"Fat's where it's at." Rocker Root Boy Slim, who sang those lyrics in the early 1980s, didn't know he hit upon a new theme for our ever expanding public health waistline. Just this week, the National Institutes of Health issued the first federal obesity guidelines. Unfortunately, the new standards say more about the bloated public health bureaucracy than they do about obesity.
According to the guidelines, a person is "overweight" if their so-called body mass index (BMI) is greater than 25. A person is obese if their BMI is 30 and above. BMI is calculated by a simplistic formula: bodyweight (in pounds) multiplied by 703 and then divided by height (in inches) squared. But while BMI may be a useful index for studying obesity in large populations, it can be a misleading indicator of obesity in individuals.
BMI does not consider, and ultimately, distinguish between body types. An individual who is relatively more muscular might have the same BMI as someone who is relatively less muscular. Rote application of the BMI might erroneously label the muscular individual as overweight. In fact, BMI is as much an indicator of muscle mass as fat. BMI also does not consider bone mass, another factor that could throw off rote application of the BMI.
BMI does not consider a person's overall health condition. Simply being overweight is not a definite indicator of poor health or health risk. While a physician's examination of a patient would likely take into consideration overall health, and muscle mass and bone mass in determining whether an individual is overweight, insurance companies and employers might be less discriminate in their use of BMI.
According to the new federal standard: 98 percent of the last year's Green Bay Packers were "overweight;" 59 percent were "obese." Is this an accurate description of young men in top athletic condition?
But aside from the technical flaws of the BMI, the campaign against obesity belies a larger problem in public health today. The American public's health is the best it has ever been. Although some public health problems remain, the mission of the public health community is shrinking. By issuing these new obesity standards, the public health establishment has declared that 97 million adults nearly 55 percent of the U.S. population are overweight. By fiat, a major new public health problem is created. The mission is expanded.
That obesity is the target should come as no surprise given recent developments. On January 1, 1998, the New England Journal of Medicine published a study on obesity as a cause of premature mortality. There was a twist, though.
In commenting upon the study results, the Journal editorialized that obesity was overemphasized as a public health problem. "The data linking overweight and death, as well as the data showing the beneficial effects of weight loss, are limited fragmented and often ambiguous... Until we have better data... we should remember that the cure [e.g., unhealthy diets and diet drugs] for obesity may be worse than the condition," the editors wrote.
The surprising, but level-headed editorial, sent the obesity industry reeling and provoked outrage among many in the public health community, including former Surgeon General C. Everett Koop who has staked out his financial claim in obesity with a program called "Shape-up America!". Apparently, the obesity industry is now rebounding.
Just days before the NIH issued the new guidelines and as if on cue, the American Heart Association declared that obesity is a risk factor for heart attack. One wonders, though, what has taken the Association so long to make this declaration? There is no new data. But timing is everything.
In the press release about the new guidelines, the NIH stated that obesity, after smoking, "is the second leading cause of death in the U.S. today." Not true. This statement is based on a figure of 300,000 annual deaths due to obesity that has been tossed around since 1993. But the source of the figure recently pointed out in the New England Journal of Medicine that "the figure...applies broadly to the combined effects of various dietary factors and activity patterns that are too sedentary, not to the narrower effect of obesity alone."
Many in America may have weight problems. But junk science standards and hysteria are not answer. In casting its net widely to capture as much of the public's attention as possible, the federal government is wasting its time and our resources. Instead of focusing on the more limited set of morbidly obese individuals, the NIH will be targeting many healthy individuals whose worst crime is perhaps not being able to win a body-building contest or wear a bikini.
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