‘Energy Balance’ in the news

He ain’t heavy, he’s my brother…..

The ‘Coke Wars’ have been raging for a week.

I read with great interest a recent piece in the New York Times – “Coca Cola Funds Scientists Who Shift Blame for Obesity Away From Bad Diets.”  It’s been making the rounds on mainstream and social media–there has been a vigorous back and forth on Twitter.  You may already be very familiar with the story.  The ‘Letters to the NY Times Editor’ were overwhelmingly negative, suggesting that the researchers in the article were in the pockets of industry.

There were several dimensions to this story that intrigued me, and so I thought it would be a good piece to discuss here on the blog.  Reading Brian McFadden’s Strip in the Sunday’s NY Times, the ‘Sugar Water Workout,‘ finally got me on the laptop.  I’m a big fan of McFadden’s irreverent strips, though in this case I think– as i do about several of the discussions I’ve seen regarding this issue in the media–he has over-simplified a contentious issue to get some laughs.

Up front, let me share with you my opinions about this matter.  Then I’ll wend my way back to some of these comments to touch on what I think is a valid point the article makes and some thoughts about transparency in health care research.

My thoughts on reading the NY Times story:

1. To achieve weight loss, an individual must restrict caloric intake.  There is a great deal of discussion about the ‘ideal diet,’ but the key is reducing calories–vegan, paleo, low carb, however one does it, reduce the ‘calories in’.   The history of dietary fads is a long one, but the most important principles are not the choice of diet as much as i)reducing intake and ii) maintaining these new habits over time.  To the extent my patients may consume a lot of carbonated soda, I have them identify that as the source of their unessential ‘extra’ calories and eliminate that from their diet while they work on other lifestyle changes as well.
2. That said, there is an overwhelming body of evidence that ‘Exercise is Medicine.’*  Put another way, achieving weight loss is many people’s goal.  But it is usually not their only health goal, nor should it be the sole goal we clinicians in sports and exercise medicine will be working on with our patients.  Increasing physical activity and exercise has a host of benefits that cannot be achieved by diet alone.  For instance, improvements in knee osteoarthritis are seen more with diet change and weight loss than exercise; but the combination of exercise and dietary changes provides the most benefit to these patients.  And to pick one more of several studies I could point out, our ‘fellow travelers’ at BJSM recently published a meta-analysis on HIIT in adolescents and found these exercise interventions (not accompanied with dietary changes) can achieve significant improvements not only in cardiorespiratory fitness but also body composition (BMI and body fat).
3. Therefore, I think it is something of a ‘Hobson’s choice’ to ask which is more important:  diet or exercise?  It’s not a ‘zero sum’ game. Diet & Exercise go hand in glove, they are complementary.  Most of us, and most of the patients we care for, need to address both parts of the equation.  The sedentary lifestyles we increasingly lead are one of the great public health crises of our time. With some irony, I think a debate that pits diet vs. exercise is a bit like the fanciful argument Lite beer used to have with itself:tastes great….no, less filling!  Tastes great!  Less Filling!!!!
   

   The stairs can be lonely in the modern world.

4. The biggest misstep the scientists made as described in the article was an initial lack of transparency.  The Global Energy Balance Network (GEBN) with which the researchers are affiliated gets substantial funding from Coca Cola. There is clear potential for bias.  Scientists affiliated with this Network must be as transparent as possible.  On the GEBN website, this at first, apparently, was not the case.
5. Finally, Social media can ramp things up to a fever pitch–it births viral memes and creates chatter that can overwhelm rational discussion.  Some of the criticism of the scientists and the science in the NY Times article is valid; much of it has descended to ad hominem attacks and is not constructive.  As someone who is involved both in the research and social media ends of clinical sports medicine, I would say the social media aspects of this story have overwhelmed rational discussion.

Returning to point #4, Anahad O’Connor, the reporter who filed the NY Times story, writes this:

“The group’s (GEBN) website also omitted mention of Coke’s backing until Dr. Yoni Freedhoff, an obesity expert at the University of Ottawa, wrote to the organization to inquire about its funding. Dr. Blair said this was an oversight that had been quickly corrected.

‘As soon as we discovered that we didn’t have not only Coca-Cola but other funding sources on the website, we put it on there,’ Dr. Blair said. ‘Does that make us totally corrupt in everything we do?’ (my itals)“

Scientific discourse is something I want to celebrate here:  plaudits to Dr. Freedhoff for looking into this and contacting GEBN to ask them about this oversight.  Plaudits to the reporter for filing this story.  Plaudits  to Dr. Blair for in fact correcting the oversight [my answer to his rhetorical question:  ‘No it does not make you totally corrupt, but it was a significant oversight that unfortunately now has possibly undermined GEBN’s work.’]

In truth, all of us doing research have to be attentive to conflicts of interest.  In the United States, NIH funding for scientific research has reached historic lows.  I have little doubt that for many of us that will mean we will be seeking more funding from private organizations, including corporations, as we go about our work.  Despite what some of the louder voices on social media would suggest, this is not inherently a bad thing.  But it is a situation that poses several challenges, and one which demands that we all must be as transparent as possible when we are speaking in public or publishing. It is also one that demands that we police our own for conflicts of interest, and that we put up as many firewalls as possible between the funding and the published research.

I look very carefully for, and at, the disclosure slide in conference talks, for instance.  Sometimes we speakers gloss over that slide; it is one of the most important in the entire presentation, to my mind.   One of the first parts of a study I look at is the acknowledgements, to see what funding sources or other conflicts of interests the authors may have.  And though I sometimes sigh over more paperwork to fill out, I am glad my home institutions have me review my ‘conflict of interest’ statement every time I filed an application for IRB approval of a new study.

Turning to point #2 while extending this meditation on transparency:  Designed to Move is another organization, along with GEBN, that is putting money and effort into the global epidemic of physical inactivity.  I have learned much from the work it has done.  However, the fact that Nike has partnered with the American College of Sports Medicine (ACSM)** and the International Council for Sport and Physical Education in developing this program does matter.  This is a relationship that should be identified clearly so any of us looking at that organization’s work can be attuned to potential biases.

I want to echo what Dr. Blair (@SteveNBlair) wrote recently on Twitter: “@gebnetwk welcomes scrutiny and constructive criticism. We respect our critics & ask that they respect us in return. http://buff.ly/1K0xBSG “

Can’t we all just get along

I think we can be civil, just as Billy and Mr. Steinbrenner were during the “Lite Beer Wars” of another era!!!  I think we can be open and vigilant while maintaining a rational scientific discourse.

We at CJSM look forward to continuing this and other topical conversations with you.  As ever, leave your comments here or tweet them to us @CJMSOnLine

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*, **Disclosure:  Besides being an Associate Editor for CJSM, a sports medicine specialist at Nationwide Children’s Hospital, and faculty at Ohio State’s College of Medicine, I am a Fellow of the American College of Sports Medicine (ACSM). ACSM manages the global health initiative known as ‘Exercise Is Medicine.’  I have no direct relationship with that initiative.

I neither have relationships with GEBN, Designed to Move, Coca Cola….or the Miller Brewing Company.