1/30/13

Myths, Presumptions, and Facts about Obesity NEJM

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Myths,Presumptions,andFactsaboutObesity
KristaCasazza,Ph.D.,R.D.,KevinR.Fontaine,Ph.D.,ArneAstrup,M.D.,Ph.D.,LeannL.Birch,Ph.D.,AndrewW. Brown,Ph.D.,MichelleM.BohanBrown,Ph.D.,NefertitiDurant,M.D.,M.P.H.,GarethDutton,Ph.D.,E.MichaelFoster, Ph.D.,StevenB.Heymsfield,M.D.,KerryMcIver,M.S.,TapanMehta,M.S.,NirMenachemi,Ph.D.,P.K.Newby,Sc.D., M.P.H.,RussellPate,Ph.D.,BarbaraJ.Rolls,Ph.D.,BisakhaSen,Ph.D.,DanielL.Smith,Jr.,Ph.D.,DianaM.Thomas, Ph.D.,andDavidB.Allison,Ph.D. NEnglJMed2013368:446454 January31,2013 DOI:10.1056/NEJMsa1208051 Share: MEDIAINTHISARTICLE

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BACKGROUND
Manybeliefsaboutobesitypersistintheabsenceofsupporting scientificevidence(presumptions)somepersistdespite contradictingevidence(myths).Thepromulgationofunsupported beliefsmayyieldpoorlyinformedpolicydecisions,inaccurateclinical andpublichealthrecommendations,andanunproductiveallocation ofresearchresourcesandmaydivertattentionawayfromuseful, evidencebasedinformation.

TABLE1

SevenMythsaboutObesity.

TABLE2

METHODS
UsingInternetsearchesofpopularmediaandscientificliterature,we identified,reviewed,andclassifiedobesityrelatedmythsand presumptions.Wealsoexaminedfactsthatarewellsupportedby evidence,withanemphasisonthosethathavepracticalimplications forpublichealth,policy,orclinicalrecommendations.

PresumptionsaboutObesity.

RESULTS
Weidentifiedsevenobesityrelatedmythsconcerningtheeffectsof smallsustainedincreasesinenergyintakeorexpenditure, establishmentofrealisticgoalsforweightloss,rapidweightloss, weightlossreadiness,physicaleducationclasses,breastfeeding, andenergyexpendedduringsexualactivity.Wealsoidentifiedsix presumptionsaboutthepurportedeffectsofregularlyeating breakfast,earlychildhoodexperiences,eatingfruitsandvegetables, weightcycling,snacking,andthebuilt(i.e.,humanmade) environment.Finally,weidentifiednineevidencesupportedfactsthat arerelevantfortheformulationofsoundpublichealth,policy,or clinicalrecommendations.

CONCLUSIONS
Falseandscientificallyunsupportedbeliefsaboutobesityare www.nejm.org/doi/full/10.1056/NEJMsa1208051 1/3

1/30/13

Myths, Presumptions, and Facts about Obesity NEJM pervasiveinbothscientificliteratureandthepopularpress.(Funded bytheNationalInstitutesofHealth.)

Theviewsexpressedinthisarticlearethoseoftheauthorsanddonotnecessarily representtheofficialviewsoftheNationalInstitutesofHealth. Supportedinpartbyagrant(P30DK056336)fromtheNationalInstitutesofHealth. Dr.AstrupreportsreceivingpaymentforboardmembershipfromtheGlobalDairy Platform,KraftFoods,KnowledgeInstituteforBeer,McDonald'sGlobalAdvisory Council,ArenaPharmaceuticals,BasicResearch,NovoNordisk,Pathway Genomics,JennyCraig,andVivusreceivinglecturefeesfromtheGlobalDairy Platform,NovoNordisk,DanishBrewersAssociation,GlaxoSmithKline,Danish DairyAssociation,InternationalDairyFoundation,EuropeanDairyFoundation,and AstraZenecaowningstockinMobileFitnessholdingpatentsregardingtheuseof flaxseedmucilageoritsactivecomponentforsuppressionofhungerandreduction ofprospectiveconsumption(patentsEP1744772,WO2009033483A1, EP2190303A1,US2010261661A1,andpriorityapplicationsDK001319, DK001320,S971798P,andUS971827P)holdingpatentsregardingtheuseofan alginateforthepreparationofanaqueousdietaryproductforthetreatmentor preventionofoverweightandobesity(patentWO2011063809A1andpriority applicationDK070227)andholdingapatentregardingamethodforregulating energybalanceforbodyweightmanagement(patentWO2007062663A1and priorityapplicationDK001710).Drs.BrownandBohanBrownreportreceivinggrant supportfromtheCocaColaFoundationthroughtheirinstitution.Dr.Mehtareports receivinggrantsupportfromKraftFoods.Dr.Newbyreportsreceivinggrant supportfromGeneralMillsBellInstituteofHealthandNutrition.Dr.Patereports receivingconsultingfeesfromKraftFoods.Dr.Rollsreportshavingalicensing agreementfortheVolumetricstrademarkwithJennyCraig.Dr.Thomasreports receivingconsultingfeesfromJennyCraig.Dr.Allisonreportsservingasan unpaidboardmemberfortheInternationalLifeSciencesInstituteofNorthAmerica receivingpaymentforboardmembershipfromKraftFoodsreceivingconsulting feesfromVivus,UlmerandBerne,Paul,Weiss,Rifkind,Wharton,Garrison, ChandlerChicco,ArenaPharmaceuticals,Pfizer,NationalCattlemen'sAssociation, MeadJohnsonNutrition,FrontiersFoundation,OrexigenTherapeutics,andJason PharmaceuticalsreceivinglecturefeesfromPorterNovelliandtheAlmondBoard ofCaliforniareceivingpaymentformanuscriptpreparationfromVivusreceiving travelreimbursementfromInternationalLifeSciencesInstituteofNorthAmerica receivingothersupportfromtheUnitedSoybeanBoardandtheNortharvestBean GrowersAssociationreceivinggrantsupportthroughhisinstitutionfromWrigley, KraftFoods,CocaCola,Vivus,JasonPharmaceuticals,AetnaFoundation,and McNeilNutritionalsandreceivingotherfundingthroughhisinstitutionfromthe CocaColaFoundation,CocaCola,PepsiCo,RedBull,WorldSugarResearch Organisation,ArcherDanielsMidland,Mars,EliLillyandCompany,andMerck.No otherpotentialconflictofinterestrelevanttothisarticlewasreported. Disclosureformsprovidedbytheauthorsareavailablewiththefulltextofthis articleatNEJM.org. WethankDrs.KyleGrimesandS.LouisBridgesfortheirsuggestionsonanearlier versionofthemanuscript.

SOURCEINFORMATION
FromtheDepartmentsofNutritionSciences(K.C.,M.M.B.B.,D.L.S.,D.B.A.), HealthBehavior(K.R.F.),Pediatrics(N.D.),Medicine(G.D.),HealthCare OrganizationandPolicy(E.M.F.,N.M.,B.S.),andBiostatistics(T.M.,D.B.A.)and theSchoolofPublicHealth,OfficeofEnergetics,NutritionObesityResearch Center(A.W.B.,D.B.A.),UniversityofAlabamaatBirmingham,Birminghamthe OPUSCenterandtheDepartmentofNutrition,Exercise,andSports,Universityof Copenhagen,Copenhagen(A.A.)theDepartmentsofDevelopmentandFamily Studies(L.L.B.)andNutritionalSciences(B.J.R.),PennsylvaniaStateUniversity, UniversityParkPenningtonBiomedicalResearchCenter,BatonRouge,LA (S.B.H.)Children'sPhysicalActivityResearchGroup,DepartmentofExercise Science,ArnoldSchoolofPublicHealth,UniversityofSouthCarolina,Columbia (K.M.,R.P.)theDepartmentsofPediatricsandEpidemiology,PrograminGraduate MedicalNutritionSciences,andPrograminGastronomy,CulinaryArts,andWine Studies,BostonUniversity,Boston(P.K.N.)andtheCenterforQuantitative ObesityResearch,MontclairStateUniversity,Montclair,NJ(D.M.T.). AddressreprintrequeststoDr.AllisonattheUniversityofAlabamaatBirmingham, DepartmentofBiostatistics,Birmingham,AL35294,oratdallison@uab.edu.

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