Correspondence

More on the Obesity Problem

N Engl J Med 1998; 338:1702June 4, 1998

Article

To the Editor:

The Massachusetts Medical Society Committee on Nutrition wishes to go on record as opposing the editorial entitled “Losing Weight — An Ill-Fated New Year's Resolution” (Jan. 1 issue).1 The editorial contradicts the position held by the Committee on Nutrition in its publication Obesity Treatment Using Drug Therapy. In addition, we take issue with the view expressed by Dr. Angell in a February 9 Wall Street Journal article.2 In the article, Dr. Angell is quoted as saying that some people “just like to eat — and in that case it's no more of a disease than bank robbery is a disease.”

It is the opinion of the Committee on Nutrition 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.3,4 Statements that belittle the life-threatening disease of obesity make a mockery of the plight of obese patients and undermine the medical profession.

It is our responsibility to treat obese patients seriously and with dignity and to impress on the general public the importance of healthful eating and exercise. It is also necessary to impress on physicians the importance of screening for obesity and providing treatment and counseling to obese patients. In addition, the appropriate role of drug therapy as a component of a comprehensive medical plan must be emphasized.5

George L. Blackburn, M.D.
Richard J. Grand, M.D.
David J. Licht, M.D.
Brenda E. Richardson, M.D.
Elpidoforos S. Soteriades, M.D.
Harrison D. Willcutts, M.D.
Massachusetts Medical Society Committee on Nutrition, Waltham, MA 02154-1600

5 References

1
Kassirer JP, Angell M. Losing weight -- an ill-fated New Year's resolution. N Engl J Med 1998;338:52-54
Full Text | Web of Science | Medline

2
Johannes L, Stecklow S. Dire warnings about obesity rely on slippery statistic. Wall Street Journal. February 9, 1998:B1.

3
Chagnon Y, Perusse L, Bouchard C. The human obesity gene map: the 1997 update. Obes Res 1998;6:76-76
Medline

4
Borecki IB, Higgins M, Schreiner PJ, et al. Evidence for multiple determinants of the body mass index: the National Heart, Lung, and Blood Institute family heart study. Obes Res 1998;6:107-114
Medline

5
Committee on Nutrition. Obesity treatment using drug therapy: a revision of the report published May 15, 1997. Waltham: Massachusetts Medical Society, February 1998.

Author/Editor Response

Drs. Kassirer and Angell reply:

Blackburn et al. say 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.” Who can quarrel with that unexceptionable statement? We would add only that it does not exhaust the possibilities. Some people may be overweight because they prefer it to constant dieting.

The quotation from the Wall Street Journal article, taken out of context, simply referred to the difficulties of ascribing disease status to a behavior, such as eating or smoking or substance abuse. It was also meant to highlight, somewhat humorously, the associated tendency in our popular culture to attribute all sorts of antisocial behavior to an “illness,” as described earlier in the Journal by Fitzgerald.1 That is not to deny that obesity in some people may have a genetic basis nor that it can be a cause of some diseases, such as diabetes.

Our editorial was not meant to imply that obesity is harmless, only that its risks should not be exaggerated nor its antidotes accepted uncritically.2

Jerome P. Kassirer, M.D.
Marcia Angell, M.D.

2 References