Is the obesity epidemic exaggerated? YesBMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39458.480764.AD (Published 31 January 2008) Cite this as: BMJ 2008;336:244
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The debate over whether the health risks of obesity are exaggerated
seriously detracts from a more crucial concern. Whether or not obesity
increases health risks, the real question is what should we do for our
health in any case?
Weight loss or control is constantly recommended—disregarding the
fact that weight is not a behavior, and as such it is not ours to
“control.” Weight results from a multitude of factors, some of which are
in our control—how we eat, how active or sedentary we are—but many of
which are internally regulated, and thus are not. In recent years a host
of studies have shed light on why some sedentary folks can eat like horses
and remain lean while their neighbors consume moderately, train for
triathlons, and stay fat. If we limit ourselves to healthy means, over the
long run the best anyone can hope for is to influence weight, not control
It turns out that prescription of weight loss as a solution to
fatness has made things worse. Research published in 1950 by Ancel Keyes
first demonstrated how and why even a moderately restrictive diet is
counterproductive for long term weight loss. New studies bear this out:
weight can be lost on virtually any contrived plan to restrict calories or
food groups, but between 80 and 95% of this weight is predictably
regained, usually with added pounds. If you doubt this well corroborated
data, just consider how many people you know who have gone on a diet once.
If dieting was effective why would it be a perennial activity, and why
would most dieters be fatter today than before their first diet?
Aside from weight loss, what recommendation with so many unpleasant
side affects and a 90% failure rate would still be prescribed? None the
less we persist in the belief that if we can make people feel bad or
afraid enough about their weight they will “do something” about it. This
flies in the face of new studies documenting that body dissatisfaction
does not serve as a motivator for healthy behaviors. To the contrary,
research has finally confirmed what those working to reverse body image
problems have known for years: unhappiness about weight leads to
disordered eating, weight gain, and poorer overall health. In light of
this, why do we persevere like Sisyphus in unrelenting talk about weight,
the risks of fatness, and the need for weight loss as if this will make
people repent? In four decades the thinner we have tried to be, the fatter
we have become. Worrying about weight is a self-fulfilling prophesy. But
if fat phobia and efforts at weight control are contributing to the
problem, what is the solution?
Studies have consistently shown that fatter people who are fit are at
lower risk for health problems than thin people who are not fit. Given
this, someone should be asking whether it’s fatness or lack of fitness
that is the problem. But even this debate detracts from the vital
question: what should we do in any case? The solution is so obvious,
perhaps it defies notice. What if instead of fear and loathing of
fatness, health promotion initiatives were to pushed the value, ways and
means for wholesome eating and fitness for everyone—irrelevant of size?
If a sustainable healthy lifestyle were the goal instead of size, some
people would remain fat and some would be thin, but virtually all would be
healthier. Isn’t this the point?
It is troubling that so few leaders in health care cannot see that
shifting the focus to how we live rather than what we weigh is an
effective solution that empowers all people of every size and shape to be
the best they can be. Few could argue that a fit and well-fed populous of
diverse sized people would not be preferable to the status quo. Campaigns
to support the development of healthy, realistic body images, wholesome,
stable eating, and lifetime fitness habits regardless of shape, size, or
weight could eliminate much of our population’s “weight problem.”
Competing interests: No competing interests
Basham and Luik submit that the epidemic of obesity has been
exaggerated (1). We think that the large average weight gain of 10.9 kg in
the U.S. population between 1960 and 2002 (2), which the authors allude
to, is compatible with an epidemic (i.e. with an increase “clearly above
Data from developing countries provide additional arguments in favor
of a global epidemic, and further insight with regards to its scale and
consequences. For example, based on three population-based examination
surveys between 1989 and 2004 in the Seychelles (Indian Ocean, African
region) (3), the yearly average weight gain of the population was two
times larger in a rapidly developing country (3) than in the U.S. between
1960 and 2002 (2), respectively 0.46 and 0.26 kg per year.
However, we agree with Basham and Luik that the consequences of the
epidemic need further research. For example, the Seychelles surveys showed
that, during the last 15 years, the upward trend in weight (the prevalence
of overweight increased from 37% to 59%) was associated with a 50%
increase of the prevalence of diabetes, as expected (4). On the other
hand, mean blood pressure did not increase over time; moreover the
relationship between weight and blood pressure unexpectedly decreased over
successive surveys, independent of treatment (3). These findings from the
Seychelles are consistent with the upwards trends for diabetes but
downward trends for blood pressure (and blood cholesterol) in the U.S.
population between 1980 and 2000, and lower risk of hypertension (and
hypercholesterolemia) associated with obesity in 1999/2000 than in
1960/62, not fully accounted by treatment (5).
A better understanding of the trends of obesity and its consequences
is needed to inform effective prevention programs. However, the upward
trends of weight in most populations are definitely worrying for specific
diseases (e.g. diabetes) and this warrants prevention interventions
without delay. This is especially true for developing countries, which may
face both a particularly steep epidemic of obesity and a lack of resources
for relying on treatment strategies to manage diabetes and other obesity-
1) Basham P, Luik J. Head to Head: is the obesity epidemic
exaggerated? Yes. BMJ 2008;336:244.
2) Ogden CL, Fryar CD, Carroll MD, Flegal KM. QuickStats: mean weight and
height among adults aged 20-74 years, by sex and survey period - United
States, 1960-2002. MMWR 2005;54:771.
3) Danon-Hersch N, Chiolero A, Shamlaye C, Paccaud F, Bovet P. Decreasing
relationship between body mass index and blood pressure over time.
4) Faeh D, William J, Shamlaye C, Tappy L, Ravussin E, Bovet P.
Prevalence, awareness and control of diabetes in the Seychelles and
relationship with excess body weight. BMC Public Health 2007, 7:163(e).
5) Gregg EW, Cheng YJ, Cadwell BL, Imperatore G, Williams DE, Flegal KM,
Narayan KM, Williamson DF. Secular trends in cardiovascular disease risk
factors according to body mass index in US adults. JAMA 2005; 293(15):
Competing interests: No competing interests
Re: Is the obesity epidemic exaggerated? Yes
Patrick Basham and John Luik have written in the BMJ on obesity, and Basham has separately written on tobacco issues.[2 3] We write to provide information on the credentials and credibility of Basham and Luik, and to raise questions about the accuracy and completeness of their BMJ conflict of interest statements.
In two BMJ blog postings Basham was referred to as ‘Dr. Basham’. [2,3] Basham has claimed on a number of occasions to have a doctorate. For example in 2008: ‘Mr Basham earned his BA, MA, and PhD. degrees in political science from Carleton University, the University of Houston, and Cambridge University, respectively’. Today his LinkedIn page lists a ‘PhD in Political Economy from Cambridge University' under qualifications. We have found no published source claiming Basham has a PhD from any other university.
Basham registered for a PhD at the University of Cambridge in 1995. Despite a claim that Basham had completed his doctoral dissertation by 2001, ,the Faculty of Social and Political Sciences at Cambridge reports that the thesis, was only ‘submitted to the Degree Committee’ some three years later on 6 April 2004. It was examined later in 2004 by Jennifer Lees Marshment, then at the University of Keele. It appears the thesis was returned to Basham for revision with a view to a further Viva.. Cambridge confirms that Basham was 'withdrawn on 8 July 2009 without qualification’. In other words, Patrick Basham does not have a PhD from Cambridge University.
It can also be noted that Basham's co author John Luik, has reportedly been dismissed from two academic posts over irregularities in his CV. He reportedly claimed, while at the Nazarene College in Winnipeg from 1977 to 1985 'to have a doctorate from Oxford University'. He eventually received his doctorate but 'not until 1986.' Luik went on to work at Brock University in 1986, until an official investigation reported,(http://www.youtube.com/watch?v=8-BRwhWW8pY), that he had cited ‘visiting professorships that didn't exist, books and articles that simply didn't exist’ in his CV.
In the Basham and Luik article on obesity and in one of Basham's blog posts on tobacco, no competing interests were declared.[1 2] In another blog post on 'snus' tobacco, Basham stated that he had 'no competing interests with any of the snus manufacturers.'  It is difficult to evaluate these claims since the Democracy Institute, the think tank to which Basham and Luik are affiliated, is not transparent about its sources of funding.
The Democracy Institute, operating since 2006, describes itself as a ‘politically independent’ think tank based in ‘London and Washington’. It argues against government regulation on issues including tobacco, alcohol, food and gambling, amongst others. [11-13] It has disclosed tobacco industry funding on one report,  but otherwise does not declare funding sources. It often declares it has not received funding from a particular industry on its publications. In one example, it stated it had received no funding 'from the food, gambling, tobacco, alcohol, or indoor tanning industries' to 'publish… research and write this paper', nor had the contents 'been shared with or reviewed by any individual or organisation affiliated with' those industries.
There are several issues with these various declarations.
First, there is the issue of the negative form of these declarations. Particular industries are said not to have funded their work, but, with the single exception noted above, nothing about who has funded the work is given. Furthermore, the BMJ's policy on conflict of interest, requires that both 'personal' and 'organisational' funding sources, not just industry funding, be disclosed.
In the case of the article on 'snus', the meaning of the phrase 'any of the snus manufacturers' is potentially unclear. Given that all the major tobacco companies (including Japan Tobacco International, Imperial, BAT and Philip Morris) are involved in the snus market, the statement by definition must be a claim of no tobacco industry funding. But this is not made explicit. BMJ readers deserve to have specific clarity on this.
In the case of the other BMJ article on tobacco, Basham arguably ought to have declared that he or the Democracy Institute were in receipt of funding from Imperial Tobacco, (mentioned above) as well as any other funding from the tobacco industry.
In the case of the BMJ article on obesity, if Basham and Luik or the Democracy Institute were in receipt of funding that has allowed them to work on food and obesity, from the food and/or tobacco or indeed any other industry or interest, it should have been disclosed. It is well known that the tobacco industry attempts to influence how risk is dealt with by policy makers and to fund work on this. In addition as in the case of climate change, corporate interests may try to disguise the funds they send to think tanks.
An additional difficulty is that, though the Democracy Institute states that it is based in London and Washington DC, it is not registered as a company or a charity in the UK. In the US it is not registered as a 501(c) organization with the Internal Revenue Service, nor as a company in Washington DC (or either of the surrounding states – Maryland and Virginia).
Both authors have also had a history of close involvement with the tobacco industry. For example:
• John Luik edited a book criticising plain packaging, receiving £155,000 in total from several tobacco firms. [21-23]
• Patrick Basham was the founding director of the Social Affairs Centre of the Fraser Institute – which received funding from Rothmans International and Philip Morris. [24 25]
It is well known that the tobacco industry has attempted, to some extent successfully, to cast doubt on the health effects of tobacco for over thirty years.[26 27] Tobacco tactics have been emulated by the food and alcohol industries.
The BMJ announced last year that it would no longer publish research funded by the tobacco industry. Apparent irregularities in BMJ conflict of interest declarations made by Christopher Snowdon of the Institute of Economic Affairs, itself a multi-year recipient of tobacco industry funding, have recently been pointed out. Snowdon is also described as an 'Adjunct Fellow' at the Democracy Institute.
Both cases suggest that medical journals may need to be more vigilant about conflicts of interest declarations. It may be advisable to insist on explicit statements specifically requiring authors to disclose the identity and amounts of funding from corporate and other sources, including charities and foundations..
We understand that the BMJ has written to Patrick Basham on a number of occasions inviting him to clarify his claim to have a PhD, so far without response. It appears that it may also need to write to both Basham and Luik to clarify this matter and their conflicting interests statements. If no response is forthcoming, it may be necessary to draw attention to this by printing a correction and to think whether any other measures can be taken against those that appear to subvert the policies of the BMJ.
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Competing interests: DM receives funding from the European Commission for an FP7 project (ALICE RAP) that focuses on rethinking addictions in Europe. He is also a director of Public Interest Investigations, a non-profit company which is behind two websites: spinwatch.org and powerbase.info. DM is a member of the UK Centre for Tobacco and Alcohol Studies, a UK Centre for Public Health Excellence (MR/K023195/1) funded by the BHF, CR-UK, ESRC, MRC, and NIHR, under the auspices of the UK Clinical Research Collaboration. SH: None declared.