Author Affiliation: Medical Affairs, Boehringer Ingelheim, Ingelheim, Germany.
The findings reported in the study by Golomb et al1 are intriguing. Several hypotheses are discussed that may account for the intuitive discrepancy between, on the one hand, more frequent chocolate consumption, increased total calorie intake, and uptake of saturated fatty acids, and, on the other hand, lower body mass index (BMI), with no apparent modification of the outcome by physical activity. However, an important potential factor of bias has not been discussed among the potential explanations. It is conceivable that subjects with a lower BMI may have been more honest when answering the questionnaire item on frequency of chocolate consumption than subjects with a higher BMI. Conscious or subconscious feelings of guilt with regard to perceived unfavorable nutrition habits are triggered by existing societal norms on body shape and may have contributed to disparate answering behavior. This would result in a systematic underestimation of BMI for a given frequency of chocolate consumption, leaving the reader in doubt as to how real the reported findings really are.
Koegler H. Too Sweet to Be Real?. Arch Intern Med. 2012;172(16):1270. doi:10.1001/archinternmed.2012.2524