This originally arose as a comment to the discussion over at Shapely Prose on the recent study which claims you cannot be fat and fit. There’s another dedicated discussion on the subject at Feed Me!. I decided to repost my comments here, too.
The study in question, of course, is this one referenced in this AP story or read the official study here. The study followed some 39,000 women with an average age of 54 over a period of 11 years, tracking their weight, physical activity, and incidence of heart disease. The study concluded that overweight active women had a 54 percent higher risk and obese women an 87 percent higher risk for developing heart disease. By contrast, overweight inactive women had a 88 percent higher risk and obese inactive women a 21/2 times greater risk for developing heart disease.
In other words, according to these researchers, weight trumps physical activity in the development of heart disease.
The AP article identifies the obvious flaw in methodology used in the study: The study relied on womens’ self-reporting of their activity levels, a method which has been shown to be unreliable, according to University of South Carolina obesity expert Steven Blair. Blair, a leading proponent of the “fit and fat” theory, claims a more objective fitness evaluation including exercise treadmill tests, which include heart-rate measures to see how the heart responds to and tolerates exercise. In Blair’s research, overweight people deemed “fit” by treadmill tests did not face increased risks of dying from heart disease.
The researchers’ position is certainly a fatalist and discouraging one, but a closer examination reveals even more pause for concern. The study admits that “the majority of Americans are inactive and not meeting the Surgeon General’s goal for adequate physical activity.” Note, not the majority of fat Americans, but the majority of all Americans are inactive. At the study’s baseline, only 34 percent of the participants – comprised of 51% average weight, 31% overweight and only 18% obese women – were considered physically active based on the Surgeon General’s guidelines. How can researchers realistically judge the effects of physical activity on heart disease or if one can be fat and fit when the majority of the study participants aren’t fit to begin with?
The study also included smokers, which I find troubling. Although the study asked women to self-report their smoking habits as “never, past or current,” they fail to separate and distinguish the variables of weight on heart disease from the variables of smoking on heart disease The study even admits that inactive women were more likely to be current smokers, thus making them even more at risk in developing heart disease, regardless of body weight. The study also admitted that hypertension, high cholesterol levels and diabetes may have accounted for a “moderate amount of attenuation” in the associations between elevated BMI and physical inactivity with heart disease, which could “likely explain a modest portion of the mechanism by which overweight, obesity, and physical inactivity may contribute to CHD.”
So, what researchers here are saying is that fat women, both active and inactive, who did not have preexisting health conditions of diabetes, hypertension and high cholesterol are not as high of a risk to develop heart disease, regardless of body weight. So, is it body weight or these particular disorders that are most linked to heart disease? And while these three conditions can be related to weight, they’re by no means conditions affecting only fat people. In other words, researchers accepted self-reported unhealthy people in the study, and then acted surprised when the same unhealthy people developed an increased risk hazard for other often related health conditions. Logic, anyone?
The study concludes with:
Our study strongly supports current physical activity guidelines recommending 30 minutes of moderate activity daily to reduce chronic disease. This level of activity improved CHD risk regardless of baseline BMI. Furthermore, this study suggests that more than 30 minutes of physical activity daily further reduces the risk.
Why wasn’t this part more widely spotlighted in both the study and the AP story on it? Maybe the money trail will explain why.
Of the eight-member team of researchers, Dr. Howard D. Sesso, who helped to analyze and interpret the study data, received investigator-initiated research funding as principal investigator from for-profit entities including Roche Vitamins Inc (now DSM Pharmaceuticals), maker of drugs to treat, amongst other things, obesity.
Dr. Michael Gaziano, one of two researchers charged with obtaining study funding, received nonfederal investigator-initiated funding from McNeil Consumer Products, whose parent company Johnson & Johnson holds a vested financial interest in seeing obesity classified as a disease. He’s also accepted research dollars from Amgen, another company currently conducting clinical trials for the treatment of obesity, and VeroScience, another company which seeks to commercially treat obesity.
Dr. Gaziano has also received research support from the aforementioned DMS Pharmaceuticals, as well as Wyeth Pharmaceuticals, maker of the diet drug fenfluramine (Fhen-phen) which was yanked from the market after it was found to cause heart valve damage. He’s also served as a consultant for McNeil and Wyeth, along with Bayer, another company dedicated to commercially treating obesity. Additionally, he has served as an expert witness for Merck, maker of a failed diet drug; diet-pill-monger Nutraquest, which settled with California in 2006 after being accused of using deceptive techniques to sell weight-loss products that contained ephedra; and GlaxoSmithKline, maker of Alli or what is better known as the Poopy Pants diet pill.
Both Dr. Gaziano and Dr. I-Min Lee both received research support from Dow Corning Corporation, makers of a silicone-rubber, acid-resistant gastric balloon used to (unsuccessfully) treat obesity (PDF link).
Whew, and I didn’t even have to break a sweat to find out this information! With financial donors like this, is it any wonder the study found fat to be so unhealthy?
I do not know the researchers nor am I familiar with their reputations. They very well may be highly ethical and altruistic people dedicated solely to advancing good health. But I do have to question their study results when companies who have vested financial interests in reducing or eliminating obesity are among their heftiest financial contributors. Are these researchers willing to bite the gloved hand that feeds them?
And it’s not just this study that is made problematic by potentially biased financial donors. Scratch any anti-obesity study and you will find much the same pattern. The weight loss industry rakes in tens of billions of dollars a year – would they really sponsor a study that could hurt their bottom line?