Monday, November 28, 2005


Last January, media outlets reported that cancer had overtaken heart disease as the number one killer in the United States. Sounds scary, no? Fear not. As is usually the case, beyond the scary headline, deep into the copy, came the real story. Both diseases are in steady decline. Cancer rates and deaths from cancer have fallen every year since the early 1990s. The thing is, incidence and mortality rates of heat disease and stroke have fallen even more over the same period (25 percent since 1990). So while it's true that cancer has "overtaken" heart disease, that's really not the story. The story is that both are in decline, heart disease remarkably so.

Late last February, another health story hit the wires: Americans are living longer than ever before. Life expectancy is up across the board, among both genders and all ethnicities. The gaps in life expectancy between men and women and between black and white are shrinking, too.

At the same time all of this good news has transpired, the number of Americans classified as "obese" and "overweight" has been on a steadily upward trajectory since about the mid-1970s. In 1985, 8 states reported that at least 10% of their populations were obese. By 1990, the number rose to 33. By 2001, it was all fifty.

Of course, as you might expect, the scariest numbers about the condition of America's waistline are overblown - there are significant problems with the way the government measures obesity, which I'll discuss in a moment. But most researchers agree that the average American is carrying 10-15 more pounds than he was thirty years ago.

If you believe media, nutrition activists, and public officials, those extra 10-15 pounds portend a looming healthcare catastrophe. U.S. Surgeon General Richard Carmona, for example, said in 2004 that childhood obesity is "every bit as threatening to us as the terrorist threat." A congressionally commissioned report from the Institute of Medicine published in the fall of 2004 called for massive government intervention to stave off the crisis. One author said we need "nothing short of a revolution." The World Health Organization warned "If immediate action is not taken, millions will suffer from an array of serious health disorders."

But if we've been getting fatter for 30 years, shouldn't we be seeing at least the front end of this coming crisis? Why are we getting healthier? In fact, a closer look at the statistics suggests that even some of the diseases most associated with obesity are in retreat.

Take cancer, for example. In 2002, the BBC reported researchers had found that "the more excess weight a person carries, the greater their risk of certain types of cancer." In 2004, USA Today echoed that claim. "The nation's current epidemic of overweight and obesity is likely to drive up cancer rates in coming years," the paper wrote. The Associated Press wrote that, "heart disease and diabetes get all the attention, but expanding waistlines increase the risk for at least nine types of cancer, too" (other sources put it at ten).

But of the ten types of cancer commonly associated with obesity, deaths from nine - pancreatic, ovarian, gall bladder, stomach, prostate, kidney, colal-rectal, cervical-uteran, and breast - have decreased since 1992, some of them significantly. Only one - pancreatic cancer - has seen an increase in mortality rates over that period.

And heart disease? Case Western Reserve University researcher and obesity skeptic Paul Ernsberger notes that "The greatest improvements are in cardiovascular disease deaths, which are most strongly linked to obesity."

As noted, the gap in life expectancy between black and white is shrinking. But at the same time, blacks as a group have put on more weight than whites......

America is at war with obesity. We could eventually come to find, however, that this war's origins are dubious as the sinking of the Maine. None of this is to say extreme or morbid obesity is healthy, or even benign (though again, there seems to be some modest protective effects to carrying some excess weight). The decline in incidence and deaths from heart disease and cancer are almost certainly due to advances in medical research and technology. We're getting better at uncovering these diseases early, and with pharmaceutical marvels like Statin drugs and chemotherapy, we're making huge leaps in treatment once we've diagnosed them. And it's of course likely that the gains we've made would be even more significant were the most obese among us a bit more svelte.

But the notion that our expanding waistlines have put us on the verge of a calamitous offensive against our health care system simply isn't borne out by the evidence. And so these incessant calls for immediate, large-scale government interference in how we grow, process, manufacture, market, prepare, sell, and eat our food ring hollow, hyperbolic, and needlessly invasive....

The bizarre thing about the obesity debate is that less than a decade ago, the very thought of it was often discussed only in parody, or in a reductio ad absurdum context. Opponents of the tobacco lawsuits often invoked the idea of trial lawyers suing fast food restaurants as one example of the "parade of horribles" that might follow should the tobacco suits be allowed to go forward.

Well, we're here now. This is post-reductio America. If the anti-obesity proposals currently up for debate become law, it's difficult to come up with any aspect of our lives that's out of the reach of the public health activists. Or, as one advocacy group that represents the food industry has put it, the question will no longer be "what's next?"...but "what's left?"

Much more here

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