Fat City

Jacob Sullum thinks it is time to get off the backs of the fat:

The government seems to have made tremendous strides in its War on Fat. In 2004 researchers at the U.S. Centers for Disease Control and Prevention (CDC) said “poor diet and physical inactivity” were killing 400,000 Americans a year, a number that was widely presented as an estimate of “obesity-related deaths.” Just one year later, the estimate had been reduced to about 100,000. To cut the death toll by 75 percent in the space of a year, the anti-fat crusaders must be doing something right.

Or something wrong. Ascribing deaths from chronic diseases to specific lifestyle variables is a tricky, highly uncertain business, and the 400,000 figure, which was announced in The Journal of the American Medical Association by a team that included the director of the CDC, was suspect from the start. For one thing, the association between fatness and mortality disappears among Americans 65 and older, the age group that accounts for most deaths. According to the CDC’s own data for the years 2001 to 2003, excluding older Americans leaves just 585,000 or so deaths a year, of which more than 180,000 are caused by accidents, suicide, homicide, lung cancer, HIV, influenza, pneumonia, and chronic lower respiratory diseases—none of which the CDC blames on obesity. To believe the 400,000 death toll, you’d have to believe that virtually all the remaining deaths, from causes such as heart disease, stroke, hypertension, cancer, and diabetes, are due to “poor diet and physical inactivity,” a phrase public health officials and the press have treated as synonymous with fatness. (More on that later.) That would leave no room for risk factors such as smoking, stress, and heredity.