Conflicts of interest

All of us hope that public health policies and care guidelines, especially those directed at our children, are based on the most careful examinations of the soundest evidence and have been shown to be safe and effective, with benefits that outweigh the potential harms. We hope that those creating health programs are free from conflicts of interest that can taint objectivity. But when we think only in terms of industry-funding, we can miss far more influential conflicts... such as from one of the world’s largest nonprofits that has made a key agenda the war on obesity.

Robert Wood Johnson Foundation has sponsored another Institutes of Medicine (IOM) project, which began on February 11, 2008, to review school meal standards and make recommendations to the National School Lunch/Breakfast Programs. The project’s goal states it will create “well-conceived, practical and economic recommendations for meal patterns and standards...to foster healthy eating habits and safeguard children’s health.”

But this isn’t about health or healthy eating. National school food programs are being poised to be revised further supposedly to combat childhood obesity.

All fourteen of the members chosen to complete this IOM project were selected by its Food and Nutrition Board’s Childhood Obesity Prevention Committee, and have had active anti-obesity roles based on diet behavioral interventions. Every one of them. And nine have had major roles in previous RWJF anti-obesity projects geared towards ‘healthy’ diet and lifestyle strategies. How likely do you think there will be a serious re-evaluation of the healthfulness and effectiveness of these child obesity interventions and examinations of the medical evidence on childhood obesity?

The Institutes of Medicine — Nutrition standards for food in schools

The National Academy of Sciences was created by the federal government to advise it on science and technology issues, but the IOM is not a government agency. What many consumers don’t realize is that the IOM is a private organization, with countless obesity projects sponsored by RWJF to support its own anti-obesity agenda. While the IOM says “unpaid volunteer experts” author most reports, does that make them objective?

The IOM established a Standing Committee on Childhood Obesity this year sponsored by RWJF which will oversee “Nutrition standards for food in school,” as well as food marketing and childhood obesity prevention programs. This Committee’s roster is a who’s-who in the war on obesity and is chaired by Jeffrey P. Koplan, M.D., M.P.H., former director of the CDC from 1998-2002 who helped to see the CDC make obesity a national priority. He has also since led RWJF projects, such as the 2005 IOM report, Preventing Childhood Obesity: Health in the Balance, the 2007 report Progress in Preventing Childhood Obesity: How do we measure up? and the 2005 symposium Progress in Preventing Childhood Obesity: Focus on Schools.

The fourteen members chosen for this latest RWJF-IOM project, called Review of National School Lunch and School Breakfast Program Meal Patterns and Standards, will probably be familiar to most readers, if not their names, the initiatives they’ve headed.

The chair is Virginia A. Stallings, M.D., who has served on numerous IOM projects, such as the Nutrition Standards for Foods in Schools: Leading the Way Toward Healthier Youth, completed last year. In a public briefing, she explained that the “evidence-based nutrition standards” they developed for National School Breakfast and Lunch Programs focused on encouraging “healthy” foods and limiting the consumption of unhealthy foods. The committee determined that school lunches were too high in calories and “proposed limits on the amount of saturated fat [<10%], trans fat, added sugars [<3.5%], sodium [<200 mg] and caffeine.” They organized foods outside lunch and breakfast into tiers based on their guiding principles. Tier 1 (“healthy”) items, for example, “include fresh or minimally processed foods such as apples, carrot sticks, raisins, low-fat or nonfat milk, and certain multigrain tortilla chips, granola bars and nonfat yogurt.” Plain water should be available, with other beverages (or tier 2 items only for high school students) available after school.

Dr. Stallings gave a February 17, 2008 IOM program, Understanding Obesity and Childhood Nutrition, Panel Perspectives on Schools, saying obesity is “the most pressing challenge to nutritional health in this first decade of the 21^st century” and that “all foods available on [school] campuses should be with the objective of promoting health and reducing obesity.” She said the IOM used the Dietary Guidelines to support a focus on calorie control, weight management, physical activity, and limiting fats, sodium and sugars. [The Dietary Guidelines, however, make no mention of restricting sodium or sugars for children. They also don’t call for low-fat diets in children, saying that children 4-18 years of age need 25-35% of their calories to come from fat — which American children already get.] The key message for school nutrition programs “should be to encourage greater consumption of fruits, vegetables, whole grains and nonfat or low-fat dairy foods,” she said. Foods that should be banned from schools included sweets, fortified sports drinks, colas, granola bars, and snack chips and crackers.

A few highlights of other committee members to supplement the partial bios and affiliations provided by the IOM will demonstrate similar perspectives:

Karen Weber Cullen, DrPH, RD, of Baylor College of Medicine has concentrated her career on the prevention of “diet-related diseases,” primarily obesity, through “nutrition behavior in childhood.” She also participated in the development of the 2007 IOM report on Nutrition Standards for Foods in Schools and has authored papers on the Texas School Food Policy changes increasing fruits and vegetables and low-fat milk and limiting sweetened beverages and portion sizes among middle-school children and the potential calorie savings; and a study of an internet dietary program for 9-12 year old African American girls and their families, to encourage low-fat foods, more fruits and vegetables, less fattening meat, and healthy meal planning.

Rosemary Dederichs, BA, worked on both of the RWJF Progress in Preventing Childhood Obesity reports and directs the food service department for the Minneapolis public school district. She was on the Steering Committee, co-authoring its School Wellness Policy (6690) Implementation Plan to curb obesity, which follows the RWJF recommendations for low-fat, whole grain, low-sugar, portion controlled meals, with one vegetarian entree offered each day; allows only healthy food or non-food items for fundraising, celebrations or class parties; prohibits students to share foods or drinks; institutes healthy eating and lifestyle educational curriculums for grades K-12, including using the cafeteria as a learning laboratory; bans soda and junkfood from all schools; increases physical education hours, including physical activity in the classroom; and mandates school staff wellness participation; all to be fully implemented in all schools this school year.

Mary Kay Fox, MEd, is senior researcher at Mathematica Policy Research, Inc. and has worked on school-based nutrition and obesity prevention programs for more than 20 years. In an issue of the Journal of Law, Medicine & Ethics last spring, she continued to advocate for schools as ideal settings for implementing anti-childhood obesity programs and cite improvements to proven strategies. She had co-authored a paper on the Eat Well and Keep Moving Program studied in African American elementary school children published in a 1999 issue of Archives of Pediatric and Adolescent Medicine. While concluding the program was effective, it had no statistically significant effects on physical activity levels, television or sedentary activities, or caloric intake compared to children in control schools after two years. And, based on self-reported dietary recalls obtained from 70% of the children, showed an increase of only 0.36 servings of fruits and vegetables per 4184k.

Lisa Harnack, DrPH, RD., MPH, also has dietary behaviors in the prevention of obesity as her primary research focus and is with the University of Minnesota Obesity Prevention Center. The program directors also oversee the RWJF Healthy Eating Research Program and wrote the seminal paper on The Role of Schools in Obesity Prevention, which blames overweight in children on their poor diets and sedentary behaviors and claims that obesity is associated with “poor academic achievement” and behavioral problems. It goes on to say that school meals must meet the Dietary Guidelines for Americans as containing no more than 30% total fat and 10% saturated fat. [Which, again, is incorrect. Those are the adult guidelines.] Another essential part of its obesity prevention recommendations is a health curriculum for kindergarten to 12^th grade children to support a “behavioral-oriented curriculum in promoting healthful food choices and physical activity.” It also recommends BMI screening by the school for all children and parental “report cards.” School employees are also to role model “health-promoting behaviors” and staff should be required to follow nutrition and physical activity guidelines, since “schools are one of the nation’s largest employers.”

Gail G. Harrison, Ph.D., has researched putting low-fat diets into practice and contributed to IOM papers linking dietary fats and dioxin in meats to cancer.

Mary Hill, MS, SNS, is president of the School Nutrition Association (SNA) and executive director of nutrition services for Jackson public schools in Mississippi. The SNA is a steering partner committee member of the RWJF-sponsored Action for Healthy Kids and with the National Alliance for Nutrition and Activity (NANA). Several of the IOM committee members are also with groups in NANA, funded by the USDA’s Produce for Better Health Foundation (National 5-a Day logo program). As JFS readers will remember, NANA is a key lobbying group of 300 organizations, founded and coordinated by Margo Wootan at the Center for Science in the Public Interest, promoting healthy eating and exercise to fight obesity and its key initiatives include School Wellness Policies. Its lobbying efforts have successfully increased the budget of the CDC’s Division of Nutrition and Physical Activity by 2,000% since 1999. NANA is also funded by the CDC to the tune of $65 million this year, with $5 million just for their fruit and vegetable programs.[ Oh, its national action plan, after 15 years and applying more than 75 strategies, has failed to increase fruit and vegetable consumption or have any effect on childhood obesity.]

Helen H. Jensen, Ph.D., has also worked on the IOM-sponsored project to increase produce and whole grain consumption, and reduce milk, eggs and dairy products to combat obesity among WIC recipients. She has also authored papers linking high fructose corn syrup and fatty meats to obesity.

Ronald E. Kleinman, M.D. is past president and on the Executive Committee of the International Society for Behavioral Nutrition and Physical Activity. Its upcoming conference in Alberta, Canada, on the promotion of healthy body weights is sponsored by the Canadian Obesity Network, with a keynote talk on the evolution of sloth. He has also worked on an IOM workshop report on the impact of pregnancy weight gain.

George P. McCabe, Ph.D., is a statistics professor for primarily nutrition studies. He worked on the IOM committee project on nutrition labeling, and on research of calcium and exercise interventions for weight loss in young women.

Suzanne P. Murphy, Ph.D., RD, is with the Cancer Research Center of Hawaii and her research emphasis is epidemiological studies linking cancer and obesity. She has participated in several IOM panels, including the 2005 Progress in Preventing Childhood Obesity: Focus on Industry project sponsored by RWJF. She chaired the IOM panel recommending increased wholegrains, fruits and vegetables available to poor women, infants and children through WIC and decreased amounts of milk, eggs and cheese because of the obesity epidemic.

Angela M. Odoms-Young, Ph.D., is a charter member of the African American Collaborative Obesity Network (AACORN), based at the University of Pennsylvania School of Medicine, working to fight childhood obesity among African American youth, a program funded by RWJF, just awarded a $3.5 million grant. She has authored numerous papers for AACORN on achieving healthy weights in African-American communities, fruits and vegetables initiatives, and obesity programs.

Yeonhwa Park, Ph.D., is a low-fat researcher at the University of Massachusetts at Amherst, receiving a $260,000 grant in 2006 from the American Heart Association to investigate conjugated linoleic acid (CLA), a compound in dairy and meat, for weight loss. While studies in mice had shown CLA to block fat uptake and increase energy expenditure, it failed in humans. They are currently testing a chemical cousin of CLA. She holds a patent with colleagues at the University for a method of reducing body fat in animals. They are currently working on a new technology for making low-fat foods with qualities of full-fat foods by encapsulating fats with fiber.

Mary Jo Tuckwell, MPH, RD, was the director of food services for the Eau Claire Area school district in Wisconsin for 18 years. Along with other Wisconsin schools, it participated in the USDA Fresh Fruit and Vegetable Program and received a $1 million grant in February 2006. As a spokesperson on behalf of the National Alliance for Nutrition and Activity (NANA), she lobbied Congress for the 2007 Farm Bill in May last year, citing the importance of produce in stemming childhood obesity. She and her Healthy Schools Program was recognized for being one of a handful of schools to meet the Alliance for a Healthier Generation guidelines, a project of RWJF. She is now a senior consultant for inTEAM Associates, Inc., a consulting company for school food services, with partners offering software and marketing.

The point of this exercise is not ad-hominem attacks, but to illustrate that industry funding is often the least of concerns when it comes to possible conflicts of interest. If your entire career has been based on the belief that obesity is due to bad foods and inactivity; if your professional reputation and status among your peers, your speaking engagements and book deals, and the grant funding you’ve brought to your university* or program have all been based on an obesity crisis and dietary behavioral interventions; if you’ve been hand-selected for a prestigious committee, sponsored by a major funder who has made obesity and diet and lifestyle interventions its key agenda; and if you are surrounded by like-minded important people — how likely do you think you would be to risk all of that by seriously questioning and objectively examining the evidence that might tumble the entire house of cards and put you on the outs in your field?

Right. It’s not going to happen. It's human nature.

The public has been invited by the IOM to comment on its provisional committee selection for the next 7 days week here, but it goes to the IOM committee members with even more prestigious and influential positions in line with the war on obesity. The bigger issue is that we have private vested interests funding and influencing the health policies of federal agencies and health programs that affect you and your children. Until the National Academy of Sciences cleans its own house, the public and the integrity of science-based policies will continue to lose.

© 2008 Sandy Szwarc

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For newer readers who may not have had a chance to read the archives, they may not realize the evidence on obesity, as well as the controversy raging in the medical community for decades over the lack of evidence and growing evidence of harm from “healthy” eating curriculums and recommendations to restrict fats, sugars and salt in children’s diets.

School lunches across the country are intently trimming fat, sugars, calories and portion sizes on their menus to focus on fruits and vegetables, trying to trim down kids — and these school nutrition policies have proven to be unsuccessful. Their dietary restrictions even go beyond what the Dietary Guidelines recommend for children’s health, growth and development. They are applying adult guidelines to young people. Even the Dietary Guidelines are questioned by significant numbers of pediatric medical professionals. Low-fat, low-sugar diets are most popularly perceived as fundamental to a healthy diet for children and thought to prevent heart disease, cancer, and other chronic diseases; and to prevent obesity. Except, there is no clinical evidence to support that.

Generations of parents have wished their kids ate better, but stories of the horrible diets of today’s children are gross exaggerations. The objective evidence simply doesn’t support the extremity of concerns over children’s diets which have continued to improve over recent decades. The latest NHANES dietary studies also show the majority of children and teens are eating within the 2005 Dietary Guidelines for fat and calories. They are even eating fewer calories and total fat since 1989 and aren’t pigging out on junk more than ever. Nor do parents need to fear typical children’s eating habits and preferences for sweets are for life. Kids grow up. As Penn State research has shown, our diets naturally get healthier and our taste buds appreciate more varied diets as we become adults.

School lunches are also not as awful as the hype, either. The School Nutrition Association, which conducts biannual surveys of national school lunch programs, finds that virtually all of them are doing a good job complying with federal nutrition guidelines.

More importantly, there is no evidence to support beliefs that bad foods or diets cause childhood obesity or chronic diseases. Even the American Heart Association’s review of the evidence on obesity in youth concluded in its Scientific Statement that “studies of diet composition in children do not identify the cause of obesity in youth.” As they noted, dietary fats and saturated fat intakes are lower today than in the past, unrelated to obesity trends. Fat and thin children eat no differently to explain obesity. Eating high-calorie, low-nutrient dense foods like sweets doesn’t correlate with children’s weights, either, and consumption has been shown to be high among all kids for generations. Canadian researchers looked at the diets of more than 130,000 kids in 34 countries and reported that fat kids even eat the least sweets, and that kids’ body weights had nothing to do with how many fruits, vegetables or soft drinks they consumed.

Kids haven't become couch potatoes like the popular hype, either. The idea that sedentary activities and kids plopped in front of the telly or playing computer games cause obesity or that increasing physical education will reduce obesity isn't supported by the evidence.

Childhood obesity cannot be blamed on what or how much kids eat or how much exercise they get. Regardless of their diets or physical activity, children will still naturally grow up to be a wide range of heights and body weights. It’s genetic. The DONALD (Dortmund Nutritional Anthropometric Longitudinally Designed) Study, for example, clinically followed children, actually weighing the individual children and recording their diets (the foods, amounts and eating occasions) at least ten times a year and followed them thusly for 17 years. They found that no matter what the children ate during childhood or adolescence, they naturally grew up to be a wide range of weights. While there were great differences in the children’s diets, these differences weren’t at all related to their weights.

The U.S. Preventive Services Task Force, which recently reviewed 40 years of evidence on childhood obesity — some 6,900 studies and abstracts — found no quality evidence to support the effectiveness of any childhood obesity intervention in reducing obesity, or for BMI screening or for dietary counseling on healthy eating in young people. But it did find evidence to suggest such interventions risk harming children.

It also found no quality evidence to support beliefs that childhood “overweight” or “obesity” is related to health outcomes. The USPSTF concluded that no scientific review has been able to find any quality evidence that any programs to reduce or prevent childhood obesity — no matter how well-intentioned, comprehensive, restrictive, intensive, long in duration, and tackling diet and activity in every possible way — has been effective, especially in any beneficial, sustained way; nor have they been able to demonstrate improved health outcomes or physiological measures, such as blood lipids (“cholesterol”), glucose tolerance, blood pressure or physical fitness.

Even while RWJF recently announced it was earmarking another $500 million towards its childhood obesity agenda and to create “a sense of national urgency to act,” its own evidence found no support for any of its far-reaching policy recommendations. Of course, you have to look carefully to realize that, because it’s not what we hear. As the IOM report, Preventing Childhood Obesity: Health in the Balance admitted: “Presently, there is limited experimental evidence regarding the best ways to prevent childhood obesity and the extent to which various potential factors contribute to weight gain.”

Nevertheless, RWJF President and CEO Risa Lavizzo-Mourey, M.D., said in a press release: “There are ‘natural experiments’ taking place...but we can’t afford to surrender an entire generation of kids to the obesity epidemic while we wait for perfect answers.”

Undeniably, the all-out, widespread efforts to address childhood obesity are disproportional to the evidence and have a disturbing level of vested interests behind them. Yet, few people are aware just how little evidence there is for the dietary or behavioral tactics that children are being subjected to. And it is unimaginable that many parents are keen on the idea of experimenting on their growing children with nothing credible to go on. Or that taxpayers appreciate having billions of their tax dollars going towards unproven, biologically implausible and possibly harmful programs.

To add to the insanity: The government’s own statistics even negate the need for any of this, as there have been no significant increases in the numbers of children considered “overweight” since 1999-2000 and children are healthier and expected to live longer than at any other time in our history.

* The significance of conducting research that is favored by vested interests who will reward your university with large grants was demonstrated in the recent controversies surrounding two preeminent University of Minnesota professors. Professors Francois Sainfort and Julie Jacko are big names in the emerging field of electronic "health informatics'' and, as the Star Tribune reported, were making a total of just over $400,000 a year at Georgia Tech and their University of Minnesota salaries top $500,000. The Dean at U of M said he wooed them for more than a year because they had reputations for winning millions of dollars in contracts and grants for research for universities. Jacko is a professor in the School of Nursing and Public Health and her husband is in health policy and public health. He has served as the principal investigator on more than $13 million in contracts and grants, as well as works as a consultant to health care delivery organizations, medical device companies, clinical labs, and pharmaceutical, insurance and information technology companies. There is no funding for resources that dare provide information that isn't popular with vested interests.