Monday, March 13, 2006

'Obesity Epidemic' Overblown, Conclude UCLA Sociologists

'Obesity Epidemic' Overblown, Conclude UCLA Sociologists

  December 1, 2005

  While the proportion of Americans who can be classified as obese may have risen 20 percent since 1980, the so-called obesity epidemic is at best a metaphor and not a very effective one at that, suggests a UCLA study in the current issue of the Journal of Health Politics, Policy and Law.

"The term 'obesity epidemic' offends many heavier people - those who the medical community most wants to influence - and may actually set them up for discrimination, even at the hands of medical providers," said UCLA sociologist Abigail C. Saguy.

Furthermore, the widely reported phenomenon implies the existence of a medical fix for fatness, when the jury ! is still out on many aspects of weight management, including an individual's ability to control his or her weight and the potential benefits of doing so.

"If a pill were discovered that produced major weight loss, we would expect to see more groups organized around the assertion that obesity is a disease," said Saguy, an assistant professor of sociology. "But existing weight-loss techniques and products are not very effective and many are outright dangerous. Moreover, there is considerable disagreement in the United States over many questions related to weight and health, including if or why higher weights have adverse health consequences, what an ideal weight is or whether a universal ideal weight even exists, why people gain weight, why some weigh more than others, and whether weight loss improves health."

Based on an evaluation of more than 100 books, articles and studies about the issue and interviews with researchers and activist! s, the study documents mounting opposition to anti-obesity messages s ince 1994 when the rise first grabbed public attention. In the intervening decade, the number of articles published about obesity has tripled in medical journals and quadrupled in the popular press, calculates Saguy and co-author Kevin W. Riley, a UCLA graduate student in sociology. A fierce "credibility struggle" has ensued between the anti-obesity camp and the camp advocating skepticism about the health risks of being heavy.

"The mistrust between these two camps can make it difficult to find a middle ground," concludes the study.

But according to the classic definition, the steady rise in Americans with a body mass index of 30 or more - the traditional definition for obesity - does not constitute an epidemic, contends Saguy, a petite mother of two small children.

"The term 'epidemic' refers to the rapid and episodic onset of infectious diseases and is associated with fear of sudden widespread death," she said. "De! aths attributed to obesity are calculated using odd ratios, which are often only slightly higher for those in the obese categories. This is a much looser use of the term 'epidemic' than, say, the flu epidemic."

In fact, recent research has found no appreciable difference in mortality rates among fat Americans with a BMI less than 35. Only 6 percent of the American population fall into that category, Saguy points out. Many more medical issues pose a greater threat to more Americans, most notably malnutrition and smoking.

"Media coverage of obesity overtook reporting on hunger and malnutrition in 2002 despite the fact that the World Health Organization deemed hunger to be the leading cause of world death," she said. "Similarly, cigarette smoking continues to be the leading cause of 'preventable death' despite the increasing shift of focus from smoking to obesity."

Given the ineffectiveness of weight-loss techniques and products! , the study questions the effectiveness of "pathologizing" or "medicalizing" heavier weights. "Weight loss is elusive for 75 percent to 95 percent of participants of commercial weight-loss programs in one- to three-year follow-ups," she said. "If one assumes that weight is largely outside of personal control, then raising concern over the health risks associated with obesity has little remedial function."

Furthermore, discussions of obesity's potential health risk can offer "a thinly veiled language through which to extend judgments of responsibility, blame and morality," the study warns. Such finger pointing, in turn, may worsen the stigma and discrimination faced by fat people. In addition to potentially offending those the anti-obesity activists hope to reach, the approach raises issues of class and race.

"Given that higher weights are inversely correlated with social class in heterogeneous and affluent societies such as the United States and that African American a! nd Mexican American women are especially likely to be categorized as obese, blaming fat people for their weight may serve to justify and reinforce social inequities," she said.

Blaming the victim can even lead to medical problems. Saguy and Riley found that prospect of "being harangued" about their weight keeps some overweight people from seeking treatment for medical conditions that are much more clearly treatable and more risky than obesity. For instance, they cite research showing that obese women are less likely to receive cervical exams than their thinner counterparts.

Nevertheless, the messages that cast obesity as a medical concern on its own have found a ready audience in the media, a subject of ongoing research by Saguy. The most alarmist of the scientific studies have received a disproportionate share of coverage, she contends. Moreover, the coverage has tended to report risks for the very obese as though they pertain to people w! ho are merely heavy.

Coverage also has tended to conflate more wid ely accepted risks associated with poor nutrition and a sedentary lifestyle with more disputed risks of obesity.

"It's easier - and seemingly more authoritative - to quantify weight trends than trends in diet and exercise," Saguy said. "With diet and exercise, researchers have to rely on what people report about their activities. Body weight is easier to measure."

"Reporting on obesity also taps into people's dread of body fat in a way that reporting on food and exercise choices does not," she added.

Moreover, conflicts of interest appear inherent to anti-obesity research, Saguy has found. While she did not find evidence that legitimate researchers are being outright compromised by the U.S. weight-loss industry, at least one admitted that his research would not be able to go forward without funding from these commercial interests.

She argues that the medicalization of obesity is part of "a strategic attempt to mak! e weight-loss treatments and surgery tax-deductible or covered by Medicare."

Before advising others to shape up, the medical community might consider curing itself, the study suggests.

"Medical equipment, medical gowns and equipment such as MRI machines often do not fit people who weigh over 350 pounds, compromising their medical care and leading these people to avoid preventative care," the study warns.

Saguy's research has been funded by the Robert Wood Johnson Foundation, UCLA and the Fund for the Advancement of the Discipline (run jointly by the American Sociological Association and the National Science Foundation


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