Undernews is the online report of the Progressive Review, edited by Sam Smith, who covered Washington during all or part of one quarter of America's presidencies and edited alternative journals since 1964. The Review has been on the web since 1995. See main page for full contents

July 29, 2009


Patrick Basham and John Luik, Baltimore Sun - Why is a thin, male smoker considered a physical role model as president but a full-figured African-American woman is considered an embarrassment as his nominee for surgeon general?

President Barack Obama's nomination this month of Dr. Regina Benjamin as U.S. surgeon general brought down upon the White House a barrage of criticism from medical "experts" who claim Dr. Benjamin is setting a bad example because of her weight. For example, Dr. Sarah Reed, who religiously keeps her own Body Mass Index in the "underweight" category, was quoted in The Daily Telegraph saying: "Although her credentials speak for themselves, her weight cannot be overlooked. Shame on her!"

Is Dr. Benjamin too fat to handle the nation's health? There are three evidence-based public health reasons why worries about her weight are unwarranted.

First, there is little credible scientific evidence that supports the claims that having an overweight or obese BMI leads to an early death. For example, Katherine Flegal of the Centers for Disease Control and Prevention found that in the U.S. population there were more premature deaths among those with BMIs of less than 25 - the so-called normal weight - than those with BMIs in excess of 25.

In fact, the lowest death rates were in the "overweight" category - that is, those with BMIs from 25 to 29.9. Indeed, in this study, Americans who were overweight were those most likely to live the longest.

In the American Journal of Public Health, Professor Jerome Gronniger looked at weight and mortality for each BMI point, rather than simply comparing, as is usually done, mortality across broad categories, such as underweight, normal, overweight and obese. He found that men in the "normal" weight category exhibited a mortality rate as high as that of men in the moderately obese category (BMIs of 30 to 35); men in the "overweight" category clearly had the lowest mortality risk.

Moreover, a new study published in the American Journal of Clinical Nutrition that looked at alternative measures of obesity, such as percentage of body fat, skin fold thickness, waist circumference, and waist-hip ratio, found even less scientific support for the alleged fat-equals-early-death thesis. The authors report that for the intermediate level of each of the alternative measures of obesity, there was a negative link with mortality. In other words, those with a higher waist circumference or a higher percentage of body fat had lower mortality rates.

A second reason why Dr. Benjamin's weight is a non-issue is because in those studies that have found statistically significant associations between overweight/obesity and premature mortality, the risks are so modest as to be essentially negligible. For example, whereas the reported lung cancer risks for smokers are typically 10 to 20 times higher than for nonsmokers, the death risks for those who are overweight and obese are often closer to only 0.5 above those of normal weight.

Third, contrary to conventional wisdom, the association of overweight and obesity with higher risks for a variety of diseases, such as cancer, diabetes and heart disease is unproven. In part, this is because these diseases have multiple causes.

More strikingly, increases in overweight and obesity have been paralleled by falls in total cardiovascular mortality and mortality from coronary heart disease and stroke, as well as in the prevalence of hypertension and hypercholesterolemia, undermining claims that overweight and obesity lead to higher rates of morbidity.

The last demographic holdout against "fatism" is the African-American female, who on average is disproportionately heavy. And she is disproportionately comfortable with her weight. The fat police view this fact as simply unacceptable.


Anonymous Anonymous said...

Hatred of fat people has become acceptable and expected. It is only a matter of time before they put them in concentration camps.

July 29, 2009 7:10 PM  
Anonymous Anonymous said...

Crush the arrogant twigs!

July 30, 2009 2:02 AM  
Anonymous Anonymous said...

Below I speak of obesity, not being what is called "overweight" by BMI. But rather obesity at a level at which it interferes with mobility, lifespan, and the ability to use normal accommodations.

Obesity is an obsessive compulsive disease. Like compulsive gambling, hand washing or hair pulling. If people choose to remain obese, that is their right, just as it is the right of the alcoholic to continue to drink. But the presence of active disease is not something to be defended in any of these cases.

July 30, 2009 9:06 AM  
Anonymous Anonymous said...

"Obesity is an obsessive compulsive disease. Like compulsive gambling, hand washing or hair pulling. If people choose to remain obese, that is their right, just as it is the right of the alcoholic to continue to drink. But the presence of active disease is not something to be defended in any of these cases."

So you're saying that it is a disease and at the same time it's a choice?

July 30, 2009 10:06 AM  
Anonymous Anonymous said...

The most likely reason those who are overweight live longer is that they have enough reserve energy stored to survive a serious illness and the often toxic treatments used to treat it.

On a related topic, I notice that the pharmaceutical/health care industry never provides all the statistics you need to evaluate their claims. If we are told a particular factor (blood pressure, weight, etc.) increases your chances of disease x by 50 percent, we really have no useful information. We need to know what the actual chance of disease x is in a person without this risk factor. If the chances are 25% then you are increasing your risk to 37.5%, and you probably want to do something about it. If on the other hand, the chances of getting the disease are 2%, you are only increasing your risk to 3%, and would have good reason to forego expensive treatments.

July 30, 2009 2:12 PM  
Anonymous Anonymous said...

So you're saying that it is a disease and at the same time it's a choice?"

It is a disease and there is a choice of recognizing that one has a problem, and be willing to do something about it.

When individuals are so obese that they can't tie their own shoes, it is clear that they have a serious problem. When people start to hide food like alcoholics hide bottles, they have a problem. Given the state of research into neurophysiology and psychology, it is more than fair to say they are suffering a disease.

People who suffer from diseases often refuse to recognize the problem, or refuse treatment. This can be a rational or an irrational choice, and in non-contagious diseases should be a matter completely left up to the individual. Forcing behavioral modification and or limitations on individuals should be limited to cases where there is a likely severe impact on the health of others. Typhoid Mary is one such reasonable case. Or perhaps consider an airplane passenger coming from Africa who evinces symptoms of Ebola fever. But when the harm is limited to self, then the choice must be left to the individual.

It is not reasonable to expect that society must always function around those who are active in their disease. I would not want a cab driver who was an active alcoholic, nor a ferry boat captain who had uncontrolled epileptic seizures.

I believe it to be reasonable to question the cognitive capabilities and the decision making powers of individuals who are morbidly obese. We would not question the refusal to hire someone who could not control their sexual appetites. An individual who can not discern the self harm of severe obesity, nor have the decision making facilities to deal with that, is likely not to have reliable decision making capabilities in other areas either. The spill over from their denial in one area of their life will affect other areas of their life.

Individuals make choices as to their disease every day. Some struggle and make incredible recoveries. Some manage as well as can be expected. Others clothe themselves in their diseases and surrender because the diseases serve a purpose.

July 30, 2009 5:20 PM  
Anonymous Anonymous said...

5:20, bear in mind that most of those who discriminate on the issue of weight do not see any difference between being overweight and being morbidly obese. To them, if you're not skinny as a rail, you are a terrible person.

July 31, 2009 10:55 AM  
Anonymous Anonymous said...

Yeah, a woman I took on a date once thought I was a gangster because I had a SwissArmy penknife on my key ring. The biggest blade as no more than 1 1/4". I can't control other peoples perceptions.

July 31, 2009 6:32 PM  

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