Last week, Religion News Service blogger Jana Riess published a column attacking Date-Onomics — specifically taking aim at the chapter in which I explore the insidious ways lopsided sex ratios affect Utah’s Mormon community. Due to high rates of apostasy among Utah’s Mormon men, there are now three Mormon women in Utah for every two Mormon men. Riess took umbrage with my argument that these lopsided sex ratios have prompted a disproportionate number of Utah Mormon women to go under the knife (or the needle) in order to improve their chances with single Mormon men.

As I show in Date-Onomics, the evidence for this is overwhelming. A study by two BYU researchers found that college-age Mormon women living in Utah were considerably more likely to suffer from body image dissatisfaction than Mormon or non-Mormon college-age women living in other states. Reports by Time MagazineForbes Magazine and KSL Newsradio (a radio station owned by the Mormon church) found that Utah and Salt Lake City ranked among the national leaders in plastic surgeons per capita. A different study from RealSelf.com — the world’s leading consumer review website for cosmetic surgery — found that Salt Lake City ranked second in plastic surgeons per capita behind only Miami. Another RealSelf study tracked inquiries from prospective patients and found that Salt Lake City lead the nation in consumer interest in breast augmentation.

Even more troubling than the research and the data are the first-person accounts. Dr. Joylin Namie, a professor at Utah Valley University, made a documentary about the phenomenon — titled “Drinking Gold: Normalization of Cosmetic Surgery Among Latter-day Saint Women” — that sounds heartbreaking. Dr. Kimball Crofts, a Salt Lake City plastic surgeon, told me that he has women as young as 20 coming to him for Botox treatments. “There are so many attractive women here,” Crofts said, “the guys get choosy.”

Riess doesn’t believe any of this. She accused me of relying on “anecdotal” and “circumstantial” evidence in order to make the case that a shortage of Mormon men in Utah has lead to above-average demand for cosmetic surgery. Her argument hinges on a private survey she said she conducted. Riess said she surveyed 1,155 Mormons nationwide, asked them whether they’d had plastic surgery and found that Mormon women in Utah “self-reported” having plastic surgery at a lower, not higher, rate than other women: 5.6% of Utah Mormon women have gone under the knife, according to Riess, vs. 7% of all women nationwide.

Before I address the obvious problem of relying on self-reported data when it comes to cosmetic surgery, I want to dig deeper into Riess’s numbers. Unfortunately, she does not disclose the distribution by sex and age within her survey sample, but she does say that the sample is “nationally representative.” If that’s true, less than a third of the Mormons whom Riess surveyed live in the state of Utah. And if her Utah sample accurately reflects the state’s demographics, Riess’s total female sample for Utah would consist of only 180 women. Let’s do the math: 5.6% of 180 is 10. That’s right — Riess’s entire argument is likely based on just 10 Utah Mormon women who admitted to her that they’d had cosmetic surgery.

Of course, the bigger problem is that self-reporting for cosmetic surgery is notoriously unreliable. According to Transform, Britain’s largest cosmetic surgery group, 71% of women hide Botox treatments from friends and family, while 34% hide liposuction. If so many women are not honest with their own friends and family, does Riess really think they’ll answer truthfully when a complete stranger calls them up, inquires if they’re Mormon, and then poses personal questions about breast augmentations and tummy tucks? Particularly when the Mormon faith explicitly frowns upon cosmetic surgery?

Even more curious than her methodology is Riess’s attempt to dismiss all the data showing high rates of plastic surgeons per capita in Utah and Salt Lake City. Riess doesn’t even bother arguing that the numbers are wrong. Instead, she relies on one newspaper article in which one Salt Lake City doctor reports that 20% of his patients hail from out of state. This lone assertion becomes the basis for Riess’s contention that Salt Lake City’s unusually high number of cosmetic surgeons per capita has nothing to do with local demand — but is rather a function of out-of-state patients flooding the offices of Salt Lake City plastic surgeons.

Needless to say, one doctor makes for a very small sample size. (You might even call it anecdotal!) But the real question is this: Does Riess have any proof that the number of out-of-state patients in Salt Lake City is disproportionately large relative to other cities? I suspect not. Had she interviewed cosmetic surgeons in cities such as New York, Chicago, Phoenix, Los Angeles and Miami, she would have discovered that medical tourism is a burgeoning business for cosmetic surgeons everywhere — not just in Salt Lake City. The websites of many top cosmetic surgeons offer tips, travel advice or even discounts to out-of-state or out-of-country patients. The news article that Riess cherry-picked happened to be about a doctor in Utah, but similar stories could have been found all across the country. Consider this quote from Arizona’s East Valley Tribune which profiles Scottsdale cosmetic surgeon Dr. Todd Malan: “About 80 percent of Malan’s patients come from out of state. He even reserves Fridays for patients from out of state or country, who travel from as far away as Saudi Arabia.”

Religion and cosmetic surgery are touchy subjects on their own. Combine them, and some people will get defensive. I understand that. I’m sympathetic. Nobody likes it when their own religion gets singled out. I just wish Jana Riess were more interested in solving the problem—in addressing the body image problems that drive young Mormon women to eating disorders and unneeded plastic surgery—than simply attacking the messenger.

Jon Birger