Fumento on Pooh Pooh of fat in NE Journal of Med
Date sent: Wed, 14 Jan 1998 00:00:20 -0500
From: Mike Fumento
American Enterprise Institute
1150 17th Street, N.W.
Washington, D.C. 20036
Copyright 1998 by Michael Fumento
January 14, 1998
The New England Journal of Medicine Pooh-Poohs Its Own Obesity Findings
by Michael Fumento
According to the prestigious New England Journal of Medicine (NEJM), obesity is one of
the greatest health problems Americans face. Also according to the NEJM, losing weight is "an
ill-fated New Year's resolution" and the public has an "excessive infatuation with being thin."
Confused? It may help to know the first NEJM position has been the conclusion of
scientific studies published in that journal dating back years, conducted by the world's top obesity
researchers. Meanwhile, the second NEJM position was merely a commentary by editors of the
journal who have never published a single paper on obesity, and who essentially ignored the
magazine's own findings.
Indeed, it even ignored the findings of the lead study, by June Stevens and others, in that
Editors Jerome Kassirer and Marcia Angell, although both M.D.s, actually devoted little
space to medicine at all, preferring politically correct platitudes such as that "doctors should do
their part to help end discrimination against overweight people." So much for doctors as healers;
let's make them propagandists, instead. And false propagandists as well, to judge from the
For example, they claim that "as weight increases, so does mortality, but only modestly."
Really? Insurance actuarial studies for literally over a century have shown a powerful association
between fatter bodies and shorter, more sickly lives. The largest and most detailed of these is the
Stevens study, comprising over 300,000 men and women.
It concluded, "Excess body weight increases the risk of death from any cause and from
cardiovascular disease in adults between 30 and 74 years of age." Longest life was associated
with the leanest bodies, specifically those with body mass index (BMI) between 19 and 22. (The
higher the BMI, the heavier the person is for their height. To determine your BMI, multiply your
weight by 705, then divide by your height in inches, then divide again by your height in inches.)
For example, the Stevens study found that men averaging six feet tall whose ages were
only 30 to 44 and were just 16 pounds overweight increased their chance of death by 50 percent
This is a BMI of just 23.8.
"I'm sorry to tell you," Stevens told one reporter, "it's the very lean weight that is
associated with the best survival rate."
Apparently a 50 percent increase in death of young men is only "modest" to Kassirer and
Angell. They said you have little to worry about until your BMI reaches 27 or 28.
Even if we accept that assertion, we must consider the context. A third of all Americans
were already above that level by 1994-95, meaning at least 30 to 40 pounds overweight.
Meanwhile, this portion keeps getting bigger because Americans keep widening at what appears
to be an accelerating rate. In 1977-78, "only" a fifth of Americans were above that level.
"Americans are getting so fat that it's incredible," commented Stevens to the New York Times.
By comparison, the EPA passive smoking report estimated a LIFETIME increase in lung
cancer deaths of only 17 percent, yet it became the basis for sweeping federal and state
regulations on indoor smoking. Moreover, the size of the group effected by passive smoking was
tiny. The EPA estimated only 3,000 extra lung cancer deaths per year.
So something that shortens the lives of 3,000 Americans a year is a massive public health
threat, while something that prematurely knocks off 60 million Americans isn't worth breaking a
Probably at least a fourth of us are at a BMI of 29 or above. This is a mere 30-40 extra
pounds on a 5'5" woman. Yet this more than doubled a woman's chance of death the 16-year
measuring period in the Nurses' Health Study, published three years ago in yes the NEJM. Only
15 to 20 extra pounds greatly increased the risk of adult-onset diabetes, hypertension, and heart
A huge study of Harvard male alumni produced similar results, as did an earlier American
Cancer Society one.
How does obesity kill? It's all right there in years of NEJM studies. Last year it published
one showing that women merely 44 pounds overweight fully double their risk of breast cancer.
Another journal reported that those same extra 44 pounds of weight increases a woman's chance
of blood-clot related stroke by 2.5 times. These strokes kill more women than breast cancer.
Studies in the NEJM and elsewhere have also correlated obesity with myriad cancers,
coronary heart disease, hypertension, diabetes, and stroke.
The Stevens study also states, "The relative risk associated with greater body weight is
higher among younger subjects." Bizarrely, Kassirer and Angell say it's somehow reassuring that
the obesity risk "declines steadily with age until about 74 years, after which there appears to be
no" increased rate of death. This stands on its head the accepted public health position that
causes costing the most years of lost life deserve the most attention.
In any case, the "reprieve" after age 74 applies only to women. For men 75-84, Stevens
found a doubling in the risk of death for those of BMIs of 32 or greater. It's just that women so
heavily outnumbered men in this category that the combined overall death rate was average.
If the NEJM editors really understood modesty, they would have assigned obesity experts
to write the commentary. At the very least, they should have stuck to medicine, leaving "fat
acceptance" rhetoric for political magazines and the fat advocacy groups.
Michael Fumento is a resident fellow at the American Enterprise Institute in Washington, D.C.
and author of The Fat of the Land: The Obesity Epidemic and How Overweight Americans Can
Help Themselves (Viking, 1997).