Obesity Crankery – A growing problem

Recently, it seems there has been a backlash against medicine and the current knowledge of the relationship between diet, weight and overall health. I don’t actually believe this is directly the fault of scientists or doctors, who react to the trashy mainstream reporting of science with little more than the occasional raised eyebrow. However, many people in response to all these silly health pronouncements, which seemingly come from on high but really are from press coverage of often minor reports in the medical literature, have lost their trust in what science has to offer as a solution to what Michael Pollan refers to as “the Omnivore’s Dilemma”. That is, what should we be eating?

The result of this confusion is a mixture of distrust, cynicism, and receptivity to crankery and lies about diet. After all, if science ostensibly can’t keep their message straight, who knows what to believe?

The fact is, science knows many things about the relationship between diet, obesity, and health with great confidence and it hasn’t changed nearly so much as the popular press would have you believe. The failure to state clear messages about nutrition is a reflection on the haphazard way in which nutritional health is reported, the often confusing nature of epidemiologic science, and the various parties that are interested in cashing in the confusion by promoting their own nonsensical ideas about diet.

Take, for example, Sandy Szwarc. Sandy doesn’t believe obesity or any food choices are actually bad for you. To help spread this nonsense she dismisses valid sources of information like WebMD (which has quite good information) based on the rather silly conspiracy that they have designed their entire website and health enterprise around misleading people into using their products – especially weight-loss products. Because, you know, it’s impossible for a corporation to offer free health advice as a public service without conspiring to grab you buy the ankles and shake the money from your pockets. But it doesn’t end there. We see rest of the standard denialist tactics of course!

Case in point, in a recent article she makes the astonishing assertion that her mortal enemy – bariatric or gastric-bypass surgeons – have admitted that obesity makes you healthier!

Today brought another unbelievable example of ad-hoc reasoning, as well as a remarkable admission that the war on obesity is without scientific merit. It appeared in a paper published in the journal for the American Society for Bariatric Surgery (now calling itself the American Society for Metabolic and Bariatric Surgery), which is edited by the Society’s president, Dr. Harvey Sugerman, M.D. FACS.

The article, “Do current body mass index criteria for obesity surgery reflect cardiovascular risk?” was “work presented at the 2005 American Society for Bariatric Surgery Meeting in poster form.” The authors, led by Edward H. Livingston M.D. at the University of Texas Southwestern School of Medicine, reported that the conventional risk factors for cardiovascular disease “decreased with increasing degrees of obesity.”

Yes, you read that correctly, decreased.

“Therefore,” the authors argued …

“the criteria for obesity surgery should be changed to lower BMIs than are currently used.”

Now, boys and girls, what is the very first thing you do when a suspected denialist feeds you some nonsense in quotes? Check the source! Always, always, always, check the source. Let’s expand those six words that Sandy lifted out of the abstract and see what else the authors had to say:

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Doctors are conspiring to convince you you’re sick!

How do doctors decide what is healthy and unhealthy? Do they arbitrarily decide on risk factors to line their pockets – creating false epidemics as Sandy Szwarc at Junkfood Science suggests? Or, is there actually a science, called epidemiology, that is the basis for health recommendations?

As I’ve said repeatedly, one of the sure signs you’re about to hear total BS is if someone suggests there is some conspiracy by scientists or doctors to hide the truth. In an article challenging the use of serum troponin levels to determine whether myocardial infarction (MI) has occurred (a more sensitive method) Sandy suggests this is yet another example of doctors lowering metrics of illness and risk to generate the impression of false epidemics.

There must be a health crisis to bring the greatest funding for research, treatments and education… even if an epidemic has to be created. One of the most common tactics is to change the definition. When diagnostic criteria is broadened, suddenly, with the stroke of a pen, new cases can appear to explode in number.

With heart disease deaths dropping dramatically for the past half century, the world’s top four organizations representing heart disease interests have all gotten together to change the definition … of a heart attack.

The World Heart Federation, American College of Cardiology, American Heart Association and the European Society of Cardiology have been championing the new criteria over recent years, and will officially release it next month in the Journal of the American College of Cardiology and in the AHA journal, Circulation. The new definition will use elevations of troponin levels, rather than the traditional cardiac biomarkers, such as the MB-CK enzyme.

This is a truly bizarre argument. Because measuring troponin will allow us to detect more MIs that have occurred, it must of course be part of a plot to make Americans think they’re less healthy. Never mind that more sensitive tests for MI are what is known as a good thing, and that current tests clearly are missing minor heart damage thus underestimating the number of true MIs. Any revision of current standards must be part of a plot! The fact that those scientists got together is a sure sign. We should never let them do that.

While troponins may go up for other reasons, the idea that the test will misdiagnose as heart attacks other disorders is pretty silly. This isn’t a test that is going to be used to diagnose MI in the absence of chest pain or abnormal ECG findings – which enhances the specificity of the test – and doctors are aware of confounding diagnoses – it’s their job to find them. Further, the idea that the new criteria were designed to somehow justify funding for heart disease (an area of medicine that will never lack for funding) is downright hilarious.

But this isn’t the only example of “false epidemics” being created by those greedy doctors trying to convince people that they’re ill. Sandy mentions other excellent examples.

First, because this is Sandy, is of course obesity:

“Overweight:”Definition changed from BMI ≥ 27 to BMI ≥ 25 by the U.S. National Heart Lung and Blood Institute in 1998, instantly increasing by 43% the numbers of Americans, an additional 30.5 million, deemed ‘overweight.’

So, did doctors just pull that figure out of nowhere to line their pockets? Or does data exist that justify the decision? This study in NEJM(1) is a prospective study of over a million people evaluating all-cause mortality (as well as a number of independent risk factors) showing the relationship between BMI and mortality. Here is the relevant figure – the dark line is most relevant – showing the relative risk of death versus BMI.

Continued below the fold:
Continue reading “Doctors are conspiring to convince you you’re sick!”