Dr Aseem Malhotra doesn't know what he's talking about

An article has appeared in the Observer under the byline of Aseem Malhotra. He is a medic and, not coincidentally, has a God complex and a shaky grasp on facts and figures. Like Liam Donaldson and many others before him, he seems to have tired of healing the sick and wishes instead to indulge his political ambitions without all the bother of having to get elected.

Malhotra has written several articles about so-called junk food, on the last occasion asking "For Big Tobacco, should we now read Big Food?" He appears to believe the absurd prediction that 90% of the population will be overweight or obese by 2050 (despite rates having been flat or declining for ten years), and has swallowed the idea that heart attacks fall dramatically after smoking bans are introduced (they don't). Today's article is headlined...

We must demonise junk food for the sake of our children

Calling for demonisation is not likely to get a warm reception round these parts, especially if the rationale boils down to 'think of the children'. Still, let's give him a chance.

A consultant psychiatrist friend, on his recent appointment to a new job, was so disgusted by the detrimental effect of the unchecked consumption of junk food on his patients' health that he successfully banned vending machines selling chocolates, fizzy drinks and crisps from the hospital grounds.

All in a day's work for your average medical busy-body, interfering in matters beyond their expertise (the guy is a psychiatrist, remember).

He wondered whether I – as a clinician – believed the consequences of eating junk food were as bad for our health as smoking cigarettes. "No, not as bad," I replied, "in many ways it's far worse!"

Oh, to be a fly on the wall when these two intellectual titans conversed. It must have been like a Pete and Dud sketch. ("You think hamburgers are worse than fags, Pete?" "Oh yes, Dud, I reckon they're far worse. Gotta be, haven't they?") If you're going to make a statement as stupid as that - dangerously stupid, in fact - you'd better have some pretty impressive evidence to back it up.

It is estimated that diet-related diseases are responsible for 35 million deaths worldwide, dwarfing smoking-related ones of 5 to 8 million.

Nice statistic. Shame it's rubbish. As the briefest Googling would have told him, 35 million is the total number of deaths caused by "obesity, cardiovascular diseases (CVD), cancer, and diabetes" worldwide, representing 60% of all deaths every year globally. In other words, he has combined the total number of deaths attributable to the diseases of old age and defined them as 'diet-related'. It is true that they can be diet related - just as they can be related to a number of other factors - but that hardly justifies presenting the bald statistic as if all these deaths could all be prevented by modifying diet, let alone drawing the conclusion that 'junk food' is more dangerous than smoking. Doing so suggests either appalling ignorance or a degree of mendacity.

As BenSix says..

CiF commentators passing off misunderstandings and received wisdom as fact is hardly new. Yet when a practicing doctor can make – unless I’ve made a ridiculous error – such a ridiculous error it drives home how lax the standards of epistemic rigour can be in today’s society.

Indeed. It is the old problem of the media assuming that someone knows what they're talking about just because they work in the medical industry. 

So what is the biggest culprit of the obesity epidemic and how do we combat it? According to Professor Robert Lustig, a child obesity expert at the University of San Francisco, it's sugar (including sweeteners) and processed carbohydrate.

If you ever find yourself reading an article in which Robert Lustig is cited as an authority, a good rule of thumb is to put it down and do something more productive with your time. This is not the first time Malhotra has cited Dr Lustig in an article and we have encountered him before. He is an anti-sugar crank and borderline conspiracy theorist who indulges in some of the strangest beliefs in the Bay Area - no mean achievement. He think that sugar-sweetened beverages have created "the biggest public health crisis in the history of the world" and seems to believe that bee stings are a sign from God that we shouldn't eat honey.

He describes sugar as being addictive and toxic...

Indeed he does. Because he doesn't understand what either of those words mean.

...and has called for a ban on the sale of sugary drinks to under-17s and a consumer tax on any substance with added sugar. This would be a good start.

And a start is all it would be, I'm sure. Presumably to be followed by minimum pricing of food and a display ban for sweets. The former was reported earlier today. The latter is hinted at here...

It horrifies me to see well-known high street brands getting away with the display of chocolates, crisps and fizzy drinks in prominent positions. It's perverse that institutions that represent health and wellbeing and treat the consequences of poor diet allow the sale of such products.

And it is perverse that newspapers which represent knowledge and information should pay people to misinform their readers, but that's life.

You will often hear two defences from big food corporations. The first: it's your choice what you eat

It is. It is the most basic of all freedoms.

...and the second: you need to exercise more.

If you're fat, you do.

In response to the second point, a study by Professor Boyd Swinburn, presented at the European Congress on Obesity in 2009, concluded that excess food intake explains weight gain.

Where would we be without professors, eh?

And so he goes on, mainly giving us a list of what he thinks should be compulsory or illegal. The only silver lining being the Guardian's choice of photo for this story, which suggests a certain mischievousness on the part of a sub-editor while illustrating the cognitive dissonance that surrounds the junk food scare.

Don't eat 'junk food' or you could end up as fat as these poor sods

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Minimum pricing for food

Alone of all news networks, the BBC has chosen to turn a press release from the public health establishment into its top news story.

Nothing in this article is new or surprising. It is just another example of the anti-tobacco blueprint being extended to other areas of public life.

Just as it shouldn't be surprising to hear that the Department of Health is looking at plain packaging for alcohol (despite having not officially made its mind up about plain packaging of tobacco), it shouldn't be a shock to find that 'public health professionals' are excited by the idea of minimum pricing for food (despite the DoH having not yet officially made its mind up about minimum pricing for alcohol). That's right - minimum pricing for food...

The first phase of the campaign will try to find out what works. It will review evidence for diets, exercise, taxation, minimum pricing, changing advertising and food labelling, which medical procedures work and how children are educated.

How blatant do these people need to be for you to see that this is not just about tobacco? It's not even just about alcohol. Plain packaging for wine? Minimum pricing for burgers? This is not some libertarian paranoia about the slippery slope. This is actually happening. It is going on before your very eyes.

I don't want to say I told you so, but...

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What effect will a fat tax have?

From The Guardian:

Imposing a 10% "fat tax" on sugary drinks would help tackle soaring rates of obesity, according to new research by international experts.

Would it, by God? And your evidence?

"In testing taxation as an option for shifting beverage purchase patterns, we calculate that a 10% increase in the price of SSBs could potentially result in a decrease of 7.5ml per capita per day." A similar 10% hike in the cost of full-fat milk would also reduce consumption of it by 5ml per person per day and increased intake of reduced fat milk by 7ml per head every day, it adds.

Okay. So a 10% tax—essentially a tithe to be given to the Gods of public health—would reduce full-fat milk intake by 5ml a day, or 1,825 ml a year. That works out at 3.2 pints a year.

Doesn't sound like very much, does it? And indeed it's not. There are 380 calories in a pint of full-fat milk and 265 calories in a pint of semi-skimmed. If a 10% tax on full-fat milk makes people replace 3.2 pints of full-fat with 3.2 pints of semi-skimmed, they would reduce their calorie intake by 368 per year ((380-265 = 115) x 3.2 = 368). This works out at one calorie per day which is, to all intents and purposes, nothing.

But there is more. The fat-taxers seem to think that consumption of reduced fat milk will increase by 7ml a day—more than offsetting the 5ml fall in full-fat milk consumption. Why they believe this, I know not, but let's roll with it for a moment.

A 7ml increase is 2,555ml a year, ie. four and a half pints a year. If this is semi-skimmed, this is an extra 1,166 calories.

If it is skimmed milk (195 calories per pint), it would be an extra 858 calories.

Remember that people will supposedly lose 1,216 calories because the fat tax makes them reduce their full-fat milk consumption by 3.2 pints.

So if they switch from full-fat to semi-skimmed milk, they will lose fifty calories per year—a whopping 0.1 calorie per day! (1166 - 1216 = -50). Just watch that flab fly off!

Even if they switch to skimmed milk, they will lose only 358 calories per year, ie. one calorie a day (858 - 1216 = -358).

As for reducing consumption of "sugar-sweetened beverages" by 7.5ml a day, there are 400 calories in a litre of Coca-Cola, so a reduction of 7.5ml works out at 3 fewer calories per day. This, of course, assumes that people would replace their Coke with water or nothing at all. If they substituted something "healthy", like an Innocent Smoothie, they would wind up consuming more calories because a typical litre of smoothie contains more than 500 calories. (But we don't mention that because middle-class people like them.)

Since the average adult male needs 2,500 calories per day to maintain a healthy weight, the idea that a reduction of 0.1 to 3 calories would "help tackle soaring rates of obesity" must be described as extremely fanciful. It would, however, be an effective way of clawing more money out of the hands of the hapless electorate on the pretext of health. And that, dare I say, is the real appeal.

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A fat man explains the slippery slope

Kelly "two chins" Brownell.
This man is an anti-obesity campaigner. Seriously.

A day might come when I get sick of reminding self-righteous nonsmokers that the anti-tobacco campaign was only a template for a larger war against every pleasure, but that day is not today.

"It's only smoking," they squealed. "Alcohol, food and fizzy drinks are completely different." Not to the British Medical Association they're not, nor to the Royal College of Physicians, the Surgeon General nor Kelly "wide load" Brownell who writes the op-ed below. Sit back and enjoy how the gluttonous soda tax campaigner draws a direct parallel between Coca-Cola and British American Tobacco. Are we getting the message yet?

Meet Big Soda — as Bad as Big Tobacco

Subtle enough for you?

...But the beverage industry, dominated by Coca-Cola and PepsiCo, and represented by the American Beverage Association, has exercised its might against this public health initiative in ways reminiscent of the tobacco industry when it came under attack in the 1950s. The beverage industry argues that such taxes are “discriminatory” in singling out one category of food, that taxes would not work, and that government should not tell people what to eat. The tobacco industry said taxes would not work (they did work — tremendously well) and that government should stay out of people’s choice to smoke.

Similar to tobacco companies, the soda industry has created a front group, Americans Against Food Taxes, to run anti-tax campaigns (a Super Bowl ad, for example). The name of the group implies a patriotic, grass roots movement, not a highly financed entity initiated and organized by industry. The tobacco industry paid scientists who did research disputing links between smoking and lung cancer, the addictive nature of nicotine, and the dangers of second-hand smoke. The soda industry funds scientists who reliably produce research showing no link between SSB consumption and health. The tobacco industry bought favor from community and national organizations by giving large donations. In an ironic twist, Coca Cola and PepsiCo are corporate sponsors of the American Dietetic Association.

Over time, the tobacco companies were outed for their dirty tactics...

And so on and so. You can read the whole thing here. There are soda taxes in more than thirty US states. Hungary and Denmark already have fat taxes. The British Medical Association says it's "time to denormalise drinking". Squeal on suckers. Like it or not, we're all smokers now.

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Obesity babble

Last night, the BBC News reported as fact that the obesity rate will nearly double to 40% by 2030. It was the considered view of "doctors and scientists" and therefore immune from doubt and criticism. Yesterday, I mentioned the last time "experts" tried to predict the future of obesity in Britain—and managed to get both the magnitude and the direction of the trend wrong.

In fact, I have yet to see an obesity forecast that has not been wildly off base. In 2009, for example, a study in the Journal of Epidemiology and Community Health tried to predict obesity rates in 2012. Not a huge challenge, you might think, to see three years in advance. The researchers concluded that:

If recent trends in adult obesity continue, about a third of all adults (almost 13 million individuals) would be obese by 2012.

To be fair, there's still four months left before we can call this a fail. All that needs to happen in the next four months is for ten percent of the population to suddenly become obese and we will have a winner.

"Off the mark" is probably the kindest way of describing the predictions made about the obesity "pandemic". Take this, from 2004, for example:

Rising obesity will condemn one in ten Britons to diabetes by 2010

At current rates, doctors predict six million British cases of the condition by 2010

One in ten Britons can expect to suffer from diabetes by 2010 as the full impact of the country’s soaring levels of obesity takes its toll on public health.

Doctors’ leaders gave warning yesterday that a diabetes epidemic was now inevitable as new figures revealed that the number of cases has gone up by more than one third in the past eight years.

The report, the first indicator of the repercussions of Britain’s obesity problem, shows that there are 1.8 million diabetics in Britain — up 400,000 cases since 1996. A further million people are estimated to be living with diabetes, but with the condition as yet undiagnosed.

While the Government has predicted a rise of up to three million cases by 2010, doctors said last night that it would be closer to double that level on current rates.

Both estimates turned out to be too high, but the government got much closer than the doctors. By 2010, there were 2.6 million cases.

The phrase "at current rates" is the key to all this. Although the BBC might treat "doctors and scientists" as if they were infallible, the forecast in the Lancet—which is "based on historical trends"—is rooted in the assumption that existing trends will continue at the same rate indefinitely. Actually, it is rather worse than that, because the forecasters have chosen to ignore the flattening out of obesity levels in the last decade and have instead based their figures on the increase between 1985 and 2002, as Nigel Hawkes has noticed:

The actual figures show that the trend from 2002 has actually been flat. For 2009 (not included on the graph, I notice) the proportion of all men who were obese was 22.1 per cent, the same as in 2002. That is far from the impression given.

Although the obesity rate has not risen at all in the last 9 years, the Lancet predicts that it will rise by more than 100% in the next 19 years. This strikes me as being a questionable assumption at best. But leaving the dubious methodology aside, obesity predictions rest on the observation that rates have increased over time and therefore obesity is effectively caused by time itself. That being so, obesity will continue to rise at a consistent and predictable rate each year. It sounds ridiculous when put in these terms—and it is—but that is fundamentally what the "science" of these projections rests on.

It is the same logic that led the banks to believe that property prices would to go up forever. It is the same logic that makes gamblers put large sums of money on "home bankers" (the best football teams playing lesser football teams at home). It is the logic that is superbly documented in Dan Gardner's recent book Future Babble, which shows that tossing a coin is a more reliable way of predicting the future than asking an expert.

One of the reasons expert predictions are so unsuccessful is that they see the future as an exaggerated version of the present. All too often, they do not really understand why the current trend is happening in the first place, but having observed it, they expect it to continue.

This is not a good way of seeing the future at the best of times, but it is particularly foolish when current trends are exceptional. After 9/11, many predicted that massive acts of terrorism would become regular events in the years to come. They didn't. When the economy had an exceptional boom, the experts called it a new paradigm. It wasn't. When the economy came out of recession, some predicted a double-dip recession. It didn't happen (or hasn't yet). The experts were reacting to what was freshest in their minds. They reacted to exceptional events and assumed that they were now the norm.

There is no doubt that the rise in obesity in the last half-century has been exceptional. It is possible that the rise might increase at the same rate and become still more exceptional, or it might rise a little bit, or it might flatten or fall (as the most recent figures from the UK and USA suggest).

The Lancet obesity experts do not take their logic to its natural conclusion and tell us when 100% of the population will be obese, but based on their trend line it will be shortly before the end of this century. If they told us that everybody will be obese by 2100, we would (I hope) find their prediction risible. But it would be an entirely fair prediction to make, based on the assumptions that underpin their current report.

This is not just an reductio ad absurdum argument. Researchers have done exactly that. Take this 2008 study published in the journal Obesity, for example:

If these trends continue, by 2030, 86.3% adults will be overweight or obese; and 51.1%, obese. Black women (96.9%) and Mexican-American men (91.1%) would be the most affected. By 2048, all American adults would become overweight or obese, while black women will reach that state by 2034.

Let us imagine how that work. No American athletes. No American anorexics. Everybody, including anti-obesity campaigners, public health researchers and the author of this study—assuming he lives that long—will be overweight or obese by 2048.

It sounds absurd. It is absurd. Only by the logic of "expert" obesity predictions does it make any sense, because those experts do not acknowledge that people are autonomous beings capable of changing, adapting and taking control of their own lives

And so, while we can't entirely rule out the possibility that the new obesity prediction will prove to be correct, all the previous forecasts have been wrong and so, "based on historical trends", if we were given to predictions, we might predict that this one will be wrong too.

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The new obesity pandemic, the same as the old obesity pandemic

And today's bollocks is...

Half of UK men could be obese by 2030

Health experts blame passive overeating for global pandemic, warning in the Lancet that governments must tackle obesity now

Ooh, it's like I Love the Noughties. It takes me back to those days when property prices were rising, the Kaiser Chiefs were in the charts, Tony Blair was still Prime Minister and everyone was worried about the obesity 'epidemic'.

Governments around the world need to make immediate and dramatic policy changes to reverse a pandemic of obesity which could affect an extra 11 million people in the UK over the next 20 years, public health scientists have warned.

Would they be the same public health scientists who predicted this in 2006?

England to have 13m obese by 2010

More than 12m adults and one million children will be obese by 2010 if no action is taken, a report by the Department of Health is predicting.

The report warns that, based on current trends, 33% of men and 28% of women will be obese by 2010.

At the time, male obesity rates were running at 23.1% and the female obesity rate was 24.8%.

So, what happened next?

Despite the government ignoring the anti-obesity lobby's urgent suggestions for traffic light labelling on food and suchlike, the latest figures show that obesity amongst men has fallen to 22% and the female obesity rate has fallen to 24%.

Given that the previous prediction could not have been more wrong—despite the modest task of forecasting just 4 years ahead—how likely do you think it is that the anti-obesity 'experts' can predict what will happen in 19 years?

As George W. Bush once tried to say, fool me once, shame on you. Fool me twice, shame on me.

Exclusive video footage of the Lancet obesity team in session

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Obesity rate is twice as high amongst nonsmokers

A study published in this week's British Medical Journal shows that nonsmokers are twice as likely to be obese—and three times as likely to be severely obese—than smokers. This is very interesting stuff, because it is is often said that smokers put on weight when they quit cigarettes. It's also said, albeit much less often, that there is some correlation between the decline in smoking and the rise in obesity. This study offers empirical evidence for both.

The connection between smoking and low weight is not much commented on, presumably because anti-smoking campaigners don't want people who are worried about their weight to 'reach for a Lucky instead of a sweet', as the old advertising campaign went. And yes, I've reproduced that advert here to annoy them.

Why, then, would any public health researcher jeopardise their future funding by highlighting this fact? The answer is that they didn't set out to. The study in question looks at obesity's role in creating health inequalities (a cast-iron guarantee for funding). Social class is closely related to mortality and life expectancy is lowest amongst the lowest social classes. Smoking is one reason for that, obesity is another. Between them, as this study shows, these two risk factors account for more than half the difference in life expectancy between the top and bottom rungs of society.

That, in itself, is useful and important information, but in the process of comparing smoking and nonsmoking women (and it was only women in this study), they also show that the difference in obesity rates between smokers and nonsmokers is, frankly, massive.

The graph above (click to enlarge) shows the percentage of women who are overweight and obese according to smoking status and occupational class. As expected, the highest occupational classes (I and II) have a lower rate of obesity than the lowest.

Also as expected, the smokers weigh less than the nonsmokers. What is surprising is the size of the difference. In most cases, rates of obesity are around twice as high for nonsmokers and, across all groups, rates of severe obesity are three times as high.

As the study says:

Severe obesity was more than twice as prevalent among women who had never smoked in the lower occupational classes than in women who had never smoked in the higher occupational classes and about seven times more prevalent than among current smokers in the higher occupational classes.

Another way to look at it is that nonsmokers in the highest social class have a higher rate of obesity (13.3%) than smokers in the lowest social class (13.1%). Rates of severe obesity—which is a condition popularly associated with the underclass—is actually more common amongst the highest class of nonsmoker than the lowest class of smoker. No matter which class you look at, obesity rates are always higher amongst nonsmokers.

To use the standard language of public health, it is true to say that not smoking is a major risk factor for obesity. This, of course, should not be taken as a green light to take up smoking. As the researchers point out, the health risks of smoking are greater than the health risks of obesity. The study shows that the mortality rate rises by around a third for moderately obese people and doubles for severely obese people. By comparison—as the same authors showed in an earlier paper—smoking increases the mortality rate by at least 75%.

I discussed the reasons why smokers tend to be less fat in Chapter 3 of Velvet Glove, Iron Fist. Partly, it is the result of nicotine suppressing appetite and partly it is the act of smoking which takes the mind off food, but mainly it is the physiological effect of nicotine that increases the metabolic rate, particularly during exercise. In his excellent, but sadly out-of-print, book Smoking: The Artificial Passion, David Krogh says that smokers, on average, weight seven pounds less than nonsmokers. Judging by this new study in the BMJ, that is probably an underestimate.

As I see it, there are two useful messages to take home from this study. The first is brought out in the study itself:

[The results] suggest the decline in smoking rates in recent decades may have contributed to the increase in overweight and obesity.

This is worth bearing in mind when you hear anti-smoking-turned-anti-obesity windbags like John Banzhaf rattling on. People like him have, in a real sense, created the problem he professes to be so concerned about. You can, of course, make a rational case for saying that obesity is less of a health problem than smoking, but you won't hear it from him. (One might even frivolously consider that since Big John's so keen to bring in a 'fat tax', there is an easy way to do it—tax nonsmokers. Sure, not all nonsmokers develop obesity-related diseases but then not all smokers get smoking-related diseases. Not all people who drink soda or eat burgers get fat either, but then taxing people on the basis of risk factors to aggregate populations is perfectly acceptable, isn't it John?)

If the suppression of smoking has indeed led to a rise in over-eating, it just goes to prove the golden rule of prohibition: people will always find some unhealthy pleasure to indulge in when other avenues are closed off. If, by some miracle, the war on obesity is won, it will only lead to excessive use of something else. The whole prohibitionist exercise is futile because the desire for pleasure is a zero sum game.

The second point to consider is that since nicotine is an aid to maintaining a healthy weight, why are alleged health campaigners banning products like snus and e-cigarettes which not only get people off cigarettes but could control their weight as well? If smoking and obesity really are the two greatest public health threats of our time, doesn't that make ultra-low risk nicotine products the penicillin of the age?

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John Banzhaf: Ronald McDonald is just like Joe Camel

This is another one to be filed under "next logical step". In the video below, John Banzhaf, founder of ASH and now a prominent anti-obesity crusader, calls for McDonald's to drop their (admittedly creepy) mascot Ronald McDonald. Why? Because we have to think of the children, of course. According to Banzhaf, McDonald's sells "dangerous products" and the clown should go the same way as Joe Camel.

As the interviewer points out, McDonald's has bent over backwards to accommodate the food faddists in recent years, but, for people like Banzhaf nothing is ever enough. The interview soon turns into a slanging match (it's from Fox News), and neither side makes a very good case. In the end, Banzhaf resorts to gloating about how that he's "winning" (although all the lawsuits he has filed against McDonald's have failed).

Don't expect a reasoned debate, but scholars of the slippery slope will enjoy counting how many times the tubby legal vulture equates McDonald's with the tobacco industry.





On a similar note, I can't recommend this article by Trevor Butterworth strongly enough. ABC News recently attacked a biostatistician for casting doubt on the idea that soda is a major contributor to obesity. Unable to find fault with his research, obesity crusaders have made the usual lazy ad hominems against him for being funded by the food industry.

“But even though study after study have [sic] shown soda to be a significant contributor to America’s staggering obesity crisis, he says there is too little ‘solid evidence’… Allison has said such studies haven’t been rigorous enough to prove soda contributes to obesity, but critics say his skepticism stems from his financial ties to entities such as Coca-Cola, Pepsi and the American Beverage Association, who, critics say, have paid Allison to poke holes in the scientific consensus.”

The problem, as Butterworth points out, is that "study after study" has shown nothing of the sort. Soda is no more fattening that fruit juice and the epidemiological evidence linking it to obesity is weak. If that weren't enough, it turns out that studies funded by the food industry are less biased than those funded by the state. This is an example of “white hat bias”, ie. distorting information to advance fashionable causes. It is perhaps the main source of bias in epidemiology today; certainly it is the most under-reported. We come across a lot of it on this blog.

When you piece all these elements together, the ABC news piece increasingly looks like journalists taking on the role of hitmen in an academic vendetta, one in which they are clueless about the underlying data but absolutely certain that the conventional wisdom is right.

And so, the result is that thanks to ABC’s totally misleading account of the evidence on sugared drinks and weight gain, Allison will almost certainly be removed from legitimate debate, tarred forever with the insinuation that he is merely a shill for industry.

The whole story of how this man has been vilified is fascinating and important. Please go read.

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Crap predictions

As any pedant will tell you, we are now in the last month of the first decade of the century. And so, on that tenuous note, let's revisit some of worst predictions for what would happen by 2010. In Britain.

Over at Spiked, Rob Lyons rightly lays into the myth of the obesity time-bomb, which was only ever the result of taking existing trends and making the bone-headed assumption that they will continue at the same pace forever. Some readers will recall Caroline "window dressing" Flint predicting that there would be 13 million obese adults in the UK by 2010.

The report warns that, based on current trends, 33% of men and 28% of women will be obese by 2010. The government says it is the "most accurate estimate so far" of future obesity rates.

The data is published just days after a "minister for fitness" was appointed.

Unless a lot of people hit the turkey and mince pies in a big way over the next two weeks, this prediction looks to be what it has always been: a scare story based on junk statistics. As Rob points out:

According to the lastest results from the Health Survey for England, regarded as the best source of information on the topic, obesity rates have fallen. Yet you could have been forgiven for failing to notice: it’s barely been reported. After all the sensationalist headlines over the past few years about an ‘obesity timebomb’, would it be too much to expect some balanced reporting over the fact that the aforementioned explosive might not be going off after all?

Of course, the powers that be can always say that they prevented the obesity time-bomb by taking action, to which Brian of Nazareth might cry "well, what sort of chance does that give me?" In fact, the decline in obesity began before Jamie Oliver got involved and before the middle-class media started sneering at parents in Rotherham. The obesity time-bomb didn't happen because it was never going to.

And what has happened to the binge-drinking epidemic that was supposed to follow the introduction of the wildly misnamed "24 hour drinking"? As Monsieur Puddlecote and myself never tire of saying, it never happened. Whether one looks at alcohol sales, per capita alcohol consumption or self-reported drinking levels, the story of the decade has been one of falling consumption. And as Dick has recently noted, police arrests for drunk and disorderly have also fallen throughout the decade. But who cares about these silly things called 'facts' when the media can show some ropey bird in high heels lying on a bench with a bottle of WKD beside her?

The tabloid version of "Binge Britain" (another classic panic phrase) is not, and never has been, the truth. And as our present recedes into the past, the hysteria is already being documented by sociologists. Rather marvellously, for those who vividly remember the prophecies of doom when the Licensing Act was passed in 2003, the whole thing is already going down in history as a great British moral panic. A study by Henry Yeomans in Sociological Research provides an academic discussion of the frenzy and reminds us of the drivel that was spouted at the time:

The Licensing Act 2003 was speculatively linked to a projected explosion of violence, sexual assault and general disorder. On the eve of the Act coming into effect, The Sun reported in battle-ready terms the creation of a ‘field hospital’ in Newcastle-upon-Tyne to handle the imminent ‘casualties of 24-hour drinking’ (Perrie, 2005). Of course the press may be prone to sensationalism, but it was not just the Daily Mail who believed that ‘the binge is about to become an uncontrolled riot of drunkenness’ (Daily Mail, 2005). David Blunkett MP described the Act as ‘a leap in the dark’ that risked worsening crime problems (Daily Mail, 2005) and Mark Oaten MP claimed that ‘when the problem is running out of control in our town centres, extending drinking hours to twenty four hours a day is madness’ (Plant & Plant, 2006: 100).

It all seems like yesterday, doesn't it? All those predictions of "urban savages", mayhem and an epidemic of drunkenness, alcoholism and disorder. In some sections of the press, the panic endures, even as alcohol consumption falls year after year (with the steepest fall in 62 years coming in 2009). Perpetuating the fear is an easy job since—as Tom Papworth wrote at Liberal Vision —"it is these days very easy to send a film crew down to a town centre and film a few dozen people behaving badly, and extrapolate this to the wider country."

Yeomans paper (which is worth reading in full) explains the panic in terms of Protestant asceticism and the 'Iron Cage of Temperance'.

This paper views the reaction to the implementation of licensing reforms in 2005 as a moral panic for two reasons. Firstly, it was an intensified period of concern about alcohol use in Britain within longer term processes that have constructed alcohol as a social problem.

Secondly, the reaction appears irrational and disproportionate to the level of threat actually posed. This is partly because of the diminutive number and length of licence extensions granted and also due to the negligible effect on crime and disorder. The Department of Culture, Media and Sport’s evaluation of the Licensing Act 2003 found no uniform detrimental effects (DCMS, 2008) and Home Office statistics show that crime levels continued to fall from 2005 to 2008 (Kershaw et al, 2008).

Although it is easier to appreciate in retrospect, the mayhem widely predicted clearly did not materialise. In the absence of any rational support for the public outrage, this paper thus seeks a moral and ideological explanation for the events of 2005.

And finally, as Britain endures its coldest December for a century—and its third "unusually cold" winter in a row—this gem from The Independent in 2000 has become rather popular on Twitter. You need to read the whole thing to fully appreciate the hubris, but this gives a flavour:

According to Dr David Viner, a senior research scientist at the climatic research unit (CRU) of the University of East Anglia,within a few years winter snowfall will become "a very rare and exciting event".

"Children just aren't going to know what snow is," he said...

The chances are certainly now stacked against the sortof heavy snowfall in cities that inspired Impressionist painters, such as Sisley, and the 19th century poet laureate Robert Bridges, who wrote in "London Snow" of it, "stealthily and perpetually settling and loosely lying".

Not any more, it seems.

Merry Christmas to all readers. I'll be back in a few days with the worst junk science of 2010.

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John Banzhaf is a liar

I've just been over to John Banzhaf's ASH website to see if he's said anything particuarly insane since the last time I visited and I see he is now claiming that ASH is 'America's first antismoking and nonsmokers' rights organization'.

This happens to be something I know a bit about. So let's see...

The Anti-Tobacco League was formed in Massachusetts in 1850.

The Anti-Cigarette League was formed in Chicago in 1899.

The Nonsmokers Protective League was formed in New York in 1911.

Action on Smoking and Health was formed in 1968.


Now, I pick my words carefully when dealing with this notoriously litigious individual, but let me say loud and clear that John Banzhaf is a liar.

Sue me, fatso.



[PS. New CATCH up now at Frank's gaff]

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Lawsuit addiction

I read an interesting story in The Sunday Times yesterday. As it's behind a pay-wall, I'll have to rewrite it from memory:

Filing frivolous lawsuits is as addictive as cocaine and alcohol

Litigation could be just as addictive to lawyers as heroin or cocaine. Chemical processes triggered by the thrill of chasing ambulances give people the same cravings as do hard drugs, tobacco or alcohol, scientists have found.

Researchers discovered earlier this year that rats became addicted to money and attention in the same way that people became dependent on hard drugs. Now experiments with sub-humans have found that litigation does indeed lead to addiction-like cravings.

The latest research used brain-imaging techniques and genetic studies to prove that the same pathways are involved in response to getting your face on television and buying a new Ferrari as the ones activated by alcohol, tobacco and cocaine.

Dopamine is a brain chemical released in response to experiences that create feelings of wellbeing, including eating and sex. People get an initial high from suing one person, but the growing tendency to sue everybody in the world dampens the sensitivity of these receptors.

As a result, more and more money and attention is needed to achieve a pleasurable feeling of satisfaction, and the weight piles on.

A team led by Eric Stice, a clinical psychologist at the University of Oregon, studied a group of 26 obese lawyers. Eight of them gained an average of half a million dollars during the six-month study period, while the rest remained stable or slightly lost money.

Those who had won a lawsuit could not get a “hit” from their moment in the spotlight because their excessive media exposure in the past lowered their ability to respond to dopamine.

“There are very strong parallels between drug abuse and being a legal vulture,” said Stice, who will publish the results of the study in the Journal of Neuroscience. You see an initially elevated response in the reward circuitry; then it reduces. As people file more and more ridiculous lawsuits, their brains become desensitised to reality, and that produces weight gain.”

Paul Kenny, a neuropharmacologist at the Scripps Institute in Florida, said: “The notion of lawsuit addiction is still controversial, but the research is certainly going that way.” His study published this summer, showed that “pleasure sensors” — the dopamine D2 receptors — are dampened down in obese lawyers in exactly the same way as they are in human drug addicts.

One such case is John Banzhaf, professor of public interest law at George Washington University, who is planning action against himself, similar to the one he led against cigarette manufacturers. “We could not have done this even five years ago, but there is now strong evidence that my forty years of bingeing on money and media attention have produced the same changes in brain chemistry as alcohol, heroin and tobacco,” he said. "Dear God, what have I done with my life?"

I'm pretty sure that's what it said, although you can check the wording here.

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Obesity, where is thy sting?

Much was written last week about Public Health Minister Anne Milton recommending doctors use the word 'fat' instead of 'obese'. Commentators like Richard Littlejohn and Harry Mount thought this was a splendid bit of straight-talking, whereas some doctors thought it could be offensive and insisted that society is to blame (ie. it isn't regulated enough).

Professor Lindsey Davies, president of the UK Faculty of Public Health, which represents public health professionals, warned against using 'fat' when dealing with patients.

"People don't want to be offensive. There is a lot of stigma to being a fat person."

She said health professionals started using the term obesity to encourage patients to think about the condition in a different way.

"Obesity is something that happens to people rather than something they are."

That last line hints at the gulf that exists between the government's focus on personal responsibility and the public health establishment's focus on changing the social environment, but that's an issue for another day.

What I don't buy is the idea that the word obese came into heavy use because it's a more sensitive term. I think I remember correctly when I say that until about five years ago, 'obesity' was not a widely used word in Britain. Like 'binge-drinking', it came into popular usage to make a problem sound worse.

When the diet wars began, being fat was not generally considered to be a terrible thing. Indeed, it had connotations of being jolly, robust and cuddly. By popularising the clinical term obesity—frequently using it to describe people who were merely overweight, and often with the prefix 'morbid'—the panic was ratcheted up. But like all over-used words, it has become familiar and lost its sting. And so we return to 'fat'.

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Is the bank closing?

Apologies for the light blogging, dear reader. I'm very busy with other things, including a heated debate involving my latest book (see here, here, here and here for the tip of that iceberg).

I'll be back with more news and views from the dark side of prohibition at the weekend. Until then, I see that The New York Times is reporting that the Robert Wood Johnson Foundation (RWJF) is diverting its vast wealth away from tobacco control and towards obesity. (And yes, RWJF's primary funders Johnson & Johnson sell a number of weight-loss drugs, as well as making nicotine replacement drugs.)

Tobacco Funds Shrink as Obesity Fight Intensifies

When the Robert Wood Johnson Foundation decided in 1991 to take on Joe Camel, it became the nation’s largest private funding source for fighting smoking. The foundation spent $700 million to help knock the cartoon character out of advertisements, finance research and advocacy for higher cigarette taxes and smoke-free air laws and, ultimately, to aid in reducing the nation’s smoking rate almost by half.

But a few years ago, the Johnson foundation, based in Princeton, N.J., added another target to its mission, pledging to spend $500 million in five years to battle childhood obesity. As the antiobesity financing rose to $58 million last year, a new compilation from the foundation shows, the organization’s antismoking grants fell to $4 million.

And RWJF are not the only ones to be shifting focus.

The steep drop-off in private funds illustrates the competition under way for money as public health priorities shift. In the race for preventive health care dollars, from charities and from federal and state government sources, the tobacco warriors have become a big loser...

The 1998 Tobacco Master Settlement Agreement between 46 states and cigarette companies provided more than $200 billion through 2025. For a while it financed preventive programs like the “Truth” media campaign from the antismoking group American Legacy Foundation. But as states used money elsewhere, “Truth” spending declined, to a low of $35 million last year from $104 million in 2000.

Naturally, uber-zealot Stanton Glantz is not happy about being moved further down the trough.

Stanton A. Glantz, director of the Center for Tobacco Control Research and Education at the University of California, San Francisco, asked, “Given that tobacco kills four times as many people as obesity does, why is the government putting more money into obesity?”

From a European perspective, the funds allocated to tobacco control remain eye-wateringly huge. Whilst I would never condone the government giving money to lobby groups, the amounts received by ASH (England) and its wealthier little sister ASH (Scotland) are peanuts compared to the billions enjoyed by American groups. And yet the smoking rate in America is virtually identical to that of Britain. Does this mean that British anti-smoking groups are exceptionally effective or are American anti-smoking groups exceptionally useless? Or are they both simply irrelevant?

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Speak for yourself, National Obesity Forum

So the British government has decided to stop spending tens of millions of pounds of tax-payers' money on anti-obesity advertising campaigns and instead spend tens of millions of pounds of the food industry's money instead.

From The Guardian :

Beer companies, confectionary firms and crisp-makers will be asked to fund the government's advertising campaign to persuade people to switch to a healthier lifestyle and, in return, will not face new legislation outlawing excessively fatty, sugary and salty food, the health secretary, Andrew Lansley, announced today.

I do like the use of the word 'asked' there, like a bank robber 'asking' the cashier the open the safe.

I find it hard to care too much about this. We'll end up paying for it either way and an industry-funded campaign won't be any less effective than Labour's state-funded campaigns. If anything, the industry might end up being slightly less profligate with the money it is forced, I mean asked, to spend.

What did make me choke on my proverbial cornflakes, however, was this :

But Tam Fry, of the National Obesity Forum, said he was "horror-struck" about the thought of getting industry involved in funding Change4Life.

He said it was "nothing other than a bare-faced request to bail out a cash-starved Department of Health campaign".

"The quid pro quo is that the department gives industry an assurance that there will be no regulation or legislation over its activities."

I'm sorry, but isn't this the National Obesity Forum that is overwhelmingly funded by the pharmaceutical industry—specifically those pharmaceutical companies that make weight-loss drugs? The same National Obesity Forum that consistently defends its sponsors' weight-loss drugs long after everybody else has recognised their dangerous and highly unpleasant side-effects?

Weight-loss drugs like Alli (otherwise known as Orlistat), which has been found to have any number of nasty side-effects:

US authorities are investigating concerns an anti-obesity drug widely available over the counter at chemists may cause liver damage.

Orlistat went on sale under the brand name Alli without the need for a prescription in the UK in April.

The US Food and Drug Administration has received more than 30 reports linking the drug to serious liver injury.

This life-threatening side-effect goes alongside other known problems caused by the drug:

Diarrhoea and gas problems are to be expected if users persist in eating fat while taking the drug.

However, concerns have been raised over the medication's other possible side-effects. The FDA said the most commonly reported adverse reactions included the yellowing of skin or whites of the eyes, weakness and stomach pain.

Lovely stuff. Oh, and there's more...

It advised people who used orlistat [Alli] to seek medical advice if they experience possible symptoms of liver injury, in particular weakness or fatigue, fever, jaundice, or brown urine.

Other symptoms may include abdominal pain, nausea, vomiting, light-colored stools, itching, or loss of appetite.

Alli is made by GlaxoSmithKline, which is one of the National Obesity Forum's most generous donors/sponsors. So who has spent the last few years pushing for this dubious pharmaceutical remedy to be made available over the counter? Step forward the National Obesity Forum (NOF)...

NOF welcomes the decision to allow Orlistat, the weight-loss drug, to be sold over-the-counter and has been working closely with GlaxoSmithKline [GSK] to ensure that its introduction to the market in May runs as smoothly as possible. 

Or take Rimonabant, made by another of NOF's sponsors—Sanofi Aventis. Actually, don't take it. Just know that this drug was launched in 2006 and got a warm reception from—who else?—the NOF.

Dr David Haslam, clinical director of the National Obesity Forum, said the drug offered a real opportunity to get to grips with the obesity crisis.

"The launch of Rimonabant is important news for patients who are overweight, with type 2 diabetes, or low HDL cholesterol or high triglycerides."

But within a year, the Medicines and Healthcare Products Regulatory Agency had received 720 reports of unpleasant side-effects, including psychiatric discorders and suicidal thoughts.

Despite a growing body of evidence that Rimonabant was unsafe, it was approved for NHS use in June 2008, leading the BBC to report "Controversial diet drug approved":

An obesity drug has been approved for NHS use in England and Wales, despite links to an increased risk of depression and suicide.

Rimonabant is already used by thousands of Britons, and, coupled with exercise, could help patients lose up to 10% of their body weight.

Scotland and the US have not approved the drug amid safety concerns. However, an obesity specialist welcomed the National Institute for Health and Clinical Excellence (NICE) ruling.

This 'obesity specialist' was, of course, an NOF spokesman:

Dr David Haslam, the clinical director of the National Obesity Forum, said that he welcomed its approval for NHS use, and predicted that it would be prescribed to many patients.

He said: "We can be absolutely reassured that they have looked closely at the evidence and made an appropriate decision.

"This is a very good drug, and there are very many people who have tried everything else, including other drugs, with little success, who might benefit from it."

But within months of the NOF winning the campaign to have the drug approved, the European Medicines Agency said the risk of serious psychiatric problems and suicide were not worth the weight-loss benefits and recommended that use of the drug be suspended. By this stage even Sanofi-Aventis's own research had shown that use of Rimonabant doubled the risk of psychiatric disorders. The drug has never been approved by the FDA in America and it would go on to be banned in India. Still, the NOF defended it:

Dr Colin Waine, chairman of the National Obesity Forum, said: "My patients were doing very well on it, and they will now have to stop and come off it."

And then, as I mentioned earlier this year, there is Reductil, which was taken off the shelves after it was found to cause heart attacks. Reductil is made by Abbott Laboratories, who happened to pay for the National Obesity Forum's website, amongst other things. The ban was initiated by the European Medicines Agency and was supported by the UK Medicines and Healthcare Products Regulatory Agency. But, as usual, there was one dissenting voice:

David Haslam of the National Obesity Forum said he was surprised by the decision and knew of no study proving that Reductil had led to a death from a heart attack or stroke.

Now, as far as I'm concerned, the National Obesity Forum can go on shilling for Big Pharma all they like—they may even be right about some of these drugs—but it's a bit bloody rich for them to complain about industry being involved with the anti-obesity campaign and warning about conflicts of interests and qui pro quos. If I was Tam Fry's boss, I would strongly recommend he keeps his mouth shut and hopes no one asks too many questions about their own funding.

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The diet police

In light of the previous post, it is with delicious serendipity that the latest episode of Bullshit looks at the myths surrounding 'junk food'. Penn & Teller argue—nay, prove—that much of the opposition to fast food is rooted in snobbery and ignorance, as well as reminding us that 'nudging' is a euphemism for regulation and coercion.

Set aside half an hour to watch this—not only is it funny and informative, it also stars none other than MeMe Roth of National Action Against Obesity. 

Has any single issue campaigner ever had a more appropriate name than MeMe? I once called her a "stick-thin obsessive" (Chapter 13 of Velvet Glove, Iron Fist). She is described in rather less flattering terms here. 

One of Penn & Teller's best episodes yet.

H/T Mr Civil Libertarian

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Ignore the food police

As I mentioned on Wednesday, a common defence of arbitrary nutritional targets is that they can't do any harm. In Velvet Glove, Iron Fist, I gave the example of George Lundberg, former editor of the Journal of the American Medical Association, who published a junk science article which showed that eating fish halved the risk of coronary heart disease. When the study was exposed as garbage, he glibly replied: "People are told that eating fish once a week is not a bad thing. What harm can it do?" That, in a nutshell, is the problem with the public health crusade. The harm, surely, is to science and to the truth. You would hope the editor of a medical journal would appreciate that.

Sometimes, however, the harm is more tangible. In the case of dietary advice, it seems that parents have been giving their children the kind of meals that would be more appropriate to a food faddist on detox. From the BBC:

"Parents are aware of the importance of ensuring their child eats healthily to avoid obesity and health problems in later life, but this can sometimes lead to parents making requests that their child follows a strict diet, such as skimmed milk and low-fat foods," says [the National Day Nurseries Association's] chief executive Purnima Tanuku.

It is the madness of public health to paint some foods as good and some as evil. Against this background of fear, parents can hardly be blamed for avoiding 'evil' foods such as fat and carbohydrates while turning to trendy alternatives. But they really shouldn't...

"Children under five have specific needs, and should not have low-fat diets as their growing bodies need fat and carbohydrates."

Growing rapidly, this age-group needs a diet which is - proportional to their size - much higher in calories than that of an adult.

An obvious point, that. Children are not adults. They need calories and plenty of them. But while a small number of parents allow their children to grow fat, many other parents have gone in the opposite direction, giving their kids meals that are only suitable for an office worker on a diet. Just as the 'evil' foods are essential for children, the 'good' foods are nothing of the sort.

Studies have shown that children burn fat much faster than adults - and so skimmed milk and other low-fat dairy products should remain off the menu until they are much older.

"And parents really shouldn't feel too anxious about puddings - sponge and custard is a good dessert to offer, surprising as that may sound," says Jessica Williams, a paediatric dietician.

And don't listen to the vegans and quacks, give them some meat.

"There have also been problems with the messages about red meat. It's a shame some parents feel so worried about it as it really is the best source of iron, and iron deficiency anaemia among toddlers in particular is common."

And what about the totally arbitrary 5-a-day target?

"And while the five-a-day message must certainly still be there, a child's portion does need to be smaller so they have room for the other, more substantial items on their plates. They simply won't get the calories they need from fruit and vegetables, even in large quantities."

The risks of following public health dogma are very real. More real, indeed, than the hysteria about childhood obesity.

There are in fact concerns that the plight of the underweight child has been forgotten amid the intense focus on childhood obesity.

Studies have shown that being persistently underweight as a child can cause problems over a lifetime, from cognitive impairment to skeletal disorders.

"Poor nutritional status in toddlerhood can be linked to permanent cognitive damage and a child never reaching their full potential, as well as shorter stature in adulthood."

But isn't all this based on sound science?

"I think that we are in danger of overlooking these children in the obsession about obesity - and I am not convinced that we have good measures of bodyweight in small children in terms of later risk," says City University's Helen Crawley, director of the Caroline Walker Trust which promotes good diet. "We should be much more careful."

As is revealed time and again, the people who issue advice about diet make it up as they go along, often swayed by their own obsessions (primarily vegetarianism). No sooner has policy been based on one study when another study comes along and says the opposite. At the very least, there should be a recognition that the available data are a mass of contradictions and that the diet which has made us the longest-living people in history remains the best bet. 

Public health has become hopelessly corrupted by the idea that 'strong messages' need to be sent out. It willfully misleads people and then refuses to take the blame for pandering to people's neuroses. In the case of diet, that means demonising some types of food (salt, fat, carbohydrates, sugar) and glorifying others (wholemeal bread, skimmed milk, broccoli). It may not be their intention to terrify parents into feeding their kids rabbit food, but it is such an obvious consequence of their actions that it can barely be called unintended.

If you want to know what to feed your children, listen to your grandmother before you listen to anything from the zealots, quacks and food faddists who now dominate the public health movement.

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Fruit and veg

The Journal of the National Cancer Institute has just published a very large study which finds that eating fruit and vegetables has, at the most, a very weak effect on cancer risk (see BBC report). This could be seen as yet another example of lifestyle epidemiology contradicting itself—only a few days ago a study reported that eating a fried breakfast was a good way of combatting obesity—but there are good reasons to take this particular paper seriously.

Firstly, it is a very large study, involving over 400,000 subjects. Secondly, it is a cohort (or prospective) study, ie. it follows people over a period of years rather than interviewing people who are already ill. In these two respects, it trumps most of the studies that have found lower cancer risk amongst those who eat their 'five-a-day'.

The JNCI study found a relative risk for those with a high intake of fruit and vegetables to be 0.97 (95% CI = 0.96 to 0.99), ie. a 3% reduction, and there are serious doubts over whether even this extremely modest reduction is genuine or the result of confounding factors. There are few areas of science where a 3% reduction would be taken seriously.

Walter Willett, a prominent figure in the epidemiology of diet, has written a frank editorial to accompany the study, calling the association "very weak" and noting that there is not a single type of cancer that is significantly reduced by eating fruit and veg (full free text). The history of how such a belief came about bears repeating:

During the 1990s, enthusiasm swelled for increasing consumption of fruits and vegetables with the expectation that this would substantially reduce the risk of many cancers. Potential reductions as large as 50% were suggested... 

However, the evidence for a large preventive effect of fruits and vegetables came primarily from case–control studies, which can be readily biased by differences in recall of past diet by patients with cancer and healthy control subjects...

In the late 1990s, the results of large prospective cohort studies of diet and cancer began to accrue, and these did not confirm the strong inverse associations found in most case–control studies. Furthermore, a series of analyses that pooled the data from prospective studies for specific cancer sites confirmed the weak and non-statistically significant associations.

There are clear parallels with the evidence for passive smoking and lung cancer here. In both cases, the largest risks were reported when research was in its infancy (eg. Hirayama, 1981) and most of the evidence came from case-control, rather than cohort, studies. As the years went on, the reported risks diminished, falling from over 2.0 (100% increase) to less than 0.3 (30%). 

Just as the World Cancer Research Fund used a meta-analysis of questionable studies in 2007 to condemn almost everything except fruit and vegetables are carcinogenic, so the EPA and SCOTH conducted meta-analyses based on shaky science to condemn secondhand smoke as carcinogenic.

In both cases, larger and more reliable studies found no risk. In the case of secondhand smoke, one of the most important null studies came from the World Health Organisation's  IARC with Paolo Boffetta as lead author (1998). It found no statistically significant association with lung cancer despite one of the largest sample groups every studied. In the case of fruit and vegetables, the lead author is, again, Paolo Boffetta, and he finds a significant, but very weak, association.

In 1998, the WHO went to the unprecedented lengths of issuing a press release to contradict one of its own studies, so important was passive smoking (and thereby, smoking bans) to the battle against active smoking. It will be interesting to see if there is any backlash against this new study. 

As it is a less heated area, possibly not. Willett concludes his editorial by calling for "heightened efforts to reduce smoking and obesity" which remain the key battlegrounds, but there are many food faddists and vegetarians who will not be happy to hear that their lifestyles are not as healthy as they believed. There will also be many epidemiologists who will (justifiably) feel their work has been discredited.

Ultimately, after a brief period of controversy, the IARC's secondhand smoke report was forgotten about and attention shifted back to the grab-bag of smaller studies which had been favorable to the passive smoking theory. This new study may meet the same fate; already the tiny association it reported is being taken as fact, with all the caveats and doubts ignored:

In any event, a reduced risk of 2.5% should not be dismissed out of hand, the World Cancer Research Fund argues.

"For the UK, this works out as about 7,000 cases a year, which is a significant number," says Dr Rachel Thompson from the charity, which in a major 1997 report said there was "convincing evidence" of the protective effect of fruit and vegetables.

In Velvet Glove, Iron Fist, I described the World Cancer Research Fund's report as "a veritable encyclopedia of weak associations and questionable meta-analyses" (p. 310). Today's JNCI study only reinforces that view. Whatever the truth about this particular issue, basing policy on statistical studies that change like the weather is a fool's errand. 

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Gimme a pack of low birth weights

From the Daily Telegraph:

Women who exercise during pregnancy produce 'lighter babies'

As Tim Worstall points out, haven't we been told that low birth weights are a bad thing ever since they were associated with smoking in pregnancy? So are we now going to stop these women exercising?

Dr Paul Hofman, from the University of Auckland in New Zealand, said: ''Our findings show that regular aerobic exercise alters the maternal environment in some way that has an impact on nutrient stimulation of fetal growth, resulting in a reduction in offspring birth weight.

''Given that large birth size is associated with an increased risk of obesity, a modest reduction in birth weight may have long-term health benefits for offspring by lowering this risk in later life."

I can't say with any confidence whether low birth weights are good, bad or indifferent, but a little consistency from the medics would be nice. It's hard to avoid the conclusion that 'lighter babies' are good/bad depending on whether the researcher is involved in the crusade against smoking or the war against obesity.

And if larger babies really do grow up to be fatter, doesn't that suggest that some people are just born fat and that the so-called 'obesogenic environment' has got nothing to do with it?

Incidentally, I remember reading somewhere (can't find it now) that the weight difference between smokers' and nonsmokers' babies was ridiculously small—something like 9 grammes. Do any of my learned readers have the figures?

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The slippery slope in action

John Banzhaf in 1991, on the 'slippery slope' argument that the war on tobacco would be followed by a war on food:

"They use the 'slippery slope' argument. 'My God, if they can do this to smokers today they can do this to people who eat Haagen-Dazs ice cream or whatever.'"

Ridiculous, yes?

Tackling obesity may require anti-smoking style approach: Canada's top doctor

Canadians need to do more to reduce their growing waistlines, but the country may not be ready for tough measures and legislation to help shrink the nation, according to the chief public health officer.

First comes the scare-mongering...

"The concern with the increasing rates of obesity is that this may in fact, be the first generation of children to not live as long and healthy as their parents," said Butler-Jones in an interview.

If that's true then why does life expectancy go up year after year?

Then the velvet glove is taken off to expose the iron fist...

Governments over the years, have passed various pieces of legislation designed to reduce smoking, including increased taxation and packaging requirements, and some health experts have been pushing for similar initiatives to combat obesity.

Proposals include banning the advertising of unhealthy foods, increasing taxes on food that isn't nutritious, subsidizing fruits and vegetables to make them more affordable for Canadians and forcing the food industry to change its labelling, packaging and ingredients.

Does anyone seriously dispute that the slippery slope is real, or that this was not always the next 'logical step'?

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Fat chance

They mean 2020, of course. Is the sub-editor of The Times on holiday, or is this headline a subtle satire on the soothsayers of public health, who were making drastic predictions about 2010 a few short years ago?

Predictions like this:

England to have 13m obese by 2010

More than 12m adults and one million children will be obese by 2010 if no action is taken, a report by the Department of Health is predicting.

Did that happen? Of course not. Back then (2006) the big headlines were about childhood obesity, which was supposed to rocket up. In fact, this happened:


It went down. This epic fail has been implicitly recognised by the new forecasters, who say:

“Unlike the recent report on child obesity, which showed some indications of a plateauing or at least a significant reduction in the rate of obesity..."

That sentence is the wrong way round, surely? Whatever. The point is that childhood obesity has fallen and was already falling when the public health doomsayers were warning of the sky falling on our heads. But hey, everyone makes mistakes. Let's change the subject...

"...the future projections for adults are less optimistic.”

Well, naturally. Show me an optimistic projection for anything to do with obesity and I'll show you a public health professional heading for demotion. Having cocked up the childhood obesity predictions, they are now focusing on adult obesity which has risen, albeit by a lot less than was predicted. It means they lose the think-of-the-children aspect, which is politically inconvenient, but nevermind.

The study, led by Professor Klim McPherson, of the University of Oxford, uses figures from 1993 to 2007 to predict future levels of obesity in England. It says that about 41 per cent of men aged 20 to 65 will be obese by 2020 and 40 per cent will be overweight; 36 per cent of women will be obese and 32 per cent will be overweight.

As the Department of Health recently - though quietly - announced, male obesity is 24% and female obesity is 25% (see here, p. 14). This is significantly less than the 33% and 28% predicted in 2006, but it is significantly more than the 16% and 13% recorded in 1998.

Leaving aside issues of data collection, that is a pretty big rise in obesity. In ten years, an extra 8% of men and 12% of women have become obese.

The new projection says that a further 17% of men and 12% of women will become obese in the next ten years. Altogether, they say, a total of 81% of men will be overweight or obese by 2020. Any projection that suggests that fewer than 1 in 5 men will be normal (or under) weight in ten years time should raise eyebrows.

And how do they get to these figures? By using "figures from 1993 to 2007". But the past is no guide to the future. How do we know that the biggest rise hasn't already come and gone? Buried away in the Health England Survey is an indication that this is exactly what has happened (emphasis mine).

Between 1993 and 2008, there has been a marked increase in the proportion who were obese. This proportion increased from 13% of men in 1993 to 24% in 2008 and from 16% of women in 1993 to 25% in 2008. However, the rate of increase in obesity prevalence has been slower in the second half of the period than the first half, and there are indications that the trend may be flattening out, at least temporarily.

You can't just extrapolate from previous figures. The childhood obesity figures show us that. Contrary to received wisdom, obesity is not a disease. It is not contagious and it won't spread inexorably. A recent study in the Journal of the American Medical Association found that obesity in America has not increased at all since 1999. 

The JAMA study is important because it shows that obesity flat-lined at 32.2% (men) and 35.5% (women). The new British projections give figures of 41% (men) and 36% (women). Is it really likely that the UK is going to overtake the fattest country in the world - by quite some way in the case of men? Isn't it much more likely that, as with children and as with the US, the 'epidemic' will peak long before it gets to that point?

Public health projections are, quite simply, worthless. Whether the issue is swine flu, smoking or obesity, they are never anything but guesses (how could it be otherwise?). They are intended purely for the purposes of lobbying. Nothing else.

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