Is it real or is it Memorex?

You’ve no doubt heard the news, reporting on a new study claiming to have shown that fat people are in denial and don’t know they’re fat. Astonishingly, no reporter or professional medical writer has noted the statistical errors revealed in the study.

Meanwhile, obesity stakeholders have been hand wringing about that very same study which reveals their efforts to market an obesity crisis may have been too successful and is showing signs of backfiring. Growing numbers of people aren’t buying what they’re selling.

Is it because fat people are in denial or was the authors’ other admission closer to the truth?

The authors of the study admitted that those photos of gargantuan fat people in health information and the media have been deceptive and don’t accurately portray obesity. The exaggerated images worked to help create public perceptions of a crisis — if people had been shown accurate representations of the obesity epidemic, most people would have realized they were being misled long before now. But the hype is now making it harder for obesity stakeholders to target their larger intended market. They’re moving forward to re-spin their message.

Before we look at the study that’s putting such a bee in everyone’s bonnet, here’s a sample of the news, for those who might have missed it:

Britain in denial over weight as 1 in 4 refuses to accept they are obese

Growing numbers of Britons are failing to realise they are overweight despite soaring levels of obesity, experts have warned. Research shows that obesity levels have almost doubled in recent years but one in four adults is in denial about their bulging waistline.

Writing in the British Medical Journal, the researchers said it seemed that being overweight was increasingly being accepted as the norm. As a result, millions may be failing to realise their health is at risk...

'Photographic illustrations often depict severely obese people, untypical of the overweight population,' said Professor Wardle. 'This might act as false reassurance for those who are "merely overweight", implicitly reinforcing a perception that messages about healthy eating and exercise are not aimed at them.'

In an accompanying article, Professor Sara Bleich... said: 'If a considerable proportion of overweight people misclassify their weight, they may ignore important messages about modifying their lifestyles. Correcting misconceptions about weight is not simple and represents one piece of the complicated puzzle that is the obesity epidemic - a problem that requires concentrated efforts and the local, national and global levels, which needs to capitalise on evidence the shape public health policy.'

The study referenced in this news story was a consumer survey conducted by the British Marketing Research Bureau. The poll results were interpreted and written up by authors from the Cancer Research UK in London, which consults with government in shaping public policy and funded the study, along with the Economic and Social Research Council.

Once again, what do we know about surveys done by marketing agencies? [Answer.] Consumer marketing polls, even those published in medical journals, are not scientific research. That was our first clue to look at the report closely for what public opinions they’re trying to shape.

For those unfamiliar with Cancer Research UK, which wrote and funded this paper, it’s been a leader in promoting an obesity crisis and calling for widespread government programs targeting diet and exercise-based solutions. According to the Cancer Research Policy Statement, rates of overweight and obesity in the UK have doubled since the 1980s. “Wrongly, only 3% of adults, when asked, described themselves as obese,” it states.

Its policy statement goes on to claim:

In the UK, estimates suggest that up to 12,000 cases of cancer a year could be avoided if no-one exceeded a body mass index (BMI) of 25... Less than a third of people in the UK are aware that being overweight or obese can increase their risk of cancer. [The evidence has continued to find these claims unsupportable.] There is a clear need to raise awareness of the links among the general public and offer guidance about how to maintain a healthy weight.

The need for Government action. We believe that a multi-faceted and integrated obesity prevention strategy is necessary to tackle existing and projected trends, including initiatives that increase levels of physical activity, improve dietary quality and reduce energy intake... Cancer Research UK believes that more should be done in this area as a matter of urgency.

Once upon a survey

This paper in the BMJ compared polling results from a survey conducted in 1999 with another survey that had been conducted on a different group of people in 2007. The authors noted that the “data collection methods were not identical between the two surveys.”

In both surveys, household addresses were said to have been randomly selected, but within each household, one adult was selected for a computer-assisted face-to-face interview. In 1999, a total of 1,894 people had been surveyed, with the pollsters including the findings of 95% of those interviewed. In 2007, they polled 1,998 people, but excluded nearly one in ten for not providing “adequate data on height and weight,” another selectivity that wasn’t explained. Only 89% of the data from women was included and 95% from the men.

The people who’d participated in the two surveys also differed. The most notable difference was that in 2007, the pollsters included 77% more people in the “obese” category and 9% more in the overweight category than they had in 1999. The average weight among the men and women included in the 2007 survey was 7 pounds higher than those who’d been surveyed in 1999 (165 and 158 pounds, respectively), with average BMIs of 26.

The authors then reported in the article’s text that “the proportion of respondents whose BMI placed them in the obese category had nearly doubled, from 11% to 19% .” This was reported in the media as “obesity levels have almost doubled.” Reporters appear to have effectively been taken in by another case of “Once Upon a Time.” Actual population statistics haven’t seen such increases in the past decade.

Given that we don't know how the poll questions were phrased or interpreted, we’re left to only surmise what’s real and what is Memorex. But it’s not hard to arrive at different interpretations of their published findings from what they presented.

The authors reported that the surveys had been conducted similarly in both poll years. The participants were asked to report their heights and weights, which the authors used to calculate their BMIs. The participants were then said to have been asked to “select a descriptor for their own body weight from the following list: very underweight, underweight, about right, overweight, and very overweight. The 2007 survey also included the category 'obese.’”

According to the authors, there was an increase in the number of people who felt their body weights were about right, from 45.7% in 1999 to 47.3% in 2007. But, by the authors’ calculations, only 44.2% of people had “normal” weights and could justify that claim.

They also reported that among those polled who they’d calculated to have BMIs in the “overweight” or “obese” categories, 81% perceived themselves to be “overweight or very overweight” in 1999; but in 2007, only 75% reported themselves to be “overweight, very overweight, or obese.” In light of what they purported to be skyrocketing obesity rates, the authors saw this 6% difference as a serious concern. One blamed on the fat people: “The changes indicate a marked decline in sensitivity with respect to individuals’ detection of their own overweight.”

Memorex marketing spin

Imagine if you were Dr. Dee in the Land of Incognita, trying to sell your invisible toe fungus medicine. What would your marketing people believe to be the biggest crisis of all? Answer: If more people thought their feet were lovely and didn’t believe their toes were diseased and in need of your remedy.

The authors began their interpretations of their poll results by stating that “inaccurate recognition of weight status is a threat to healthy weight control.” If fat people “fail to identify themselves as targets” (yes, they used that term), then their public health messages are more likely to fail.

Attention needs to now be turned towards increasing “awareness of weight status among those who are overweight or obese,” they said. “A considerable proportion of overweight adults — men in particular — do not recognise that their body weight is too high, and many parents fail to recognise that their children are overweight,” they said. [As we’ve seen, this claim is popular but the realities illustrate the absurdity of the definitions being used to label more children as overweight to create epidemic numbers.]

Fat people need to be made aware they’re fat, the authors urged policy makers. The authors reported that 70% of those who were overweight and 94% of those who were obese identify themselves as fat, rates they felt were problematic. Their report, however, noted that weight status was still most strongly associated with perceptions of being weight. Most fat people know they’re fat and significant numbers of people in other weight categories also see themselves as fat. Those with BMIs in the overweight and obese categories were 3.7 times and 4.8 times, respectively, to see themselves as overweight or obese.

The authors also negated concerns that heightened messages about health dangers of obesity could be harmful or risk contributing to eating disorders and lead more women, especially, to “inappropriately” see themselves as overweight. To support this assertion, they claimed that there’s been no increase in anorexia and that they’d found that fewer women of normal weight perceived themselves as being overweight. They made no reference to the documented increases of eating disorders among children and adults of all BMIs. Nor have many consumers heard that even this paper’s own data showed 1 out of 5 women in the “normal” weight category thought they were overweight.

The authors speculated as to the reasons for the “declining ability of overweight individuals to recognise that their weight is too high.” The first factor they suggested is that it’s become socially acceptable to be fat, supporting the “social norm hypothesis” and pointing to the “beneficial role of social comparison.” They don't appear to read mainstream media or the medical literature. Social stigma and discrimination against fat people, especially women, is prevalent and increasing, even exhibited in national newspaper articles, such as a recent one about the “social usefulness” of shouting abuses at fat people — ignorantly attributing fatness to “stupidity, laziness and gluttony” — articles that would never be acceptable if they were about another group, such as minorities or homosexuals; and online discussions that reveal, let’s just say, some less creditable sides of humankind.

There is no evidence that social discrimination and stigma is anything but unhealthful and harmful for the targets of such abuse, and adversely affects their healthcare. The fact that nearly half of the adults polled, regardless of their size, had been able to retain a positive body image in the current culture is remarkable.

Another explanation given by the authors for why fewer fat people are purportedly recognizing they have a weight problem appeared more directed to obesity stakeholders and the media. They blamed the “images that often accompany media and health information.” They admitted that depictions of obesity have been exaggerated in efforts to promote an obesity crisis. As they acknowledged: “Photographic illustrations often depict severely obese people, untypical of the overweight population.” Incredibly, people can be easily misled believe what they think they see with their own eyes. They believe that there really is an epidemic of gargantuan people (without heads), as seen on television, and that those images represent the obesity epidemic. Most consumers would be astounded to learn the actual percentages of the population that are those sizes.

Humans have always come in a variety of sizes, with those at the extremes in height and weight less prevalent than those closer to the mean. Everyone knows those images that have exemplified the obesity epidemic. When we hear that more than a third of the population is obese, those extreme images are what everyone now thinks of.

According to CDC Behavioral Risk Factor Surveillance System statistics, the largest Americans, and those most depicted in the media, with BMIs ≥50 — a man 5’-11” tall and weighing 360+ pounds or a 5’-4” woman weighing 291+ pounds — represent 0.5% of our population. Even people weighing 100 or more pounds over government recommendations (BMIs ≥40) represent only 2% of the population.

The study authors closed by saying too many overweight and obese individuals are failing to recognise that they’re overweight and are resistant to accepting disease labels they see as stigmatizing. The study authors didn’t consider the possibility that growing numbers of fat people aren’t in denial, but are becoming more savvy of the evidence. Nearly all those who fall into today’s clinically-defined BMI categories of “overweight” and “obesity,” aren't diseased or lazy gluttons as is being portrayed.

An assistant professor in health policy at Johns Hopkins Bloomberg School of Public Health in Baltimore, MD, wrote an accompanying editorial in the same issue of BMJ. In it, Sara Bleich said: “Healthcare professionals have a role in correcting misconceptions about weight” and she called for doctors to be trained and given incentives to manage overweight patients. Based on this survey, she also called for comprehensive approaches to change public perceptions and educate the public about the obesogenic environment and create public campaigns that focus the blame on the entire society. “Working with the popular press and television industry to diminish negative stereotyping of obese people” and redirect it to the environment that makes overeating and sedentary activity inescapable, was a key to promoting their obesity policies. The obesity epidemic, she wrote, is “a problem that requires concerted efforts at the local, national, and global levels, which needs to capitalise on evidence to shape public health policy.”

We need no further evidence that this survey was marketing.

© 2008 Sandy Szwarc. All rights reserved.