The sun revolves around the Earth. Thalidomide is a great treatment for morning sickness. Heroin is a non-addictive substitute for morphine. Lysol is a fantastic douche. Everyone who tries hard enough can lose weight.
These are all things that science believed at one time. Three of them used to be the basis of healthcare advice. One of them still is. Sometimes science gets it wrong and there’s no crime in that – it’s the nature of science. The problem starts when science isn’t willing to admit that it’s gone really far down the wrong road.
That’s the situation that we find ourselves in when it comes to the “obesity epidemic.” A panic around fat people has been trotted out by the media to the multi-billion dollar profit of the diet and pharmaceutical industries. Now a researcher has come clean about the prevalence of myths that are floated by people in the field as fact.
According to Dr. Jeffrey M. Friedman, an obesity researcher from Rockefeller University, “there is more misinformation pretending to be fact in this field than in any other I can think of.”
Some of the myths he mentions are :
- Walking a mile a day can lead to a loss of more than 50 pounds in five years.
- Diet and exercise habits in childhood set the stage for the rest of life.
- Add lots of fruits and vegetables to your diet to lose weight or not gain as much.
- People who snack gain weight and get fat.
- If you add bike paths, jogging trails, sidewalks and parks, people will not be as fat.
It’s a good start in breaking down supposed “healthcare interventions” that make sweeping health generalizations based upon a single physical characteristic. But we’re not all the way there. He also includes some “facts” that I think warrant a closer look:
- Weight loss is greater with programs that provide meals.
- Some prescription drugs help with weight loss and maintenance.
- Weight-loss surgery in appropriate patients can lead to long-term weight loss, less diabetes and a lower death rate.
Though weight loss may be greater with programs that provide meals in the short term, long-term weight loss does not go up – there is no study of any “lifestyle intervention” where more than a tiny fraction of participants maintained their weight loss for 5 years or more and many of those had weight loss from 2 to 5 pounds. Not for nothing, but I could exfoliate and lose 5 pounds in 5 years, and I wouldn’t have to eat highly processed food that comes in a baggy to be microwaved to do it.
As for drugs and surgery, there is no drug that has shown long-term success for weight loss, and some diet drugs have been taken of the market because they had a pesky habit of killing people so I’m not sure that this is a bandwagon on which fat people should be prepared to jump.
Weight loss surgery is nowhere near the panacea we’ve been promised. Whether it’s stomach binding or stomach amputation there are major risks, awful complications (anal leakage anyone?) and serious ethical questions. As Linda Bacon points out in her book: Dr. Edward Mason, who developed gastric bypass surgery said “For the vast majority of patients today, there is no operation that will control weight to a ‘normal’ level without introducing risks and side effects that over a lifetime may raise questions about its use for surgical treatment of obesity.”
Why does he say this? As Dr. Bacon explains, maybe it’s because almost 3% of the patients died after the first year, and 6.4% die at the end of the fourth year. Sandy Swarze a science blogger at Junkfood Science found that “By best estimates, bariatric surgeries likely increase the actual mortality risks for these patients by 7-fold in the first year and by 363% to 250% the first four years.” And among those who don’t die, many regain their weight. In the case of those who’ve had a bypass, they will never regain their ability to properly process nutrients since a surgeon has redesigned their innards to optimize weight loss over digestion.
Still, “everybody knows” is powerful and if you don’t believe me you can check out the comments on this article (provided you’ve been banking your Sanity Watchers points of course). Though Dr. Friedman is trying to explain that the sun does not revolve around the Earth, commenters help play out this modern-day Galileo story and would have him be made to recant and put under house arrest if they could.
People of all sizes deserve evidence-based healthcare and the right to informed consent. Fat people have been the victims of experimental medicine pretending to be evidence based medicine for far too long. Dr. Friedman’s confession is, despite its flaws, at least a step in the right direction.
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