Let’s Talk (fat) Politics!

With it being so close to election day (in the US) I just couldn’t resist this topic!  Just a few more days and we’ll at least get some relief from all the political ads!

For the first time, I am going to be an election poll worker this year, so I voted early, in person.  There is something about voting, the “election day” kind of experience that I just love.   My experience has been that the other voters, and myself of course, are grateful and proud to be there.  We recognize in each other that attempt to do what we think is best for our country, county or town.  I guess it is the sense of community that I am appreciating.

I am a little nervous about being a poll worker, but I am looking forward to it.  It was something that I have been interested in for a long time-I think in part because I felt like I should help, “do my part”- those people are there for such long days!  OMG I have to be there at 5:30 AM!!! (have I shared with you my deep appreciation for sleeping during those early morning hours??? Lol)

Eric Oliver’s book (link here) echoes and clarifies claims about obesity “politics” that I have been reading for several years.  It is an older book but the political and financial influences on how obesity is addressed in our healthcare system and in our scientific institutions persist.   Outcries over the obesity epidemic creating a huge drain on our healthcare and economic systems are largely misrepresentations.  How and why does this situation persist?  It’s the politics and financial influence of the industrial health complex at work.

The claims of obesity being a threat to health and life led to obesity being classified as a disease, versus a symptom of multiple inputs has created a huge industry to “battle the epidemic”.  The use of and especially the lowering of BMI standards has created a huge target market for that industry.

Obesity was identified as a major risk to morbidity and mortality mainly by two studies.  One study linking obesity to mortality (death) was done in 1999 (Allison –study link).  In this study, they divided the population into two groups: obese and non-obese, and measured the death rate in each group.  But they attributed all deaths in the obese group to obesity.  So, an obese person could have died in a car crash but this study attributed that death to obesity.

The other study linking obesity to higher death rates was done by the CDC in 2004.  They attributed deaths to poor diet and inactivity, but only because they caused obesity, not because they carry their own risk (which they do).  This study attributed deaths caused by obesity to be 400,000/year.

Kathryn Flegal at the National Center for Health Statistics (taking into consideration factors like smoking, access to medical care, family history, exercise, diet) estimated the number of deaths attributable to weighing too much at less than 26,000/year.  (that is a big difference, no?) https://jamanetwork.com/journals/jama/fullarticle/200731

The setting of the BMI standards is another example of scientific recommendations not quite matching up with the evidence.

In 1988 the NIH convened a panel of “experts” in health research, epidemiology and nutrition to reconcile differences in BMI classifications between the NIH (National Institutes of Health), WHO (World Health Organization, and USDA (United States Department of Agriculture, who set the dietary guidelines).  They set for the standard of overweight at BMI>25 and obesity at BMI> 29…to match the WHO standards.  So overnight 37 million Americans became overweight.  The research they cited actually contradicted the lowering of the standards and was inconclusive at best.  The new adjusted standards were just a subjective and arbitrary call on the part of a few researchers.

Why would the NIH, an incredibly influential organization use such unclear science?  Well, the WHO exerted a powerful influence, so there was pressure to set standards in line with them.

How did the WHO set THEIR standards?  Well, the International Obesity Task Force (IOTF) was instrumental in influencing the WHO to set the lower standards.  Who was the IOTF?  Their website sported logos of the WHO and the International Association for the Study of Obesity, looking very authentically scientific.  They were funded by drug companies manufacturing anti-obesity drugs Xenical and Meridia.

Their primary mission?  To lobby international governments to advance scientific and health related agendas that coincide with pharmaceutical industry goals.  Their first mission?  To get the WHO to set the lower BMI standards.

The chairman of the IOTF?  A researcher paid by pharmaceutical companies to conduct clinical trials for weight loss  drugs, conduct promotional activities for weight loss drugs, and to write favorable press releases about weight loss drugs.  The chair of the NIH was also on the WHO panel, another very credentialed scientist in the weight loss field, was also a paid consultant for many diet and pharmaceutical companies (including the makers of fen-phen, which was found to cause heart valve damage and removed from the market after the fact).  Many members of the NIH panel had ties to diet and pharmaceutical companies.  (This is not an accident).

The industry that creates and markets weight loss drugs supports researchers on the WHO and NIH advisory panels that promote the idea of the threat of the obesity “epidemic”.  By lowering the BMI standards, a much much larger target market was created overnight.

It is important to remember, securing funding is incredibly important so that researchers can continue their work, keep their labs, pay their lab employees.

The diet and weight loss industry influence what obesity research gets done, as well as the results of that research by funding research that is likely to support what they want to promote.  They also pay researchers as consultants for their products.

I would also say that this pattern repeats in many areas of healthcare, not just with obesity medications…where officials of government regulatory agencies are influenced by commercial groups that benefit from favorable rulings/finding by the regulators.  After leaving the government space, these ex-officials are often rewarded with high paying jobs in the private sector. (This is very common with the CDC or the FDA and pharma, for example).

There are also financial incentives for university health researchers and US government agencies.  There is a symbiotic relationship between health researchers, government bureaucrats, and drug companies.  The weight loss industry supports research that helps develop or support the need for marketable products (like drugs).  What gets funded becomes “the current issue or topic of interest”.  NIH/CDC promote messaging to “advertise” for these products, thereby securing more money for research.  The more funding a university receives, and the more publications (research) it produces, it gains more prestige, which can also help with attaining grant funding.

Grant funding is very political, and what money and what it will be granted for depends on how important it is perceived by members of Congress who award the money.

Lobbying groups spend tons of money to persuade members of Congress that what they, the lobbyists, are lobbying for is important.  “Bigger problems” get bigger money.  That is a big incentive for obesity researchers to present obesity as as big of a problem as they can. (like, for example, making more people overweight and obese overnight by lowering the BMI standards).  In fact, after the standards were lowered, the NIH and CDC both got more money for obesity research.  (I have heard that there are twice as many pharma industry lobbyists than members of Congress!)

I have been “attending” a self-study seminar on chronic dieting, binge eating disorder and intuitive eating (presented by PESI) https://catalog.pesi.com/.  One of the speakers is Christy Harrison, RD who shared research (Caulfield and Condit,2012  https://doi.org/10.1159/000336533 )   about what she called “The Hype Pipeline” which documented influences on scientific research.

Here’s a summary of the “Hype Pipeline”-(which could be considered more of a cycle going multiple directions)

*Publication pressure (“getting published” is very important to career success and getting future funding.  Publications gives “credibility” to individual researchers and the institutions they work for.

*Commercialization/translation pressure: pressure to research things that can lead to product/revenue generation

*Institutional press releases: today we often see “science by press release” with very early or preliminary results that often may have little real world value or application but are hyped as if they do.  Fantastic headlines about research results may be in cell lines, animals or very small non-diverse groups of people.

*Media practices: especially in the digital world-headlines, click bait, goal is to generate activity (be it conflict, drama, moral outrage etc) not as much as report the truth/facts.

*Public interests/expectations: many people are looking for novel, excitement, quick fixes, unusual or unexpected suggestions or outcomes.

*Marketing-do I need to explain this one?

*Science Bandwagon:  As topics gain interest and excitement, money follows for research…other researchers follow.  Not necessarily because something is good or helpful, but because it can get funding and attention for institutions and individuals.  Once an idea takes hold, it is very hard to question it, let alone correct a misrepresentation or error.

Does all this matter? Why?

If you are high weight, being labelled obese or overweight carries definite stigma and creates stress.  Both are bad for health.  They can lead us to attempt an ineffective solution-a focus on weight loss.  It also ignores the most meaningful impacts on health.

• Socioeconomic status
• Exercise
• Safety of environment
• Access to care
• Availability of healthy food
• Smoking/drug use (prescription and recreational)
• Alcohol
• One’s relationship to food and eating

Recipe for optimal health- http://eat-learn-live.com/truth-a-recipe-for-good-health/

So be careful when you catch headlines or posts about “exciting new research findings”.  Consider where it might fit in or be influenced by the “hype pipeline”.

 

Mindset Matters Most-Let’s Mantra

Try repeating this mantra (out loud) every day (shoot for at least 25 repetitions).   Have fun with it!

Imagine really embodying the mantra, enjoy imagining how it feels, let yourself smile when you say it.  Let yourself expect this to become your reality.

Feel free to make your own mantra-I’d love to “hear it”.  Email me (mary@eat-learn-live.com) or reply to this newsletter  or post on my FB page.

Coaches Corner-Goal Review

Setting goals can help you create a sense of progress towards your goals, they can help you notice what you are doing.  Goal review helps you celebrate that.  It also helps you recognize when you need to create different or more support or structure around a certain goal, or to evaluate its importance to you.

Remember, schedule goal review.  Allow 5-15 minutes.

Here’s a printable cheat sheet

Ask yourself-what percentage of the time did I complete the goal?  It’s important to consider the percentage instead of thinking I succeeded or I failed.  How often did I do the “bare bones minimum”?                                        The stretch goal?

What helped you succeed?

What obstacles did you run into?

Are you ready to progress this goal?

Do you need to “back it down”

Do you need/want to change it some how?

What are some ideas for your next goal?