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.