Opinion

Dr Katz: Foie gras in humans? Obesity crisis is no myth

Dr. David Katz. Dr. David Katz. Photo: (contributed Photo) Photo: (contributed Photo) Image 1 of / 1 Caption Close Dr Katz: Foie gras in humans? Obesity crisis is no myth 1 / 1 Back to Gallery

Like most topics of widespread interest and/or genuine significance, obesity spawns quite a lot of folklore and myth. Much of the mythology is about remedies, and is often profit-driven. Congress and the Federal Trade Commission have directed scrutiny, and scolding, in that direction of late, and rightly so. Some of it is simply a product of excessive zeal for any given hypothesis or isolated study. Some, like very specific convictions about breakfast much in the news of late, or fixed beliefs about the costs of more nutritious foods, is the result of an echo chamber effect: something repeated enough times seems like it must be true.

I have colleagues who have made obesity-related myth-busting, in both peer-reviewed and pop-culture contexts, a career focus — and these days myth-busting itself has evolved into something of a cottage industry. I’ve never considered it my vocation, but do find that as a defender of epidemiologic fact, I am obligated to confront quite a lot of nonsense, folklore and myth.

One myth stands out for its sheer audacity, and that is the myth that the obesity epidemic itself is a myth. The argument is propagated in particular by University of Colorado law Professor Paul Campos, whose book entitled “The Obesity Myth” garnered considerable attention when first published and has a following to this day.

I always wondered why a law professor would presume to know that the CDC, a legion of epidemiologists and in-the-trench clinicians had confabulated one of the salient concerns of modern epidemiology. My best guess, based in part on debates with Mr. Campos — and with others holding similar beliefs — over the years is that the motivation is a defense against obesity bias. The assertion that epidemic obesity is a myth is not so much a valid refutation of epidemiologic trends, but an offensive against the prejudices that attach to obesity, against assumptions about character and the tendency to blame the victim. If these are indeed the motivations, I am supportive of them. Just not the message.

Epidemic obesity, alas, is no myth. I have long pointed out that while we might debate the importance of some particular number of pounds, or the prevalence of some BMI cut-point, we simply cannot debate the importance of diabetes or other life-altering pathology. We can all be OK about ‘OK at any size’ if indeed we can be healthy at any size. But for the most part, we cannot, and are not.

When I went to medical school in the mid-1980s, we were taught about two kinds of diabetes: juvenile onset and adult onset. Back then, adult onset diabetes was, obviously, not a condition affecting kids. It now is, so often that the name was changed to “type 2.” The transformation of a serious condition of mid-life into an established pediatric scourge is a direct consequence of epidemic childhood obesity.

As are the even graver consequences that ensue. When 7- and 8-year-olds get what used to be “adult onset” diabetes, they are prone to stunningly early onset heart disease, even in adolescence. The rate of stroke has been rising in children between the ages of 5 and 14 in the U.S., with epidemic obesity the only smoking gun on the scene to account for it. The frequency of bariatric surgery has been rising as the age of candidates has been falling.

And now comes the latest bit of bad news. As reported recently in the New York Times, there has been a dramatic increase in the rate of fatty liver disease among adults and children alike in the U.S. This condition, a fatty infiltration of the liver just the like one imposed on force-fed geese to produce “foie gras” (which means ‘fatty liver’ in French), can lead to cirrhosis, liver failure and the need for transplant.

That, in turn, provides a very robust basis for busting the myth that obesity is a myth. Liver transplant is major, life-altering surgery, not broached casually by either patient or doctor. Prior to the procedure, the evaluation of the underlying liver disease is exacting. Those assessments are the basis for reports that nonalcoholic fatty liver disease is fast becoming the most common indication for liver transplant in the country, surpassing the toll of infections, autoimmune disease and alcohol. We are inadvertently doing to our own livers, and those of our children — out of cultural inattention to healthful eating and regular exercise — what can only be done to geese when force-fed.

Which brings us back to French. The word for liver in French is “foie.” The word for faith is “foi.” That similarity belies the reality. Those of us fussing about the urgency of epidemic obesity are not doing it on the basis of faith, but epidemiologic fact. The gravest of all myths about obesity is that the gravity of the obesity epidemic is itself a myth. Would that it were so. It is not.

Dr. David L. Katz; www.davidkatzmd.com; author, “Disease Proof.”