The country’s most massive childhood obesity program — has it helped children?

Two bills were filed this week, one attempting to repeal the 3-year old Arkansas law that has required schools to measure children’s body mass index (BMI) and the other to make it voluntary and at parents’ request. Concerns that the program misdirects needed academic resources and is labeling children and leaving them traumatized was driving these moves. News stories reported that Governor Mike Bebe would support both of these initiatives.

Former Governor Mike Huckabee, who spearheaded Act 1220, disagreed, saying that this program has been responsible for halting childhood obesity in Arkansas and has been “heralded across the nation.” He told reporters that Robert Wood Johnson Foundation has recognized Arkansas as “the only state in the nation to have stopped growth in childhood obesity.”

Is this program really the first to successfully halt the growth in childhood obesity? Incredibly, not a single reporter has sought out the source of this claim and revealed the actual findings.

This issue is bigger than measuring BMI — that was just a small part of the Arkansas Act 1220 passed in 2003. It launched the most comprehensive statewide program to combat childhood obesity in public schools and communities. It changed the children’s environment, mandating “healthier” foods in schools and school lunches, eliminating foods and drinks deemed unhealthy, and increasing physical activity in schools. It was designed to engage the community and support parents, including giving them information annually on the dangers of high BMI and importance of nutrition and physical activity; and it incorporated “healthy eating” and exercise lessons into student curriculum; as well as annual BMI testing of every school child and reporting results to parents.

The Act also mandated the formation of a Child Health Advisory Committee to oversee the program which included representatives from the Dept. of Health; Arkansas Dietetic Association; Academy of Pediatrics; Academy of Family Practice; Association for Health Physical Education, Recreation and Dance; Heart Association; American Cancer Society; American Lung Association; various child and public health advocacy agencies and university programs; Arkansas School Food Service Association, Dept. of Education, School Nurses Association, Association of Education Administrators and PTA.

This unprecedented effort has included everything popularly believed to be necessary to address childhood obesity.

The Robert Wood Johnson Foundation sponsored the creation of the resulting BMI database and its analysis. Last August, the three-year results were released by the Arkansas Center for Health Improvement (ACHI) and called “the most comprehensive and accurate single-state profile of the childhood obesity epidemic.”

This report, “The Third Annual Arkansas Assessment of Childhood and Adolescent Obesity,” is the source for former Governor Huckabee’s claims. The report stated that the percentage of students labeled “overweight” (BMI >95th percentile) had decreased by 0.6% over the 3-year period. And over that period the percentage of children “at risk for overweight” (BMI in 85-95th percentile) dropped by 0.1%, from 17.2% to 17.2%. Whether such small changes in population-wide statistics are clinically meaningful has yet to be seen.

Governor Huckabee hailed the results as “the end to rising obesity rates in the state.” The 0.1% drop in at risk for overweight was considered evidence of success and especially highlighted in the report.

Yet no concern was noted for similar changes indicating potential harm:

The percentage of children underweight had increased by the same amount as the decrease of at risk for overweight. Hispanic and Caucasian girls during ther high school years were the most affected by the program and accounted for the most significant falls in BMIs (5-11% change in overweight or at risk). These are worrisome indications that the focus on weight and healthy lifestyles could be leading teen girls into unhealthy weight and eating behaviors.

During this program,the percentage of overweight and at risk African American girls significantly increased as they grew — from about 32% in prekindergarten to 46% among the twelfth graders — about 14%. Other minorities also increased by several percentages with age. So the program most "failed" minority children, which make up a quarter of the population. These children also have 2 1/2 times the poverty of the Caucasian children.

This comprehensive statewide program focusing on children’s BMI — which has thrown every possible resource into the project and $1.4 million in start up costs the first year alone — has yet to demonstrate any positive effect on children’s health. [That’s what happens when interventions work from popular beliefs about obesity and its causes, versus the evidence. More on that soon.]

In fact, the latest reports on the health status of children in Arkansas, one of the poorest states in the country, give every indication it is not the best use of healthcare or educational resources.

The National Survey of Children's Health under the U.S. Department of Health and Human Services, reports that Arkansas’ children are well below the national average for receiving well-child checkups, dental care and mental health care; and above national averages for poor academic achievement, injuries and health problems. From 2005 to 2006, alone, immunization coverage dropped from 82.4% to 67.8%, according to the Arkansas State Health Department.

© 2007 Sandy Szwarc