Fat and fatter
I’m sure that everyone who has watched TV or read a newspaper over the past couple of days has heard about the new survey showing that Americans are fatter than ever. The Trust for America’s Health (TFAH), one of those ‘think’ tanks loaded with ex-politicians and former government employees of one stripe or another set up to suck money from donor organizations to create meaningless reports while paying its members large salaries issued its 2007 report a couple of days ago. And all the media obliged by rushing the TFAH conclusions into print and onto the airwaves.
The report comes in two forms: the actual big 120 page report filled with the kind of gibberish expected in a document with the touch of the federal employee on it that no one reads; and the press release that everyone reads. Both can be found on the TFAH website.
In sum, the report states that the rate of obesity rose in 31 states last year, no states experienced a decrease, and 22 states went up for the second year in a row.
How did the TFAH find all this out? They used publicly available data from the Behavioral Risk Factor Surveillance System, which was obtained by the self reporting of about 350,000 who were called on the phone. Among other things, these subjects were asked for their height and weight, which was then used to calculate their BMIs. Wait a minute here. We all know that the BMI is a notoriously inaccurate measure of obesity, but what about the self reporting of weight and height? That can’t be reliable, can it?
Nope.
Several studies looking at this very thing have shown that women tend to under report their weight and men tend to over report their height. In both cases, what you will find with self-reported heights and weights is an underestimate of the BMI, and, theoretically, the amount of obesity.
According to the TFAH report, Mississippi led the way with a 30.6% rate of obesity while the other states stratified between Mississippi and Colorado, the state with the lowest rate of 17.6%. I didn’t do any kind of accurate analysis on the data as presented, but with the high at a little above 30% and the low at about 18% you would have to reckon that the overall rates of obesity would fall somewhere in that range, probably around 24%. Looking at the three states with the largest populations and their obesity statistics (California 22.7%; New York 22.4%; Texas 26.3%) would seem to confirm the 24% number.
But according to the CDC in its 2003/2004 estimate, which didn’t rely on self reporting over the phone, 32.2% of the population is obese.
How did the CDC get its height and weight numbers to calculate the obesity rate? The good old-fashioned way: it measured them.
A household interview and a physical examination were conducted for each survey participant. During the physical examination, conducted in mobile examination centers, height and weight were measured as part of a more comprehensive set of body measurements. These measures were taken by trained health technicians, using standardized measuring procedures and equipment.
The actual obesity rate as measured in 2003/2004 is about a third higher than that calculated several years later by asking people for their heights and weights over the phone. So as a nation were not just fat, we’re fatter.
With a report so wildly inaccurate in its statistics, one would have to wonder about the validity of anything else it said. And it said plenty. Sort of.
The one overriding them of the entire report is that the obesity epidemic is with us in large measure because of mass inactivity. The message is that people just don’t exercise enough. And its the government’s fault. Why? Because of inattention to the growing masses of fat people. And what is the solution? You guess it. Government intervention.
What gets me about these kinds of reports is that they are filled with inaccuracies, yet mainstream press people who should know better swallow their idiotic bait hook, line and sinker.
The venerable and hallowed Wall Street Journal reports (subscription required) that
A lack of exercise is a huge factor in obesity rates.
This is reported as fact: ” A lack of exercise is…” Not ‘A lack of exercise may be…’ or ‘some experts believe that a lack of exercise’… or any other kind of iffy business. By God “a lack of exercise IS a huge factor…”
Unfortunately, their certainty isn’t backed up by the scientific data. Exercise has little, if any, affect on whether one gains or loses weight.
As if to prove this, the WSJ goes on to say, and this without batting an eye at the overt inconsistency
Minnesotans led the way when it came to exercise. An estimated 15.4% of the state’s residents did not engage an any physical exercise, the best rate in the nation. Still, the state ranked 28th overall when it came to the percentage of obese adults.
Say what? Let’s think this one through.
People living in Minnesota exercise more than those in any other state. In fact, only 15.4% of Minnesotans did not exercise, which would imply that 84.6% did exercise. And since “a lack of exercise is a huge factor in obesity rates,” then Minnesota should have the lowest rates of obesity, right? Well, uh, no, actually not. The state was about right in the middle of the rankings in terms of obesity. Hmmm.
And this actually made it through the editorial process. Gives one pause.
If the TFAH is wrong about exercise and the Wall Street Journal is wrong about exercise, who has got it right. Well, William Banting for one.
Remember what he wrote:
I consulted an eminent surgeon…who recommended increased bodily exertion before my ordinary daily labours began, and thought rowing and excellent plan. I had the command of a good, heavy, safe boat, lived near the river, and adopted it for a couple of hours early in the morning. It is true I gained muscular vigor, but with it a prodigious appetite, which I was compelled to indulge, and consequently increased my weight, until my kind old friend advised me to forsake the exercise.
He exercised on the advice of a physician and developed “a prodigious appetite,” which undid whatever good the exercise did him in terms of weight loss. He realized it and even his physician realized it.
Why is it that a retired undertaker from 19th century London can figure these things out and the people who write the lack-of-exercise-is-a-huge-factor drivel can’t? Perhaps the retired undertaker is eating brain food and these other folks aren’t.
When an average person runs or walks a mile (it doesn’t matter which – calories are burned by moving mass across a distance) that individual burns about 100 calories more than he/she would burn sitting on the couch staring out the window.
Now open any book of nutritional values and look up the amount of food it takes to give you 100 calories. It’s almost nothing. A half an ounce of nuts, an extra bite of pizza, a little extra half and half in your Starbucks throughout the day, a little over an ounce of trail mix, half of a granola bar, a few crackers, a half a bagel, a couple of extra forkfuls of most any casserole dish, and on and on. So, you go out and run a mile in the morning and you make up for it during the course of the day by increasing your intake by virtually unmeasurable amounts. That’s why exercise doesn’t work for weight loss.
But getting back to our report…
What does the TFAH recommend to decrease the rampaging rates of obesity that it so sorely underestimated? Let’s take a look at the 12o page report and find out.
There are five strategies listed.
A. Improving federal leadership: National strategy;
B. Fighting obesity in the workplace;
C. Helping all Americans become more physically active;
D. Helping Americans choose healthier foods; and
C. Accelerate and escalate the research into ways to promote lifestyle changes.
There you have it: The Big Five. Those are pronouncements that any bureaucrat could be proud of.
Here is my take on those five.
First, perhaps we should start by encouraging our federal leadership to abandon price supports on sugar so that more food processors will move away from high-fructose corn syrup, which has been shown to be a major driving force in the obesity epidemic. This would be real leadership because it would cost politicians a lot of Big Sugar money. I suspect you won’t see this happen, but you will hear a lot of talk about how Washington will solve this problem. Remember that talk a few years ago about how the obesity problem would be solved by 2010? And it’s increased every year since.
I’m all for fighting obesity in the workplace. I think every business ought to have an onsite meat store. Geez. Fighting obesity in the workplace…what a nothing suggestion.
We could help all Americans become more physically active. And we would accomplish what? They would be healthier, of that I’m pretty sure. But there wouldn’t be any less obesity.
I’m all for helping Americans choose healthier foods. MD and I have written a number of books on the subject. But somehow I don’t think the TFAH’s idea of healthier foods coincides with mine.
I’m all for more research, but I’m not sure that the best target for funds would be on finding ways to help Americans adopt the lifestyle changes that TFAH thinks they should adopt.
In my opinion there is not a lot of value in this report other than as a blueprint for someone wishing to start a lucrative business. Get letters of intent from a bunch of has-been government blowhards that they’ll sign on if you can pay them a big salary (and make sure they’re from both parties so that it will be bipartisan). Use data that the taxpayers have already paid for once. Mulch it around a little so that it’s slightly disguised. Come up with a handful of inane recommendations. And have the whole thing funded by a large foundation. Release your findings to the press so they’ll run with them as if it’s really big news. Then repeat yearly.
Only in America is there this kind of opportunity.
Hi Doc –
I watched the video at “CSPI Scams”, and was prepared to see Jacobson come off really, really badly ( based on the lead-in ), but I have to say that, with the huge and ever-present exception of the low-fat/High carb initial assumption mistake they all fall prey to, I don’t think he came off all that bad. Certainly NOT humorless. I think the CSPI Scam folks are not keeping in mind the caution from “Stumbling on Happiness”. We tend to need very little evidence to see what we want to see, especially if it something negative about our “enemies”.
But, I’ll await your post on the video.
Best,
John
Hi John–
You’re certainly right that I always look for the worst in Jacobson, and I’m very rarely disappointed.
Cheers–
MRE
Great post again. As Thomas Sowell once said, you solve a problem by not doing the things that created the problem in the first place. Junk the food pyramid, and end corporate welfare for the sugar and corn industries. (I love how Michael Pollan, in the Omnivore’s Dilemma, lays out how much corn and corn products are in the typical American diet, and how this came to be. Worth the price of the book.) As it is, eating healthy food takes more time, money, and willpower than most Americans seem able to muster. To see the results all you have to do is some people watching at a mall or airport.
If Thomas Sowell said it, it must be true. Most of the problems we are having today can be laid at the doorstep of our friends in government. Don’t even wait for Gary Taubes’ book to come out. Read about the government finagling with things in his article from a few years ago titled “The Soft Science of Dietary Fat.”
Cheers–
MRE
After reading your blog the last couple of days, I was struck by this article found on Runner’s Worlds’ Ask the Doctor.
“But one recommendation is incontrovertible from our study: Keep exercising. Healthier low total cholesterol profiles are unequivocally associated with some of the healthiest people among us—marathon runners and their friends.
So what about people with cholesterol levels 200 and above who eat “right” and exercise? Well, you just can’t pick your parents! Heredity is the most important factor in your being able to get your level within a “good range.” The new statin drugs like Lipitor and Crestor are excellent at controlling your cholesterol with minimal side effects.”
Not only does exercise “incontrovertibly” equal good health, but if you add some statin drugs with it, now you’re really smokin’ and with “minimal side effects!” AAAARRRRRRGGGGGHHHHH!
Idiocy abounds. What can I say.
I was first referred to this site from some exercise sites that I read, and I enjoy getting your perspective on issues. I realize that this is not an exercise site, but I have to question some of your comments regarding exercise. First, your use of the Minnesota data to discount the value of exercise for weight loss is a bit disingenuous. A few paragraphs before this you questioned all of the obesity data in the news reports due to the way in which the data was acquired, namely, through self reporting. I assume that the exercise data from Minnesota was also obtained through self reporting, so the most you can say is that this data is also likely not valid and has no bearing on the value of exercise for weight loss.
Second, running a mile consumes more calories than walking a mile. This is due to the up and down motion of running vs. walking. If you view a person walking and focus on the center of mass, you can see that the center of mass stays a relatively fixed distance from the ground. For a person running, the center of mass moves up and down since running consists more of a bound (cm moves up) and a catch (cm moves down), thus leading to somewhat greater calorie expenditure.
Third, I was going to point out how exercise can change underlying metabolism and body composition, but I see that this point was already raised. I would like to emphasize the value of high intensity interval training in addition to weight training as an effective form of exercise. Tabata intervals, only four minutes in duration (20 seconds hard, 10 seconds easy for eight cycles) give a particularly good bang for the buck.
Hi Elmer–
I wasn’t really being disingenuous. First I discussed how inaccurate self-reported weights and heights are by comparing the TFAH data to data obtained by actually weighing and measuring subjects. Second, I was demonstrating how invalid their presumptions were even if based on their own flawed data. (And you’re correct – they did obtain exercise data along with all other data via phone interviews.) In other words if their data were correct, they couldn’t really draw the conclusions they did from it. IF lack of activity were the main driving force behind the increased rates of obesity, and IF the vast majority of Minnesotans exercised regularly, THEN Minnesota should be at the bottom of the obesity charts. Instead Minnesota is buried somewhere in the middle.
Second, I figured I would hear from a hair-splitter on the calories-per-mile issue. Okay, there is a tiny difference in calories expended because of the up and down motion of running verses walking, but not enough to spit at.
Finally, I do agree that exercise is good and healthful, especially resistance exercise. But, based on my experience with a whole lot of patients and based on the medical literature, there is no weight loss benefit to simply increasing activity. It’s got to be done in conjunction with diet, and even then, the diet does most of the heavy lifting.
Cheers–
MRE
The low fat movement will never die as long as you have people like Dr. Mehmet Oz spouting its benefits in front on 50 million people on the Oprah Winfrey Show and on 5 different programs on the Discovery Health channel. Not to mention his books. This guy is everywhere. He is a cardiothoracic surgeon but also believes himself to be a nutrition expert and is constantly tells us to reduce our saturated fat and eat more whole grains. Today on one of his programs he showed an overweight woman examples of real plaque-filled and damaged arteries – the result of years of high cholesterol levels he said. He pop quizzed the woman by asking her the origin of the high cholesterol. She said “a diet high in fat and saturated fat”. He nodded and smiled in approval. If a “top-rated” and “world-renouned” cardiac surgeon (and clearly a marketing genius as well based on the way he markets himself) is saying that low fat is best, who are we to dispute it?
But what if the “top-rated” and “world renowned” cardiac surgeon is a moron when it comes to nutrition? Which is obviously the case, so you ignore him.
Cheers–
MRE
The cardiothoracic surgeon is a great example of what I believe is called eminence based medicine. Wish I’d thought of that one first!
Hey Neil–
Beautiful! I wish I had thought of it first, too. I’m certainly going to add it to my arsenal of pithy comments.
Cheers–
MRE
[...] Länk till Michael Eades bloggpostning. [...]
I took the “Real Age” test from the website of Drs. Michael Roizen and the aforementioned Mehmet OZ. What a joke. I am 45, the test said that my “real age” is 43. I could be doing a lot better if I ate less red meat and more whole grain!
Jesus wept.
It seems like there is often a hidden “agenda” with these studies.
There usually is.
I just took that real age test. I didn’t know my cholesterol numbers so I just lied and said my total was 200 and my Hdl was 70. It gave me advice about how to get my raging cholesterol numbers under control. Does that sound right?
No, it sounds like a moron giving medical advice.
Thoughts:
I think I’m more of an idealist (though working for the government is slowly crushing the impulse), when it comes to government. I used to have hope for large reform to the civil service due to the exit of many baby boomers with retirement, but think the culture is too crystalized, at least at Labor where I perform work like activities. That said, rewriting the farm bill on the economics is more likely than on the side benefits (I would advocate turning back to what it looked like during WWII, only with thoroughly liberalized trade, but that’s a wonk discussion for another day). But neither is particularly likely with the morons we call an electorate. Ditto for reform of the flat tax (what we essentially have currently, despite “progressive” income taxes, another story for another day).
On the data, self reported, regarding exercise: Unless we believe that there is some reason why Minnesotans tell taller tales of their exercise habits than Idahoans, New Hampshirites, and everyone else in the Union, then we can take it at something like face value. They may not exercise as much as they say they do, but neither does anybody else, so it should even out. I think it’s pretty clear than Flat Cardio is worse than useless when it comes to weight loss for most people. I think it’s reasonably clear that lifting in a structured manner and HIIT are considerably better than ass on couch.
Real Age: Hrm, I do LC, I eat tons of meat, no whole grain, and not enough veggies and I’m 11.6 years under my 34.6 years of age. It’s stupid, but in my first year of PPLP, I increased my under from 3 to 11.6. Not bad. Course, it’s the cholesterol, weightloss and exercise (plus I’m a year beyond moving, being unemployed, having grave financial worries, etc).
On low fat going out of style: It doesn’t not work for everyone, so there will always be role models. The meme is too simple to be wrong (Fat makes you Fat). I think it’s gonna be here a long time, even without Oprah, Roizen, Oz, or even Ornish. Look at how many people think the earth is 6000 years old and in basic creationism or the watered down version, design. Yeah, you need pushers, but when it comes to science versus mumbo jumbo, MJ seems to win a lot.
I’m interested in your statement that you “used to have hope for large reform to the civil service due to the exit of many baby boomers with retirement…” What I find amazing about this statement – that no doubt is true – is that the baby boomers were the hippies, and anti-war activists, the first generation in who knows how long who bucked the system and demanded change. They brought down a presidency, yet are now a cause of stasis in government. One would think that the most activist ones of them all would gravitate to government where they could ‘make a difference,’ but it seems that they are just there putting in their time.
Cheers–
MRE
Here is a real life example for how ingrained the “move more” meme is. My ex-brother-in-law sported a huge gut. He was obese for sure. Then one Christmas, I saw him again, and he had melted away. When I asked what happened my sister explained he had changed job. He was now a forklift operator and “moved more”. Fair enough. Except that his previous job (which he did for many years) was delivering pizza. One of the perks of the job, was free food and free pizza. I think it would be more correct to attribute his weight loss to cutting out the daily carb-laden lunches and suppers.
Hi Angelyne–
I’m sure you’re correct.
Cheers–
MRE
“One would think that the most activist ones of them all would gravitate to government where they could ‘make a difference,’ but it seems that they are just there putting in their time.”
I suspect that a lot of these people were once upon a time very active in the way that makes one an activist. You join the government because JFK inspires you to. Back when folks really believed in big Gov. You maybe enjoyed working under LBJ. But then Nixon wages his war on the Civil Service. Ford not a big friend either. Carter, I dunno. Reagan modernized the benefits and did a great sales job on it, so that the unions bought in, and people given the choice of opting out of the old system (CSRS) for the new system (FERS) actually did it (even though it makes no practical sense to do so whatsoever for anyone who was a civil servant). And the Reagan years were no picnic for feds either. So, it’s probably a case of hard reality crushing the activism out of them.
But there’s the other thing. When it’s the 60′s and 70′s, and you’re having fun in your twenties, marching on the capitol and changing things, maybe you feel great about everything. Then, you marry that hippie guy/girl, move out to NoVa or Maryland, buy a house, crank some kids, get your fed job so you can change things from the inside. You get a steady paycheck, a retirement plan, health insurance, etc. And the status quo seems a lot more attractive.
Last thing: Because of low pay for middle/senior management (don’t mind the studies that say Civil Servants make more than others. Average MBA, class of 2005 makes $90K in base salary. Average MBA, Dept of Labor, class of 2005 makes under $70K, and gets no bonus), clotted culture and maybe a feeling that inside activism doesn’t work, most of the sharpest leave the profession early. It’s Jack Welch in reverse.
I have great hope for Government solutions when they’re run with good economics and the heart in the right place. I have lost some hope for this government’s ability to craft those solutions in the face of:
1- The rules that run the civil service
2- The great incentives provided by the political donor class
3- A setup where you have to be a millionaire to run for national political office.
4- A lot of little stuff that also provide improper incentives.
I was at a lecture given by Dr Joel Fuhrman last winter and Dr Oz was brought up.
Dr Fuhrman stated that actually Dr Oz and his family have been on his diet for quite
a long time and what Dr Oz advocates is for the masses, but what he eats is totally
vegan. This is true….Just saying!
Interesting.