In March 2004, Tommy Thompson, then Secretary of the U.S. Department of Health and Human Services, joined representatives of the Centers for Disease Control (CDC) and National Institutes of Health at a joint news conference warning, “Americans need to understand that overweight and obesity are literally killing us.”
At the news conference, the CDC released a study concluding obesity is now the second leading cause, behind tobacco, of preventable, premature death in America. The report attributed some 400,000 deaths per year to obesity.
Number Criticized from Start
Almost immediately, the study came under heavy criticism. The May 2004 issue of Science magazine fired the first volley, reporting that CDC scientists who had cast doubt upon the reliability of the 400,000 figure (one called it “loosey-goosey”) were ignored.
“I am worried that the scientific credibility of CDC likely could be damaged by the manner in which this paper and valid, credible, and repeated scientific questions about its methodology have been handled,” Terry Pechacek, associate director for science in the CDC’s Office on Smoking and Health, told the Wall Street Journal last year.
“I would never clear this paper if I had been given the opportunity to provide a formal review,” said Pechacek.
The Journal conducted its own review of CDC documents and reported in November 2004 that the 400,000 figure was inflated by approximately 20 percent because of a statistical error. In response to that report, the CDC on January 19, 2005 reduced the figure by about 9 percent, to 365,000 deaths per year.
Rep. Henry Waxman (D-CA), who requested a Government Accountability Office investigation of the CDC study, praised the agency’s work as a good start, but said it needed to reexamine its data and methodology even further.
“CDC needs to disclose how a flawed paper was cleared within the agency and what measures are in place to prevent similar problems in the future,” Waxman said in a written statement.
“I am pleased that the agency has pledged to pursue better methods to assess the harm of obesity, a serious public health problem,” Waxman continued. “This effort needs to move quickly.”
Redefinition Caused Inaccuracy
A lengthy study of the CDC’s obesity work was undertaken by the Center for Consumer Freedom (CCF), a nonprofit coalition representing restaurants, food companies, and consumers. That study, published in June 2004 and titled “An Epidemic of Obesity Myths,” revealed a number of flaws in the CDC study.
Citing work by CDC scientists who dissented from the agency’s original obesity report, CCF pointed out that the CDC study relied on a Body Mass Index (BMI) measure to determine whether to place persons in the “obese” category or the “overweight” category. The BMI measure considers only a person’s height and weight and does not take into account frame size, body fat percentage, or muscle mass.
Thus, as the Associated Press reported on March 14, 2005, about half of all current National Basketball Association players are overweight, according to the BMI. Half of all National Football League players are obese, and almost all of them are overweight.
Beginning in 1942, the Metropolitan Life Insurance Company developed height and weight tables for its insureds, taking into account gender and frame size. The tables, widely used to identify “desirable” body weight, were revised upwards in 1959 and 1983.
The federal government adopted the BMI in the 1990s as a guideline to help doctors determine when to address medically their patients’ overweight or obese status. Initially, the BMI tables used by the federal government labeled men as overweight if they scored 28 or above, and women at 27 and above. In 1998, the National Institutes of Health lowered the overweight score to 25 for both men and women.
Under the 1999 Metropolitan Life tables, a 5’3″ woman with a large frame and a weight of 151 pounds was not considered overweight. Under the revised BMI, however, she has a BMI score of 27, solidly in the overweight column.
Millions Suddenly Became Obese
The impact of the BMI revision was to classify an additional 30 million persons as overweight. As Rick Berman, an Atlanta Journal-Constitution columnist, noted on February 23, 2005, “One night in 1998, 30 million Americans went to bed a ‘normal’ weight and woke up the next morning as ‘overweight.’ It wasn’t due to midnight snacking. It was the result of a grand redefinition, which vastly expanded the potential market for prescription diet pills and landed the likes of Will Smith, Pierce Brosnan, Tom Brady, Kobe Bryant, and President Bush in the ‘overweight’ category.”
Obesity Deaths Miscalculated
A second flaw in the 400,000 number is that it counts as “obese” persons who are merely “overweight,” CCF notes, a total of 57,698 deaths that should not have been attributed to obesity.
A third flaw in the CDC’s number, the CCF study notes, is that it was arrived at merely by calculating the number of obese persons who died in excess of the death rates of non-obese persons and concluded that “all excess mortality in obese people is due to obesity,” without controlling for age or other causes of death.
Daniel Mindus, a CCF senior analyst, wrote: “If the technically overweight Kobe Bryant were to die in a car accident, he’d count towards the mythical 400,000 deaths figure.”
A further flaw was noted by reporter Betsy McKay in the Wall Street Journal on November 23, 2004, who pointed out the CDC’s 400,000 death figure is difficult to square with the fact that overall life expectancy in the United States rose to 77.4 years in 2002 from 75.2 years in 1992, using the CDC’s own figures.
Mindus stated in a November 2004 press release, “The problems with [the CDC] study go well beyond the simple math errors that the CDC admitted to. Since the CDC knowingly used refuted research as the basis for their false 400,000 figure, they have a public obligation to go back to the drawing board.
“Policymakers, public health groups, and the media should immediately cease using this data and stop the ridiculous claim that obesity-related deaths rival those of smoking,” Mindus said.
Crises Need Big Numbers
“What I find remarkable about the CDC’s obesity figures isn’t that the federal government’s Body Mass Index defines many professional athletes as overweight, and tens of millions of perfectly healthy Americans as exhibits in the Crisis of Obesity,” libertarian columnist J.D. Tuccille told Health Care News. “After all, what are government officials to do to advance their careers if there’s no crisis requiring their attention?”
“Nor am I shocked that official data about deaths attributable to obesity have been crudely (or incompetently) manipulated,” continued Tuccille. “It’s apparent that a good crisis requires a body count if it’s to get headlines and budget appropriations.
“No, what strikes me is that, after millennia of suffering famines, droughts, crop blights, and depleted hunting ranges, the human race–the American component, anyway–has arrived at a position of prosperity that makes food abundant and cheap, and our crisis-dependent health bureaucrats are reduced to pointing to the results of plenty as a problem equivalent to the plagues of the past.
“We must be very healthy indeed,” observed Tuccille.
Maureen Martin ([email protected]) is a senior fellow with The Heartland Institute.