Letters

From the May 1998 issue

(Page 2 of 2)

Young struck a raw nerve with me in detailing the "consequences of a restraining order." Year after year, good men like me can spend our own time and money petitioning the court with pleas for "more" time with our children (in Massachusetts, if you are an unwed father your child basically belongs to the mother and state), only to be trumped when, after discovering she will be brought into court to explain why father and child are not spending time together, the mother files for a restraining order and that hearing comes before the long-awaited visitation hearing.

I applaud REASON for publishing Cathy Young's blazing article. I hope it enrages readers to the point of taking action. The horrors of the family law courts need to end.

Tony Lizza
Marietta, GA

Weighty Questions

Jacob Sullum's review of Michael Fumento's Fat of the Land and Richard Klein's Eat Fat ("Fat Chances," February) was disappointing since it didn't address head on the dispute between Fumento and Klein over the evidence that obesity contributes to increased mortality. This is important because in his zeal to attack gluttony, Fumento appears to directly contradict previous claims he has made about the reliability of epidemiological studies to measure increased mortality.

In a 1995 op-ed piece, for example, Fumento refers to a study that found secondhand smoke was associated with a 19 percent increase in mortality and concludes, "At the time, many people including myself criticized the EPA report, saying [with] such a small apparently increased risk (so tiny, in fact, that the medical community has rejected much larger ratios as being conclusive on other potential carcinogens)...that the tiniest problem could throw the whole thing off."

But now Fumento apparently accepts American Cancer Society claims that men 19 percent overweight have a 15 percent increased likelihood of death. What ever happened to the difficulty with "such a small apparently increased risk"?

Fumento also repeats the claim that 300,000 people die every year from obesity, but as Marcia Angell wrote in a recent New England Journal of Medicine editorial, "[A]lthough some claim that every year 300,000 deaths in the United States are caused by obesity, that figure is by no means well established. Not only is it derived from weak or incomplete data, but it is also called into question by the methodological difficulties of determining which of many factors contribute to premature death."

As Steve Milloy of The Advancement of Sound Science Coalition put it, the 300,000 figure is "classic junk science." Apparently the limitations and difficulties of epidemiology, which Fumento discusses so well in his book Science Under Siege, are irrelevant when one strikes out on a crusade to save people from themselves.

Brian Carnell

Reviewer Jacob Sullum seems to buy Michael Fumento's claim that we should lose weight and live longer. This is one of the most widely believed erroneous ideas that is debunked in my book, Things You Know That Are Not So: A Digest of Erroneous Popular Wisdom on History, Science, Health & More. Losing weight does improve blood pressure, cholesterol levels, and other markers for health. Despite this, dieters die sooner.

A 32-year study of Dutch men showed the leanest men had the highest mortality. A Finnish study found the lowest mortality at a body mass usually considered obese. A Kaiser Foundation study found no increased mortality associated with weight. A study published in the American Journal of Epidemiology (September 15, 1992) reported that dieters who lost over 15 percent of their weight increased the risk of mortality by two times over those with little or no weight loss. Even studies that headlines claimed associated higher obesity with increased mortality actually produced raw data that show the opposite.

A widely publicized report in the New England Journal of Medicine (September 14, 1995) said the lowest mortality was observed in women weighing at least 15 percent below the U.S. average. The actual data in the report showed that mortality was lower for women who were as much as 50 percent over the optimal weight. The researcher had discarded 68 percent of the deaths. Even if her selection was scientific and valid, the conclusion was not valid for over two thirds of her subjects.

The same issue had another study which said, "Men losing 4.5 kg had, independently of the level of weight at the base line and the confounders, a significantly elevated risk of death from noncardiovascular and noncancerous causes and from all causes." This study, as most studies published in refereed professional journals, shows higher mortality associated with losing weight.

The food police have unconsciously encouraged dangerous anorexia and bulimia. They have actually increased obesity because dieting rarely lasts. Most dieters gain back more than they lose. The pressure on dieters has created an environment of prejudice and guilt. Shortcuts encouraged by the food manufacturers, weight loss groups, and bariatric physicians cost much time and wealth, yet end up also costing longevity.

No doubt Mr. Fumento is well-meaning, but he will not improve our mortality by adding to the pressure. A lifetime of brussel sprouts and low-fat foods may not last longer, but it will seem longer.

David Moshinsky

I read and greatly enjoyed the review of the books on fat. However, I would like to make two points.

First, the Rubens stuff is a widely misused myth. Yes, he painted fat women, but he was unique even in his day. True, fads do change from time to time, as with the latest body-piercing craze. However, that doesn't mean every man, or even a substantial fraction, now desires a woman with a nose ring, where we did not previously. It is just a passing fashion.

Bottom line, despite passing fads, men's ideal of desirability has not dramatically changed over tens of centuries. At no time or place did men find obese women to be more desirable than 36-24-36. Rubens wasn't painting erotica, and an abundance of images of "attractive" women throughout the ages demonstrates a fairly constant ideal of feminine beauty.

Second, I have wondered about the "calories are all that counts" argument, but have never seen a serious discussion of it. In the simple model, calories in = calories burned + calories stored (as fat). If this is true, a calorie is a calorie, regardless of the source. I am not a biologist, but I suspect that this simple model is wrong. I would expect the body to be able to dump excess calories in the urine. If this is so, the form of the foodstuff in the bloodstream may influence whether it is stored or discarded. I would be interested in knowing if you are aware of any such mechanism for calorie dumping.

Thomas Cunningham
Pasadena, CA

Jacob Sullum replies: Brian Carnell shows appropriate skepticism in asking how we know that the associations between obesity and various diseases represent cause-and-effect relationships. To make that judgment for a given health risk, you need to look at several factors: How strong is the association? Is it consistent across studies? Does the risk rise steadily with weight? Is there a plausible biological mechanism? Have alternative explanations for the association been ruled out?

I have not examined the evidence about the health risks of obesity closely enough to answer those questions. But Michael Fumento has, and since he has shown a keen awareness of epidemiology's limits in his previous work, I tend to give him the benefit of the doubt when he says that a particular risk is well-established.

Then, too, Richard Klein does not offer a very rigorous rebuttal of the view that obesity is hazardous. In any case, I did not mean to endorse Fumento's conclusions on this point, only to accept them for the sake of argument.

As for the figure of 300,000 obesity-related deaths a year, all such death tolls should be taken with a tablespoon of salt. As tricky as teasing causation from correlation can be, estimating the magnitude of each risk and applying it to the general population is fraught with even more uncertainty.

Since I have not delved into the literature, I cannot address the studies that David Moshinksy cites (though I am sure Fumento would be eager to do so). One point to keep in mind, however, is that an association between weight loss and higher mortality could be due to the fact that sick people tend to lose weight--a complication that Klein fails to consider.

Thomas Cunningham is probably right that our ancestors' admiration for fat is often exaggerated, but Klein does make a convincing case that standards of beauty have changed noticeably, if not "dramatically," over the years. Though "Rubens wasn't painting erotica," his nudes were not intended to be repulsive either, and he is not the only artist to present such figures in a positive light.

Regarding the fat-vs.-calories issue, Fumento concedes that "dietary fat converts more efficiently to body fat than does carbohydrate or protein" and that carbohydrates are "almost always burned off immediately as fuel." But he argues that the practical significance of the first point is nullified by the second: "It doesn't really matter that carbohydrates convert less efficiently to body fat, since that conversion rarely takes place at all."

If you eat excessive amounts of carbohydrates, Fumento says, all your dietary fat will be converted into body fat instead of being burned for energy, and none of your existing body fat will be lost. That is why he insists that calories are the bottom line.