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QUALITY/PHARMA: A response to the obesity question

Leonard Soloniuk, MD had this to say about my recent post on the obesity issue:

    I have seen the assertion that obesity is not a health problem in several different contexts, but Paul Campos appears to be quite flamboyant in his arguments. There seem to be several issues here including the utility of BMI is categorizing people at risk. The whole question of the efficacy of interventions is also subject to question.

    One of the reasons Campos’s arguments are worth considering is the recent history of the abuse of science and epidemiology in the pursuit of political goals. Examples would be the HIV epidemic and the medicalization of handgun restrictions. In these cases, interpretations of data have been distorted to fit predetermined policy goals. Thus,
    when the usual suspects (e.g. the CDC, JAMA, etc.) declare a new health crisis, skepticism is in order.

    There are a number of issues that need clarification in this debate: What is the role of BMI? Is body fat a better predictor and a better secondary outcome to follow? What are the true risks for mildly overweight patients? Which interventions lead to improved outcomes.

    However, it is difficult to take seriously an attack on Americans, ascribing to them the need to discriminate. This seriously lessens his credibility for all of his arguments. And that’s unfortunate, because a reasoned analysis of this issue would be quite welcome

I’m inclined to agree with with Leonard that the generic attack on Americans as “wanting to discriminate” is simply not helpful to serious discsussion of this topic, even if there is 200+ years of history showing way more discrimination in the US than we’d like. However, you can make an argument that handgun wounds showing up in emergency rooms constitute, or at least cause, a health crisis (morbidity and mortality in young inner-city men) even if the initial study of the article was clearly politically motivated. So we should not be ready as Leonard to dismiss the CDC/JAMA “establishment” and their views on obesity just because (for instance) as NRA members we didn’t like their views on gun control. (I’m more confused by Leonard’s critique of the CDC’s actions around HIV, but maybe he’ll enlighten me).

However, Leonard does get to the right set of questions, when he asks whether BMI, body fat percentage or anything else really matters, and what the outcomes for overweight people truly are. These clearly require more study with real data rather than emotion amongst the medical community, and I suspect there is emotion on both sides–as there clearly is in Campos’ views.

As a non-medical healthcare blogger, I’m though asking a slightly different question which is, “will these opinions become mainstream” and if so “will that change the way healthcare services (including drugs) are used?” And if you don’t think that psycho-social changes in attitudes to health can change service provisions in health care you might want to take a look at this article about how the Atkins low-carb diet fad has revolutionized the restuarant and food business. (Arrgghh. Can”t find the NY Times article I read last night so here’s one about the chain Ruby Tuesday’s profit rise on the back of their low carb menu).

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