Junkfood Science: October 2007

October 31, 2007

You’re fine just how you are

A picture is worth a thousand words. This T-shirt graphic was designed by Allan Faustino and has become the topic of the day because it powerfully illustrates the futility and heartbreak of trying to become something you were never naturally meant to be. Just as this adorable little rhino can never become a unicorn — which is a fictitious, unattainable figure, anyway — a genetically fat person can’t just become a thin one.

As anonymous writer at Kate Harding's, who brought this precious story, said, the rhino’s only failing is in being a rhino instead.

“I just want to tear that poster down and coax him out to the open plains, where he can run freely, far from the oppressive eye of his impossible aspirational image,” she wrote. “With the speed of a rhino. They’re actually pretty great athletes! But you know, oh their poor joints etc. etc.”

And her boyfriend’s response was what every little blue rhino should hear: “I want to tell the rhino that he’s just fine how he is.”


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Happy Trick-or-Treating!

Predictably, the alarm bells began weeks ago, as sugar-fearing writers began advising parents to “just say no to Halloween candy” and for everyone else to play a trick on the kids that come to their doors.

One author actually wrote:

Halloween frightens me. Not because of ghosts, goblins or ghouls — or even the costumed monsters, witches and pirates. What’s spooky about the holiday is that it’s a mandatory “Sugar Overload Day.” I’m dismayed that, despite soaring rates of obesity and type 2 diabetes among kids, on Halloween, it’s an accepted tradition to send your and your neighbors’ kids into sugar shock.

The “healthy Halloween” movement has been warning that Halloween is no excuse for allowing an indulgence and that anything with sugar would send blood sugars soaring and contribute to child obesity. [Clearly these are not JFS readers.] Instead, they’ve been recommending everyone give kids things like sunflower seeds, cheese, bottles of water (“trick or treaters need to stay hydrated”), glow-in-dark insects, stickers, pencils, key chains, pens, whistles, notebooks, pencils and crayons.

These are adults who have definitely forgotten what it’s like to be a kid. While a bottle of water may not get quite the same reaction as Charlie Brown who got a rock at each house in the 1966 Great Pumpkin Halloween special, the let down may feel pretty close to kids who’ve looked forward to their candy hauls all year.

There are few exceptions that sound almost sad. One elementary school child was quoted as saying she would prefer to get a pencil because candy could give her “a tummy ache...and it’s bad for your teeth.”

But most kids needn’t worry that Halloween is nearing extinction. The National Retailers Federation says that at least three-quarters of households have stocked up on $20 worth of candy to dole out tonight. One grown-up, Emma Curran, wrote a sweet piece in the Retriever Weekly celebrating the “free candy for everyone” meaning of Halloween, arguing:

You’re never tool old to trick-or-treat

...I have a major philosophical problem with losing Halloween. I already feel way too old most of the time, weighed down by the responsibilities of age. Halloween is a chance to forget all that and be a kid again.... It would be nice to have one night a year when I can act like a total child and run around collecting free candy. Halloween is a day of no shame, when you can dress like anything you want and not feel humiliated, just like a kid.

The last reason trick-or-treating is so great is because it is like a get out of jail free card. I can eat all the candy I want without guilt, because Halloween is like Vegas. What happens in the Halloween universe stays in the Halloween universe....It's unlike any other day of the year, and if we lose it, we will be losing something more than just a plastic jack-o-lantern filled with candy.

And David Curran, wrote one of the funniest Halloween commentaries in SFGate.com with advice for other parents:

It's Halloween-candy meltdown time

After a few days of waiting for my newsletter from the Society of Neurotic, Concerned and Overinvolved Parents, it was time to take action. The hours were ticking by and I was becoming a little desperate to find out how people tackle that singular crisis that arrives every October 31: How to deal with all the Halloween candy the kids bring home....So I head over to the local schoolyard, where my daughter's in third grade, for some sage advice. People appear remarkably calm considering the severity of the approaching day. I spot one dad, Zach Supar, his arms folded in this super laid-back manner as though it's Groundhog Day that's just around the corner. He simply laughs off the notion of some kind of Halloween candy rules: “Nah, I don't have a policy. I just let 'em eat all they want."...

Standing over by the tetherball court, Lori Saaf speaks from the other side of the candy spectrum: “I throw it all out. Except they get about two pieces a day for a few days from what neighbors give them."... The children get all dressed up, go door to door, they gather all these treats, and then they come home, only to hear, “Wasn't that fun? Now give your candy bag to me and I'm going to toss it into the garbage." ... Bye bye, Baby Ruth. Sayonara, Snickers. Nice knowin' ya, Nerds....

But extremes are sometimes made to be forgotten. Karen Nierlich recalls, “I used to be pretty controlling about the whole thing. But then I figured no one ever controlled what I ate and I turned out OK." She goes on to explain -- with, I believe, a full set of teeth that doesn't get placed in a cup at night -- that “on the scale of battles you want to fight, this one's pretty low on the list." While we may have to check back and see how Karen feels about her kids having Skittles for breakfast for the next month, she does represent a number of parents who let their kids go hog wild, at least for Halloween night....

If all this sounds like too much management, just forget it. Hark back to the days when Mom and/or Dad read the paper, sipped a martini and didn't give a fig that the youngsters had 18 pounds of chocolate and were bouncing off the ceiling until sometime in mid-January.... As Henry Weller, 10, in Connecticut puts it, on Halloween “you get all this candy, and it's FREE!" That's not an easy battle for any parent to win. So, if you can't beat 'em you might as well snag a few Snickers and join 'em.

There’s no evidence to fear the sugar or the fun. And to help ensure a safe Halloween for everyone, common sense safety tips are just a click away at Keep Kids Healthy.


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October 30, 2007

Herbs and healthy livers

The pursuit of optimal nutrition, ‘wellness’ and slim bodies has become fertile ground for the marketing of products, diets and regimens that promise “a lifetime of good health.” Herbal and natural dietary and weight loss supplements can be alluring because they may seem safe. Three new studies, however, have documented liver toxicity among healthy people using natural herbal supplements — more than 20 cases were just among Herbalife customers in two small countries.

Few consumers hear about the reports in the medical literature of liver and other toxicities from herbal products. Dr. Leonard B. Seeff, M.D., of the National Institutes of Health, reviewed the herbal products that have been associated with liver damage in the journal Clinical Liver Disease. His concerns about the growing numbers of medical cases were similar to an earlier 2005 comprehensive review for the European Association for the Study of the Liver in the Journal of Hepatology, led by Dr. Felix Stickel, M.D.. These doctors reported that, depending on the geographic region, 21% to 65% of patients seen for liver disease have been taking herbal preparations. Most evident is that women are at greatest risk not only because they use more herbals, but because of their higher susceptibility to herbal- and pharmaceutical-induced liver damage. Because many practitioners and consumers believe herbals are safe, the doctors noted the many times patients will even continue to take them as their liver diseases worsen.

Dr. Stickel and colleagues added:

Another problem is that herbals are usually mixtures of several ingredients or plants harvested during different seasons and extracted through variable procedures, which makes the identification of both the pharmacologically active and toxic compounds difficult. Also, contamination of herbals with microorganisms, fungal toxins such as aflatoxin, with pesticides, heavy metals and synthetic drugs has been described. Interactions between herbs and chemical drugs are another source of problems associated with the intake of herbal compounds.

While liver damage appears infrequently, the consequences are serious enough for patients that these cases are getting the notice of doctors. Another article in this month’s issue of the Journal of Hepatology by researchers at Hadassah-Hebrew University Medical Center in Israel reported on 12 patients (11 women) with acute liver injury after using Herbalife products. Incredibly, after three patients recovered, they resumed taking Herbalife products and succumbed to a second bout of hepatitis.

Another article in the same issue reported on a study by doctors in Switzerland. They had become concerned after seeing several patients with severe liver damage who had been using Herbalife products and tried to determine how prevalent liver toxicity due to Herbalife products might be. They surveyed all departments of medicine at 121 Swiss public hospitals, divisions of gastroenterology/hepatology, pathology and the Swiss pharmacovigilance database and identified 10 cases of liver toxicity in otherwise healthy people not taking any other herbal products or medications from 1998-2004. Rigorous questioning proved necessary as patients consistently underreported their use of herbal products, they said. They carefully documented the cases, including obtaining liver biopsies in most. Three of the ten patients had potentially life-threatening liver failure requiring liver transplants.

“The lack of labeling of contents of these products renders causality assessment impossible,” they reported. But using the WHO criteria for Causality Assessment of Suspected Adverse Reactions and expert hepatopathologists blinded to the patient information of herbal use, they determined that two were certainly caused by the Herbalife products, seven cases were probably and one case possibly.

This is not the first time that Herbalife has been in the news and the target of governmental regulatory agencies and concerned medical professionals. As recently reported, it is one of the oldest multi-level marketing companies selling vitamin and herbal products promising better health and slimness. Herbalife has found it especially lucrative to take advantage of poor people in developing countries. MLM is a sales technique where people, working as independent distributors, buy sales kits and products which they sell and, in return, are promised they’ll make money from those sales as well as from a percentage of the sales of those who they recruit as new distributors. However, fewer than 1% of distributors ever earn much money and many are stuck with thousands of dollars of products. MLM and pyramid schemes are listed on many attorney generals' top ten lists of consumer complaints. At MLM Watch.org, you can read more about MLM, including a summary of complaints that have previously been submitted to the FTC on Herbalife products.

A few years ago, the National Council Against Health Fraud issued a position paper on MLM health product companies. It listed important precautions for consumers, as well as described the harm that’s come to people who’ve gotten mixed up in them. Dr. Stephen Barrett, M.D., NCAHF Vice President, examined more than 100 MLM companies offering health-related products and concluded “that every one of them has made false or misleading claims in their promotional materials.” He said:

The products promoted as remedies are either bogus, unproven or intended for conditions that are unsuitable for self-medication...Most supplement companies get their raw ingredients from the same bulk wholesalers and merely repackage them...During the past several years, many physicians have begun selling health-related multilevel products to patients in their offices. Doctors are typically recruited with promises that the extra income will replace income lost to managed care....During the past 20 years, more than 25 health-related MLM companies have faced regulatory actions for false advertising, operating a pyramid scheme, or both. Although such actions usually improve future behavior, they rarely provide adequate redress for victims. Moreover, the number of MLM frauds known to Federal Trade Commission vastly exceeds its capacity to prosecute them on a case-by-case basis.

The growing reports of life-threatening health risks among users of these products remind us to not to be taken in by claims of magical benefits of any dietary intervention. Beyond preventing deficiencies — which is easily achieved by virtually everyone simply when enjoying all sorts of foods — no food or supplement is supernatural. When we hear claims that optimal or personalized nutrition is science-based and can improve our heart, digestive or immune health; help us age healthfully, improve our memory or eyesight, or remove wrinkles; increase our energy and fitness; or manage weight, control our appetite or boost metabolism...we know it sounds too good to be true.


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Update: European Union Commission ban on MRIs postponed

Leading scientists were able to convince the European Union Commission of the lack of scientific evidence behind its Directive that would have outlawed the use of magnetic resonance imaging (MRI) for patients beginning this spring. JFS readers will remember that fears over electromagnetic fields had led to a Directive setting ‘safe’ exposures so low that they would have made MRIs illegal.

The EU has announced a four-year postponement — until April 30, 2012 — to allow time to consider the scientific research.


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October 29, 2007

“Adults today are more active than their parents were”

When it comes to exercise, we believe more is better and moderation is rarely mentioned in the same breath. We are told that exercise is a win-win situation and that getting everyone to exercise 60 to 90 minutes a day will guarantee better health and reduce healthcare costs. This belief forgets the other side of the calculation: the growing costs resulting from overuse injuries and joint damage sustained during high-impact activities.

It’s been called ‘little league-itis’ in kids and ‘boomeritis’ in young adults. Earlier this year, an orthopedic specialist estimated 90% of the annual 30,000 joint replacements in Australia were due to osteoarthritis and the biggest increase is among people under age 50 engaging in more competitive sports and high-impact activities. The American Academy of Orthopedic Surgeons has reported that total knee replacements among patients aged 38 to 56 has doubled in the past ten years. Many of these younger patients are athletic types who sustained injuries in their 20s, or are people who continue to indulge in high impact sports. While physical activity is certainly a natural, healthful part of life, we rarely hear in the news that more of us are more active today than previous generations or of the benefits of moderation.

The trend of soaring hip and knee replacements among young boomers has also been reported in Canada. The Canadian Institute for Health Information released the most recent data on hip and knee replacements last fall. It reported that over the past decade among adults aged 45-54, the rates (per 100,000 people) of knee replacements had increased 174% for women and 125% for men; and hip replacements were up 41% and 53%, respectively.

As the Vancouver Sun reported this week:

A hip surgery for young boomers

It wasn't his intention, but Dale Saip is something of a trendsetter these days. Two years ago, at the age of 46, Saip underwent surgery on his left hip to treat crippling osteoarthritis — a degenerative disease caused by the breakdown and loss of the cushioning cartilage in the joint. In Saip's case, the arthritis was likely the result of an old sports injury.... Increasingly, younger and younger patients across the country are seeking surgical repairs to, and replacements of, their damaged and worn-out hip and knee joints - surgeries that were, not so long ago, considered the strict domain of patients 65 and older. No more....

[A] recent report by the Canadian Institute for Health Information found the number of patients heading into operating rooms across the country for a total replacement of either a hip or knee has leapt an incredible 87 per cent from an estimated 31,500 patients in 1994-95 to more than 58,000 in 2004-05, with the number of procedures increasing at a faster rate than the population is aging.

The report also found that while Canadians 65 years and older continue to make up the majority of joint replacement patients (representing about 66 per cent of total surgeries performed), the largest rate of increase recorded over the decade is for patients between the ages of 45 and 54 years. Hip replacements doubled in this age group over 10 years - from 1,313 in 1994-95 to 2,664 in 2004-05, while knee replacements nearly quadrupled, from 655 in 1994-95 to 2,529 in 2004-05. [figures are total numbers]

The costs just for the hospitalization and physician (not including physical therapy, lost time from work, medications, etc.) for each hip and knee replacement, according to their Ministry of Health, was reported as about $13,100 and $14,500, respectively. Intense exercise can exacerbate joint damage for heavier people who make up the largest portion of those getting joint replacements. The increases in joint replacements exceed increases in the average weights of the population.

But health care professionals are also seeing a dramatic rise in the number of patients like Saip, who have spent much of their lives involved in sports of one kind or another..."I did pretty much everything," he said. By the time he was in his early 30s, Saip began to feel the brunt of those years of chronic-impact athletics...A portion of that trend, he said, has to do with the general mentality and activity levels of the so-called baby boomer generation, now between 41 and 61 years old. “They are more active than their parents were," [Dr. Paul Sabiston, a North Vancouver orthopedic surgeon who specializes in knees] said... Other factors also play a critical role in the patient increase - namely advancements in surgical procedures, as well as faster discharge and recovery rates.

In B.C., the total number of surgeries is expected to reach about 14,400 by 2010, up another 25 per cent over current annual figures of 11,135. Adding to the pressure, surgical patients now in their 40s and 50s, will likely be facing revision surgery in the next 10 to 15 years to correct or replace failing artificial joints....


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October 28, 2007

Epidemics by definition

Epidemics can sometimes be created. One of the most common tactics is to change the definition. When diagnostic criteria is broadened, suddenly, with the stroke of a pen, new cases can appear to explode in number.

The World Heart Federation, American College of Cardiology, American Heart Association and the European Society of Cardiology have been championing new criteria for heart attacks over recent years, and will officially release it next month in the Journal of the American College of Cardiology and in the AHA journal, Circulation. The new definition will use elevations of troponin levels, rather than the traditional cardiac biomarkers, such as the MB-CK enzyme, along with traditional symptoms. Troponin is more sensitive and is released more quickly with even the slightest heart cell damage or ischemia, meaning it will diagnose more heart attacks, even including other things that can cause temporary elevations in troponin levels. Troponin levels can rise for many reasons beyond heart attacks, such as acute or chronic myocarditis (heart inflammation), congestive heart failure, infections, kidney disease, dermatomyositis, polymyositis (muscle inflammation), pulmonary embolisms, as well as after therapeutic procedures like coronary angioplasty, electrophysiological ablations, other heart catheterization procedures, or electrical cardioversions.

What will this new definition mean? Dr. Richard N. Fogoros, M.D., described it on his blog this past week, writing:

1) Under the new definition, many patients with chest pain who previously would be told a heart attack had been “ruled out" will now be diagnosed as actually having a heart attack. Accordingly, because they indeed do have unstable coronary artery disease, they will get more appropriate and more aggressive therapy than they would have received in the past....

2) The number of patients who are diagnosed with heart attack will increase by at least 25% under this new definition, according to some estimates. Officially, the incidence of heart attacks will rise. Therefore, in a year or two expect breathless news stories about the alarming new “epidemic" of heart attacks. Any time we get better at making earlier diagnoses of any disease -— whether coronary artery disease, infectious disease, or cancer — the reported incidence of that disease will go up. This is something we need to remember whenever experts call for new federal regulations (which seems to be the main job of experts), based on the increasing incidence of some disease or other.

3) Because these “new" heart attack patients will have a milder form of heart attack, the acute mortality rate reported for heart attacks will go down. It will be very tempting for some to use this entirely predictable improvement in acute outcomes to justify the expensive technologies or procedures that will be said to have produced it. Careful analysis will actually be required to tease out the reasons for improvements in clinical outcomes. We already know of one — a new definition of heart attack.

And when claims of skyrocketing heart attacks make the news — perhaps attributing it to ‘obesity,’ the evils of our modern diets or lifestyles, pollution or whatever — how many will be told that the definition criteria had simply changed? Or, will it be like so many other popularized ‘epidemics’ and people just readily accept them and not take a critical look at the definitions?


“Overweight:”Definition changed from BMI ≥ 27 to BMI ≥ 25 by the U.S. National Heart Lung and Blood Institute in 1998, instantly increasing by 43% the numbers of Americans, an additional 30.5 million, deemed ‘overweight.’

“High cholesterol:”Definition changed from a total cholesterol ≥ 240 to ≥ 200 in 1998 increasing by 86% the numbers of Americans labeled has having high cholesterol, an additional 42.6 million adults.

“Hypertension:”Definition changed in 1997 from 160/100 to 140/90, instantly adding 35% more Americans, 13.5 million, to the rosters of hypertensive. A new definition for ‘prehypertension’ in 2003 increased to 58% the Americans believing they have hypertension.

“Diabetes:” Definition changed from a fasting glucose of ≥ 140 to ≥ 126 in 1997 by the American Diabetes Association and WHO Expert Committee on the Diagnosis and Classification of Diabetes Mellitus, increasing by 14% and 1.7 million the people diagnosed with diabetes. With the proposal of a new term, ‘prediabetes’ by the First International Congress on Prediabetes, and promoted by the International Diabetes Federation (sponsored by 12 pharmaceutical companies), 40% of the adult population was added to the rosters believing they have diabetes and are in need of treatment.


© 2007 Sandy Szwarc. All rights reserved.


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October 27, 2007

GI — more ‘bad carb’ myths

One of the more popularized beliefs is that you can give yourself type 2 diabetes by eating sugars or ‘bad carbs’ because they cause blood sugars and insulin levels to surge. No matter how many times researchers have shown this not to be the case, myths surrounding dietary sugars and carbohydrates, especially those that come in the color white, continue, with each generation 'refining' their explanations.

A study just published in the American Journal of Clinical Nutrition adds to the body of evidence on whether foods that cause blood sugars and insulin secretion to spike can increase risks for developing diabetes.

To attempt to accurately predict foods’ blood sugar effects, the researchers used glycemic index and glycemic load. The glycemic index, first suggested as a way to manage blood sugars among diabetic patients in 1981, is a measure of foods’ immediate effects on blood sugars. The thinking is that foods that break down quickly (thought to be refined sugars and simple carbs) will have a high GI, while those that digest more slowly (thought to be complex carbohydrates, high fiber and high-fat foods) will have a lower GI. The index was created by measuring the change in blood sugar levels after a person eats a set amount of a single carbohydrate food (usually 50 grams) compared to a control food with the same amount of digestible carbohydrate, such as white bread or glucose. Glycemic load considers the GI and the proportion of carbohydrate content of foods eaten.

The study subjects were 7,321 white London civil service workers, average age of 50, first recruited to the Whitehall II study in 1985-8. After clinical examinations, they were followed at 2.5 years intervals and detailed dietary information was obtained from food frequency questionnaires. The researchers calculated the calorie-adjusted average GI and GL, using the 2002 international table of GI food values. These subject had no history or diagnosis of diabetes by doctors and were followed for 13 years, well into the years at highest risk for developing diabetes.

Incidences of diabetes were determined by actual blood tests and glucose tolerance tests. Blood was collected to determine fasting blood sugars and the test subjects were then given 75 grams of anhydrous glucose to drink and their blood retested 2 hours later to measure glucose and insulin levels.

The researchers reported their findings:

After 65,774 person-years of follow-up, 329 incident cases of diabetes were identified ... Dietary GI was not associated with the risk of incident diabetes. Further adjustment for employment grade; physical activity; smoking status; intake of alcohol, fiber, and carbohydrates, WHR and BMI did not alter the findings. Hazard ratios across tertiles of GL showed an inverse association with diabetes risk in the base model (P for trend 0.011). The weak protective effect of high GL remained after adjustment for employment grade, physical activity, smoking status, and alcohol intake, but it was not significant after further adjustment for carbohydrate and fiber intakes and in a model additionally adjusted for BMI and WHR.

In the actual data, fasting blood glucoses and insulin levels were slightly lower among those in the highest tertiles of GI and GL, and incidences of diabetes were slightly lower, too. Before and after adjusting for all of the possible confounding factors (sex, age, employment grade, physical activity, smoking, alcohol, fiber, BMI, etc.), the risk for diabetes was 6% lower among the highest GI tertile and 30% to 20% lower in the highest GL tertile, respectively. All too small to be significant, but clearly showed that low GI and GL levels did not reduce risks for developing diabetes.

The researchers discussed the conflicting evidence from both observational and clinical trial studies in the published literature and an important point deserves our attention: the need to differentiate the management of the symptom of high blood sugars in people with diabetes versus prevention. Also, all of the controlled trials on humans to date suggesting that low GI diets may help insulin sensitivity have been done on those who already have impaired glucose tolerance, not the prevention of diabetes in the general population.

The misnamed U.S. Diabetes Prevention Program trial, for example, screened 133,683 people and included only the 2.2% found to have impaired glucose tolerance.

There is also a widespread misconception that simple carbs are bad, and that complex carbs are good because they don’t spike blood sugars or insulin levels as much. Not only is this of little concern to nondiabetics, in reality, many complex carbohydrates have higher GI levels than pure sugar. Baked potatoes and corn flakes have higher glycemic indices than jellybeans and soft drinks. “Although hundreds of scientific articles have studied [GI] and many popular books have espoused it, the practical significance is still debatable,” said Dr. David Klurfeld, professor and chairman of the Department of Nutrition and Food Science at Wayne State University and editor-in-chief of the Journal of the American College of Nutrition, in a series of articles on GI in Nutrition News Focus. “The glycemic index can be influenced by the amount of fiber and carbohydrate but also by fat....The type of starch, particle size, maturation of a fruit or vegetable, cooking time, and many other factors affect the glycemic index.” It is also based on single foods and people eat foods together. “No expert panel has endorsed using the GI to choose foods, and the American Diabetes Association believes it is of little use [even] to diabetics in making food choices,” he wrote.

Similarly, many believe that only carbohydrates in the diet stimulate insulin production and that high-carb diets are responsible for obesity and illness, but this is a “a very undeserved reputation based on false and twisted truths,” explains Kathy Goodwin, R.D. “The truth is that all ingested foods stimulate insulin production.” And even population studies completely contradict such fears, she said. In Japan, for instance, high carb foods like white rice [with a GI higher than pure sucrose] is a daily staple, yet Japan “has one of the lowest rates of obesity, heart disease, cancer and diabetes in the world.” Again and again, the science supports there being nothing magical in the foods we eat or that there is one perfect diet.

As Dr. Elliot J. Rayfield, M.D., professor of medicine at Mount Sinai School of Medicine, explains:

Because diabetes is often referred to as a sugar disease, many people mistakenly think that it is caused by eating too much refined sugar. While it is true that sugar and other simple carbohydrates can produce a rapid rise in blood glucose in the absence of adequate insulin, they do not cause diabetes.


© 2007 Sandy Szwarc. All rights reserved


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October 26, 2007

Predictions are just guesses

All of these government doomsday predictions have become so preposterous, the best thing for our sanity can be to laugh. Humor often offers more truth than government statistics, as this piece by Mike Bentley for the York Press reveals:

They’re telling us big fat lies

IT'S BEEN a bumper week for the Office of National Statistics, the official government branch of Mr Keith Waterhouse's legendary Department of Guesswork. First of all they blithely inform us that 3.7 million immigrants are arriving in the country every week... Then our premier purveyor of pernicious porkies announces that there are now more old people than children in the country (old people being over 60; young people being under 16) and that from now on every supermarket queue will be full of Victor Meldrews complaining about the amount of packaging on their cauliflowers and the fact that the green beans have been flown in from Kenya.

Their coup de grace was the so-called news that everyone is now obese and will only get bigger and fatter in years to come. So serious was this guestimate that the Prime Minister himself “declared war" on the obesity epidemic blighting Britain, warning that it is “as serious a threat as global warming"....

Pushing the ‘pause’ button for a moment, he's hinted at a great point that’s rarely considered. There’s been enormous changes in the demographics of our population in the United States, too. It has become considerably more racially/ethnically diverse over recent decades, and people are healthier and living longer, which means that devised health epidemic statistics are looking at very different populations over the years. One with more bodies naturally larger with aging, for example, swings the population-wide numbers upward a few pounds... an instant contribution to an “epidemic.” It helps, too, to change the population survey designs to include more poor and minorities, to change the definition of “too fat,” and then define the epidemic by numbers crossing the new threshold, rather than reveal the actual weight gain among the population. Why? Because if it were known that, even then, the actual weight gain was little more than a handful of pounds, everyone would see how silly the doomsday claims of a crisis are.

[I]s an increase in the number of fat people really as much a threat to our planet as global warning? Really?.. Where the Office of National Statistics perennially lets itself down is when it tries to estimate the cost of the various blights heading our way... How on earth can they possibly calculate this? It's just complete and utter guesswork.

Then we have the moronic quality of life surveys... I'm sorry, but as a statistic that's entirely meaningless. You may as well argue that listening to loud music causes spots, on the grounds that every teenage kid has an iPod and a complexion like the surface of the moon. Yes, the two things are linked - but... I have come to the conclusion that the only way to get through modern life is to assume everything we are told by any public body is either wrong or a lie.

Read the part about government recommendations of how much alcohol is ‘safe’ to drink — a big controversy that’s been brewing in Europe. As he reveals, health officials admitted that the safe levels shown in the medical research would have sent “the wrong message,” so they halved it. “Completely arbitrary and based more on what the public might accept rather than on medical reasoning,” he wrote.


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Being smart does not make one right

“Question authority” was once the young people’s code, but it’s falling by the wayside as people of all ages more readily accept as fact whatever someone with a prestigious title, notable academic credentials or distinguished awards might say. But no amount of education or recognitions makes someone’s views credible.

The editors of the Daily Stanford have written a hard-hitting piece today, with an incredible illustration that even the best minds can exhibit ignorance and prejudice.

Questioning Nobel authority

The Nobel Prize is regarded by many in academia as the most coveted award for one’s achievements. After a long life of dedication to a field, specialists of physiology or medicine, literature, physics, economics, peace and chemistry hope to be recognized by the Nobel Prize Committee and catapulted into the annals of history. Worldwide recognition, mainstream admiration and substantial prize money naturally follow. So does courting from leading research institutions across the world, with Stanford as no exception. With 17 Nobel laureates on faculty, the Stanford community greatly appreciates having so many distinguished persons contributing to University education. We should, however, show serious reservations if such laureates misapply their legitimacy to advance reprehensible opinions.

Consider the following remarks:

On obesity: “Whenever you interview fat people, you feel bad, because you know you’re not going to hire them.”

On genetically engineering beauty: “People say it would be terrible if we made all girls pretty. I think it would be great.”

On race: “[I am] inherently gloomy about the prospect of Africa...all our social policies are based on the fact that their intelligence is the same as ours — whereas all the testing says not really.”

All of these comments were made by James Watson, co-winner of the 1962 Nobel Prize in Physiology or Medicine for the discovery of the structure of DNA. The last remark, on race, was made about two weeks ago...

This lengthy article concludes with the hope that a “moral obligation can be fostered against prejudice no matter how prestigious the perpetrator.”


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Milkshake Friday: More important things

Maya’s Granny has written a lovely little post about how good it feels to be free from dieting and obsessions with her body. Eating normally — meaning enjoying everything and not counting calories or grams of whatever, or eating certain foods she believed might make her thinner — has given her so much extra time and energy to live life and contribute to the world and the loved ones in her life. Living by calories in and calories out has become so commonplace, it's easy to forget that it's not natural or healthful. Well worth a read in its entirety. Here is a taste:

Obsessing

Know any people like this? Folks who focus on the world through the lens of weight? I used to be one. For most of my adult life I weighed every morning. Felt guilty and incomplete if I hadn't. And I had all these insane rules about that....

The other side of that coin, is figuring out how much exercise I'd done for the day. Pedometers. Stop watches. The little meter on the exercise machine. Figuring out if I had exercised enough to allow me to have a few calories more.

Oh, and the third side — counting those calories or points or carbs or whatever when they went in. Adding fiber to things so that they would fill me up sooner and transit the system faster, taking some extra calories along with them...

Do you have any idea how good it feels to be sane at last? To have a healthy relationship with food? To have time and energy to think about other things?


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October 25, 2007

Lookism

Are men and women judged differently at work? Do appearances, rather than qualifications, dedication and work performance, actually influence hiring practices, career advancement opportunities and raises? New research just published in the Journal of Vocational Behavior found that the most common form of workplace bias continues to be race or ethnicity. But for very fat white women, it is their weight. For them, it’s a source for more discriminatory practices than age, gender, race or ethnicity, sexual orientation, religion or disability. But the researchers findings brought more surprises.

The fact that prejudices, insensitivities and inequities against fat people exist in the workplace was documented by professors Rebecca Puhl and Kelly Brownell in their classic 2001 article in Obesity Research. But no research has yet attempted to objectively learn how prevalent weight discrimination might be and sort it out from gender and race ... until now. This study, led by Mark Roehling of the School of Labor and Industrial Relations at Michigan State University in East Lansing, not only found that body weight bias exists in workplaces across the country, but that there are dramatic differences according to gender, race and weight.

For those unfamiliar with the work of Puhl and Brownell, they described studies of stereotypic attitudes among employers, showing that fat people may be at a substantial disadvantage in employment, beginning during the hiring process. Several studies using various techniques, such as videotape interviews, found that employers were significantly less likely to hire qualified fat applicants and more apt to judge them as lacking self-discipline and having low managerial potential, less ambition, poor personal hygiene, and less likely to be productive.

Such prejudices carry over into wages and career advancement opportunities, they documented, as over a dozen studies had found that fat employees are assumed by bosses “to lack self-discipline, be lazy, less conscientious, less competent, sloppy, disagreeable, and emotionally unstable. Obese employees are also believed to think slower, have poorer attendance records, and be poor role models.” As Puhl and Brownell reported, fewer ‘obese’ people are hired for high-level positions, they receive lower wages for the same jobs performed by thinner coworkers, and are more likely to be denied promotions. A study of over 2,000 women and men reported that obesity lowers wage growth rates by nearly 6%. But several national surveys have reported that ‘obese’ women appear to face the greatest wage-related bias, earning 12% less than thinner women.

The mere existence of weight discrimination, however, doesn’t tell us if it occurs in great numbers among the general population, nor separate it out from possible racial/ethnic and gender discrimination. Most surveys in the past have involved select groups, such as fat acceptance or weight loss organizations, making it difficult to generalize throughout workplaces. That’s what makes this new study so important to furthering our understanding weight prejudices and how it can impact the health and welfare of millions of Americans.

The researchers began by reviewing the research published since 2001, finding that weight discrimination in employment appears to be growing internationally. Simultaneously, human resource managers are becoming increasingly troubled about the legal implications of such discrimination and its potentially devastating costs to employers who fail to recognize and remedy such practices. It is also becoming a growing issue for policy makers faced with calls for legislation to protect against weight discrimination. And as the medical literature grows, healthcare professionals as never before are recognizing the health effects of the stress of discrimination, along with its economic impact.

This study quantified perceived discrimination in employment settings because “research has shown that the perception that one has been the victim of employment discrimination may have adverse psychological and physical health outcomes for employees.” It is the perception that one is treated differently based on being associated with a group and the belief that his/her treatment is unfair or unjust that also affects job satisfaction, workplace dynamics, career decisions and job turnover.

These researchers randomly interviewed 2,838 adults (average age 44.8 years and half male) from the MacArthur Foundation National Survey of Midlife Development in the United States database, a nationally representative sample of noninstitutionalized English-speaking adults in the continental U.S. Everyone in their cohort had worked and all had BMIs of 19 or greater. They controlled for variables such as age, marital and socioeconomic status, height, education and occupation. The respondents were asked open-ended questions to determine if they’d experienced “at least one of three forms of employment discrimination (not hired for a job, not given a job promotion, fired from a job), and identified weight as a primary basis for his or her discriminatory experience.”

Overall, they reported that “weight-related perceived discrimination was found among 4% of the total sample, a frequency that was greater than employment discrimination attributed to religion, disability, or sexual orientation.” But there was a “dramatic difference between sexes among very obese respondents, with 27.7% of very obese women reporting weight-related employment discrimination, and only 12.1% of the men.”

And weight discrimination steadily increased with weight— occurring in 27.9% of very ‘obese’ women compared to 6.6% of ‘obese’ women, 2.7% of ‘overweight’ women, and 0.7% of ‘normal weight women. Of surprise to these researchers was that at even low levels of ‘overweight,’ women reported experiencing weight bias. This negates the integrity of workplace weight discrimination policies reserved only for the most obese, they said, but necessitates it be prohibited in general.

The research indicates there are different standards for men and women, Dr. Roehling said. This means that much of weight discrimination could fall under sex discrimination, adding:

We are less accepting of overweight women... If women are experiencing workplace discrimination based on their weight 16 times more frequently [overall] than men, employers ought to be very concerned about valid sex discrimination claims.

Among the most ‘obese,’ the incidences of weight discrimination was the same regardless of race. Among Blacks, race or ethnicity is still the most common type of employment discrimination they experienced, but discrimination attributed to race or ethnicity was highest among the most ‘obese’ Blacks — 31.6% among the women and 75% of the men; higher than Blacks of ‘normal’ weight, at 28.7% for women and 44.9% for men.

Some researchers have actually suggested that fat people are less likely than other discriminated groups to perceive their negative treatment as “unfair discrimination,” believing that fat people see it as “their due.” In other words, that fat people had internalized the misconceptions about their size and believe it to be their own fault. But these researchers argued that they found this to not be the case among most fat people. They said that this study provides evidence of the need for employers to be concerned about weight discrimination, adding:

There is evidence that in both an absolute sense and a relative sense, a substantial number of individuals perceive that they are being discriminated against in employment settings because of their weight....

To the extent that employers rely on highly subjective and/or unvalidated hiring practices (e.g., traditional unstructured interviews), the findings provide employers additional reason to be concerned that the full potential of overweight employees is not being utilized, and further, that female applicants and employees are being treated differently on the basis of their weight. Legal concerns aside [not to mention moral], the inclusion of weight-related bias in company diversity programs would seem to be warranted.

For employers who need an impetus to ensure all employees and prospective employees are treated equitably and compassionately and not judged by their appearances, this study provides that.

And as with all discrimination, of course, alleviating it begins with education to correct the nescience behind such prejudices, not trying to change the victims — be it by skin whitening, sex change operations or weight loss.


© 2007 Sandy Szwarc


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October 24, 2007

Such a deal ...or is it?

IBM has taken its employee wellness programs from the workplace into employees’ homes. The company announced today that it will pay employees to put their children into a 3-month online childhood obesity program. For every child that parents enroll in a “‘healthy’ eating and exercise training” program, they’ll get a $150 Children’s Health Rebate. But there’s a lot more to this story than meets the eye.

As CNN reports:

IBM's New Children's Health Rebate for Employees Helps Families Attain a Healthy Lifestyle

IBM today announced a new wellness incentive for U.S. employees that encourages healthy living for families and children. The Children's Health Rebate... is one of four $150 cash rebates available to IBM employees in the U.S... The program is available online to U.S. employees, and offers participants a wide range of educational resources, such as sample menus, exercise suggestions and nutritional value of popular foods... Employees also receive the book, “Family Power" by Karen Miller-Kovach, Chief Scientific Officer at Weight Watchers.

To qualify for the Children's Health Rebate, IBM employees use an interactive online tool to manage their family's eating and exercise habits with self-paced tracking plans that can be securely accessed only by the employee's family.... It suggests activities for families such as preparing family dinners together, and spending time on family walks and active games. Families take an inventory of their eating and activity habits, considering such points as how often they eat dinner together, how many servings of fruits and vegetables they eat each day and how often they exercise. Participants then set goals to build on those healthy habits, and keep a daily diary over any 12-week period using the site's “healthy lifestyle planner." The planner can be printed out and children can mark their success with gold stickers provided by IBM. At the end of the 12 weeks, families complete a brief online inventory to evaluate their progress....

IBM has teamed up with Weight Watchers, a fellow member of the National Business Group on Health. It’s easy to see how Weight Watchers will benefit by such compulsory participation of 128,000 IBM employees in a Weight Watchers’ branded program...one that will simultaneously bring up an entire generation of weight-absorbed future customers. But IBM has not disclosed what’s in the deal for them. Even if such a program worked, by the time any health benefits might materialize, the children will long since be off on their own and no longer on their parents’ insurance plan.

The money may be enough to coerce some workers let their employer decide what their family eats, where and when they eat, and how often they exercise and what type of exercise they do. But using children is especially insidious, because what isn’t being said is that this childhood obesity program is an experimental pilot project with absolutely no evidence that it will prevent child obesity, let alone improve their children’s health. In fact, all of the evidence to date has shown similar programs to be ineffective for improving children’s health — such as changing their blood pressures, glucose tolerance, fitness, ‘cholesterol’ levels or rates of childhood illnesses — or change long-term obesity rates. But they do leave young people vulnerable to body-image problems and life-long dysfunctional relationships with food and eating.

The book which the IBM childhood obesity prevention program is based upon is the Weight Watchers Family Power: 5 Simple Rules for a Healthy-Weight Home. The book’s Introduction was written by Meredith Vieira, who JFS readers will remember narrated the GlaxoSmithKline-funded PBS special, “FAT: What No One Is Telling You.” The content of that program was carefully written to convince the public that obesity was a crisis and the result of an obesogenic environment.

According to the Weight Watchers Family Power book, its goal “is to help our kids grow up to be lean and healthy adults.” By following easy rules — eat whole foods, limit screen time and engage in one hour of activity a day — it claims that all children will easily achieve a healthy weight. A ‘healthy weight’ is defined as thin and complying with the CDC’s new BMI growth charts. Pages are devoted to explaining BMI and a ‘healthy range’ for children.

These popular, but unsound myths, are followed by countless more. The book heavily quotes the Robert Wood Johnson Foundation-commissioned and sponsored Institute of Medicine report, “Progress in Preventing Childhood Obesity: How Do We Measure Up?” The opening makes the typical claims that 30% of children are ‘overweight’ or ‘at risk of overweight,’ that childhood obesity is a global epidemic, and that the main reason is kids’ unhealthy lifestyles, bad diet, processed foods, insufficient activity, and screen time. The book has chapters such as “Setting Food Policy” and sidebars addressing problems like “The Reluctant Teen.”

But parents will be most concerned to learn what Weight Watcher’s author Karen Miller-Kovach admits about this program:

While the Weight Watchers approach has been developed and extensively studied in adults, it has not been rigorously evaluated in children. The fact is, none of the popular weight-loss methods have, so any recommendations about their use in children and adolescents are based on the assumption that what’s right for adults is appropriate for kids. Recognizing that popular adult-based programs had not been adapted and carefully studied in children and adolescents, Weight Watchers took on the challenge, resulting in the Family Power pilot project and this book.

This experimental program claims that it is simple “to make small changes in eating and activity patterns” among the whole family to have a “big impact” on children’s body size, and that by simply teaching children “the principles of a healthy-weight lifestyle,” they’ll be left with “a legacy of a healthy weight.” More concerning, it claims that “it is best to start early, with children as young as three years of age.”

We’ve examined at length the lack of evidence for the safety and effectiveness of childhood obesity prevention programs — all of which have unsuccessfully applied these very techniques. How many parents will check out the program, research the facts and not want their children subjected to another unproven program? How many will help their children — whatever their natural body shapes and sizes— grow up free from childhoods dominated by body concerns and lifetimes of dieting? How many parents will recognize that they do not need or want their employer or Weight Watchers telling them how to feed and raise their children? And how many will find the $150 too irresistible?


© 2007 Sandy Szwarc


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October 23, 2007

Pick-up Sticks — the latest breast cancer scare

Women were once again frightened this week by news warning that gaining weight could endanger their health. We learned of a study linking weight gain — any at all after age 18 — to breast cancer. Except it wasn’t based on good science, but on a mail-in survey.

Let’s start with the source of this claim. It was a paper published in the October issue of Archives of Internal Medicine, led by Jiyoung Ahn, Ph.D., at the National Cancer Institute in Bethesda, Maryland.

The researchers tabulated answers to an AARP survey sent out in 1995-1996, asking its senior members to remember their measurements, diets and lifestyle habits through their lives. Women were also asked the age of their first menses, reproductive history and hormone use. The researchers didn’t verify any data in the AARP Study database, and had only this unreliable self-reported retrospective information.

The AARP had mailed out 3.5 million questionnaires to members living in just six states (California, Florida, Pennsylvania, New Jersey, North Carolina and Louisiana) and in two metropolitan areas (Atlanta, Georgia and Detroit, Michigan). This represents only a fraction of its 38 million members. Only 132,942 women, average age of 63 and mostly Caucasian, completed and returned the risk factor questionnaire used in this study. These 0.3% of AARP members are not likely representative of women aged 50-71 in the United States, let alone representative of AARP members. To examine breast cancer risks, these researchers went a step further and unexplainably eliminated the questionnaires from nearly 34,000 additional women: more than 9,000 who had a personal history of cancer, 4,445 who were still premenopausal, and 20,420 who reported extremes of height or weight. This left 99,039 women (0.23% of its members). They then matched these women with state Cancer registries and identified 2,110 cases of breast cancer. That’s our non-Trojan number. This study was looking at a nonrandom sample of only 2,110 women, not the 99,039 reported.

The elderly women in their sample differed considerably from postmenopausal in the U.S., beyond the fact that over 90% were White. Fifty-five percent were still taking hormones at the time of the survey. In contrast, according to the Centers for Disease Control and Prevention, 1988-1994 NHANES data showed only 22% of postmenopausal women had been currently taking hormones, mostly those of higher socioeconomic status. The ‘obese’ women in their sample were also over three times as likely to be African American (6.8% versus 2.1%) and more than 25% less likely to be taking hormones compared to the ‘normal’ weight women.

The researchers divided their sample according to BMIs at various ages, looking for relationships to postmenopausal breast cancer risk. Keeping in mind the caveats about the quality of the data and its applicability to most women, let’s look at what they found.


Findings

Among the 1,162 women who had been using hormones at the time of the survey and developed postmenopausal breast cancer, the very fattest (BMIs ≥ 40) had the same breast cancer risks as the ‘normal’ or ‘overweight’ women. And those who gained weight through adulthood, even over 50 pounds, had the same risks as those whose weights had remained stable. “No associations with weight gain were observed in current [hormone] users,” said the authors.

And looking at each of the periods of the women’s lives, those using hormones who had been the most ‘obese’ at age 50, and at age 35, and at age 18, actually had up to 35% lower risks for developing postmenopausal breast cancer than women who were ‘overweight’ or ‘normal’ weight.

In fact, noted the authors: “BMI at age 18 years was inversely associated with breast cancer risk regardless of [hormone] use.”

Among the 948 women not using hormones at the time of the survey, those who had been ‘obese’ at ages 18 had 52% lower risks for developing postmenopausal breast cancer than the ‘normal’ weight women. Those ‘obese’ at age 35 even had lower risks than the ‘overweight’ women.

We’ve now covered 98% of the women in their cohort, all but 40 women, and there’s no tenable correlation between breast cancer and fatness.

The only higher relative risk for postmenopausal breast cancer of any note that they were able to derive was a 2.0 associated with older women with BMIs ≥ 40 and not using hormones at the time of the survey. But this relative risk was too small to be tenable. More disturbingly, it was derived with a statistical sleight of hand — it was not in reference to ‘normal’ weight women as is being claimed, but only the thinnest women (BMIs of 18.5-22.4). They made up a new definition for a ‘normal’ weight. The real relative risks among those not taking hormones, based on their numbers, were only 75% - 89% higher for the women with BMIs ≥ 40 and 25% to 36% higher among most ‘obese’ women, compared with most ‘normal’ weight women — noncredible correlations and not beyond statistical error or random chance. Remember, these relative risk are percentages of an actual incidence of breast cancer for women of 0.119% according to U.S. Cancer Statistics (USCS). But to tell ‘obese’ women not taking hormones that, based on iffy data, their actual risks could go from 0.119% to 0.14 - 0.22% wouldn’t sound nearly as worrisome.

Considering the shakiness of the questionnaire data being used and the confounding factors not considered, these computer-derived correlations are simply not meaningful. For all of the women in this survey, weight wasn’t demonstrated to matter.

In fact, the odd finding of slightly higher risks among nonhormone users regardless of their weight or weight change, conflicts with the literature, according to the American Cancer Society, which suggests that hormonal use might be associated with a higher risk, not lower. There are countless confounding factors not accounted for in this study, which make any credible interpretations impossible and the idea that weight is the cause especially unsupported. Considerably higher relative risks (up to 4-fold), for example, were associated with menarche at age 15 years or older.

It’s so easy to believe that high-sounding relative risks derived from data dredges mean something. But any authors can search hard enough and put enough data into a computer model to come up with all sorts of meaningless associations. Remember that 2005 study of a random sample of 12,178 women published in the British Medical Journal that found a relative risk for breast cancer of 2.41 among left-handed women with BMIs of 25 or under? We can drive ourselves nuts worrying about every correlation that can be dredged up, most of which are never supported in clinical trials.


The news

Was this study a sincere attempt to find a cure for breast cancer, or another attempt to scare women into losing weight? The insinuations we’ve heard in the news and the press release issued by the American Medical Association have been that this study showed that natural weight gain with aging is something to avoid and that losing weight might lower one’s cancer risk.

There’s one big problem with that. It’s the opposite of what the authors found:

Adult weight loss was unrelated to breast cancer compared with stable weight. The lack of association of weight loss with breast cancer risk was consistent across the entire lifetime. Associations between weight loss and breast cancer did not differ based on [hormone] use... To confirm that weight loss due to preclinical disease did not account for the null associations observed, we repeated all the analyses after excluding women who were diagnosed as having cancers of any type during the first two years of follow-up. Risk estimates remain unchanged.

The same AARP data has shown that women with ‘normal’ BMIs of 20.9 and lower have higher risks for premature death than women who are ‘overweight’ or even ‘obese’ with BMIs to 35. In fact, the same AARP data has previously shown that the heaviest women (BMIs ≥ 40) have lower mortality rates from any and all causes than the thinnest women (BMIs < 18.5). An analysis of the AARP data through 2005, led by Dr. Kenneth Adams, Ph.D., found that with aging, mortality rates also dropped for those who were ‘overweight’ and ‘obese’.

And concerning dieting or any intentional weight loss efforts, Adams and colleagues concluded in an August 2006 issue of the New England Journal of Medicine, that it was especially ill advised for women and men, writing:

Among both men and women 65 years of age or older, weight loss after the age of 50 years was more strongly associated with the risk of death than was weight gain.

JFS readers have seen time and again that what is written in an abstract or press release often differs from what a study’s data actually found. In fact, it can be the complete opposite, especially when it contradicts “what everybody knows that being fat is bad.” That’s why it is increasingly necessary to look carefully at the study data because the media or peer reviewers aren’t going to.


© 2007 Sandy Szwarc


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October 22, 2007

One size children

The results of two long-term studies of childhood obesity programs were published last week. The programs tried all of the prevalent techniques: childhood obesity prevention through intensive school-based education to teach ‘healthy’ eating and avoidance of sodas; and behavioral modification and social-environmental weight management, targeting families, peers and their environment to promote ‘healthy’ eating and physical activity.

Here's what they found.

Prevention

The first was the Christchurch obesity prevention programme in schools (CHOPPS), which was a randomized control trial launched in 2001. This trial included 644 school children in southwest England, aged 7 to 11, and was popularly called the “ditch the fizz” project. It focused on attempting to teach children about the dangers of carbonated drinks, telling them the sugar was bad for their health and would make them fat. Educators also showed them a tooth left in a jar of citric acid and told them that soda would dissolve their teeth. [This myth is a topic for another day.] This was followed by year-long interventions by teachers, including plays, websites, and games to encourage fewer fizzy drinks.

The control group started out slightly larger (in body mass indexes) than the intervention group, with a higher percentage of girls, and would be expected to gain weight ahead of the boys as they entered puberty. The one year results were published in 2004 and reported no difference in the percentage of weight gained by the intervention or control group. They both gained 4% of their starting weight during that year. [Because the control group was larger to start with, they gained on average 0.4 BMI units more.]

The follow-up results three years after the program began were just published in the British Medical Journal. The researchers had lost one-third of the original cohort, leaving an even greater percentage of boys in the intervention group. Of the remaining 434 children, they found, not unexpectedly, that all of the children had grown. The average BMIs of the control group had increased 1.4 units and the intervention group by 1.1 units, and again, there was no statistical difference in their BMI changes.

Nor were there any statistical differences in the numbers classified as “overweight” or “obese” [current classifications are correctly termed "at risk for overweight" and "overweight"]. As the authors explained, they “analyzed the data for each measure of change from baseline using baseline values, sex, and secondary school as covariates or cofactors. This made no material difference to the significance levels or mean changes between control and intervention group.”

They concluded:

The original project provided hope that a simple intervention could be beneficial in preventing obesity, but our new results show no effect two years after the end of the intervention.


Weight control

The second randomized controlled trial, published in the Journal of the American Medican Association, was led by Denise Wilfley, Ph.D., of the psychiatry department at Washington University School of Medicine in St.Louis, MO. A total of 204 healthy fat children, ages 7 to 12, underwent an intensive 5 month family-based weight loss treatment that included strict calorie restrictions, education on “healthy” foods as classified by the Traffic Light Diet, 90 minutes of at least moderate-intensity exercise every day at least 5 days a week, limits on sedentary activities, and behavioral change training which included a family-based reinforcement system.

The children were then randomized to a 9-month intense “behavioral skills” or a “social facilitation” weight maintenance program or to a control group. The behavioral intervention used a “cognitive-behavioral approach” adapted from adult weight maintenance programs and substance abuse disorders. It emphasized teaching self-control to maintain balances of calorie intakes and physical activity. The social approach used family and peers to reinforce ‘healthy’ eating and physical activity and remove environmental barriers to healthy lifestyles. Parents were guided to encourage children to form friendships and ensure play dates with peers who were healthy role models for ‘healthy eating’ and physical activity. [Stop and think, for a moment, what they were teaching, here.] Both weight maintenance interventions groups were similar in the amount of contact and duration. The children who hadn't lost sufficient weight, or any at all, were encouraged to continue to try and lose during the maintenance programs.

The researchers found that the weight outcomes for the two intervention groups “were not significantly different from each other across any time points” (throughout the trial or 2-year follow-up period). The children in the intervention groups lost more weight during the weight loss and weight maintenance period than the control group, but rebounded all the more quickly during the first year follow-up. The BMI z scores of the growing children in the maintenance intervention groups went from 1.95 at the beginning of the follow-up period to 2.00 after 2 years. The control group went from 2.04 to 2.11. A difference of 0.02 between the groups. No statistical difference.

In the end, weight maintenance interventions showed no effect on changing the rate of children’s BMI growth.

Nor did the weight control interventions result in lower percentages of children classified as ‘overweight.’ At the end of the intervention period, 52.7% of the intervention group had been labeled as ‘overweight,’ and 60.5% were at the 2-year follow-up. This contrasted with the control group which ended the intervention period with 57.9% labeled ‘overweight’ and 64.8% at the 2-year follow-up. You’ll note that slightly more children under the weight maintenance interventions than the controls rebounded into the ‘overweight’ category during the two-year follow-up.

This study didn’t measure the physical or psychological health impacts on the children from any of their interventions, nor did they consider pubertal stages.


Their future

Although both studies found null results, the authors suggested that more intense and continuous interventions might be necessary.

But, of course, doing more of the same won’t work, either. Nor is it surprising that no obesity prevention or weight intervention program to date has been able to demonstrate effectiveness in changing obesity rates among children or teens long-term. That’s because, as we know, the science has shown for decades that the natural diversity of sizes among kids, as in adults, isn’t about what they eat or the exercise they get. Thin kids may eat like horses, while fat kids like birds and it doesn't much change their natural sizes in the end. As a group, fat and thin eat the same. No dietary or activity factor among children explains the differences in their sizes. The studies and multiple expert reviews of the evidence continue to make these conclusions — as reviewed here, here and here — and they continue to be ignored.

More worrisome, studies continue to ignore the physical and psychological costs of these interventions on children.


© 2007 Sandy Szwarc


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Everyone says this doctor’s great

Have you ever had a problem with a car, computer or appliance and gone online for help, only to come away feeling like a shmuck because everyone, it seems, has had a bad experience and is saying they’ll never buy that product again? It’s a common phenomenon that those with complaints do a lot of complaining. Every business owner knows that an unhappy customer will tell a bunch of people, whereas a happy one may tell one other, if you’re lucky. Bad publicity isn’t always good for business.

Similarly, when people are personally invested in a health treatment or believe in it, they'll often paint a rosy picture and not reveal the downsides.

These tendancies are difficult to overcome because so many people will base their health decisions and beliefs on what everyone else seems to be saying, even people they don't know. It's easy to mistake anecdotes, groupthink and consensus of opinions for facts and sound information.

That’s why doctors are concerned about a new plan by WellPoint health plans to publish online a Zagat Survey guide to their doctors, based patient comments and rankings on a 30-point scale considering things like their office environment and scheduling. The ratings guide won’t include information on medical expertise or malpractice convictions. It’s also different from another type of profiling based on a healthlplan’s viewpoint, such as UnitedHealthcare’s recent rating of doctors based on their claims data and compliance with healthplan performance measures.

Sadly, the popularity of a doctor and customer satisfaction are not always the best measures of the best quality of medical care and expertise.

As USA Today reports, WellPoint is the largest insurer to partner with Zagat for such a project. Today’s news offers some helpful cautions for consumers:

WellPoint doctors to get Zagat ratings

One of the nation's largest health insurers, WellPoint, has teamed with Zagat Survey to let patients rate their doctors, just as diners rate restaurants in Zagat's burgundy-colored guides...the ratings guide will consider trust, communication, availability and office environment. In addition to giving doctors a numerical score based on a 30-point scale, the site will include comments from patients...

Still, efforts to rate doctors have brought controversy. Another type of doctor ranking, in which insurers use claims data and other methods to evaluate doctors on cost and quality, has led to lawsuits from doctor groups and warnings to insurers from New York Attorney General Andrew Cuomo, who says the ranking efforts may be misleading or designed to steer patients mainly on cost. WellPoint, whose Empire Blue Cross Blue Shield subsidiary is among those being reviewed by Cuomo, says its Zagat survey is unlike the doctor rankings.... WellPoint says its Zagat survey will not include information about medical expertise or other factors, such as malpractice settlements....

“The fact that a doctor might have a friendly administrator at the front desk is meaningless if they have a high medical-error rate," says Jerry Flanagan of the Foundation for Taxpayer & Consumer Rights. Disgruntled patients are more likely to submit a survey than happy ones, says physician Jim King, president of the American Academy of Family Physicians. Still, he's not too concerned. “In my small town, it's word-of-mouth," King says. “If someone uses this survey intelligently to make a short list of doctors to interview, that's OK. But they still need to depend on their own personal opinion."


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