He who attends a lame person learns how to hobble along

Author: Elio F. Gagliano, MD
Article Published: 05/10/2007

It's said that he who attends a lame person learns how to hobble along. In other words, sharing experience with another or others may influence one's own perceptions and behaviour: for example, if one spends most of his time with softheaded folks, after a few years he'll have a good chance of becoming a cuckoo himself.

That’s what probably happened to Nicholas Christakis, who, in the July 26, 2007 issue of the New England Journal of Medicine, said that obesity is "socially contagious." This amazing discovery was made with the help of James Fowler, professor of political science.

I learned of this revolutionary finding only late in September, through a communication from the University of California at San Diego (UCSD), and was surprised, as a physician, not to have been urgently informed earlier! Such brilliance! An Epiphany!

Irony aside, think of this: in the USA, where, at least by recently lowered "official" thresholds, about everybody and his uncle is "overweight" or "obese," well, do you suppose some of these officially chubby persons might know one another socially? One would expect some margin of similarity in many aspects between social partners -- likes attract -- but who has not had both fat and thin friends and acquaintances? Who would not be enormously sceptical -- to say the least -- of the notion of people contracting "secondhand fat"? All of these questions have simple answers but the answer to the last is easiest of all. Lifestyle epidemiologists, all too often, are inclined to the least scepticism of the most hare-brained ideas.

Of course, according to the distinguished authors and their article in the esteemed NEJM, obesity in the USA is spreading from person to person in a social network. I will propose a far sounder hypothesis. If this study proves contagion it is the contagion of daftness amongst practitioners of lifestyle epidemiology. For proof of this we may turn not just to this study or any particular selection of studies but to the entire corpus of lifestyle epidemiology, reaching down to its roots, in the fascist era, and further still to the eugenicists who developed the fundaments of such statistical lunacy as Christakis et alia now present. Scepticism, the natural basis of science, is the natural bane of junk scientists. Sound analysis in lifestyle epidemiology has long been more rare than are skinny Americans. The cuckoos squawk ever louder over time. Here is what they tell us now:

From Christakis: "What appears to be happening is that a person becoming obese most likely causes a change of norms about what counts as an appropriate body size. People come to think that it is okay to be bigger since those around them are bigger, and this sensibility spreads."

From the UCSD: "The study -- the first to examine this phenomenon -- finds that if one person becomes obese, those closely connected to them have a greater chance of becoming obese themselves. Surprisingly, the greatest effect is seen not among people sharing the same genes or the same household but among friends. If a person you consider a friend becomes obese, the researchers found, your own chances of becoming obese go up 57 percent. Among mutual friends, the effect is even stronger, with chances increasing 171 percent."

Christakis also tells us: "When we help one person lose weight, we're not just helping one person, we're helping many." (Does this remind you of similar rhetoric about "more education" and "de-normalisation" to the end of "helping" all smokers to quit?)

Fowler, the political expert, adds: "And that needs to be taken into account by policy analysts and also by politicians who are trying to decide what the best measures are for making society healthier." (Does this not surely portend paternalistic intrusions and restrictions on overweight persons such as those increasingly wrought upon smokers?)

The UCSD announcement also notes: "Research funded by the US National Institutes of Health/National Institute on Aging".

By Jove, that is an important sponsorship! It's likewise interesting to note that partners of the Institutes include the American Pharmaceutical Association Foundation, Agouron Pharmaceuticals, Inc., and Aetna, Inc., which of course have their commercial interests, including a burgeoning interest amongst the pharmaceutical trade in touting their anti-obesity drugs.

Healthy foods and exercise, moderation of indulgences, avoidance of excess, in other words keeping mindful of keeping fit, is the most basic of health advice. I support such advice and I give it. On the other hand does a lot of "scientific research" -- perish the thought -- have to do with money-making? Could it be? It could. For instance, when looking into obesity-related issues recently I came across a touted event called Obesity Drug Development World 2007. Under a most interesting title, "Lean investment, large returns", among other things, we find:

"This is a huge market that is going to continue developing."

"In essence, the event is scientific but also covers the commercial angle."

Scientific ... huge market ... the commercial angle? Am I surprised? As much as by the notably unsceptical Christakis study? Just about that much. I wonder if I missed in the past something like Anti-smoking Drug Development World. That would have been a hot ticket too.

We may anticipate: the remedy to the contagious epidemic of fatness will be to isolate fatsoes and convince (force) them to get appropriate (especially costly drug) therapy. Clubs, schools, all public places (i.e. publicly and privately owned places) must forbid biggish individuals: others who might mistake largeness as an "appropriate body size" -- especially children and pregnant women who tragically might "think it is okay to be bigger" -- must be educated to the menace and protected from it even despite themselves. Foods must be banished from the menu by law even as the fatties are legislatively ostracised from society. The public must understand that tubbies jeopardize not only themselves but all those around them. They must learn what it is and is not "okay" to be.

Of course, the pimpled child, passive smoke, has begotten of its kind, a big fat lie about passive obesity. Christakis and Fowler are undoubtedly pioneers. Scientific studies proving the existence of the environmental fat germ can be expected to flow at least enough to grease every commercial angle. This will produce anxiety but will it make the world thin? No. People still smoke. People will continue to eat. Some will be fat as ever.

I am not saying that prudent attention to obesity is unneeded. My "J'accuse" is directed at slick methods, at an unseemly influence of pharmaceutical merchandisers, and panderers to these interests. Responsible programs of education and advice regarding healthy lifestyle and balanced diets are to be welcomed, including an emphasis on moving one's limbs, with far less emphasis on shots in the buttocks.

Hyperbole and alarmism are never welcome. The US Surgeon General has said, "Obesity may soon overtake smoking as the leading cause of preventable death in the US." I don't trust him or believe him. I recall his ridiculous statement, "Scientific evidence indicates that there is no risk-free level of exposure to second-hand smoke. Breathing even a little second-hand smoke can be harmful to your health."

It should be noted that there are people, including athletes, who may be above-average in weight while also being in excellent mental and physical condition. It is likewise important to keep balance in perspective. A single-minded outlook or obsession with weight is far unhealthier than a few extra kilos. It should also be well noted that overweight is no more dangerous to health than is underweight.

Furthermore civility and good humour are precious. Every person deserves respect. Many heavy persons are happy persons, most are fun and loving persons, and healthier by far than those who resort to fad diets and extreme regimens, or lapse into anorexia or bulimia, in worship of skinniness. Unhealthy dieting vexes both body and brain. I am particularly dismayed at the prospect of social discrimination toward overweight persons as we have seen imposed on smokers. This must not be allowed to happen!

Now we must await startling research on "passive boozing." In the meantime scary warnings are appearing on wine bottles patterned after those on cigarette packets. That shall be the subject of my next column here.

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