A Diet of Contradictions

What's on your spoon?

By Rashmi Vasudeva

Being fat is bad, scream headlines. But wait, good fat is good for you. Wine is even better. Chocolates can actually bail you out. Soya does the trick. Or does it? The appetite for solutions to the burgeoning trouble of obesity has put media reportage about diet and nutrition in the spotlight.

My cousin Vimal Simha is 22, and a brilliant, hardworking postgraduate student at the University of Ohio. He is also 40 kg fatter than he should be. And like all obese people, he has been bombarded with advice and admonitions. His mother has told him to pore over the health sections of newspapers. “They are always writing about people like you,” she says.

He listens to his mother and often goes on weight-loss programmes, but the advice he gets from the papers is a puzzle. Not only is he told that a low-fat diet will not cut his health risks (Boston Globe, The New York Times, cnn.com, Science Daily and others), he is also advised to increase intake of carbohydrates or carbs as they are fashionably called in the papers (The Los Angeles Times, Flour Advisory Bureau, ABC, etc). And it doesn't stop there.

He is instructed to drink moderate amounts of wine (Medical News, Health Daily, The New York Times, Times of India), eat bagfuls of soya (Deccan Herald, Channel 4, BBC) and not go easy on chocolates (The Daily Mail, Science Daily). If by this time poor confused Vimal decides to read on, he will find out from the same papers that carbohydrates may not really benefit him so much after all (cnbc.com, Women's Health). He will be lectured about glycemic indexes, warned about the dangerous effects of eating too much soya (The Guardian, The Daily Telegraph), and threatened with a dreadful fate if he goes within smelling distance of alcohol.  OK, that’s an exaggeration.

What to believe?

What is not an exaggeration is the media explosion about diet, especially with regard to hot topics such as obesity. There is simply too much information floating around and too many contradictions to count. To the general reader, it seems as if the media and nutritionists are out to confuse the world. Eggs were bad, now they are good. Chocolate has been promoted to a health food and obese people who eat nuts are not nuts.

Earlier, people like Vimal got such information from their family doctors. But today, there is a storm of information that blows in from newspapers, the internet, television and magazine stories, each proclaiming different theories. According to Excellence in Journalism, a group that monitors media coverage in the US, the number of newspaper frontpage stories on science and nutrition went up from 1 per cent to 3 per cent in the period 1977 to 2004.  The pharmaceutical industry and companies producing weight loss products tripled their advertising budgets because of the heightened interest and media hype.

Yet, two-thirds of Americans are overweight or obese (Newsweek) and obesity has trebled in Britain in the last 20 years. Obesity figures in countries such as India, where the economy is booming, are not as bad as the UK and the US – but they do not look very good either. According to the American Obesity Association, there are over 300 million obese adults and 1.1 billion overweight people in the world (WHO). Being underweight used to be much more common worldwide but now the two conditions co-exist, with half of the world's population underweight and the other half overweight.

PR Power

Scientists working on obesity-related diet and nutrition research are in the public eye more than ever today. Universities and hospitals send out polished press releases to glossy women’s magazines and lifestyle sections of newspapers. It is a far cry from the time when the scientist Richard Dawkins remarked, "science journalism is too important to be left to journalists".

This change may be because scientists are finally recognising that journalism is important for science, but it may also be to generate a buzz about their research. Scientific research today is fiercely competitive. Dr James Le Fanu, a GP who writes a column on health for The Daily Telegraph, says: “Nutritionists and dieticians have to justify their existence, get publicity as well as funding. Hence they make their research sound terribly important and interesting. And they have learnt very well how to subvert the press.”

Mr Naveed Sattar, professor of metabolic medicine at the University of Glasgow, who recently published his study findings on obesity and cancer in the British Medical Journal, looks at the issue from the other side: “The problem arises because explaining scientific studies in press releases is never easy but we do it,” he told me. “Reporters are looking for clear messages, like for instance, ‘nuts help you lower cholesterol’, which are topical and can sell papers. But such observational studies are always too complex to be written in a 200-word release and unfortunately, get only partially, and sometimes, incorrectly reported.”

Mr Sattar seems to have hit the nail on the head.  The enormous coverage of issues concerning obesity and diet would, in fact, be beneficial if the result of studies reported were as straightforward as the media makes them out to be. Unfortunately, that’s not the case. Headlines have to be short and catchy and they, more often than not, end up distorting the actual findings of a study. “The media has enthusiastically published reports of studies that have tried to document the health hazards of a diet high in calories and animal fat and low in fibre, fruits and vegetables – a diet typical of western market economies.

But what the newspapers don’t report, or perhaps don’t get to know, is that such surveys of eating habits are consistently confounded because of under-reporting by obese respondents," says Mr Sattar. In other words, people who overeat tend not to accurately report what they eat and in most cases, underestimate their caloric intake. 

"Science and medicine promise a lot but in many cases, we still don't have the answers," Dr Jerome Groopman of Harvard Medical School once said. That still essentially holds true. But there is erroneous reportage because writers fail to specify the kind of study that is being reported, says Mr Tim Radford, former science correspondent, of The Guardian. Studies on the same topic vary immensely in terms of sample, demographics and time period. "The media report all studies as if they all have yielded definite results. This is not true at all," says Mr Radford.

Low-fat and high-visibility

Let’s take the instance of the recent Women’s Health Initiative (WHI), a long-term federally-funded national health study in the US that tested 161,808 women aged between 50 and 79 over a period of 15 years. It was widely reported the world over, many times inaccurately. A sample of headlines reporting the study includes:
- Low-fat diet's benefits rejected (Washington Post)
- Low-fat diet does not cut health risks (The New York Times)
- Study finds no major benefit of low-fat diet (Times of India)
- Low-fat diet may not be healthier (The Daily Mail)
- Is fat all that bad really? (Deccan Herald)

Fat, these headlines seem to say, is not bad at all. But the actual results were much more complex. The complexity was indeed explained in some of these articles, if the reader bothered to scan the final paragraphs. The study never said fat was great, though those who just read the headlines, might have made a beeline to the nearest pizza outlet.

The study was confined to women aged 50 to 79. And its aim was to test whether cutting fat would reduce the risk of breast cancer. The results were published in the Journal of the American Medical Association in February 2006 with the neutral headline “Low fat dietary pattern and risk of invasive breast cancer”. The article had a plethora of statistics, details of the number of women in the trial, and goals. But all this and the original intended message that a low-fat diet may not lower the risk of breast cancer got lost amid the trumpeting headlines about how low-fat diets are “not beneficial”.

Newsweek reported that at a conference held at the National Institutes of Health, which sponsors WHI, researchers hoped that women would not start piling on the fat because of the study.

Chocolate – angel in disguise?

Dr John Ioannidis, of the University of Ioannina in Greece, wrote an article in the same journal analysing 45 well-publicised health studies that had appeared in leading journals between 1990 and 2003. He reported that about a third of them were flatly contradicted or significantly weakened by later work (The Guardian, August 2005). A typical example is that of chocolate’s health benefits.

John Allen Paulos of the Temple University, Philadelphia, says in The Guardian: “How credible you find studies on chocolate may say more about your psychology than the biochemistry of chocolate!” Dr Le Fanu agrees: “Many such studies are just funds and publicity-driven nonsense.”

Take the example of a study conducted in 2001 and funded by the American Cocoa Research Institute. It found that cocoa powder boosted “good cholesterol”. Welcomed by the public as well as the media, this was published in several papers and websites, though some like the bbc.com and The Guardian were sceptical. Mr Radford believes that in many instances, the money trail determines the results. “Sometimes, they are tweaked a little to suit interests.”

In 2005, a study published in the Archives of Internal Medicine, found that people who ate food containing dark chocolate (candy bars, pudding, spreads) had slightly lower blood pressure. Professor Carl Keen of the University of California presented his team’s research at the British Association Festival of Science held in Glasgow in September 2001. The research was led by and was sponsored by chocolate makers Mars. Professor Keen reported that flavonoids present in higher concentration in dark chocolate keep the heart healthy and prevent blood clotting.

Both these studies were reported in sections of the media with the same enthusiasm. Headlines included:
- Chocolate is good for you (The Washington Times, Feb 28, 2006)
- Chocolate is good for you (The Los Angeles Times, October 20, 2005)
- Chocoholics, rejoice (Women’s Health, September 2005)
- Chocolate good for you, docs say (msnbc news, September 3, 2005)
- Stay happy with chocolate (Deccan Herald, Sept 23, 2005)

Recently, scientist Dr Alan Crozier of the Institute of Biomedical Science at the University of Glasgow, came up with conflicting findings.  A study he conducted with colleagues revealed that though dark chocolate appeared to be a slightly better option than the milk ones, the milk proteins present in all chocolates stop the anti-oxidants in chocolate, known as flavonoids, from being absorbed into the bloodstream.

Dr Crozier says: "Dark chocolate is indeed healthier but it does not make it ideal food. It still has fats, it still has sugar and a whole lot of calories. I advise only moderation and not pretence that chocolate is health food. It is wrong to say that chocolate is good for you.”  All the newspapers promptly reported Dr Crozier’s findings and quoted him extensively on his views about how “chocolate is not health food”. A headline from The Guardian summed this situation up rather well: “The good news is chocolate won't kill you, the bad news is it will” (August 5, 2005).

Dr Parul Dube, a dietician and member of the Health Professions Council, UK, says she is worried about the kind of message such media reports send to her patients. “It might encourage my obese patients to relax. You can’t really blame them for trusting newspapers especially if they tell people who like chocolate that it’s good for them.”

And the debate goes on …

This flip-flop, both in the case of studies and in media reports, is not a new thing. Nearly 200 years ago, William Cobbett wrote a series of articles about the marvels of fresh milk, the awfulness of Irish potatoes and the healthy qualities of fat bacon. We all know the extent of debate about the good and bad of milk, potatoes and bacon since then.

So where does it all end? Dr Le Fanu is not very hopeful of there being more clarity in the near future. He believes it to be a vicious cycle fuelled by the media’s desire to “fill health sections”, the nutritionists’ need to find “meaning for their existence and money for research” and the big companies’ ambition to sell more.

“It all began in the late 1980s. Editors earlier believed that medical news was not news. Slowly, the trend of devoting a page to health began. Nowadays, there are six-page health supplements and people are getting fatter all the time. Naturally, reporting a study on wine or chocolate is interesting, popular, and easy. Journalists cannot question scientists and neither is it their job to do so. But they can question themselves.” Dr Le Fanu’s column is one of the few exceptions, where he takes a sceptical look at it all. “Perhaps the diet hype will die down and there will be more sensible reporting when people will begin to get bored or thinner!” he says.

William Gratzer, a biophysicist, in his wonderfully erudite book Terrors of the Table – The curious history of nutrition, reviews the complicated data regarding diet and nutrition and finds that public understanding of such issues has little to do with actual results. Gratzer’s advice? “Diets full of processed foods promote hypertension and obesity. Fresh fruit and vegetables are good for you and it is prudent to avoid excess of any type of food.” This, every journalist and nutritionist worth his salt, will agree, is as near truth as it can be.

If only my cousin Vimal could hear this message loud and clear, minus all the clutter.