A special article was released in the New England Journal of Medicine today, entitled "Myths, Presumptions, and Facts about Obesity." The piece was written by David Allison, Ph.D. and his colleagues who work in the health research fields. Allison and his group lay out seven popular "myths" (contradicting known scientific evidence) and identify six "presumptions" (lacking scientific evidence) with regard to weight gain and loss. Finally, they outline nine scientific facts relevant to sound messaging about healthy weight and how to achieve it. The reason for this seemingly trite paper? According to the article:
"False and scientifically unsupported beliefs about obesity are pervasive in both scientific literature and the popular press."
And we are all to blame.
In the scientific world, we live by the tenet "association does not assume causation." That is, just because two things happen to be related, does not mean that one caused the other. A recent popular example is that there is a strong association between per capita chocolate consumption and the number of Nobel laureates in that country. It is true that there is some compelling research regarding the positive cognitive effects of the polyphenols found in chocolate, but downing a few extra Hershey bars does not a laureate make.
Regardless, some scientist did the study. And The New England Journal of Medicine reviewed and published it. And the popular media ate it up. (No statistics have been released regarding the sale of chocolate bars, but it wouldn't be surprising to see a bump in Mars' profits right around the time of publication.)
Part of the problem comes into play with the types of research that examine health and how the data is interpreted. We have (generally) three types of studies: population, individual, cellular. Population studies show associations, which are the conclusions that tend to be extended into presumptions or, even worse, myths. Unfortunately, these studies are more often than not the end-all for media and food industry messaging. When, in the scientific world, these studies are really only useful as very general roadmaps -- guiding researchers where to look deeper. Randomized trials, evaluated at the individual and cellular level, are really the only way to demonstrate causation and until those studies have been done, the correlational results are simply conjecture.
When facts based on causal evidence get lost or are lacking, the message becomes muddled. An example Allison uses in his paper is: "Large rapid weight loss is associated with poorer long-term weight outcomes than is slow, gradual weight loss."
When, in fact, several studies he cites demonstrate this is not necessarily the case. But we have heard it so often from well-meaning personal trainers, nutritionists, and doctors that we have all come to believe it -- possibly to the detriment of many a dieter.
When the narrative becomes so ensnared in repetition alone, no matter how factually or poorly informed, professionals and the public alike default to, "Oh, that makes sense," rather than, "Where's the evidence?" This is how myths and presumptions grow legs and run. Worse yet, when some entrepreneurial ideologue wants to sell a product, or write a book, or get on TV, the message gets even more bogged down in bias and truth-stretching. Unfortunately, real people suffer when facts regarding health are misinterpreted or twisted to conform to an agenda.
To avoid and correct a plethora of misinformation, researchers, academic journals, industry, government officials, popular media journalists, and the public share a collective obligation to ensure accuracy and honesty. As professionals in the realm of health science, messaging, and policy implementation, we have a responsibility to ensure that the information disseminated to the public is cogent and factual, not simply based on correlation or, worse, marketability. As consumers, we have the responsibility to ask for proof of health-related claims and declarations. For, only by impartially educating ourselves -- from consumer to journalist to researcher -- can we ensure that the information we guide our lives by is reasonable, reliable and true.
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