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History Reclaimed: Part of The [Missing] HAES Files Series

Put up your Dukes – How HAES Fought its Way to the ADA Platform

By Lindo Bacon, PhD

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The long road to the 2011 American Dietetic Association’s Annual Meeting (FNCE) debate between Dr. Lindo Bacon advocating for a HAES approach and Dr. John Foreyt promoting the conventional anti-obesity approach.

Formerly published on “The HAES files” blog, the Association for Size Diversity and Health. May be slightly edited since original publication.”

The American Dietetic Association’s annual Food & Nutrition Conference & Expo—scheduled in San Diego this month—has wide influence on U.S. nutrition education and practices, so you might naturally expect to learn about Health at Every Size® there. To date, though, HAES^SM has never been the primary topic of an ADA FNCE session. That’s why it comes as major news that conference-goers on September 25 will hear obesity researcher John Foreyt debate size acceptance advocate Lindo Bacon in a session called, “The War on Obesity: A Battle Worth Fighting?”

Some people wonder why size acceptance suddenly makes an ADA appearance this year. Others ask if Foreyt and Bacon are far enough apart in outlook to make this a “real” debate. Bacon offers answers, along with the backstory to this groundbreaking event: 

It wasn’t how I imagined I would finally debut at the ADA FNCE, but I can’t wait to debate Dr. John Foreyt in San Diego on September 25. What an audience! For starters, ADA members are influential, dedicated professionals on the front lines of the weight wars. And my rival? I hear Dr. Foreyt is a nice guy and great to talk to. He’s also a four-star general in the Obesity Wars, as a veteran of government obesity panels and large-scale weight loss studies, both corporate- and government-funded. 

Until recently, it was hard to get anyone in the traditional “weight control” community to even acknowledge size acceptance, let alone debate its merits. So the chance to have it on the ADA conference agenda? Well, it’s unprecedented. 

Literally unprecedented, in fact. The reason I know that ADA conference planners repeatedly turned down HAES presentation proposals is that most of them came from me. I am a professor, recipient of U.S. government research grants, and a multiply credentialed scientist with credits in peer-reviewed journals, as well as an accomplished and sought-after speaker. I say this not to toot my own horn, but to show why I assume something other than my resume was at issue in these rejections. The fact that my work challenges the scientific credibility of the ADA’s official position on weight management? That may have had something to do with it. 

This year, though, ADA members demanded HAES representation: Dawn Clifford, member of both ADA and ASDAH, launched a letter-writing campaign to insist on a HAES forum at the FNCE. Others with joint ADA ASDAH memberships (Dayle Hayes, Joanne Ikeda, and Michelle Morris, among them), joined the outcry. And there was a different outcome. Not only did I receive an invitation, but I even heard from conference committee members that they are fans of my work. 

Imagine how my excitement deflated, then, when I read the fine print. Unlike every other FNCE panel, mine was required to take the form of a point/counterpoint debate, with a speaker presenting the “other side.” 

I did appreciate the irony. As ASDAH member Deb Burgard expressed it, the full weight of ADA history, its years of voluminous presentations on obesity, and every other presenter on weight-related issues would not suffice to counterbalance my presentation. Deb advised me to take it as a compliment, and I do! 

If it was a debate they wanted, I figured the bigger the name I went up against, the better. But those in the anti obesity camp proved less eager. [Note: some names have been removed to respect concern that it may impact the ADA’s future speaking requests.] The ADA first approached a medical school professor who co-founded a weight control registry and helped develop NIH guidelines to “treat” obesity. His secretary said he was available. Then she said he wasn’t.

TV personality and surgeon Mehmet (“Dr. Oz”) Oz was considered. His speaking fee? $75,000—not an option. And no nonprofit discounts, either. As someone who dedicates much of her labor and income to gratis and non profit advocacy, I found this, well, disappointing. 

In turn, the ADA also approached a prominent professor of medicine and public health at Harvard; another prominent professor who was co-founder of a weight control registry; and the director of a center for obesity research and education and former president of the Obesity Society. All routinely give talks at similar conferences. All declined. 

I do understand that people are busy. Maybe busy enough to be booked six months out for a Sunday in September. But do I also detect a whiff of fear in the air? 

That’s why I congratulate Dr. Foreyt, who teaches and directs the Behavioral Medicine Research Center at Baylor College of Medicine, for stepping up to the plate. He is a highly respected, credentialed and experienced researcher with numerous (17!) books and 300+ articles to his credit, and a worthy opponent. And he has devoted his career to seeking ways to help people who struggle with cardiovascular disease and other health problems, so his dedication is obvious. 

Dr. Foreyt’s name might have come up even sooner in the ADA search, however, committee members feared we hold views too similar to allow for robust debate. They needn’t have worried. Dr. Foreyt’s feet are firmly planted in the anti-obesity/pro-diet world, and, like his fellow Obesity Warriors, he is well-supported by corporate interests. 

As an example, he served on the NIH panel that, with a swipe of the pen in 1998, played a role in 29 million Americans becoming “fat” overnight, by suddenly lowering the nation’s BMI standards. In my book and elsewhere, I have described this reset as unsupported by data. 

Dr. Foreyt is also representative of his colleagues in an obesity research field that is rife with conflicts of interest: Like them, he has been compensated by and received grants from a slew of diet and food industry behemoths. For instance, according to information from the Center for Science in the Public Interest [enter “Foreyt” in the search line], he has been a paid advisor to Slimfast. He has even made a personal testimonial about incorporating Slimfast shakes into his diet and appeared in Coca Cola ads. Not just pro-diet, Dr. Foreyt has also supported—and been supported by—purveyors of pharmaceuticals and weight-loss surgery, consulting for and/or receiving grants from a long list of drug firms that includes Sanofi Aventis, Roche Pharmaceuticals, Abbott Laboratories, GlaxoSmithKline, and Regeneron Pharmaceuticals, and from Orexigen, a manufacturer of bariatric surgery equipment. Contrast this with my commitment not to accept money from any food, diet or pharmaceutical company. 

By naming this, I am not suggesting that Dr. Foreyt is personally dishonest or part of a conspiracy. Indeed, I believe he – and most obesity researchers – is well-intentioned. But that doesn’t mean he is uninfluenced. Think of the penalty he would pay for questioning obesity myths. And research confirms that industry-sponsored research yields more favorable results than independent research. 

As I wrote in Health at Every Size, “My concern is that obesity researchers are highly vulnerable to accepting cultural assumptions—even more so than the general public—because their status, reputation, and livelihood are in large part determined by how well they promote the diet and pharmaceutical industries. Career opportunities are limited if they choose not to participate, resulting in little incentive to question the status quo. … 

“Public/private conflicts of interest… [are] not conducive to being open-minded about new ideas or making sure important research gets conducted or reported, or that the best information directs public policy and gets out to the general public.” 

If John Foreyt and I stand on common ground, it is our mutual desire to improve Americans’ health. I trust his good intentions. And that’s a great basis for moving the discussion forward.

Kudos to the American Dietetic Association for opening the floodgates and airing the debate. The organization may never be the same!