Abstract
Among the innumerable canards (which, by the way, means “ducks” in French) bedeviling the response to epidemic obesity in adults and children alike, one myth stands out for its sheer audacity: the myth that the obesity epidemic itself is a myth. The argument is propagated by many factions, but, in particular, is associated with University of Colorado Law Professor Paul Campos, whose book entitled The Obesity Myth 1 garnered considerable attention when first published and has a following to this day.
I always wondered why a law professor would presume to know that the CDC, a legion of epidemiologists, and in-the-trench clinicians had confabulated one of the salient concerns of modern epidemiology. My best guess, based, in part, on debates with Mr. Campos over the years—and with others holding similar beliefs—is that the motivation is a defense against obesity bias. 2 The assertion that epidemic obesity is a myth is not so much a valid refutation of epidemiological trends, but an offensive against the prejudices connected with obesity, 3 assumptions regarding character, and the tendency to blame the victim. If these are indeed the motivations, I am supportive of them. But I cannot be supportive of the message, because it is wrong.
Epidemic obesity, alas, is no myth. I have long pointed out that although we might debate the importance of some particular number of pounds, or the prevalence of some BMI cut-off point, 4 we simply cannot debate the importance of diabetes or other life-altering pathologies. We can all be fine with “OK at any size” if indeed we can be healthy at any size. But, for the most part, we cannot, and we are not. And neither are our children.
When I went to medical school in the mid-1980s, we were taught about two kinds of diabetes: juvenile and adult onset. Back then, adult-onset diabetes was, obviously, not a condition affecting kids. As we all know, it now is, 5 so often that the name was changed to “type 2.” The transformation of a serious condition of mid-life into an established pediatric scourge is a direct consequence of epidemic childhood obesity.
So, too, are the even graver consequences that ensue. When 7 and 8 year olds get what used to be “adult-onset” diabetes, they are prone to stunningly early-onset heart disease, 6 even in adolescence. The rate of stroke has been rising in children between the ages of 5 and 14 in the United States, 7 with epidemic obesity the only smoking gun on the scene to account for it. The frequency of bariatric surgery has been rising as the age of candidates has been falling. 8
And now comes the latest bit of bad news. As reported recently in The New York Times, 9 there has been a dramatic increase in the rate of fatty liver disease among adults and children alike in the United States. This condition, a fatty infiltration of the liver just like the one imposed on force-fed geese to produce foie gras (which means ”fatty liver” in French), can lead to cirrhosis, liver failure, and the need for transplant.
That, in turn, provides a very robust basis for busting the myth that obesity is a myth. Liver transplant is major, life-altering surgery, not broached casually by either patient or doctor. Preceding the procedure, the evaluation of the underlying liver disease is exacting. Those assessments are the basis for reports that nonalcoholic fatty liver disease is fast becoming the most common indication for liver transplant in the United States, surpassing the toll of infections, autoimmune disease, and alcohol. We are inadvertently doing to our own livers, and those of our children—out of cultural inattention to healthful eating and regular exercise—what can only be done to geese when force-fed.
Perhaps I am over-reacting to the contention that epidemic obesity is a myth. I suspect most people, and certainly most readers of this journal, reject that proposition already. But, on the other hand, the contention persists, commanding, at times, rather rarefied real estate. 10 We can ill afford such diversions.
The ominous rise in the prevalence and toll of childhood obesity around the globe is not a tale of bland statistics. It is one of children, with names and faces as well as hopes and dreams and, more often than not, loving families. It is a tale of potential loss of years from life as well as loss of life from years—and all of that is avoidable.
Doing what is necessary to turn this menacing tide and avert that preventable misery is not, in my view, complicated; but it is far from easy. There is a whole lot of heavy lifting to be done. 11 It is unlikely to get done by any culture that gets bogged down in debating the validity of the crisis, let alone the urgency of response.
The word for liver in French is “foie,” and the word for faith is “foi.” That similarity belies the reality. Those of us fussing about the urgency of epidemic obesity are not doing so on the basis of faith, but epidemiological fact.
The contention that epidemic obesity is a myth is, in a word, preposterous. Diverting debates about the existence of a crisis are unlikely to foster the dedicated, collective efforts required to end it. The proposition of a myth is belied by the relevant math, the objective tracking of epidemiology. Acknowledging the salience of this public health menace, and the need for addressing it as the urgency it is, requires no faith. We may simply count the rapidly rising tally of fatty livers.