STAR-LEDGER - February 1997

The harshest critics of the diet industry say that Americans are being inundated with information about the risks of obesity that is not always accurate.

The problem, they say, is that many proponents of fat facts are sponsored by pharmaceutical companies involved in diet drugs or other segments of the weight-loss industry.

At best, there is considerable difference among experts about the facts.

Among the more disputed statements are:

"Obesity is an epidemic."

"Physicians can no longer sit on the sidelines as America's obesity epidemic reaches crisis levels," said former US. Surgeon General C. Everett Koop, founder of Shape Up, America!

Others say the Issue is overblown.

"It's a serious health problem, but I wouldn't call it an epidemic," said James Bilstad, a Federal Drug Administration official who oversaw the recent approval of Redux, the first diet drug sanctioned In 23 years. "It's not a word I would use."

Fred Hassan, an executive vice president of American Home Products, which sells Redux, concedes that "obesity is not an Infectious disease."

"One-third of the adults In this country are obese."

Last month, a study by the Centers for Disease Control and Prevention and the state health department found that 24 percent of New Jersey residents are obese. And nationally, the CDC said, nearly 27 percent of the population is obese.

Julianna Kasper, a Bristol-Myers Squibb marketing vice president said: "There are 60 million adults in the US. who are obese."

Obesity, however, is really a moving target. There are no uniform medical definitions, nor is there agreement on what constitutes overweight.

Some like the CDC and the NIH, rely on the Body Mass Index, a formula for calculating obesity.

"It's a useful benchmark," said Michael Rothkopf a Florham Park physician with an extensive weight-loss practice.

Others use older gauges.

"I look at the ideal body weight," said Christine Scott, a dietitian at Summit's Overlook Hospital. "It's really a numbers game."

Standard weight charts are based on half-century-old data and assumptions that have been repeatedly revised and criticized. Constructed by actuaries at the Metropolitan Life Insurance Co., the tables dictate that weight gain after age 30 is unhealthy. This now-discredited theory that rests on the notion younger people have lower mortality rates than older and, typically, heavier people. "Tables of ideal and desirable weights make as much sense as tables of ideal and desirable heights -- that is, they make no sense at all," said Glenn Gaesser, a University of Virginia associate professor of exercise physiology, who wrote "Big, Fat Lies," a book that attacks assumptions about dieting. "All we learn from the life insurance data is that, as you get older, you are more likely to die not exactly an earth-shattering revelation."

The Body Mass Index presents similar problems. The formula was established by federal researchers who studied 20,000 people in the late 1970s. But it was based on people in their 20s and those in the top 15 percent weight class the heaviest people were declared obese and at premature risk of death.

Yet, an obvious reality was ignored. Most people gain weight as they age.

"You really can't be a slave to the weight tables," said Reubin Andres, an obesity specialist at the National Institute on Aging In Baltimore. "Their standards are too heavy for young people and probably too thin for those who are older."

"It is now recommended that even a modest weight loss of 5% to 10% is better than none at all."

This statement appears in brochures that American Home Product's Wyeth-Ayerst unit distributes to doctors in touting Redux. American Home Products, of Madison, best known for Advil and Primatene Mist, markets Redux, while Interneuron Pharmaceuticals, of Lexington; Mass., makes it.

But there is no evidence that a modest weight loss is any easier to maintain than a major weight loss. Experts differ on who benefits most from modest weight loss.

Glenn Cooper, chief executive of Interneuron, said thinner people would probably benefit most as they approach a so-called ideal range. Kenneth Storch, a Florham Park physician and weight-loss expert, said heavier people would probably benefit since they'd be losing more weight and a larger percentage of body fat.

But Timothy Seaton, a senior medical director at Knoll Pharmaceuticals in Mt. Olive, whose diet drug was recently rejected by a Food and Drug Administration advisory panel although it may still get approved, simply shrugged: "I don't know of any studies that distinguish a difference."

There is some evidence that people with high blood pressure or diabetes can benefit from a modest weight loss. But the argument of modest weight loss for most is predicated on the notion that lower-weight people live longer, a contention disputed in many quarters.

Perhaps the most oft-cited study is a 1995 paper written by a team of Harvard Medical School scientists that concluded body weight had some bearing on longevity. But a recent article in the International Journal of Obesity, compiled by scientists at Cornell University and the Centers for Disease Control, concluded the health risk of being overweight remains equivocal despite almost a century of investigation.

Yet another 1995 study, published by the Institute of Medicine, found risks in weight loss, especially If weight is regained. And regaining weight is common after ending a regimen, whether it consisted of dieting, drugs or exercise.

"Obesity kills."

"Obesity is a silent killer," said Interneuron's Cooper.

"It kills 300,000 people a year," said Richard Atkinson, head of the American Obesity Association.

Thousands of overweight people die each year. But there is considerable disagreement about the cause. Andres, of the National Institute of Aging, contends the major population studies of obesity failed to show a link to an increased risk of death.

Here's the problem: Fat on bodies is often confused with fat in the arteries, which is the real culprit in coronary artery disease. Studies show a link between obesity and clogged arteries, but nothing indicates obesity is a direct cause.

Autopsy studies conducted by Ancel Keys of the University of Minnesota and Yogesh Patel at Louisiana State University found the same thing neither body fat nor weight was related to clogged arteries.

Studies also show obesity is a poor predictor of high blood pressure and high blood fats. Steven Blair of the Cooper Institute for Aerobics Research in Dallas found most people with a common form of diabetes can improve their health with changes in diet and exercise, even if they remain at weights thought to be obese.

In a lengthy and respected study issued In 1995, the Surgeon General's Office reported that 250,000 deaths could be attributed annually to a lack of physical activity. But critics say that many physicians mistakenly presume that lack of physical exertion equals obesity.

According to Gaesser, there are plenty of fat people who are physically fit and not in any grave danger of dying. Conversely, there are plenty of thin people who won't exercise and are in danger, but don't know it because of the present emphasis on obesity.

The confusion seems to stem from a 1993 article in the New England Journal of Medicine that attempted to trace all causes of death in the United States that couldn't be attributed to genetic factors. Combining deaths from syndromes that are often associated with obesity, such as high blood pressure, physical inactivity and diabetes, the article concluded that between 300,000 arid 500,000 people die from obesity in any given year.