It’s official: the world has gone nuts :-)

There is simply no other explanation. In no particular order, I present as evidence:

Personal trainers and mini-exercise treadmills, child-size stair steppers, rowers and spinning bikes are now offered for children 3+ years of age to combat childhood obesity: The Oxy-Kids classes in Sydney are already booked. Parents work out in an adjoining gym. The mother of a 4-year old said her son’s trainer told him fruit was a healthy food to eat before going to the gym.

The first ever fat camp for toddlers under age 5: A professor from Leeds Metropolitan University has launched a fat camp for toddlers called Too Fat to Toddle.

Childhood obesity blamed on children eating playground mulch and wearing flip flops: Cincinnati Children’s Hospital Medical Center issued a press release claiming their study (unpublished) found that children in daycare weren’t getting enough exercise because they were wearing flip-flops; and that workers didn’t want to deal with playground mulch because it got in their shoes and was messy and being eaten by the kids.

A new ten-week healthy eating course for toddlers age 2 to 4 years old has been started in the UK: Called Mini-MEND, it will teach them and their parents healthy eating and exercise, food labels and portion control to combat obesity. It’s an extension of MEND for fat children 7 to 13 years old.

For PE class, six grade students in a Chicago school were informed of their “ideal” weight and percentage of body fat and instructed to count their daily calories: The father of a 12-year old girl wrote an outraged letter to the Vice Principal, noting that his daughter and her friends “now discuss each other's weight, body fat, and how many calories they ingested the night before.”

Five centers for weight maintenance for nursery-aged infants: Also now offered is Headstart Early Learning for weight maintenance and exercise, with bikes, cycle tracks, beams, climbing frames and obstacle courses.

Food Tsars introduced in UK schools monitor packed lunches from home and eaten in the canteen: The food tsars persuade pupils to ditch bad foods and dish up advice on healthy food choices.

Eating at Grandma’s or friends’ homes is said to lead to obesity among Latino children: Obesity among Hispanic children in Southern California has been blamed on eating meals at the homes of relatives or friends once a week. Latino children were said to be at special risk because their culture is more family-oriented. “Latinos appear to rely on friends and family for support and childcare more than other cultures do,” said the lead author of a study in the current issue of Obesity.

This study deserves a more serious look because it might be thought to support several popular myths about poor and minority adults and children, but its findings didn’t.

Eating with friends and family study

Authors from the Graduate School of Public Health at San Diego State University in California recruited 812 parents of children aged 4 to 7 years of age through phone calls and on the school grounds of 13 elementary schools along the Mexico border with at least a 70% Latino population, paying the caregivers $20 to complete the 22-page self-administered questionnaires. The questionnaires included an abbreviated 49-item food frequency screen and questions on meals away from home. The children and adults were weighed and measured, their BMIs calculated and their overweight status determined by the cutoff points on BMI growth curves.

For this secondary analysis, they used only 708 of the questionnaires. A high proportion of the children and families selected were fat, with “31.1% of the children classified as overweight.” Most of the families were lower socioeconomic status (37% of the 5-person household incomes were <$1,500/month) and one-third of the parents were unemployed. Overall, 45.9% of families ate a meal away from home at least once a week from some type of restaurant — “similar to national data” and no different than the rest of the population — and 37% at the homes of relatives or friends. The researchers then looked for correlations between BMIs and foods eaten in and outside the home.

Null findings. There was no association between children’s BMIs among those eating at fast food or sit-down restaurants, nor in the reported number of fruits and vegetable servings or water consumed as beverages. There was no tenable difference in any of the relative risks for number of servings consumed of sweetened beverages, water, fruits and vegetables, or sweets or snacks among those who ate at fast food, buffet or sit-down restaurants versus the homes of relatives and friends, regardless of frequency. Nor was there a significant difference in the children’s BMI status (underweight, normal, at risk for overweight or overweight) or the parents’ BMI status between those eating at similar frequencies at friends and relatives versus restaurants (fast food, buffet or sit down).

There was no relationship between adult BMIs and the frequency of eating out at fast food, buffet or sit down restaurants, nor eating at the homes of friends or relatives. The popular myth of fast food as especially contributing to obesity was not supported.

They also concluded: “No associations were observed between child and adult BMI and type of restaurant frequented,” nor in the quality of diets.

“In contrast to our hypothesis, few associations were observed between children’s diet intake and type of restaurant frequented,” said the authors. “When examining the effects of restaurant type on children’s dietary intake and child and adult BMI, our hypotheses were not support [sic].”

Looking at the fat children (at-risk-for or overweight), the only difference seen among the heavier children was a mere 7% higher association with eating at friends or relatives one or more times a week, but since they weren’t eating tenably different foods or beverages and the lack of rigorous methodologies in this study, the researchers couldn’t explain this correlation. “Although differences in the frequency of various foods consumed were statistically significant, additional research is needed to determine whether these differences are clinically meaningful.” They also did a literature search that revealed no other studies of eating with relatives and friends and associations with risks for childhood obesity. In fact, they note that foods eaten in other people’s homes are unlikely to be as poor as food served in restaurants and may not represent the same level of risk for obesity.

Nevertheless, with no evidence in this study, they turned an untenable correlation into a cause and concluded: “Given evidence that one of the most important parenting behaviors related to childhood risk for obesity is monitoring, clearly more research is needed on how to teach parents to monitor and regulate the foods that their children consume in the homes of other people.”

That concluding quote, which would appear to support the popular belief that children are fat because their parents don’t take responsibility to monitor and control their children’s diets, is important. It references the original study used for this secondary analysis: ‘Aventuras para Niños’. That original study, published in a 2006 issue of Health Education Research, used all of the 812 questionnaires and was designed to examine the correlations between parenting styles (“monitoring, reinforcement, discipline, limit setting and control”) and physical activity and the healthfulness of the children’s diets — with ‘healthy’ or ‘unhealthy’ defined by what the reviewers believed would contribute to obesity (fats, sugars, snacks and sodas being bad, versus produce, salads and low-fat dairy being good). Unlike the children used in their secondary analysis, considerably fewer, 26%, of these children’s BMIs fell into the ‘overweight’ category.

Their results:

Parental discipline was not significantly related to children’s unhealthy eating or physical activity. However, parental control was positively related to children’s unhealthy eating. Parental control was not significantly associated with children’s healthy eating or physical activity... girls were significantly more likely to eat unhealthy than boys when parents used more control strategies for eating.

In other words, the more controlling the parents, the less “healthy” the children ate, especially the girls. The authors found that Latino mothers engaged in more restraining behaviors with their daughters the more acculturated they became to American culture and “society’s pressures towards thinness, particularly among women and young adolescent females.”

Another glaring omission was seen in this study: It did not report any actual relationship between the children’s diets (‘healthy’ and ‘unhealthy’ foods) and the children’s BMI!

Definition, definition, definition. One additional note deserves attention. Remember to question the definition: BMI ≠ weight. The authors concluded that their study supports an obesity problem among Latinos in poverty, especially their children, saying: “The problem of obesity is clear and present in this study.” First of all, the families were hand selected, which means this study can’t be used to make any sweeping conclusions about minorities or poor families. But more importantly, the problem is being defined by the percentage of children who cross an arbitrary cutoff based on BMI, without reporting actual weights and heights. This can create a perception of an epidemic of gargantuan children, when, in reality, a tiny fraction in increased height or weight tip these growing children into the category. A 6-year old girl, for example, becomes labeled “obese” by being a mere 1/8 inch taller, or staying the same height, a mere 5 pound makes the difference between her being labeled as “normal” weight or all the way to being “obese.” In both papers, these authors carefully avoided reporting the average BMI of the children, although it did note the parents'.

Children of disadvantaged immigrant families, hopefully suffering less hunger here in America and getting enough to eat, will mature faster and grow taller and larger than their parents. There is no evidence that this is anything but a good thing for these children.

In contrast, while the study was focused on purportedly fat children, 56% of the poor children were underweight or “normal” weight, but how many of those children were underweight and not getting enough good food to eat or struggling with food insecurity? The medical literature is overwhelming that such children suffer very real risks to their growth and development and health and they would have been healthcare professionals’ key concern. But we don’t know, as this paper didn’t even mention them.

© 2008 Sandy Szwarc