The Messenger or the Message? Part I

September 27th, 2009 by LHill Leave a reply »

July 30, 2009 :: By Morgan Downey

The ongoing furor over President Obama’s pick of Dr. Regina Benjamin as the next Surgeon General is to prejudice and obesity as the Harvard Professor Henry Lewis Gates’s arrest by Sergeant James Crowley in Cambridge, Mass., is to prejudice and race.

In both cases, it seems that a great magnet pulls part of the population to one side and part to the other side. After positions are staked out, we sort out the facts to fix our positions or, in some rare cases, to actually change our mind.

Dr. Benjamin’s opponents say that an overweight person cannot carry the message of healthy living. An ABC News report Is Regina Bejamin, Surgeon General Nominee, Overweight? – ABC News quotes former editor of the New England Journal of Medicine Dr. Marcia Angell stating, “I think it (the Surgeon General nominee’s weight) is an issue but then the president is said to still smoke cigarettes. It tends to undermine her credibility. We don’t know how much she weighs and just looking at her I would not say she is grotesquely obese or even overweight enough to affect her health. But I do think at a time when a lot of public health concern is about the national epidemic of obesity, having a surgeon general who is noticeably overweight raises questions in people’s minds.”“Grotesquely obese?” Is this not the crassest view of obesity that it offends my sense of beauty? And, is Dr. Angell aware of the scientific literature that even modest amounts of overweight may lead to increased risk of disease such as hypertension and type 2 diabetes? Does this mean that the Surgeon General cannot be a disabled person or someone with HIV/AIDS? I doubt she would say that.

The ABC NEWS piece neglected to mention Dr. Angell’s controversial editorial of January 1998 in the New England Journal of Medicine. In this editorial, Dr. Angell observed that weight loss efforts (which she acknowledged were nearly impossible) were “virtually ubiquitous among adolescent girls and young women. In middle schools and colleges throughout the country, girls who are far from overweight believe they are obese, or “gross.” (No citations in original). While dissing weight-loss efforts and physician counseling, she advised physicians, “Until we have better data about the risks of being overweight and the benefits and risks of trying to lose weight, we should remember that the cure for obesity may be worse than the condition.” Really, Dr. Angell? Eleven years later with obesity rates going through the roof, do you want to revisit that advice? Contrary to her statements to ABC NEWS, Dr. Angell closed by stating, “Finally, doctors should do their part to help end discrimination against overweight people in schools and workplaces. We should also speak out against the public’s excessive infatuation with being thin and the extreme, expensive, and potentially dangerous measures taken to attain that goal.”

Dr. Angell’s editorial produced strong reactions from obesity experts. William Dietz, MD and director of the CDC Division of Nutrition and Physical Activity wrote prophetically,

“You endorse the prevention of obesity but suggest that physicians “should provide advice if an overweight patient asks for help in planning a weight-loss program and recommend weight loss if a patient is suffering from health problems that can be ameliorated by weight loss.” This passive approach will not prevent weight gain in those at risk, nor will it prevent further weight gain in those who are already overweight. Furthermore, the rapid increase in body-mass index in the U.S. population over the past 15 years will most likely continue unabated if this passive approach is used.

The Massachusetts Medical Society Committee on Nutrition went on record opposing Dr. Angell’s editorial. In addition, the Committee took issue with an interview Dr. Angell gave to the Wall Street Journal on Feb. 9, 1998, in which she stated that some people “just like to eat — and in that case, it (obesity) is no more of a disease than bank robbery is a disease.” The Committee stated that such broad, unsubstantiated statements are inaccurate, inappropriate and irresponsible. The committee, whose members are physicians with extensive training and expertise in the fields of nutrition and obesity treatment, stands firm in its belief that obesity cannot be blamed solely on lack of willpower to control eating and activity. It also results from genetic factors affecting energy metabolism and eating behavior. Statements that belittle the life-threatening disease of obesity make a mockery of the plight of obese patients and undermine the medical profession.

Doctor Angell, you should take your own advice and unequivocally support Dr. Benjamin as Surgeon General regardless of her BMI.