[Part 1 is here.]
Kenneth W. Krause has a column in Skeptical Inquirer magazine in which, lately, he has been taking on fat activists. By comparison of this page and this page, he appears to be the same guy who tried to shame fat newscaster Jennifer Livingston into losing weight for the good of society. (I’m not trying to imply that Skeptical Inquirer is hiding Mr. Krause’s other activities, just that identifying people can be tricky because different people can have the same name. Note also that the Skeptical Inquirer articles I am discussing here are not available online.)
That was in 2012. In 2013, he took his anti-fat crusade to the pages of Skeptical Inquirer. Now, before Mr. Krause gets mad at me (assuming he ever reads this) for saying that he is on an anti-fat crusade, let me state that the first of this series, in the May/June issue, is relatively even-handed about the science of fatness. He starts off discussing why the energy balance concept (calories in = calories out) is an oversimplification, and that we need a better approach to fatness. He then discusses other hypotheses for fatness (hormonal imbalance, carbohydrates, lack of will power), and shows that they are all oversimplifications. But he can’t resist a “PS we hate you” at the end, stating the usual alarmist stuff about the “obesity epidemic” and how we must do something. (I agree, if that something starts with acceptance of fat people.)
But in the Sept/Oct issue, Krause tackles head-on the idea that fat could be a good thing. He starts with the most recent Flegal study, which confirmed that people in the “overweight” BMI category (between “normal” and “obese”) have the lowest risk of death (by a small margin), and that even the biggest fatties have only a modestly elevated risk of death (29% higher). Krause latches on to Flegal’s list of potential explanations, specifically the idea that the lower risk is because “heavier patients” (Flegal’s words) get better health care because they go to the doctor earlier. That actually sounds like an argument for Health at Every Size: “overweight” people can improve their health without losing weight. (And while this may be true for those in the “overweight” category, we larger fatties have had a different experience with the medical profession.) Even better, Krause himself admits that, among those with many chronic illnesses, fatties have better outcomes than thinner people (the “obesity paradox“). But he says that these people benefit from “a little, though never a lot, of extra weight.” (Then why is it called the “obesity paradox” and not the “overweight paradox”?) He concludes this part of the column with the following:
We should of course remain open to all potential subtleties regarding adiposity and health. But given the depth and breadth of the evidence associating extreme overweight with all manner of affliction, the primary public health objective must be to prevent both obesity and pre-obesity.
First of all: “pre-obesity”? Gimme a break. Second, more research is fine, but given that today we don’t know how to prevent or get rid of fatness in a way that works over the long term for most people, and since you (Mr. Krause) believe that better health care has given “overweight” folks longer lives, why not work toward better health care for the “obese” patients as well?
The next part of his Sept/Oct column looks at various diets (Paleo, Mediterranean, and vegetarian), showing that they all have flaws and none of them is for everyone. On that we can agree. But, you guessed it, he finishes by returning to the idea that we need to keep trying to lose weight, phrasing it as a way to give fat children “an opportunity for accomplishment and not . . . an excuse for regression to mediocrity.” Excuse me, pal: Fatness is not mediocrity; there are wonderful fat people who are exceptional musicians, writers, even (that’s right) dancers and athletes. Equating fatness with mediocrity is an opinion that is not based on science.
Finally we come to the latest (Jan/Feb 2014) issue of Skeptical Inquirer. This time he limits himself to a response to a letter, and here he takes off the gloves. He starts off with this gem:
Doctors tell people to lose weight because, by definition, that’s what obese and overweight people need to do.
Did we not just talk about this? Do you (Krause) not remember the paper that showed that the “overweight” had the lowest risk of death? Isn’t it clear that these definitions are unhelpful?
He then states, “And I don’t know of any doctor, dietician, or personal trainer who has ever advised a patient or client to go on a “yo-yo” diet.” Dude, look at the scientific evidence: weight-loss diets are yo-yo diets. He goes on to state that weight loss is “not impossible”. So you recommend an intervention that works 5% of the time because it is “not impossible” that it works?
He wraps it up by suggesting that we “frustrated and angry” fatties should have sympathy for health care professionals who are only trying to help. OK. But if they really want to help, they should stop using interventions that don’t work, and try the HAES approach, which has science behind it.