An article in the New England Journal of Medicine debunks much of what we think we know about obesity, diets, and weight gain/loss. If the authors' assertions are true, should there be a call for the dissemination of more accurate information to the public and a cessation of misleading product advertising?

Much Fiction Found in Obesity Reporting

By Cole Petrochko, Staff Writer, MedPage Today

Published: January 30, 2013

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Press reports and scientific writing on dieting, weight gain, and obesity are burdened by false or unproven claims, a literature review found.

A search of popular media and scientific literature showed seven myths and six presumptions about obesity were prevalent in text, mostly related to false or unsupported claims about caloric intake or expenditure and dieting, as well as breast feeding, environment, and types of food eaten, according to David Allison, PhD, of the University of Alabama at Birmingham, and colleagues.

Along with pervasive myths and misconceptions, the authors listed nine facts and the practical implications they have for health policy and in clinical recommendations. They published their findings online in the New England Journal of Medicine.

"When the public, mass media, government agencies, and even academic scientists espouse unsupported beliefs, the result may be ineffective policy, unhelpful or unsafe clinical and public health recommendations, and an unproductive allocation of resources," Allison and colleagues noted.

To establish what misinformation was prevalent in popular and scientific literature, the researchers gathered data from Internet searches of mass media and published studies about common myths and misconceptions related to weight gain or loss and obesity.

The authors defined myths as claims that persist despite contradicting evidence, while presumptions and misconceptions were defined as beliefs that persist without supporting scientific evidence.

Myths addressed related to weight loss included the idea that small sustained changes in energy intake or expenditure produce longer-term weight changes; that realistic goal setting leading to fewer frustrated attempted weight-losers; that rapid loss of great weight was associated with poorer long-term weight loss compared with gradual weight loss; and that diet readiness was an important element of weight-loss success.

The authors also pointed out other myths, including the usefulness of play in physical-education classes in weight loss, breast feeding as protection against obesity, and sexual activity as a 100-to-300-calorie-burning activity.

A number of presumptions about obesity included dietary misconceptions, such as the idea that eating breakfast being a protective act against obesity; that eating more fruits and vegetables encourages weight loss or decreases weight gain without other behavioral or environmental changes; and that snacking is a contributor to weight gain and obesity.

Other presumptions were based on misconceptions about activity and environment, including identifying early childhood as the point in time when individuals learn to exercise and eat for the rest of the person's life; associating yo-yo dieting -- quickly regaining weight lost after quickly losing weight -- with worse mortality outcomes; and believing that the presence or absence of parks or sidewalks and other environmental fitness outlets can help or hinder obesity.

"Many of the myths and presumptions about obesity reflect a failure to consider the diverse aspects of energy balance, especially physiological compensation for changes in intake or expenditure," the authors noted.

"The facts that we have about obesity and obesity management are those that should be heeded and really applied to day-to-day operations," Robert Eckel, MD, of the University of Colorado School of Medicine in Denver, told MedPage Today in a video interview.

Two facts that should be emphasized are "the idea of eating less as the way to lose weight, and, perhaps, the more important aspect of physical activity [being] that it should be applied once weight is lost to help sustain weight loss," said Eckel, who was not involved in the study. Eckel is past president of the American Heart Association (AHA) and a contributor to an AHA diet book, "No-Fad Diet: A Personal Plan for Health Weight Loss."

To counteract the misconceptions and myths, the study authors listed nine facts about obesity that could aid in reducing public and practice false beliefs and promote factually supported, healthier lives. These included:

• Genes as a large contributor to obesity, but not one that cannot be overcome with sufficient environmental influence
• The importance of dietary intake -- and accompanying lower caloric intake -- in weight management
• Exercise as a positive factor on health
• Exercise in sufficient doses -- and accompanying caloric expenditure -- becoming routine as a way to maintain weight loss
• Involving parents or a home setting in weight-loss programs to help overweight children
• Structuring meals or use of meal replacement as an aid in weight loss
• Use of pharmaceutical agents as an effective treatment in weight reduction
• Adoption of bariatric surgery for long-term weight loss and to decrease rates of incident diabetes and mortality

"The myths and presumptions about obesity that we have discussed are just a sampling of the numerous unsupported beliefs held by many people," they noted, adding that many myths and misconceptions likely remain pervasive because of repeated exposure to them.

Continued research and elimination of "the distortions of scientific information" would cut down on the spread of these fallacies, the authors concluded.

The study was supported by the NIH.
Dr. Allison served as an unpaid board member for the International Life Sciences Institute of North America; received payments from Kraft Foods; received consulting fees from Vivus, Ulmer and Berne, Paul, Weiss, Rifkind, Wharton, Garrison, Chandler Chicco, Arena Pharmaceuticals, Pfizer, National Cattlemen's Association, Mead Johnson Nutrition, Frontiers Foundation, Orexigen Therapeutics, and Jason Pharmaceuticals; received lecture fees from Porter Novelli and the Almond Board of California; received payment for manuscript preparation from Vivus; received travel reimbursement from International Life Sciences Institute of North America; received other support from the United Soybean Board and the Northarvest Bean Growers Association; received grant support through his institution from Wrigley, Kraft Foods, Coca-Cola, Vivus, Jason Pharmaceuticals, Aetna Foundation, and McNeil Nutritionals; and received other funding through his institution from the Coca-Cola Foundation, Coca-Cola, PepsiCo, Red Bull, World Sugar Research Organisation, Archer Daniels Midland, Mars, Eli Lilly and Company, and Merck.
One co-author received payment for board membership from the Global Dairy Platform, Kraft Foods, Knowledge Institute for Beer, McDonald's Global Advisory Council, Arena Pharmaceuticals, Basic Research, Novo Nordisk, Pathway Genomics, Jenny Craig, and Vivus; received lecture fees from the Global Dairy Platform, Novo Nordisk, Danish Brewers Association, GlaxoSmithKline, Danish Dairy Association, International Dairy Foundation, European Dairy Foundation, and AstraZeneca; owned stock in Mobile Fitness; held patents regarding the use of flaxseed mucilage, an alginate for the preparation of an aqueous dietary product, and a method for regulating energy balance for body-weight management.
Two co-authors received grant support from the Coca-Cola Foundation through their institution.
One co-author received grant support from Kraft Foods.
Another co-author received grant support from General Mills Bell Institute of Health and Nutrition.
Another co-author received consulting fees from Kraft Foods.
Another co-author had a licensing agreement for the Volumetrics trademark with Jenny Craig.
Another co-author received consulting fees from Jenny Craig.

Primary source: New England Journal of Medicine
Source reference:
Allison DB, et al "Myths, presumptions, and facts about obesity" N Engl J Med 2013; 368: 446-454; DOI: 10.1056/NEJMsa1208051.