False Memories:

Do Surveys and Interview Techniques

Result in Meaningless Dietary Data
and Poor Public Policy?

Edward Archer, PhD, MS

Obesity Theorist & Computational Physiologist
Chief Science Officer, EnduringFX

Current Nutrition Research

Barrage of specious nutrition
claims in the media
Coffee causes cancer!
Sugar is toxic!

The public is both incredulous and

confused
Decrease the legitimacy of science
Vaccines

A Simple Question

For most of human history

Why?
Subjective experience
The apparent movement of the Sun

Science overcomes subjectivity

with objective measurement

Measurement of Drunk Driving

How do we collect dietary data?

Uncorroborated anecdotes
Subjective estimates of food
consumption
Not objective measurement

Memory-Based dietary assessment

Methods (M-BMs)
Interviews or questionnaires
24-hour recalls (24HR)
Food Frequency Questionnaires (FFQ)

Archer et al., PLoS ONE 2013;8(10): e76632

A Simple Scientific Question?

Could people survival on the amount of
food & beverages they reported?

Method
Examined 39 Years of NHANES
dietary data
63,362 people
28,993 men and 34,369 women,
aged 20 to 74 years
Physiologically Plausible Reporters
Mere survival

Reported Energy Intake (rEI) &

Basal Metabolic Rate (BMR)

rEI BMR = ~1.55

<1.35 or >2.40 = Implausible
<1.35 = Confined to bed, no
activity
>2.40 = X-country skiing all day

The Results
Expected value = 1.55
Implausible = <1.35

Men: 1.31
Women: 1.19
Obese Men: 1.21
Obese Women: 1.10
Comatose patient on an IV drip
~50% of obese women reported lower
values

Over-reporting: rEI/BMR > 2.40

> 2.40 = X-country skiing all day
4.9% of men
High of 6.4% NHANES III

2.9% of women
3.9% in NHANES 2003-2004

Extreme Physiologically Implausible

Over & Under-Reporting

Method #2
Institute of Medicine
Total Daily Energy Expenditure
Equations from objective DLW database

rEI - TDEE = Disparity value

Negative values = underreporting

Disparity w/TDEE
Men -281 kilocalorie-per-day (kcal/d)
Women: -365 kcal/d
Obese Men: -467.4 kcal/d
Obese Women: -553.5 kcal/d
Greatest values (NHANES I):
Obese men: 716 kcal/d
Obese women: 856 kcal/d

Across the 39-year history [Energy

Intake] data on67.3% of women and
58.7% of men were not
physiologically plausible.
~63% were not compatible with survival
Empirical falsification of M-BMs

Prevalence of Misreporting
37 studies across 10 countries
>65% of the energy intake
estimates were implausible.
Goldberg, et al. (1991) Eur J Clin Nutr 45: 569-581.

These findings are nearly identical

to Archer et al., 2013: (63%)
PLoS ONE 2013;8(10): e76632

OPEN Study
Subar et al (2003) Am J Epi 158, 1; 1-13

Men underreported EI
24HR: -375 kcal/d (~13%)
FFQ: -961kcal/d (~34%)

Women underreported EI
24HR: -410 kcal/d (~18%)
FFQ: -818 kcal/d (~36%)

Archer et al 2013:
Men: 24HR: -281 kcal/d (~11%)
Women: 24HR: -365 kcal/d (~18%)

Moshfegh et al. Am J Clin Nutr.

2008;88(2):324-332.

Underreporting:
Obese men: -620 kcal/d (~20%)
Obese women -524 kcal/d (~21%)

Archer et al. 2013

Obese men: -467.4 kcal/d (~15%)
Obese women: -553.5 kcal/d (~23%)

Lissner et al., Int J Obes (Lond).

2007;31(6):956-961.

we measure energy so poorly

the 24HR may be particularly
problematic in the obese.
From over 60 years ago:
With obese women, individual food
recording methods gave grossly
inadequate mean caloric intakes.
Beaudoin & Mayer. J Am Diet Assoc. 1953;29(1):29-33.

Energetics Study
Arab et al., J Am Diet Assoc. 2010;110(6):857-864.

Repeated (8) 24-hour recalls

rEI decreased -535 kcal/d
Protein: -88 kcal/d
Fat: -243 kcal/d
Carbohydrate: -216 kcal/d

Refutation not Limitation

No where else in science is there a
tool that performs worse with
repeated use

2015 Dietary Guidelines Advisory

Committee (DGAC) Scientific Report

For NHANES, repeated 24-hour

recalls remain the backbone of dietary
assessmentto inform nutrition
policy.
Physiologically implausible data that
are not compatible with life cannot be
representative of what Americans are
eating
DGAC ignores the evidence

Replication and Refutation

Replication is an issue in other
domains
60 years of highly replicated and
unequivocal evidence refuting M-BM
A simple scientific question: Why are
the data implausible?

Archer et al., Mayo Clinic Proc.

2015;90(7):911-926.

~80% of Obese Womens Dietary Reports

were Incompatible with Survival
Archer et al., Mayo Clin Proc. 2015;90(7):911-926.

False Reporting: an inherent design

feature of M-BMs

Deese-Roediger and McDermott

(DRM) paradigm
A list of semantically related words
Eggs, orange juice, pancakes, toast

FFQ:
A list of semantically related words
Eggs, orange juice, pancakes, toast

False Reporting:
A design feature of M-BMs
24-HR are interviews
False confessions & False convictions
Coercive interviewing
Rapport, silence, imagery, props, repeated questioning, eye
contact

NHANES 24-HR training manual

Rapport, silence, imagery, props, repeated questioning,
eye contact
expectant looks to encourage and motivate
respondent to answer more fully
imagine eating and drinking and be convinced of the
importance of the survey.

False Reporting:
A design feature of M-BMs

NHANES 24-HR training manual:

If you sit quietly but expectantly your
respondent will usually think of
something. Silence and waiting are
frequently your best probes for a
dont know reply. Always try at least
once to obtain a reply to a dont
know response, before accepting it
as the final answer.

Validity of Human Memory

Upon leaving a restaurant
1) report on the attire of the wait-staff
2) the restaurants choice of music.

Greater agreement on what the waiters

attire than the waitresses.
There were no waiters in the restaurants.

Greater detail on the music in

restaurants that were not playing music.
Kronenfeld et al., Inst Vol Feed Manage. 1972; 70: 3844
Bernard et al. Annu Rev Anthropol. 1984; 13: 495517

M-BMs are Inadmissible

as Scientific Evidence
Human memory Scientific tool
False memories, omissions, and misestimation
Intentional misreporting: People lie
Lara et al. (2004). J Hum Nutr Diet 17(3): 209-218.

Recalled memories are nonempirical

Not subject to independent observation,
measurement, quantification or falsification

Error is unknown, unknowable, and

nonquantifiable
Unknown to even the respondent

What we know that Aint True

The greatest problem is not
ignorance; it is the illusion of
knowledge created by M-BM

Strengthening the
U.S. Dietary
Recommendations
through Enhanced

M-BM & 2015 US Dietary Guidelines for

Americans (DGA)

Chapter 2: Current Eating

Patterns in the United States
Every figure, every table
100% NHANES/WWEIA data

USDAs National Evidence Library

~80% of studies use M-BM
~20-100% of the RCTs use M-BM

2015 US DGA

Data Sources: What We Eat in America, NHANES 2007-2010 for average

intakes by age-sex group. Healthy U.S.-Style Food Patterns, which vary
based on age, sex, and activity level, for recommended intakes and limits.

Archer et al., Mayo Clinic Proceedings.

2015;90(12):1736-1738

Doctoring the Dietary Data

Statistical and post-hoc data
manipulations
Willet et al. calorie-adjusted intakes are
likely to be more appropriate with respect
to public health policy
Willett et al. Am J Epidemiol. Jul 1985;122(1):51-65.

Poslusna et al. energy adjustment

seems to be a good tool for practice to
decrease an influence of misreporting
Poslusna et al., Br J Nutr. Jul 2009;101 Suppl 2:S73-85.

Doctoring the Dietary Data

Donin et al. simply removed...176
participants with implausible
energy intakes
Donin et al. Diabetes Care. 2014;37(1):116-123.

If implausible data were removed

from NHANES, ~40,000 of the
60,000 participants would be
removed.

Correlations Causation
DGAC report
Terms association, associated, and
relationship
>900 times in the 571-page DGAC text

Evidence in the DGAC report are mere

statistical correlations derived from
physiologically implausible data yet
presented as scientific fact
There is no evidence of causality for any
diet-health relation in the report

DGAC: Misrepresents the Evidence

The terms misreporting,
underreporting, and implausible are
never used
The term over-reporting used in reference to
physical activity

Do not acknowledge or attempt to refute

Archer et al., 2013 findings or >60 years
of unequivocal refutation
The DGAC simply ignores the evidence

What we know that Aint True

Every Diet-Health hypothesis uses
M-BM for support
Cholesterol-CVD
Fat-CVD
Saturated Fat-CVD
Sugar-Obesity
Sugar-T2DM

Moving Forward?
M-BM data are meaningless and
therefore useless
What Should We Use to Measure
Diet?
Nothing
The American diet is no longer a
major risk factor for disease

The American Diet

~100 years ago
Pellagra, rickets, goiter

CDC Biochemical analysis

80% of Americans were not at risk
of deficiencies in any of the 7
vitamins
A, B6, B12, C, D, E, and folate
~90% of women of childbearing age (12-49
years) were not at risk for iron deficiency.
Pfeiffer et al., J Nutr. 2013;143(6):938S-947S.

Lifestyle Diseases
What about Obesity and T2DM?
Arent these diet-related diseases?
No.
Lifestyle diseases are the result of
nongenetic evolution
Via Maternal Effects

Mayo Clinic Proceedings.

2015;90(1):77-92.

Maternal Resources Hypothesis (MRH)

Major paradigm shift
Rejects or subsumes all current models of
obesity

Competitive dominance of fat cells

Gene-centric paradigm
Epigenetic paradigm

The microbiome research fad

We are what we eat
Unscientific idea that sugar causes obesity &
T2DM

MRH: Only Theory to Explain

All the Data

Childhood obesity
Infants are being born fatter
It is not their physical activity and diet.

What about cats, dogs, horses,

cattle, sheep, lab animals, deer,
elk, moose, etc..
Maternal Effects

Multi-Generational Observation:
Same Genes & Same Food
Mice w/ Wheels =
Same Size Offspring

Mice w/o Wheels =

Bigger Offspring

Prenatal Effects:
The Intrauterine Environment

http://www.sevencounties.org

Birth Outcomes &

Maternal Energy Available to Fetus
Archer (2015) Mayo Clinic Proceedings. 2015;90(1):77-92.

Barker Hypothesis
Hales & Barker Diabetologia. Jul 1992;35(7):595-601

2 Week old v. 2 day old (1200g v. 3730g)

Source: neonatal.files.wordpress.com

Birth Outcomes &

Maternal Energy Available to Fetus
Archer (2015) Mayo Clinic Proceedings. 2015;90(1):77-92.

Pedersen Hypothesis
Pedersen J. Copenhagen: Munksgaard; 1967.

Maternal Glycemic & Lipidemic Control

Source: http://macrosomia.com/

Maternal Effects
How a mothers traits affect her offspring
Metabolic and Behavioral phenotype

Metabolic Phenotype
Glycemic & Lipidemic control
Insulin resistance (IR) of pregnancy in
confluence with IR of inactivity

Behavioral Phenotype (pre & post

natal)
Physical Activity
Sedentary Behaviors (TV)

Epidemiology Trends &

Phenotypic Evolution

Organ mass increases 1962-2002

6-100% across organs
Thompson & Cohle, 2004. J For Sci;49:575-585

Birth weight increases of 40-100g

Chike-Obi et al., Am J Epi, 144,6: 563-569

Increases in fetal fat mass

Godfrey et al., Semin Reprod Med. 2011;29(3):257-65

Head circumference
Karvonen et al., Ann Med 2012;44(4):369-74
Paul et al., Arch Dis Child 1986;61(9):927-8
Ounsted et al., Arch Dis Child 1985;60(10):936-9

Evolutionary Consequences: Cesarean Section Rates

US 1965: 4.5%
US 2010: 32.8%
China 2009: 46%
All Asia 2008: 27%
Latin America 2005: 35%
We are altering evolution & natural
selection
Taffel et al., Am J Public Health 1987;77:955-9.
Hamilton et al.,Natl Vital Stat Rep 2011;60(2):1-25. Available at www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_02.pdf
Gibbons et al., (2010) World Health Report (2010) Background Paper 3

Accumulative Maternal Effects

Larger inactive, metabolically
compromised mothers produced
heavier, inactive children with an
ever-increasing risk of obesity and
T2DM.
Snowballing evolutionary effects of
inactivity, adiposity, and metabolic
dysfunction.

Maternal Effects
Scientific literature is unequivocal
Ovum/embryo transfers, animal
breeding, and cross-fostering studies
Phenotype begets phenotype
independent of genotype.
Rats, Mice, Sheep, Dogs, Horses

Metabolic dysfunction is ameliorated

when the embryo is gestated in a
normal metabolic environment.
Garg et al., Metabolism. Mar 2013;62(3):432-441.

Human Ovum Donations

The only discernible factor
influencing infant birth weight was
the surrogate mothers body mass.
Brooks et al., Birth weight: nature or nurture? Early
Hum Dev. May 12 1995;42(1):29-35.

Phenotypic Evolution

MRH Summary

Obesity is not a complex

phenomenon
Accumulative Maternal Effects
leading to the competitive
dominance of fat cells
In Utero (prenatal) alterations in fat,
muscle, and pancreatic beta cell
development
Postnatally learned physical inactivity.

Science can Improve the

Human Condition
but only if we are actually
doing science
Good Intentions and
Meaningless data cannot

Thank you!
Questions?

Childrens Cardiorespiratory Fitness

(CRF)

50% of boys & 70% of girls aged 12

15 years did not have adequate
levels of CRF.
Gahche et al. NCHS Data Brief No. 153. Hyattsville, MD: CDC;
National Center for Health Statistics.; 2014.

Adolescent girls (>15 years) peak

VO2 has decreased ~20% over the
past few decades.
Eisenmann JC, Malina RM. Secular trend in peak oxygen
consumption among United States youth in the 20th century.
Am J Hum Biol. 2002;14(6):699-706.

Archeretal.PLOSONE2013;8(2):e56620

Womens Physical Activity & Obesity

Household Management Energy

Expenditure in Women over 5 Decades

Archeretal.PLOSONE2013;8(2):e56620

Household Management Energy

Expenditure in Women over 5 Decades

Archeretal.PLOSONE2013;8(2):e56620

Screen-based Media Use and

Leisure-Time Physical Activity

Archeretal.PLOSONE2013;8(2):e56620

Archer et al., Mayo Clinic Proceedings.

December, 2013;88(12):1368-1377

Maternal Activity & Sedentary

Time

Archer et al. Maternal Inactivity: 45-Year Trends in Mothers Use of Time. Mayo Clinic Proceedings.
2013;88(12):1368-1377

Maternal Activity & Sedentary

Time

Archer et al. Maternal Inactivity: 45-Year Trends in Mothers Use of Time. Mayo Clinic Proceedings.
2013;88(12):1368-1377