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Pattie Thomas in 'Psychology Today'

This seems like a good time to give a heads up on "I Take Up Space," a series of articles that Pattie Thomas (author of "Taking Up Space,") has been writing for Psychology Today's web site. Her newest article, "Stigma is BIG Business," focuses on Allergen and the lap band.

It's a great article, and it includes some interesting numbers:

What Allergan calls "obesity intervention products" are expected to bring in $220 to 240 million in NET sales. That is what they will make beyond the cost of production. This expansion is estimated to have created a new market of over 26 million Americans, quite a significant boost to their potential sales...

Going from 15 million potential customers to 41 million customers is a 173.33% increase in a market in which Allergan basically has a monopoly. In other words, our government handed over to Allergan an incredible increase in market with a simple vote.

Other recommended links:

On Live Once, Juicy, Shaunta reflects on yet another (Remember Peta's?) god-awful anti-obesity ad campaign in Georgia, this one focusing on kids.

and

on Living ~400 lbs, there's a post on a new study that's - big surprise - being negatively spun in the press. Guess what? When you take other risk factors into consideration, BMI is not strongly linked to heart disease risk - even for apple-shaped people. Of course, the press is interpreting that as "Body shape has no impact on heart disease risk! If you're fat and pear shaped, you're still doomed!! Bwahahahaha!"

Why does FDA approval matter? | Paul Campos on Bullying

pani113's picture
pani113
March 14th, 2011 | Link | I personally am going to

I personally am going to make sure to link Patty's articles where ever I can. I share them on my FB, put a link to them on Care2 and also in newspaper comments under the fat scare articles. I feel it is also important to comment under the Psychology Today blog. People do go with the bandwagon effect, which is why many businesses pay professional trolls to post under articles. Maybe if enough of us present our side, it will start some people on the path to critical thinking. If even ONE person breaks the chains of weight obsession, it is worth it!

"Fat can be beautiful. Intolerance is ALWAYS ugly!"

DeeLeigh's picture
DeeLeigh
March 15th, 2011 | Link | Squeegeelicious, 5x is a

Squeegeelicious,

Thanks for taking a look at the study, but those numbers seem weird to me.

5:1 is a very significant risk. To tell you the truth, I'm surprised that someone with a subscription to the Lancet would say that that kind of risk isn't "statistically significant." That's just not the case at all, if you're talking about risk factors. Unless you meant 1.5:1.0, which is a 50% increase in risk? They don't break out the data for BMIs of 40 and up in the abstract, so I'll have to look at the actual study.

However, you say "statistically significant enough to be used as a diagnostic tool." Of course, BMI can't be used as a diagnostic tool for heart disease, since BMI is a risk factor, not a symptom.

Since it seems unlikely that they were minimizing the effects of BMI on heart disease risk, I'll look at the study myself to check the numbers. I'm skeptical. The only explanation I can think of is that those were the numbers before they controlled for age, but even then, it seems high.

People, take the numbers in the post above with a grain of salt until I have a chance to confirm them.

DeeLeigh's picture
DeeLeigh
March 15th, 2011 | Link | Okeydokey. I read the study

Okeydokey. I read the study myself.

They did exclude people with BMIs under 20. In fact, judging from their graphs, people with BMIs in the mid-twenties are at the lowest risk for heart disease and stroke, and the curves start going up below a BMI of around 23 and above a BMI of 28 or so. Slightly. It's noticeable that for heart disease, the risk for someone with a BMI of 20 is roughly equal to the risk for someone with a BMI of around 32 when adjusted for age, sex, smoking status, and baseline values of systolic blood pressure, history of diabetes, and total and HDL cholesterol. When all those risk factors are taken into account, the largest relative risk by BMI (and this is at a BMI between 35 and 40 - the highest they go) is 1.3:1 (30%). With only age, sex and smoking status taken into account, that relative risk is around 2:1 (twice the risk - not 4x).

The data shown in the paper stops at a BMI of around 37, on the high end. There's no data given on people with BMIs of 40 and over. It's true that they report the data in increments of 4.56 points BMI, 12.6 cm waist circumference increase, and every 0.083 higher hip-to-waist ratio. However it doesn't follow that "a person with a BMI of 40 would be 5.55:1 more likely than a person with a BMI of 20 to be at risk of coronary heart disease when smoking was controlled for." As I noted, there's no data given for people with 40+ BMIs. Also, there's no data that controls for smoking but not age and sex. Squeegelious, I can't figure out how you came up with that. Can you explain?

The really interesting stuff is on page 6, where they show the predictive ability of various types of information. It's clear that BMI, waist-hip ratio, and waist circumference are absolute crap for predicting heart disease risk compared to systolic blood pressure, history of diabetes, total and HDL cholesterol. Practically useless, in fact.

The review board concluded

The results from this study show that, whether assessed singly or in combination, body-mass index, waist circumference, and waist-to-hip ratio do not importantly improve prediction of first-onset cardiovascular disease when additional information exists on blood pressure, history of diabetes, and cholesterol measures.

This is great news! Because the risk factors that really matter? Don't get me wrong; they've got a big hereditary component, just like build. But, in my experience, they do respond to HAES. Linda Bacon's research shows that, too, and Steven Blair's research certainly implies it. So yay! I'm gonna go exercise now.

DeeLeigh's picture
DeeLeigh
March 16th, 2011 | Link | The first and easiest to

The first and easiest to understand charts make it clear that there isn't a linear relationship between BMI and heart disease or stroke risk. I disagree with you when you say that there's a linear relationship implied elsewhere in the study.

The HRs (hazard ratios) shown in figure 1 are not linear multipliers, and it's not implied anywhere that they are. They've been calculated in order to compare the strength of association between BMI, waist circumference, hip/waist ratio, and heart disease and stroke risk. The point that the chart is trying to make is that all three are of similar value for predicting risk (and that they're all kind of crap).

The "obesity paradox" isn't the dip in risks, mortality and morbidity that occurs at BMIs in the mid-twenties. BMIs in the mid-twenties are categorized as "normal" and "overweight," not "obese." The fact that people with mid-twenties BMIs are the healthiest and longest-lived is just evidence that they've placed the cutoffs for the BMI categories too low, medically speaking. The "obesity paradox" is actually the greater survival rate that people in the obese category benefit from after cancer, heart surgery, etc. In other words, we're more likely to get some diseases, and we're also more likely to survive them. It's not really a paradox, of course. It's just that fat people are resilient.

You've implied that you're a high level medical or scientific professional by saying that you have a subscription to The Lancet. You're also adopting a formal tone in your posts. However, you made errors that someone with that kind of background - hell, anyone with a basic knowledge of statistics and obesity research - wouldn't make.

If you're not well qualified to do this sort of thing, then it's okay. Just don't act like you are. Present your interpretations with the appropriate caveats, especially if you're not sure about them. Look up things that you don't understand and/or ask an expert for help (and I'm not one, BTW - those are the rules I try to follow myself).
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If anyone wants look at the study themselves, just e-mail me.

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