Amazing Food Detective for doctors

In promoting its childhood obesity programs, Kaiser Permanente has been on television, although viewers might not realize the source of the show.

It just teamed up with Discovery Health to launch a documentary geared to “instruct physicians and healthcare professionals about childhood obesity and the necessary steps to treat and prevent this epidemic.” The program, “Healthy Steps to Treating Childhood Obesity,” is currently airing across the country and offering doctors free continuing education credit (CME).

The Discovery Health show is best described as a grown-up version of the ‘educational’ video game Kaiser created for kids — “The Incredible Adventures of the Amazing Food Detective” — which Scholastic distributed to thousands of elementary schools across the country. [Reviewed here.] Kaiser’s National Director of Community Health Initiatives, Loel Solomon, PhD, has continued to promote it on network television.

In fact, the Kaiser press release for the new Discovery Health show said: “Collaborating with Discovery Health CME to create this program is one of the many creative tools Kaiser Permanente has developed to educate and arm communities to fight childhood obesity... ‘The Incredible Adventures of the Amazing Food Detective.’”

The Discovery Health program was developed by a group of Kaiser Permanente pediatric experts, but the detailed script is right out of the new “Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity” published in the December issue of Pediatrics and posted on the AMA website last summer. These have been extensively reviewed here and need no introduction for JFS readers.

Coincidentally, John Whyte, MD, MPH, Vice President for Continuing Medical Education at Discovery Health, said in the Kaiser’s press release for the Discovery Health show, that the premier of this show was “just days after the new, aggressive childhood obesity guidelines were published in Pediatrics [and] the timing couldn’t be better.”

Dr. Philip Wu, M.D., a Portland, Oregon, pediatrician is the clinical pediatric lead for Kaiser's Care Management Institute Weight Management Initiative and one of the three professionals** who created the Discovery Health show. Dr. Wu was interviewed in November by Andrew Schorr for the online medical talk show, Patient Power, where he explained that the reason for the childhood obesity problem “has everything to do with how we eat collectively and how much activity we get.” It’s reversible, he said. He shared the five recommendations Kaiser teaches parents and children as part of its childhood weight program:

One: eat breakfast every day. Number two: try to reduce the amount of time you spend watching TV, a movie, playing video games or spend time on the computer to no more than one or two hours a day. Number three: Try to increase fruits and vegetables in the diet, five servings or more. Number four: Try to cut down on sweetened beverages. This is soda, juice, sport drinks; limit that to no more than four to six ounces a day. Number five: Of course try to be physically active in some sort of activity for at least 60 minutes or more each day. Those are the key top things.

Is there any evidence to support Kaiser’s childhood obesity program — that calls for multidisciplinary interventions of doctors, community and government sectors to encourage “healthy” eating, increased physical activity, and behavioral changes — will reverse or prevent childhood obesity?

We already learned the answer to that when Di P. Lam, a registered dietitian with Kaiser Permanente Healthcare Organization in Los Angeles, reported the results of its pilot program on hundreds of children, whose pediatricians had participated in an intense family-based intervention program. After one year, none of the healthy behaviors had been maintained in the children and the program had no effect on the weight status of the children. The review of Kaiser’s childhood obesity initiatives and its work with William Dietz, M.D., Ph.D., Robert Wood Johnson Foundation, American Association of Health Plans, Health Partners, and the National Business Group on Health to develop a “national broad-based approach to the public health crisis of obesity” may be helpful background reading for anyone who missed it.

Kaiser Permanente has known for years that these childhood obesity interventions are insupportable and potentially harmful. Its researchers had conducted the major review of nearly 40 years of evidence — about 6,900 studies and abstracts — on screening and interventions for childhood and adolescent “overweight” for the U.S. Preventive Services Task Force. The Task Force’s findings were reviewed here, and concluded that there was still no evidence to support the effectiveness of any weight loss interventions or preventive measures addressing childhood obesity, or that such behavioral interventions improve long-term health outcomes or physiological measures. The report, however, did note the “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.”

For Patient Power, Dr. Wu also discussed Kaiser’s childhood obesity weight management program, SHINE, which he leads:

SHINE is actually one of many what are called “high intensity weight management” programs. SHINE happens to be one that is in the stage of being studied as a research model here in the northwest. SHINE actually stands for the Study for Healthy Integration of Nutrition and Exercise. That’s its full name. SHINE is just one of several examples of these three to four month high intensity programs.... This is all designed to look at the effectiveness of making lifestyle changes for teenagers and children who participate in these kinds of studies.

The SHINE program was described recently in the Oregonian as being experimental. As of yet, there is no published data on its effectiveness.

To get the CME credits for the Discovery Health show, doctors have to answer ten questions on a forced choice test... incorrectly.

© 2008 Sandy Szwarc

** The other two professionals who are part of the Discovery Health show are:

Dr. Francine R. Kaufman, M.D., a Los Angeles pediatrician who authored Diabesity: the obesity-diabetes epidemic that threatens America and what we must do to stop it. Her full bio is here, and financial disclosures are here. Dr. Kaufman holds numerous patents, including the use of uncooked cornstarch in the glycemic diet and energy bar, Extend Bar™, she invented.

Dr. Michelle May, M.D., author of Am I Hungry?, a non-diet weight loss book and programs to think yourself thin; and co-author of H is for Healthy - Weight Management for Kids.