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Follow the money trail

29th April 2008

Follow the money trail

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?

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This entry was posted on Tuesday, April 29th, 2008 at 4:03 pm and is filed under Arts and Music, Fat Bias, Health, Nutrition & Fitness, New Research, Personal. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

There are currently 13 responses to “Follow the money trail”

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  1. 1 On April 29th, 2008, spinsterwitch said:

    What’s an even bigger issue for me is that the weight, height and activity levels had only one measurement and that was baseline of this 11 year study. I don’t know about you, but my life has radically changed in 11 years. I can’t really even see how they could ethically call this a correlation when there was no interval or endpoint measure for those factors.

  2. 2 On April 29th, 2008, Arwen said:

    I completely agree with your analysis of this study.

    I’m a little confused by them pointing out the treadmill study, however. The treadmill studies are a bit of a tautology if you’re not fat prejudiced: fit people are fit.

    That you can be fat and fit and be healthier than thin and unfit makes perfect sense and I think is a well needed boot to the North American consciousness.

    But IF this new study said anything, which, without followup about lifestyle factors, it doesn’t – it’s seems to be suggesting that fat raises your likelihood of being unfit, even if you’re exercising.

    Which I don’t think the treadmill study was trying to quantify. It was *qualifying* that it is possible for obese folk to be healthier than thin folk, not *quantifying* the rate at which that is true.

    Does that make sense?

  3. 3 On April 29th, 2008, Geogrrl said:

    What is also forgotten here is, again, genetics.

    Jim Fixx, the running guru, dropped dead of a heart attack at age 52, shocking everyone. He came from a family with a history of dying young from heart disease. He also smoked two packs a day until about age 40. It is possible he had done previous, irreparable damage with heavy smoking.

    My father dropped dead of his FIFTH heart attack at 44. His first was at age 38. Dad was one of those small, wiry types that ate anything and everything and never gained weight. Again, his family history includes a lot of people (mostly males) dying young of heart disease. Dad also smoked 2.5-3 packs a day until he died.

    This is to say that there is no ONE thing that will determine whether someone develops cardiovascular disease. Particularly not weight, not fitness level. It is largely controlled by genetics and other factors.

    Studies like this one just piss me off.

  4. 4 On April 29th, 2008, Twistie said:

    Sloppy methodology will pretty much always result in useless data. This study had some remarkably sloppy methodology. And seeing where the money came from, I can’t say I’m surprised. I only wish I were.

  5. 5 On April 29th, 2008, Harriet said:

    Great post, Rachel.

  6. 6 On April 30th, 2008, MrsDrC said:

    This post came just in time for me! I was just commenting on a message board that I dont buy it, pointed out many of the things that have been said about flawed this study is…and said I bet big drug companies footed the bill.

    Just another “study” to prove how unhealthy we all are…now dont we all want to march right out and join WW? It’s for our own good! Ugh.

  7. 7 On April 30th, 2008, Fauve said:

    It’s very confusing. Did the fat women who exercised also smoke? My mother, quite fat when she died, lost her life at 61 to a heart-attack. She was a long-time smoker, but stopped, 3 years prior to the fatal heart-attack. I guess the damage had already been done, though. I’m active at least 30 minutes, most days (will skip 2 out of 7 days, usually). But I’m also heavier than my mother had been, at her heaviest weight. I’m sure my weight impacts negatively on my health, despite my not smoking. Still, exercise most days is better than not doing it. All the study says to me is that my (extreme) obesity is still going to hurt my health, despite my exercise. No offense to anyone but – that makes sense to me. I can already see how my health is worsened by being so large. To use but one, relatively minor example, my feet definitely hurt more at higher weight. Foot pain won’t kill me, but it is pain I have less of when not quite so heavy. Since dieting doesn’t work, however, I think I am doing what I can do to exercise. A BMI of 47+ is a sobering thing for me. I can’t deny that.

  8. 8 On April 30th, 2008, Rachel said:

    All the study says to me is that my (extreme) obesity is still going to hurt my health, despite my exercise.

    Actually, they’re saying that both overweight and obesity have the same risk factors for heart disease. It isn’t just the “extreme obese” they claim are at risk. And since you can be considered overweight at just 10 – 15 pounds above what is classified as normal weight, I see this as problematic to lump such a wide range of people together.

  9. 9 On April 30th, 2008, Stan said:

    “Fit” generally means cardiovascular and respiratory function levels, e.g., can you climb 10 flights of stairs without gasping? Fat people can certainly be fit in this respect. “Fit” doesn’t make any claims about life expectancy or late life disability.

  10. 10 On April 30th, 2008, Rachel said:

    Stan – I think the study authors are referring to recent studies that show fitness is a better predictor for longevity and health than body weight itself. In these cases, researchers are making claims that fitness correlates to longevity and health.

  11. 11 On April 30th, 2008, Fauve said:

    “…I see this as problematic to lump such a wide range of people together.”

    I agree. Plus, it’s also just disturbing to have headlines constantly trumpeting the ill effects of obesity, yet hardly ever offering fat people any hope for increased health, unless they lose weight. Or have gastric bypass. I do get sick of it. They could slant the article differently than they are, with an emphasis that, although risks are there if one is very overweight, exercise *still* helps, rather than the other way around. Seems trite, but not really. Not to people who are struggling to exercise, even at high weights and health issues. Stop throwing sand in our faces, I’d like to say to them.

  12. 12 On April 30th, 2008, Allegra said:

    This is interesting to me, because I am technically overweight (I have a very large frame and a lot of muscle on it, with quite a bit of fat as well) yet I have lower blood pressure, work out at least 5 to 6 times a week and have significantly better overall health than my friends (who almost NEVER exercise), who all weigh at least 40 pounds less than I do. I am so much stronger and eat way healthier than they do as well, and yet this study is telling me I’ll probably have a heart attack and they won’t…this is not reasonable at all.

  13. 13 On April 30th, 2008, Sherie Sanders said:

    Many researchers don’t even consider anything under a 100% statistically significant. Percentages mean nothing without actual numbers anyway. For instance, in JoAnn Manson’s infamous Nurses and Health study, the press had a field day with the fact the heaviest women had a 300% greater risk than thin women of a nonfatal heart attack. What were Manson’s actual numbers? “Average” weight women = approx 3 in 10,000. The heaviest women approx 10 in 10,000!!! (It was slightly over but am way too tired to look it up exactly!) That was what all the fuss was about. The media and the pharma scum puppets take advantage of the fact the public knows nothing about how research works. The claim that one can’t be fat and fit is worthless, because no doubt there were many many heavy women who did NOT get heart disease!!! These numbers only mean that ever so slightly more in the heavier group did, certainly not all of them.

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