Abstract
Abbreviations and Acronyms:
BF (body fat), BMI (body mass index), CHD (coronary heart disease), CVD (cardiovascular disease), EB (energy balance), EE (energy expenditure), EI (energy intake), FLT (first law of thermodynamics), PA (physical activity), RCT (randomized controlled trial)Issues and Concerns
Obesity Is a Pandemic
Lack of conceptual clarity
|
Imprecise measurement
|
Obesity paradox
|
Inferring causality
|
Responsibilities of the scientific community
|
Factor facilitating propagation of presumptions and myths | Example of presumptions erroneously accepted as fact that seem to be facilitated by the factor in column 1 | Example of myths erroneously accepted as fact that seem to be facilitated by the factor in column 1 |
---|---|---|
Failure to conduct the probative studies (typically RCTs with weight or body fat as outcomes and sufficient durations to test postulated effects on body composition) needed to prove or disprove hypothesized effects | Regularly eating (vs skipping) breakfast is protective against obesity | NA; things typically can become myths only after probative studies are done |
A resistance to abandoning cherished ideas even when refuting data exist (ie, cognitive dissonance) | Early childhood is the period during which we learn exercise and eating habits that influence our weight throughout life | Breastfeeding is protective against obesity for the breastfed offspring |
Excessive repetitive presentation of the idea (often on the basis of gratuitous association studies long after they are needed) to the point at which the idea comes to be believed merely by the excessive repetition (ie, the mere exposure effect) | 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 | Large, rapid weight loss is associated with poorer long-term weight outcomes than is slow, gradual weight loss |
Failure to ask for supporting data from some ideas that seem intuitively obvious | Preventing obesity is easier than treating obesity 15 | Assessing the stage of change or diet readiness is important in helping patients who seek weight-loss treatment AND Setting realistic goals in obesity treatment is important because otherwise patients will become frustrated and lose less weight |
Failure to take into account the passive compensation in energy expenditure that occurs merely as a function of changes in body size that occur with initial alterations in energy intake or expenditure | NA; the passive compensation is an established fact, so any calculations that do not accommodate it are effectively myths, not presumptions | Small, sustained changes in energy intake or expenditure will produce large, long-term weight changes that accumulate indefinitely, which fails to take into account compensatory mechanisms |
Failure to take into account the active compensation in components of energy balance that may occur when another component of energy balance is manipulated | Snacking contributes to weight gain and obesity | Physical education classes in their current format play an important role in preventing or reducing childhood obesity |
Failure to take into account that the active compensation (or lack thereof) in components of energy expenditure that occurs when another component of energy balance is manipulated over a short period (eg, 1 d) may not be maintained if the manipulation is maintained over a longer period; ie, there may be learned compensation | Reducing portion size in some sources of food will reduce body weight or lead to less weight gain in the long-term 16 Small L, Lane H, Vaughan L, Melnyk B, McBurnet D. A systematic review of the evidence: the effects of portion size manipulation with children and portion education/training interventions on dietary intake with adults [published online June 15, 2012]. Worldviews Evid Based Nurs. http://dx.doi.org/10.1111/j.1741-6787.2012.00257. | NA |
Distortion of the existing scientific evidence by publication and reporting biases or misleading statements | Regularly eating (vs skipping) breakfast is protective against obesity 17 | Breastfeeding is protective against obesity for the breastfed offspring 18 |
Major Presumptions and Myths About Obesity
Defining Obesity: Need for Conceptual Clarity
Obesity Paradox
Scientific Standards, Assumptions, Methods, and Discourse Limiting Examination of Alternative Explanations of Cause
Presumption
Description vs Explanation
Simplistic Determinism and Reductionism
Measurement and Introspection
- Ockene I.S.
- Hebert J.R.
- Ockene J.K.
- et al.
Misuse of Population-Level Data Sources
Lack of Due Diligence in Upholding Rigorous Standards of Scientific Evidence When Seemingly Good Ends Are Pursued
Discussion and Recommendations
Conclusion
Supplemental Online Material
References
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Article Info
Footnotes
For editorial comment, see page 533.
Grant Support: Dr Hebert was supported by an Established Investigator Award in Cancer Prevention and Control from the Cancer Training Branch of the National Cancer Institute ( K05 CA136975 ).
Potential Competing Interests: Dr Allison has received grants, donations to his university, and consulting payments from numerous nonprofit and for-profit organizations with interests in obesity, including the National Institutes of Health, National Science Foundation, Federal Trade Commission, Food and Drug Administration, private foundations, pharmaceutical companies, food companies, beverage companies, litigators, and publishers. Dr Blair has received grants and consulting payments from organizations such as the National Institutes of Health, food companies, beverage companies, publishers, and equipment companies.
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- PreviewIn the article “Scientific Decision Making, Policy Decisions, and the Obesity Pandemic,” published in the June 2013 issue of Mayo Clinic Proceedings (2013;88(6):593-604), the citation to reference 21 lists the wrong journal. It should be J Cardiopulm Rehabil Prev, not J Mol Signal. It is now listed correctly here:
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