Researchers have estimated that obesity contributes to 300,000 deaths in the U.S. every year. Putting aside the junk science nature of this estimate (i.e., population or "attributable" risk estimates are inherently faulty), given the relative severity of the obesity problem, you would think that anyone REALLY interested in public health would be in favor of whatever helps people lose weight and keep it off.
Anyone, that is, except many in the public health community. With them, it's "their way or the highway." And their way is behavior control. No fast food, sweets, snack foods, Chinese food, Italian food, grease, taste, flavor... you get the picture. And eat less of whatever it is you do eat.
A current example of this is the new fat substitute olestra.
Now, the target is diet drugs. And, not coincidentally, just in time for the first diet drug approved by the Food and Drug Administration in 20 years.
Abenhaim et al concluded that the appetite suppressant drug Redux substantially raises the risk of pulmonary hypertension, a life threatening lung condition.
The researchers found that those who had used the drug for more than three months had a 23-times-higher rate of pulmonary hypertension than nonusers. Sounds like a lot BUT:
Based on their data, the authors acknowledge that pulmonary hypertension is very rare (i.e., 1 case annually per 500,000 inhabitants). In comparison, the reported annual rate of lung cancer in nonsmokers is 1 in 10,000. So while the "relative" risk is great, the "absolute" risk is minuscule.
Publicity about a possible association between diet drugs and pulmonary hypertension may have increased referral of patients treated with drugs to study hospitals (detection bias). Unaccounted for differences between patients and controls in their recall of drug treatment may have also biased the data (recall bias).
According to Manson and Faich, if only five additional control patients had been treated with appetite suppressants, the risk estimated by Abenhaim would have been halved. (As if it wasn't microscopic enough already!)
Because Abenhaim et al.'s analysis did not entirely eliminate the possibility that at least some of the pulmonary hypertension observed was independently caused by obesity, a causal association between Redux and pulmonary hypertension could not be clearly established.
Thus, although appetite suppressant drugs may not be absolutely risk-free, obesity is a far more serious risk.
This story made me think of those immortal lyrics of the late Root Boy Slim,
"Death by chocolate" certainly beats being told how to live based on junk science!