An Inconvenient Finding? “We Have to Stomp It Out”

The Archangel Michael Trampling the Devil UnderfootAre people with overweight, but not obesity, more or less likely to die early than people with a lower BMI? When researchers at CDC and NCI published an answer to this question in 2005, it created quite a stir. The surprising finding was that folks in the range of overweight were not more likely to die than those in the normal weight range. In fact, their odds of dying were slightly less. To some, this was an inconvenient finding. So it sparked a reaction from some scientists that was even more surprising than the research finding. “We have to stomp it out,” said Walter Willett of the Harvard School of Public Health.

Katherine Flegal has just published a detailed personal account of the response to this research. She was the lead author. Her account shows in vivid detail how bias about obesity enters into supposedly scientific dialogue about it. Thus bias corrupts our understanding of obesity and undermines the public health response to it.

A Hot Button Topic

The anti-science reaction to Flegal’s research is surprising for many reasons. But perhaps the most surprising thing is that the controversy really has nothing to do with the primary finding of this research. The main finding was that both underweight and obesity have a clear association with higher mortality.

To gin up the controversy, one had to dig into the bowels of this paper. The abstract simply says that “overweight was not associated with excess mortality.”

Nonetheless, it generated sensational headlines about how having excess weight might help people live longer. Those headlines fed into a hot argument about the risks of excess weight. Fat acceptance advocates like to argue that the whole concept of obesity is overblown.

Bringing the Argumentation of Politics into Public Health

Willett and others at the Harvard School of Public Health were happy to take that argument and attack the study in dubious ways. Willett called it “deeply flawed.” A graduate of the school, Leigh Senderowicz,  described the hostility she observed in the response to this inconvenient research:

“I was a first year doctoral student in global health at HSPH in 2013 and took a nutrition class out of naive curiosity. Of all of the overtly sexist and racist comments that the professor made in that class, his treatment of Dr. Flegal was perhaps the most egregious.

“One of the most memorable claims is that we shouldn’t trust Dr. Flegal’s scientific analysis because she was ‘a little bit plump herself’ and thus couldn’t be trusted to do non-biased work on obesity.”

Flegal’s paper in Progress in Cardiovascular Diseases describes a disturbing situation in great detail. Public health suffers great harm when an inconvenient finding is viewed as something to “stomp out.”

Such conduct perpetuates bias in research about obesity. And in turn, the profound misunderstanding of obesity perpetuates bias against people who are living with it. All of this bias explains why the public health response to obesity has been so ineffective for decades now.

Click here for Flegal’s paper. For further perspective on prevailing bias and obesity research, click here.

The Archangel Michael Trampling the Devil Underfoot, painting by Simon Ushakov / WikiArt

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June 21, 2021

7 Responses to “An Inconvenient Finding? “We Have to Stomp It Out””

  1. June 21, 2021 at 8:35 am, David Brown said:

    If you don’t agree with those who control the narrative, you are either attacked or ignored. For example, this narrative says excessive intake of the omega-6s family of fatty acids is problematic for population health.
    This is the Soy Nutrition Institute’s response to that narrative.
    Here is experimental evidence explaining the difference between the metabolically healthy obese and metabolically unhealthy normal-weight individuals.

    • June 21, 2021 at 10:38 am, Ted said:

      Thanks, David. I remain unconvinced that linoleic acid can explain all of our cardiometabolic health problems. No doubt, excess consumption of omega six fatty acids can be problematic. But it’s not clear that this is the biggest dietary problem we face for population health.

  2. June 21, 2021 at 10:40 am, Mary-Jo said:

    The remark about Katherine Flegal’s weight affecting the rigor of her work is appalling. Moreover, it would undermine the great work a nutrition professor might have done, making me think things like — of course, he touts benefits of the Mediterranean diet and wholesome eating and being lean and fit — he’s probably a tall thin man who can afford plenty of wholesome foods of high quality, as well as active, interesting vacations. He probably lives in a wonderful, safe neighborhood where he can walk or cycle to work. How would he feel about assumptions like that?

  3. June 21, 2021 at 12:22 pm, Justin said:

    In the years since Dr. Flegal’s initial study was published, have additional studies corroborated the conclusion that overweight and moderate obesity do not lead to increased risk of mortality?

    • June 22, 2021 at 2:20 pm, Ted said:

      First, Flegal’s paper found that obesity does lead to increased risk of mortality. “Underweight and obesity, particularly higher levels of obesity, were associated with increased mortality relative to the normal weight category.”

      Second, to answer your question, yes, other studies have produced similar findings. For example, a 2010 study from Canada found the same result. Overweight was not associated with increased mortality.

  4. June 23, 2021 at 5:48 pm, Katherine Flegal said:

    To address Justin’s question. First, actually our 2005 paper found no significant increase in mortality for grade 1 obesity either (BMI 30-<35) and the number of excess deaths (relative to normal weight) was not statistically different from zero and was higher than the number of excess deaths associated with underweight, even though there are far fewer underweight individuals. I did not emphasize any of this at all in our paper, but if you read it, you will see it's there. Second, our 2013 meta-analysis and systematic review covered 97 articles with almost 3 million participants. That study found Grade 1 obesity overall was not associated with higher mortality, and overweight was associated with significantly lower all-cause mortality. So lots of studies have produced findings similar to our 2005 paper.

  5. June 25, 2021 at 1:28 pm, John DiTraglia said:

    Sorry I’m late to this discussion but one thing that has been shown in other countries is that fatter people live longer but that is because in those countries weight is so tightly connected to socio-economics that it is impossible to tease apart. The opposite is true in rich countries but SE factors are difficult to totally control for in observational studies.