Dear Michael Fumento:
In your book The Fat of the Land you rail against what you call " 'fatlash' books" (including mine, Eat Fat), those that argue, in one way or another, for greater tolerance of obesity and more acceptance of fat. It's true: Such books mark a recent trend, personified by Glenn Gaesser's Big Fat Lies or Laura Fraser's Losing It. You fiercely reject those attempts to ease the stigma of fat and to put its risks in perspective. You belong to what you call "the obesity backlash backlash." Yours is the response of those who believe, and always have believed, that fat is unhealthy, ugly, and immoral--that, in your head and around your hips, you can never be too thin.
The backlash backlash transcends all conventional political distinctions: It goes from Susan Estrich on the left, who proclaims that "fat is no longer a feminist issue, [i]t's a question of health and personal responsibility," to you on the right, for whom there are no excuses for being fat and obesity is a sign of moral failure.
You write: "A lot of people are going to hate me for what I've done here. I've taken away their excuses. I've shown them in no uncertain terms that they're fat because they eat too much and exercise too little, and that if they think otherwise they've been dishonest with themselves." It is true: A lot of people will hate your book. It adopts repeatedly the same argumentative strategy you used in your first book, The Myth of Heterosexual AIDS. To prove your outrageous and politically motivated contention you needed to demonstrate that the AIDS victims who claimed in studies to have contracted the disease from prostitutes were deceiving their doctors; in reality, you say, they were homosexuals or needle addicts. Similarly, in The Fat of the Land, you maintain that studies that seem to mitigate the risks of obesity are in fact based on lies that fat people tell investigators. This is not a balanced look at the evidence. It is a rant that lacks all judiciousness, that echoes the tone and the terms of the worst sorts of alarmism.
The leader of the alarmist school of obesity research is Harvard's Dr. JoAnn Manson, who wrote the foreword to your book and whose stark conclusions are dramatically announced on the first page and underlie your most ominous pronouncements. Her 1995 study of 16,000 nurses called obesity an "epidemic" and calculated that 300,000 deaths a year could be attributed to it, making it the second-highest cause of death in America after smoking. In her conclusions, she was sharply critical of recent, more permissive tendencies to cut fat some slack, to lighten up on the perceived risks of being overweight. Her study, in turn, has come under sharp attack by other doctors and by those, like me in a chapter of my book, who dispute her methods and epidemiological conclusions.
Her statistic, 300,000 deaths, was recited like a mantra by the sponsors of Redux, the serotonin-enhancing diet drug, who last year were seeking FDA approval to distribute their product, dexfenfluramine. Redux, as you know, was recently withdrawn from the market by the FDA because of its suspected implication in heart-valve disease. Manson, when she wrote the study, was a consultant for the drug company, Interneuron, that developed Redux. She was present, ready to testify on its behalf, at the fateful meeting in November 1995 that many of us followed with deep concern. The commission narrowly reversed itself and was led to approve this terrible drug in the name of public health, despite deep misgivings. She was reprimanded later, in 1997, by the New England Journal of Medicine, for having written an editorial minimizing the dangers of Redux without acknowledging her connection to the drug companies.
It is estimated that 18 million prescriptions for Redux and fenfluramine, the serotonin-enhancing half of fen-phen, were written in the period after Redux came on the market last May. The most recent evidence suggests irreparable heart-valve involvement in as many as one-third of those who have taken the drug for as little as a month; millions are directly at risk. Anyone who has taken these drugs is urged to see their doctor.
My point is this: Alarmism surrounding the risks of obesity, represented by the two of you, works in the interest of the $40-billion diet industry and on behalf of pharmaceutical companies eager to exploit the vast potential for abuse that anorexic drugs represent. The potential consequences for public health are, in my judgment, much graver than the disease they claim to cure.
You systematically ridicule other diet books and push your own conventional regime of caloric reduction and exercise. But in the chapter you devote to diet pills, written before the latest revelations, you benignly suggest that there isn't "any cause for going on Redux unless [my italics] you've tried phen-fen [sic] and have had no success." This book is bad news.