Here’s the context

A couple of days ago, I wrote a post explaining, from a history and philosophy of science perspective, that studies don’t prove things. The corollary, of course, was that debunking studies doesn’t disprove things, and that the focus in both cases should be on the scientific context — the framework in which the study’s findings will be interpreted and upon which new studies will be based. This raised some hackles, maybe because there were a lot of words in my post, so I’ll restate it more succinctly here: a study is just a fucking study. Deflate it, and you’ve got a deflated study. Analyze and critique the paradigm that devised, interpreted, reported, and incorporated it, and you’re getting somewhere. Many studies are problematic in and of themselves; others are problematic because they’re being interpreted either in a vacuum or in an unsuitable framework.

Now, the anti-fat crusaders at the Robert Wood Johnson Foundation have been kind enough to collate and illustrate this unsuitable — and irresponsible — framework for us. No guesswork here; it’s the full gamut of anti-fat prejudices and misconceptions in one handy PDF. This is what we’re up against, not a flash-in-the-pan article in NEJM showing that suicide, malnutrition, and botched surgery were somewhat less deadly than diseases that can be exacerbated by behaviors that can also cause fat. This is the context that makes studies like that get reported, by scientists and by the media, as “gastric bypass saves lives!” and not “dangerous surgery marginally less harmful than diseases that are correlated with fatness in some patients!” This is the reason that study got done — because people can’t tell the difference between enforced starvation and healthy living, or between fatness and disease.

The problems with this report are legion. You’ve heard them all before, of course. First of all, the Robert Wood Johnson foundation has a lot to gain financially from the sale of diet drugs and medications, as Sandy frequently reminds us. Second… man, it’s all so bad that I don’t even know what to put second. There’s the brief ingenuous mention of poverty and its correlation with fat — “oh gee, they seem to be related!” — which then disappears for the entire rest of the report. (There’s one more mention of poverty on page 78, but not a damn thing is made of it.) There’s the definition of moderate physical activity, clearly tailored so that anyone who doesn’t do their activity on a treadmill will report that they don’t meet the minimum. There’s the across-the-board conflation of health with weight reduction. There’s the assumption that better funding for gastric bypass would be a big step forward. There’s the refusal to recognize that a family history of fat doesn’t indicate a “risk factor,” but a different baseline; there’s no recognition of a normal distribution, which is fucking funny because they keep going on about eliminating “overweight” as though there could exist a bell curve with no upper slope. There’s the comparison of 1991 and 2004-2006 obesity data — the cool purple map vs. the infernal red! — with no mention of the rewritten definitions. And there’s the fucking thing’s subtitle — “How Obesity Policies are Failing in America” — contrasted with the theme of the report: more obesity policies! Bigger! Faster! Harder!

It’s hard to even begin on what’s wrong with this report, and it’s impossible to end. Because it doesn’t end: this is our at-a-glance look at the real problem, the incredibly flawed foundation on which everything else is built. Forget the individual studies that lean on this foundation, which would be constructed differently but might have similar results in another context; they are necessarily incomplete, and it’s the cracks in the foundation that are showing through. This is what we’re up against: the fallacies so old that they’re being treated as common sense.

17 thoughts on “Here’s the context

  1. I read thru enough of what I could stomach (no pun intended) of the report.

    Most mind boggling to me is the list of recommendations at the end. Nothing that really hasn’t been said before, except at the personal level it recommended that some sort of personal accountability programs be considered? WTF is that?!?

    The pictures throughout the PDF are also ridiculous. There is a woman on a scale who appears to be of “average” weight- yet she is standing on a scale and clearly dismayed from what the scale shows. Way to promote food and diet obsession!

  2. There’s the brief ingenuous mention of poverty and its correlation with fat — “oh gee, they seem to be related!” — which then disappears for the entire rest of the report. (There’s one more mention of poverty on page 78, but not a damn thing is made of it.) There’s the definition of moderate physical activity, clearly tailored so that anyone who doesn’t do their activity on a treadmill will report that they don’t meet the minimum.

    Well, no wonder they don’t want to talk about poverty in detail, then. How many poor people have access to a treadmill? Almost none, and therefore they’ve just “proven” that no one who isn’t affluent enough to belong to a gym or own their own pricey exercise equipment can possibly be “fit,” not even if they move pianos for a living.

  3. First of all, the Robert Wood Johnson foundation has a lot to gain financially from the sale of diet drugs and medications

    And don’t forget surgical equipment.

    Great work, FJ. Right now I’m feeling a bit too fragile to peruse this in the detail you have, but it looks pur-etty bad.

    Here’s the thing, though. The tobacco industry has a PR machine just as slick and revved-up as Big Pharma, and financial interests at least as great, so why aren’t we hearing night and day from the Paid Media about all the benefits of smoking and how it keeps your weight down and so forth? Because people don’t wanna hear that shit. Even smokers don’t wanna hear that shit anymore. The message has to dovetail with what people want to hear. They want to hear that fat is deadly, because they can’t stand the sight of it. “They” couldn’t sell it if a whole lot of “us” weren’t buying it.

  4. If you can stand it, turn to page 96 of the report, where there’s a section labeled “Challenge to the Research Community: Five Major Research Questions.”

    The first two of the five questions are:

    “How does obesity relate to people’s health and life expectancy?”

    “What is success: Can people be fit and fat or is weight loss necessary for good health?”

    Sooooo, this study spends 119.5 pages carrying on about how terrible the obesity epidemic is, how we must be thin, blah, blah, blah … and then says in one-half of a page “except that we’re really not sure whether being fat causes the problems we think it does and maybe it’s OK to be fat as long as you have a relatively healthy diet and exercise regularly and maybe someone could look into this.”

    I think we should take those 5 questions (especially the first 2) and ask the people at the RWJF why they continue to perpetuate the misconceptions about weight when they acknowledge IN THEIR OWN STUDY that they aren’t really sure whether being fat is a problem or not.

  5. Excellent point, Meowser, as usual. That’s the glimmer of hope every time I think “god, what the hell can be done in the face of all this” — the fallacy thrives on complicity.

    Jmars, but we know the real reason they perpetuate the misconceptions — it’s all about the money!

  6. If they had to answer those questions, especially the first two, they would have to admit they don’t have a clue about why some people are fat and some are thin and some are in-between, and that it’s damnably difficult to make a permanent change in any size. If they admit that, then they have to admit it’s all hype designed to get our money out of our pockets and into theirs by selling us something we don’t really need and isn’t good for us (and isn’t that the basis of most advertising for most products out there?). I’m not saying that everything that is advertised is bad for us, but really, now, how many times can something be new and improved? Dissatisfaction sells, whether it be your car, your house, your clothes, your body.

  7. I think we should push back harder at the diet industry. The good thing is that the public is more cynical today. Does anyone really believe we went to Iraq to promote democracy??? I think it will be easier to make the point between special interests and distortion of data than ever before. IMO, everyone should write their politicians and give them the other side of the story. Make sure they know WE KNOW the RWJ Foundation is just a front for Johnson & Johnson. I am also going to start boycotting Johnson&Johnson. When I get the time, I may even set up a site to encourage others to do so. They have gotten some bad PR lately because they are suing the Red Cross over the use of their symbol. Just shows how greedy this company really is. Maybe a few public protests are in order too! Meanwhile, you guys are doing a GREAT job just letting people know the hidden agendas behind RWJ. And I hate to say this, but they are going to lose in the end because our economy is tanking fast. People need to worry more about how they are going to keep food on the table rather than low numbers on the scale. Weight obsession is a product of good economic times. We just need to be there to remind them that if their media had brought them more balanced info on what was really happening in the world rather than just harping on obesity they would have been much better off in the long run!

    “Fat can be beautiful! Ignorance is ALWAYS ugly!”

  8. Way OT here, but I miss the comments link being at the bottom of the entry.

    Way on-topic, keep up the excellent work!

  9. I was browsing through the report (can’t read it all, I mean, it’s called “F as in Fat” for crying out loud). Then, on page 51, under the headline “Promoting Physical Activity as a Strategy to Improve Health”, I stumbled apon these gems:

    “Experts agree that a more nutritious diet and taking part in physical activity are good for everyone, regardless of their current weight.
    […]
    A recent review of strategies to prevent, control, and treat obesity, funded in part by NIH, found that adult weight-loss centered strategies often yield limited results, and successes are “typically small and tend to be transitory.” Another review found that “a focus on weight loss is often counterproductive and unsuccessful, and sometimes may even be unnecessary,” compared to focusing on encouraging people to engage in healthier behaviors whether or not they are overweight.
    While there is little support for effective, long term approaches to successful weight loss, there is significant scientific consensus around the health benefits of physical activity for everyone, no matter their weight.”

    A couple of pages down the line:
    “Experts have found that:
    ■ Physical activity helps control and prevent a range of health problems, including diabetes, heart disease, and stroke; and
    ■ Even small amounts of physical activity can improve health, no matter how much a person weighs or whether a person loses weight.”

    OMG, I thought, it’s *right there*! Were these people even aware what they’d written down, I wonder?
    Not only do these couple of paragraphs admit that HAES is the way to go, between the lines – if you read correctly and carefully – we can all read what we already knew:
    “a focus on weight loss is often counterproductive.” In plain English: dieting doesn’t work and makes you fatter. Now we all knew that already, didn’t we? So if weight loss is counterproductive, why do these boneheads still cry out at the top of their lungs we need to lose weight? Why do they even write down the subtitle of this report “How obesity policies are failing in America” (well, and all around the western world, that is, from my perspective) when they already know it’s not about friggin’ obesity at all??? AAARRGGH!!!!

  10. Sherie, J&J is also undergoing a mass amount of layoffs right now, so i wonder whether their suing of the Red Cross is out of financial desperation (?) As much as J&J is an evil overlord at times (the whole Splenda thing seriously keeps me up at night), I also saw them revitalize the city in which I did undergrad. Of course, the revitalization wasn’t all icecream and roses – they did tear down buildings for parking decks and the like – but they also made the area safer for students and created a more pleasant atmosphere overall. Yes, i’m probably being naive, but i can’t say i didn’t benefit from their presence.
    HOWEVER, yes, they are a huge proponent of bariatric surgery, so we’re back to the evil side of the coin…..

  11. To be honest with you, I’m not entirely sure if there is but a v.small role for science in this.

    What is the endgame? To invent pills, I don’t want to be a pill-popper, if I did, I would take the fun drugs that are available already.
    I don’t want any operations so that’s no good to me.
    Any good social policies that could come out of this are a reversal of things that used to be such as phys. ed. the best nutrition we could afford for our kids. We dispensed with nourishing meals and fed them food industry slop, because we had better things to spend our money on, i.e. adult pleasures such as tax cuts.

    I didn’t need science, drugs or the knowledge of leptin to become fat, so why should I need it to become thin, if indeed that is doable?

    I’m saying that this is as much a question of logical thought as opposed to fat people tend to have more of this or that chemical in their make-up. I think scientists may agree, or they would not bypass their normal intelligence gathering regarding fat.

  12. I didn’t need science, drugs or the knowledge of leptin to become fat, so why should I need it to become thin, if indeed that is doable?

    If you’re asking whether you would need intervention to become thin, you absolutely would, because thinness is not a natural, sustainable state for your body. It’s scientists who figured that out.

    There is a role for science in determining what is healthy and how to best improve public health. The focus on becoming thin is an industry focus, with science as a tool.

    Yes, studies are corrupted when science has to turn to industry for funding it’s not getting from the government. But I don’t understand the desire to condemn science as a whole because you don’t want drugs to make you thin.

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  14. It’s scientists who figured that out.

    Really? Because I thought it was my failure to lose weight after numerous futile efforts!

    And who says it is or isn’t my ‘natural’ state to be thin? The issue is not whether thinness is ‘natural’ it is whether it is acheivable and maintainable. That is not the same as saying you I or anyone else can or can’t be thin, theoretically speaking.

    Scientists and doctors told me as everybody knows to keep dieting, they say it at the end of any of their papers ‘this is not an excuse for fat people to stop their diets’ so I eventually accepted of my own violition, thanks very much, that I had to stop what was damaging me. I resent any suggestion that scientist guided me there, or a lot of other people for that matter. It was in spite not because of them that I stopped. What I may or may not of learned subsequent to that is another story.

  15. Science can’t tell you with perfect accuracy how your own body is going to behave; you have to determine that. But neither can your observations of your own experiences stand in for what happens to everyone. We need empirical studies in order to make a conclusion beyond “diets don’t work for wriggles.”

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