In an article entitled “The shape we’re in” Guardian health editor Sarah Boseley presents “ten shocking facts about Britain’s health crisis” which claim to be the truth about obesity (1). Unfortunately she simply re-hashes the stale old arguments and false information, which is why we are in such a mess.
There is no doubt that people are getting heavier but where is the evidence that the extra weight per se is responsible for the deterioration in public health? The article cites a study published in 2009, which concludes that moderate obesity (BMI 30-35) means a reduction of 2-4 years life expectancy while severe obesity (BMI 40-45) results in a loss of 10 years life expectancy. Not everyone accepts this as definitive.
Detailed reliable studies in the USA (2) and in Canada (3) involving large numbers of participants provide conclusive evidence that those with a BMI classed as “overweight” have a greater life expectancy than those with the so-called “ideal weight” ( BMI 20-25). Furthermore there is no convincing data to demonstrate that there is any significant decrease in life expectancy in those with a BMI of 30-35 (mild obesity) compared with the ideal. Data collected In a Norwegian study based on 1.7 million people confirmed that the highest life expectancy was amongst those who were classed as overweight. Even more unexpected it was found that in those over 65 years old, which is when most deaths occur, the death rates of those with BMI >35 were very similar to those with a BMI in the ideal range ( BMI 20-25).
When physical fitness is factored into the equation it becomes clear that it has a major impact on life expectancy (4).The results in Table 1 show that there is very little difference in the death rates across the entire BMI range for those who were physically fit. However for those who were physically unfit, the death rates for those in the overweight and mild obesity BMI categories were approximately twice as high as for those who were fit. The death rates for those with BMIs in the normal and severe obesity ranges were even higher. Similar differences were also observed when obesity was assessed by waist circumference or by percent body fat.
EFFECT OF PHYSICAL FITNESS ON DEATH RATES (PER/1000 PERSON-YEARS) FOR DIFFERENT BMI CATEGORIES
Similarly Lee and co-workers observed that the higher risk of cardiovascular mortality was no longer significant once fitness change was taken into account. They also reported that all-cause mortality was not significantly associated with change in BMI (5).
In patients who had coronary heart disease and were also hypertensive it has been found that those who are overweight and obese had a much lower death rate compared with those in the “normal” BMI range. This study had 22,576 participants (61,835 patient-years) with an average age of 66 years. The authors concluded that the “excess” weight was actually protective (6).
The reality is that overweight/obesity is not a disease. Recently in the American Medical Association decided to classify obesity as a disease but the “justification” has been subject to severe criticism (7).
Sarah Boseley implies that part of the problem arises from the fact that the food industry spends about £1 billion on food promotion and this dwarfs the expenditure on the government’s Change4Life which is only about £14 million. She fails to mention that Change4Life advocates a reduction in saturated fats (SFAs) which is no longer tenable. The rationale for concluding that SFAs are damaging to health just does not stand up to rigorous examination (8). It is highly significant that this topic has been analyzed in a recent issue of Time magazine, which now recognizes that butter is a valuable source of key nutrients (9). Even The Guardian had an editorial “In praise of …..butter” (10).
Despite the relationship between obesity and life expectancy, there is no question that the standard of public health is deteriorating. However obesity is not the fundamental issue as presented by the government and the health professions ably supported by articles such this one in The Guardian. The focus of attention should be on diabetes, particularly Type 2. The incidence has doubled in the last 15 years, while pre-diabetes trebled between 2003 and 2011 (11). Those with diabetes have a greatly increased risk of developing a range of diseases/conditions including heart disease, cancer, Alzheimer’s Disease and obesity. Obesity should be considered a symptom rather than a disease in its own right.
Recognizing what is really happening provides a sound basis for dealing with the problem. Diabetes is caused by excess glucose in the blood. This in turn causes insulin to be secreted in order to control the glucose. When the organs are subjected to continuous excessive insulin they develop insulin resistance, which impairs their ability to function effectively. Unfortunately the usual approach to treatment is to prescribe drugs which may include insulin therapy. While these may help to control the blood glucose the organ damage is exacerbated. If dietary advice is given, this usually is to reduce fat and increase carbohydrates. You do not have to be a high –powered scientist to understand this must be counter-productive. Carbohydrate foods such as bread, potatoes, rice and pasta all contain starch which breaks down to produce glucose. Surprise, surprise this only adds to the glucose-load in the blood, thereby making things worse. On top of all this, patients who follow the advice are likely to choose from the “low fat” variations so heavily promoted by the food industry. More often than not these are formulated by taking out the fat and replacing it with sugar!!!
The article states that being overweight is the chief cause of diabetes, but does not provide a shred of evidence in support. The study of diet and health is littered with examples of researchers concluding that an association demonstrates a cause and effect. Just because the incidence of obesity and diabetes are increasing at approximately the same time does not mean that the obesity is causing the diabetes. Possibly it is the other way round and it is the diabetes that is causing the obesity. However the most probable rationale is that both have a common cause, which is of course excess sugar/refined carbohydrates in the diet. This is not just a matter of nit-picking because an understanding of the fundamental cause is essential for developing strategies which will be effective.
The logic is irrefutable. Over the past 30 years or so in response to the signals sent out by government, the amount of fat and SFAs in the typical diet has fallen substantially only to be replaced by sugar and carbohydrates. In particular there has been a huge growth in the consumption of soft drinks which are packed with sugar. There can be no doubt that this is why we have experienced such dramatic increases in the incidence of diabetes. So the answer is obvious. Reverse the trend. Therefore it is essential to reduce the intake of carbohydrates, especially those which are refined because they are broken down quickly and lead a steep increase in the blood glucose concentration. But these have to be replaced by fats such as those present in meat and dairy products which are exactly those fats the government is telling us to avoid. It is absolutely crucial to help people appreciate that it is not the total amount of food consumed (ie calories) but the type of food which is the key to the solution. There is now research which confirms that diabetes can be overcome by reducing the consumption of carbohydrates and increasing certain fats. In addition, there are numerous case studies from individuals who were able to terminate drug treatment as a result of dietary changes (12).
The truth is that public health policy is a disaster. As long as journalists in the so-called quality press continue to regurgitate the “official wisdom” they will remain an integral part of the problem and will certainly not contribute to an effective solution.
I find it unbelievable that a senior journalist on a leading broadsheet seems to be totally ignorant of the information currently available which conclusively shows that many of the official dietary recommendations are fundamentally flawed. I suggest Sarah Boseley makes herself familiar with the works of people such as Gary Taubes, Barry Groves, Zoe Harcombe, John Briffa and Robert Lustig to name but a few. In fact she would be well advised to consult her colleague on the leader writers’ team who was responsible for the editorial about butter mentioned above.
- K M Flegal et al (2005) Journal of the American Medical Association 282 (16) pp 1530-1538.
- Heather M Orpana et al(2010) Obesity18 (1) pp214-218.
- D Lee et al (2011) Circulation 124 (23) pp 2483-2490.
- S Uretsky The American Journal of Medicine (2007) 120 (10) pp 863-870.