an increasing focus of research. Last fall, Dr. Oliver, the University of Chicago political scientist, went to Las Vegas to attend the annual meeting of the North American Association for the Study of Obesity, whose members include obesity researchers and doctors who run weight loss clinics.

At lectures and other events, many sponsored by drug or medical supply companies, Dr. Oliver heard about the dangers of obesity. "Wherever possible," he said, "data were interpreted to portray obesity as a major problem, no matter how weak the actual findings were."

One talk, he said, involved data correlating obesity with the risk of deaths from auto accidents, with the preliminary finding that obese men are more likely than thinner people to die when they are in a car crash.

Such a conclusion would contradict the so-called obesity paradox - the frequent observation cited by experts like Dr. Katherine Flegal, a statistician at the C.D.C., that the obese tend to fare better than thinner people if they are sick or injured.

Dr. Oliver said he was surprised that the proposed link between obesity and auto fatalities was taken so seriously. But he said he realized that "an association that is dedicated to the study of obesity presumes that obesity is a problem."

Dr. Louis Aronne, the association's president, said there was no reason to single out obesity researchers for such criticism. "I would say the same things about any professional association - the diabetes association, the heart association, the cancer society," said Dr. Aronne, who also directs the weight loss clinic at Weill-Cornell Medical College in New York and is a scientific adviser to Metabolic Therapeutics and Manhattan Pharmaceuticals, two companies developing obesity drugs.

"We're doing what every organization does," Dr. Aronne said, "and this is what we believe - that obesity is a problem."

One leading obesity researcher, Dr. Stephen O'Rahilly, an endocrinologist at Addenbrooke's Hospital in Cambridge, England, focuses on the extremely obese, even though he knows they are a small group, and that the drug industry would like to find a fat cure to sell to the masses.

"We're working aggressively with pharmaceutical companies," said Dr. O'Rahilly, declining to identify the drug companies backing his work or to quantify their support.

Scientists, studying families and twins, have long known that genes help determine weight. So Dr. O'Rahilly is now looking for genetic abnormalities that can make some children enormously fat. Those same genes, he theorizes, may be at work to a slighter degree in people who are overweight or obese, but not morbidly so.

Dr. O'Rahilly does not dispute the statistics showing that on average people of all genetic makeup have grown fatter in recent years in industrial countries. "But genes determine where a person fits in the bell curve," he said. "Not everyone is fat. If the environment is so toxic, if whatever we're doing is like mercury poisoning, we'd all be fat."

So far, he says he has found four previously unrecognized genetic disorders that can cause obesity. Each one makes people eat voraciously, Dr. O'Rahilly says. Rather than being slothful, he said, "these children simply are not satisfied."

He knows his results make many people uncomfortable because they suggest that free will may be an illusion when it comes to how much a person eats.

"Lean people think they stay lean because they are morally superior," he said. His data suggest that they are simply genetically lucky.

He also knows there is money to be made in circumventing genes that make people fat - whether truly obese or simply heavier than normal. That is fine with Dr. O'Rahilly, he says, because a drug for the masses will be a drug for his patients.

"Would I use a powerful pill?" he said. "You betcha."
 
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