Vol. 49 August 1, 2011 How Did “Fat” Become “Obese”?

August 1, 2011

I was really tired of words like ‘plus size,’ ’round’ and ‘large.’ I thought, ‘Come on, we’re fat.’

Kirstie Alley

For the first time ever, overweight people outnumber average people in America. Doesn’t that make overweight the average then? Last month you were fat, now you’re average – hey, let’s get a pizza!
Jay Leno

We used to call overweight people “fat”.  Now they are “obese”.

This now politically-correct nomenclature has emerged from the medicalization of heaviness.

You use to be able to tell when someone was overweight by just looking at them. Now you must calculate their BMI, a measurement derived from height and weight, that superseded the more primitive measurement of skin fold thickness that nobody liked doing anyway. Scientific-looking graphs allow you to plot BMIs on a percentile scale. If your BMI is over the 90%tile you are REALLY FAT, excuse me, obese.

You can graduate from being merely obese to the Metabolic Syndrome with just a few blood tests; triglycerides, cholesterol, and insulin levels. People with Metabolic Syndrome have large belt circumferences; ie. they are fat. If your belt length is over 47 inches your mortality rate is doubled. (1) If you are a man with a belt circumference over 35 inches you are at increased risk for heart disease, stroke, hypertension, and , of course, diabetes. Overweight people tend to develop diabetes, so now all fat people are “pre-diabetic”. In fact half of the U.S. population could be called “pre-diabetic”. This recognized medical diagnosis has changing criteria. Just ask your own doctor what level of blood sugar he or she now considers “pre-diabetic”.

A pediatrician and a lawyer from Children’s Medical Center in Boston recently suggested that really fat children should be removed from their families by the state because extreme obesity in a child should be considered a form of child abuse; a striking example of the medicalization of  heaviness (2). One of the problems with this idea is that “you can’t pick your parents” and obesity does have a large genetic component. If parents are fat, their children will tend to be so also (even if they reside in a foster home).Once you start expanding the definition of child abuse where do you stop? What about parents with more than the  “normal number” of guns in the house. What  is that number? What about parents who watch more than 6 hours of TV a day? More than likely their kids do too, and we know that  prolonged TV watching leads to obesity.

No less a moral authority than renowned biomedical ethicist Daniel Callahan, retired Director of The Hastings Center  (dare I call him a “heavyweight”), has joined the discussion. In “Harnessing Stigma or Stigmatizing Stigma? The Case for Obesity” he proposes that the obese be subject to the same social stigmatization as smokers. The similarities are numerous. Both cause expensive medical illness. Both seem to be the result of individual’s choices. Calorie counts on foods are now required like Surgeon General’s warnings on cigarette packs. Callahan never published the article after public health researchers battling against the stigmatization of fat people changed his mind; i.e he returned to  “political correctness”. (Ah hah! When battling for a cause it is OK to call them “fat”, not “obese”.) Ironically if everyone stopped smoking the improvement in life expectancy would be completely cancelled out by the decreased life expectancy of obesity. If everyone in the U.S. stopped smoking AND returned to normal weight, our average life span would increase by almost 4 years. (3)

The many modes of obesity treatment are only 4% effective. Gastric bypass surgery has great potential for weight loss, though its reasons for effectiveness are still a subject for speculation and research. (4) So unlike smoking which is an addiction and perhaps more amenable to behavioral therapy and temporary medication aids, being fat is “more about the person and less about the behavior” according to Rebecca Puhl, Director of Research at Yale’s Rudd Center for Food Policy and Obesity.

That title definitely plays better than “Yale’s Research Center on Fat People.”      Q.E.D.

References:
1. Arch Int Med 2010 Aug9/23 170:1293
2.State Intervention in Life-Threatening Childhood Obesity    JAMA. 2011;306(2):206-207.
3. NEJM 361;23 22252
4. Lee Kaplan, MD, 2007, MGH Weight Center, MGH)


Vol. 24 July 1, 2010 More Things That Can Harm or Kill Ya.

July 1, 2010

Average number of Americans hospitalized each July with sparkler injuries: 1,020 (1)

Per cent of 1255 people (100%) going to the ER with serious food allergy symptoms due to peanuts or milk respectively:  23% / 15% (2)

Per cent of people who self-report having a milk allergy or a peanut allergy that actually have a positive skin or blood test for either allergy: <1% (3)

Amount spent by food companies on cross-promotion advertising (agreements between different companies to promote each other’s products) to children and adolescents in 2006:  $195 million (4)

Number of cross-promoted products in 2006 and 2008 respectively: 96 / 171

Per cent of cross-promoted food that met the Institute of Medicine’s standards for foods sold in schools: 18%

Increased risk of collision when texting while driving: X 23 (5)

Number of annual traffic accidents associated with use of cell phone talking or texting: 1.6 million

Per cent of all traffic accidents associated with same: 28%

Number of states that have passed laws regarding cellphone use while driving: 40

Rate of gastrointestinal bleeding within 30 days of a colonoscopy: 1.6 per 1000 exams (6)

  • This very low rate and the even lower rate of 1 perforation per 5000 exams means that colonoscopies are quite safe.

Per cent reduction in rates of all kinds of cancer in people who eat lots of fruits and vegetable: 3%

  • This massive study of 500,000 people in 11 European countries completing a year-long food-frequency questionnaire with an average of 9 years of follow-up led the NIH to the conclusion that “a broad effort to increase fruit and vegetable consumption would not have an effect on cancer incidence” …unless you are a smoker or a heavy drinker. (7)

Increased risk of dying from a motorcycle injury if you are over 40 years old rather than under 40:  x 2  (8)

Per cent of injured motorcyclists who were wearing a helmet:  73% for both over and under 40 years old

Number of poisonous gases , chemicals, or metals identified in tobacco smoke:  250 (9)

Number of those that are classified as class A carcinogens: 11

Chance that a lifelong smoker will die prematurely from a complication of smoking:  50% (10)

Per cent who resume smoking within one month after trying to quit on their own: 80%

  • There is no question that nicotine is addictive, and that smoking is a highly efficient means of drug administration.
  • Smoking tobacco “improves concentration, reaction time, and performance of certain tasks. Relief from withdrawal symptoms is probably the primary reason for this enhanced performance and heightened mood.”

Number of Burmese pythons captured in the Everglades in 2000 and 2008 respectively:  2 / 343   (11)

  • Such pythons grow to 20 feet in length, weigh up to 200 pounds, and EAT alligators! “By the time they reach two years of age, not much can eat them in the Everglades.” This population was started by the release of pet snakes which can grow from 20 inches to 8 feet in a single year.

Number of minutes of cell phone use equivalent to one day’s exposure to radio frequency waves if you live next to a cell phone tower: 30  (12)

  • This study of 1400 cancer cases in children over a 3 year period in the U.K. showed no increase in childhood cancers in offspring of mothers who lived near cell phone towers while pregnant.

References:
1. Harper’s Index; June 2010, U.S. Consumer Product Safety Commission
2.Pediatrics April 2010
3. JAMA May 2010
4. Public Health Nutr March 2010
5. NEJM June 10, 2010; 362:23
6. Clin Gastroenterol Hepatol 2010 Feb.
7. J Natl Cancer Inst 2010 Apr 21,
8. Univ. of Rochester medical Center
9. NEJM June 17, 2010, 326:24, pg. 2319 National Toxicology Program
10. NEJM 362:24 June 17, 2010, pg. 2295, “Nicotine Addiction”, N. Benowitz, MD
11. Sci Am Feb 2010, pg. 16
12. BMJ online, June 23, 2010, Paul Elliot


Vol. 22 June 1, 2010 Drugs, Tobacco, and Insurance

June 1, 2010

Tobacco is a drug.

Date that the Family Smoking Prevention and Tobacco Control Act gave the FDA extensive authority to regulate tobacco products: June 22, 2009

Date that the FDA regulated use of “modified-risk” words like “light”and “low tar” in cigarette advertising and banned candy- or fruit-flavored (but not menthol-flavored) cigarettes: June 22, 2010 (1)

Value of stocks in tobacco companies held by 7 health and life insurance companies: $ 4.5 Billion  (2)

Amount the drug company making Flomax (for prostate symptoms) spent in 2008 on direct advertising to consumers: $116 Million (3)

Per cent increase in price for Flomax in 2009 “anticipating health care reform”: 20% (4)

Year that the FDA was given authority to approve generic drugs (Waxman-Hatch Act): 1984

Per cent of prescriptions dispensed in U.S. in 2009 that are generic and per cent of total dollars spent on generic medications: 70% / 20% (5)

Number of years of patent protection and market exclusivity for new drugs under the 1984 Act:  5 and 5 years

Number of years of market exclusivity for biologics (like Herceptin, Epogen, Humira) under Health Care Reform Bill of 2010: 12

Number of registered drug-company lobbyists in Washington, D.C. for every member of Congress: 2 (6)

Per cent of U.S. military stockpiled drugs found in a FDA study to be perfectly safe and effective after their expired date: 90% (7)

Per cent of 17,000 retirees with a new diagnosis of hypertension and a higher co-pay ($15-20) that failed to fill their antihypertensive prescriptions: 55%

Per cent of the same group with a lower co-pay ($5) that failed to fill their prescription: 40% (8)

Per cent of patients in health plans that had NO co-pay for medications that did not adhere to their lipid-lowering prescription instructions: 40% (9)

Per cent increase in “abandoned prescriptions” (prescriptions submitted but never picked up) from 2006 to 2008: +34% (10)

References:

1. NEJM 362:19, May 13, 2010, p.1753
2. NEJM 360:23, p.2483
3. Consumer Reports, Dec. 2009 (from Nielson Media Research)
4. AARP Bulletin, Jan-Feb 2010, Patricia Berry
5 .NEJM 361;20, p.1917
6. Harper’s Index, November 2009, (from Open Secrets. com)
7.Wired, December 2009, p. 46
8. Arch Int Med 169:740, Apr 27, 2009
9. Circulation 2009;119:390-7
10. Wolters Kluwer Health 2009 survey in Philadelphia, AARP Bulletin, Oct 2009, p.10


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