Casazza and colleagues offer a list of seven myths about obesity in the New England Journal of Medicine. They claim that people who should know better – physicians, medical researchers, academics, epidemiologists, even! – believe these myths and perpetuate them with attendant harms (not making the world a better place) and benefits (but making their careers better). Here’s a brief table of the myths (click to enlarge).
The review team also identifies what claims about obesity that are supported by – hold your hats – experimental data as opposed to Fairy Tales. The list (click to enlarge).
The authors take pains to criticize the obvious and continuing failures of the research community to apply the standards of science on the problem of obesity and amazingly employ persuasion principles to explain this eternal recurrence. I’m hearing voices in my head.
Why do we think or claim we know things that we actually do not know? Numerous cognitive biases lead to an unintentional retention of erroneous beliefs. When media coverage about obesity is extensive, many people appear to believe some myths (e.g., rapid weight loss facilitates weight regain) simply because of repeated exposure to the claims. Cognitive dissonance may prevent us from abandoning ideas that are important to us, despite contradictory evidence (e.g., the idea that breast-feeding prevents obesity in children). Similarly, confirmation bias may prevent us from seeking data that might refute propositions we have already intuitively accepted as true because they seem obvious (e.g., the value of realistic weight-loss goals). Moreover, we may be swayed by persuasive yet fallacious arguments (Whately provides a classic catalogue) unless we are prepared to identify them as spurious.
Now I’m swooning. Marilyn Monroe just walked up to me and gave me a big wet kiss and pledged undying love and attention. Or something like that. Picking myself up from the floor, regaining composure, and now thinking, what do we make of this?
First, thanks for the confirmation. Many of the concerns raised in this paper underscore much of my take on obesity in particular and lifestyle factors in general. When you read the Methods and Results instead of the Discussion or the press release rewritten in the New York Times you tend to miss the part called science. As this article demonstrates, many people who think of themselves as scientific, are not. Please. Please. Read the Methods and Results. If science was easy everyone would do it and we’d all be Sheldon Cooper.
Second, notice what you don’t see on the Fact list. Nothing about Sitting versus Standing. Nothing about Large Size Soda Servings versus Small Size Soda Servings. Nothing about Calorie Counts on a Menu, Bottle, or Can. Nothing. Neither as cause or effect, none of these active areas of research rise to the level of fact for qualified observers. Here’s an interesting thought experiment. Ten years from now these researchers revisit Obesity Myths and Facts. Where do you think Sitting, Calorie Counts, and Large Servings will appear?
Third, some of the concerns seem directly contradictory to persuasion theory. Take the myths about the effect of planning and goal-setting. The researchers assert that there’s no evidence to support the hypothesis which is not the same thing as saying planning and goal-setting don’t work. I’d argue as I often do in this area that the problem isn’t with the theory, but with the people doing the theory. Many interventionists simply do a lousy job at these interventions precisely because they are trained in medicine and not in persuasion. As I frequently criticize on the Persuasion Blog, researchers will assert that they did PersuasionPlay54 on weight loss (or any other lifestyle factor) and PP54 failed. However, when you read the Methods, you realize they did not implement PP54, they just said they did in yet another demonstration of General Semantics. But, instead of eating the menu, they eat the textbook!
Fourth, I fear you’ll continue to read mythic research in NEJM or JAMA as people will continue to possess a human nature susceptible to persuasion. While science is the Great Corrective to human nature, you still have to overcome your human nature to do science. As many entries in this blog demonstrate, even at the coolest Cool Table journals, researchers continue to sell sand to Sauds, ice to Aleuts, and persuasion to persuaders with their bad science wrapped in great persuasion. Consistently applied, the principles of this paper would require the NEJM to retract most of the Tooth Fairy work from the Harvard epi boys and girls already published, but most certainly to reject without review all future Tales. Hmmm. To quote the immortal Wayne Campbell from Aurora IL: And monkeys might fly out of my butt.
Fifth, see the amazing and continuing presence of persuasion in science of all places. People who are supposed to know better by every standard of judgment simply cannot surpass the limits imposed by persuasion. Past all my wailing and lamentation over the destruction of science, see all the persuasion opportunities. Assuming you can park your sincerity at the door, you can make a killing on the very people aimed at stopping the killing. And you can make the biggest killing with the smartest guys at the coolest Cool Tables. Combine incentives with Dissonance Reduction and you get a river of Fairy Tales. These guys feel better about themselves and their work the more money they spend on their research. Just hang around their office door. Ask them to autograph a reprint of one of their Fairy Tales. Plus they like really good food and wine as we’ve seen.
This paper shouts blessings and curses. Mavens are truly fortunate to have Other Guys this easy, ripe, and luscious. But, curses fall upon us all from those who delude themselves as scientists. We profit while we lose.
Krista Casazza, Ph.D., R.D., Kevin R. Fontaine, Ph.D., Arne Astrup, M.D., Ph.D., Leann L. Birch, Ph.D., Andrew W. Brown, Ph.D., Michelle M. Bohan Brown, Ph.D., Nefertiti Durant, M.D., M.P.H., Gareth Dutton, Ph.D., E. Michael Foster, Ph.D., Steven B. Heymsfield, M.D., Kerry McIver, M.S., Tapan Mehta, M.S., Nir Menachemi, Ph.D., P.K. Newby, Sc.D., M.P.H., Russell Pate, Ph.D., Barbara J. Rolls, Ph.D., Bisakha Sen, Ph.D., Daniel L. Smith, Jr., Ph.D., Diana M. Thomas, Ph.D., and David B. Allison, Ph.D. (2013). Myths, Presumptions, and Facts about Obesity.
New England Journal of Medicine, 368:446-454.