Commentary

Fat Risks? Sumo, Some Less

By John Luik and Patrick Basham
This article appeared in the Washington Times on July 11, 2008.

Recent news dispatches from Tokyo have highlighted a new Japanese law that ranks as the world’s most aggressive, and possibly most ill informed, anti-obesity measure.

The law requires everyone between 40 and 74 years of age to have their waist measured. The requirement, which will cover almost half of the country’s population, stipulates that people whose waists exceed the allowable limit — 33.5 inches for men and 35.4 inches for women — will be given three months to get in to shape. Failing that, they will be given another six months of health re-education to reduce their waist measurements. Companies with large-waisted employees will be financially penalized.

The Japanese government argues that such draconian measures are necessary to prevent significant increases in diabetes and cardiovascular diseases (CVDs), as well as to rein in health-care costs. According to the Health Ministry, the underlying problem is metabolic syndrome (MS), which the Japanese call “metabo,” a collection of supposed risk factors, such as waist circumference, along with blood sugar blood pressure and cholesterol levels, which increase the likelihood of cardiovascular disease.

For the advocates of MS, risk factors such as waist size provide a much better indication of cardiovascular risks than Body Mass Index, the height-to-weight ratio that is the conventional obesity measurement. The argument is that fat is the real cause of MS, which puts the large-waisted at an increased risk of heart disease and sudden death.

Is this really so? Does MS actually increase the risk of heart disease? The answer from two studies published last month in the British medical journal, the Lancet, suggests it does not.

The studies, led by Professor Naveed Sattar from the University of Glasgow’s Faculty of Medicine, looked at the link between MS and CVD and diabetes in the elderly. Dr. Sattar and his colleagues focused on the elderly as the association between MS and CVD and diabetes in younger populations remains, as they note, “contentious.” As they observe, the lack of supporting evidence for a link between MS and, with it, waist sizes, and heart disease and diabetes, has led to significant questions as to whether MS can usefully predict the onset of these diseases.

To test the MS/waist-size-heart disease/diabetes link, Dr. Sattar used two prospective studies — the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) and the British Regional Heart Study (BRHS) involving more than 7,000 patients aged 60-82 who were followed for three years.

The results are astonishing: They completely discredit the assertion that MS, with its claims about waist size and heart disease risk, provides a reliable predictor of CVD. In both PROSPER and BRHS, there were no statistically significant differences in waist measurements, BMI, or blood sugar levels between subjects who had heart disease and those who did not develop it.

Metabolic syndrome, with its regime of measuring waist circumference, was not useful in predicting risk for heart disease in the elderly. As the authors note, “Our findings concur with data in middle-aged populations for whom criteria for MS are inferior to, and do not enhance conventional methods for, risk prediction of coronary heart disease.”

Lest these results be dismissed as a British quirk, the findings of the Cardiovascular Health Study, involving older Americans followed from 1989 to 2004 and published last month, refute the hysteria surrounding MS. The American study found that, after controlling for confounding factors such as smoking, drinking and physical activity, there were no statistically significant associations between heart disease mortality and the components of MS (waist measurements, cholesterol levels, etc.).

In fact, men and women with large waist sizes had lower risks for CVD mortality than the thinner-waisted. Moreover, these were Americans, who generally have larger waists than the Japanese.

The assertion that those with MS (particularly large waists) are likely to develop heart disease and run a higher risk of dying from a heart attack is unproven hysteria on the part of the obesity-obsessed public health establishment comparable to the discredited claims that those with BMIs in the overweight or obese category are likely to live shorter lives.

Let us hope this reassuring message reaches the Japanese before 50 million people are ordered to get their waists measured, let alone sent for obesity re-education, in the phony belief that there is a connection between a small waist and avoiding a heart attack.

Patrick Basham directs the Democracy Institute and is a Cato Institute adjunct scholar. John Luik is a Democracy Institute senior fellow.