The article in the New England Journal of Medicine caught my eye immediately, even before I'd read any of the coverage. "Myths, Presumptions, and Facts about Obesity," was what it said, and I quickly clipped it and saved it. With all the recent controversy among science journalists over what does or what doesn't work regarding weight loss, this seemed like the answer to a prayer–a summary of the evidence on key points, and published in the reputable New England Journal.
Marilynn Marchione at The AP wrote it up this way:
Fact or fiction? Sex burns a lot of calories. Snacking or skipping breakfast is bad. School gym classes make a big difference in kids' weight.
All are myths or at least presumptions that may not be true, say researchers who reviewed the science behind some widely held obesity beliefs and found it lacking.
But in the fifth graf, we get the reveal: "Independent researchers say the authors have some valid points. But many of the report's authors also have deep financial ties to food, beverage and weight-loss product makers — the disclosures take up half a page of fine print in the journal."
I was tempted to go back where I'd saved the piece and delete it before any of its conclusions leached into my brain, where I might remember them but forget where they came from.
Here are some of the financial ties reported by the article's 20 authors, who come from six universities and one research center. I've edited out some of the details and broken the half page of fine print into a numbered list:
1. Dr. Astrup reports receiving 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; receiving lecture fees from the Global Dairy Platform, Novo Nordisk, Danish Brewers Association, GlaxoSmithKline, Danish Dairy Association, International Dairy Foundation, European Dairy Foundation, and AstraZeneca; owning stock in Mobile Fitness; holding patents regarding the use of flaxseed mucilage or its active component for suppression of hunger and reduction of prospective consumption…; holding patents regarding the use of an alginate for the preparation of an aqueous dietary product for the treatment or prevention of overweight and obesity; and holding a patent regarding a method for regulating energy balance for body-weight management.
2. Drs. Brown and (3.) Bohan Brown report receiving grant support from the Coca-Cola Foundation through their institution.
4. Dr. Mehta reports receiving grant support from Kraft Foods.
5. Dr. Newby reports receiving grant support from General Mills Bell Institute of Health and Nutrition.
6. Dr. Pate reports receiving consulting fees from Kraft Foods.
7. Dr. Rolls reports having a licensing agreement for the Volumetrics trademark with Jenny Craig. Dr. Thomas reports receiving consulting fees from Jenny Craig.
8. Dr. Allison reports serving as an unpaid board member for the International Life Sciences Institute of North America; receiving payment for board membership from Kraft Foods; receiving 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; receiving lecture fees from Porter Novelli and the Almond Board of California; receiving payment for manuscript preparation from Vivus; receiving travel reimbursement from International Life Sciences Institute of North America; receiving other support from the United Soybean Board and the Northarvest Bean Growers Association; receiving grant support through his institution from Wrigley, Kraft Foods, Coca-Cola, Vivus, Jason Pharmaceuticals, Aetna Foundation, and McNeil Nutritionals; and receiving 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. No other potential conflict of interest relevant to this article was reported.
Ordinarily, I would limit myself to reviewing the coverage of this article, not the article itself. But this is not a scientific article; it's a plain-language summary of obesity research, and it almost reads like a piece of journalism, if a bit more technical than what you get from the AP.
This list of conflicts-of-interest makes the article useless to reporters. Who can know what to believe here? Imagine an article on the myths and preconsumptions of smoking written by a group of authors with extensive ties to the tobacco industry. Or a piece on the health consequences of alcohol written by consultants for the beer and liquor industries.
This would be true no matter what the article concluded. But what makes the situation worse is that some of the article's conclusions align it with industry. One "fact" is that "provision of meals and use of meal-replacement products promote greater weight loss," a conclusion that should delight Jenny Craig, which appears three times in the list above.
The list above also calls to mind an omission in the article: It says nothing about whether soft drinks containing sugar do or do not contribute to obesity, a subject that has been in the news in recent months largely because of Mayor Michael Bloomberg's move to ban large soft drinks in New York City. You will notice Coke and Pepsi in the list.
Gary Schwitzer of HealthNewsReview.org asks, "Should we trust the NEJM obesity mythbusters?" He asked one of his reviewers, the journalist Kevin Lomangino, editor of Clinical Nutrition Insight, to evaluate the mythbusters article. "I don’t think there is much doubt that these relationships influenced the content of the paper, and not for the better," Lomangino writes. "How else to explain the choice of “facts” that the authors chose to highlight in the paper, and those they inexplicably left out?"
He notes other conflicts and omissions that I missed. Weight-loss drugs, described as "suited to clinical settings" in the "facts" section of the paper "figure prominently in the authors' list of financial disclosures," he writes. And the authors omit mention of behavioral therapy which, according to Lomangino, has demonstrated value. Lomangino doesn't disclose his financial ties, which would have been nice given the circumstances, but the criticism seems valid nonetheless.
I looked at a few stories to see how the financial issue was handled. WebMD called the article "groundbreaking" in an anlysis by Dr. Pamela Peeke, who gave us her take on the issues the article raised; she did not mention the financial ties of its authors. The new Science Times column "The Week" by Jennifer A. Kingson did a brief on the article, calling it last week's "big story" and saying "obesity researchers applauded it." The column did not mention the financial ties.
Gina Kolata, a veteran medical writer at the Times, wrote a lengthy article in which she extensively quoted David B. Allison, the article's senior author, and several other obesity experts not connected with the article. The Times ran a table of the myths and facts of obesity, as presented in the article.
The article did not mention the financial ties.
-Paul Raeburn
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