Dr. Joan Bushwell's Chimpanzee Refuge

Like religious zealots, fat advocates bristle en masse at any challenges - however reasoned and plausible - to their doctrine, and go to great lengths to bar the door to those contradicting the party line. Big Fat Blog, for example, welcomes no input deviating from its pro-fat message, even warning against the posting of weight-loss stories - regardless, apparently, of how permanent or subjectively life-enriching. At the same time, the site is rich with examples of "fat-unfriendly" machinations by the press, private corporations, and the government; these are indicted and summarily dismissed. After former Health and Human Services Secretary Tommy Thompson announced new government dietary and exercise guidelines, which claim that some overweight people may need 90 minutes a day of strenuous exercise in order to reach what the government deems a healthy size, he was vilified by BFB. That the site's commentaries are both contentious and founded on sketchy premises probably explains, at least in part, the group's desire to keep non-sycophants at bay: Much of the time, they're fairly screaming to be set straight by medical data. McAleer does, however, offer other, credible reasons for closely monitoring what's posted on his site, where the appearance of outright trolls and bitter disputes would be virtually assured in an anything-goes environment.

So with so much apparent evidence working against their "fat-isn't-unhealthy" refrain, how do size advocates go about rejecting the mountains of evidence to the contrary accumulated over decades of clinical research? And with widespread weight problems being far from a new issue in the U.S., why has this movement only recently gained momentum?

The latter question can probably be answered on the simple basis of how many fat Americans there are now as compared to times of yore; tell two-thirds of the country to change what they're doing or else, and you can expect noisy reprisals. In terms of the former question, the same popular press implicated in thin America's ongoing trivialization and deception of fat people is responsible for bringing the reading public a number of controversial tomes around which fat advocates have rallied. One of the earliest in the current generation was Glen Gaesser's 1996 book Big Fat Lies. Gaesser, an exercise physiologist, contends that many of the perils ascribed to obesity stem from the insurance industry, drug makers and "medical mafia" types who fail to thoroughly investigate what they endorse. Although positioning himself as an enemy of cholesterol and a friend of low-fat diets, he states in this book that oft-publicized links between obesity and heart disease and other conditions are factitious, and emphasizes that fitness is compatible with a rotund physique. Fat advocates still point to many of Gaesser's claims when marshalling support for their contention that the dangers of fat are overblown. But in 2002, Gaesser co-wrote a book, The Spark: The Revolutionary New Plan to Get Fit and Lose Weight-10 Minutes at a Time, thereby distancing himself to some extent from the pro-fat movement by virtue of the apostasy of the book's title alone.

More controversial - and celebrated - was University of Colorado law professor Paul Campos' 2002 book The Obesity Myth. Here, Campos, as have many before him, attacks the BMI, citing hyper-muscular statistical outliers such as pro athletes as evidence that the index is useless as a gauge of body fat but failing to account for the vast majority of people defined as obese by the BMI criterion who are simply flabby. Moreover, he doesn't explain how scientists' use of an allegedly unsatisfactory measure of obesity - one to which he proposes no alternative and in fact invokes for his own purposes when attacking various published research findings - invalidates the established links between excess weight and various diseases.

A shining example of the bold vacuity with which Campos pursues "dishonest" statistics comes from the same The New Republic piece:

What accounts for the conflict between studies that claim being "overweight" is a significant health risk and those that suggest such weight levels might actually be optimal? The biggest factor is that researchers fail to point out that, in practical terms, the differences in risk they are measuring are usually so small as to be trivial. For example, suppose that Group A consists of 2,500 subjects and that over the course of a decade five of these people die from heart attacks. Now suppose that Group B consists of 4,000 subjects and that five members of this group also die from heart attacks over the same ten-year span. One way of characterizing these figures is to say that people in Group A are subject to a (implicitly terrifying) 60 percent greater risk of a fatal heart attack than those in Group B. But the practical reality is that the relevant risk for members of both groups is miniscule. Indeed, upon closer examination, almost all studies that claim "overweight" people run significantly increased health risks involve this sort of interpretation (or, less generously, distortion) of their data.

What Campos has offered here is a classic bait-and-switch: He accurately describes how a comparatively trifling rise in absolute risk may underlie a startlingly high increase in relative risk, but ignores a basic and obvious (to clinicians, at least) reality: Mortality attributable to myocardial infarctions and other cardiac diseases is not only not rare, but represents the leading cause of death in the United States. If Campos could establish a cohort of either 2,500 or 4,000 adults in which only five died of heart attacks over a ten-year period, he'd be rightly regarded as the Messiah. Furthermore, the studies most often credited with establishing links between overweight and disease are frequently much larger and lengthier. Nevertheless, for the same essential reasons Ann Coulter will always have a fan following, Campos retains a modicum of credibility within a subset of the population committed to a world view in which critical thinking is, at least in certain areas, an anathema.

For their part, medical sources say the BMI, while like any such tool yielding imperfect results at the individual level, correlates extremely well with body fat in the population at large. "The BMI and the with the waist-to-hip ratio are the best indicators for people at risk from obesity," says Albright. "Both are useful and good predictors of true body fat." Adds Meir Stampfer, M.D., Dr.P.H., a professor of nutrition and epidemiology at the Harvard School of Public Health: "BMI is not a perfect measure of adiposity, but to the extent that it is not, it is only adding noise. A better measure would yield even stronger relations to heart disease, diabetes, et cetera."

In The Obesity Myth, Campos engages repeatedly in sophistry, gilding his arguments in the very statistical chicanery he says fuels the "unfair" presentation of studies connecting excess weight with a plethora of disease states and premature mortality - chicanery upon which so many of his conclusions rest. For example, he touts falling rates of heart disease in conjunction with rising average weights in the U.S. as prima facie evidence that obesity and heart disease are uncoupled - a vacuous analysis that ignores studies examining the direct relationship between weight and risk of coronary disease, many of which indeed point toward a much greater incidence in cardiovascular-disease-related deaths in the clinically obese than in normal-weight people. (Using reasoning similar to Campos', one could conclude that because U.S. life expectancies have risen steadily for decades, cigarettes aren't harmful in the least and HIV did not preferentially strike homosexual men in early 1980s.)

In interviews, Campos has, with no trace of jocularity, assumed positions such as "it makes as much sense to say that everybody should be thin as saying everybody should be tall." He emphasizes that modern medical machine's "war on fat" is driven primarily by special interests and collusion - ironic, perhaps, in light of Campos' own distinct history of writing books which appear to capitalize as much on their ability to inflame as they do on their capacity to inform. In The Obesity Myth, he employs one overarching strategy: He artfully trots out a number of legitimate issues (discrimination; a profiteering diet industry; dangerous weight-loss drugs; a thinness-championing media) and uses these to usher in, and then attack, the logically unrelated but emotion-fraught contention that being fat is medically risky. His claim that it is not is thus attractive and credible in the eyes of those with an inherent need to believe, but, medical experts contend, is frivolous and dangerous.

Echoing what Campos writes, Albright says that there is some evidence that for African-American women, the BMI standards should be adjusted slightly upward (32-34 for obesity). "In my practice, 75% of the people I see are African-American and obesity is more socially acceptable, I think, in blacks," Albright says. "But the health risks are still just as real."

And what do those risks entail? In January 2005, a team of CDC researchers concluded that 365,000 Americans die every year as a result of "poor diet and physical inactivity," which is largely synonymous with excess body weight. This figure was controversial from the start, not only in the eyes of radicals who assumed it was about 365,000 too high but because in 2004 the CDC had placed it at 400,000, blaming a computer error for the 35,000-stiff difference. Then, in April of last year, a group led by the CDC's own Katherine Flegal published a paper in the Journal of the American Medical Association claiming that this number was as low as 26,000 and suggesting that being overweight may even help prevent death.

The results were predictable. The lay press had a feeding frenzy with the new findings and BFB went ballistic, calling for CDC director Julie Gerberding's head. Although the CDC itself and not an external revire board was responsible for the revised death total, BFB had despised Gerberding for some time; its bereaved were no more likely to credit Gerberding for helping to clean her own house than evolution deniers are apt to acknowledge that evolutionary biologists, not Bible scholars, were the ones who exposed "Piltdown Man" as a hoax.

Ultimately the CDC decided to stick with the 112,000 figure, admitting that such estimates are inherently subjective but emphasizing that regardless of the exact number, being overweight - and perhaps just as importantly, physically inactive - carries undeniable health risks. Meanwhile, researchers at the Harvard School of Public Health explained the discrepancy, attributing much of it to flawed methodology on the part of Flegal's team; Flegal countered by disputing some of the Harvard scientists' claims.