[Paleopsych] NYT: C.D.C. Team Investigates an Outbreak of Obesity

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C.D.C. Team Investigates an Outbreak of Obesity
New York Times, 5.6.3
http://www.nytimes.com/2005/06/03/health/03obese.html

    By [2]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
    infectious disease.

    Kerri Kennedy, the program manager at the West Virginia Physical
    Activity and Nutrition Program, said the state had requested the
    agency's investigation.

    "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
    choices."

    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.