TOS Response to New York Times, Our Absurd Fear of Fat, Jan. 2, 2013

Article By Paul Campos

January 2, 2013


Dear Editor,

Let us not, again, fall into the trap of over interpreting a single recent paper on obesity, while forgetting the many findings that set the context for that paper. Despite the many interpretations to the contrary, the recent paper by Flegal et al actually reports that obesity is associated with increases in mortality among a largely elderly population. The conclusion of that paper garnering much of the news, however, is that overweight, a weight status between normal weight and obesity, is not associated with increased mortality and in fact confers a small decrease in the risk of death in a population that is largely elderly. This is important because the percentage of older adult population is in excess of 40% and now constitutes the largest portion of US elderly.

The issue of age is also very important because previous studies have shown that increased mortality is far more strongly associated with obesity in individuals under 50 and 60 years of age than it is among those over 65 years of age and what we are seeing in the US are very dramatic increases in obesity among those non-elderly adults, not to mention the tripling of childhood obesity. This paper also does not address the issue of extreme obesity.

Other studies have shown that the most dramatic increases of mortality are associated with extreme obesity, and the prevalence of extreme obesity among US adults has increased from less than 1% in 1962 to over 6% in 2010. As such, this most recent paper by Flegal et al, is not even addressing the central age related aspect of the current obesity epidemic. To be fair this was noted by these authors when they concluded that further research is needed, but is being overlooked by many who are using this paper to make erroneous arguments that obesity is not a disease of consequence.

It should be noted that this recent paper investigates only mortality and not the burden of chronic disease.

Multiple studies have found that both overweight and obesity are associated with more than a tripling of diabetes, heart disease and vascular disease. These are serious health issues that decrease the quality of life and increase health care costs. In these difficult economic times, it should be pointed out that the large obesity related increases in morbidity increase the cost of health care for the US by 150 billion dollars per year, and thus are one of the largest single preventable contributors to the ever growing problems of funding Medicaid and Medicare.

The recent paper by Flegal et al does constitute one of the largest single summaries of data relating excess weight to mortality, but that does not mean it is the final word on obesity and health. It does not, nor was it intended to, address the issues of early death, increased rates of chronic disease, decreased quality of life, nor the economic costs of obesity. Moreover, it has been known for over a decade that the effects of overweight on mortality are diminished in the elderly, and thus the findings are not even that novel. The many commentaries regarding the paper by Fegal et al over interpretations are misleading and unacceptable.


Submitted on behalf of The Obesity Society

Harvey J. Grill, PhD

President, The Obesity Society

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