Critical thinking has left the building

The UK news this week has been reporting that parents are to blame for childhood obesity and that excess weight in children is due to bad parenting. So, parents, beginning with those “from low-income backgrounds,” have been made the focus on a new Healthy Living Initiative, launched by health minister Caroline Flint “to help parents recognize the warning signs of childhood obesity and adopt healthier lifestyles.”

According to the Guardian:

Parents who fail to control what their children are eating, because of their busy lives, social pressures or lack of knowledge, are the focus of a new anti-obesity campaign launched by the government today. It follows a report from the Medical Research Council's human nutrition research centre linking bad parenting to obesity in children. It identified four areas in which parents need support:

· Parents often have no idea that their child is overweight and know little about the damage that could do to their health.

· Parents sometimes think changing to a healthy lifestyle would be too difficult.

· Parents are under pressure to provide high fat, salt and sugar food, not just from advertising, but from their children who do not want to be different from friends.

· Parents think it is not easy for their children to have an active lifestyle because sporting activities can be expensive and playing out may be dangerous.

The report finds evidence that parents are not in control of their children's eating habits...

Everybody “knows” that fat kids aren’t eating fresh fruits and vegetables or lean meats and fish. When it comes to obesity, even usually critically thinking analysts readily cite news reports as having “medical findings documenting some very disturbing dietary findings.”

But we know better than to blindly take media stories as having credible evidence without going to the original sources to see the quality of research for ourselves — or, incredibly, if there even is any research at all!

The news stories were taken verbatim from a press release that mentioned only nebulous “evidence from a diverse range of sources.” Just what were those sources?

The search for the evidence begins

Going first to the Medical Research Council, we find another news release stating that to encourage healthy living, eating right and exercising, Dr. Susan Jebb of the MCR Human Nutrition Research chaired the expert group that created the framework for the Department of Health’s “social marketing campaign” that will be launched in March of 2007:

Scientists who work in the Communications team at MRC HNR have developed a document that provides an overview of the evidence informing the campaign The ‘Healthy Living’ Social Marketing Initiative: A Review of the Evidence, is aimed at health professionals, academics and other interested groups.

Now knowing the name of this report, we find no such document available anywhere on the MRC’s website and even contacting the press office came up empty. The 40-page publication was finally located at the Department of Health’s website here.

In the Forward, Caroline Flint, MP, Minister of State for Public Health, writes that this “work has been informed by the collective knowledge of 80 stakeholders from across academia and the not-for-profit and for-profit sectors. An Expert Review Group of leading academics in the fields of physical activity, nutrition and behavioural psychology took this input and their own knowledge to provide us with this detailed evidence review....This report is already informing our approach in tackling obesity. A programme of initiatives will begin to roll out from March 2007, beginning with ‘Top Tips for Mums.’”

This prestigious report begins by laying out the working premises behind the government’s initiatives, citing that the prevalence of obesity is rising:

Moreover, the magnitude and duration of excess weight are strongly associated with the burden of related ill-health. Accordingly, childhood obesity is sometimes referred to as ‘a ticking time-bomb of disease.’

According to the report, the Department of Health; the Department for Education and Skills; and the Department for Culture, Media and Sport have made it their goal to halt the rise of childhood obesity among children under 11 years of age by the year 2010. For that, it says, social change is necessary to encourage the population to adopt healthier diets and levels of exercise. Their social marketing campaign “recognises that there are common lifestyle traits that underpin obesity and a range of other health outcomes.”

“An incontrovertible fact about the aetiology of obesity is that energy intake must exceed energy expenditure over a prolonged period of time,” this report states. “Today’s lifestyles determine obesity.”

It went on to repeat several popular observations, such as there are more fast food restaurants, cars, televisions, and computers today and that children have less PE and those who don’t participate in sports are heavier than those who don’t — hoping, it appears, that we will jump to conclude that these associations are the cause of obesity. But this report provided no evidence to carry these assumptions forward to show they’ve caused weight gain in children or that interventions addressing these areas have any affect.

Yes, you read that correctly. There was no evidence in this report. Incredibly, in building their case, this publication was a compilation of no less than ten opinion polls and attitude surveys.

We’ve discussed here how polls are manipulated and used to sell an idea and shape public opinion, not gather scientific evidence. The Burger Boy and Sport Girl survey cited in this publication, for example, asked 174 children their opinions of factors influencing food choices. The Project Rainbow survey for the Co-op polled the attitudes of 629 parents and found that 60% said children’s diets today were worse than ten years ago and half believed too much fast-food/convenience food is the main contributor to childhood obesity. MORI Survey of Sport and the Family found that 80% of parents believed ‘children today get less exercise because parents are afraid to let them go out alone.’ The Food Standards Agency – Consumer Attitudes Survey said that two-thirds of those polled believed people were eating too much fat and sugar, half thought we were eating too much salt, and 25% thought meats needed to be cut. You get the idea. They strung opinion polls together.

This was a report of the success of anti-obesity marketing and tallying of popular beliefs, not evidence.

Concerning any actual evidence for interventions to prevent or address childhood obesity, the report states only:

To date, evidence of specific interventions to tackle obesity is limited. But...it is likely that new evidence will emerge in the near future to refine and develop strategies to prevent and treat obesity.

The recent NICE guidance on the prevention of obesity in children has collated the existing body of peer-reviewed research on effective interventions and developed a series of guidelines.The ‘Healthy Living’ Social Marketing Initiative will help to increase awareness of this information and extend knowledge and understanding of the issues.

So the National Institute for Health and Clinical Excellence (NICE) must be where we’ll find the evidence for the government’s ‘Healthy Living’ Social Marketing Initiative....

Digging deeper

The NICE document, Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children, was found here.

File upon file outlines the extensive clinical guidelines and public policy initiatives for more than 20 interventions claimed to help the Department of Health; Department for Education and Skills; and the Department for Culture, Media and Sport meet their 2010 goal of halting childhood obesity among children under age 11 “in the context of a broader strategy to tackle obesity in the population as a whole.”

“These are delivered through a range of organisations and partnerships at national, regional, local and frontline level.” This is a massive, far-reaching effort addressing every aspect of family home, workplace, school, business, medical and social settings; with key child programs tackling “school meals, health school program, play, obesity campaign, and school sports strategy.”

But even the full guideline report #43 for healthcare professionals cited no evidence. The NICE website did offer a Word document, “Guide to resources to support implementation.” For the evidence for the NICE and MCR recommendations, we're finally referred to this paper: “Tackling Child Obesity — First Steps.” This was a joint study by the Healthcare Commission, the National Audit Office and the Audit Commission published on February 28, 2006. It was the third in a series examining the effectiveness of the government’s national policy programs and their effectiveness. Here’s what it found:

There is limited evidence of effectiveness in preventing or affecting obesity or overweight in children to support:

· school-based health promotion (classroom curriculum to reduce television, videotape and video game use)

·family-based behaviour modification programmes (family therapy in addition to diet education, regular visits to a paediatrician and encouragement to exercise)

There is no evidence of effectiveness for:

·school-based physical activity programmes led by specialist staff or classroom teachers

· family-based health promotion interventions (dietary and general health education and increased activity, or involving sustained contact with children and parents)

The report went on to say:

While the evidence is that a multifaceted approach to child obesity is the most effective [although none is provided],there is little evidence as yet to determine whether the Departments’ range of programmes and initiatives to improve children’s health and nutrition generally is sufficient to achieve the target. Given the shortage of evidence on what works for obesity, it will be of critical importance to ensure that high quality evaluations are put in place as programmes and initiatives are rolled out.

Without reliable baseline data, there is a risk that resources will be wasted in unproductive activity. With pressure to tackle child obesity, there have been instances where local delivery bodies have devised or continued collecting their own sets of potentially incompatible measurements of child obesity, with the risk of producing inconsistency in activity and data...At this stage, with the programme not yet rolled out, there are few data on how efficiently the extra money will be used by different local authorities and schools...

And in Section 1.9, they asked and answered the pivotal question:

What works when tackling childhood obesity?

There has been little comprehensive research on the effectiveness of prevention strategies in this area. The Health Development Agency previously reviewed the evidence surrounding effective interventions in the prevention and management of obesity. A lack of strong evidence, however, does not necessarily mean evidence of ineffectiveness – only that more research is needed and better methods for evaluation should be developed.

So, essentially, they plan on evaluating things as they go along. “Strong evaluation is particularly important, given that evidence on what works to tackle this new problem is in short supply,” it said. It appears, this will be a huge and costly social experiment on England’s families and children, based on no evidence.

The report concluded that achieving the government’s obesity targets “will involve major social change, sophisticated approaches to raising awareness and to changing behaviour, and a comprehensive range of policy measures and interventions.”

© 2007 Sandy Szwarc

P.S. An upcoming post will look specifically at the claim that parents are irresponsible and not even able to recognize when their children are “overweight.” It deserves its own note.