Evidence or message: Which comes first?

In discussions about how to improve health, we have two potential starting points: the evidence on that particular health topic or the message we want to convey about said health topic.

Call it a chicken or egg example.

Starting point #1: Do we create our message (and its subsequent communications and advocacy strategy) and then go hunting for evidence to support it?


Starting point #2: Do we seek to understand existing evidence and then create our strategy based on it?

Let me share a recent example of how this actually plays out.

The other week I presented results at a conference from an evaluation I led of a pilot pediatric obesity treatment program. The program uses a family-based, home-based health coaching approach to support young kids and their family in modifying obesity-related health behaviors.

Though my co-presenter and I drew the short straw and received the last breakout session slot of the two-day conference, a good crowd of healthcare and public health professionals showed up.

Two of my slides focused on BMI changes during the life course of a family’s involvement in the program (albeit among a small sample size of 26). Like just about all other lifestyle-based obesity treatment interventions, sustained BMI reduction is an elusive goal. In our sample, BMI remained constant or decreased in about half of subjects using self-reported data (this percentage was lower using EMR-based data). The recent publication of national childhood obesity trends among 2-19 year olds provides a humbling reminder of just how much we still don’t know.

But it’s hard to admit you don’t know the answer, as I’ve written about before. Instead, it’s a lot easier to filter evidence and create a story that fits your interests. (This type of filtering happens whether I’m a researchers or multinational company. As I wrote in this post, it’s about the person holding the megaphone and their interests; and we all have megaphones. It’s this person (or department, or company) who decide what makes it through, when, and how.)

This was exactly what I heard in one particular conversation I had with someone from the state health department after my presentation. They cautioned about how best to present and share BMI data, especially with policy makers (i.e. Those who hold the purse strings). Their point was to not give the impression that these type of interventions don’t work because there wasn’t an overwhelming reduction in BMI.

I concede the point about BMI being only one indicator of health (and based on the research, not always a very good one), and the potential for misinterpretation of its utility and limitations among policymakers.

But here’s my point. Rather than presenting “negative” data as essential to learning, the argument was to filter out the unsupportive evidence to create the best possible message before it goes through the megaphone.

The message came first, and only the evidence that supported the message would make it through the filter. Starting Point #1.

The solution became more important than understanding the problem. And once our inertia propels us down this particular road, it’s awfully hard to change course.


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