Wednesday, January 9, 2013

Rebuttle to Health at Every Size: Life expectancy is not the only measure of health


In the December 2012 issue of Discover, Dr. Linda Bacon provides a commentary which supports the HAES approach to healthy active living. Dr. Bacon cites data from the CDC (published in the Journal of the American Medical Association in 2005 and an independent report in 2011 - not referenced) which shows that people classified as overweight live longer than normal weight people, and that despite the increases in obesity in the US between 1970 and 2007,  life expectancy has increased from 70.8 to 77.9 years.

The claims that overweight people live longer than normal weight people, and that life expectancy has increased alongside obesity are important to recognize - indeed, overweight is associated with longevity in many other species in the animal kingdom, and there are metabolically healthy obese individuals.

While all of this true, Dr. Bacon does not mention the effects of overweight and obesity on morbidity or quality of life. A paper published by the American Journal of Preventative Medicine in 2010 suggests that quality-adjusted life years lost due to obesity doubled from 1993 to 2008. Overweight and mildly obese people may be expected to live longer than their normal weight counterparts, but time and time again the research literature has shown that obesity is associated with a number of chronic diseases. Chronic diseases have a tendency to reduce an individual's quality of life. 

A meta-analysis published last week in the Journal of the American Medical Association provides a similar conclusion- while grades 2 and 3 obesity (BMI= 35-40, and 40+) are associated with an increase in all-cause mortality (basically, death from everything), grade 1 obesity (BMI=30-35) was no different than normal weight, and overweight (BMI= 25-30) was associated with lower all-cause mortality. The authors note in their discussion a major limitation of this meta-analysis - not evaluating weight status according to a measure of morbidity.

As we continue to conduct research in this area it is important to remember that life expectancy is not the only measure of health. There is much more to both health, and obesity, than meets the eye.

Please comment!

Health at Every Size - a brief comment

Let's face facts. We've lost the war on obesity - Health at Every Size community (http://www.haescommunity.org/)

The health at every size (HAES) approach to healthy active living is gaining steam. Indeed, there has been collateral damage in the war against obesity, such as food and weight preoccupation, eating disorders, stress, weight bias, etc. However, to say that we've lost the war on obesity is too simplistic. Firstly, the 'war' on obesity is not really a war at all. For instance, we can have a war on tobacco, which is a much simpler concept (see previous post on XX). But our stance against obesity is more of a conquest...a life-long struggle to gain minor but significant advancements against a multi-facted disease which affects millions of people. And to say that we've lost it? Look around you...as our environment becomes more and more obesogenic, it seems as if the 'war' has barely begun.

Indeed, one could make the argument that we have lost the war on obesity treatment:

1) lifestyle interventions may not be successful (weight regain and the associated effects of this cycle)
2) drugs don't work so well - the only approved pharmaceutical drug for weight lost in Canada (Orlistat) can provide very modest weight lost- about 3kgs on average (Lancet, 2007: http://www.ncbi.nlm.nih.gov/pubmed/17208644)
3) bariatric surgeries, while to-date the most effective method of inducing weight loss in an individual, are costly and frequently include side effects and weight re-gain (again, as well as the associated effects).

But surely not the war on obesity prevention.

Prevention of obesity through lifestyle modification is arguably the most effective way to reduce chronic disease risk, both at the individual and population levels- we must not forget this.

It is said, albeit refutable, that the current generation of children may have a lower life expectancy that that of their parents, for reasons such as our increasingly obesogenic environment. We have an opportunity with our current generation of children to change things for them - to provide them with an environment that promotes health (yes, in all shapes and sizes). 

We may not finish this conquest, but if we don't, it's up to them.

The message that we've lost the war is not productive. The last thing we need people to do is give up on preventing obesity. While I appreciate many of the other messages from the HAES movement, the notion that we've lost the war on obesity needs to go.

Feel free to refute in the comments section!