This commentary isn't about salt. But the games being played with regard to the National Business Group on Health's Guide to Clinical Preventive Services, a document likely quite familiar with salt company HR managers, are the same kinds of "ends-justify-the-means" shennanigans that plague the salt and health discussion.
Junkfoodscience points out "unenthusiastic conclusions about the evidence in support of obesity screening and interventions" by the too-often-ignored U.S. Preventive Services Task Force (part of HHS), are the tip of a dangerous iceberg. As author Sandy Szwarc elaborates:
Even so, the NBGH Guide found them sufficient to support their recommendations, stating:
"The U.S. Preventive Services Task Force recommends that clinicians screen all adult patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults....There is fair to good evidence that high-intensity counseling - about diet, exercise, or both - together with behavioral interventions aimed at skill development, motivation, and support strategies produces modest, sustained weight loss (typically 3 to 5 kg for 1 year or more in adults who are obese.
"Modest weight loss maintained for a year is hardly commanding evidence of long-term effectiveness for intense interventions. In fact, the dismal failure of any type of intervention in achieving long-term success was highlighted in the acclaimed, comprehensive review of more than 500 studies on dieting and weight loss by David Garner, Ph.D., and Susan Wooley, Ph.D.. They concluded: 'It is difficult to find any scientific justification for the continued use of dietary treatments of obesity.'"
Nevertheless, the Guide left out key sentences from the actual USPSTF report:
"The evidence is insufficient to recommend the use of moderate- or low-intensity counseling together with behavioral interventions to promote sustained weight loss in obese adults...The relevant studies were of fair to good quality but showed mixed results....studies were limited by small sample sizes, high drop -out rates, potential for selection bias, and reporting the average weight change instead of the frequency of response to the intervention. As a result, the USPSTF could not determine the balance of benefits and potential harms of these types of interventions."ยท The USPSTF concludes that the evidence is insufficient to recommend for or against the use of counseling of any intensity and behavioral interventions to promote sustained weight loss in overweight adults."
It reminds me of when the Dietary Guidelines Advisory Committee used just half a graph from Miller et al of Indiana University showing the variable blood pressure response to salt restriction -- some people's blood pressure falling more than others. But the original graph had simply been dissected and the portion showing that some people (about a quarter of the total) had a blood pressure INCREASE on lower salt was simply dropped. It wasn't politically correct.
While lots of scientists claim to employ "evidence-based" analysis, the assertion cannot be taken at face value. The truly disturbing thing here -- besides the science and health isssues involved, about which we claim no special knowledge -- is the intentional undermining of the federal government's science watchdog, the USPSTF. We need an honest broker like USPSTF so this preversion of its cautionary conclusions is perverse.
