In case you missed it, this week’s featured cover story in Woman’s World Magazine, available at the register in every supermarket and drugstore in the U.S., claims to have found the next weight loss miracle. But I’ll save you the $1.79 and reveal the identity of this “miracle” food – it’s chia seed. It’s even endorsed by TV’s Dr. Bob Arnot.
Logically, we all question whether munching chia seeds will melt fat, but we still might buy the magazine. It’s like getting a lottery ticket – we know the odds are against us, but maybe just this once we’ll hit pay dirt. Millions of us shell out hard-earned cash in hopes of finding the golden weight loss cure, creating a $60.9 billion weight loss industry in the U.S.
Businesses are also investing in weight-loss, and the cost to them is significant. Over 90 percent of employers offering health insurance report investing in some kind of wellness program, usually designed to address the many health and disability costs associated with the increasing girth of the workforce. As discussed in one of my earlier Forbes.com posts, the research on whether they are seeing returns for these programs shows that, so far, the answer is no. The harsh reality is that scientists know as much about curing obesity as they do about curing the common cold: not much. But at least they admit their limitations in treating the cold. Many doctors seem to think the cure for obesity exists, but obese patients just don’t comply. Doctors often have less respect for obese patients, believing if they would just diet and exercise they’d be slim and healthy.
Some physicians notably take exception to the blame-the-patient approach to the obesity epidemic. “In case you hadn’t noticed, the obese will do anything not to be obese, even throw their money away on ‘get-thin-quick’ schemes,’” says Robert H. Lustig, MD, in his new book, “Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease.” The book details the evidence and concludes that research overwhelmingly discredits the notion that the obese bring the whole thing on themselves. “Obesity is a combination of several factors: physics, biochemistry, endocrinology, neuroscience, psychology, sociology and environmental health, all rolled up into one problem,” Lustig explains, “The factors that drive the obesity pandemic are almost as myriad as the number of people who suffer from it.”
Physicians, Heal Thyselves
Connecting the advice doctors give to the scientific evidence is the point of a new commentary on obesity appearing this week in the electronic edition of the respected New England Journal of Medicine (NEJM), Myths, Presumptions, and Facts About Obesity.
The authors identified seven common myths repeated in the media by purported medical experts. These range from the number of calories burned in sexual activity to the value of physical education classes to the notion that burning 3,500 extra calories leads mathematically to a one-pound weight loss. The authors document how conventional wisdom parts ways with the actual evidence.
Unfortunately, though the effort to connect medical advice to medical science is noble, the article is less so. To these NEJM authors and the NEJM itself, sadly we must say: Physicians, heal thyselves. The NEJM authors suffer the same disease that they accuse their myth-making colleagues of in their article: unscientific bias-itis. These authors disclose that they have been paid by and/or sat on the boards of dozens of food and beverage giants and industry advocates, as well as pharmaceutical companies. One of the authors, David B. Allison, has faced so many ethical questions about the objectivity of his obesity research that ABC News did an investigative story on him in 2011.
These ties don’t in and of themselves discredit the article; researchers often get money from industry without compromising their objectivity. But the content of this particular article rules out even the veneer of objectivity. Specifically, the article contains a strange omission: Readers can’t easily figure out what these authors think obese people should eat. In fact, a distillation of the recommendations and analyses in the article finds a grand total of two pieces of specific advice on what obese people should consume to lose weight, both presented as “facts”:
1. Provision of meals and use of meal-replacement products promote greater weight loss.
2. Prescription drugs can help.
Given that several of the authors have serious ties to the meal-replacement diet company Jenny Craig and other authors to pharmaceutical companies, the article is so blatantly consistent with authors’ commercial interests – it’s hard to elevate this beyond the credibility of an infomercial.
We Need Our Doctors
No doubt there is some science behind the value of meal-replacement products and prescription pills, and the food and beverage industry have every right to promote their products — indeed their businesses help fuel our economy and create jobs. But it’s a different story for the doctors and for the publishers of NEJM. Even the appearance that they are putting the interests of anything ahead of their patients undermines public trust.
To its credit, NEJM enforces a policy of author disclosures, which is how we know about the author conflicts described here. But transparency doesn’t absolve the Journal’s editors from their responsibility to offer guidance for physicians and other readers that is as objective as possible.
Whether it’s Woman’s World or NEJM, American medicine disappoints in the face of the obesity epidemic. Obesity poses challenges unprecedented in human history. It threatens the health of our children, our society, our government and our business community. We need our doctors to get us through this. Instead, too often we get hucksterism, unscientific advice and a blame-the-victim mentality that is failing this generation and threatening the next.
We need the best and the brightest of American medicine to face the facts about obesity, admit they don’t know all the answers, pledge to fight for their patients instead of disparaging them, and commit to the highest levels of scientific and research integrity in pursuit of a cure.