[Paleopsych] NYT: C.D.C. Team Investigates an Outbreak of Obesity
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Fri Jun 3 19:38:21 UTC 2005
C.D.C. Team Investigates an Outbreak of Obesity
New York Times, 5.6.3
By GINA KOLATA
For the first time, the Centers for Disease Control and Prevention has
sent a team of specialists into a state, West Virginia, to study an
outbreak of obesity in the same way it studies an outbreak of an
Kerri Kennedy, the program manager at the West Virginia Physical
Activity and Nutrition Program, said the state had requested the
"We were looking at our data," Ms. Kennedy said, and saw that "we are
facing a severe health crisis."
The state ranked third in the nation for obesity - 27.6 percent of its
adults were obese, compared with 20.4 percent in the country as a
whole. And, Ms. Kennedy said, "our rate of obesity appears to be
increasing faster than the rest of the nation."
Going along with the obesity was a high prevalence of diabetes and
high blood pressure, which are associated with extra pounds. West
Virginia ranks fourth in the nation for diabetes, with 10.2 percent of
the population affected, compared with 6.4 percent nationwide. And it
is No. 1 in its prevalence of high blood pressure, with 33.1 percent
having the condition, compared with 25.8 percent of people nationwide.
So the state asked the agency's disease detectives to tackle its
obesity problem, and a three-week investigation began on April 25. It
focused, Ms. Kennedy said, on two places that represented towns and
cities in the state - Gilmer County, with 7,160 residents, and
Clarksburg, a city with 16,743 residents.
The investigative teams spent a week and a half in each place, going
to schools and asking about physical education programs and about what
sort of food was provided. They asked, for example, whether students
"were offered at least one or two appealing fruits and vegetables
every day," Ms. Kennedy said. And "would you replace regular sour
cream with low-fat sour cream?"
They went to workplaces, asking whether there were policies to
encourage physical activity. For example, Ms. Kennedy said, "if you
choose to walk, could you have an extra 15 or 20 minutes added to your
lunch break?" And, were there items like 100-percent fruit juices and
bottled water in vending machines?
They went to random grocery stores and restaurants, asking whether
they offered fruits and vegetables and skim or 1 percent milk. And
they asked whether it was safe to walk along the roads, whether there
were sidewalks and whether they were in good repair, whether there was
good lighting for walking at night.
"The C.D.C. came up with the questions for us," Ms. Kennedy said. But,
she noted, many of the questions, like the ones about sidewalks, were
designed for urban areas. She said she was not sure how well they
would work in rural West Virginia, and some statisticians said they
did not think the study would work at all.
Dr. Julie Gerberding, the director of the disease centers, said in a
press conference yesterday that this type of investigation was a first
for the agency.
"This has never happened in the history of the C.D.C," she said.
The centers held the news conference to clarify its position on weight
and obesity. Agency scientists recently published a study concluding
that overweight people had a lower risk of death than normal-weight
people and that even obese people did not have much of a risk of early
death unless they were extremely obese. A year earlier, different
researchers at the agency published a study saying that obesity and
extra weight were markedly raising death rates in this country.
Obese people were defined as having a body mass index, a measurement
of weight in relation to height, of 30 to 34.9; the extremely obese
had an index of 35 or higher.
Dr. Gerberding said that there were still questions about the best
ways to estimate death risks from extra weight but that there was no
question about the health impacts of being obese or overweight, which
can increase the risk of diseases like diabetes, high blood pressure,
arthritis and some cancers. Being obese or overweight, Dr. Gerberding
emphasized, are "critically important health threats" and the agency
is increasing efforts to understand the causes of the obesity epidemic
and how to help people lose weight and keep it off.
The West Virginia data are now at the agency, being analyzed. Some
preliminary information may be available in August, Ms. Kennedy said.
Rudy Philips, a 27-year-old clinical nursing assistant who lives in
Clarksburg, said that he was unaware of the study, but that he knew
something of the dietary problems in the state. He himself had a good
diet, he said, and while "I could stand to lose 5 or 10 pounds, I am
not obese." But obesity is a problem in the state, he observed.
"We tend to eat a lot of fried foods, we're meat-and potatoes type
people," Mr. Philips said. "Most restaurants don't have healthy
But some statisticians said it was hard to see what could be learned
from the agency's investigations.
Daniel McGee, a professor of statistics at Florida State University
who has analyzed obesity data, burst out laughing when he heard about
it. "My God, what a strange thing to do," he said.
"They'll find out what we all know - that the country is no longer set
up for physical exercise," Dr. McGee said. And that schoolchildren
"don't get a nutritious diet." And that "there is a lot of high-fat
food on the shelves of every supermarket."
But, he said, "that doesn't tell you much."
"I'm sure skinny people go to those same restaurants," Dr. McGee said.
"Skinny kids go to those same schools."
David DeMets, a professor of biostatistics at the University of
Wisconsin, was also extremely skeptical.
"We get a lot of false positives from that kind of investigation," Dr.
DeMets said. "We get people worried," but there is no way to know
whether what is found - a lack of fruits and vegetables in the
schools, for example - has anything to do with the obesity epidemic.
"Perhaps it is true, perhaps it is not," Dr. De Mets said.
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