‘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.

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