Reader Question- How Does Questionable Research Happen?

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!

I received this question from reader Lanelle:

“I’m so frustrated when I read the analyses that you and others do on weight loss and health and weight research with terrible methods and dishonest conclusions.  Are the researchers all just corrupt? And the doctors who give quotes to the press about how great weight loss is? Is everyone being paid off by the diet industry? I just don’t understand.”

As someone who performs the analyses of this research, I share your frustration and your question is one that I’ve asked myself many times. It’s incredibly difficult for me to believe that people who are educated as researchers, some of whom are professors at prestigious universities, could honestly come up with research designs and create studies that are so egregiously poor in terms of methodology, and so misleading in terms of the conclusions. Part of me wants them to be doing this on purpose just to restore my faith in the field.

I think there are probably some people and companies, and I don’t know how many, who are simply willing to create research designed to come to the conclusions chosen by the people/companies/industries who pay them, or for their own profit interests.

For example, based on the company announcement that Novo Nordisk released about their cardiac study (in lieu of releasing the actual study) you would think that they didn’t know high-school level statistics (or the definition of “adult.”) But when a study suggested that there might be fatal side effects to their drugs, suddenly we get "Analyses of spontaneously-reported adverse event data (such as that performed by Tobaiqy and Elkout) are informative but suffer from numerous inherent limitations which preclude drawing conclusions about association or causation." in a Newsweek interview.

For others, I think it’s more complicated. I think it’s about an entrenched paradigm. These are highly educated, often well-meaning people who have completely bought into a paradigm that simply existing in a higher-weight body (regardless of actual health status) is a “disease” that requires weight loss ‘treatment.” They have accepted it as full truth and are unwilling to even entertain the idea that they might be wrong about the paradigm as a whole.

Story time: You probably know the story of Galileo and how, based in large part on discoveries from looking through a telescope that he made, he wrote a book that angered the pope which saw a case brought against him by the Inquisition ending in his being convicted of being suspect of heresy, forced to (at least partially) recant, and sentenced to a lifetime of house arrest. The part of that story that most interests me is that, it is said, those who disagreed with him refused to even look through the telescope. They weren’t questioning his arguments on their merits, they were simply accusing him of disagreeing with their sincerely held beliefs - which they were completely, utterly, (and totally incorrectly) sure were the truth.

I see this sometimes in audience members at my talks. I’ll provide an hour, an hour and a half, two hours, four hours of research explaining the issues with the current paradigm. Someone will throw their hand up as soon as the Q&A starts and angrily say “This is irresponsible. Everybody knows that being “ob*se” is unhealthy and weight loss improves health!” They don’t disagree with me on the evidence or critique my analysis (sometimes further discussion suggests that it’s quite possible that they weren’t listening at all,) they are simply insisting that there can be no argument against their sincerely held beliefs. which they are completely, utterly, (and, I would argue incorrectly) sure are the truth. They are looking in the opposite direction of the telescope.

I suspect that this may help explain some researchers who create studies and write articles using methodology that veers far from anything resembling the scientific method or research methods best practices. They are sure what the outcome should be, so they keep trying things until they get the outcome “right.” Or they accept a position as part of a group or collaboration that is charged with creating research to support a chosen conclusion (rather than exploring a question to find the best answer scientifically.) They have decided/committed to the idea that making fat people into thin people is the right thing to do, so the only questions they are asking are about how to do that - not about whether or not that’s actually the best way to support the health of higher-weight people. We see this when research methodology excludes any studies that consider health changes but not weight changes (for example, in the American Academy of Pediatrics guidelines for higher-weight children and adolescents). By simply excluding weight-neutral options from research around weight and health, they eliminate any possible answers besides weight loss and open the door for it to seem reasonable to develop increasingly dangerous and expensive “treatments.”

When it comes to doctors who shill for the weight loss industry there are additional layers. First, we know that pharmaceutical companies work hard to infiltrate and influence medical training, we also know that research finds that payments from pharmaceutical companies (even very small payments) influence doctors' behaviors.  Then there’s the fact that some have pinned their entire careers to the fat=bad, weight loss = good paradigm, and even if they don’t run weight loss centers, call themselves “ob*sity medicine” providers, take payments from the weight loss industry, or write weight loss books, they have still typically been prescribing weight loss in various forms to patients for their entire career. It’s much more comfortable, even if it’s subconscious, to blame patients rather than blaming failed weight loss interventions.

When I say it can be subconscious, I mean that. There’s a great book that my soon-to-be brother-in-law Abel recommended to me. It’s called “Mistakes Were Made, But Not By Me” by Carol Tavris and Elliot Aronson. It explains how people deal with the cognitive dissonance of something challenging their beliefs and decisions by implementing self-justification and confirmation bias,  and they can do it in ways that are subconscious. I think we see this a lot when people double down when challenged.

Tavris and Aronson explain one example of this as:

“What they see confirms what they believe and what they believe shapes what they see. It’s a closed loop”

They are discussing therapists. Here is my interpretation for physicians and weight loss: Fat* patients eat too much and don’t exercise enough. Did my patient lose weight? Excellent, the advice I gave them to eat less and exercise more was effective! Did my patient not lose weight, or did they gain it back? It’s the patient’s fault – everyone can succeed at intentional weight loss if they try hard enough. Did almost all of my patients regain the weight they lost? Does a century of research say that almost everyone regains the weight they lost? That’s because fat people eat too much and don’t exercise enough which is why my advice to eat less and exercise more would be effective if they would just follow it.

Again, for doctors, the stakes are even higher since admitting the truth about weight loss interventions – that they hardly ever work and often lead to harm – would be to admit that they had been emphatically giving bad advice to a high percentage of their patients for their entire careers and blaming their patients for the failures of the healthcare interventions they recommended. That’s…a lot. Easier and massively less uncomfortable to (again, sometimes subconsciously) just stick with the status quo.

The fact that this may be explainable, and even the fact that it may be subconscious, does not absolve people from the harm that they do. We are all capable of confirmation bias, so those of us who do this work have an obligation to constantly be self-interrogating. Those whose choices to mistreat or harm higher-weight people are conscious (rather than subconscious) have some different self-interrogation to do.

Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter (and the work that goes into it!) and get special benefits! Click the Subscribe button below for details:

Liked the piece? Share the piece!

More research and resources:
https://haeshealthsheets.com/resources/

*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’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.