Run! FAT BOMB getting ready to detonate and splat fat everywhere!

The Olympic fat torch has just been passed from “supersized” Americans to the Aussies, according to the international press. In fact, nearly 400 headlining stories this week have reported that Australia has “overtaken the USA as the fattest nation in the world.”

The origin of this claim is a report called Australia’s Future FAT BOMB ... Not to be confused with Fat Man, the 1945 atomic bomb code name. This bomb is made of fat. It’s “loudly ticking,” the report says, and set to explode across Australia in the next twenty years, and kill 123,000 people, unless it’s defused.

No need to wait, let’s pull the fuse now, and perhaps help save a few hundred billion dollars in taxpayer money for elaborate special task forces.

As much as some may have looked forward to a dueling fat-off to see which rival country can assume the heavyweight crown, America never held the prize in the first place. And, sorry mates, but you don’t stand a chance, either. The claim that the USA was the fattest country in the world was a marketing gimmick, bought along with all of those profitable Brooklyn Bridges. But, even according to the International Obesity Task Force, both the USA and Australia have long fallen surprisingly low on the list of “obese” BMI rates among various regions and nations of the world.

This FAT BOMB report wasn’t a study published in a peer-reviewed medical journal. It was a paper released to the press this week, ahead of the government’s obesity inquiry, by the Baker IDI Heart and Diabetes Institute. But the report has actually been circulating for months, and had also been submitted to the House of Representatives Health and Ageing Committee on Obesity on May 7^th. The cover letter by the report’s lead author, professor Simon Stewart, head of preventive cardiology, had said it would provide the Committee the evidence it needed to address the growing burden of obesity to protect Australia’s heart health. But it was the press release that made it news to the media and they’ve eagerly picked up the report’s sensationalized obesity imagery and rhetoric.

The report claims that an astounding 7 out of every 10 middle-aged men and 6 out of 10 women are too fat. It describes what it says are the grim future cardiovascular consequences of Aussie’s expanding waistlines. "If we don't do something about this, we will have an MCG-sized crowd full of deaths over the next 20 years, directly as a result of our expanded waistlines,” Professor Stewart said. “The ‘Fat Bomb’ is ticking loudly.”

Health Minister, Nicola Roxon, told the press that she found the report’s findings “shocking” and “staggering” — a sentiment disappointingly shared by other doctor and university professor spokespersons. These are the leading political and health professionals who are shaping public health policies, conducting the research, and establishing clinical care guidelines for our friends in Australia.

Did anyone actually read it?

Let’s take a look at this paper with a critical eye and see what it said. The paper was titled: “Australia’s Future ‘Fat Bomb’ — A report on the long-term consequences of Australia’s expanding waistline on cardiovascular disease.”

This report, produced by the Preventive Cardiology group at the Baker Heart and Diabetes Institute, opened by laying out their entire premise, saying:

The future health implications of this potential ‘Fat Bomb’ are evident in the escalating morbidity and mortality associated with weight-related risk factors such as high blood pressure and high blood cholesterol as well as chronic disease states such as Type 2 diabetes and CVD (including heart attacks and strokes)...

Large-scale population studies ... highlight the association between weight status and various adverse health conditions such as CVD and Type 2 diabetes... In summary, this report supports obesity being named a National Health Priority.

So, they claim, weight status has been shown in population studies to correlate with poorer health and the leading causes of death, heart disease and type 2 diabetes. Poor health and mortality is supposedly escalating across the land.

The glaring problem with these claims is that their government’s own health statistics have been reporting that Australians are living longer and are healthier than ever, despite the numbers classified as “obese” and “overweight.” The latest report issued from the Australian Bureau of Statistics found that Australians are among the longest-living people in the world, with an average lifespan of 78.5 years for males and 83.3 years for females.

The results of the most recent National Health Survey, which is conducted regularly on a representative sample of the Australian population to assess the nation’s health and risk factors (similar to our Health and Human Services’ Health United States reports), found that the majority of Australians report being in excellent or very good health. Heart, stroke and vascular disease rates had dropped from 4.3% in 2001 to 3.8% in 2004-5, with no change in rates of high blood pressure. The prevalence of most health conditions rose with age, according to the report, and the most commonly reported long term conditions were problems with eyesight, including long and short sightedness, hayfever and allergies, arthritis and back problems. Health discrepancies related primarily to factors of poverty and healthcare access, not weight and height.

With the population aging and the number of residents growing, reporting raw numbers, rather than providing age-adjusted and rates (percentages) for health conditions, could be used to create misleadingly scary perceptions of increases. But who would want to do that? ;-)

The same fun with numbers, BMI thresholds and redefinitions to accentuate perceptions of an obesity epidemic has also been happening there, like here. Remember the Bio-pedagogies Conference at Wollongong University? Far from obesity being a national health priority, Australians aren't actually getting fatter at all, said the University researchers. There is are no longitudinal figures to support expanding waistlines, reported professor Jan Wright, associate dean, who said the obesity epidemic is a money-wasting illusion perpetuated by those capitalizing on the obesity myth.

Nor does the evidence support beliefs that Australians' lifestyles are so dangerous that massive government interventions are needed. ABS health statistics also reported that two-thirds of Australians exercise during their leisure time, in addition to their work-related activities. Although this report couldn’t assess intensity and duration, it appears Aussies are actively enjoying their lovely country and beaches. The National Heart Foundation of Australia had also recently reported that there was little evidence to support claims that the fat in Aussie’s diet was contributing to coronary events or death.

The FAT BOMB authors, however, said that current data was not available to assess risk factors, diet and lifestyles, and health consequences. They excused the lack of supportive evidence for their report’s claims by making this incredible disclaimer in their opening:

Overall, there is a paucity of data regarding the projected, long-term impact of obesity on CV morbidity and mortality in middle-aged Australians. This “missing” information is critical as it would provide estimates of the direct and indirect costs of Australia’s future ‘Fat Bomb’ on our hospitals, health services and health departments.

In the absence of such data (which will, unfortunately, take a long time to obtain) there is urgent need to accurately determine the future impact of excess weight in middle-aged Australians in respect to their long-term "heart health". It is only with such data can that we can prepare the health care system and public health initiatives to defuse our future ‘Fat Bomb’.

Translation: We’re just going to make this up?

The authors then laid out the objectives of this report: “To provide the Australian public with an accurate description of their current weight profile with a particular focus on middle-aged Australians and the likely consequences of their expanded waistlines on CVD-related admissions and deaths in the next 20 years.” They went on to say:

In order to achieve this primary goal, we aimed to:

• Generate national data to describe the contemporary weight profile of Australian adults with a focus on those aged 45 – 64 years.

• Provide long-term projections of the potential impact of excess weight on future CV events (both fatal and non-fatal) in middle-aged Australians.

• Outline the potential impact of “defusing” our future ‘Fat Bomb’ through achievable weight targets and waistline reductions on future CV events.

• Describe practical strategies that would enable Australians to collectively tighten their expanded waistlines.

To make their long-term projections, they identified obesity as a risk factor for heart disease and high cholesterol, high blood pressure and diabetes — the metabolic syndrome premise. Misusing these risk factor correlations as causations, they then attributed obesity as the significant causative factor for rising health care costs and “epidemic-like increases of type 2 diabetes and cardiovascular disease.” It can’t be that these chronic diseases of aging are most related to aging and Australians are among the longest living people on earth!

Instead, they blamed “poor health choices and lifestyles” for health risk factors, including obesity. And they claimed that “healthy eating and fitness habits” could cut all of those metabolic risk factors. There’s no need to rehash the evidence for JFS readers, who will be most interested in what they did next.

How they “generated” their data to create their “weight profile of Australians,” is what deserves particular attention and has been missed in every review of this report.

The Land of Incognita

The authors recently offered screenings of heart disease risk factors across Australia (“National Blood Pressure Screening Day” (NBPSD)), where they collected their data. As they said:

We recently examined the weight profile of close to 14,000 Australian adults aged between 18 and 95 years of age as part of a national screening program of common CV [cardiovascular] risk factors conducted in June 2007. The program was conducted in 100 centres nation-wide ... collected information on CVD risk factors such as age, gender, blood pressure, smoking status, education level, measures of obesity (body mass index (BMI)), as well as a self reported history of CV-related illnesses...

The same rates for each age observed in their screening sample, was “used to estimate the proportion of ‘overweight’ and ‘obese’ men and women” throughout Australia. “These rates were then applied to the demographic profile of the Australian population according to the 2006 Australian Bureau of Statistics Census, to estimate the total number of Australians affected within our target gender and age groups.” — To arrive at a total of 9 million Australians they say who are too fat!

So, when looking at the report's figures showing the percentages of men and women classified as “obese” and “overweight” at various ages, how many people have noticed that clarification in the titles? For example:

Figure 3 illustrates the weight profile of Australian men and women who participated in the NBPSD.

And, how many also noted in the text that the rates for each age group were derived from those who had participated in the NBPSD?

Results from the total of 5,873 men and women aged 45-64 years who participated in the NBPSD according to their BMI status are depicted. In summary, this screening program showed that obesity was prevalent in about 30% of men and women aged between 45 and 64 years of age.

The weight profile data they generated was not from a random or representative sampling of the Australian population, but of those people who’d been led to be concerned about their blood pressure and heart disease risks; so much so, they came to the free screenings. And who are the people being most hounded by scares that they’re going to die of heart disease and to be most likely to be over-represented? Fat people.

When we look at the weight status for various ages, they clearly rise through middle age, something that every population study has found since records have been kept. The authors, however, found this disturbing, as well, and stated that the middle-age “group of Australians are at greater risk of developing a spectrum of CV related outcomes largely attributed to their increase in weight status.”

Translation: See, we’re “supposed” to always have the same body (and indices) we had when we were 18 years old. That way, we’ll still have the same risks for heart disease that we had when we were 18 years old, too! [It doesn't really work that way, as much as we might like to believe so.]

Balancing the budget

To put price tags on their projections, they essentially assumed that obesity caused each cardiovascular risk factor and piled on the costs of treating EACH risk factor — meaning heart disease could be counted multiple times for each risk. The formulas they used for “estimating excessive costs due to obesity” were derived in part from correlations seen in a population study in Scotland and included, for example, blaming those with BMIs ≥30 for double the risks and costs for treating heart failure, 80% higher for hospitalizations for heart arrhythmias, 60% higher for heart disease and 40% for strokes. Each of “these unique data, when combined” with the BMI profiles taken from their screening results, “provide an ideal platform to project the number of excess cardiovascular-related events in Australia due to our expanding waistlines,” they said.

But, they said, things are really worse than their projections:

The main limitations of this report are the lack of specific long-term data to describe the morbidity and mortality related to CVD in Australia in addition to the direct and indirect cost of each CVD-related hospital admission and death. Therefore, our reported estimates are likely to be an underestimation of the true burden associated with the ‘Fat Bomb’.

This report was based on no evidential data, but since everyone “knows” fat is horrible and debilitating, we should trust that things will be worse. And everyone should disregard the evidence showing no link between body weight itself and heart disease.

The chapter on defusing the fat bomb is where things became simply comical. They used their psychic powers to “predict” the long-term savings that could result if every Australian lost 5 kg (11 pounds) in 5 months; and then if they lost 5kg more. They didn’t provide evidence for their proposals to accomplish this, nor did they include any of the costs of weight loss programs or the costs of their complications.

They tallied the potential savings from their contrived costs, in proportion to the weight lost, over the next 20 years. Yes, they assumed that the weight loss population-wide would be maintained for decades, which would be a magical feat, indeed, given that centuries of weight loss experts have failed to accomplish that, healthfully. [Starvation and famine don’t count.]

So, by their predictions, if every man and woman lost just 10 kg, they said cardiovascular-related hospital admissions would be cut in half! And save $472 - $1,272 million over the next 20 years.

They also predicted that losing 5 kg would cut deaths by a third and 10 kg would cut them by half... along with all of those hospitalizations and healthcare costs. They provided no support for these predictions... remember they had no data to go on.

The splat. In a misnamed chapter, “Realistic strategies to diffuse [sic] our future FAT BOMB,” they proposed their solutions for community-based incentive programs to change behaviors. Their solutions “depend on individual and collective desire,” they said.

"A varied diet of the ‘right’ type of foods," will supposedly get everyone slimmed down and healthy. Their list of diet solutions included every idea that's been given and tried by dieters... and has failed ... for decades:

Cut calories and increase exercise. Eat healthy diets from Asia and the Mediterranean to reduce calories. Drink plenty of water. Eat low salt. Drink less alcohol. Limit sugars. And finally, limit portion sizes.

Their last chapter, “Community-based strategies for weight reduction and control,” outlined the changes to homes and work environments, and lifestyles, to “better monitor” what people eat and their lifestyles. Their plan included “Healthy Towns” to achieve these fundamental changes; traffic-light food labels that put green lights on low-fat, low-calorie, low-sugar and low-salt foods; and raising costs of bad foods.

The activity component to “prevent the FAT BOMB from exploding,” included “the development of a healthier macro-environment.” To increase strenuous activity, their suggestions went beyond sports and jogging, to redesigning society to make walking and stairs necessary and reduce time people could spend at their computers and in front of television.

Yup, that’ll work. It’s based on the very same evidence behind every other obesity initiative in the developed world.

© 2008 Sandy Szwarc

Apologies if this post sounded a bit snarky, but it got really hard to take a professional paper about a FAT BOMB seriously.

As usual, you can click on images to see them larger.