Weight of the Nation — “We have a plan”

If anti-obesity news coverage has seemed to get a shot in the arm the past few days, you might want to know why. The Centers for Disease Control and Prevention’s Division of Nutrition, Physical Activity, and Obesity has literally given it an injection of media stories, even down to free graphics and banners, with its inaugural obesity conference, Weight of the Nation, held in Washington, D.C. on July 27-29^th.

The conference, funded by a grant from Robert Wood Johnson Foundation and partnered with preventive wellness, chronic disease councils, and disease management and public health organizations, was announced a couple of months ago, saying its objectives will be to set policies and environmental strategies to overcome barriers to obesity prevention and control in communities, healthcare, schools and workplaces… set specific policy and environmental initiatives impacting obesity; and highlight the use of law-based efforts to prevent and control obesity (e.g., legislation, regulation and policies). The agenda is all politics, not a single examination of the science.

How many know what the CDC’s Division of Nutrition, Physical Activity, and Obesity (DNPAO) does? It’s the arm of the agency directing the development of the government’s regulations, economic strategies and laws to impose changes in the country’s infrastructure and society — at the community, state and national levels. “For your health,” and more specifically changing the “obesogenic environment,” is being used as the grounds. As its website explains, the CDC has “collaborated with policymakers, partners and stakeholders in these leadership activities” — which have included some frightening programs if anyone stops and thinks about them for a moment, such as “Legal Preparedness for Chronic Disease Prevention” and “Legal Preparedness for Obesity Prevention and Control.”

Its website openly describes its partnerships. To change medical settings, for example, the CDC is “creating partnerships with commercial health plans.” For changing communities, its partnerships include the Healthy Eating Active Living Convergence Partnership, to change transportation and food systems; and the Common Community Measures for Obesity Prevention (Measures Project), which works to change local governments' policies. Few people likely know about these groups, or that those seeming grassroots movements of non-government, nonprofit groups in their communities and states are actually funded by the CDC to put the goals of the government and its partners into action. As the website explains:

Twenty-three states are currently funded through CDC's Nutrition and Physical Activity and Obesity (NPAO) Cooperative Agreement Program which coordinates statewide efforts with multiple partners to address obesity. The program's focus is on policy and environmental change initiatives. These initiatives help support the following behavioral targets: increasing physical activity; the consumption of fruits and vegetables; and breastfeeding initiation, duration, and exclusivity; and decreasing television viewing, the consumption of sugar-sweetened beverages and the consumption of high-calorie/low-nutrient foods. The program seeks to address health disparities and requires a comprehensive state plan.

The Common Community Measures for Obesity Prevention Project is a Robert Wood Johnson Foundation program in collaboration with the Kellogg Foundation, Kaiser Permanente and the CDC Foundation. The Healthy Eating Active Living Convergence Partnership, as its website says, “is a collaboration of funders who have come together with the shared goal of changing policies and environments to better achieve the vision of healthy people living in healthy places.” It’s also a partnership of the Robert Wood Johnson Foundation, Kellogg Foundation, Kaiser Permanente, California Endowment and the CDC. Any industry or stakeholder, even the largest drug company in the world, can set up a foundation to lobby for its interests yet those receiving foundation money aren't seen as having any conflicts of interests to report or as having any industry ties.

According to this week’s Weight of the Nation program, the NPAO expects two outcomes of this conference, besides a media blitz:

First, in collaboration with partners, CDC will synthesize lessons learned from the conference to identify the challenges to obesity prevention and control, identify setting appropriate policy and environmental strategies to overcome these challenges and determine indicators of progress in implementing these strategies, and then disseminate policy and environmental best practices for obesity prevention and control. Then, CDC will utilize this information to produce its “National Road Map for Obesity Prevention and Control”; guidelines for investing in integrated obesity prevention and control initiatives.

Stakeholders are setting national policy. Worse, we’re funding them.

Background — “CDC says” doesn’t mean science says

Before we take it as a given that science has proven obesity to be a deadly crisis requiring a massive reorder of our society, it’s critical to understand the difference between science and marketing. Few consumers realize that most of what we hear coming from the CDC isn’t from the scientists at the CDC’s National Center for Health Statistics (NCHS), but from CDC’s various marketing divisions. It’s important to understand the difference.

As regular readers remember, in 2005, after CDC scientists published the CDC’s own national data and nearly brought down the government’s entire war on obesity, a press conference was hastily called to, as then director Dr. Julie Gerberding said, “translate our science more effectively so that we avoid this kind of communication in the future.” [The CDC’s evidence had shown that, instead of being deadly, obesity (BMI 30 to <35) was associated with a 24% lower risk for premature death than those of ‘normal’ weight, and that even most fat people outlive those of normal weight.]

It was at this conference, the public first learned that the CDC had been massively restructured to create what its director called, “the new CDC.” It created the National Center for Health Marketing and a second center on public health informatics, as well as four new coordinating centers. “At the new CDC, we are engaging the entire agency in the development of our strategies around obesity,” said Dr.Gerberding.

Dr. Edward Sondick, director of the NCHS, said that the bottom line is the NCHS was to be placed within the Coordinating Center for Health Information, along with the National Center for Health Marketing and the National Center for Public Health Informatics. In other words, the NCHS (and its problematic science) was put behind several layers of political firewalls. Thereafter, all communications to the public would come through CDC communications and marketing departments. The CDC directors would have first access to NCHS data before it is released to the public to ensure that the scientific data was released as “actionable” points based on the government’s Healthy People goals.

The org chart just approved looks little different from that first one after the reorganization, with coordinating centers of health information, under which you’ll find the National Centers for Health Statistics, along with the new one for Public Health Informatics, and for Health Marketing; the new National Center for Chronic Diseases Prevention and Health Promotion is under the Coordinating Center for Health Promotion. [Click on any image to see enlarged.]

You may also remember that there was a mass exodus of the top CDC scientists during 2004-2006, who were concerned with the honesty and integrity of science and the information reaching the public. By the end of 2006, in addition to more than a dozen leading scientists, all but two of the directors of CDC’s eight primary scientific centers had left.

When Dr. Gerberding said that every activity of the CDC would be engaged in its strategies around obesity, she meant it. And it continues to be evident today, as in the CDC’s latest budget for fiscal year 2010. Its total $10,101,606,000 budget includes $6,389,000,000 in discretionary spending authority for the CDC and another $1,000,000,000 from the stimulus bill. The changes in this year’s budget reveal its dissolute priorities, such as cuts in Vaccines for Children by $54.1 million, while increasing funding for REACH (Racial and Ethnic Approach to Community Health) by $4 million, and gives $18.54 million more for Health Promotion.

● The budget for obesity programs under the Nutrition, Physical Activity and Obesity department totals $44.4 million; which includes “developing innovative partnerships,” such as with the Healthy Eating Active Living Convergence Partnership and with the Produce for Better Health Foundation (where the CDC co-chairs the National Fruit and Vegetable Alliance). PBH was honored at the Weight of Nation conference, by the way, with an award for its work “advancing policies and environmental strategies to prevent and control obesity.”

● The $62.47 million budget for REACH, which targets minority communities for intervention, is part of its Healthy Communities Program which, it says, is an integral part of CDC’s response to the epidemics of obesity and chronic disease.”

● $7.3 million is for the Behavioral Risk Factor Surveillance System.

● $12.3 million for Genomics is described as “opportunities for public health and preventive medicine, which support the President‘s Healthier U.S. Initiative and the Secretary‘s Personalized Health Care Initiative.”

● $65.99 million is budgeted for diabetes surveillance, prevention and education (such as its Diabetes Primary Prevention Initiative which is “focused on approaches that identify people with pre-diabetes... to adapt lifestyle behaviors aimed at reducing modiable risk factors for type 2 diabetes” – i.e. obesity).

● $341 million is for cancer prevention and control programs, such as WISEWOMAN (Well-Integrated Screening and Evaluation for Women Across the Nation, which targets low-income women “to improve diet, physical activity, and other lifestyle behaviors to prevent, delay, and control cardiovascular and other chronic diseases”) and NCCCP (National Comprehensive Cancer Control Program, which “provide a blueprint to encourage healthy lifestyles, promote recommended cancer screening guidelines and tests,…[and] education programs about cancers or their associated risk factors”).

● The $62.78 million budget for School Health is focused on physical activity, nutrition and tobacco use prevention and other priority health risk behaviors, most notably obesity and type 2 diabetes (which it says “has become increasingly prevalent among children and adolescents as rates of overweight and obesity rise”) and funds 22 state agencies “to focus on reducing chronic disease risk factors such as tobacco use, poor nutrition, and physical inactivity” and funds 29 NGOs (non-governmental organizations) to “promote healthy behaviors for the nation’s youth.”

● $22.8 million is for its Healthy Communities program for “community leaders and public health professionals to equip these entities to effectively confront the urgent realities of the growing national crisis in obesity and other chronic diseases in their communities.”

And there's much more, but you get the idea. As the sampling of links above show, the scientific evidence, often from CDC statistics itself, fails to support any of these programs. That’s why it’s never been more important for us to remember those fallacies of logic and to think and look deeper than the headlines.

The speakers at this week’s Weight of the Nation conference came from these extensive partnerships. For example on Monday, Dr. Thomas Frieden, M.D., MPH, alongside the acting Surgeon General, Steven K. Galson, M.D., MPH, and the Senior Vice President of Robert Wood Johnson Foundation, James S. Marks, M.D., MPH, opened the conference. Dr. Frieden’s proposals to tax sugary drinks and salt to prevent obesity and diabetes didn’t have any science behind them when he was New York City’s Health Commissioner and didn’t become any better when he became the new Director of the CDC.

Tuesday, HHS Secretary Kathleen Sebelius spoke about moving the CDC’s preventive wellness policies forward and “transform our healthcare system from a sickness system to a wellness system.” If you thought her speech, which was also issued in a press release, sounded like it was written by RWJF, you would be right. All of the oft-repeated, and unsupported, claims about the deadly crisis of obesity were there, with RWJF even cited as the source. The government’s solutions are based on the pop beliefs about the causes of obesity: bad eating and sedentary lifestyles. Not what obesity researchers have long recognized.

Before she told audiences “about some of the exciting plans the administration has in this area,” she talked about the children. She cited a list of health problems caused by childhood overweight, according to RWJF, even down to the oft-repeated claim that this might be the first generation to have shorter lives than their parents. “The share of children that are overweight has quadrupled in the last 40 years,” she said. “Type 2 diabetes used to be called ‘adult-onset’ diabetes. Now doctors don't use the term because so many kids are getting it.” This is coming from the leader of the nation’s health agency.

But, Secretary Sebelius said “we finally have a plan” to put the nation on a weight loss diet. Thanks to research, she said, “we don’t just have good ideas, we have ideas that are tested and whose success can be measured.” She was right that every proposal she described has been tested — and they’ve all failed to show any effect on reducing obesity over time and improving actual health outcomes. And every independent examination of the evidence has concluded diet and behavioral changes are ineffective.

So, the government proposes to throw more money at them:

President Obama and I are committed to delivering a health care system that provides all Americans with better quality and lower costs. And fighting obesity is at the heart of both of these goals. That's why the President and the First Lady have made investing in prevention and wellness one of their top priorities.

It's why we're going to require health insurance plans to cover preventative services like the kind of counseling and care that can help people lose weight or keep the weight off in the first place. It's why as part of health reform, we'll also be investing in programs like the ones highlighted in the CDC report… President Obama and I don't think this issue can wait. And neither does Congress, which is why they appropriated $1 billion for prevention as part of the American Recovery and Reinvestment Act.

Part of this money will go to immunizations and another part will go to prevent patients from getting infections during surgeries and other medical treatments. But most of the money is going towards a prevention initiative that was developed by the CDC and the Office of Public Health and Science with input from many of the groups that are here today.

We aren't ready to officially announce this initiative, but we expect that a significant amount of the money will go to help states and communities attack obesity and other public health challenges.

This Weight of the Nation summit was carefully staged to correspond to the release of policy papers also funded by RWJF and CDC’s partners. Tuesday afternoon, the Urban Institute hosted a media event called “Ousting Obesity: Strategies from the Tobacco Wars” where it released its policy paper for combating the obesity epidemic. It proposed fat taxes, as Dr. Frieden had, purportedly to reduce consumption of foods they want the public to believe are fattening (based on Britain’s traffic light system that judges the health value of food according to its sugar, fat and salt content). Their policies included other food regulations, such as calorie counts on menus, bans on advertisement and marketing of “fattening food,” and subsidies of fruits and vegetables. The tables and text in the last half of the report revealed what it was really about. They calculated the revenue that state governments could bring in with fat taxes, even after funding fruit and vegetable initiatives to appear to support healthy eating.

The Urban Institute describes its Health Policy Center as devoted to examining the social, economic and government problems affecting health insurance. This report was funded by WellPoint Foundation, the foundation for Wellpoint, a family of health insurance companies that includes the Blue Cross and Blue Cross Blue Shield licensee in 14 states, pharmacy benefit managers and managed care services. WellPoint Foundation has been spending $30 million over three years to lobby for mandatory health insurance to cover the uninsured and $16 million to market health management programs. Last Monday, on July 20^th, the Urban Institute hosted its “Step One: Pass Health Reform Legislation. Step Two: Administer Reforms” to correspond with another policy paper it released, funded by RWJF. It covered policy initiatives that really need no further explanation:

● structuring a health insurance exchange [which determines what government-approved plans people will be allowed to purchase]

● administering individual mandates and subsidies

● subsidizing health insurance premiums and cost sharing

● regulating health insurance

● restructuring health insurance markets

● simplifying administration and controlling costs (electronic medical records)

Retrospective

More than two years ago, a Dr. Miguel A. Faria, Jr., M.D., made troubling observations in the journal Surgical Neurology about the misuse of statistics and epidemiology surrounding most of the studies associated with the Healthy People 2010 agenda. There is a worrying trend in academic medicine, he said, that “equates statistics with science, and sophistication in quantitative procedures with research excellence.”

The corollary of this trend is a tendency to look for answers to medical problems from people with expertise in mathematical manipulation and information technology, rather than from people with an understanding of disease and its causes…

Much of CDC-funded research and Healthy People 2010 initiatives, he explained, “are generally geared toward promoting social engineering and enlarging the scope and collective role of government in the lives of citizens… than with making genuine scientific advances and improving the health of humanity.”

In some cases, these [CDC] grant proposals (many of which are actually funded) use or misuse statistics, collect data of dubious validity, and even use “legal strategies” to reach social goals and formulate health care policies that the public health researchers believe may achieve “social justice.”… The reader will be surprised to learn that I found probably as many lawyers and social workers as practicing physicians and nurses applying for public health “scientific” research grants!

Public health is no longer about people’s health, but about preventive wellness and efforts to change behaviors for the good of society. It redefines medical ethics to mean a collective act of healthism. A leading organization in the government’s preventive wellness movement and promoter of the Healthy People 2010 goals is Partnership for Prevention, funded by RWJF and GlaxoSmithKline, along with Prescription for Health, a five-year initiative funded by RWJF.

When Dr. Faria wrote this a few years ago, it may have sounded extremist, but it doesn’t sound so much so today:

Frankly, money is being squandered by public health, politicized, pre-conceived research toward collectivist agendas, while the government (and the insurance companies follow suit) keeps cutting reimbursement for the physicians and nurses who are actually ministering care to patients with real, individual medical problems. It's not only a question of squandering money and misallocation of finite health care resources, but also, in the end, a question of population-based ethics versus the reinstitution of the individual-based ethics of Hippocrates.

© 2009 Sandy Szwarc