obesity research

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Episode Description:

David Allison is an award-winning scientific writer who has been at the forefront of obesity research for the last 20 years. Currently the Dean of the Indiana University School of Public Health, he has also authored many publications on statistical and research methodology and how to improve research rigor and integrity. David’s focus on evidence and data brings forth an interesting discussion of what we know (and don’t know) about the science of obesity. He provides an insightful and unemotional explanation of the potential impact of nutritional epidemiology in public health while also explaining its many pitfalls and limitations. He offers his take on the path forward in addressing the obesity epidemic, and he closes with a lucid explanation for the evident lack of credibility in science and the steps we can take to change that. 

We discuss:

• David’s background, interest in obesity, and focus on evidence [5:00];
• The moment when the obesity crisis was recognized, and the sloppy science that ensued [13:00];
• What twins studies tell us about the genetics of obesity [20:30];
• How doctors and scientists have historically approached obesity treatment [23:45];
• Do surgical procedures for obesity prolong life? [32:00];
• The ‘Obesity Paradox’ [36:00];
• Interpreting BMI and mortality data and considering confounders [43:15];
• How body composition and ethnicity factor into consideration of BMI data [50:30];
• Superior tools for measuring obesity at the individual level [57:15];
• Using BMI data for actionable steps to combat obesity [1:02:00];
• Why maintaining weight loss is more challenging than losing weight [1:06:00];
• Differing perspectives on the utility of nutritional epidemiology [1:16:30];
• A mouse study illustrating the impossibility of fully controlling for confounds in observational studies [1:22:15];  
• Limitations of nutritional epidemiology and how it can improve [1:26:30];
• Addressing the obesity epidemic—the path forward and obstacles to overcome [1:37:15];
• What David believes to be the most promising interventions we could take to address obesity and improve public health [1:47:30];
• Reproducibility in science, normative and non-normative errors explained [1:51:30];
• Rebuilding trust in science and differentiating between science and advocacy [1:59:00];
• More.

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For nearly four decades, Americans have heard a simple story about health, longevity and obesity. This week, we learn it's a little more complicated. 

Thanks to Katherine Flegal, Paul Campos, Jeff Hunger and Jason Salemi for helping us research and fact-check this episode! 

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Links!

• Katherine Flegal’s “The obesity wars and the education of a researcher”
• Walter Willett's " Evidence does not support benefit of being overweight on mortality"
• Flegal’s 2005 paper
• Flegal’s 2013 article
• Willett’s 2016 meta-analysis
• The infamous 2004 CDC paper
• Fat: A Cultural History of Obesity
• Paul Campos's "The Obesity Myth"
• Walter Willett’s Food Fight           
• The obesity research that blew up
• Flawed methods and inappropriate conclusions for health policy on overweight and obesity: The Global BMI Mortality Collaboration meta-analysis
• Does Body Mass Index Adequately Convey a Patient’s Mortality Risk?
• The Weight of Medical Authority: The Making and Unmaking of Knowledge in the Obesity Epidemic
• Obesity: An Overblown Epidemic? 
• Commentary: On ‘public health aspects of weight control’
• Obesity And Its Relation To Health And Disease
• Does Being Overweight Really Reduce Mortality?
• Individual and Aggregate Years-of-life-lost Associated With Overweight and Obesity

Gary Taubes is an investigative science and health journalist and a best-selling author. In this podcast, Gary explains how he developed a healthy skepticism for science as he was transitioning from being a physics major to beginning as a science journalist. He talks about how he was particularly drawn to sussing out “pathologic science,” telling the stories behind his books on the discovery of the W and Z bosons and cold fusion, emphasizing the need for researchers to perform a thorough background analysis. Gary then describes how his work came to focus on public health, nutrition, and obesity. He provides a great historic overview of obesity research and provides his explanation for why the conventional wisdom today is incorrect.
We discuss:

• Gary’s background in science and journalism, and developing a healthy skepticism for science [2:20];
  
• Gary’s boxing experience, and the challenge of appreciating behavioral risk [8:40];
  
• How Gary developed his writing skills, and what the best science writers do well [16:45];
  
• Example of how science can go wrong, and the story behind Gary’s first book, Nobel Dreams [25:15];
  
• Theoretical vs. experimental physicists: The important differentiation and the relationship between the two [36:00];
  
• Pathological science: research tainted by unconscious bias or subjective effects [40:30];
  
• Reflecting on the aftermath of writing Nobel Dreams and the legacy of Carlo Rubbia [49:45];
  
• Scientific fraud: The story of the cold fusion experiments at Georgia Tech and the subject of Gary’s book, Bad Science [53:45];
  
• Problems with epidemiology, history of the scientific method, and the conflict of public health science [1:09:00];
  
• Gary’s first foray into the bad science of nutrition [1:26:45];
  
• Research implicating insulin’s role in obesity, and the story behind what led to Gary’s book, Good Calories, Bad Calories [1:36:15]
  
• The history of obesity research, dietary fat, and fat metabolism [1:46:00]
  
• The evolving understanding of the role of fat metabolism in obesity and weight gain [1:55:15]
  
• Mutant mice experiments giving way to competing theories about obesity [2:04:00]
  
• How Gary thinks about the findings that do not support his alternative hypothesis about obesity [2:08:00]
  
• Challenges with addressing the obesity and diabetes epidemics, palatability and convenience of food, and other hypotheses [2:14:45];
  
• Challenging the energy balance hypothesis, and the difficulty of doing good nutrition studies [2:25:00]; and
  
• More.
  

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