The new national school health policy — a look at the evidence

How much money does it take to buy your child’s educational curriculum?

$269,000

That’s all it took to get curriculum standards for our nation’s schools published, as well as policies “to fight childhood obesity and promote healthy eating and physical activity” developed and mandated in schools by State Boards of Education… without any sound evidence that they are effective or safe.

The National Association of State Boards of Education had been awarded $269,000 from Robert Wood Johnson Foundation to fund its Obesity Prevention Project. The NASBE Obesity Prevention Project was tasked with providing school boards and education officials nationwide with the “best and promising practices, evidence-based research, and access to top school health and nutrition experts to help states develop education policy solutions to the childhood obesity epidemic,” said Brenda Welburn, NASBE Executive Director. Working with 14 state teams, the NASBE revised the State Education Standard with a special Obesity Prevention edition and issued a policy brief on obesity prevention policies. The NASBE State School Healthy Policy Database describes the curriculum standards that its participating states have mandated for nutrition and healthy lifestyles to date.

The NASBE Obesity Prevention Project just published its “Preventing Childhood Obesity: A School Health Policy Guide.” Its opening paragraph, presenting its rationale for obesity prevention, states:

Preventing childhood obesity is a pivotal issue for the United States that requires top priority attention from policymakers at all levels of government. An ever-expanding base of credible evidence indicates the childhood obesity epidemic has far-reaching consequences for the nation’s public health system, economy, and overall prosperity. The epidemic is even more pronounced for children, whose development is being adversely impacted not only physically and mentally but also academically.

Let’s look at the credible evidence-based information and practices presented in this new national school policy for our children and families.

Child obesity epidemic and health crisis

The NASBE School Health Policy Guide says: “This nation is facing a serious childhood obesity epidemic. Today 16.3 percent of children and adolescents ages 2 to 19 are obese [defined as ≥ 95th percentile on new the BMI growth curves], and 31.9 percent are obese or overweight [defined as ≥ 85th percentile on the growth curves]... During the past four decades, the obesity rate for children ages 6 to 11 has more than quadrupled (from 4.2 to 17 percent) and more than tripled for adolescents ages 12 to 19 (from 4.6 to 17.6 percent).”

Fact checks: The epidemic that wasn’t (since the childhood growth charts and NHANES surveys were redesigned a decade ago by the CDC, there have been no statistical change in the percentages of young people at or above the 95th percentile on those growth curves), Where’s the crisis (creating an epidemic based on “prevalence” — the numbers of children crossing the threshold of new cutoffs defining overweight, not on actual weight and height changes, which have been surprisingly small over the past half century…), Misplaced priorities for children (how perceptions of an epidemic are created), Obesity staticulations (misleading with staticulation and chartsmanship; the difference between natural diversity of physical shapes and sizes and a contrived epidemic), New Age Numerology (child and teen normal growth and development, growth curves and definitions), Advocacy for whom? (media images and marketing versus reality)

The NASBE School Health Policy Guide says: “Obese and overweight children are likely to suffer health consequences not only during childhood and adolescence, but also throughout their adult lives. They are at greater risk as children and as adults for bone and joint problems, sleep apnea, social and psychological problems, heart disease, type 2 diabetes, stroke, cancer, and osteoarthritis... it is critical to prevent obesity and overweight in childhood before these chronic health problems arise.”

Fact checks: Is it for real? (obesity and diet has nothing to do with the extremely rare genetic disorder of familial hypercholesterolemia; National Health and Nutrition Examination Survey data shows there’s been no increase in lipid and lipoprotein levels in children, adolescents or adults since at least the 1960s; U.S. Preventive Services Task Force examined 81 quality clinical studies and found no evidence that diet or exercise interventions in childhood improve lipid profiles or result in better health outcomes in adulthood; USPSTF found that low-fat diets, most popularly referred to as ‘healthy eating,’ not only lack evidence of effectiveness in reducing obesity, cholesterol levels or risks for heart disease, but they found evidence to suggest harm for children and teens, who need fats; body fat itself is unrelated to atherosclerosis), Helping to protect children from wrong diagnoses (blood pressures have not increased for decades and blood pressures in children and teens have not been shown to identify those at risk of later getting heart disease), How real is the crisis of undiagnosed hypertension in children?, Does it really matter how your numbers measure up? (no body measurement or body composition is predictive of higher risks of dying from all causes; National Center for Health Statistics at the CDC found all-cancer mortality was unrelated to any BMI category), Fat and long life — The “obesity” crisis is crumbling (there were no significant relations between BMI and overall, cardiovascular disease, or cancer mortality risk), One more time: fatness not linked to overall cancer risks, and the Obesity Paradox series

The NASBE School Health Policy Guide says: “Early indicators of atherosclerosis, which is associated with poor dietary habits and is the most common cause of heart disease, can already be found in many children and youth... In fact, a recent study conducted by the University of Missouri Kansas City’s School of Medicine shows that obese children as young as 10 had thickened arteries more commonly seen in 45-year-old adults. The findings, one researcher said, suggest that cardiovascular disease could someday become a pediatric illness.” The reference cited for this claim was the New York Times newspaper article.

Fact checks: Questions media didn’t ask.

There is no evidence linking child nutrition to heart disease or that “heart healthy” diets are healthy for children: The big one — results of the biggest clinical trial of healthy eating ever, Food and heart attacks — is a link for real?, Low-fat is not for kids, Making it up on volume, Feeding our children well, Brain food for kids: Having enough to eat, Toddlers and bunnies.

The NASBE School Health Policy Guide says: “Of particular concern is the rapidly rising rate of diabetes. Overweight and obesity, especially at younger ages, substantially increase a person’s lifetime risk of diagnosed diabetes; the risk of diabetes among 18 year olds who are obese is 70 percent for men and 74 percent for women.”

Fact checks: Phantom epidemic of child diabetes (NHANES data of actual physical exams and blood tests on representative samples of the population have tracked type 2 diabetes in young people for more than two decades and show no change in the prevalence of type 2 diabetes for more than two decades; rates among young children are so low they can’t even be measured and appear in only about 0.04% to 0.15% of teens; there’s not even a hint of an impending epidemic; obesity is not a factor for impaired glucose tolerance; prediabetes isn’t predictive of anything; type 2 diabetes is considerably more genetic than type 1 diabetes and moreso than even height; and type 2 diabetes is not brought on by eating bad foods or having a bad lifestyle; “Bad eating habits such as too much refined sugars, empty carbohydrates and fructose do not cause diabetes.”) A costly truism that’s not true — obesity has led to an epidemic of type 2 diabetes in young people, Government health officials decide it’s acceptable to bully fat children

The NASBE School Health Policy Guide says: “1 in 3 children born in the new millennium can be expected to live substantially shorter lives than those in the previous generation.”

Fact checks: The sky is not falling, Health of the nation — Did you hear the good news? (we are not dying in record numbers from unhealthy lifestyles and modern life is not killing us; children today are not sicker or expected to live shorter lifespans than their parents; according to the CDC, babies born in 2006 are expected to live 80.7 years for girls and 75.4 years for boys, a steady increase for more than a century; today’s children are nearly five times less likely to die in childhood compared to children born in 1950; CDC data reports 98.2% of American children and teens are in good or excellent health)

The NASBE School Health Policy Guide says: “Obese children are two to three times more likely to be hospitalized and are about three times more costly to care for and treat than the average insured child… Children covered by Medicaid account for $3 billion of those expenses. Annually, the average health expenses for a child treated for obesity under Medicaid is $6,730, while the average expenditure for all children on Medicaid is $2,446.”

Fact checks: Fat children burdens? (It turns out, there is no correlation between a young person’s BMI and emergency room usage or visits to the doctor. Higher medical expenses are not because fatter children are sicker. They were 5.5 times as likely to have extensive laboratory and screening tests ordered in accordance with Medicaid guidelines for fat children or children with a family history of obesity, despite no evidence for efficacy. Then, the costs of those added medical tests are used to blame the fat children for raising health costs!)

Increasingly, Medicaid recipients must follow the state’s prescribed healthy diets and preventive wellness management in order to receive benefits, such as care for their special needs children.

BMI screenings — weighing the efficacy and harm

The NASBE School Health Policy Guide says: “Arkansas’ Act 1220 was the first state policy to mandate BMI screenings in school. The results are kept confidential and sent to the parents in a Child Health Report that contains evidence-based guidance for parents to help improve their child’s weight status, tailored to the individual students’ BMI screening results.”

Fact checks: School childhood obesity and BMI screening legislation update (a review of the CDC policy brief “Body Mass Index Measurement in Schools”; after its comprehensive review of the evidence, the U.S. Preventive Services Task Force concluded that there is no quality evidence to support that childhood “overweight” or “obesity” is related to health outcomes and that the evidence shows that BMI fails to predict fitness, blood pressure, body composition or health risk. A recent 50-year prospective study found no association between children’s BMI and heart disease later in life, and other research found weight to be unrelated to children’s risks for insulin resistance. The USPSTF found no evidence to support routine screening for overweight in children and adolescents as a means to improve health outcomes, but did note potential harms of screening programs. 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 — have 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. Nor has any diet or exercise interventions in children been shown to lead to better health outcomes in adulthood. The USPSTF found no evidence to support the effectiveness of counseling for healthy eating in young people or to support low-fat diets in children, but growing evidence for harm.), When schools grade looks (parents share the actual BMI letter received from school officials and found the guidance was far from evidence-based), parents can just say “no”, BMI screening and BMI report cards

The NASBE School Health Policy Guide says: “Recent studies have found that many families of overweight and obese children do not recognize that fact, with most families underestimating the severity of their child’s weight situation. Thus, BMI screening can prove to be a powerful tool for both schools and families.”

Fact checks: The faces of childhood obesity (a mere 5 pounds makes the difference between a first grader being labeled as ‘normal’ or ‘obese’), By who’s definition?, Clueless parents? Not necessarily, Actual pictures of childhood overweight, Reader feedback and reactions

The NASBE School Health Policy Guide says: “Many parents worry that their child, if labeled as obese or overweight, will be subject to bullying and harassment. A University of Arkansas study of the Act 1220 policy [sponsored by RWJF] has found that there has yet to be any increase in teasing since the state implemented mandatory BMI measurement.” [No mention was made of any other adverse effects being shown from childhood obesity programs.]

Fact checks: Does the evidence really show that school obesity policies and weigh-ins don’t increase taunts against fat kids?, Innocence lost. Health messages are not harmless, Remember the BMI report card debate? (Act 1220 has failed to have any measurable effect on children’s weight status; failed to demonstrate meaningful improvement in their overall diets or physical activity levels; failed to demonstrate improved health outcomes; and there are growing indications that it is causing harm, especially to girls and minorities), The country’s most massive childhood obesity program — has it helped children?, Teaching tots — what our youngest children are internalizing from the war on obesity (striking and disturbing evidence of adverse consequences for children and teens of anti-childhood obesity programs promoting healthy eating and exercise)

If we forge ahead with an intervention (whether therapeutic, preventive or even diagnostic) without knowing whether it is beneficial, we run the risk of causing unintentional harm. — U.S. Preventive Services Task Force Childhood Obesity Working Group, “Screening and Interventions for Childhood Obesity”

Physical activity

The NASBE School Health Policy Guide says: “[A] large number of students still do not receive opportunities to be physically active, as 64 percent of high school students do not meet their quota for daily recommended physical activity.”

Fact checks: Telly tubby myth (no correlation found between TV watching and levels of physical activity; CDC data found walking and biking among young people haven’t declined in decades, but children are bicycling nearly three times more and walking has increased 12% since 1977; time spent in organized sports and outdoor activities increased by 73 minutes per week between 1981 and 1997 for younger children, with no change among teens), Myth of sloth (the government’s own evidence doesn’t support fears that we’re a nation of couch potatoes or that sedentary behaviors are a new public health crisis), Myth of sloth slayed again (using doubled labeled water method and direct measures of basal energy expenditure by respirometry, researchers found no indication that physical activity or calories burned in activity have declined since the 1980s), No support for finger pointing teens (the Steering Committee of the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development found no support for the popular belief that low-income kids are more sedentary, as they were actually significantly more active than kids from higher incomes), Fact or Fiction? Kids today are fat because they’re not getting enough PE (the largest systematic review of the evidence on school-based physical activity interventions to date found no statistical difference between the BMIs of children who received school based physical activity interventions and those in the control groups and concluded: “Current population-based policies that mandate increased physical activity in schools are unlikely to have a significant effect on the increasing prevalence of childhood obesity.”), Whipping kids into shape (examining evidence on fitness and overweight among school-age youth found no credible support that levels of physical activity and fitness among fat children are less than thinner kids to explain their diversity in sizes)

The NASBE School Health Policy Guide says: “A scientific consensus has emerged that every young person needs to participate in at least 60 minutes of moderate to vigorous physical activity daily… If time is made for physical education and supervised recess, then kids are more physically active; and if they are more physically active, then they expend more calories and are closer to achieving an energy balance.” [The only paper cited had no evidence for 60 minutes a day of exercise in young people, it looked at short-term intervention studies of supervised programs of moderate to vigorous physical activity of 30-45 minutes and the “panel believed that a greater amount of physical activity would be necessary…”]

Fact checks: Is school PE really the answer to “childhood obesity?” (U.S. studies of fitness, examining actual peak oxygen consumption measurements, indicated that there has been little change in absolute and relative peak V-O2 levels in children from the 1930s through the 1990s; reduced participation or time spent in school athletics or physical education does not translate into significant differences in total daily energy expenditures among children; child exercise physiologists caution that young people are not little adults and 60-90 minutes a day of sustained activity in structured or organized activities, exercise or sports is inappropriate; there have been dramatic increases in extracurricular sports and physical activities among young people since the 1960), Fact or Fiction? Kids today are fat because they’re not getting enough PE (not one study has found physical activity interventions — no matter how intense, prolonged or type — to have an effect on children’s BMI)

The NASBE School Health Policy Guide says: “[T]he evidence is compelling that regular physical activity improves academic performance...The study found that physical activity has a positive influence on concentration, memory, and classroom behavior and that the addition of P.E. to the curriculum can result in small positive gains in academic performance.”

Fact check: Take home message from school: Kids, spend as little time reading as possible (examining the research claiming fitness improves academic scores, underscoring the importance of “correlation is not causation”)

Healthfulness of school lunches and kids’ diets

The NASBE School Health Policy Guide says: “[T]he latest findings from the third School Nutrition Dietary Assessment Study (SNDA-III)...shows that among schools participating in the National School Lunch Program, only 6 percent offered lunches that met all of the School Meal Initiative standards for energy, fat, saturated fat, protein, Vitamin A, Vitamin C, calcium and iron. Other SNDA-III findings showed that 42 percent of schools did not offer any fresh fruits or raw vegetables in the reimbursable school lunch on a daily basis. In addition, the study indicated that one or more sources of competitive foods, typically characterize as low-nutrient, energy dense foods and beverages, were available in 73 percent of elementary schools, 97 percent of middle schools and 100 percent of high schools.”

Fact checks: School lunches — Are kids eating healthfully? (an examination of the third School Nutrition Dietary Assessment (SNDA) study found the data didn’t support the claims and alarm about the unhealthfulness of children’s diets), Brain food for kids — having enough to eat (school lunch reports from School Nutrition Association and NHANES dietary surveys found the majority of children’s dietary intakes are well within the 2005 Dietary Guidelines), Another from the recommended reading file (stories of the horrible diets of today’s children found to be gross exaggerations), We're not eating so badly, Are kids really eating that badly? (government data reveals that since the 1960s, children and teens are eating less fat, fewer calories, more fruits and vegetables, and more dairy), Our kids are doomed-not!

Healthy eating and nutritional education being taught in schools

The NASBE School Health Policy Guide says: “Additionally, nutrition education and physical education should be closely aligned to reinforce the importance of the “calories-in/calories-out” energy balance equation that is critical to maintaining healthy weight.”

Fact checks: First law of thermodynamics, No tomorrows, Cradle to grave customers

The NASBE School Health Policy Guide says: “Integrated Policy to Promote Healthy Eating. All schools shall encourage and provide opportunities for students and staff members to practice making healthy eating choices on a daily basis, and shall educate every student on essential knowledge and skills for a lifetime of healthy eating... The integrated policy shall include...a sequential program of behavior-focused nutrition instruction that aims to influence students’ knowledge, attitudes, planning skills and eating habits; is part of the comprehensive school health education curriculum.”

Fact checks: We’ve seen the government’s and schools’ unsound ideas of healthy eating education for young people in Government diet plan for girls, "Eat Smart" teaches children, Of concern to parents: what are children really being told in school?, What do healthy eating and lifestyles have in common with woo?, This is scholastic achievement?

The NASBE School Health Policy Guide says: “Because schools are singular entities where the interests of community, families, and government intersect, we can start to reverse the obesity epidemic by implementing and enforcing positive policies and practices in schools nationwide... If schools limit competitive foods and provide appetizing school meals that meet dietary guidelines, in appealing circumstances with sufficient time to eat, then they will consume appropriate calories and come closer to achieving an energy balance. If schools have a healthy environment for eating and physical activity, and community and family environments are also healthy, then children will achieve an energy balance and maintain healthy weight.”

Fact checks: The two-year Comprehensive School Nutrition Policy Initiative study for reducing childhood obesity — an intensive study which included every school-based program recommended in the U.S. Centers for Disease Control and Prevention’s “Guidelines to Promote Lifelong Healthy Eating and Physical Activity” — was supposed to have provided the evidence for school wellness policies. It failed on all counts. The results were reported in a JFS Special Report: Major findings on childhood obesity programs.

Overwhelmingly, school, community and clinical child obesity prevention programs continue to fail: Stepford kids (the results of the “Shape Up Somerville” project, where every exercise, sports, healthy eating and weight management program in town and in schools focused on losing weight), New CME for doctors — What wasn’t said about childhood weight management (findings issued by the U.S. Preventive Services Task Force after examining 40 years of evidence, about 6,900 studies and abstracts, on childhood obesity initiatives), Experimenting on a new generation, Evidence-based childhood obesity programs — another case of mistaken definition, What you may not know about childhood obesity programs, The country’s most massive childhood obesity program — has it helped children? (the findings of Arkansas 1220, the most extensive and costly childhood obesity program in the nation, focused on schools and communities), Remember the BMI report card debate?, Innocence lost — health messages are not always healthful, and If we passed out grades for science (national data shows that after 15 years, the entire 5-A-Day for Better Health Program first launched by the National Cancer Institute to increase consumption of fruits and vegetables as part of a low-fat, high-fiber diet, has been a dismal failure)

They knew there was no evidence for their childhood obesity prevention proposals when they started.

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.— Institutes of Medicine, “Preventing Childhood Obesity: Health in the Balance,” commissioned and funded by RWJF

But that wasn’t a deterrent then.

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. — Risa Lavizzo-Mourey, M.D., President and CEO of RWJF, which committed $500 million “to reverse the epidemic of childhood obesity in the United States by 2015”

And the evidence since then hasn’t been a deterrent, either. — Evidence that continues to show that promoting ‘healthy eating and physical activity’ fails to reduce child ‘obesity’ rates or to benefit children’s health, and is increasingly showing harm. — Evidence that isn’t surprising at all, since their proposals weren’t based on sound premises to begin with.

Only in a doublespeak world is it possible to create so much from so little… to convince people to believe and see a reality that is far from real.

© 2009 Sandy Szwarc