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A pound of anxiety
Scripps Howard News Service


April 26, 2005

Regular readers of this column won't be surprised to hear that many people forwarded me copies of last week's Journal of the American Medical Association study, which confirmed the central points I've been making for several years about our ongoing panic regarding so-called "overweight" and "obesity."

The study's main conclusions - that all of the "overweight" and much of the "obese" range of body mass doesn't correlate with any increased mortality risk, and that, indeed, people who weigh more than the government's recommended maximum have a lower relative risk of early death than those who don't - are merely restatements of what the medical literature as a whole indicates.

Of course, in the short term none of this is going to do much to slow down the current hysteria over fat, since that hysteria has never been about science. An amusing example of this was provided by Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, who announced that the CDC wouldn't be altering its message in regard to the risks posed by higher-than-average weight.

Apparently Gerberding, who at this time last year was at the forefront of those proclaiming that fatness was about to overtake smoking as the nation's leading cause of preventable death, isn't going to allow a little (actually, an overwhelming amount of) adverse evidence interfere with her pet agenda.

All this brings to mind a fascinating article published in last week's British Medical Journal by Iona Heath, a London physician who focuses attention on a troubling paradox. Heath draws on work done by economist Amartya Sen to illustrate the following point: "It seems that the more people are exposed to doctors and contemporary health care," Heath writes, "the sicker they feel."

Heath points out that the enormous emphasis on preventative health care in rich countries such as Britain and the United States has some significant disadvantages. An ounce of prevention may be worth a pound of cure, but what are the costs of making an obsession with avoiding ill health - or, more precisely, risk factors for ill health - a central focus of one's life?

Heath uses Sen's comparative economic work to illustrate that people in the United States are far healthier by every objective measure than people in a particularly poor Indian state, yet have vastly higher rates of self-reported illness.

"The danger," Heath says, "is that the achievement of longer and, by all objective measures, healthier lives, may result in those lives being increasingly dominated by illness and fear."

Heath is well aware of the economic factors that are driving the distribution of health care in rich nations. She emphasizes that at any one time the vast majority of people in such nations are quite healthy, and that powerful incentives are pushing our health-care systems toward prescribing ever-more-elaborate treatments, especially drugs, for people who are in no sense sick.

A particularly disturbing aspect of this trend is illustrated by the increasing tendency to portray risk factors as illnesses. Heath mentions high blood pressure and low bone density; yet the most striking example of this trend has been the transformation of higher-than-average weight into a supposedly epidemic disease.

Heath emphasizes that we have only a limited understanding of the social effects produced by such trends. Telling healthy people that they're sick is obviously a bad thing, and we need a more vigilant attitude toward those who profit from doing so.

Information about risk is a trickier issue. Yet Heath is surely right to point out that preventative health initiatives can do more harm than good, especially if they end up producing a pound of anxiety in return for an ounce of cure.


Paul Campos is a law professor at the University of Colorado
and can be reached at Paul.Campos(at)

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