-NBC News in depth tonight: Americans eating themselves to
death.
-As we begin this new decade, the country is facing a dangerous
weight problem.
For decades, Americans have heard the same message.
-Americans are heavier than ever
with the obesity epidemic only getting worse.
-Experts worry that will translate into declining life expectancies.
-We're just too darn fat, ladies and gentlemen.
But what if the connection between
weight and health was a lot more complicated than it seemed?
-I don't think you should rule out the idea that our whole perspective has
been wrong about this.
By the early 1990s, Americans' obsession with weight was in full
swing.
-You can lose weight deliciously with the aid of AYDS.
-I found the secret to losing weight.
It’s Sprinkle Away and it can work for you.
C.D.C. epidemiologist Katherine Flegal
decided to conduct a study to see whether the number of
overweight Americans had actually shifted over the last few decades.
-I thought we should write an article, figuring it hadn't really
changed for like 20 years. Much to our surprise, we found an increase.
And that was really the point at which suddenly interest
perked up.
-The increase was across the board and that’s why researchers are
mincing no words.
In the 90s in the United States, we have had an epidemic
of obesity.
After Flegal’s study, the research intensified as others examined the
connections between weight and health, producing estimates that
excess weight could be contributing to 300,000 to 500,000 premature
deaths each year.
-The new results out tonight from a study on obesity and health. They
underscore what you may already know in your gut.
Fat is a health risk across the board.
-If something more isn't done to fight obesity, if Americans don't
change the way they eat, obesity will soon be the greatest single
cause of death in the country, greater than smoking.
Flegal was surprised by these rising numbers.
-We’d all been taught for years that smoking is very bad for you,
smoking kills all these people, and suddenly the message was, well,
obesity is so bad, it may be going to overtake smoking. That was really
shocking to people. In adults, there's only like a little over
two million deaths a year. So 500,000 is a very large number.
Flegal agreed that obesity wasn’t without risk. After all, it was
associated with conditions like Type 2 diabetes, heart disease, and
certain types of cancer. But she had found issues with some mortality
estimates, even outright miscalculations. And she worried
that these inflated numbers might skew health policy away from other
important factors, while providing a justification for rushing weight loss
drugs onto the market.
-This will be the first time that the government has allowed a drug to
be used for maintenance of weight loss.
-There was a drug, Redux, that got approved by F.D.A., which was later
withdrawn from the market for safety reasons. One of the reasons
it was approved, and you read this in the approval, is because – We're
not sure about this drug, but since obesity is so important, we should
approve this drug. So we started to realize this wasn't just a,
you know sort of, a little methodological
niche but it actually was an important topic.
Most of these population-level studies gauged risk using the Body
Mass Index, or B.M.I., a crude calculation of weight versus height.
But when Flegal completed her own large-scale analysis and broke it out
into these categories – underweight, overweight, and
obesity – she found something surprising. The number of
premature deaths was far lower than what the public had been led
to believe. And that wasn’t the only twist.
-So the collective finding was that
obesity was associated with about 112,000 deaths more than normal
weight. But that was counterpoised by the finding for overweight, which
was associated with about 80,000, 90,000 fewer deaths.
-Medical experts have told us repeatedly that being overweight
can take years off our lives. Well get this. Now a new government
study says maybe not.
-It was not our intention to have a
message. We just said this is what we found, period. I think I should
have prepared better for the onslaught of negative coverage.
Critics attacked Flegal’s work, claiming her results were skewed
by looking at data that was overly broad. But as she reanalyzed her
work in response, the findings stuck.
-We published a whole government report. We looked at all these
issues of smoking and previous disease and weight stability and so
on. And we found the same results, basically, no matter what we did.
Even today, Flegal finds herself under attack, despite the fact that
her results have long been accepted by the C.D.C.
-This narrative was being constructed, that our article was
dangerous and threatening to science, as though any new
information is intrinsically dangerous. What does that say?
Science is supposed to have new findings.
Counterintuitive results actually shape our understanding of weight
all the time, despite the public skepticism they can produce.
-A new study finds that heart failure patients carrying extra pounds have
a lower risk of death and they’re calling it the obesity paradox.
-Is it possible to be overweight and healthy? Are there times being
overweight actually helps?
For decades, researchers have
found that heavier patients with conditions from heart failure to lung
cancer can sometimes do better than thinner ones. These so-called
paradoxes can upend standard protocols, as Bette Caan found as a
cancer researcher over a decade ago. Back then, worries over weight
caused doctors to counsel breast cancer patients not to gain pounds
during treatment and even put them on diets. But when she tested that
rationale, Caan got a very unexpected result.
-In 2008, I published an article that
demonstrated that, in fact, those people who gained weight had no
worse outcomes. Those people who lost weight, however, did have
worse outcomes. It was the first finding like this, so I thought that
there's something going on that I have to pursue. As a good scientist,
you want to make sure that the finding is right.
The breakthrough finally came when C.T. scans showed that
heavier patients also had more skeletal muscle,
and that made all the difference.
-It took a while to get people used to that idea, because there was
such a belief that, no, it was weight
gain and that was important. I was part of a guidelines committee at
that point from the American Cancer Society. In 2010, they
weren't willing to accept my study. But now, 10 years later, there's
been so many findings that they're going to be included. We have
learned that overweight and even mild obesity is, for most cancers,
associated with either an improved outcome, or no worse outcome than
people who are in the so-called normal range.
While Caan focused on body composition, her fellow cancer
researchers have discovered other seemingly paradoxical findings.
Certain drugs, particularly in
immunotherapy, are more effective on heavier patients, and being
overweight can be correlated with less aggressive types of tumors.
-There are many answers to why the findings that we have are true.
So I think that we've turned the tides to understand we have to
study everything. If I have to conclude with anything, it's B.M.I. is
just a number. Assuming that that captures what's really going on in
the body is not true. We should not be calling it a paradox. It's a finding,
and we need to pursue the finding. If we didn't follow that, and we just
assumed that it was wrong, we may not find anything new.
Obesity specialist Fatima Cody Stanford says that health is
complicated, and by focusing on a weight chart instead of the science,
we may be missing a chance to help everyone live better and
longer lives.
-We've seen for so long that thinness equates to health
because, I mean, the B.M.I. chart tells
us that, right? And when you tell anyone anything differently, even if
the data support it, oh, no. Leanness wins, always wins.
Dr. Stanford points out that, for the majority of Americans, a healthy
lifestyle should focus on factors like proper sleep, exercise and a
nutritious diet, instead of revolving around achieving the perfect weight
or B.M.I.
-There is this hyperfocus on getting into these narrow, confined boxes
that are often set up by us in both the medical and the public health
community. We don't listen to people because we make these
judgments about how they look and how they must feel. So the quality
of care for patients with obesity is often significantly lower. This leads
to poor health outcomes. You see a
large number of people that are avoiding care, and we miss
diagnoses. For example, I’ve had a patient that had significant hip pain
for quite some time. And the surgeons were like, you know – it's
all because, you know, you just need to lose the weight and your
hip will feel better. She lost 120 pounds. So what was the issue?
She ended up having a big cancer in her hip that went unevaluated.
Not because she didn't complain about the fact that she had hip pain,
but all you could see was her excess weight.
Kelly Peters had a similar experience. Her serious hormonal
disorder went undetected for decades.
-I believed what doctors have been telling me for 20 years to just lose
weight. Just lose some weight, and you'll be fine. I was never tested for
anything. Nobody ever even sent me for an ultrasound. Not once,
until I was 35. As a fat person walking into a doctor's office, you're
both blamed for everything because of your weight and dismissed and
they won't look beyond your weight. So you exist on this line between
‘you’re dying an early death’ and ‘there's nothing really wrong with
you that losing 50 pounds won't solve.’
-I think we need to take a more holistic approach. And it's not just the number
on the scale. It's about other risk
factors that can contribute to worsened health outcomes. So we
have to look at the whole picture. It's not just one size fits all.