Oh, you guys. For a minute there, I was so excited to see this David H. Freedman piece in the Columbia Journalism Review on the problems with personal-health journalism–a topic about which I’ve written a gazillion blog posts and part of a book. (The link came via my science-writer friend Robin Marantz Henig, who prefaced it on Twitter with, “Lots to disagree w here, but lots to chew on, too. Should get science journos talking for a long time.” I probably should have braced myself better.)
When I saw that Freedman started off with a recent Tara Parker-Pope article in The New York Times about the futility of dieting, I was even more excited. That subject, in particular, is what gave rise to my own strong feelings about the sorry state of health journalism. How lovely to see someone else take it seriously as an example of research gone wrong, time and again!
Then I kept reading. And fuck me if I wasn’t suddenly motivated to sit down and start fisking like it’s 2008.
Freedman:
There’s really just one problem with Parker-Pope’s piece: Many, if not most, researchers and experts who work closely with the overweight and obese would pronounce its main thesis—that sustaining weight loss is nearly impossible—dead wrong, and misleading in a way that could seriously, if indirectly, damage the health of millions of people.
“Many, if not most.” Well, that sure clears up which researchers you’re talking about, what their conclusions are, and how they arrived at them! And “experts who work closely with the overweight and obese” obviously implies unbiased people of science, rather than folks whose primary income is derived from weight loss-related products and services!
What else have you got?
…the fact that many programs and studies routinely record sustained weight-loss success rates in the 30-percent range…
Again, would it kill you to cite this? And to specify things like how long those studies followed their subjects, or how much weight the average person lost, and whether they regained some percentage of it? Because when you start to look at those details, you find things like–I’m making this up rather than finding you an example, because I never claimed to be a proper science journalist, but trust, it’s not pulled completely out of my ass–”a third of participants maintained a 5% reduction in body weight over one year.” Which could mean that someone like me–5’2″ and 215 lbs.; the scientific term is “obese as fuck”–lost 20 pounds (a nearly 10 % reduction!), gained back 10 in the first year, and ended the study at 5’2″ and 205 lbs. SUCCESS! (And never mind if 5 years later, I weigh 225. That’s way beyond the scope of the study.)
Seriously, that is what the typical weight-loss-study “success story” looks like when you read past the press release, folks.
Freedman again:
…most experts have insisted for some time now that successful, long-term weight loss requires permanent, sustainable, satisfying lifestyle changes, bolstered by enlisting social support and reducing the temptations and triggers in our environments…
Again, who are these experts? I mean, do you need some help here? Walter Willett of the Harvard School of Public Health is one example of an obesity researcher who strongly resists the notion that permanent weight loss is unsustainable for the vast majority of people who attempt it. That’s off the top of my head. Maybe you could just use Google Scholar to search for some of his work, if you wanted to include a citation anywhere in these claims?
And hey, can you clarify what you mean by “permanent, sustainable, satisfying lifestyle changes”? Oh, wait, you did: ”…the so-called ‘behavioral modification’ approach typified by Weight Watchers.”
Blink.
Blink blink.
To recap: in your critique of someone else’s scientific research on weight loss, the very first name you drop is Weight Watchers. How’s your weight, by the way, sir? I imagine it’s difficult to exercise with brass balls.
People, in case you don’t have time to read a whole other post, let me just point this out: the “sustainable, satisfying lifestyle change” Weight Watchers put me on the last time I used their services was a 1200-1300-calorie diet. Of course, Weight Watchers deals in healthy, sustainable “POINTS,” and not evil, failure-inducing calories. So what if POINTS are derived by counting calories (50 = 1) and adjusting slightly for fat and fiber intake (>5 grams of fat= +1; >5 grams of fiber = -1)? And so what if staying on Weight Watchers permanently would qualify me to hang out with people who practice extreme calorie restriction in hopes of living, literally, forever? IT IS NOT A DIET SHUT UP.
Where was I?
Echoing the sentiments of many experts, Barbara Berkeley, a physician who has long specialized in weight loss…
Sweet Jesus, it’s a source! A source who makes a living promoting weight loss. And who “wants you to know that she practices the principles laid out in Refuse to Regain as a method for controlling her own weight, and has successfully maintained a 20 pound weight loss for approximately 8 years.”
Impressive! And I mean that sincerely, because very fucking few people manage to do that much. But do you recall what BMI category I’d be in if I lost 20 lbs.? Obese! And you know who else that’s true of? Most obese people!
Freedman also links to a HuffPo blog post by David Katz, M.D., director of Yale’s Prevention Resource Center, author of multiple weight loss books, and founder of the Turn the Tide Foundation, which aims to “develop, evaluate, and disseminate creative, yet practical programs to empower individuals and families to achieve sustainable weight control and robust good health.” So clearly, that’s a dude with a wide open mind about whether long-term weight loss is possible for most people.
What other evidence does Freedman offer that sustained, substantial weight loss is possible for even 30 percent of people?
Most of us know people—friends, family members, colleagues—who have lost weight and kept it off for years by changing the way they eat and boosting their physical activity. They can’t all be freaks of biology, as Parker-Pope’s article implies.
Well! There’s some bulletproof science!
In fact, I do know two people in my very own gene pool who lost a great deal of weight and kept it off. The first was my mom, who controlled her Type 2 diabetes with diet alone for over a decade (i.e., “reversed it” in the wishful language of current weight loss boosters), and never needed insulin injections–right up until she died of a heart attack at 64 anyway, after many years of declining health. The second is my cousin, who had a big chunk of stomach and esophagus removed. I mean, it’s true that starting out obese probably helped her not die from esophageal cancer (she’s an 8- or 9-year survivor now), but the point is: She lost weight and kept it off! So can you!
Never mind that all three of my siblings and I have lost and gained back the equivalent of at least four more obese adults; that our father has yo-yoed for much of his 77 years; that both of our grandmothers and one grandfather were obese, and all lived into their eighties or nineties. (The other grandfather died of heart disease in his thirties.) And never mind all of the friends I have in my real life, plus all the readers I had when I was blogging at Shapely Prose, who have lost weight and gained it back, usually more than once. Usually much more than once. In the world of responsible personal health journalism David H. Freedman envisions, anecdotes about the futility of dieting are lazy substitutes for research, but anecdotes about long-term weight loss totally count.
To be fair, Freedman does eventually link to a 2007 study from the Journal of the American Medical Association, one I’ve linked to many times myself, and cited in my own book.** Hooray for actual science that doesn’t come from a HuffPo blog or one called “Refuse to Regain!”
Of course, Freedman uses that study to support the statement that “more than one in 20 deaths in the US is a premature death related to obesity.” I usually use it because that study found that overweight BMI is associated with significantly decreased mortality, and although obesity is associated with significantly increased mortality from cardiovascular disease (so with my family history, I’m quite possibly screwed; the question is whether I can magically make the weight disappear), it’s “not associated with cancer mortality or with non-cancer, non-CVD mortality.” In other words, the big picture is significantly more complicated than “overweight and obesity kill,” but whatever. [Update: That very study was just updated, and the new version released this week. This time, they broke obesity down into 3 grades, and found the lowest grade--i.e., the category most obese Americans fall into--is not associated with higher mortality.]
All right, I’m already bored with this, so I can only imagine how you, dear reader, are feeling. Before I go, though, let me reiterate that the reason I’m so incensed by this piece is because I completely agree with Freedman’s original premise: that science journalism is easily messed up, and both journalists and researchers need to do better at conveying accurate information to the public. I REALLY WANTED TO LOVE THIS FUCKING ARTICLE, YOU GUYS. (I still do love the graphics!)
But Freedman’s decision to hang an argument about journalistic and scientific integrity on “many” unnamed researchers, a couple of blog posts fisking a New York Times article, the premise that “most of us know” someone who disproves theory X, and motherfucking WEIGHT WATCHERS, is equally baffling and infuriating–unless this is a really high-concept piece and his whole point was to personally demonstrate the problem he describes.
Finally, Freedman slams Parker-Pope for highlighting a small, inconclusive study–which she fully acknowledges as such–but a UCLA meta-analysis of diet outcome studies, published in 2007, concluded basically the same thing: “The benefits of dieting are simply too small and the potential harms of dieting are too large for it to be recommended as a safe and effective treatment for obesity.”
And no, that study does not distinguish between “dieting” and “permanent lifestyle changes.” If someone wants to point me toward even one study that shows “permanent lifestyle changes” working for obese people–and by that, I mean a study involving a large number of formerly obese people who lost weight and kept it off for the rest of their lives, because otherwise, we’re just guessing about the “permanent” thing, aren’t we?–I will seriously reconsider the conclusions I’ve drawn from the research I’ve done on the topic.
Until then, I’m going to stick with the considered opinion that “permanent lifestyle changes,” as distinct from “permanent dieting,” are little more than a marketing gimmick and a myth that allows obesity researchers–who frequently have ties to commercial weight loss programs and/or pharmaceutical companies developing diet drugs–to continue blaming their many failed attempts to create long-term weight loss on the desperate people who keep coming to them for help.
