Friday, November 28, 2003

Looking for the obesity bogeyman

The fast food, snack and confectionery companies seem to be in the dock for the rising levels of obesity in the UK. This is all based on a mixture of bad science, risk aversion and societal self-loathing.

(1) We have enough food to go around for the first time in our history. We can actually fuss about the quality of what we eat, when and where we eat it, and if we're all eating too much. Most of us eat a greater variety of foodstuffs than ever before. But this achievement is generally ignored.

(2) MPs asked various food companies to explain how far people would have to run to burn off the calories consumed in their products. So, for example, running off the energy from a Big Mac meal would require running nine miles. But this is a stupid comparison. Most of the calories we burn each day would be burned even if we lay in bed, because they are required for the general maintenance of our bodies. It is unrealistic to assume that people always eat 'junk' food on top of their normal food intake. If I've eaten a Big Mac meal, that is generally as one of my three meals per day. If people decide to eat more than three meals a day, they're bound to get fat. That's not the responsibility of McDonalds.

(3) The obsession with obesity ignores the fact that our food is not toxic. Obesity will not kill people in and of itself, but being heavier does dispose us to other diseases. However, even fat people will probably live into old age. So, the 'obesity epidemic' is really about determining whether we live a few months, or a couple of years, longer but eat less. Some people might decide to be fat and happy, as opposed to thin and always watching their weight. Let's have the freedom to decide for ourselves.

(4) People are, apparently, all morons. One look at Ronald McDonald, and we're all desperate for a hamburger. One 'Books for Schools' promotion and all our kids are shovelling crisps down their throats like there's no tomorrow. There is a vein of utter contempt running through the discussion of food.

Guardian Unlimited | The Guardian | Blame obesity on bad diets, say food chiefs

Heart disease risk overstated

This is an interesting look at the dangers of risk calculation which don't give some weight to wider changes in society. It would seem that the Framingham Risk Equation, which has been used to assess whether men should go on medication to prevent heart disease, has overstated the risk to individuals. For example, from the 6643 men studied, it was predicted that 4.1% would die of heart disease. In fact, only 2.8% died, an overstatement of 47%.

Predictive accuracy of the Framingham coronary risk score in British men: prospective cohort study, British Medical Journal, 29 November 2003

Monday, November 24, 2003

Painkillers and kidney damage

I wonder how many people read far enough into a story like this to realise that unless they are taking painkillers every day AND they are susceptible to kidney problems, that aspirin, paracetamol etc are harmless - at least, as regards our kidneys.

Not that the study is overwhelmingly powerful, anyway. 'Over 200 patients treated for kidney failure across the US were scanned for SICK and asked about their use of painkillers. Seven per cent were found to have SICK, and a third of those patients had overused analgesics,' according to BBC News. In other words, four or five patients with SICK were heavy users.

BBC NEWS | Health | Painkillers 'cause kidney damage'

Sweetened fears

Eating a lot of sugary foods during pregnancy could lead to an increased risk of birth defects, according to research to be published in the American Journal of Clinical Nutrition (AJCN). Mothers who ate a lot of foods with a high glycemic index, which cause a rapid rise in blood sugar followed by a sharp fall, apparently doubled their risk of having children with neural tube defects, such as spina bifida. Obese mothers were found to be four times more likely to have children with such problems.

By focusing on the 'double' or 'quadruple' supposed relative risk of birth defect, the headlines disguise the fact that the absolute risk of birth defect remains very small. Department of Health figures suggest that there are about 800 cases of neural tube defects in England and Wales each year - about one case for every 1000 live births. Most of these cases are detected by routine antenatal screening. The majority of such pregnancies end in termination, so that very few children are born with these conditions.

Studies like the one published in AJCN should never be taken at face value. For example, Andrew Russell of the Association for Spina Bifida and Hydrocephalus told BBC News: ‘The idea that a sugar surge in the maternal blood could cause spina bifida, while not impossible, would need quite a lot of corroboration because there are so many other things that feed into the metabolic process which controls development and closure of the spinal column.’ The safest thing that any parent-to-be can do in relation to reports like these is generally to ignore them.

Whatever the merits of the science, the effect of such news reports is further to increase the nine-month guilt-trip that is pregnancy today. Mothers are already lectured about giving up cigarettes, alcohol and caffeine. Now, it is suggested, they should avoid eating a range of foods from white bread to cooked carrots - despite the fact that the medical basis for most of this advice is shaky at best.

Andrew Russell says: ‘I would not feel at all comfortable about telling a mother that because she ate a cream bun in the early stages of pregnancy she was responsible for her child's lifelong disability.’ Exactly. The stress of such guilt-trips is the last thing an expectant mother needs.

Sugary foods 'birth defect risk', BBC News, 24 November 2003

Folic acid and the prevention of spina bifida: new campaign plans, UK Department of Health, 13 July 1995

(also posted on spiked)