Misleading Study Conclusions Part 2 - Patient Impacts

Studying the studies

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In part one, we talked about a study whose goal was to study the effects of psychiatric drugs on weight loss. I mentioned that the lead author of that study was quoted in the online version of US Pharmacist, which bills itself as both “The Leading Journal in Pharmacy” and “The Pharmacist’s Resource for Clinical Excellence.” as saying

“The results of this study are relevant not only to the healthcare professionals providing care to those who have both excess weight and mental illness, but also to the patients who experience these comorbidities themselves.”

The lead author is correct, just not in the manner intended…but we’ll get to that.

Healthcare practitioners rely on the stated conclusions of these types of studies as primary sources for information. They don’t typically have the time or desire to buy the study and dig into it to see if the results are extremely misleading (as I did, and as they are.)

So when a study’s conclusion states “Results of this study suggest that those who participate in a weight management program can lose significant amounts of weight regardless of psychiatric medication use,” it’s unlikely that a psychiatrist (or anyone else reading it) would guess that the average weight loss was less than 3% of starting body weight.

They probably wouldn’t guess that within the study the authors would say “Indeed, while the overall amount of weight loss achieved in this sample was modest (3.4 kg or 2.9%), this is consistent with 3% achieved on average from long-term lifestyle interventions,” without pointing out that the idea that small amounts of weight loss produces “clinically meaningful” health outcomes is not supported by the evidence.)

So getting back to the lead author’s quote about how the study’s conclusions are relevant to both healthcare practitioners and patients, that is a true statement in that it misleads and harms both. More of the harm is done to patients, with those at the highest weights and/or with multiple marginalized identities being harmed the most.

I don’t believe that prescribing weight loss meets the basic requirements of ethical, evidence-based medicine because of the extremely high failure rate combined with the negative health impacts of failure. (Which I wrote more about here, here, and here.)

But even if a psychiatrist thinks it’s appropriate and within their scope of practice to prescribe weight loss, the fact is that their patient has very little chance of success. But instead of understanding that and correctly setting the expectations of themselves and their patients (that if they lose about 3% of their body weight in about 16 months they would be “successful” and that they are extremely likely to gain it back,) unfortunately the misleading conclusions of weight loss studies like this lead practitioners (and patients) to expect more weight loss, and they both blame the patient for “failing” if it doesn’t materialize, or when the weight comes back.

Healthcare practitioners are supposed to be able to trust the conclusion statements of peer-reviewed articles, patients are supposed to be able to trust their healthcare practitioners to provide ethical, evidence based care and informed consent. Research like this leads directly to patient’s being misled by their HCP, who was misled by the research.

And if a patient were to research this online (as I originally did,) they would find article after article in (what are theoretically) legitimate publications that just repeat the conclusion that “Results of this study suggest that those who participate in a weight management program can lose significant amounts of weight regardless of psychiatric medication use.” They would have to be able to buy the study and analyze it to find the truth.

For those patients who know the truth, they may be dealing with a practitioner who is not only rooted in misinformation, but absolutely committed to defending that and completely unwilling to listen to or learn from their patient.

This can cause missed or delayed diagnoses and treatment by practitioners who are so distracted by weight loss that they fail to give their higher weight patients the same treatment as their thin patients. It can also cause patient disengagement from higher weight patients who don’t want to have to fight for basic healthcare, or whose experience has been that there is no point in trying to access healthcare when they just get diagnosed as fat and prescribed weight loss. Especially when they’ve tried over and over and always had the same result (short-term loss and long-term regain, which is exactly what the research actually predicts.)

We often talk about the dangers this causes in physical healthcare, but the stakes are just as high, and sometimes higher, in care for mental health. The researchers creating these studies, and the reporters who are writing about them, owe more to everyone than to tell anything less than the truth about the abysmal success rate of intentional weight loss attempts.

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*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings: Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.