A step towards healthier model figures

America’s Next Top Model was just announced. The lovely Whitney Thompson is the first winner for the show to look closer to what healthy, average-size women look like. Clothes sizes vary, but she is said to wear a size 10, while the average American woman wears a 14. This may seem a trivial moment, but for many young women at a time in their lives when their figures seem paramount and believe they’re supposed to weigh 100 pounds and look like the thin figures they see in magazines, she brings an especially valuable, and hopefully more healthful, reality. Beauty comes in all shapes and sizes.

And she understands the significance of her being in this competition, saying in an interview, “I'm going to survive this competition because I know that every single woman in America is behind me.” She added: “I’m here because my 13-year-old cousin has no one to look up to. I’m here because 40% of all 9-year-old girls have been on a diet... and it’s so sad, because they have no one to look up to. They have no one to mould themselves after.”

She has a classic beauty and as a fashion model offers a healthier role model for young women. Video here. Congratulations Whitney!

“Plus size models are not beautiful despite the fact that they're full-figured, or beautiful and just happen to be full-figured. Rather, plus-size models are beautiful because they are full-figured.” — Whitney Thompson

It seems like almost daily, the news reports of another celebrity model, star or athlete — one who is seen by our culture as having a perfect, slender, fit body — admitting to having an eating disorder to attain that figure. The list grows as the truth comes out and more come forward, sometimes decades later. They remind us that this degree of thinness is not natural for most women. Remember the bell curve — people with weights that low are not the norm, nor the natural, healthy weight for most.

Sadly, many young people don’t realize that these popularized thin images are not realist, natural or healthy. They feel fat and unacceptable by comparison and begin the journey of trying to be slender, “fit,” “healthy” or whatever the euphemism. But it can take just one diet to send them, too, into life-long battles with their bodies and food or devastating and life-threatening struggles with eating disorders. Thinness isn’t glamorous.

Christina Ricci is the latest celebrity to admit to struggling with anorexia. As she told Now Magazine today: ‘If you choose to let go of your self-consciousness and insecurities about physical appearance, then you’ll get to a place where you are present to see the world and enjoy yourself.’

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Conflicts of interest — Ya think?

All of us hope that public health policies and care guidelines, especially those directed at our children, are based on the most careful examinations of the soundest evidence and have been shown to be safe and effective, with benefits that outweigh the potential harms. We hope that those creating health programs are free from conflicts of interest that can taint objectivity. But when we think only in terms of industry-funding, we can miss far more influential conflicts... such as from one of the world’s largest nonprofits that has made a key agenda the war on obesity.

Robert Wood Johnson Foundation has sponsored another Institutes of Medicine (IOM) project, which began on February 11, 2008, to review school meal standards and make recommendations to the National School Lunch/Breakfast Programs. The project’s goal states it will create “well-conceived, practical and economic recommendations for meal patterns and standards...to foster healthy eating habits and safeguard children’s health.”

But this isn’t about health or healthy eating. National school food programs are being poised to be revised further supposedly to combat childhood obesity.

All fourteen of the members chosen to complete this IOM project were selected by its Food and Nutrition Board’s Childhood Obesity Prevention Committee, and have had active anti-obesity roles based on diet behavioral interventions. Every one of them. And nine have had major roles in previous RWJF anti-obesity projects geared towards ‘healthy’ diet and lifestyle strategies. How likely do you think there will be a serious re-evaluation of the healthfulness and effectiveness of these child obesity interventions and examinations of the medical evidence on childhood obesity?

The Institutes of Medicine — Nutrition standards for food in schools

The National Academy of Sciences was created by the federal government to advise it on science and technology issues, but the IOM is not a government agency. What many consumers don’t realize is that the IOM is a private organization, with countless obesity projects sponsored by RWJF to support its own anti-obesity agenda. While the IOM says “unpaid volunteer experts” author most reports, does that make them objective?

The IOM established a Standing Committee on Childhood Obesity this year sponsored by RWJF which will oversee “Nutrition standards for food in school,” as well as food marketing and childhood obesity prevention programs. This Committee’s roster is a who’s-who in the war on obesity and is chaired by Jeffrey P. Koplan, M.D., M.P.H., former director of the CDC from 1998-2002 who helped to see the CDC make obesity a national priority. He has also since led RWJF projects, such as the 2005 IOM report, Preventing Childhood Obesity: Health in the Balance, the 2007 report Progress in Preventing Childhood Obesity: How do we measure up? and the 2005 symposium Progress in Preventing Childhood Obesity: Focus on Schools.

The fourteen members chosen for this latest RWJF-IOM project, called Review of National School Lunch and School Breakfast Program Meal Patterns and Standards, will probably be familiar to most readers, if not their names, the initiatives they’ve headed.

The chair is Virginia A. Stallings, M.D., who has served on numerous IOM projects, such as the Nutrition Standards for Foods in Schools: Leading the Way Toward Healthier Youth, completed last year. In a public briefing, she explained that the “evidence-based nutrition standards” they developed for National School Breakfast and Lunch Programs focused on encouraging “healthy” foods and limiting the consumption of unhealthy foods. The committee determined that school lunches were too high in calories and “proposed limits on the amount of saturated fat [<10%], trans fat, added sugars [<3.5%], sodium [<200 mg] and caffeine.” They organized foods outside lunch and breakfast into tiers based on their guiding principles. Tier 1 (“healthy”) items, for example, “include fresh or minimally processed foods such as apples, carrot sticks, raisins, low-fat or nonfat milk, and certain multigrain tortilla chips, granola bars and nonfat yogurt.” Plain water should be available, with other beverages (or tier 2 items only for high school students) available after school.

Dr. Stallings gave a February 17, 2008 IOM program, Understanding Obesity and Childhood Nutrition, Panel Perspectives on Schools, saying obesity is “the most pressing challenge to nutritional health in this first decade of the 21^st century” and that “all foods available on [school] campuses should be with the objective of promoting health and reducing obesity.” She said the IOM used the Dietary Guidelines to support a focus on calorie control, weight management, physical activity, and limiting fats, sodium and sugars. [The Dietary Guidelines, however, make no mention of restricting sodium or sugars for children. They also don’t call for low-fat diets in children, saying that children 4-18 years of age need 25-35% of their calories to come from fat — which American children already get.] The key message for school nutrition programs “should be to encourage greater consumption of fruits, vegetables, whole grains and nonfat or low-fat dairy foods,” she said. Foods that should be banned from schools included sweets, fortified sports drinks, colas, granola bars, and snack chips and crackers.

A few highlights of other committee members to supplement the partial bios and affiliations provided by the IOM will demonstrate similar perspectives:

Karen Weber Cullen, DrPH, RD, of Baylor College of Medicine has concentrated her career on the prevention of “diet-related diseases,” primarily obesity, through “nutrition behavior in childhood.” She also participated in the development of the 2007 IOM report on Nutrition Standards for Foods in Schools and has authored papers on the Texas School Food Policy changes increasing fruits and vegetables and low-fat milk and limiting sweetened beverages and portion sizes among middle-school children and the potential calorie savings; and a study of an internet dietary program for 9-12 year old African American girls and their families, to encourage low-fat foods, more fruits and vegetables, less fattening meat, and healthy meal planning.

Rosemary Dederichs, BA, worked on both of the RWJF Progress in Preventing Childhood Obesity reports and directs the food service department for the Minneapolis public school district. She was on the Steering Committee, co-authoring its School Wellness Policy (6690) Implementation Plan to curb obesity, which follows the RWJF recommendations for low-fat, whole grain, low-sugar, portion controlled meals, with one vegetarian entree offered each day; allows only healthy food or non-food items for fundraising, celebrations or class parties; prohibits students to share foods or drinks; institutes healthy eating and lifestyle educational curriculums for grades K-12, including using the cafeteria as a learning laboratory; bans soda and junkfood from all schools; increases physical education hours, including physical activity in the classroom; and mandates school staff wellness participation; all to be fully implemented in all schools this school year.

Mary Kay Fox, MEd, is senior researcher at Mathematica Policy Research, Inc. and has worked on school-based nutrition and obesity prevention programs for more than 20 years. In an issue of the Journal of Law, Medicine & Ethics last spring, she continued to advocate for schools as ideal settings for implementing anti-childhood obesity programs and cite improvements to proven strategies. She had co-authored a paper on the Eat Well and Keep Moving Program studied in African American elementary school children published in a 1999 issue of Archives of Pediatric and Adolescent Medicine. While concluding the program was effective, it had no statistically significant effects on physical activity levels, television or sedentary activities, or caloric intake compared to children in control schools after two years. And, based on self-reported dietary recalls obtained from 70% of the children, showed an increase of only 0.36 servings of fruits and vegetables per 4184k.

Lisa Harnack, DrPH, RD., MPH, also has dietary behaviors in the prevention of obesity as her primary research focus and is with the University of Minnesota Obesity Prevention Center. The program directors also oversee the RWJF Healthy Eating Research Program and wrote the seminal paper on The Role of Schools in Obesity Prevention, which blames overweight in children on their poor diets and sedentary behaviors and claims that obesity is associated with “poor academic achievement” and behavioral problems. It goes on to say that school meals must meet the Dietary Guidelines for Americans as containing no more than 30% total fat and 10% saturated fat. [Which, again, is incorrect. Those are the adult guidelines.] Another essential part of its obesity prevention recommendations is a health curriculum for kindergarten to 12^th grade children to support a “behavioral-oriented curriculum in promoting healthful food choices and physical activity.” It also recommends BMI screening by the school for all children and parental “report cards.” School employees are also to role model “health-promoting behaviors” and staff should be required to follow nutrition and physical activity guidelines, since “schools are one of the nation’s largest employers.”

Gail G. Harrison, Ph.D., has researched putting low-fat diets into practice and contributed to IOM papers linking dietary fats and dioxin in meats to cancer.

Mary Hill, MS, SNS, is president of the School Nutrition Association (SNA) and executive director of nutrition services for Jackson public schools in Mississippi. The SNA is a steering partner committee member of the RWJF-sponsored Action for Healthy Kids and with the National Alliance for Nutrition and Activity (NANA). Several of the IOM committee members are also with groups in NANA, funded by the USDA’s Produce for Better Health Foundation (National 5-a Day logo program). As JFS readers will remember, NANA is a key lobbying group of 300 organizations, founded and coordinated by Margo Wootan at the Center for Science in the Public Interest, promoting healthy eating and exercise to fight obesity and its key initiatives include School Wellness Policies. Its lobbying efforts have successfully increased the budget of the CDC’s Division of Nutrition and Physical Activity by 2,000% since 1999. NANA is also funded by the CDC to the tune of $65 million this year, with $5 million just for their fruit and vegetable programs.[ Oh, its national action plan, after 15 years and applying more than 75 strategies, has failed to increase fruit and vegetable consumption or have any effect on childhood obesity.]

Helen H. Jensen, Ph.D., has also worked on the IOM-sponsored project to increase produce and whole grain consumption, and reduce milk, eggs and dairy products to combat obesity among WIC recipients. She has also authored papers linking high fructose corn syrup and fatty meats to obesity.

Ronald E. Kleinman, M.D. is past president and on the Executive Committee of the International Society for Behavioral Nutrition and Physical Activity. Its upcoming conference in Alberta, Canada, on the promotion of healthy body weights is sponsored by the Canadian Obesity Network, with a keynote talk on the evolution of sloth. He has also worked on an IOM workshop report on the impact of pregnancy weight gain.

George P. McCabe, Ph.D., is a statistics professor for primarily nutrition studies. He worked on the IOM committee project on nutrition labeling, and on research of calcium and exercise interventions for weight loss in young women.

Suzanne P. Murphy, Ph.D., RD, is with the Cancer Research Center of Hawaii and her research emphasis is epidemiological studies linking cancer and obesity. She has participated in several IOM panels, including the 2005 Progress in Preventing Childhood Obesity: Focus on Industry project sponsored by RWJF. She chaired the IOM panel recommending increased wholegrains, fruits and vegetables available to poor women, infants and children through WIC and decreased amounts of milk, eggs and cheese because of the obesity epidemic.

Angela M. Odoms-Young, Ph.D., is a charter member of the African American Collaborative Obesity Network (AACORN), based at the University of Pennsylvania School of Medicine, working to fight childhood obesity among African American youth, a program funded by RWJF, just awarded a $3.5 million grant. She has authored numerous papers for AACORN on achieving healthy weights in African-American communities, fruits and vegetables initiatives, and obesity programs.

Yeonhwa Park, Ph.D., is a low-fat researcher at the University of Massachusetts at Amherst, receiving a $260,000 grant in 2006 from the American Heart Association to investigate conjugated linoleic acid (CLA), a compound in dairy and meat, for weight loss. While studies in mice had shown CLA to block fat uptake and increase energy expenditure, it failed in humans. They are currently testing a chemical cousin of CLA. She holds a patent with colleagues at the University for a method of reducing body fat in animals. They are currently working on a new technology for making low-fat foods with qualities of full-fat foods by encapsulating fats with fiber.

Mary Jo Tuckwell, MPH, RD, was the director of food services for the Eau Claire Area school district in Wisconsin for 18 years. Along with other Wisconsin schools, it participated in the USDA Fresh Fruit and Vegetable Program and received a $1 million grant in February 2006. As a spokesperson on behalf of the National Alliance for Nutrition and Activity (NANA), she lobbied Congress for the 2007 Farm Bill in May last year, citing the importance of produce in stemming childhood obesity. She and her Healthy Schools Program was recognized for being one of a handful of schools to meet the Alliance for a Healthier Generation guidelines, a project of RWJF. She is now a senior consultant for inTEAM Associates, Inc., a consulting company for school food services, with partners offering software and marketing.

The point of this exercise is not ad-hominem attacks, but to illustrate that industry funding is often the least of concerns when it comes to possible conflicts of interest. If your entire career has been based on the belief that obesity is due to bad foods and inactivity; if your professional reputation and status among your peers, your speaking engagements and book deals, and the grant funding you’ve brought to your university* or program have all been based on an obesity crisis and dietary behavioral interventions; if you’ve been hand-selected for a prestigious committee, sponsored by a major funder who has made obesity and diet and lifestyle interventions its key agenda; and if you are surrounded by like-minded important people — how likely do you think you would be to risk all of that by seriously questioning and objectively examining the evidence that might tumble the entire house of cards and put you on the outs in your field?

Right. It’s not going to happen. It's human nature.

The public has been invited by the IOM to comment on its provisional committee selection for the next 7 days week here, but it goes to the IOM committee members with even more prestigious and influential positions in line with the war on obesity. The bigger issue is that we have private vested interests funding and influencing the health policies of federal agencies and health programs that affect you and your children. Until the National Academy of Sciences cleans its own house, the public and the integrity of science-based policies will continue to lose.

© 2008 Sandy Szwarc

For more information:

For newer readers who may not have had a chance to read the archives, they may not realize the evidence on obesity, as well as the controversy raging in the medical community for decades over the lack of evidence and growing evidence of harm from “healthy” eating curriculums and recommendations to restrict fats, sugars and salt in children’s diets.

School lunches across the country are intently trimming fat, sugars, calories and portion sizes on their menus to focus on fruits and vegetables, trying to trim down kids — and these school nutrition policies have proven to be unsuccessful. Their dietary restrictions even go beyond what the Dietary Guidelines recommend for children’s health, growth and development. They are applying adult guidelines to young people. Even the Dietary Guidelines are questioned by significant numbers of pediatric medical professionals. Low-fat, low-sugar diets are most popularly perceived as fundamental to a healthy diet for children and thought to prevent heart disease, cancer, and other chronic diseases; and to prevent obesity. Except, there is no clinical evidence to support that.

Generations of parents have wished their kids ate better, but stories of the horrible diets of today’s children are gross exaggerations. The objective evidence simply doesn’t support the extremity of concerns over children’s diets which have continued to improve over recent decades. The latest NHANES dietary studies also show the majority of children and teens are eating within the 2005 Dietary Guidelines for fat and calories. They are even eating fewer calories and total fat since 1989 and aren’t pigging out on junk more than ever. Nor do parents need to fear typical children’s eating habits and preferences for sweets are for life. Kids grow up. As Penn State research has shown, our diets naturally get healthier and our taste buds appreciate more varied diets as we become adults.

School lunches are also not as awful as the hype, either. The School Nutrition Association, which conducts biannual surveys of national school lunch programs, finds that virtually all of them are doing a good job complying with federal nutrition guidelines.

More importantly, there is no evidence to support beliefs that bad foods or diets cause childhood obesity or chronic diseases. Even the American Heart Association’s review of the evidence on obesity in youth concluded in its Scientific Statement that “studies of diet composition in children do not identify the cause of obesity in youth.” As they noted, dietary fats and saturated fat intakes are lower today than in the past, unrelated to obesity trends. Fat and thin children eat no differently to explain obesity. Eating high-calorie, low-nutrient dense foods like sweets doesn’t correlate with children’s weights, either, and consumption has been shown to be high among all kids for generations. Canadian researchers looked at the diets of more than 130,000 kids in 34 countries and reported that fat kids even eat the least sweets, and that kids’ body weights had nothing to do with how many fruits, vegetables or soft drinks they consumed.

Kids haven't become couch potatoes like the popular hype, either. The idea that sedentary activities and kids plopped in front of the telly or playing computer games cause obesity or that increasing physical education will reduce obesity isn't supported by the evidence.

Childhood obesity cannot be blamed on what or how much kids eat or how much exercise they get. Regardless of their diets or physical activity, children will still naturally grow up to be a wide range of heights and body weights. It’s genetic. The DONALD (Dortmund Nutritional Anthropometric Longitudinally Designed) Study, for example, clinically followed children, actually weighing the individual children and recording their diets (the foods, amounts and eating occasions) at least ten times a year and followed them thusly for 17 years. They found that no matter what the children ate during childhood or adolescence, they naturally grew up to be a wide range of weights. While there were great differences in the children’s diets, these differences weren’t at all related to their weights.

The U.S. Preventive Services Task Force, which recently reviewed 40 years of evidence on childhood obesity — some 6,900 studies and abstracts — found no quality evidence to support the effectiveness of any childhood obesity intervention in reducing obesity, or for BMI screening or for dietary counseling on healthy eating in young people. But it did find evidence to suggest such interventions risk harming children.

It also found no quality evidence to support beliefs that childhood “overweight” or “obesity” is related to health outcomes. The USPSTF concluded that no scientific review has been able to find any quality evidence that any programs to reduce or prevent childhood obesity — no matter how well-intentioned, comprehensive, restrictive, intensive, long in duration, and tackling diet and activity in every possible way — has been effective, especially in any beneficial, sustained way; nor have they been able to demonstrate improved health outcomes or physiological measures, such as blood lipids (“cholesterol”), glucose tolerance, blood pressure or physical fitness.

Even while RWJF recently announced it was earmarking another $500 million towards its childhood obesity agenda and to create “a sense of national urgency to act,” its own evidence found no support for any of its far-reaching policy recommendations. Of course, you have to look carefully to realize that, because it’s not what we hear. As the IOM report, Preventing Childhood Obesity: Health in the Balance admitted: “Presently, there is limited experimental evidence regarding the best ways to prevent childhood obesity and the extent to which various potential factors contribute to weight gain.”

Nevertheless, RWJF President and CEO Risa Lavizzo-Mourey, M.D., said in a press release: “There are ‘natural experiments’ taking place...but we can’t afford to surrender an entire generation of kids to the obesity epidemic while we wait for perfect answers.”

Undeniably, the all-out, widespread efforts to address childhood obesity are disproportional to the evidence and have a disturbing level of vested interests behind them. Yet, few people are aware just how little evidence there is for the dietary or behavioral tactics that children are being subjected to. And it is unimaginable that many parents are keen on the idea of experimenting on their growing children with nothing credible to go on. Or that taxpayers appreciate having billions of their tax dollars going towards unproven, biologically implausible and possibly harmful programs.

To add to the insanity: The government’s own statistics even negate the need for any of this, as there have been no significant increases in the numbers of children considered “overweight” since 1999-2000 and children are healthier and expected to live longer than at any other time in our history.

* The significance of conducting research that is favored by vested interests who will reward your university with large grants was demonstrated in the recent controversies surrounding two preeminent University of Minnesota professors. Professors Francois Sainfort and Julie Jacko are big names in the emerging field of electronic "health informatics'' and, as the Star Tribune reported, were making a total of just over $400,000 a year at Georgia Tech and their University of Minnesota salaries top $500,000. The Dean at U of M said he wooed them for more than a year because they had reputations for winning millions of dollars in contracts and grants for research for universities. Jacko is a professor in the School of Nursing and Public Health and her husband is in health policy and public health. He has served as the principal investigator on more than $13 million in contracts and grants, as well as works as a consultant to health care delivery organizations, medical device companies, clinical labs, and pharmaceutical, insurance and information technology companies. There is no funding for resources that dare provide information that isn't popular with vested interests.

Click here for complete article (and single page version).

First it’s a scarlet D, then O, H, C...

Did you hear that San Antonio Metro Health District has decided to create a surveillance program of the lab results on its residents to identify diabetics who aren’t keeping their indices to government-approved levels? Health officials there are initiating a program to make it mandatory that all laboratories electronically turn over hemoglobin A1c results (along with the people’s names, addresses and dates of birth) to its government agency for a database of diabetics.

Not surprisingly, they’ve bought the same technology sold to Vermont and New York City, Vermedx™ Diabetes Information System (VDIS), the largest diabetes registry service and recently recognized by the National Business Coalition on Health. It can electronically compile whatever labwork a government agency might wish, compare it with targeted numbers and initiate follow-up to both the people and doctors, simultaneously generating population reports for the government agency.

This same company has been lobbying hard to label diabetes “a crisis that is becoming an epidemic,” with journal articles claiming that one-third of people have diabetes and don’t know it, as well as many others with “prediabetes” in need of intervention and that there are major problems from lack of managed care and the inability of health insurers to monitor compliance with indices. The debates among doctors about this program and the conflicts of interest behind the “diabetes epidemic” were covered here, indicating a very different reality from the sales and marketing being given to the public.

Vermedx is already laying the groundwork for monitoring blood pressure, cholesterol, depression, health literacy, etc. and working to lay the plans for national public health surveillance of those with chronic diseases.

As the San Antonio Business Journal reports:

Metro Health steps up its fight against diabetes in San Antonio

The San Antonio Metropolitan Health District (Metro Health) selected Vermont Clinical Decision Support LLC to help the city launch its new diabetes intervention pilot program. The Burlington, Vt.-based company will deploy its patented Vermedx technology to create a city-based registry. Metro Health will also use the data to map the epidemiology of hyperglycemia, monitor the diabetes epidemic and initiate improvements. Vermont Clinical Decision Support CEO Benjamin Littenberg says Metro Health's program could improve the health of diabetes patients while reducing the total cost of care. The technology for the Vermedx Diabetes Information System was developed during the course of a five-year clinical trial funded by the National Institutes of Health...

San Antonio's pilot program is starting in May and will run over the next 18 months. It will involve at least 50,000 active diabetic patients and four major testing labs. Metro Health will present a detailed summary of the pilot program to the Texas Legislature in September 2009. If the pilot program is successful, state lawmakers may consider similar programs in other major Texas metropolitan areas.

Healthcare IT News also covered this development, adding its IT expertise:

Texas city uses IT to monitor "diabetes epidemic"

The San Antonio Metropolitan Health District has established a city-based registry to more closely monitor the south Texas city's "diabetes epidemic" and initiate improvements in care throughout the region. SAMHD officials say they intend to use data from the registry to map the epidemiology of hyperglycemia, keep a closer eye on the growing number of diabetes cases and ultimately improve the medical care of San Antonio's diabetic residents...

The Burlington, Vt.-based company will supply San Antonio with its Vermedx Diabetes Information System, or VDIS, a patented technology developed during the course of a five-year clinical trial funded by the National Institutes of Health. "We are delighted to have the opportunity to participate in a program with such far-reaching implications for improving the health of diabetes patients and reducing the cost of care," said Benjamin Littenberg, MD, CEO of Vermont Clinical Decision Support.

VDIS captures laboratory test results from multiple labs and automatically produces population summary reports and "report cards" at regional, community, provider and practice levels. The system also generates individual patient level health status reports with accompanying guideline-based recommendations for care....

The Texas Legislature initially directed the SAMHD to conduct a pilot program for capturing and analyzing the scope and nature of the diabetic populations as the basis for future interventions to curtail the growth of the epidemic in prevalence and cost. If the pilot proves successful, the Legislature plans to consider a similar program in other major Texas metropolitan areas.

Behind every “epidemic” claimed to need government intervention and oversight, you’ll find a lot more going on than objective measures of health problems.

Click here for complete article (and single page version).

It’s official: the world has gone nuts :-)

There is simply no other explanation. In no particular order, I present as evidence:

Personal trainers and mini-exercise treadmills, child-size stair steppers, rowers and spinning bikes are now offered for children 3+ years of age to combat childhood obesity: The Oxy-Kids classes in Sydney are already booked. Parents work out in an adjoining gym. The mother of a 4-year old said her son’s trainer told him fruit was a healthy food to eat before going to the gym.

The first ever fat camp for toddlers under age 5: A professor from Leeds Metropolitan University has launched a fat camp for toddlers called Too Fat to Toddle.

Childhood obesity blamed on children eating playground mulch and wearing flip flops: Cincinnati Children’s Hospital Medical Center issued a press release claiming their study (unpublished) found that children in daycare weren’t getting enough exercise because they were wearing flip-flops; and that workers didn’t want to deal with playground mulch because it got in their shoes and was messy and being eaten by the kids.

A new ten-week healthy eating course for toddlers age 2 to 4 years old has been started in the UK: Called Mini-MEND, it will teach them and their parents healthy eating and exercise, food labels and portion control to combat obesity. It’s an extension of MEND for fat children 7 to 13 years old.

For PE class, six grade students in a Chicago school were informed of their “ideal” weight and percentage of body fat and instructed to count their daily calories: The father of a 12-year old girl wrote an outraged letter to the Vice Principal, noting that his daughter and her friends “now discuss each other's weight, body fat, and how many calories they ingested the night before.”

Five centers for weight maintenance for nursery-aged infants: Also now offered is Headstart Early Learning for weight maintenance and exercise, with bikes, cycle tracks, beams, climbing frames and obstacle courses.

Food Tsars introduced in UK schools monitor packed lunches from home and eaten in the canteen: The food tsars persuade pupils to ditch bad foods and dish up advice on healthy food choices.

Eating at Grandma’s or friends’ homes is said to lead to obesity among Latino children: Obesity among Hispanic children in Southern California has been blamed on eating meals at the homes of relatives or friends once a week. Latino children were said to be at special risk because their culture is more family-oriented. “Latinos appear to rely on friends and family for support and childcare more than other cultures do,” said the lead author of a study in the current issue of Obesity.

This study deserves a more serious look because it might be thought to support several popular myths about poor and minority adults and children, but its findings didn’t.

Eating with friends and family study

Authors from the Graduate School of Public Health at San Diego State University in California recruited 812 parents of children aged 4 to 7 years of age through phone calls and on the school grounds of 13 elementary schools along the Mexico border with at least a 70% Latino population, paying the caregivers $20 to complete the 22-page self-administered questionnaires. The questionnaires included an abbreviated 49-item food frequency screen and questions on meals away from home. The children and adults were weighed and measured, their BMIs calculated and their overweight status determined by the cutoff points on BMI growth curves.

For this secondary analysis, they used only 708 of the questionnaires. A high proportion of the children and families selected were fat, with “31.1% of the children classified as overweight.” Most of the families were lower socioeconomic status (37% of the 5-person household incomes were <$1,500/month) and one-third of the parents were unemployed. Overall, 45.9% of families ate a meal away from home at least once a week from some type of restaurant — “similar to national data” and no different than the rest of the population — and 37% at the homes of relatives or friends. The researchers then looked for correlations between BMIs and foods eaten in and outside the home.

Null findings. There was no association between children’s BMIs among those eating at fast food or sit-down restaurants, nor in the reported number of fruits and vegetable servings or water consumed as beverages. There was no tenable difference in any of the relative risks for number of servings consumed of sweetened beverages, water, fruits and vegetables, or sweets or snacks among those who ate at fast food, buffet or sit-down restaurants versus the homes of relatives and friends, regardless of frequency. Nor was there a significant difference in the children’s BMI status (underweight, normal, at risk for overweight or overweight) or the parents’ BMI status between those eating at similar frequencies at friends and relatives versus restaurants (fast food, buffet or sit down).

There was no relationship between adult BMIs and the frequency of eating out at fast food, buffet or sit down restaurants, nor eating at the homes of friends or relatives. The popular myth of fast food as especially contributing to obesity was not supported.

They also concluded: “No associations were observed between child and adult BMI and type of restaurant frequented,” nor in the quality of diets.

“In contrast to our hypothesis, few associations were observed between children’s diet intake and type of restaurant frequented,” said the authors. “When examining the effects of restaurant type on children’s dietary intake and child and adult BMI, our hypotheses were not support [sic].”

Looking at the fat children (at-risk-for or overweight), the only difference seen among the heavier children was a mere 7% higher association with eating at friends or relatives one or more times a week, but since they weren’t eating tenably different foods or beverages and the lack of rigorous methodologies in this study, the researchers couldn’t explain this correlation. “Although differences in the frequency of various foods consumed were statistically significant, additional research is needed to determine whether these differences are clinically meaningful.” They also did a literature search that revealed no other studies of eating with relatives and friends and associations with risks for childhood obesity. In fact, they note that foods eaten in other people’s homes are unlikely to be as poor as food served in restaurants and may not represent the same level of risk for obesity.

Nevertheless, with no evidence in this study, they turned an untenable correlation into a cause and concluded: “Given evidence that one of the most important parenting behaviors related to childhood risk for obesity is monitoring, clearly more research is needed on how to teach parents to monitor and regulate the foods that their children consume in the homes of other people.”

That concluding quote, which would appear to support the popular belief that children are fat because their parents don’t take responsibility to monitor and control their children’s diets, is important. It references the original study used for this secondary analysis: ‘Aventuras para Niños’. That original study, published in a 2006 issue of Health Education Research, used all of the 812 questionnaires and was designed to examine the correlations between parenting styles (“monitoring, reinforcement, discipline, limit setting and control”) and physical activity and the healthfulness of the children’s diets — with ‘healthy’ or ‘unhealthy’ defined by what the reviewers believed would contribute to obesity (fats, sugars, snacks and sodas being bad, versus produce, salads and low-fat dairy being good). Unlike the children used in their secondary analysis, considerably fewer, 26%, of these children’s BMIs fell into the ‘overweight’ category.

Their results:

Parental discipline was not significantly related to children’s unhealthy eating or physical activity. However, parental control was positively related to children’s unhealthy eating. Parental control was not significantly associated with children’s healthy eating or physical activity... girls were significantly more likely to eat unhealthy than boys when parents used more control strategies for eating.

In other words, the more controlling the parents, the less “healthy” the children ate, especially the girls. The authors found that Latino mothers engaged in more restraining behaviors with their daughters the more acculturated they became to American culture and “society’s pressures towards thinness, particularly among women and young adolescent females.”

Another glaring omission was seen in this study: It did not report any actual relationship between the children’s diets (‘healthy’ and ‘unhealthy’ foods) and the children’s BMI!

Definition, definition, definition. One additional note deserves attention. Remember to question the definition: BMI ≠ weight. The authors concluded that their study supports an obesity problem among Latinos in poverty, especially their children, saying: “The problem of obesity is clear and present in this study.” First of all, the families were hand selected, which means this study can’t be used to make any sweeping conclusions about minorities or poor families. But more importantly, the problem is being defined by the percentage of children who cross an arbitrary cutoff based on BMI, without reporting actual weights and heights. This can create a perception of an epidemic of gargantuan children, when, in reality, a tiny fraction in increased height or weight tip these growing children into the category. A 6-year old girl, for example, becomes labeled “obese” by being a mere 1/8 inch taller, or staying the same height, a mere 5 pound makes the difference between her being labeled as “normal” weight or all the way to being “obese.” In both papers, these authors carefully avoided reporting the average BMI of the children, although it did note the parents'.

Children of disadvantaged immigrant families, hopefully suffering less hunger here in America and getting enough to eat, will mature faster and grow taller and larger than their parents. There is no evidence that this is anything but a good thing for these children.

In contrast, while the study was focused on purportedly fat children, 56% of the poor children were underweight or “normal” weight, but how many of those children were underweight and not getting enough good food to eat or struggling with food insecurity? The medical literature is overwhelming that such children suffer very real risks to their growth and development and health and they would have been healthcare professionals’ key concern. But we don’t know, as this paper didn’t even mention them.

© 2008 Sandy Szwarc

Click here for complete article (and single page version).

Please be careful out there — supplements for sick children

Growing numbers of children and teens are taking alternative supplements and most parents and healthcare professionals believe them to be completely safe. Two recent studies of children in the hospital alert us to the need for both parents and healthcare professionals to take extra care to be aware of potentially harmful reactions with natural remedies.

The first study was conducted by physicians at a large pediatric emergency room in Toronto, Canada, led by Dr. Ran D. Goldman, M.D., at British Columbia Children’s Hospital in Vancouver. These researchers had previously found that 49% of the children visiting their emergency room used some type of alternative therapy. This had concerned them given the adverse reactions that have been identified with some, such as intracerebral hemorrhage with ginkgo biloba. For this paper, trained researchers conducted interviews of a randomized sampling of 1,804 parents of children registered in their emergency room. They obtained demographic information, chronic illnesses and the use of prescription and over-the-counter (OTC) medicines and natural health products. The average age of the children was 5.2 years.

Forty four percent of the children had been given prescription medications during the past 3 months and 26% also used OTC medications (i.e. tylenol). As many as 810 of the children had seen an alternative practitioner or used a natural remedy, with 20% of the patients using natural remedies concurrently with conventional medications, and 15% taking more than one natural remedy. Children with chronic illnesses were more likely to be taking more medications and natural remedies, increasing the risks for interactions.

Using three different medication databases and published reviews, the researchers identified potential drug interactions and found 285 children (16%) were taking natural remedies that risked potentially adverse reactions with the conventional medications they were on. These weren’t necessarily minor reactions, as a full 25% risked increased bleeding, for example, which could have serious consequences for children needing surgical procedures. Other possible adverse reactions included blood sugar abnormalities, central nervous system problems, liver toxicity, potentiate/inhibit medications or absorption of vitamins and nutrients, or affecting the accuracy of lab tests. Some potential interactions were serious and potentially life threatening, they said, such as the combination of warfarin and St. John’s Wort.

Most parents believed the natural remedies were safe, they found, with only 15% of the parents who were giving their children alternative remedies believing they could be potentially harmful.

What may be surprising is that CAM (alternative modalities) use rose with increasing education levels in both the mothers and fathers — 74% of the children receiving alternative remedies had mothers with college or advanced university educations — and the higher-educated parents represented even more of the children with potentially harmful interactions.

They also found that many medical students and doctors in New York asked their patients about their use of alternative modalities but rarely checked them in a reference text for potential adverse reactions, highlighting the need for immediate access to such reference materials. While this study was only conducted at one major pediatric emergency center and the precise prevalence may not apply to other institutions, the overall problem it identified can serve to alert parents and healthcare professionals of these risks.

But a study in Pediatrics was perhaps more worrisome as it revealed possible risks for sicker children admitted to the hospital. Little is known about the safety of supplements for children in the hospital and there are few pediatric clinical trials on their use. So, Harvard Medical School researchers examined the policies concerning in-hospital herbal and dietary supplement use in a cross-sectional sample of children’s hospitals. Only 59% of the eligible children’s institutions responded, but revealed considerable inconsistencies in policies. Only 44% had written policies in place at all on the use of over-the-counter vitamins and minerals, herbs and other supplements.

Only 2% of the hospitals included herbals on their formularies and just over a third included dietary supplements. Even so, most (84%) let patients take their home supply, two-thirds of hospital staff was allowed to make recommendations for supplements, and in 70% of the hospitals, the nurses even stored and administered the home supply of supplements. Less than a third of the surgical preoperative procedures mentioned supplement use prior to surgery. And less than half (46%) required documentation that drug or dietary supplements interactions had been checked for, with 14% having no formal or specified procedures in place for checking supplements for possible interactions.

This study, too, didn’t attempt to identify and quantify actual adverse events, but serves to caution parents and healthcare professionals that we all need to be more careful about checking the safety of supplements before administering them to sick children and to make sure healthcare providers know what each child is taking that might potentially put them at risk or complicate their care.

Click here for complete article (and single page version).

When food fears deserve special attention

It’s common on forums discussing the painful and difficult road back from eating disorders, to hear nutritional misinformation and fears about certain foods. Many who are avoiding certain foods are convinced they are aren’t dieting or restricting their eating, but are eating healthy. While the idea of foods that are good and bad mimic what is popularly cited in mainstream media and often taught to young people in nutrition classes, recent research by Columbia University eating disorder specialists suggests that recovery from disordered eating requires getting past fears of ‘bad’ foods.

This small study in the current issue of the American Journal of Clinical Nutrition looked at two eating disorder studies on 47 women (18-45 years of age) who had been hospitalized for inpatient treatment of their eating disorders between June 2000 and July 2005 and followed for an average of 6 to 8 months after discharge. Forty one women successfully reached 90% of their ideal body weight during inpatient treatment. While there is no universally accepted definition of relapse or recovery from anorexia nervosa, they said, they used several definitions for their analysis, examining psychological, dietary and weight measures. The researchers, led by Janet E. Schebendach, MA, RD, sought to quantify the food choices made by these recovering anorexia nervosa patients to determine whether calories and diet variety predicted their recoveries.

They found that those who avoided energy-dense foods, — what many will call ‘junkfood’ — desserts and snacks, meats and milk, and added fats like salad dressings and butter, were more likely to have failed recovery from eating disorders, regardless of their BMI and regardless of their caloric intakes. All of the patients were prescribed diets with 30% of calories from fat, in accordance with the Dietary Guidelines, and 2,600 kcal/day to maintain their weight and while caloric intake didn’t differ significantly between the outcome groups, fat avoidance was significantly higher among the failure group. The researchers also found that the more the women restricted and limited the variety of foods they ate, the poorer their recovery from eating disorders.

The authors concluded that while it can be emotionally difficult for these patients to bring themselves to eat energy-dense foods and a greater variety of foods, it may be crucial for helping them prevent relapse. And this information may also help alert us to women and men at risk.

Click here for complete article (and single page version).

Our growing culture of disordered eating

How often do you see a mature woman with little of the natural fat that comes with healthy aging? How often do we want to believe they’re just naturally thin? How many women do you know who continue to watch their figures and restrain their appetites? This important Guardian article by Kate Hilpern discusses the recent death of a prominent professor who died of malnutrition while no one noticed that she, like growing numbers of mature women, had been suffering from disordered eating.

A lifetime of denial

On March 20, the eminent academic Rosemary Pope was found dead in her Bournemouth home. She was 49 years old, and weighed just four stone 10lbs... her heart - which, the inquest last week heard, had shrunk to the size of a child's because she had been starving herself for so long - gave out first. Pope's story isn't just tragic, it is also - on the surface, at least - shocking. How could a renowned professor with an international reputation and a PhD in psychology find herself in the grips of a condition usually labelled a young woman's disease?...And didn't anyone - her friends, family or colleagues - notice that this mature, professional woman was starving herself to death?

The reality is that Pope's story is becoming more and more common, with anorexia increasingly affecting older women. Like Pope, many of these women are extroverts who hold down good jobs and manage to survive in a very compromised state for years, even decades. "Ten years ago, there were very few women in their 30s, 40s, 50s and older who were diagnosed with anorexia. That has changed significantly, especially in the past five years," says Susan Ringwood, chief executive of Beat, the national eating disorders charity...

While this rise may be partly due to increased awareness of anorexia across all age groups, experts believe that increasing numbers of young people with anorexia are growing older with the disease, as well as a significant number of women who develop it later in life. Experts blame, at least in part, the increased pressure on older women to stay young....

The article goes on to describe the observations of family, friends and co-workers and how no one responded to the fact she was starving to death.

"Adults with anorexia can, like Rosemary Pope, be emaciated for years, but still function, and other people get used to them being like that," says Ringwood. "Add to this their heightened energy, a very driven personality and the fact that the general public still associates anorexia with adolescents and you can see how it can get missed by others. Even if people do suspect it, they often fear saying the wrong thing, or think that it might actually be cancer." Also significant is the increasingly thin line between disordered eating, which has become normalised among many women, and eating disorders. As one 42-year-old woman with anorexia puts it: "If you see an extremely thin woman on the street, you might think 'anorexic', but put a pushchair in her hands, and you think, 'overworked mum.'" Simpson, who is six stone, thinks her friends would be amazed if they discovered she suffered from anorexia....

Diana Brighouse, 53, a doctor who is married with four children and has had anorexia since she was 16... have various 'rules' about food, like never eating lunch, forbidding various foods, having to exercise a certain amount and so on." Brighouse believes people are remarkably oblivious to her illness. "The vast majority of my friends just think I'm naturally thin. I think that's largely because older women are much more clever about not drawing attention to it. While anorexic girls will cut up their half an apple and make it last a whole meal, older women are much more canny about appearing to have a plateful of food that actually only has 50 calories in it."...

In many cases, however, relations and family members of someone with anorexia are aware, but don't know how to help. Adult anorexics have the added risk of passing their food obsessions on to their children, points out Gura...

It's not because doctors are uncaring but, like the rest of us, they tend to stereotype anorexia as an adolescent problem. One woman who told her doctor she had dietary problems recalls being sent to a homeopath, whose colonic irrigation methods reduced her "to a crisp". Others are given antidepressants... [Click on title to read full article and for a photo of professor Pope.]

The article ends by asking: “Wouldn't it be fitting if Rosemary Pope's legacy was to put these women on the radar in this country and wake us all up to the changing face of anorexia?”

Click here for complete article (and single page version).

Doctors and intensive care units for sick babies

It’s hard to read this story without your heart going out to these women with high-risk pregnancies who, at one of the most stressful times in their lives, learn there are no intensive care beds for their babies. In just the past year, more than a hundred Canadian women and babies have had to be transported out of the country and away from their families to receive care.

As the Globe and Mail reports this week:

More than 100 Canadian women with high-risk pregnancies have been sent to United States hospitals over the past year – in what a doctors' group attributes to the lack of a national birthing plan. The problem has peaked, with British Columbia and Ontario each sending a record number of women to U.S. neonatal intensive care units (NICUs)... André Lalonde, executive vice-president of the Society of Obstetricians and Gynaecologists of Canada, said the problem is due to bed closings that took place almost a decade ago, the absence of a national birthing initiative and too few staff. “Neonatologists are very stretched right now,” Dr. Lalonde said in a telephone interview from Ottawa. “We're so stretched, it's kind of dangerous.”...

Canada, once able to boast about its high rank in the world for low infant-mortality rate – sixth place in 1990 – saw its rank plummet to 25th place in 2005, according to figures published this year by the Organization for Economic Co-operation and Development. Specifically, Canada's infant mortality rate of 5.4 deaths per 1,000 live births is tied with Estonia's and more than double Sweden's rate of 2.4.

The inability for Canada to care for all of its sick and premature babies has caught the attention of renowned pediatrics professor Shoo Lee, who is studying the health outcomes of infants sent abroad, in addition to those who remain here, often under stretched staffing conditions. “If you have insufficient resources in the province, what does that mean for those kept in the system?” Dr. Lee, director of the Canadian Neonatal Network, said from Edmonton. “Are they being admitted to the NICU only when they are very sick? Are they being pushed out too early to make room for others?”

Philippe Chessex, division head of neonatology for B.C. Women's Hospital & Health Centre, said every effort is made to avoid out-of-province transfers. Even sick babies who aren't sent to the U.S. can still face several moves while at home. “We're transferring babies across the province, in all directions, to try to find an extra bed for the next potential birth or for any baby already born,” Dr. Chessex said in a telephone interview from Vancouver. “We now have babies who have been transferred up to six times after leaving here before reaching home.”

For parents, the devastating news that their baby is sick due to a malformation, illness or being born prematurely is compounded by the reality that there simply is not a bed available for their infant close to home....

The article goes on to profile the heartbreakingly stressful stories of several families of premature or sick babies, although thankfully, they all appear to have had happy endings. According to B.C. Health Minister George Abbot, simply adding NICU beds isn’t the answer because when they added beds in Victoria, they weren’t operational for a year because there was no neonatologist or skilled nursing staff to care for the babies. Before parents panic, press secretary to Health Minister George Smitherman stressed that these were still a fraction of deliveries and that the province will do everything to take care of mothers and babies, which is why they pay to send them out of the country.

Dr. Lalonde says the key is developing a national birthing plan, which SOGC estimates would cost $43.5 million through March, 20012. Its report, called A National Birthing Initiative for Canada, says that medical professionals “are telling us cracks in the system are reaching a breaking point and that the current situation is potentially dangerous and cannot be sustained.”

Blogger Patrick McIlheran, however, made an interesting observation. Canadian officials are saying the problem is the lack of a national birthing plan, but:

Spokane is located in a country which, best I understand, lacks a national birthing plan. Yet it managed to have a neonatal bed available. Great Falls, Mont., had space some months back when that mother in Calgary, a much larger, richer place, had to deliver quadruplets. Yet it, too, is in a country without a national birthing plan. In fact, it's in a country without a national health care plan, which Canada has, and yet the flow of patients is most decidedly from Canada to the United States, not vice versa. This might suggest that the problem isn't the lack of a national plan of one sort or another but, rather, its presence. But, hey, I'm not a doctor, so I'm sure I can't say.

While there are those who believe the healthcare system in the United States is so deplorable it should be totally tossed out and taken over by the government, undeniably, people from other countries come here for care, not the other way around. Similarly, while there’s a worldwide nursing shortage, Canadian nurse organizations are concerned about an especially critical shortage there. Our system is by no means perfect, but allowing the marketplace to respond to demands, rather than a government bureaucracy to act, appears to have offered some benefit for U.S. Americans.

Perhaps most troubling, is that this problem doesn’t seem impossible to have been foreseen, especially knowing that populations are growing and additional healthcare services would be needed to care for them. A 2002 article in the journal Pediatrics by doctors at the Dartmouth Medical School in Hanover, New Hampshire, for example, had found that the United States had greater neonatal intensive care resources per capita compared to Canada. Back in the late 1990s, there were already only about 6 pediatricians for every 1,000 live births in Canada compared to 14 in the United States. There was less than one intensive care unit (0.72) per 10,000 live births in Canada, with about half the intensive and intermediate care beds available there compared to the U.S. While overall neonatal mortality figures between countries are difficult to compare, looking at mortalities among specific weight babies defined as live births in 1997-1999 offered signs of concern: neonatal mortality among babies weighing 1000-2499 grams was 1.69% in Canada compared to 1.32% in the U.S., and 6% higher among larger babies weighing over 2500 grams.

SOGC issued a study last summer looking at maternity care in rural British Columbia and the closure of increasing numbers of rural maternity services. Its data suggested that “women and children are more likely to have perinatal morbidity if they live in rural and remote communities and deliver in a referral hospital.” As its consumer advisory said:

“Our findings point to a higher incidence of inductions, and preterm and cesarean section deliveries among these women,” says Dr. Shiraz Moola, an obstetrician with Kootenay Lake Hospital and one of the study’s principal investigators. “We also found that women in rural and remote communities whose obstetric care is outside their local health area are more apt to have babies with lower birthweights.”

The study has found that the reduction and removal of healthcare services – especially obstetric care – has had a negative impact on women in Canada’s rural communities. “We have a number of concerns with this issue,” says outgoing SOGC President Dr. Donald Davis. “To begin with, women forced to seek maternity care outside their local health area may face increased financial, emotional and psychological stress as a result – especially if they must travel long distances, are by themselves or are leaving young children back at home.”

It can also be a question of safety. Women who choose to delay travel until labour starts – for whatever reason – are placing themselves and their babies at greater risk if they deliver en route and encounter complications without the proper medical assistance. Faced with this possibility, more healthcare providers and their rural patients are now considering elective labour induction.

The situation underlines the real and growing need for safer and more accessible rural care and an increase in maternal service providers in these areas, but current statistics are not encouraging. With 30 percent of Canadians living in rural and remote communities and only three percent of Canada’s obstetricians practicing in those communities, the need for additional rural maternity care services is pronounced. Adding to this dilemma is the fact that many smaller hospitals are facing nursing shortages – further reducing the level of care available – and recruiting and retaining general practitioners who provide maternity care is becoming more difficult as older practitioners offering this service retire.

Amidst the discussion of medical home and the nationalized healthcare delivery system being envisioned for us, perhaps there's a lesson for us in this story.

Click here for complete article (and single page version).

Cut and paste: school nutrition research goes to Canada

A new study was just reported by the Heart and Stroke Foundation in Canada as finding that schools that stop offering sugary sodas and fatty snacks could see significant drops in childhood obesity in just two years — a 33% lower risk for becoming overweight among the students.

A gold star if you realized it was the same study reported last month.

Remember those long-awaited results of the intensive program that put to test the Student Nutrition Policy being promoted in U.S. schools? It threw every intervention recommended in the Centers for Disease Control and Prevention’s Guidelines to Promote Lifelong Healthy Eating and Physical Activity at the kids. While billions of dollars were riding on proving school healthy eating programs are effective and help children, the results didn’t receive much fanfare here.

Not surprisingly. Despite what it put the children through, the school nutrition program had no effect on the incidence, prevalence, or remission of obesity, nor on changing BMIs. Worse, the intervention actually resulted in the children eating fewer fruits and vegetables. Rather than repeat the full scoop and the story behind the claim it lowered the risk of overweight, simply cut and paste the comprehensive overview here.

For readers who may be unfamiliar with the Heart & Stroke Foundation, it’s a partner in the Canadian Obesity Network. According to its position statement on school nutrition, a recent survey found school children in Nova Scotia had poor diets, with over half not meeting Canada’s Food Guide to Health Eating for fruits and vegetables. Are kids really eating that badly?

The food guide for those 4 years of age and older recommends 5 to 10 servings of fruits and vegetables every day, as well as low fat milk products, lean meats, and whole grain and enriched products.

It pays to ask how success and failure are defined.

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Saving Babies’ Lives

Repeating a scare — no matter how often or how loudly — won’t make it true. Once again, fat women are being meanly frightened by news their bodies could cause their babies harm.

In the news, a new government report is said to have found that rising levels of obesity could be contributing to rates of stillbirths in the UK. The same source used by the news last year to claim obesity contributed to mothers dying in childbirth is now being used to scare them about their babies’ safety. It wasn’t true last year and it isn’t today. But the misperceptions are the same, so let’s start by looking back at what we learned about the women in the report last year.

The Confidential Enquiry into Maternal and Child Health (CEMACH) just issued its report, Perinatal Mortality 2005: England, Wales & Northern Ireland. This report examines the perinatal outcomes in 2005 among women in Britain, just as the CEMACH had done for its Saving Mothers’ Lives report, examining maternal deaths. As you’ll remember, the most striking things in this report were its heartbreaking examinations of the hardships and suffering among the most disadvantaged women in our society. It had found that the most significant underlying factors for women with high-risk pregnancies and who died in childbirth were social and economic deprivations.

Extremely higher rates of maternal deaths were seen among immigrants and refugees, who were often in poorer health and suffering from medical conditions, such as HIV and TB; among minorities, with Black African women, including asylum seekers and newly arrived refugees, suffering mortality rates nearly six times those of White women; women living in poverty and those receiving less or late prenatal care had more than 7 times the risks of dying, with 5-fold higher rates of death and high-risk pregnancies seen among women living in deprived areas of the country; and higher deaths among victims of domestic abuse denied access to prenatal care. A total of 1.5% of maternal deaths, alone, were due to women who had had genital mutilations that hadn’t been recognized and repaired prior to delivery.

And among all of the direct causes for maternal deaths, the report found that 64% were among women who had received substandard care, especially seen among the heaviest women.

This report had found no substantiation for blaming obesity. Nor did its own data show obesity was a growing problem among women in the UK. In 2005, 21.9% of women of childbearing age had BMIs>30. This compared to 23.5% in 2001 and 21.2% in 1998. [Data also used in this new report.] Despite the fact that focusing on obesity, for which no known effective intervention exists anyway, would do nothing towards helping to lessen and prevent the needless suffering and deaths for these women and their babies, the CEMACH “selected obesity in pregnancy as its principal [sic] project with a maternal health focus for 2008-2011.”

The new perinatal report

This new report on 2005 perinatal outcomes also pulled from the same CEMACH database compiled from notification forms and surveillance activities on women and babies in Britain.

Before needlessly worrying mothers-to-be, it’s important to keep this report in perspective. As Professor Ian Greer, Chairman of the CEMACH National Advisory Committee wrote in the Preface, while the loss of a baby is a devastating event for any parent, “the perinatal mortality rate remains low.” From 1954 to the mid 1990s, stillbirth and neonatal death rates in England and Wales fell steadily. Since then, neonatal mortality has continued to drop slightly, while stillbirths have largely remained unchanged, according to the report. The stillbirth rate was 0.56% in 2000-2004 and was 0.55% in 2005. The neonatal mortality rate was 0.35% in 2005 compared to 0.37% in 2000-2004. Late fetal losses dropped dramatically from 2,764 in 2003 to 1,102 in 2004.**

The actual findings, unlike the media spin, found no support for blaming obesity. In fact, the report notes that the rates of stillbirths among women of various BMIs are similar in proportions to their representation in the population of women of childbearing age, but records didn't allow for more definitive conclusions. Most late fetal losses, stillbirths and neonatal deaths occur among women who make up the bulk of the bell curve (BMIs 18.5 – 24.9).

Instead, the exact same social and economic deprivations were described and found to be most related to poorer outcomes for the babies, just like for their mothers.

Social deprivation accounted for over one-third of all stillbirths and neonatal deaths in this report. The most deprived women had about twice the rate of stillbirths (0.62%) and neonatal deaths (0.38%) as the least deprived women (0.35% and 0.17%, respectively).

Minority women in England had significantly higher rates of stillbirths and neonatal deaths — among all Black women stillbirths totaled 4.23% of total births — 9 times those of White women at 0.48%; stillbirth rate among Pakistani women was 1.2%; and among Indian women was 0.96%.

Most of the deaths among the babies were to those born premature or weighing less than 1500 grams, and higher rates were also seen in mothers who were teens or over 40 years of age. While the causes for most stillbirths are never found, among the most commonly recognized are birth defects and chromosomal abnormalities, which account for up to 20% of stillbirths. Placental problems are believed to cause another 10-20%, the most common being placental abruption. Other factors are poor fetal growth (intrauterine growth restriction), infections (such as listeriosis or paraovirus), umbilical cord accidents (as many as 15% of stillbirths, alone), street drugs, trauma and accidents, and about 10% are related to poorly managed medical conditions such as preeclampsia and kidney disease.

When the disparities of stillbirths among more than 10 million births in the U.S. were examined, using the CDC National Center for Health Statistics data, lack of prenatal care was found to be the most significant factor, in both non-risk and high-risk pregnancies. “Lack of prenatal care increased the (adjusted) relative risk for fetal death 2.9-fold in blacks and 3.4-fold in whites. Blacks were 3.3 times more likely to have no prenatal care compared with whites,” the study concluded.

While it appears currently popular to blame obesity for just about everything, if the health of women and their babies were really the primary concerns, then we’d be looking at things we can do that might make a real difference. And those aren’t always the easiest or most comfortable issues to confront, such as socio-economic disparities and access to early and quality prenatal care. Professor Jason Gardosi, director of the Perinatal Institute, for example, recently presented the results of a ten-year study of stillbirths in Britain and estimated as many as 1,000 a year might have been avoided had the early danger signals been recognized and the women received appropriate medical care. He and professor Sabaratnam Arulkumaran, the incoming president of the Royal College of Obstetricians and Gynaecologists, were part of a story noting a need for better trained prenatal and delivery care personnel, adequate staffing levels, and more resources directed towards prenatal care to help improve outcomes. Not for blaming mothers for their figures.

So, even if the most socially disadvantaged women in certain population studies may also happen to be fatter, that correlation does not make fat the cause. Blaming their fat is unwarranted and needless. As was recently seen, in more than 19,000 pregnancies from 2000 to 2004 seen at Kaiser Permanente Northwest healthplan, there was no difference in stillbirths related to obesity. The most “extremely obese” women had the very same stillbirth rate (0.6%) as the “normal” weight and “overweight” women.

The news

Reading the media reports is almost a moot point, but now you may read it more critically and see a very different story than you might have without the facts:

Obesity linked to high stillbirth rates

Rising levels of obesity could be contributing to the rates of stillbirths in the UK, a new study has warned today. [The study actually urged caution in making conclusions about obesity.]

The Confidential Enquiry into Maternal and Child Health (CEMACH) found that the stillbirth rate in England, Wales and Northern Ireland is not decreasing, with 5.3 babies out of every 1,000 births being stillborn in 2006. Women who had a stillbirth were found to be more likely to be aged below 20 or above 40; from deprived circumstances; or from an ethnic minority. Over a quarter (26 per cent) of the mothers who had a stillbirth and 22 per cent of mothers who had a neonatal death were obese... [By mentioning these facts together, we are to assume that obesity was shown to be related to the stillbirth rates, when no such correlation was demonstrated.]

Jane Brewin, chief executive of the baby charity Tommy's, said the CEMACH study shows more research is "desperately needed" into finding the causes of stillbirth. "Obesity in pregnancy is a significant problem in this country and has massive implications for both mother and baby," she explained. "It carries an increased risk of major pregnancy complications including miscarriage, preterm birth and stillbirth."... [Repeating statements without evidence won’t make them true.]

All mothers-to-be need and deserve good prenatal care for the sake of their health and safety and that of their babies. Sadly, the continued war on obesity could distract us from real healthcare priorities and that would come at the most tragic cost of all.

© 2008 Sandy Szwarc

**Some caution is warranted whenever we look at neonatal data from other countries, of course, as it’s also variable depending in the definitions. Since 2004, babies who die before completing 24 weeks gestation don’t have to be registered as stillbirths in the UK, according to the Royal College of Obstetricians and Gynaecologists. But they might be, or they could be reported as “late fetal losses,” or reported as a neonatal death if they lived a period in the NICU. In the U.S., stillbirths are any deaths after 20 weeks, and definitions in other countries vary from 16 to 28 weeks. The point being, be careful when comparing data between countries or from year to year, but the overall figures for Britain continue a downward trend.