In her rebuttal to my initial post in this debate, Ms. Widemark ignores most of the studies that I presented. In fact, she only attacks one statistic that I presented and one study. She did not address any of my other points. This indicates to me that she has no answer to the wealth of data that clearly demonstrate a link between obesity and chronic illness.
With that out of the way, let’s concentrate on the few issues she does address. First, she claims that data by Dr. Kathleen Flegal support her claim that only 26,000 deaths per year are linked to obesity, despite the fact that the CDC says the number is 112,000. However, she once again provides no reference for her statement at all. When one looks at the actual study that was published by Dr. Flegal1 , one sees that Ms. Widemark still has no grasp of the facts.
For example, Ms. Widemark claims that of the 112,000 deaths Dr. Flegal associates with obesity, “Some 86,000 were at BMIs of 26-35.” This is simply false. In the study, Dr. Flegal defines obesity as BMI>30, and all of the 112,000 deaths come from BMIs greater than 30. In fact, Dr. Flegal specifically mentions the number of deaths from BMI>35: “Of the excess deaths associated with obesity, the majority (82 066 deaths; 95% CI, 44 843 to 119 289) occurred in individuals with BMI 35 or greater.”1 Thus, even if one wants to include only those people who had BMI greater than 35, the number of deaths is 82,000, not 26,000.
She also questions which fraction of the 112,000 deaths due to obesity were actually due to poor diet and lifestyle choices. If the study is accurate, the answer, of course, is zero. As Dr. Flegal and her coauthors state, “We estimated relative risks of mortality associated with different levels of BMI (calculated as weight in kilograms divided by the square of height in meters) from the nationally representative National Health and Nutrition Examination Survey (NHANES) I (1971-1975) and NHANES II (1976-1980), with follow-up through 1992, and from NHANES III (1988-1994), with follow-up through 2000. These relative risks were applied to the distribution of BMI and other covariates from NHANES 1999-2002 to estimate attributable fractions and number of excess deaths, adjusted for confounding factors and for effect modification by age.”1 Thus, confounding factors such as poor diet and lifestyle choices were included in the analysis and factored out of the final number. This is why the CDC says the number of deaths due to obesity by itself is 112,000.
She also claims that Dr. Flegal says the connection between obesity and the 112,000 deaths might be weak. This is just false. Nowhere in her work does Dr. Flegal suggest this. Instead, she states quite clearly that the 112,000 deaths were due to obesity.
This once again demonstrates that Ms. Widemark does not do very careful research. The study is very easy to find and read. I am not sure why Ms. Widemark has not done this. Instead, it seems that she has read someone’s commentary on Dr. Flegal’s work and has simply believed it without investigating the truth. If she were to actually read the study, surely she would see that what she is saying about Dr. Flegal’s work is not true.
Ms. Widemark then tries to confuse the issue by bringing up lung cancer. That is not the issue here. The issue is that she claims obesity is not an independent risk factor for chronic illness, when study after study clearly shows that it is.
Ms. Widemark then goes on to claim that 95% of studies have fatal flaws in them. She once again gives no reference for such an outlandish statement. She asks us to simply believe her. If she were more accurate in her other statements, we might be tempted to believe her, but since I have shown her to be wrong in most of what she says, I for one am not tempted to take her word on it. In fact, I don’t think that Ms. Widemark even believes this. Why? Because when she thinks that a study supports her views (such as the HAES study), she trumpets it as “proof” that her view is correct. Why is the HAES study not considered 95% likely to be flawed? Because she thinks it agrees with her position. In fact, as I have demonstrated in my first rebuttal, the HAES study does not support Ms. Widemark’s position. It simply confirms a more detailed study that shows the opposite of Ms. Widemark’s position.
Of all the studies I quoted in my original post, Ms. Widemark finally tries to refute the only study she is willing to discuss in her rebuttal: the study of Hu and others.2 Since this study disagrees with her preconceived notions, she assumes it is part of the 95% of studies she claims are flawed. She tries to bring up several flaws in the study, and she is, of course, wrong on most counts.
She claims that the data on exercise habits was self-reported and thus could be inaccurate. What she fails to mention is that like most studies which use self-reported data, the questionnaire that was used had been previously validated by studies that compared the results of the questionnaire to actual measurements. Thus, the self-reported data in this case is not inaccurate, as the method for self-reporting has already been shown to actually mirror the results of direct measurement.
She then states the study assumed that if someone exercised 3 times a week or more, they were fit. This is, once again, simply untrue. The authors state, “In terms of physical activity, low risk was defined as an average of at least one half-hour per day of vigorous or moderate activity, including brisk walking, in keeping with published guidelines.”2 Thus, a “fit” person was defined as one who exercises vigorously or moderately for at least 30 minutes each day. This is, of course, in keeping with the standards in obesity research.
She also claims that the study used only the recorded weight of the participants in 1976. This is also completely false. As the authors state, “For variables unrelated to diet and exercise, we used the most recent information; the body-mass index and smoking status were updated every two years, and the information about alcohol intake was updated in 1984, 1986, and 1990.”2 Thus, the body weight was recorded every two years, and the most recent one was used.
She then makes the most outrageous claim about the study. She claims that one of the study’s authors, Dr. Willett, has been on the payroll of the Atkins Corporation. Once again, she cites no evidence for this, but simply expects us to believe her. In fact, I have looked at all of Dr. Willett’s research that I can find. In his research, he is required to report his funding sources, and the Atkins Corporation never appears. The study in question was supported by research grants DK36798 and CA87969 from the National Institutes of Health (NIH) and by an American Diabetes Association (ADA) Research Award that was given to Dr. Hu. In fact, in all of Dr. Willett’s papers, I see support only by the NIH, the ADA, and the National Colorectal Cancer Research Alliance. It is unfortunate that Ms. Widemark makes such an outrageous claim and cannot provide any evidence for its veracity.**
Finally, she wants the reader to think that this study is “junk science,” and she quotes a FOXNEWS article to support her position. This, in fact, may be one reason she is so confused on the obesity issue. She seems to get her information from the media, which does a very poor job reporting on science issues. If she were to read the medical literature instead, she would not be so confused about obesity.
Rather than relying on FOXNEWS to determine what is “junk science,” I prefer to rely on the scientific community. One way you can measure the respect with which a study is held in the scientific community is to see how many times it is referenced by other scientists. According to the New England Journal of Medicine, this study has been referenced by more than 120 other studies.3 Clearly, then, the scientific community does not consider this to be “junk science.” I will take the scientific community’s view over that of a FOXNEWS analyst any day of the week.
In the end, then, her discussion of the only study I brought up once again shows that she has not actually read the study. Instead, she has read someone’s comments on the study and has made conclusions based on that. She needs to read the study itself. It is unfortunate that she has not.
Ms. Widemark then makes an incredible logical blunder. She claims that many studies look at risks numbers such as C-reactive protein, blood pressure, and cholesterol rather than actually clinically examining the patients. This, she says, does not accurately reflect a patient’s risks, since some patients (such as AIDS patients) have low values for these parameters but a higher risk of disease and death.
The first of her logical blunders here is that one of the main studies she quotes in favor of her views did just that. The HAES study4 measured ONLY blood pressure and blood lipids and then concluded the general CVD health of the patient from that. It didn’t even bother to measure C-reactive protein, which is a much better indicator of CVD health5 . Of course, as I stated in my first rebuttal, a much more detailed study examined several more risk factors and showed that while fitness does lower some of the risk factors (including blood pressure and blood lipids), it does not reduce all of them. Only a combination of fitness and weight loss reduces all risk factors.6 Thus, the HAES study simply serves to confirm this more detailed study, which demonstrates fitness and obesity to be independent risk factors for CVD.
The second logical blunder she makes is to assume that the only situation by which you can have a high risk of death is to have high risk factors such as C-reactive protein, blood pressure, and cholesterol. This is, of course, nonsense. There are many ways to have a high risk of death. AIDS patients, for example, are susceptible to infections that can cause death. This has nothing to do with C-reactive protein, blood pressure, and cholesterol. However, in otherwise healthy individuals, C-reactive protein, blood pressure, and cholesterol are good measures of health risks. 5 If Ms. Widemark were to read the medical literature, she might understand these distinctions.
She then claims that “many” studies on obesity are funded by the diet industry or pharmaceutical companies selling diet pills. Once again, she gives no reference for such a statement. She just asks us to believe it. However, all of the studies I have referenced in both my initial post and my first rebuttal are funded by standard organizations like the NIH, ADA, etc. Not one of them is funded by the diet industry or pharmaceutical companies selling diet pills. Why, then, did Ms. Widemark not comment on them? Because she cannot refute the fact that they clearly show obesity is an independent risk factor for chronic illness.
Ms. Widemark then goes into a pointless discussion of the Met Life Build studies of the 1970s. I have not referenced them in any of my posts, and they are not relevant to this discussion. In fact, they are simply used by insurance companies to define risk. They are not used by the scientific community. The only reason I can fathom for her bringing up these studies is to cloud the fact that she cannot answer the majority of the studies I have cited that clearly show obesity to be an independent risk factor for chronic illness.
In the first of two “finally” statements, Ms. Widemark accuses people of misreading studies so as not to disturb their agendas. I certainly agree with this, and the fact that I have demonstrated that she has mischaracterized several studies in the course of her two posts shows that she does this quite frequently.
She also seems to indicate that I have not properly listened to the speech given by Dr. Leibel, which she mentioned in her initial post.7 This is something she has tried before, so I E-MAILed the Naomi Berrie Diabetes Center, with which Dr. Leibel is affiliated. In discussing a previous conversation with Ms. Widemark, I said, “I have quoted her some of [Dr. Leibel’s] research as well as a presentation he made at the NIH and an interview he had in the Women's Health Journal. These all indicate that Dr. Leibel thinks that obesity is an independent risk factor for certain chronic illnesses (CVD, type 2 diabetes, and some cancers), and that while weight loss is DIFFICULT, it is not IMPOSSIBLE.” In response, Dr. Leibel himself said, “Dear Dr. Wile: Your summary of my views is quite accurate.”8 Please note that the “presentation he made at the NIH” is the talk to which she refers. Thus, it is clear who is ignoring what Dr. Leibel says in an effort to hold on to her agenda.
In the second of her “finally” statements, Ms. Widemark claims that weight loss is impossible for most people. She says, “Bottom line, only 5 percent of people can keep off the weight they lose but 95 percent of people seem to think they are in that 5 percent.” Once again, she gives us no references to back up such an outlandish claim. She simply makes it and hopes we will believe her. Since she has been shown to be wrong in most of what she says about obesity, there is no reason to believe her here.
It is interesting that Ms. Widemark uses the figure 95% a total of five times in her rebuttal. First, she says 95% of the public does not exercise enough to affect weight. Next, she claims that smoking is related to 95% of all chronic lung disorders. Then, she claims that 95% of studies are flawed. Finally, she claims that 95% of people cannot keep weight off, and 95% of the remainder think they are a part of the remaining 5%. She does not give a single reference to back up any of these supposed “statistics.” I am left to conclude that Ms. Widemark likes the number 95% quite a bit and simply inserts it whenever she wants to make a point. Once again, this is not the hallmark of reliable research.
Even though Ms. Widemark already issued two “finally” statements in her rebuttal, she continues by once again citing the Cooper Institute study and the HAES study that she already cited in her opening statement. I have already shown in my initial rebuttal that both of those studies show the opposite of what Ms. Widemark claims.
In summary, then, Ms. Widemark was not able to rebut any of the studies that I presented in my opening statement. In fact, she only tried to rebut one of them, and as I have shown, she has not read the study. Even if we throw out that study entirely (which we need not), there are still 22 other studies that she has not even attempted to refute. Each of these studies shows that when fitness and obesity are considered, they are each independent risk factors for chronic illness. Once again, this is why the American Diabetes Association, the Centers for Disease Control, the National Institutes of Health, the National Cancer Institute, the Mayo Clinic, the American Cancer Society, the American Academy of Pediatrics, the Cooper Institute, Dr. Rudolf Leibel, and the authors of the studies that Ms. Widemark cannot refute all state that obesity is an independent risk factor for these diseases.
If you are interested in staying healthy, then, it is important that you try to reduce ALL of the risk factors that you can. You need to exercise, eat right, not smoke, and if you are overweight, you need to LOSE WEIGHT. It is hard for some people to lose weight, so they try to delude themselves into thinking that being overweight is not a health risk. That makes them feel better about themselves, but unfortunately, it makes them less healthy. Now that you know the facts, please remember what Dr. Rudolf Leibel says: “Even a little bit of weight loss can do a lot of good — modest weight loss improves health. Use whatever works, but is healthy. Try different approaches.”7
REFERENCES
1. Katherine M. Flegal, PhD; Barry I. Graubard, PhD; David F. Williamson, PhD; Mitchell H. Gail, MD, PhD, Excess Deaths Associated With Underweight, Overweight, and Obesity, JAMA 293:1861-1867 (2005). Return to Text
2. Frank B. Hu, M.D., JoAnn E. Manson, M.D., Meir J. Stampfer, M.D., Graham Colditz, M.D., Simin Liu, M.D., Caren G. Solomon, M.D., and Walter C. Willett, M.D., Diet, Lifestyle, and the Risk of Type 2 Diabetes Mellitus in Women, N Engl J Med. 345:790-797 (2001) Return to Text
3. http://content.nejm.org/cgi/content/short/345/11/790Return to Text
4. Bacon L, Stern JS, Van Loan MD, Keim NL., Size acceptance and intuitive eating improve health for obese, female chronic dieters., J Am Diet Assoc. 105:929-36 (2005).Return to Text
5. Ridker, P. M., Rifai, N., Rose, L., Buring, J. E., and Cook, N. R., Comparison of C-Reactive Protein and Low- Density Lipoprotein Cholesterol Levels in the Prediction of First Cardiovascular Events, The New England Journal of Medicine, vol. 347, no. 20, pp. 1557-1565 (2002). Return to Text
6. Demetra D. Christou, PhD; Christopher L. Gentile, MS; Christopher A. DeSouza, PhD; Douglas R. Seals, PhD; Phillip E. Gates, PhD, Fatness Is a Better Predictor of Cardiovascular Disease Risk Factor Profile Than Aerobic Fitness in Healthy Men , Circulation111:1904-1914 (2005). Return to Text
7. http://videocast.nih.gov/ram/ccgr011404.ram Return to Text
8. E-MAIL communication to the Naomi Berrie Diabetes Center, which was answered by Dr. Leibel himself. Return to Text