Friday, December 31, 2004


People Shoving Food In Their Mouths - Not McDonald's or Burger King - Make People Fat

This Study recently published in the Lancet is outrageous. Their claim is that fast food, in and of itself, causes type-2 Diabetes, obesity and heart problems. They say that they have controlled for all other variables and that fast food consumption more than three times per week leads to the aforementioned health problems. The only problem is that there is no controlling for the variable of personal responsibility. Only persons living in caves for the last fifty years would not have at least some idea that fast food is not good for you. Yes, it is quick and inexpensive, but that comes at a price. Much like the tobacco companies, the fast food industry has been attacked in recent years for peddling a product which can have bad health problems. And, like the tobacco companies, never is the choice of the person to smoke or eat fast food taken into account. Now the tobacco companies have been harshly - and rightfully so- punished for advertising to kids and covering up their own evidence that nicotine is addictive and causes cancer. However, fast food companies, to my knowledge, do not put "addictive chemicals that make you crave it fortnightly" (special acknowledgment to anyone who correctly identifies that movie quote), and there is no law against their marketing to children. In a related article, one researcher is quoted as saying:

Fast-food restaurants may argue that the evidence that customers are being super-sized by their meals is too weak. But should customers not be given the benefit of the doubt? Appropriate action would be to reduce portions to normal sizes, and to sell burgers of lean meat, whole-grain bread or buns, fat-reduced mayonnaise, more vegetables, lower-fat fried potatoes, and reduced-sugar soft drinks. Although the price may be increased, at least such changes in fast-food meals can have no adverse health effects.

The only problem is that there is no evidence that the above meal is any better. Moreover, just by changing the composition of the fast food, you do nothing to the food one eats at home. I guess the next logical step is to outlaw selling anything that the Lancet thinks is bad for your health.

Another big problems here is that there are huge behavioral differences in people that manifest as a propensity to eat fast food, smoke, drink or engage in other unhealthy activities, or not. A case in point: several years ago, a large clinical trial looking at women who had taken hormone replacement therapy made the conclusion that the HRT dramatically lowered the incidence of heart disease and osteoporosis. We later found out that this conclusion was not correct. What really had happened is that all the women who were taking HRT generally were more health conscious. They tended to have a more healthy diet and exercised more. Healthy eating lead to better heart health and exercise lead to decrease in osteoporosis. When the study was repeated, this time in a prospective fashion so as to control more variables, the previous conclusions were not borne out. This is the problem with most large retrospective studies - there is no control of many confounding variables. So does fast food cause type-2 diabetes - we do not know. The only way to tell would be to have one group eat fast food 3 times per week and another group not eat the fast food and have both groups eat the exact same diet otherwise, participate in the same amount of exercise and all participants must have the same genetic predisposition to diabetes. We will never know the answer.

Finally, the attack on the fast food industry is another example of trying to take care of the symptom, instead of the problem. As a doctor, I would never give pain medication alone for an infection. While this would dull the pain, it simply would not solve the problem. Here, the fast food industry is not the problem, personal choice and irresponsibility are the problem. Trying to regulate or eliminate the symptom will not change the fact that there is no social doctrine which says that staying healthy so as not to unduly stress the resources of your community is wrong and borders on immoral. So enjoy your Whopper or Big Mac, just don't do it too often, eat reasonably at other times and exercise - these are the things will keep you from getting fat.

UPDATE: Maybe the fact that Obesity is rising sharply among US preschoolers has something to do with why they are becoming diabetic earlier.

Update #2: Anonymous correctly identified the quote as being from "So I Married An Axe Murderer" but inocrrectly identified it as awful.

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