Journalists are very interested in obesity. The papers, magazines and television shows are full of stories about the latest news about weight loss. Cable TV is full of infomercials touting the latest surefire cure for obesity. "If it works for me it can work for anyone," they shout while a half-second line at the bottom of the frame says, "Results not typical."

But we expect most good journalists to get it right. So why do so many get it wrong. Many get two figures wrong. Several have dismissed the figure of 300,000 deaths a year due to obesity. Among them is Alicia Mundy author of "Dispensing with the Truth, " an account of the fen-phen litigation.

Repeatedly, Ms. Mundy, a respected journalist, casts doubt on the 300,000 figure without ever digging into its origin. She writes, "Obesity was a killer, said the paid experts. It kills 300,000 people a year. And though no one could say exactly where the number came from, it became the mantra of "Obesity Inc." (p.42) Repeatedly she implies that the figure was bogus and made up.

The issue is not irrelevant. If it is true, obesity must be taken seriously as an important public health issue. If false, then obesity can continue to be trivialized or ignored. One way dictates millions of dollars for research, prevention and treatment and carries implications for regulation of the causes. The second approach can leave the present allocation of health care dollars intact and remove any potential challenges to the folks who want to continue promoting high consumption of foods.

Ms. Mundy cites many sources and many articles in the medical literature. How did she miss the source for the 300,000 number?

The first article setting the 300,000 figure was written by two highly respected government public health doctors. (MGGinnis, JM, Foege WH, Actual Causes of Death in the United States. JAMA, 1993, Nov.10;270(18):2207-12). Their article established the relative contribution to US deaths from tobacco, alcohol, microbial agents, toxic agents, firearms, sexual behavior, motor vehicles and illegal use of drugs. Their work established that dietary factors and activity patterns that are too sedentary are together accountable for at least 300,000 deaths a year. Their article estimated US deaths in 1990 attributable to "overnutrition" was between 309,000 and 582,000. Because of uncertainties, they chose the lower figure.

The most recent study was published in 1999. (Allison DB, Fontaine KR, Manson JE, Stevens J, Van Italie TD. Annual deaths attributed to obesity in the United States, JAMA 1999 Oct 27;282(16) 1530-8) The authors looked at data from 6 studies to estimate an annual number of deaths attributed to obesity between 280,000 (all subjects) and 325,000 (only nonsmokers) in 1991. The McGinnis study was published in 1993, the Allison paper in 1999 and Ms. Mundy's book in 2001.

The second frequently distorted figure is that 95% of all diets fail, resulting in weight regain. This figure has become an urban legend most recently reported by Morley Safer on "60 Minutes" on CBS. This figure has become written in concrete as a true reflection of weight loss efforts. Many people accept it on its face. Yet, a moment's reflection might call it into question. How could anyone know that? How is "diet" defined? What is its source? Is that what the number is about?

A moment's reflection might call this figure into question. How could anyone know how many diets fail? Who measures them? How is "diet" defined? What is its source?

One journalist did get it right. In the New York Times on May 25, 1999, Jane Fritsch tackled this piece of folklore.

Well, the source is Albert Stunkard MD, of the University of Pennsylvania and a director emeritus of the American Obesity Association. The figure comes from an article he published in 1959 on 100 patients treated in the 1950s. The 100 patients were given a diet and sent away. However, the figure is frequently applied to everything available today from surgery to drugs to behavior modification programs.

The fact is that one has to look at well-controlled studies of specific interventions to get a good idea of their success rates. Two well respected researchers, Rena Wing and James Hill, believe more than 20% of overweight/obese persons can lose 10% or more of body weight and keep it off for over a year. (Wing RR, Hill JO, Successful weight loss maintenance. Annu Rev Nutr 2001;21:323-41)

But the fact is that the 95% failure rate is repeated over and over as the truth. Why does a figure so old and so weakly established survive and thrive? It may be that it actually reflects people's own experience. Or it may be used to discourage vigorous weight loss efforts. Maybe some of us with obesity find it helpful to have company in our own weight loss failures.

It is interesting to note that a well-established figure of mortality due to obesity is so dismissed while a dubious figure of failure of weight loss is so trumpeted. Maybe it is time to take the folklore out of the debates about obesity and stick with the science.

Morgan Downey
AOA Executive Director