This is a story that starts out with announcing the approval of two new devices for reducing a person’s waistline but then quickly takes an interesting detour through the biology of fat cells — their function, how they work, and their diversity. The story goes on to make clear that after treatment with these devices, "the fat is reabsorbed by the body," indicating that while they may bring about a change in appearance, there is no loss of weight. Through great use of independent experts the story excels where many fail by explaining that high-tech solutions to a low-tech problem may not be a wise choice. It fails in other areas, though, including any mention of costs and any evaluation of the evidence being used to promote these devices.
The story matters because many people are dealing with weight-related health issues and the future risks associated with being overweight or obese. The story maks it clear that these devices are for "cosmetic" use only and are of no utility for people with serious weight problems.
There was no mention of costs for any of the treatments mentioned, which is especially troubling given that most cosmetic procedures are not covered by insurance.
The story provided no insight about the amount of circumference that could be reduced with the use of these devices or whether the reduction was predictably long term or not.
There was discussion of hypothetical harms that might results from eliminating a cache of subcutaneous fat. It flags this early on by saying, "Eliminating fat cells without also eating less or exercising more may make fat crop up elsewhere and ultimately do more harm than good." However, the story does not provide any data about whether the harms considered have been demonstrated to occur.
There was no actual evidence presented in this story for the efficacy of the devices. In the headline and first section, this story hyped the new devices without providing an appraisal of the evidence what, if any, benefit people get from their use. FDA approval of a medical device is not the same as an evidence base for clinical benefit.
To begin with, there does not appear to be any published science behind the Zerona device. A search of PubMed for Zeltiq turned up a couple of small studies that indicated using the device did not cause any change in circulating lipid levels or liver test results in the 12 week following treatment. This is all the more reason to proceed with caution when writing about it.
Despite the lack of evidence, though, the story, uses action-packed language in the headline, lead and first section to give readers the impression that these devices might solve their weight problem. "Zeltiq grabs onto love handles and belly pouches and freezes the fat cells inside, causing them to self-destruct over several months. Zerona is a low-level laser that rotates around the waist, hips and thighs, forcing the fat cells to empty in a matter of weeks. In both cases, there are no incisions, no downtime and no need for anesthesia. The fat is reabsorbed by the body." Can’t you see those quotes being used on an infomercial? It is only in the fifth graph that the story puts the brakes on the hype and spends the rest of the story talking about the problems of trying to break up fat.
The story did not engage in disease-mongering.
The story included comments from a number of clinicians and adipose tissue researchers who had no connection with the highlighted devices.
There was no comparison of the circumference reduction obtained with the devices either to each other or to other protocols.
The two devices mentioned in the story were described as FDA approved, which is true. The story could have made it clear, though, that both devices have been in use for a while and that off-label use of devices is common.
The story shows that these types of devices are being used now and more are in the pipeline.
The story did not appear to be drawn from a press release from either company.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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