Are we getting all the facts about weight?
By Sally E. Smith and Janey Milstead
"In the scientific world, if a new research finding doesn't fit with the (mainstream belief), it is called an anomaly. If enough anomalies accumulate, they challenge the current paradigm. When this happens, our belief system about this 'truth' crashes. A new truth dawns and the process starts over again." So asserts Cheri Erdman, Ed.D., who teaches at Illinois' College of DuPage.
The prevailing belief of the mainstream scientific community can be summed up as "fat-is-bad/thin-is-good." While being larger than average was once seen as a positive attribute, Twiggy-esque ideals began to haunt the public's and medical community's consciousness'. Indeed, scientists now view someone with a high body weight as having a chronic disease requiring lifelong treatment. Dietary and behavioral changes, along with pharmaceuticals, have been promoted as the way to achieve and maintain thinness, which is now equated with health and longevity. As a result, a weight loss industry with annual revenues of $33 billion now exists in the U.S.
However, the anomalies to the mainstream belief that extra weight is harmful are accumulating, with a growing body of research demonstrating that permanent weight loss is achievable by only a small percentage of those who attempt it (approximately 3-5%); that some methods of weight loss can be harmful (remember Redux and fen-phen?); that for some people, conditions associated with a higher weight (high blood pressure, gallstones) may actually result from weight loss attempts; and that large people can improve their health without ever losing a pound.
Thus, the scientists who conduct the research that results in this new information are challenging the current paradigm about weight. In addition, this renegade research rings true for a growing number of nutritionists, health educators, therapists, physicians and other health care professionals, who find that these theories validate their clinical experience.
The question then becomes, why haven't we, the public, heard about the theories and research that may point to an alternative view of weight? Is there a coven of diet industry bigwigs out there, cackling around a cauldron of Slim-Fast and conspiring to keep this research suppressed? Has media bias resulted in the underreporting of important scientific findings? Or is it something far less sinister - simply a number of factors that make changing public perception a Sisyphian task? In fact, there appears to be evidence to support all of the above.
But before we start, let us first review the machinations of the world of research publishing. In order for a study to be considered legitimate by both the scientific community and the media, it must be published in a peer-reviewed journal. The Journal of the American Medical Association and the New England Journal of Medicine are examples of these. After a researcher's study is completed, s/he must write a paper on the subject and submit it to a journal. That journal editor then sends the paper out to experts in the field to be critiqued. No one receives payment of any kind: not the writer or the reviewers. If the paper doesn't receive the amount of favorable commentary the journal requires, it is returned to the sender unpublished.
Being published is the lifeblood of researchers. Publication or lack thereof impacts whether or not they receive funding for future research, their standing at the academic institutions at which they're based, and their level of credibility within their field. "Publish or perish" is the axiom of those who inhabit this world.
The experience of psychologist David M. Garner, Ph.D. may support the conspiracy theory. Dr. Garner, who is widely published in the field of eating disorders and is an adjunct professor at both Bowling Green State University and the University of Toledo, as well as the director of the Toledo Center for Eating Disorders, says, "For many years, there has been a problem with research that led to conclusions that are critical of the traditional weight loss industry."
About a decade ago, Garner and his colleague, Susan C. Wooley, Ph.D., Professor Emeritus at the University of Cincinnati College of Medicine, submitted an article to a major scientific journal for review. The article, which was used as a background document for the House of Representatives' 1990 committee investigation of the diet industry, was critical of the traditional dietary and behavioral treatments of obesity.
"The scientific review process for our paper was disturbing, to say the least," Garner says now. Their paper was sent out to three experts for review, and came back with mixed conclusions. Garner and Wooley addressed most of the concerns in what they considered a thorough fashion and resubmitted the article. According to Garner, "Apparently, the journal editor could not make up his mind and sent the paper out to other experts in the second round of reviews."
Eventually, the article was rejected, in part on the basis of another expert's review. "We were sent this review as support for the editor's decision," says Garner. It was only later that they found out that a highly favorable review of their paper, written by Paul Ernsberger, Ph.D., a biomedical researcher at Case Western Reserve University, had been suppressed by the journal editor, in that Garner and Wooley never received a copy. "Dr. Ernsberger later sent me a copy of his review, which was one of the most scholarly and complimentary reviews I have ever received - or in this case, not received," recalls Garner. "Clearly, the failure to forward a copy of this review reflected editorial policies rather than fair and impartial science."
Ultimately, their article, "Confronting the Failure of Behavioral and Dietary Treatments for Obesity" was reviewed by the editor of Clinical Psychology Review and was accepted with editorial accolades. It was published in that journal in 1991.
Esther Rothblum, Ph.D., a professor of psychology at the University of Vermont who is the preeminent researcher on weight and social stigma in this country - if not the world - had similar experiences. "One expert reviewer wrote that the findings in one of my obesity studies were not valid 'because they differed from those currently held by psychologists,' and went on to cite Glamour magazine - in a prestigious medical journal! - to back up this point," she says, incredulously.
As for how the mainstream media reports studies that go against the mainstream, Dr. Susan Wooley's experience suggests that they often simply dismiss it. When she was interviewed on 20/20, for example, the ever-combative John Stossel's response to her findings was "Why should we believe you? You're fat yourself. Couldn't you be biased?" Wooley (who, when asked for a photo to accompany this article responded, "Oh, I don't have a new one. Just tell them I look like a queen-size Sandra Dee with brown hair") recalls, "I was introduced on the program as an expert, and it took them three minutes to discredit me."
According to Wooley, for many decades research has revealed that diets really don't work and the reasons why, and that powerful genetic influences affect body size. However, she says, "We're just beginning to hear about it from major media sources."
Ed Silverman, a reporter for the New Jersey Star-Ledger, articulates the trap that many journalists fall into when he says, "There is a working assumption that all fat is bad, along with a cultural bias. This is just more justification for harping on the dangers of fat, and reporters tend to turn to sources who validate that belief."
To Glenn Gaesser, Ph.D., an associate professor at the University of Virginia and a fellow of the American College of Sports Medicine, one of the more annoying falsehoods endlessly repeated by the media is the statistic that "300,000 people die each year from obesity." That sound bite originated with former Surgeon General C. Everett Koop during the launch of his organization, Shape Up America. Gaesser resolved to find the source of that statistic, and discovered it in a study done by Foege and McGinnis. Much to his surprise, the study never mentioned weight. Instead, it said that 300,000 deaths each year were related to a combination of dietary factors and sedentary lifestyles.
Why has this bogus statistic become a media mantra? According to Silverman, "The average reporter...often (doesn't) have time to really delve into the subject. As a result, you miss the more sophisticated nuances that lurk behind the machinations, and you get people in the media who take Koop's pronouncements for granted, not knowing his non-profit organization is funded by grants from the weight loss industry."
Silverman knows something about the way that economic interests may influence the manner in which research is promoted or suppressed. In 1997, he and a colleague at the Star-Ledger completed a year-long investigative report, "Fat Pills, Fat Profits," which, among other findings, clearly demonstrated that "Some of the doctors, researchers and scientists who shape the public's perception of obesity and what the government should do about it accept money from companies that profit from weight loss pills and programs."
From a startling diagram accompanying their series of articles, one can clearly see how some might view the mainstream obesity research community as incestuous. Almost half of the members of the National Institutes of Health (NIH) Task Force on the Prevention and Treatment of Obesity (the federal government's weight-related public health policymaking committee, which we - as taxpayers - support) are affiliated with the diet-industry-funded American Obesity Association. Two of these scientists are members of a council funded by Knoll Pharmaceuticals, makers of the diet drug Meridia. And both Koop and Shape Up America's executive director are on the advisory council of the American Obesity Association.
In the early '90s, a NIH panel reviewed all of the studies on weight loss, and found that, instead of improving health, weight loss actually increased mortality. Dr. Glenn Gaesser recalls being told by a reputable source that, "one of the panel members actually said, 'I don't believe it, and even if it's true, we can't let the American public know about it.'"
Given that the vast majority of research money is provided either by the National Institutes of Health or by pharmaceutical companies, one may wonder whether the policymakers' potential conflicts of interest has an impact on the types of research that are funded.
When discussing the molasses-like speed of change in shifting the weight paradigm, some authorities also point a finger at the public. "The diet industry doesn't want to hear this, but people don't want to believe it either," says Pat Lyons, RN, MA, director of Connections Women's Health Consulting Network. "So instead of promoting a healthy lifestyle for people of all sizes, we have an unenlightened 'fat-is-bad/thin-is-good' consciousness." Lynn McAfee, director of the Medical Advocacy Project of the Council on Size and Weight Discrimination, says, "People have to change, too. We have to be willing to change our perceptions instead of preferring to keep our illusions."
Despite the seeming damning evidence, most experts don't see a conspiracy at work. Instead, they feel that mainstream obesity researchers are simply the reigning royalty within the present structure. According to Dr. Cheri Erdman, "Research (from the new weight paradigm) isn't so much suppressed as ignored." Dr. Gaesser concurs, saying, "There is very selective use of literature with regard to size. Pharmaceutical companies quote directly from findings in their favor and dismiss any study that shows otherwise. If it's anything about improving health independent of weight loss, those references are not publicized."
Dr. Esther Rothblum attributes the difficulty of getting published less to conspiracy and more to cultural bias. "It's always very hard to be at the vanguard of anything," she says. Her theory is that it takes people time to 'get it,' regardless of the subject. "Years ago, I was asked questions like, 'Why would you be studying women?' and 'Why bother to analyze gender?' That's funny now, but that's how people think."
Lynn McAfee also doesn't believe there's a conspiracy at work. She says with conviction, "As for an organized effort on the part of the diet industry to prevent the public from finding out the truth, that is not happening." She believes that, "They make individual attempts to ignore the research, but they're not 'in it together.' They hate each other too much to do anything together, even something this vital to their survival. The diet business is that competitive."
Instead, they suggest that perhaps the fact that we haven't heard as much about the alternative theories of weight is due less to collusion, and more to a collision of cultural bias, a lazy media, economic interests and a public clinging to the old "truths." Time will tell whether the "anomalies" to the current dogma about weight will reach critical mass, and thus crash the belief system. If they do, it will be interesting to see what new truth rises from the ashes.
Whatever The Truth may be, we consumers should probably bear in mind that science is Big Business, and therefore, not always as objective as we might assume. Ultimately, we should keep in mind that our health is individual and that what works best in our lives is our own personal choice.