April 1, 2004 (Ira Pilgrim)

Obesity and Cancer

A fat man is no good in war; he can neither fight or run away.

American proverb

The April 24, 2003 issue of the New England Journal of Medicine had an article entitled 'Overweight. Obesity, and Mortality from Cancer in a Prospectively Studied Cohort of U.S. Adults." It was considered important enough to be featured on the two main evening news programs. The study involved over 900,000 adults and concluded that the fatter a person is, the greater the chance is of that person dying of cancer.

It was a very careful study and the data indicate that the fatter a person is, the greater his/her chance is of dying of cancer. The conclusions in the abstract that "Increased body weight was associated with increased death rates for all cancers combined and for cancers at multiple specific sites." is supported by the data. However , the further extrapolation that cancer deaths can be prevented if "men and women could maintain normal weight," is not. The study did not address the important question of why obese people die more readily of cancer. The increased death rate could be associated with an element related to the cause of obesity, such as an increased intake of a carcinogen such as those found in broiled meat. A further problem has to do with the difficulty of early diagnosis of a malignancy in an obese person. It could also be related to a gene or genes that cause certain individuals to make fat more readily. In other words, even if more obese people die of cancer, no one knows why.

It has been known for a long time that cancer is a disease of well nourished people. People living at the edge of starvation get less cancer than those who are well nourished. People who live on the edge of starvation also die of other things before they get old enough to get cancer.

I was looking at some photographs with my wife, and I remarked, "Those are big women." My wife asked, "Do you mean that they are overweight?" There is a big difference between saying that someone is big and someone is overweight. To say that someone is big or small, thin or fat, white, brown or black is to describe something, To say that someone is overweight is to make a value judgment that implies that there is some ideal weight and that a person who is over that or under that is, in some way, abnormal. In the case of "overweight," that implies that being over that normal value is undesirable, or bad, bad, bad. Being underweight can, depending on your point of view, be desirable or undesirable; usually depending on the degree of skinniness.

If we weigh a lot of people and average them, we will find that there is a mean or median weight and that everyone who isn't close to that average is considered to be either below average or above average. That average weight will depend on which population is being measured. There will be a different average for Tonga than there will be for Sweden. Does that mean that many people will be "abnormal." The answer is "Yes."

The word "abnormal," taken literally, simply means that some people are very different from the norm, or average. However, the word "abnormal," often implies illness. If you are abnormal, there is something wrong with you. But it ain't necessarily so. Beethoven was clearly abnormal, and the world is all the richer for it. By the same token, Adolph Hitler was clearly abnormal, to the detriment of the world.

It is fairly common for men, like lumberjacks, who do strenuous physical work to develop a belly when they retire. I suspect that this is because they don't change the eating habits that they had when they were working to conform with a sedentary life. The Italians have a saying, "He is a man with a belly." which implies that he has made it and is important. He no longer has to exert himself physically and can eat as much as he wants. In other words, he has made it.

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