Misinformation, ignorance and prejudice masquerade as a serious article about obesity.

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A friend of mine at university once described articles written by the likes of Enoch Powell or Tony Benn as superficially works of logical completeness and coherence that, on closer examination, reveals a huge leap of what can only be faith half way through the article.

This article on obesity lacks the intelligence, wit or wisdom of Enoch or Tony but it suffers the same problem. It starts like this:

McDonald’s cookies have an energy density comparable to hydrazine. Hydrazine is a rocket fuel used to manoeuvre spacecraft in orbit. It was astonishing, then, to watch a small child graze through two boxes of the desiccated biscuits in one sitting. His parents watched on, preoccupied with their own colossal meals: a noxious amalgam of meat, grease and sugar.

Now I'm not about to defend the quality of McDonald's food (although - and we'll return to this - there isn't any proven link between fast food and obesity) but we know where the author is coming from. We have a problem with obesity and, our author argues, it isn't enough to say that it's a matter of personal choice.

It's an argument - one I don't agree with but an argument nevertheless. And we do have a problem with obesity. However, the author loses me with this single line:

Over 63% of Australian adults are overweight or obese.

Note what has been done here. We were talking about obesity - being grossly and unhealthily overweight - and suggesting that perhaps the morbidly fat really do have a problem resisting food. But now all of a sudden we're talking about obese and overweight. We have, to use that piece of sociological jargon, 'problematised' being overweight by implying that it falls in to the same health category as being obese.

And, to put it bluntly, this simply isn't true. Here's the science:

Relative to normal weight, both obesity (all grades) and grades 2 and 3 obesity were associated with significantly higher all-cause mortality. Grade 1 obesity overall was not associated with higher mortality, and overweight was associated with significantly lower all-cause mortality.

This is not some little study either but:

...97 studies were retained for analysis, providing a combined sample size of more than 2.88 million individuals and more than 270,000 deaths.

Essentially the research is saying that having a BMI of between 25 and 35 doesn't represent a health problem  - overwhelmingly the people our author is talking about fall into this category.

So what is the actual scale of the problem? If we take morbid obesity as the essential measure (in the UK this is defined as a BMI over 40) then currently around 1.5% of men and 3.5% of women are morbidly obese. Now this is a lot of people - about 1.5 million - so we shouldn't ignore it as a problem but it isn't anything approach the scary 63% that our author cites. Even if we add those with a BMI between 35 and 40 the numbers only rise to 5% or so - between 3 and 4 million.

And this brings us back to fast food. Quite simply there isn't a strong connection between takeaways and obesity (which isn't to say that fat people don't eat in McDonald's but to say that's not why they're fat):

When the researchers weighed these children they found something rather interesting. Here are the average body mass index (BMI) figures for each group by frequency of visits to fast food outlets. Bear in mind that a 'healthy weight is 18.5 to 25:

Weekly visits        BMI

Every day:            17.8

4-6 times:              18.3

2-3 times:              19.6

Once:                    20.3

Less than once:     21.4

OK this is for children but it makes the point - quite remarkably showing a negative relationship between regular fast food consumption and obesity. It's whats in the fridge at home and the drawer in the office that's the problem not Burger King or the kebab shop.

Our author concludes that we are all victims of:

...the roots of overconsumption: cost of living, manipulative marketing, nutritional misinformation and – often overlooked – simple palatability.

The overconsumption point is an interesting one for, as our author should know but doesn't, overall calorie consumption has been falling. We're still fatter but it's too simple to blame advertising, fast food, offers of chocolate oranges or Big Sugar for the problem. A proper assessment would pick up these facts and ask questions about our sedentary lifestyle, about the support given to very fat people and medical interventions that are possible.

Instead Ben Brooks (an arts/law student or so his biography tells us) chooses to play silly games with the statistics - the evidence, the truth, if you prefer - in order to make his snide little prejudice against McDonalds into a public health point.

Update: some more practical evidence that it's not McDonald's but our broader food choices that matter are on view in this fascinating student project.

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Malnutrition and public health - it's not austerity that's the problem

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Some "Doctors" have written a letter to the British Medical Journal expressing concerns about malnutrition:

In a letter to the British Medical Journal, David Taylor-Robinson from the University of Liverpool and six other academics warn: "This has all the signs of a public health emergency that could go unrecognised until it is too late to take preventive action."

They say they are particularly worried about the number of children with malnutrition because it can cause cardiovascular and other chronic diseases in adulthood.

And the newspapers and broadcasters lap it up without asking some simple questions - ones like "how many cases of child malnutrition are there?"

To help them, here are the figures from an answer to a Parliamentary question  - in 2008/9 there were 201 cases of children admitted to hospital where  the primary or secondary diagnosis was malnutrition. In 2012/13 this figure had soared to 205 admissions.

There is absolutely no evidence at all - other than anecdotes from teachers - to support the contention that child malnutrition is rising. The thing that should concern us is malnutrition among the elderly because this has risen significantly. The question is why?

Here's one stab at assessment that followed a report in The Independent earlier this month:

People with certain long-term health conditions can't always retain all the nutrients they need - particularly the elderly, who might also struggle to make the trip to the supermarket. With this in mind, the higher incidence of malnutrition might also reflect broader demographic trends, including the fact that the UK's population is ageing. The most recent Nutrition Screening Survey showed that those aged 65 plus were more likely to be malnourished than those who were younger. In addition, it may also be that hospitals are now more likely to screen a patient for symptoms of malnourishment. 

The reasons for increased malnourishment may be entirely unrelated to the current economic climate. Since the elderly are largely protected from the impact of welfare reform and make up the overwhelming majority of malnutrition cases, we should perhaps look elsewhere for the causes of the problem. There may be consequences from 'austerity' - reductions in social care visits, for example - that impact on the elderly eating properly but equally the rise may be a simple reflection of people living longer.

All this may not suit the political agenda of the people writing to the BMJ but we should perhaps pay more attention to the real challenges rather than write ill-researched and polemical letters that serve only to misdirect (and get a nice headline).

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Doesn't look full too me!

The Greens, their fellow travellers and the proto-fascists at the Daily Mail have returned to the subject of population and how the human species, like some spawny bacterium, is devouring the planet with its excessive breeding.  And coming up on the rails is the BBC celebrity – in the form of “wildlife expert” Chris Packham. Demonstrating an almost complete ignorance of population geography or demographics, Mr Packham launches an appeal for us to have fewer sprogs:

The Springwatch presenter suggested offering Britons tax breaks to encourage them to have smaller families. He effectively endorsed China’s controversial one-child policy, which sees couples who adhere to the rule given a lump sum on retirement. But he stopped short of suggesting people should be penalised for having too many children.

This charming childless chap thinks that the pandas will die out if we don’t stop breeding:

‘I question the way, for example, people have two children with one partner, then split up and have two with their next partner, just to even up the score.

'Fact is, we all eat food, breathe air and require space, and the more of us there are, the less of those commodities there are for other people and, of course, for the animals.’

I hate to be a controversialist on this matter but it really is about time we started thinking about this issue on the basis of fact rather than prejudice (indeed the Daily Mail’s problem with population growth appears to be the lack of blonde, blue-eyed Anglo-Saxon Christians).

The Journal of Comparative Family Studies celebrated its 40^th anniversary with this observation:

A global fertility decline has left only a small set of countries and a few percent of the global population with very high fertility. The dominant pattern is fertility decline to low levels-with over half of the global population now living in countries with below replacement level fertility. Concerns of a population explosion are now geographically concentrated and are being supplanted by concerns of a population implosion (i.e., declining population size and rapidly aging populations).

Britain’s problem is going to be an ageing population, declining fertility rates and the crisis of too few workers (something that contributed to our recent immigration episode). Yet there remain useful idiots like Mr Packham to indulge the nastier elements of the Green movement such as the Optimum Population Trust – the ones who think the UK population should be cut to just 29 million and who promote draconian disincentives to larger families.

It is organisations such as this – and the equally unpleasant uber-greens at Forum for the Future – who are wrong, both in their science and in the proposals they put forward to control fertility. Just because a few celebrities can be rolled out to tell us not to have babies doesn’t mean for one second we have a population problem.

As the picture at the top makes pretty clear – whatever is said about England’s population density (and it does suit the green fascists to select England rather than the UK for their figures) – the country is a long way from full and very unlikely to be concreted over anytime soon!

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