The Catastrophe

Obesity Kills! Hype and Bullying Don’t Help, Either

Once again, we see the impulse rise to catastrophize obesity. A new study in BMC Public Health offers up a comparison of deaths due to smoking and adiposity. So naturally, this sparks splashy headlines. Obesity kills more than smoking! Scary stuff. But not terribly helpful. Because the subtext of this sort of hype is finger pointing. Or to be more blunt, bullying. Why are you so fat? Don’t you know that obesity kills?

Not helpful.

The Misleading Comparison of Smoking and Obesity

The analysis is not bad, but it offers nothing new. Back in 2004, Ali Mokdad et al published a sensational study in JAMA with a similar theme. “However, poor diet and physical inactivity may soon overtake tobacco as the leading cause of death,” was the conclusion. That publication sparked a furious debate over the accuracy of this work. Mokdad et al issued a correction a year later, but insisted their principal conclusions “remained unchanged.” The result was years of stupid controversy that caused more confusion than anything.

Comparing smoking and obesity is a fool’s errand. In the Mokdad paper, authors explicitly argued that the problem with obesity is bad behavior. But obesity is not a behavior. Smoking is. Trying to compare smoking and obesity leads to fuzzy thinking. They are two very different problems.

In the BMC analysis, the authors are more careful to stick to the facts. Excess adiposity is a measurable health risk. So, too, is smoking. They conclude that adiposity is now contributing to more deaths in England and Scotland than smoking is. These findings are likely correct. They also correctly suggest putting more priority on both prevention and treatment to reduce adiposity.

Bias Takes Over in the Press

“Junk food grows more popular than cigarettes, study reveals,” says the Daily Mail. This is the quiet part said out loud. And it’s utterly false. The study had nothing to do with junk food and junk food is not the singular cause of obesity. But when the subject is obesity, the facts are not going to get in the way of a juicy story. Especially in the UK, where weight bias is so strong and destructive.

Hype and Bullying Don’t Help

The bottom line is that hype and bullying don’t help with obesity. Most people who are carrying too much fat know it. In fact, some people think they have a problem with fat when they don’t. The real problem is what to do about it. Behavioral therapy, anti-obesity meds, and surgery can all be very helpful. But in the UK, access to such treatment is very limited.

Prevention is a good idea, too. But highly effective prevention strategies have not yet appeared. We have much work to do on that front.

In the meantime, hyping the problem without offering up good solutions really only makes things worse. Cut the hype.

Click here for the study in BMC Public Health, here and here for further reporting. For perspective on the Mokdad controversy, click here. Finally, for perspective on misbegotten obesity “awareness” campaigns, click here.

The Catastrophe, painting by Eduard von Grützner / WikiArt

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February 12, 2021