| I am attaching an article below from the New York Times from last month discussing the potential problems with the exaggeration of the number of deaths being attributed to obesity from some recent reports in the United States. I want to be careful as to how to approach this topic. The purposed of our board is to primarily focus on smoking cessation issues. We have very strictly enforced guidelines on now allowing debates or discussions that can easily divert readers attention from smoking issues, and this issue can take on a life of its own if we are not careful. I am just going to discuss how these reports may have affected the way some people thought about smoking and to try to make it clear on how important not smoking is for reducing people's risks of premature death. Over the past few months that has been a lot of attention given to the issue of the dangers of obesity soon becoming the number one cause of preventable death in the United States, possibly overtaking smoking which now carries that dubious distinction. If smoking were to one day fall to the number two position, it should by no means fall off the radar string of public health concerns--it would still be killing well over 400,000 Americans a year and not a single one of these victims' family members or friends would take any solace that at least the person did not die from the #1 killer. |
My concern with these reports though was that it was very likely leading some smokers to conclude that they should not quit smoking because they would gain weight and that weight would result in a greater risk of death than smoking. No matter where the overall numbers end up being of how many people die from obesity, it doesn't change the fact that from what we know now that a person would have to gain over 75 pounds to increase the workload on the heart and elevate the risk of premature death to levels experienced by smokers.
The original projection being raised was that obesity deaths were going to overtake smoking deaths in the next year or two. It was found though that the projections were based on a math error performed in the statistical calculation in the CDC published reports--resulting in an overestimation of about 80,000 deaths, or about a 20 percent exaggeration of the number of deaths. There are a few other issues being raised by some scientists that there are other flaws in how the numbers were calculated which may very well result in the numbers of deaths attributed to obesity being overestimated. Unless smoking rates drop dramatically it is likely that smoking is going to still carry the dubious distinction of being the number one cause of preventable deaths for many years to come.
Besides my concern that some people will underestimate the risks of smoking, my other concern is that some people will think that if obesity studies were impacted by a math error, that smoking numbers are also grossly exaggerated by similar errors happening every now and then. People need to know that the dangers of smoking have been studied critically for decades now. Not just by one government agency in one country, but by lots of official agencies from governments all over the world, and most public health and most of the voluntary professional health organizations too and have consistently been shown to be a major cause of preventable deaths throughout the world for decades now. The way to reduce your own personal risk of becoming one of these smoking statistics is to simply continue to stick with your commitment to never take another puff!
Article from the November 24, 2004 New York Times
Data on Deaths From Obesity Is Inflated, U.S. Agency Says
By GINA KOLATA
Published: November 24, 2004 The Centers for Disease Control and Prevention says that its widely publicized estimate that 400,000 Americans die each year from being too fat is wrong and that it will submit a new, lower figure to the medical journal that published its original estimate last March.
It will be a simple correction of an inadvertent calculation error, the centers said.
But that figure of 400,000 deaths has taken on a life of its own. Those concerned about obesity cite it to show that being fat is almost as bad as smoking. And tobacco opponents attack the number, saying it is grossly, possibly purposely, inflated.
Yesterday, The Wall Street Journal reported that the centers planned to revise the estimate and had undertaken an internal review of the study, published in The Journal of the American Medical Association.
The estimate originated with an effort by the C.D.C. to determine the effects of the nation's growing number of overweight and obese people.
The result was a paper by Dr. Ali H. Mokdad and colleagues published in the medical journal that was controversial from the start, with some of the most vigorous attacks coming from antitobacco groups.
But beneath the dispute lies a truth about science and its uses in an age of limited resources.
If obesity is a leading cause of death, more money should be spent to try to prevent it, and to treat it. Insurers should pay for diet programs or weight-loss surgery. If it is not so deadly, some fear, the impetus to pay for such things might vanish.
On the other hand, the more money that goes to fighting obesity, the less will be available for other programs, like antitobacco ones.
"The tobacco people are afraid that it's a zero sum game," said Dr. Eric Oliver, a political scientist at the University of Chicago who is writing a book in the politics of obesity. "If obesity gets declared Public Enemy No. 1, it's going to come at their expense."
Now, with disputes and reviews under way, it is by no means certain what the final, official consensus on obesity deaths will turn out to be. The correction to the original article may be just the beginning as the agency has now asked for outside advice on how to do the calculations.
In response, said Dr. Dixie Snider, the chief scientist at the centers, the Institute of Medicine will have a meeting next month to discuss the appropriate statistical methodology to calculate obesity deaths. "One of the things we're trying to do is not to come up with any one person's favorite method," Dr. Snider said.
But Dr. Snider insisted that the paper in question was actually of only minor importance in the nation's fight against fat.
"We regret that we published a number that in retrospect was incorrect," Dr. Snider said. "And we regret the confusion. But the underlying message does not change. The paper makes clear and the erratum makes clear that tobacco and obesity are the two biggest killers."
Others disagreed, often forcefully.
"The kind of policies one would develop for something that is killing about as many people as tobacco or a quarter as many people as tobacco are very different," said Dr. Stanton A. Glantz, professor of medicine and director of the Center for Tobacco Control Research and Education at the University of California, San Francisco.
Dr. Glantz estimates that the number of deaths from obesity to be more like 100,000 than 400,000. And the inflated numbers of obesity deaths, he added, represent " a very, very fundamental mistake that was made in the paper, which they have done nothing to address."
"This is not some esoteric little detail over which there is huge uncertainty," he said.
Others, who are not part of the antitobacco movement, agreed with Dr. Glantz that the 400,000 figure made little sense.
Dr. Oliver, for example, said obesity, like tobacco, had little effect on mortality in people over 65. So with two million deaths a year in the United States, 70 percent of which are among people over 65, virtually every younger person who dies would have to die from obesity. "The numbers simply don't add up," he said.
That is the same argument made by two statisticians at the disease control agency, Dr. David Williamson and Dr. Katherine Flegal, who published papers this year reporting that the statistics used to calculate the obesity deaths were wrong.
They noted that the way to estimate deaths from obesity was to look at each age group and ask how many deaths might be due to obesity and then add the numbers to get the total deaths. That is the way the agency calculated tobacco deaths, coming up with a figure of 435,000. But for obesity, the agency looked at the death risk in younger people and extrapolated it to the entire population.
In response to the obesity analysis, the Office on Smoking and Tobacco at the centers circulated its own analysis of tobacco deaths. Using the same methodology as had been used for obesity, it came up with about 640,000 deaths from tobacco.
Dr. Snider says he knows about that tobacco office analysis and is aware of that criticism of the mortality estimates. But, he said, he does not think that is the entire answer to getting the statistics right, and he is counting on the Institute of Medicine Review to provide guidance.
But that institute is not going to satisfy someone like Dr. Glantz.
Antitobacco advocates are furious, he said, and he hears from them regularly. But others, too, are outraged, Dr. Glantz said. When he mentioned his criticisms of the centers' statistics at a National Cancer Institute meeting on tobacco control, he said, "it was like turning on a spigot."
The Institute of Medicine meeting, he added, "is more politics."