What you may not know about childhood obesity programs

With our busy schedules, it’s easy to glance at a headline and browse the first few lines of an article, or listen to a soundbyte on the television or radio, and believe we’ve grasped the gist of the story. Marketing professionals know that, too, and take advantage of that to sell us on ideas by soundbytes and press releases. Far too often, however, a close look at the evidence being reported reveals the truth is exactly opposite of what we’re being told. But few of us take the time to do the digging to find it.

It may still seem unbelievable that we could continually be misled so blatantly, but what happens when medical professionals don’t get the full story, either? As this news story illustrates, the ramifications are more significant than we may imagine.

Evidence-Based Program Helps Fight Childhood Obesity

A novel, multidisciplinary childhood obesity intervention program helps children adopt healthier eating habits, increase their physical activity, and maintain or improve their body mass index (BMI), a new study reveals....

This recent headlining news story was reporting on an abstract presented at the annual American Public Health Association meeting on November 6, 2006. You will remember from this post, that it was at this meeting that APHA developed its national public health agenda and at the conclusion of the meeting issued its, “Urgent Call for a Nationwide Public Health Infrastructure and Action to Reverse the Obesity Epidemic,” where it called for the “immediate mobilization of governmental, public and private agencies” and “mass communications campaigns that promote healthy eating and physical activity.” So the soundness of the information presented at this conference would seem to hold special importance.

Di P. Lam, a registered dietitian with Kaiser Permanente Healthcare Organization in Los Angeles, described the results of a pilot program called KP Kids. More than 500 children and their parents attended 9 hours of educational sessions over six weeks on physical activity, nutrition and behavior changes to encourage “healthy” eating and developing new lifestyle habits. This major undertaking, she said, involved pediatricians, registered dietitians, registered nurses, exercise physiologists and behaviorists.

At the end of the six weeks, the children were eating an additional one-half serving of fruits and vegetables, drinking one-half fewer servings of fruit juice or soda, eating less “junk food” (of undisclosed significance), had cut 11 minutes from their television watching and video game playing, and increased their exercise by about 2 1/2 minutes a day.

The children were followed for another year, weighed and measured, and their diets and habits assessed. At the end of that year, none of the “improvements,” as minimal as they were, had been maintained. The program also had no effect on the weight status of the growing children.

The suggestions proposed by Lam and others were to expand the program into the community!

Kaiser Permanente — one of the largest health-maintenance organizations in the country, with 8.4 million members across the country and a system which includes hospitals, medical providers and a foundation — has had a partnership with William Dietz, M.D., Ph.D. and the Centers for Disease Control and Prevention for years “to develop a national broad-based approach to the public health crisis of obesity.” Kaiser Permanente convened a meeting in Oakland, CA on August 14-15, 2003 to develop a “roadmap for advocacy and action.” It was jointly sponsored by the Robert Wood Johnson Foundation, the CDC, American Association of Health Plans, Health Partners, and the National Business Group on Health. While these interests support the spending of untold amounts of public and private healthcare resources on expansive obesity intervention and prevention programs, parents care about what is best for their children and few want their children to be used, experimented on or put at risk for the sake of politics and profit.

So, they’ll be especially interested in this. There’s more to the story that never made the news:

Kaiser Permanente and governmental health agencies have known for years that childhood obesity interventions are unsupportable and potentially harmful.

A major review of nearly 40 years of evidence — about 6,900 studies and abstracts — on screening and interventions for childhood and adolescent “overweight” was recently conducted by Kaiser Permanente researchers for the U.S. Preventive Services Task Force. The USPSTF is sponsored by the Agency for Healthcare Research and Quality, the Federal government’s lead agency under the U.S. Health and Services Department for research on health care quality, costs, outcomes and patient safety. It is charged with issuing careful, evidence-based findings that are used to develop clinical guidelines for healthcare providers and justify all aspects of government healthcare spending and HHS health policies.

Their comprehensive findings and recommendations released in July of 2005 were remarkable. While they did their best to put the best spin on the evidence possible and insert the government’s obesity initiatives into the text, they couldn’t change the actual evidence. Here were their conclusions:

1. There is insufficient evidence to recommend routine screening for overweight in children and adolescents as a means to prevent adverse health outcomes. These findings resulted in a major reversal on previous recommendations that had been in place since 1996 and which had recommended periodically measuring the height and weight of all children. This was big news that most parents never heard, and probably a lot of doctors. While school districts across the country are increasingly rushing to measure all children as part of popular “anti-obesity” and “healthy lifestyle” initiatives, it is not evidence-based and no longer recommended by leading experts. Yet it is a very rare parent who insists that their child be excluded from these BMI screenings.

2. Despite concerns of “overweight” children being at risk in adulthood and a public health issue, they said: “Data suggests that a substantial proportion of children under age 12 or 13, even with BMIs above the 95th percentile, will not develop adult obesity.”

3. There was no adequate longitudinal data relating childhood weight status and health outcomes. In other words, despite all of the concerns about today’s taller and larger children, there is nothing to support it being a concern at all.

4. There is no quality evidence that behavioral interventions for overweight in children and adolescents improves health outcomes or physiological measures, such as blood lipids (“cholesterol”), glucose tolerance, blood pressure or physical fitness. Few trials have included minorities and while “overweight treatment” in children aged 8-12 have been the most studied, the data was still fair to poor for effective interventions. In other words, there has been no intervention that's been able to prove measurable health benefits. In forty years, if there had been a program able to find beneficial outcomes, you can bet it would have been published by now, replicated and implemented everywhere.

5. “There is insufficient evidence to ascertain the magnitude of the potential harms of screening or prevention and treatment interventions....potential harms include labeling, induced self-managed dieting with its negative sequelae, poorer self-concept, poorer health habits, disordered eating, or negative impacts from parental concerns.”

6. There is no quality evidence to support the effectiveness of any weight loss interventions — behavioral, diet, medications or bariatric surgeries — or preventive measures.

Of course, like all research reviews and studies, more studies are always recommended. The problem is, when something has been disproven, or shown not to work or unable to support a modality (after 6,900 studies), in the scientific process good scientists move on to other hypotheses. Only junk scientists don’t.

Next: We’ll look at the USPSTF’s latest commentary on childhood obesity interventions. Those definitely didn’t make the news!

© 2007 Sandy Szwarc