The Obesity Myth The Obesity Myth Why America’s Obsession with Weight Is Hazardous to Your Health Paul Campos GOTHAM BOOKS Published by Penguin Group (USA) Inc., 375 Hudson Street, New York, New York 10014, U.S.A. Penguin Books Ltd, Registered Offices: 80 Strand, London WC2R 0RL, England Penguin Books Australia Ltd, 250 Camberwell Road, Camberwell, Victoria 3124, Australia Penguin Books Canada Ltd, 10 Alcorn Avenue, Toronto, Ontario, Canada M4V 3B2 Penguin Books (NZ) cnr Airborne and Rosedale Roads, Albany, Auckland 1310, New Zealand Published by Gotham Books, a division of Penguin Group (USA) Inc. First electronic edition, May 2004 Excerpt from “Let Them Eat Fat: The Heavy Truths About American Obesity” by Greg Critser, reprinted with permission from Harper’s magazine. Copyright © 2004 by Paul Campos Foreword copyright © 2004 by Paul Ernsberger, Ph.D. All rights reserved Gotham Books and the skyscraper logo are trademarks of Penguin Group (USA) Inc. Campos, Paul F. The obesity myth : why America’s obsession with weight is hazardous to your health / Paul Campos. p. cm. Includes bibliographical references and index. MSR ISBN 0-7865-4657-3 AEB ISBN 0-7865-4658-1 Set in Fairfield Designed by Sabrina Bowers Without limiting the rights under copyright reserved above, no part of this publication may be reproduced, stored in or introduced into a retrieval system, or transmitted, in any form, or by any means (electronic, mechanical, photocopying, recording, or otherwise), without the prior written permission of both the copyright owner and the above publisher of this book. The scanning, uploading, and distribution of this book via the Internet or via any other means without the permission of the publisher is illegal and punishable by law. Please purchase only authorized electronic editions, and do not participate in or encourage electronic piracy of copyrighted materials. Your support of the author’s rights is appreciated. Making or distributing electronic copies of this book constitutes copyright infringement and could subject the infringer to criminal and civil liability. Visit our web site at www.penguinputnam.com For my daughter, Leia Contents Foreword by Paul Ernsberger, Ph.D. ix Introduction xv Part I: Fat Science 1. Fat on Trial 3 2. The World Turned Upside Down 41 Part II: Fat Culture 3. Fear and Loathing in Los Angeles 57 4. Lost in the Supermarket 70 5. The King’s Two Bodies 79 6. The Bimbo Culture 90 7. Weight Problems 99 8. All the News That’s Print to Fit 107 9. The Endless Debut 113 viii Contents 10. Chronic Restrained Living 119 11. The Athlete Within 131 12. Why Do Americans Diet? 137 13. The Last 10 Pounds 144 14. Life During Wartime 153 Part III: Fat Politics 15. The Feeding of the President 185 16. Feminist Accused of Unsightly Weight Gain 199 17. Anorexia Nervosa and the Spirit of Capitalism 218 18. The Last American Diet 238 Conclusion 247 Notes 253 Body Mass Index Table 273 Suggestions for Further Reading 275 Acknowledgments 277 Index 279 Foreword HE WAVE OF HYSTERIA surrounding obesity can be traced back T to many watershed events. In 1986, an NIH consensus panel on obesity ignored nearly all of the data presented to it and declared obe- sity a serious health threat. It did so despite presentations showing that people who gained weight as they aged reduced their risk of pre- mature death, and that obesity was not related to hardening of the ar- teries. In the press conference afterward, the panel went much further and declared obesity to be a “a killer disease.” This idea did not catch on at that time, even among anti-fat crusaders. In the early 1990s a more moderate and balanced view of obesity prevailed, illustrated by congressional hearings that found fault with the weight-loss industry and emphasized the mild nature of obesity-associated risks for all but the most extreme cases. I recall vividly the day I realized that obesity science was out of control and out of touch with reality. It was at the 1996 FDA hearing on the approval of dexfenfluramine, the most damaging half of the wildly popular drug regimen known as fen-phen. The fen-phen craze was triggered by publication of a single small trial of the drug com- bination in 1992, conducted by John Weintraub. Few people knew it then, but the publication costs were paid by the drug’s manufactur- ers. Weintraub was hired by the FDA, and continued to promote the drug combination while he was an FDA employee. Clinics devoted to ix x Foreword writing prescriptions for fen-phen, and collecting fat fees from them, were springing up all over the country. The major diet clinic chains like Nutri-System were offering fen-phen prescriptions in their store- fronts. A big obstacle to promotion of these diet pills, however, was that their use was strictly limited to twelve weeks. Use beyond this time was thought to be too dangerous because of side effects and the potential for addiction. So the drug’s manufacturer sought approval for a reformulation of fenfluramine—known as dexfenfluramine or Redux—intended for lifelong use. Editorials by obesity experts duly appeared, calling for lifelong use of diet pills, and comparing obesity to chronic conditions, such as high blood pressure, that need daily treat- ment for life. George Bray, a leading expert, famously quipped, “Drugs don’t work when not taken,” implying that one needed to take diet pills permanently to achieve permanent weight loss. When I arrived to testify at the FDA hearing that would decide dexfenfluramine’s fate, I was struck by the impressive array of obesity experts in attendance. Everyone who was anyone seemed to be there. I was there, in part, because experiments with laboratory animals con- ducted by my colleagues and me at Case Western Reserve University indicated that regaining lost weight undoes all of the apparent benefits of weight loss, and also creates new problems, such as high blood pres- sure, enlargement of the heart, and even kidney damage. Indeed, long- term human studies show that almost all of the excess risk associated with obesity can be accounted for by the higher incidence of weight cycling in obese people, and that obese people with stable weights have very little excess risk. George Bray came over and greeted me, and I expressed my awe at the assemblage of experts. “This is an important day for the obesity field,” he said loftily. “We are all united in our support for this drug ap- proval,” he said a bit pointedly, knowing that I was about to testify against approval. I wasn’t the least bit shaken. I was well aware that in the past the obesity field had been just as impressively united be- hind many failed treatments, including intestinal bypass surgery, zero- calorie diets, liquid-protein diets, jaw wiring, thyroid pills, injections of horse urine extract, and amphetamines. As a scientific (as opposed to an economic) matter, obesity research did not have an impressive record of success—and it was about to get worse. A simple computer search using the words “fenfluramine” and “adverse effect” turned up hundreds of reports. The drug was already linked to a fatal lung condi- Foreword xi tion in people, and to brain damage in animals. Rarely, if ever, had a drug with such a long history of dangerous side effects been up for government approval. And for what benefit? The clinical data indi- cated that dieters taking fenfluramine lost only seven pounds more than dieters taking a placebo. As I testified to the FDA committee, this was not a favorable ratio of risk to benefit. There is a gradual fall of life expectancy associated with extremes of weight, resulting ulti- mately in a loss of six to eight years of life expectancy for “morbidly obese” women. In other words, being 150 pounds “overweight” has a risk association similar to that seen with light cigarette smoking. But a loss of seven pounds would not move anyone perceptibly down this risk gradient. More important, dexfenfluramine had not been shown to produce any improvement whatsoever in the major risk factors as- sociated with high weight, such as blood pressure and cholesterol. It is these risk factors that form the rationale for treating obesity in the first place, so why approve a drug that had no proven health benefit other than producing a tiny amount of weight loss? My testimony was followed by that of Judith Stern, professor of nu- trition at the University of California–Davis. She testified that she was speaking not as an expert but rather simply “as an obese woman” who wanted to see a “valuable” treatment made available. She spoke on be- half of the American Obesity Association, a powerful DC lobbying group, funded by drug companies and the diet industry, that claims to represent the interests of 160 million “overweight” Americans. After the hearing, she told the Associated Press that any expert who op- posed approval of Redux “should be shot.” Clearly, emotions were run- ning high among obesity experts, many of whom were eager to keep their pill-dispensing clinics open and filled with patients desperate to lose weight. Further key testimony came from Jo Ann Manson of the Harvard Medical School. She did not dispute the fact that the drug had fatal side effects and produced an average weight loss of only seven pounds. But she argued that extra weight was so deadly that a seven-pound weight loss would save slightly more lives than would be lost from the fatal lung disease caused by the drug. She assumed a great many things in making this argument, some of which seem especially absurd in retrospect.