Bicknell Lecture Ignites Debate on Weight

Posted on: October 25, 2013 Topics: bicknell lecture

Paul Campos has a dream:

If an academic author could alter public discourse, he would “just get rid of the word ‘obesity.'”

It’s a charged word, he says – it pathologizes weight, stigmatizes fat people, and obscures other, more pressing health concerns.

“There was a (Vietnam War era) senator who said, ‘The way we get out of Vietnam is to just declare victory and go home.’ If we were to do that with obesity, ” Campos said, “we’d certainly have a happier society and I think also a healthier one.”

The rationale – or irrationality – of the national campaign against obesity was the focus of BUSPH’s 2013 William J. Bicknell Lecture, delivered by Campos, a University of Colorado at Boulder law professor, with responses by Dr. Frank Hu, professor of nutrition and epidemiology at the Harvard School of Public Health, and Abigail Saguy, associate professor of sociology and gender studies at UCLA.

(The complete Campos lecture, including commentary from Hu and Saguy and audience questions, is available on the BUSPH YouTube Channel.)

Campos, who authored the controversial 2004 book, The Obesity Myth: Why America’s Obsession with Weight is Hazardous to Your Health, laid out arguments against what he described as a misguided war on fat, questioning why a condition that affects two-thirds of the population (the ‘overweight’ and ‘obese’) had been framed as a medical crisis to begin with.

“The pathologizing of an enormous part of the weight spectrum . . . is not a healthy way of thinking,” Campos told an overflow crowd in Bakst Auditorium. He challenged claims he said were common in the mass media, including that hundreds of thousands of deaths each year are linked to obesity, and that the rate of obesity is rising exponentially.

“We do not know at all, even in the loosest sense . . . the extent to which higher-than-average weight is a cause of mortality,” Campos said. He said studies linking obesity and mortality risk show a correlation only at “high levels of the BMI (body mass index) range,” adding that, “Noting a correlation is a long way from demonstrating a causal relationship.”

Campos disputed the notion that obesity rates are climbing, saying they have actually plateaued in recent years, after rising through the 1980s and ’90s.

“The obesity lobby has to . . . deal with the embarrassing fact that the public health of the population is getting better and better,” he said. “We’re not seeing this exponential growth.”

Campos said that if obesity is, in fact, a cause of certain health risks, “getting people to obsess on their weight” is not a good strategy for intervening. People who diet regularly don’t end up thinner in the long term, and efforts to “get fat kids to be thinner” don’t produce thinner children, he said.

2013 Bicknell Large

Paul Campos, center, responds to a question from the audience, flanked by Abigail Saguy of UCLA and Frank Hu of Harvard School of Public Health

But despite those repeated findings, “the evidence seems to run up against an ideological brick wall, where it seems to just bounce off,” he said. In the meantime, obese people are increasingly stigmatized and stressed by anti-obesity messages – potentially harming their health, he maintained.

Campos proposed re-framing public health efforts around “harm reduction,” rather than weight reduction. The messages in that campaign would be different, he said, suggesting that encouraging people to be physically active and to eat a balanced variety of foods would be more effective than tethering health to weight.

Saguy, the UCLA professor and author of the recently published book, What’s Wrong with Fat?, said that the way obesity is framed in public discussion has intensified anti-fat prejudices and obscured more important health issues. Treating BMI as a medical condition can lead to misdiagnoses – or missed diagnoses – by medical professionals who have lapsed into “size profiling” of patients, she said.

Instead of the focus on pounds, Saguy suggested that public health efforts should turn to food distribution, nutrition, poverty, and improving access to “health-enhancing environments” for low-income people.

Hu, whose research focuses on diet and lifestyle determinants of type 2 diabetes and cardiovascular disease, countered that downplaying the role of obesity in health was dangerous.

“Trivializing the problem can mislead and confuse the public and harm the most vulnerable groups of individuals,” he said, stressing that the role of excess body fat in certain illnesses and premature death had been firmly established.

Hu disputed Campos’ claim that BMI cutoff points were arbitrary inventions, saying they were sound standards backed by medical experts and the Centers for Disease Control and Prevention. And he argued that obesity prevention campaigns were a factor in stabilizing childhood obesity rates in recent years.

“If we don’t do anything,” he said, “it will cause more harm to our children and to public health.”

Hu, Campos and Saguy sparred over the methodology of a recent study of nearly three million people that found that those whose BMI ranked them as overweight had less risk of dying than people of normal weight.

But they had a meeting of the minds over another topic: Their views on the TV reality show, The Biggest Loser.

All three said the popular show shamed and stigmatized obese people — with Hu adding that, “this kind of show is not helpful to our patients.”

BUSPH Dean Robert Meenan said the Bicknell forum was exactly what its benefactor, the late Dr. William J. Bicknell, founder of BUSPH’s Department of International Health, would have wanted:

“We’re continuing the tradition of thought-provoking, controversial topics.”

Submitted by: Lisa Chedekel