The content of this television segment is generally accurate. A small study suggests that obese, diabetic teens can benefit significantly from gastric bypass surgery.
It correctly says that this is an important finding for a condition that is serious and very hard to treat. It also indicates the surgery is controversial and its long-term effects unknown.
But the story’s tone is excessively positive in a way the facts do not allow. The study’s flaws and limitations should have made the report more circumspect and restrained. The surgery group was very small, extremely obese and not well-matched to the controls. The study was retrospective and as a result fails to capture some key data.
In addition, the surgery has serious side-effects that were not reported. The lack of data on long-term risks and benefits is mentioned as a small caveat, rather than a major gap in the research that leaves the most fundamental questions unanswered.
The story’s most serious technical shortcoming is a failure to quantify the findings, which would have allowed people to appreciate how few teens were involved yet how many of them benefited. It would also have shown viewers how unusually obese the studied population was.
The story illustrates how journalists may use unnecessarily loaded language to overdramatize findings.
The segment uses the following words:
* dramatic (2)
* drastic
* radical
* remarkable
* huge
* dire
* life-threatening
* reversed
* disappeared
* vanished
While some of these words may be accurate in context, the cumulative effect is to heighten hope and fear beyond what the facts permit.
This is often found in television reports, where the need to "sell" the story both to get it on the air and to engage viewers second-by-second drives writers and producers to hyperbole.
If findings are significant enough to justify air time, they do not need to be oversold. If they need to be oversold, they do not belong on the air.
The story does not report the costs of gastric bypass surgery. $20,000 is a figure commonly cited.
The report says little more than that in the small study diabetes was "reversed, disappearing in almost [all]" of the obese teens who got the surgery.
The overall impression this creates is accurate. But the term "reversed" has unclear medical meaning, and "disappearing" is not correct either. This appears to be a case of the familiar habit of journalists using overheated language to make the story seem even more dramatic than it is.
A more accurate statement of the findings would be that the surgery led to significant improvements in the important markers and risk factors for diabetes in nearly all patients. If these changes remain over time and don’t increase risk of other serious diseases, the surgery could save lives and improve quality of life. That’s a mouthful, but the report could have tailored its language more carefully to reflect this.
The story also missed two easy opportunities to quantify the benefits. It could easily have said that 10 of 11 patients had these results. It could also have stated that the average weight of surgery patients was 313 pounds, indicating that these were not merely "fat teens" but unusually, dangerously obese ones. It could also have said that while all of the patients lost significant amounts of weight, none reached a BMI within the healthy range, and some remained obese.
The segment mentions at the beginning that the treatment is controversial. Near the end it says some doctors oppose the surgery in teens because it may affect growth and development and its long-term effects are unknown.
But this is insufficient.
A recent study of the surgery in pediatric patients showed a 25 percent rate of serious complications, a fact the report fails to mention.
It should also have mentioned that there is a substantial incidence of weight regain in adults who get the procedure. There have been deaths in adult surgery patients as well.
The report hinges on a very small study with 11 patients in the experimental group and 67 controls. The story responsibly describes the study as small. But it doesn’t drive home the point about why that’s an important limitation.
The research itself has serious shortcomings–it is based on retrospective chart reviews, the control group is not well-matched and some key data on blood sugar levels is missing–limitations that should have dampened the story’s enthusiasm. Existing data suggests that the failure rate for excessively obese adults to avoid weight gain after successful surgery and significant weight loss can be as high as 50%. Given the short follow up period of the study, suggesting the patient is diabetes free is premature.
While the story opens with a dramatic anecdote about a severely obese patient with multiple morbidities, she fairly represents the treated population. Her successful outcome is consistent with the findings.
But the second-hand report of the doctor’s prediction of her death by 25 is clearly excessive and unsubstantiated by the literature.
Lead-ins are meant to be hooks – to keep us watching. This story’s lead-in, promising "new findings tonight that could offer hope to the growing number of teenagers struggling with obesity and diabetes" failed to acknowledge that the study subjects were extremely obese with nearly all in excess of the 99th percentile for body mass index.
The report includes interviews with one patient, the lead researcher and one independent expert. It’s interesting that the ABC website includes a skeptical quote from another independent source, but the on-air story minimized the following caveats that WERE on the website:
Dr. David Nathan, the director of the Diabetes Center at Massachusetts General Hospital, believes there is still reason to delay the surgery in children because "there is concern regarding the effects of such surgery on growth and development."
Also, doctors say little is known about the long-term effects of this surgery.
Physicians, including the study authors, caution that gastric bypass surgery does not cure diabetes. If patients regain their weight, the diabetes can resurface.
The segment fails to report the conventional treatment for severely obese teens with diabetes is drug management.
It also fails to mention that even in morbidly obese teens, diet and exercise are recommended and can improve markers and risks for a number of cardiovascular diseases and diabetes. Diet and exercise have not been shown to be effective strategies of achieving a healthy weight in this population, however.
The story fails to mention where, if anywhere, gastric bypass surgery is done on teens. It fails to mention how often it is used in teens for its current indication, to reduce weight for the morbidly obese.
The story correctly reports that the surgery is often used in adults but is not commonly used in teens.
One independent expert was interviewed, so we can assume that that the story did not rely solely or largely on a news release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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