Monday, April 28, 2014

Canada's Right Wing Fraser Institute Pours Their Special Stupid on Obesity

It's so biased, massaged, and cherry picked that it's almost not worth commenting on, but given it may well be all over the Canadian news today here's my brief comment on the Fraser Institute's Obesity In Canada polemic.

Cherry picked data can support anyone's position. Here the Fraser Institute presents many cherries in an aim to prove that obesity rates haven't been rising, that obesity is not a medical concern worthy of alarm, and that government interventions that target obesity are folly and have already proven themselves to be ineffective.

To make their case they start out by publishing a great many graphs of various age groups vs. their self-reported body mass indices that are meant to impress readers that obesity rates aren't rising in Canada. While you're welcome to go take a peek at all of them, here's a graph of Canadian obesity rates that isn't part of the Fraser Institute's report:

As you can see, it demonstrates a near tripling in self-reported obesity rates since the mid 70s and it also reveals a not-so-surprising fact. When you call people up on the telephone and ask them to self-report how tall they are and how much they weigh, they magically wind up taller and lighter than their realities. To be more precise according to a 2014 Statistics Canada report, men's self-reported BMI's are 9% lower than in actuality, while women's are 6% lower. So when considering the Fraser Institute's graphs, none of which include any data prior to 2003 and most only from 2005 (clearly they went to the Fox school of how best to use an axis to make a point), you have to keep in mind that along with purposely and disingenuously ignoring the very dramatic rise in Canadian weights since the 1970s, all of their graphs present self-reported data and hence also knowingly and markedly under-report the actual weights of Canadians.

Regarding obesity not being a medical concern the report rightly begins by castigating BMI as a measure of health. BMI truly is a crappy measure which is why we who actually work with patients prefer the use of the Edmonton Obesity Staging System which in turn considers weight's impact on health. The fact that BMI is a sub-par measure of health isn't disputed by anyone, though you wouldn't know that from the Fraser report. Next the report cherry picks from the research to pull those papers that demonstrate less awful morbidity and mortality with obesity but yet do so with that same crappy BMI value that the report so rightly said was a poor measure as it falsely includes people with great health but higher weights. Chutzpah aside, this is a common attack on initiatives aimed at helping to either treat or prevent overweight and obesity and it's an odd one. Even the most conservative of data would suggest thousands of weight relatable deaths per year in North America. How many deaths would the Fraser Institute consider to be an alarming number? And of course it's not just about mortality there's morbidity to consider and when considered in the context of weight, morbidity markedly affects mortality as seen by Dr. Sharma's work below where mortality as a function of weight is plotted on the basis of EOSS score (higher scores represent individuals who have accumulated multiple weight responsive and relatable conditions)

And the chutzpah doesn't end there. Despite the Fraser Institute's report asserting that obesity doesn't dramatically increase mortality, later in this same report they go on to explain why obesity won't in fact be a burden on the healthcare system because those with obesity will die so much younger that their earlier than expected deaths will offset any potential increase in healthcare costs (and irony aside, following this logic I'm looking forward to the Fraser Institute's next likely report, The 3 Most Expensive S's in Canada: Seat-belts, Street-signs and Speed-limits)

The stupid culminates with the report's discussion of the failure and folly of government intervention. Like Margaret Wente before them, the Fraser Institute refuses to appreciate that there will never be a singular solution or intervention that will have an impact on obesity. Society's increasing weights are consequent to the perfect storm style convergence of dozens and dozens of changes to our environment. Getting worked up about singular interventions not working is akin to getting mad at a single sandbag for not stopping a flood.

Overall it's an idiotic read but not a surprising one given the source, after all, this is the same organization that as recently as 1999 put out, Passive Smoke: The EPA's Betrayal of Science and Policy which,
"highlighted the absence of any scientific evidence for linking cancer with second-hand smoke"
The first line of the Fraser Institute's mission statement is
"Our vision is a free and prosperous world where individuals benefit from greater choice, competitive markets, and personal responsibility."
which was translated brilliantly by Steven Lewis as stating,
"Public health care sucks because it must suck, because it’s public. Therefore, let’s gather skewed estimates on a hot-button issue, retail them as hard data, and lure Canadians toward the promised land of private medicine."
A perfect description of their most recently spun drivel.