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.

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  1. Follow the money trail:

  2. Exactly what one would expect from a right-wing think tank!
    The depressing part is that fat acceptance advocates also tend to distort the research in similar ways. They're doing good work in making sure that everyone gets fundamental human rights, it's just that one wishes they were more honest about the health consequences of overweight and obesity.

  3. The focus on single issue policies and responses to childhood obesity is a recurring theme of those critical of obesity interventions: just see comments by Eric Oliver about the supposed cost of soda to half obesity rates. As you so rightly mention, obesity is a complex issue and there needs to be multi-faceted solutions that focus on health, not weight. We need to look at policy responses and ask not if this single intervention creates a statistically significant decrease in individual BMI, but if they help us toward societal goals and whether, if applied in combination, they help us achieve those goals. E.g. reducing car transport may promote walking, cycling etc and, even if it does not reduce an individual BMI it is likely to have beneficial effects for them, while also reducing pollution and potentially increasing safety (which in turn may promote outdoor play for children) and so on. We need joined-up policy thinking and the promotion of health-in-every-policy.

  4. I learned of this astonishingly obtuse "report" via the Weather Network, of all places! It continues to be quite alarming that the national media pays any attention to non-peer reviewed material. Somehow it reminds me of the attention given to right-wing 'think' tanks who are given media space for their unscientific attacks on the reality of climate change.
    While there certainly are metabolically healthy people with BMIs of 30, they are not the norm. Public health must continue to spend money on multi-faceted solutions for achieving health and addressing obesity remains firmly connected to reducing unhealthy, costly outcomes in our population.

  5. Thank you Dr Freehdoff, thank you! Can we take this to court?!

  6. Anonymous3:22 pm

    I personally am blase about the Fraser Institute's report. Just some economists trying to present one side of an argument. Left wing, right wing- it doesn't matter. Everyone is subject to confirmation bias.

    Margaret Wente is a social commentator. Take what she writes with a grain salt. She is an entertainer, not a doctor.

    My concern is her Globe and Mail colleague Leslie Beck. I consider her a threat to national health. She off-handedly refers to meaningless associational studies as if they were RCTs of the highest order. Her obsession with low fat and whole grains borders on the ridiculous. Telling people to eat carbs every three hours to keep their blood glucose levels from falling is a prescription for insulin resistance aka diabetes. She is a danger to society.
    The difference is, she holds herself out as an expert on nutrition, so susceptible people may be influenced by her opinions. Margaret Wente and the FI make no such claim.