Fascinating article extracted in The Guardian from a new book from Paul Campos suggests that obesity is not a health problem. Well worth reading the article, but basically he suggests that while fitness and excercise have some impact on health outcomes, in general people with a Body-Mass Index (BMI) in the “recommended range” don’t do any better and in some cases do worse than those who are above that range. In fact it’s better to be overweight by several pounds than underweight by a few. Additionally the desire to reduce BMI suggests that people who become thinner have the same health outcomes as those who were thin all along, and although there have never been studies to support this (because you can’t get fat people to stay thin long enough) the evidence suggests that it’s not true. Further, the “propaganda” causes health problems by encouraging yo-yo dieting and poor body image, particularly amongst young white women. This leads of course to the serious medical and psychological consequences of eating disorders.

I’m not sure I know enough to be convinced of his arguments, but of course the treament of obesity is big business and getting bigger for the pharmaceutical industry. Campos lays at least some of the blame for the acceptance of the argument that “obesity is a disease that needs treatment” at their door. The rest he ascribes to the desires of Americans to discriminate, and now that civil rights and political correctness have taken away the ability to aim that discrimination at ethnic minorities, obese people are an easy target.

So basically I can have that bacon sandwich so long as I go to the gym. But on an industry level this conversation about what to do about obesity has serious implications for physicians and pharmaceutical manufacturers. And if the answer is not to worry about reducing obesity per se, that has some profound implications for how we may treat some of our biggest disease classes–diabetes and cardio-vascular disease–in the future. We are very quick to go to the pill when “diet and excercise” hasn’t worked. But what if, even if the pill works in reducing obesity, it doesn’t in improving outcomes?