Tuesday, May 21, 2013

The American Board of Obesity Medicine Must Choose: Quackery or Quality?

Since 2005 I have been a certified Diplomate of the American Board of Obesity Medicine (ABOM) - now a joint venture between the American Society of Bariatric Physicians and the Obesity Society - and in a few more years I'll be faced with the choice of re-certifying, or letting my credentials lapse.

Part of my decision no doubt will be whether or not I feel the ABOM and I are on the same page in regard to science, medicine, ethics, and values when it comes to obesity medicine and I'm not convinced right now that we are.

You see a few months ago the ABOM put out a press release (that's a screenshot up above) highlighting the upcoming appearance of one of their board members on the Dr. Oz show. Her name is Dr. Denise Bruner and she was on Dr. Oz to promote the use of 5-HTP as an appetite suppressant. The ABOM also showcased her upcoming appearance of their Facebook page:

Both the press release and the Facebook update were quickly removed after I pointed out that given the ABOM's ultimate aim to be accepted as a credible medical organization it might be best to not promote 5-HTP supplementation for obesity given that the evidence base on its utility is anything but robust (here's a pubmed search that includes the 25 total citations that mention 5-hydroxytryptophan and obesity whereby the most generous take on the research would be that in the late 1980s and early 1990s two small studies suggested the possibility that 5-HTP supplementation might help ever so slightly with weight management).

But that's not the end of the story. While I was heartened that the ABOM saw fit to rapidly remove their endorsement of a nationally televised promotion of a non-evidence based supplement, I still struggle with Dr. Bruner's ongoing inclusion on the ABOM's board.

I struggle not simply consequent to Dr. Bruner's at best highly preliminary promotion of 5-HTP to literally millions of members of a very trusting public, I struggle because Dr. Bruner is currently a provider of the, "HCG Diet Protocol". Below is a screenshot from her office's website, and because I found it so incredulous that a board member of the ABOM was an HCG diet provider just to be sure I called her office yesterday and confirmed that if I paid Dr. Bruner $200 for an initial consultation, and then an additional $800, that she would inject me with HCG daily for a month.

The evidence base to date on the hCG Diet is clear. It's quackery.

The Obesity Society put out a position piece on the hCG diet last year. In it they state,
"We conclude that the scientific evidence does not support the use of HCG for the treatment of obesity. This position is in agreement with the U.S. FDA. The Obesity Society is committed to advocating the use of therapies for the treatment of obesity that are evidence-based and rejects those that have been shown to be ineffective."
The American Society of Bariatric Physicians also has a position piece affirming their non support of the HCG diet and in a 2011 press release supportive of the FDA's removal of "homeopathic hCG" from the market noted succinctly,
"Obesity is a chronic disease which is best treated by a physician who specializes in weight loss and practices medicine based on sound scientific principles. Unfortunately, hCG does not live up to those standards."
Dr. Bruner's practices, both in what I see as a markedly overhyped promotion of 5-HTP on national television and her use of hCG on her patients, run contrary to my take on what represents evidence-based obesity medicine, and the fact that she sits on the ABOM's board gives me great pause as to the value of that certification. So too does the title of one of the ASBP's upcoming webinars, "Controversies Concerning HCG for Weight Loss". Malpractice isn't controversial, it's malpractice.

Perhaps with this post the ABOM will see fit to consider whether or not Dr. Bruner represents their organization's aims, and moreover, whether or not there should be some mechanism to de-certify physicians whose practices belie the ABOM's standards of practice.

At the end of the day if the ABOM is hoping to be deemed credible it's going to have to choose to stand strongly against quackery and it's going to have to do so without external blowhards like me needing to point that out.

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  1. Good call, Dr. Freedhoff.

  2. Really excellent post, Dr. Freedhoff. And I totally agree with you.

    We have something aligned to this going on with fitness blogging right now. Popular morbidly obese bloggers who make constant excuses for having very poor eating and exercise habits that are winning the "fitness" blog awards. These bloggers have extremely dangerous health habits, which they role model to their followers. They are key speakers at "fitness" blog conventions.

    Many of us serious fitness bloggers who have really changed our ways--lost our weight and exercise religiously--do not like how the term "fitness" and "fitness blog" is now used to mean the very opposite of what we do.

    Many of the fitness blogs I personally follow have marathon runners, moms who are weightlifters, people who walk hundreds of miles every year, and women who have kept off big weight losses for several years. On my blog, I advocate: exercise regularly at a challenging level, food journal, and eat within calorie limit every day. <<This is health and "fitness" in our minds.

    So I empathize with you being very wrongly grouped with Dr. Bruner. Her quackery is NOT at all what you are about. And we serious fitness bloggers keep our dedication to our cause of doing whatever we can to advocate health.

    :-) Marion

    1. Anonymous5:33 pm

      if you want to abolish quackery, abort the mindset that focuses on calories and focus instead on the role of carbohydrate driven fat storage.

    2. Well, counting calories has been super successful for me. So I'll stick with it.
      ~ Marion

  3. Although I would like the medical community to widen its reach and consider, and research, alternative approaches to good health, I have to ultimately agree with you - especially when steep fees are involved. There's so much we don't yet understand about how supplements may react with our bodies that, until further research, it may be best to stick with the simplest and traditionally most effective solutions - moderate amounts of natural foods and a good amount of exercise.

  4. Ah, but what about the short term placebo effect of both 5-HTP and HCG. These gives a bit more motivation push, but much less that a both way-cost/benefit analysis, long and short term. (8 way analysis)

  5. I initially started the certification process without the American Board of Bariatric Medicine (renamed American Board of Obesity Medicine) ABBM/ABOM - but realized that too many of the physicians in this organization use the "certification" as a "paper diploma" to scam their patients. The HCG Diet is not an unproven treatment, but is a DISPROVEN treatment. The only physicians who support the idea that HCG might work to help with weight loss are the ones who are ACTIVELY SELLING HCG DIET TREATMENTS to their patients. Promoting a product just to make money selling it (whether it be a quack remedy for cancer (e.g. Laetrile) or a specific horse at the racetrack (i.e. to influence the odds on a race that is fixed by doping the horses with PEDs) is called "TOUTING". It is blatantly illegal at the racetrack, and definitely unethical in the doctor's office.

    The ABOM doesn't police itself, nor establish standards of ethics for its licensees. That is why this board is not recognized by the American Board of Medical Specialties (ABMS), the American Board of Physician Specialties (ABPS), the Florida Board of Medicine, or any other organization.

    I have decided to not associate myself with the ABOM for these reasons. Until Dr. Freedhoff's recommendations are followed, the ABOM will remain nothing more than a "paper diploma mill".

    Kenneth Woliner, MD