Is it irresponsible to call obesity an "epidemic"?

Ha! Evidently, you haven’t heard of the word 'abuse!" :cool:


There was a rapid increase per capita in BMI over the latter half of the 20th century into the 21st, and a concomitant increase in the percentage of the population fitting the medical definition of obese. Obesity as defined is a pathological state, with a reasonably well-characterized syndrome and significant comorbidity. So, you’ve got a rapid and unexpected increase in the incidence of a particular pathology affecting a particular population (primarily those living in the USA, especially sub-populations thereof). All the basic criteria of an epidemic have been met. There’s nothing remotely irresponsible about the use of the label in this case. What the media does with this information, or their misapplication of the terminology, is not the fault of epidemiologists.

I’m on my lunch break now, and wrote up a summary of information from a book I read recently:

The following information comes from the book The Diet Myth by Paul Campos (previously published until the title The Obesity Myth. I’ll quote some excerpts here, which I think aren’t too big and fall under “fair use.”

However, let me just say right away that this book does not try to claim that being overweight is great and that morbid obesity is just dandy. Rather, he’s saying that the medical risks associated with being somewhat overweight are exaggerated, and that you need to get into very high levels of obesity (100 to 150 pounds overweight) before the medical risks are significant. At that point, there’s no kidding yourself that your weight isn’t harming your health at all. However, relatively few people are at this extreme. The vast majority people who qualify as overweight are not that overweight. Also, weight loss is difficult to maintain, and the majority of dieters regain all they lost, or even more. “Yo Yo” dieting is much more dangerous to your health than just being overweight in the first place.

Some main points that he makes are:

[ul][li]The health risks associated with increasing weight are generally small, in comparison to those associate with, for example, being a man, or poor, or African American.[/li][li]These risks tend to disappear altogether when factors other than weight are taken into account. For instance, fat active people have half the mortality rate of thin sedentary people, and the same mortality rate as thin active people.[/li][li]There is no good evidence that significant long-term weight loss is beneficial to health, and a great deal of evidence the short-term weight loss followed by weight regain (the pattern followed by almost all dieters) is medically harmful. Indeed, frequent dieting is perhaps the single best predictor of future weight gain.[/ul][/li][/quote]

Some quotes and research from the book, italics are in the original and bolding was added by me:

This Norwegian study is: Waaler et al., “Height, Weight and Mortality: The Norwegian Experience, Acta Med Scanda Suppl 679, 1-5 (1984).

From: Troiano et al., “The Relationship Between Body Weight and Mortality: A Quantitative analysis of Combined Information from Existing Studies.” Int J Obesity 20, 63-75 (1996).

From: Menotti et al., “Underweight and Overweight in Relation to Mortality Among Men Aged 40-49 and 50-59 Years: The Seven Countries Study”, am J Epidemiol 151, 660-66 (2000).


Anecdotally, I also remember that in my first year of university I took a course on heath and wellness (a requirement for my Physical Education degree program). At that time, in 1997, a normal BMI was defined at 20 to 25, “caution” was 25 to 27, overweight was 27 to 30 and obese was 30+.

Several years later, they eliminated the “25-27” category, and now just call those people overweight. So people who previously had been simply “high normal, watch out in case you gain weight and become overweight” were now simply “overweight.”
Full disclosure – I have been extremely overweight (5’5” and 275lbs). I have been tracking calories and eating healthy for about a year and a half and have now lost over 55lbs (currently 218) and I plan to continue losing more weight. My eventual goal is about 150 to 160lbs (which would be a BMI of 25.0 or 26.6 – considered the absolute upper limit on “normal”, verging into “overweight”).

I lost the initial weight for health reasons, but I’d be kidding myself if I didn’t admit that my goal of 160 is mostly out of vanity – I was extremely fit at that 170lbs when I was eighteen, and if I only get down to about 180 and maintain the weight loss without regaining that I’ll have done as much as is needed, statistically speaking, to be more healthy. The extra 10 to 20 lb loss would just be to look better in a bathing suit. Which is a good goal – but it’s not for medical reasons.

I think that these three statements are true, just based on what I see around me and read:

  1. Being a trifle overweight is not a big deal, healthwise. Good nutrition and healthy activity are more important than a simple measurement of weight to height like the BMI. In short, I find Waenara’s quotes persuasive.

  2. There is a bit of a “moral panic” atmosphere about the weight issue.

  3. People are on average getting fatter every year, and this is a genuine public health problem.

Disclosure: I have myself recently lost 40 pounds, and I’m now 6’ and weigh 195 pounds. I’m starting my exercise regime in a gym that is in the same building where I work on Monday.

A bit, maybe, but I don’t think I would qualify it as a real “moral panic”. It doesn’t have the elements usually associated with it:

  1. A public outcry for someone to do something to protect them

  2. A vague but intensely-felt sense of having “our way of life” attacked

  3. The dehumanization of the culprits.

Fat people are not seen as “the enemy”, but rather people who need help. Obesity is thought more along the lines of an illness, not as an overtly anti-social act.