Treating obesity: Comfort, affliction, and confusion

Perhaps you already know the behind-closed-doors guiding principles of the news media, but if so, I suppose I’m a bit naïve in comparison. I thought they would be all about reliably reporting the news. Instead, I learned this guiding principle during my days working as an on-air contributor for ABC News’ Good Morning America: “Comfort the afflicted, and afflict the comfortable.” This is by no means an ABC mantra; it’s industry-wide. And if we append to these two a third — “propagate perennial confusion all around” — we might just about have the complete picture.

That’s the problem. That addendum of mine follows logically and all but invariably from the prevailing devotion to the first two dicta.

Here’s why:

Let’s say you are among the afflicted. This comes in many flavors, of course. But because ratings and audience size matter, you may not get much comfort unless you happen to be afflicted in one of the more popular ways. So if you have a rare disease or some uncommon misfortune, your story may get airtime when it’s time to afflict others — but you shouldn’t expect much on-air comfort.

But, if you are struggling with your weight, for example — then you are blessed with a very popular affliction. You will be comforted, and often. Unfortunately, since there isn’t anything both new and actually valid for weight loss every week, day and hour — your comfort will largely come in the form of unsubstantiated hooeymisguided fads, and silly fashions. You will hear about every cockamamie approach to fast weight loss that ever worked for anyone in Hollywood. You will hear about every supplement and silver bullet that might work, but actually doesn’t.

You will get your comfort in the form of effortless success, magic, and fatuous guarantees. If you are afflicted by the challenges of living better and being healthy, you will be comforted with all the ways to get there from here that require no work whatsoever. So you will feel better — until you actually try any of this nonsense. Because the promises are all false. This, in turn, will propagate your affliction — and keep you tuning in for more comfort. Somebody wins in this scenario, but it sure isn’t you.

But maybe you are not among the afflicted; maybe you are among the comfortable. On any given day, most of us are comfortable in one way or another — so we all get a steady dose of bad news to make sure we have the right balance of comfort and affliction.

But let’s be more specific. Perhaps you are comfortable that you know a drug prescribed to you by your doctor is good for you. You need to be afflicted with news about horrible potential side effects, no matter how rare.

Maybe you are comfortable with your basic knowledge of healthful eating. You need to be afflicted with competing theories every day.

If, in fact, you are comfortable in your basic understanding and beliefs about anything — based on some combination of life experience and a large and consistent body of evidence — you need to be afflicted with the latest conspiracy theory. The science inveighs consistently and overwhelmingly against any link between vaccination and autism, so you need to hear from someone who knows all of that science to be confabulated. You need to hear from her or him, no matter how lacking in credentials or genuine expertise she or he may be — because you need to be afflicted. If 9,999 studies all support the same version of truth, and one goes the other way — you need to hear about that one. It will afflict you.

And the affliction does not result in confusion commensurate with the content. It results in confusion commensurate with the coverage. That one study at odds with every other hints at scandal and conspiracy and cover-ups. So that’s the one likely to go viral. That’s the one that will reverberate forever in cyberspace. Lost in all that sauce is the most likely reason for the one result discrepant from the slowly, incrementally, and arduously aggregated weight of evidence: the one result is just plain wrong.

And so the heroes of our flavor-of-the-day news cycles are not those who prove to be right or actually know what they are talking about. The heroes on any given day are the iconoclasts, conspiracy theorists, and — just plain wing nuts. Affliction is the plat du jour, and these — its master chefs.

There are consequences of this for us all — always important, often vexing, and sometimes dire. I have seen each kind up close and personally.

For example, it has always been important to me to convey consistent and reliable sense about diet and health in my own media efforts. Some years ago, I was prepping a segment on a diet study for a major news show the following day. I was on the phone with a segment producer, senior producer, and writer — running through the Q&A: Here’s what the anchor will say, how will you answer? (The fact that the anchor in question never actually asked the questions we ran through was always part of the fun.)

Everything went fine until we got to my final punchline. At that point, the senior producer chimed in and said: “You can’t say that.” I asked why. “Because you said almost the same thing last week, and it would be boring to repeat it.”

“That may be” I said, “but the fact is that vegetables and fruits actually still are good for people this week.”

My most recent brush with the comfort-affliction-confusion trifecta relates to the NuVal nutritional guidance system. I won’t dwell on NuVal per se, except to say I consider its development my greatest contribution to public health. And, objectively, it is the first and to date only nutrition guidance system to correlate directly with health outcomes, including all-cause mortality. But I digress.

recent Huffington Post piece written by someone I don’t know sang the praises of NuVal, and of the supermarket chains bold enough to put the unvarnished truth on display. It got a lot of attention — including from mainstream media. The next thing I knew, I was being asked to do an interview about NuVal for CBS This Morning.

Logically, since the reason for this attention was a column characterizing the unique merits and value of NuVal, one would expect that related coverage would focus on bringing the same positive news to a bigger audience. But that, I suppose, would risk comforting the already comfortable. So even though the coverage was largely positive, the associated headlines hinted at scandal. Interviewees included people with no particular credentials or knowledge of the system, invited to talk about some score they didn’t like.

This is personally rather vexing, I admit. But the issue goes way beyond me and my parochial concerns. What happens when something actually is good and works as intended, but we are given hints of scandal about it? We don’t trust anything. We can’t tell the difference between what’s legitimate and what’s not, because in a comfort-affliction-confusion paradigm, everything is treated the same. We can manage to disbelieve global warming even as the melting polar ice caps flood our basements. We can manage to believe that vaccines are sinister, even as we raise children never subject to polio.

Nothing is off-limits to the mantra, save celebrity and deep pockets. Schlemiels like you and me can do good works for a lifetime and get no attention. A celebrity who renounces pedophilia — again, this week — winds up in the middle of a media love-fest. And big companies with deep pockets can spend vast fortunes on products and practices that help make people sick, and still get a photo op with the first family for spending one-thousandth as much on helping those poor sick people.

OK, now I’m whining. Sorry.

For the most part, it’s the comfort-affliction-confusion paradigm for all. And as noted, the effects can be genuinely dire.

We got comfortable, for example, with the belief that hormone replacement therapy at menopause could prevent disease and improve quality of life. So, when studies showed that one particular form of HRT in women a decade or so out from menopause resulted in a slight excess of harms over benefits, that wasn’t nearly enough of an affliction. The story, as conveyed to us in the news media, was that HRT was a killer. That we’d been wrong, utterly wrong, in our prior comfort.

This makes for more provocative coverage, certainly. But unfortunately, it’s wrong — and lethally so. Colleagues and I have a paper due out in a major journal this summer showing how exaggerations and sweeping generalizations about HRT have cost lives. Details of that story will  have to wait for the paper to come out, but they really are dire. And it’s just an example — there are others like it.

We can’t just blame this on the news media. They don’t show what we won’t watch. They won’t waste time on soundbites to which no one will listen. True, they build it; but it’s because we come, and keep coming.

But we pay a high price for doing so. We no doubt pay a price in many areas — from technology, to finance, to the environment. But I know we pay a price in public health. And our currency is human lives.

News of this sort — that emphasizes what’s new over what’s true, what’s scandalous over what’s reliable — propagates confusion and undermines genuine understanding of anything. That, to me, seems a genuine affliction. It’s an affliction we could eradicate if we could manage a cold, hard look at business as usual, and decide — we’re just no longer comfortable with it.

David L. Katz is the founding director of Yale University’s Prevention Research Center

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