What's Wrong With Fat? (21 page)

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This chapter and the preceding one have examined both the opinions of obesity researchers and the content of news media reporting. Clearly both of these are important, but what is their relative importance? To what extent are news media reports shaped by scientific studies and vice versa?
The next chapter addresses these questions.

Many people assume that if the risks of “obesity” have been exaggerated, it is the fault of the mass media. Scientists, many think, do their best to accurately present their research, which typically has important limitations and a fair amount of uncertainty. In contrast, journalists tend to sensationalize scientific findings and minimize uncertainty to produce more dramatic and compelling news stories in order to sell copy. 1 They favor imagery over content, cover research as a series of dramatic events, and report on provocative theory as if it were fact. 2 That science journalists typically lack scientific training and hold scientists in awe makes them unlikely to question research findings. Journalists and newspaper editors’ decisions about which studies to discuss and which to ignore have also been shown to influence public opinion. 3

Yet scientists also routinely simplify and sensationalize their own results to attract news media attention, thereby boosting their visibility and attracting funding for their research. 4 So is it journalists or scientists who have produced the received wisdom that Americans are eating themselves to death? More broadly, how do scientific studies and news reporting on such studies frame fat differently?

A brief historical examination of the emergence of the term
obesity epidemic
points to the interdependent role of science and media coverage. 5
This term was first used by the news media in the mid-1990s, in response to a 1994 study published in the
Journal of the American Medical Association
(
JAMA
) showing that, between 1980 and 1991, the proportion of overweight or obese Americans jumped by 20 percent so that, by 1991, nearly one-third of the population was overweight or obese. 6 The authors of the study concluded that overweight and obesity presented “a public health dilemma for which no efficacious, practical, and long-lasting preventive or therapeutic solution has yet been identified.” 7 In an accompanying editorial in
JAMA
,
obesity researcher Xavier Pi-Sunyer lamented the “fattening of America” and asserted that “if this was about tuberculosis, it would be called an epidemic.” 8

Throughout the summer and fall of 1994 and the following winter, the U.S. and foreign news media spread the message of an “obesity epidemic.”
An article in the Cleveland
Plain Dealer
asked readers, “Have you heard? Obesity is an epidemic in our country,” while the London
Independent
announced that “new statistics on obesity [in the United States] suggest the national problem of fatness should be regarded as an epidemic.” 9 A
New York Times
editorial warned that “obesity has reached epidemic proportions in the US and nobody knows quite what to do about it,” 10 while a
Washington Post
article announced: “Fact: Fat’s an epidemic.” 11 The epidemiological trends were harnessed to create drama and a sense of impending doom: “Listen to the sounds of big America: pants splitting, stomachs roiling, buttons popping, hips spreading like kudzu. We do not need a penny scale to know which way the fat is blowing... ” 12

In the following years, the news media continued to disseminate scientific research about the health risks and economic costs associated with obesity. As is illustrated in figure 4.1, an exponential increase in the early 2000s in the number of scientific articles on the topic of “obesity” has been closely followed by a similar upward trend in the number of news media articles on this topic. Specifically, figure 4.1 shows the number of scientific articles published between 1980 and 2010, based on a PubMed search of studies with the term
obesity
in the title or abstract, and the number of news reports published during these years, as measured by a search of LexisNexis U.S. news sources with
obesity
in the headings or lead paragraphs. What I wish to highlight here is that scientific attention to this issue has preceded news media attention.

According to political scientists Rogan Kersh and James Morone, invoking medical scientific evidence is necessary for garnering public support for U.S. government intervention in citizens’ private habits. The science does not have to be accurate to have an impact, they argue. They point to cases, such as that of tobacco, in which there was strong scientific evidence of harm and others, such as that of liquor, in which the science was only partially true:
“Liquor contributes to health problems, but it is not poison, as prohibitionists insisted.” 13 In still other cases, they show that “the science can be entirely fictitious, as when Victorian physicians warned men that self-abuse or too much sex could maim, blind, or kill them.” 14 Moreover, medical knowledge is rarely in itself sufficient to stimulate a political response, they argue. Rather,
it needs to be spread by policy entrepreneurs. The news media provides a critical avenue for the dissemination (and potential contestation) of scientific knowledge. 15 As with other medical issues, most people—including practicing physicians—get their information about the medical risks of obesity from the news media, rather than from scientific publications. 16
Given this, it is crucial to understand the role played by the news media in filtering and disseminating scientific knowledge.

Figure 4.1:
Science and News Reporting on Obesity.

When I began research on this topic, there were a couple of books written that underscored the important and interdependent role played by science and the news media in constructing a sense of an “obesity crisis,” but they had not systematically examined how the news media report on science about body weight and health. 17 My goal was twofold. First, I wanted to methodically show which kinds of research articles get news media coverage in the first place, and how the news media frame this research compared to the original scientific research. Second, I wanted to examine how the news media cover scientific controversy, when such controversy arises.
These goals eventually led me to develop two different news media studies, which I describe below.

WHICH STUDIES DO THE NEWS MEDIA COVER AND HOW?

If specific scientific studies frame issues differently and if the news media cover some kinds of studies more than others, news media framing may be partly driven by the types of scientific studies that get the most coverage.
Of course, there are many factors—besides the content of the study itself—that influence news media attention. Notably, scientific findings, or any other potentially newsworthy event, are more likely to receive media attention if they occur at a quiet time in the news cycle, when journalists have few other topics on which to report. Inversely, extremely newsworthy research findings may be buried if they are published at the same time as a major event, such as a presidential election, a natural disaster, or a terrorist attack. In order to examine the extent to which the news media tend to report on certain sorts of scientific findings, I needed a news sample that would allow me to control for—or hold constant—moments in the news cycle. Moreover, all things being equal, research published in more prestigious and visible scientific journals will attract more news media attention, so I also wanted to hold prestige of publication constant.

JAMA
,
the flagship journal of the American Medical Association, is widely regarded as one of the most prestigious medical journals. Published continuously since 1883, it showcases studies that are considered widely relevant, rather than those that are of interest only to specific medical subfields. Moreover,
JAMA
has an active new media relations department.
Since 1998,
JAMA
has published several theme issues that focus on specific topics, including infectious disease, cancer, medical education, malaria, violence/human rights, HIV/AIDS, and cardiovascular disease. These theme issues are themselves potential media events, often generating considerable news media attention. Because they include several different studies on a general theme, they provide an excellent opportunity to examine which types of studies attract the most news media coverage. Because all articles in a theme issue are published on the same day and in the same journal, comparing across studies within a theme issue effectively holds constant both prestige of journal and moment in the news cycle.

At the time of this writing,
JAMA
has published two theme issues on obesity, including one in 1999 and another in 2003. Many of the articles in the 1999 issue sought to establish the importance of obesity as a public health priority. For instance, one study announced that obesity was an “epidemic,” based on its findings that the prevalence of people with a BMI over 30 had increased dramatically between 1991 and 1998. 18 Another estimated that obesity was associated with between 280,000 and 325,000 excess deaths in the year 1991. 19 An editorial sounded the alarm on increasing rates of obesity and called for policy intervention. 20 The 1999 theme issue also included technical studies on various issues related to body size, nutrition, physical activity, and health. By 2003, when the second theme issue was published, “obesity” was more institutionalized, or taken for granted among scientists and the public alike, as a public health problem. 21 Perhaps reflecting this, the studies in the 2003 issue tended to take for granted, rather than assert, that obesity represented a major public health crisis. They included mostly studies of the relative efficacy of different weight-loss diets, programs, or medicines. 22 The one partial exception was a study on the quality of life of children with an average BMI of 34.7, which could be argued had the effect of raising awareness about the specific problem of
childhood
obesity. 23

I created a matched scientific and news media sample for each of these two theme issues. The first includes the ten scientific studies published in the 1999 theme issue of
JAMA
and 69 news reports on those studies; the second includes the ten scientific studies published in the 2003 theme issue of
JAMA
and 59 news reports on those studies. Using these two matched samples allows me to examine which articles within each theme issue received the most news media coverage for each year. 24 There are limits to the extent to which my findings can be generalized beyond these two theme issues. Nonetheless, analyzing two separate publication events occurring four years apart—as opposed to a single one at one point in time—enhances generalizability.

CREATING CRISIS

My analyses suggest that the news media do indeed tend to dramatize “obesity.” 25 One reason for this is that the news media disproportionately focus on the most alarming/alarmist scientific reports, in turn, favoring a public health crisis frame. Routine use of evocative metaphors and language in press releases and by the news media further strengthens the public health crisis frame.

Figure 4.2 gives the proportion of scientific and news articles dramatizing obesity in various ways. As this figure shows, in both 1999 and in 2003, the science and news samples are equally likely to treat obesity as a public health crisis. Specifically, in 1999, 70 percent of the research articles in the
JAMA
theme issue and 72 percent of the news sample on that issue overwhelmingly portray overweight and obesity as a crisis. In 2003, these figures are 40 and 34 percent. It is not that the scientific reports in the 2003 theme issue or news reports on those studies counter claims that obesity was a crisis. Rather, they tend to take this for granted and focus on more technical issues. However, news reports on both theme issues are significantly more likely, than the theme issues themselves, to refer to obesity as an epidemic, to blur the lines between different levels of overweight or obesity, and to invoke war metaphors. Forty-nine percent of news reporting on the 1999 theme issue, compared to only 20 percent of the scientific articles in the issue, labeled obesity an epidemic. Less dramatically, 31 percent of the news coverage of the 2003 issue—compared to 20 percent of the scientific sample—framed obesity as an epidemic, as in the following: “There’s a rapidly spreading epidemic afflicting all regions of the country, all ethnic and economic groups, and all ages.... It’s not SARS, West Nile virus, or Lyme disease. It’s obesity.” 26

Part of the explanation for these patterns is that the news media focus more heavily on scientific studies that lend themselves to more dramatic reporting. In 1999, the research report that received by far the most journalistic coverage reported that the prevalence of people with a BMI over 30 had dramatically increased between 1991 and 1998, labeling it an “epidemic.” 27 The study that received the second greatest amount of media attention estimated 280,000 to 325,000 excess deaths in 1991 due to obesity. 28 More technical studies received less coverage. 29