Myths, Presumptions, and Facts about

Obesity
Where might they come from and what we can do?
Andrew W Brown, PhD

Acknowledgments

Acknowledgments and
Disclosures

Some slides were inspired by or made in collaboration with numerous

colleagues. They will be acknowledged throughout verbally, with citations,
or on the slides.
However, the content reflects my thoughts, and not necessarily these
individuals, anyone else, or any organization.

Disclosures
Dr. Brown has received travel expenses from Academy of Nutrition and
Dietetics, Alberta Milk, American Heart Association, DC Metro Academy of
Nutrition and Dietetics, Federation of American Societies for Experimental
Biology, and International Life Sciences Institute; speaking fees from
Academy of Nutrition and Dietetics, Alberta Milk, American Society for
Nutrition, Birmingham District Dietetic Association, International Food
Information Council, and Rippe Lifestyle Institute, Inc.; monetary awards
from Alabama Public Health Association, American Society for Nutrition,
and Science Unbound Foundation; and grants from NIH/NIGMS-NIA-NINDS,
and UAB NORC. He has been involved in research for which his institution
or colleagues have received: unrestricted gifts from National Restaurant

Conflicts of interest

Would you believe the results more

or less if they were in the opposite
direction?
Given the disclosure below, would
you believe the results more or less
if they were in the opposite
direction?

Funding disclosures impair

objectivity

Hypothetical drug studies of varying rigor and disclosed

funding.
Disclosure of industry funding vs no disclosure
decreased:
ratings of rigor of trials (OR: 0.63 [0.46,0.87])
confidence in the results (OR: 0.71 [0.51,0.98])
willingness to prescribe the hypothetical drugs (OR:
0.68 [0.49,0.94])

Outline

Introduction
Myths, presumptions, and
facts
Where do they come from
and how are they
perpetuated?
Red flags in obesity
conclusions

Science and Beliefs

Science: knowledge about or study of the natural
www.merriam-webster.com
world based on facts learned through experiments
and
observation
Belief: a feeling of being sure that someone or
something exists or that something is true www.merriam-webster.com
Example of three classifications of beliefs about
scientific topics:
Myths: beliefs held to be true despite substantial
refuting evidence
Presumptions: beliefs held true for which convincing
evidence does not yet confirm or disprove their truth
Facts: propositions backed by sufficient evidence to
consider them empirically proved for practical
purposes
In
science, 'fact' can only mean 'confirmed to such a
degree that it would be perverse to withhold
provisional assent.'
Stephen Jay Gould

Myths, Presumptions, and Facts about Obesi

Myth
a belief held to be true despite substantial refuting evidence

Myths
Small sustained changes in energy intake or expenditure will
produce large, long-term weight changes
Setting realistic goals in obesity treatment is important
because otherwise patients will become frustrated and lose
less weight
Large, rapid weight loss is associated with poorer long-term
weight outcomes than is slow, gradual weight loss
Assessing the stage of change or diet readiness is important
in helping patients who seek weight-loss treatment
Physical-education classes in their current format play an
important role in preventing or reducing childhood obesity
Breast-feeding is protective against obesity
A single bout of sexual activity burns 100 to 300 kcal for each
person

Presumption
a belief held true for which convincing evidence
does not yet confirm or disprove their truth

Presumption
Regularly eating (vs. skipping) breakfast is protective
against obesity
Early childhood is the period during which we learn
exercise and eating habits that influence our weight
throughout life
Eating more fruits and vegetables will result in weight
loss or less weight gain, regardless of whether one
intentionally makes any other behavioral or
environmental changes
Weight cycling (i.e., yo-yo dieting) is associated with
increased mortality
Snacking contributes to weight gain and obesity

Facts
propositions backed by sufficient evidence to consider
them empirically proved for practical purposes

Facts (some abridged)

Heritability is not destiny
Diets (i.e., reduced energy intake) very effectively reduce
weight, but trying or recommending dieting not work well in
the long-term
Increased exercise increases health
Exercise in a sufficient dose aids in long-term weight
maintenance
Continuation of conditions that promote weight loss promotes
maintenance
Programs that involve parents and home promote greater
weight loss or maintenance
Provision of meals and meal-replacement products promote
weight loss

Outline

Introduction
Myths, presumptions, and
facts
Where do they come from
and how are they
perpetuated?
Red flags in obesity
conclusions

How do we know things in Nutrition

Science?

Wesleyan
Nutrition Quadrilateral
Quadrilateral
Reason

Scripture
Research
Tradition

Experience

The quadrilateral requires of a [nutrition scientist] no more than what he

or she might reasonably be held accountable for: which is to say, a
familiarity with [scientific literature] that is both critical and faithful; plus,
an acquaintance with the wisdom of [nutrition science history]; plus, a
adapted
from than
Outler. Wesleyan
Theological
Journal. 1985;20:1
taste for logical analysis as something
more
a debaters
weapon

Incomplete in Context

Assume you are alone on a desert island

for
one year
and youshould
can have water
Which
foods
you and
eat?
one other food. Pick the food that you think
would be best for your health (never
mind what food you would like).
Check the foodAyou
would pick.
Corn

Alfalfa
B sprouts
C Hot dogs
D Spinach
E Peaches
F Bananas
Milk

Incomplete in Context

50
40
30

Students
Physical plant
workers
National sample
Faculty

20
% of Respondents
10
0

Scientific Literature

RESULTS: Based on our observations, it appears

that those who have higher BMIs are less likely to
consume fast food as often.
CONCLUSIONS: These schoolchildren are
exposed to an obesogenic environment, and it is
not surprising that in this situation, many of these
children are already overweight and will likely
become obese as adults.

Scientific Literature

Brown A W et al. Am J Clin Nutr 2013;98:1298-1308

Translating Scientific
Literature

Effect of the Healthy Schools Program on

Prevalence of Overweight and Obesity in
California Schools, 20062012

Headli
ne

Study

Analyses showed no difference

between Healthy School
Program schools and control
schools in overweight and
obesity prevalence
Healthy School Program
appears to be an important
means
of supporting
schoolsstudy
in
Now, as the Alliance celebrates its 10-year
anniversary,
a new peer-reviewed
confirms we are delivering on our mission
of reducing
the prevalence of childhood
reducing
obesity
obesity. an important means of supporting schools in reducing obesity.

http://www.wassermanfoundation.org/news/new-study-shows-that-combatin
g-childhood-obesity-in-schools-works/
http://www.cdc.gov/pcd/issues/2015/15_0020.htm

Bias in Media Exposure

Media

High Impact
Journals
III; 8%

II-3; 3% III; 5%
I; 17%
II-1; 7%

II-2; 68%

II-3; 1%

I; 40%

II-2; 51%

Hierarchy of research designs

I Properly randomized controlled trial.

II1 Well-designed controlled trials without
randomization.
II2 Well-designed cohort or case-control analytic
studies.
II3 Time series with or without the intervention.
III Opinions.

Media Cover Inferior Study Designs

Whats Being Published?

Studies indexed in PubMed

40,000

Nutrition-Related Studies: 886,658

30,000
In humans: 433,131
RCTs: 31,848
20,000
10,000
0

Bias Presented to the Public

Spin: specific reporting

strategies, intentional
or unintentional,
emphasizing the
beneficial effect of the
experimental treatment
Spin perpetuates
throughout the
reporting

Headlines vs Study

Can cause
irregular
heartbeat,
low blood
pressure,
coma, and
death

Contributes
to heavy
metal
poisoning
Binds to the
same
receptors as
marijuana

Causes
hepatic
necrosis in
rats

Not a new problem

Benevolent Myopathy

Action
Label
unhealthful
foods with
messages that
encourage
Describe certain
consuming
restaurantsfruits
and
and
vegetables.
foods
as more
healthful and
low-calorie.
Labeling calories
and removing
value pricing on
menu items.
Discourage
chocolate
consumption.
Tax sugar
sweetened
beverages (SSBs).

Good intention
Increase healthful
behaviors and decrease
unhealthful
behaviors.
Decrease caloric
consumption and shift
consumption toward
healthful foods.
Awareness of calories
and eliminating value
pricing will decrease
energy consumption
Decrease caloric
consumption.
Decrease energy intake
to decrease weight.

Documented unintended
consequence
Increased selection of an
unhealthful snack.

Consumers consumed more calories

in side dishes and beverages, and
underestimated total meal calories
when choosing healthy
restaurants
or calories.
main dishes.
Men ate more

Chocolate consumption increased

for some women in some
circumstances.
Increased consumption of beer
beyond the decrease in sugar
sweetened beverages.

Teaching Myths and Presumptions

as Fact

To assess knowledge scores, correct and incorrect

answers were tallied for beneficial and detrimental choices
on both pre- and post-tests.
Supports Healthy Promotes Obesity
Weight
Eating breakfast Sweetened beverage intake
regularly
Fruit juice Snacking frequencies on junk
food
Eating frequency Time spent watching TV
Dietary variety Dietary fat intake
Dietary fiber Sugar intake
Parental restriction on Carbohydrates intake
food
Regular physical activity Frequency of eating away from
home
Protein intake Fast food consumption
Reduced fat food Total caloric intake

Outline

Introduction
Myths, presumptions, and
facts
Where do they come from
and how are they
perpetuated?
Red flags in obesity
conclusions

Over Simplification
Myth: small sustained changes in energy intake
or expenditure will produce large, long-term
166
weight changes
165

Weight Loss Predictor

164
163

35 year old
165 lb male
walking 1 mile/d
=
~100 kcal/d

162

Weight (lbs)

161
160
159

In 10 years, he would weigh

61 lbs by the 3500 kcal rule

158

3500 kcal rule

157
156
0

22

4 4

6 6 8

8 10

10
12

14
12

Month
Weight Loss Predictor: http://www.pbrc.edu/research-and-faculty/calculators/weight-loss-predictor/

Irrelevant Effect Size

Presumption: Eating more fruits and vegetables will

result in weight loss or less weight gain, regardless of
whether one intentionally makes any other behavioral or
environmental changes
atic Review and Meta-Analysis of Prospective Cohort Studies
Fruit Veg F & V Higher intake of fruits was
associated with decreased weight
Weight Change
S
NS
NS
-13.68 g BW/y per 100-g/d in fruit
Waist Circumference
S
NS
NS
intake.
Risk of weight gain or S
S
S
abdominal obesity

Mean weight change NS

NS
NS
(hi/lo)

.67 tonnes of fruit per 1 kg weight loss per yea

Nevertheless, when combined with evolutionary
nutrition and epidemiological modeling studies, these
findings have public health relevance and support all
initiatives to increase fruit and vegetable intake.

Non-significant Effect Size

Presumption: Eating more fruits and vegetables will
result in weight loss or less weight gain, regardless of
whether one intentionally makes any other behavioral or
environmental changes

Correlation Causation
Associations between snacking and weight
9
8
7
6
5
Number of Studies
4
3
2
1
0

Positive
Null
Negative

Adapted from Mesas et al Obesity

reviews 2012

Effects of snacking on weight

Slide adapted from Allison, Lewis, and Brown presentation (2

An eating episode by any other

How Researchers Define Snacks
name
By time: 8-10AM,and
12-2PM, and
6- 8PM = meals; Other times =
Meals
snacks

(Gergori et al, 2011; Gregori, & Maffeis, 2007)

By food composition/type:

Based on taxonomy of food,

or calories in eating occasion

How
Individuals Define Snacks
and Meals
Meal Related-Perceptions
Snack Related-Perceptions
Eating with family vs. Eating alone
Cloth napkin vs. Paper napkin
Sitting while eating vs. Standing while eating
Expensive vs. Inexpensive
Prepared food vs. Packaged food
Healthy food vs. Unhealthy food

(Adapted from Wansink et al, 2010. Appetite. 54(1),

214-16)

Implications for measuring or advice about snacks

and
meals?
Slide adapted from Allison, Lewis, and Brown presentation (2

How Could We Possibly Know

Myth: A single bout of sexual activity burns
That?
100 to 300 kcal for each person involved
Representative sample?
Realistic conditions?
Realistic expression of data?

10 Healthy Men
Energy Expenditure
21 kcal
14 kcal

Arch Intern Med 1984;144:1745-1748

Outline

Introduction
Myths, presumptions, and
facts
Where do they come from
and how are they
perpetuated?
Red flags in obesity
conclusions

Focus on the Science

Myths and presumptions can derive from:
Beliefs Conventional Wisdom Bad
research reporting
Reasonable hypotheses
Bad media
reporting
RepeatedComment
exposure from
Financial
Conflicts
prominent
Honestresearcher
error Poor about
study design
Laziness
the Myths,
Almost
anything and Facts paper.
Presumptions,
"I think its weird. I dont get it.
"I cant understand the point of the paper
unless its to say that the only things that work
are drugs, bariatric surgery, and meal
replacements, all of which are made by
companies with financial ties to the authors."

Focus on the Science

Myths and presumptions can derive from:
Beliefs Conventional Wisdom Bad
research reporting
Reasonable hypotheses
Bad media
reporting
RepeatedComment
exposure from
Financial
Conflicts
prominent
Honestresearcher
error Poor about
study design
Laziness
the Myths,
Almost
anything and Facts paper.
Presumptions,
"I think its weird. I dont get it.
"I cant understand the point of the paper
unless its to say that the only things that work
are drugs, bariatric surgery, and meal
replacements, all of which are made by
companies
withof
financial
ties
the authors."
Plenty
science
toto
focus
on

The Human Element: For interest,

not evidence
Science

Human Audiences

Only three things matter:

Interest matters:

1) The data

Love stories

2) The methods used to generate

the data

Remember stories

3) The logic connecting the data

to conclusions
All else is tangential

Particularly like stories about

other humans
Ad hominem arguments are
not evidence

Use the human element for embellishment and interest,

not for scientific conclusions.

Slide adapted from Allison, and Brown presentation

Resources

http://nationalpress.org/

Latest obesity and energetics

research
www.obesityandenergetics.com

https://bookofbadarguments.com/

www.nhs.uk/News/Pages/NewsIndex.a
spx

www.senseaboutscience.org
www.healthnewsreview.org

Myths, Presumptions, and Facts about

Obesity
Where might they come from and what we can do?
Andrew W Brown, PhD