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.

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By whose definition?

Among the efforts to convince us all of a childhood obesity epidemic are expressions of dismay that parents are failing to recognize that their children are “overweight.”

This has been a real thorn in the side for those trying to advance anti-obesity programs and anti-fat sentiment. For years the medical journals and media have lamented this “troublesome” problem because, as they've noted repeatedly, getting parents to recognize and accept childhood obesity as a health risk is vital before anti-obesity initiatives can be successful. Parents have been accused of being in denial, being “blind to the realities of childhood fat,” being “guilty of overlooking the obvious,” and failing to appreciate the problem and dangers childhood obesity.

A member of Australia’s National Health and Medical Research Centre working panel on obesity told the Australian News on February 22, 2005, that “so often parents interpret children who look well-covered as being healthy, rather than interpreting that they are at risk of becoming obese and having a range of diseases.” Earlier this month, UK health authorities launched their Health Living Initiative targeting parents, beginning with those of lower socioeconomic status, who “often have no idea their child is overweight and know little about the damage that could do to their health.”

A 2003 issue of Obesity Research, the journal for the North American Association for the Study of Obesity, a trade association for obesity researchers, reported that only 10.5% of parents of “overweight” children understand that their child is too fat. The pediatricians concluded: “Given that most parents of overweight children fail to recognize that their child has a weight problem, pediatricians should develop strategies to help these parents correct their misperceptions.”

Another survey of 99 mothers of “overweight” children published in the Pediatric Nursing Journal, found that 79% failed to identify their children as too fat. And a survey of 277 “overweight” children, aged 7-8 years old, published in the British Medical Journal reported 75% of parents didn’t realize their children were fat. This report, led by a senior research nurse at Derriford Hospital in Plymouth, did debunk what many incorrectly believe, however, that parents who are fat, uneducated or poor are less aware of childhood obesity. They found no difference in parents’ ability to recognize “overweight” in their children based on social class, education or weight status. But their conclusions do give us better insight into what the real issue here is:

The layperson’s perception of average weight, however, now conflicts with the clinical definition of normal weight, and a label of overweight from a health professional may be insufficient motivation for a change in lifestyle. The apparent lack of parental concern about their child being overweight probably stems from a lack of awareness. Until this is resolved, we are missing critical partners in our efforts to stem an impending health crisis.

While it has become popular to indict parents of “overweight” children for being irresponsible and to hype a "crisis of childhood obesity," those eagerly doing so are often the ones who don’t understand childhood obesity. Perhaps, many have come to believe the media hype and marketing, and actually think that those extreme examples being trotted out on television are representative of “the problem.”

As a Cleveland, Ohio columnist wrote this morning while talking about the 500-pound teen being profiled in Al Roker’s “Childhood Obesity: Danger Zone” for Food TV, it’s a “sobering look at what is shaping up to be a real national crisis. His story mirrors the childhood obesity story for the 12.5 million kids in America who are considered overweight or obese.”

This exemplifies the difference between what vested interests are trying to convince us is “childhood obesity” and the reality — that "conflict" mentioned by the British researchers.

So let’s start with a few basics. Body weight and size is nothing more than a description of a body characteristic. Obesity, including childhood obesity, is not a disease like polio or something you catch like strep throat. It is no different than trying to say that ear lobe creases or balding are diseases simply because some may find them unattractive or because they are associated with some chronic disease, and hence a “risk factor.”

What many don’t realize is that the definition for what is “too big” — “overweight” and “obese”— is a totally arbitrary thing, with various cultures and historical times seeing it very differently. We’ve already looked at some of the ways childhood obesity has been redefined over the years to include more children. Also popularly misunderstood is that the prevalence of overweight and obesity being used to define the "crisis" merely describes the numbers who have crossed the line of these arbitrary cut-offs for the labels of “overweight” or “obese.”

When we hear scary statistics that, for instance, childhood obesity among children aged 2-5 years has soared from 5% in 1971 to 13.9% in 2004, that doesn’t mean that children’s weights have ballooned by nearly 9% over the past 33 years. Nor does it mean that 13.9% of children today weigh 500 pounds. It means that 9% more children today have crossed that arbitrary threshold to receive the clinical label of being “overweight.”

A recent Voices of America article reported on the “alarming number of obese children worldwide at risk for heart disease” and the “disturbing global trend.” To illustrate the “20 million children under the age of five considered ‘too fat,’” they showed this adorable little girl:

We’ll look more at the creation of an epidemic of childhood obesity Monday, but for our discussion today, we are trying to get a more realistic picture of what “childhood obesity” and this supposed epidemic looks like. For our illustration, we’ll even use the CDC’s latest BMI growth charts and calculator for the cutoffs for “overweight” and “obesity” in children. Remember, children who are at or above the 85th percentile on the new BMI-based growth charts are considered clinically “at risk for overweight” (or “overweight” by the term popularized in the media). And at the 95th percentile, they become “overweight” (or “obese” in popular terms).

If we have a 6-year old girl who is 3 foot, 9 inches tall she would be considered to be a “healthy, normal weight" at 49 1/4 pounds (BMI 17.1).

If she gained 1/4 pound more, however, she becomes “overweight” at 49 1/2 pounds. For untold numbers of children classified as “overweight” they are within a fraction of a pound or few pounds of “normal.”

However, if this little girl grew a mere 1/8 inch, she would be considered to be a “healthy, normal weight” again!

At 54 1/2 pounds (BMI 18.9) she crosses the 95th percentile cut-off and is now labeled “obese.” A very different picture of childhood obesity than the mainstream media is portraying.

However, if this little girl was a mere 1/8 inch taller, at 3-9 1/8 inches tall, she would be merely “overweight” again.

So, for a 6-year old girl who theoretically isn’t growing taller, around a mere 5 pounds makes the difference between being labeled as a “normal” weight or all the way to being “obese.”

It’s no wonder that most parents aren’t readily able or willing to “recognize” that their child is overweight or obese.

And it’s no wonder that parents aren’t readily accepting the notion that this is a health crisis.

It also appears that parents have more common sense and wisdom than many experts and journalists in understanding the genetic component to the natural diversity of sizes that’s always been evident among children. They see that their children take after the other members of the family, aren’t eating or behaving any differently than the other kids, and are just as healthy. Increasing numbers of parents are not readily buying into the belief of a need to medicalize their healthy, active children based on such a spurious label.

© 2007 Sandy Szwarc

[The wonderful opening photo is courtesy of Deb Lemire of Queen Bee Productions.]

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Moving from skinny Santas to skinny kids

This week, the country’s new Surgeon General kicked off his latest childhood obesity initiative with a nationwide tour that began in Charleston, West Virginia. “Healthy Youth for a Healthy Future” is the name of this new U.S. Department of Health and Human Services’ campaign to recognize obesity prevention programs that promote ‘healthy’ eating habits and active lifestyles.

This is the second news-making childhood obesity move of the new Surgeon General, Dr. Steven K. Galson, M.D., MPH, who took office last October. His first, which gave most Americans their first introduction to him and an idea of what was in store, came in December when he declared that Santa Claus is too fat to be a good role model for children. As he told the Boston Herald: “It is really important that the people who kids look up to as role models are in good shape, eating well and getting exercise... Santa is no different.”

“Healthy Youth for a Healthy Future” was first introduced in November when Surgeon General Galson established a Childhood Overweight and Obesity Prevention Council. As Robert Wood Johnson Foundation reported, this Council was made up of stakeholders and HHS agency officials to strengthen federal childhood obesity programs, such as the CDC’s School Health Index, the National Institute of Health’s children’s activity and nutrition program, the FDA’s healthy food choices program, the Indian Health Services diabetes prevention programs, and the President’s Council on Physical Fitness and Sports’ National Fitness Challenge.

Plans for a new National Center for Physical Development and Outdoor Play were simultaneously announced, which will assist the federal Head Start program in educating children and their parents about ‘healthy’ eating and physical activity. The HHS offered a $12 million grant to create the center and $10 million for Head Start playground projects.

As JFS readers will remember, the federal Head Start program, funded with over $6.96 billion this fiscal year, has made reducing childhood obesity a mandate, with a compulsory “Healthy Kids” program to cut calories, fats and sugar from children’s diets. National Head Start programs are also being enrolled in physical fitness program, NikeGo Head Start. Nike is the largest private funder of the Head Start lobbying group, National Head Start Association (the second largest funder is Johnson & Johnson, the world’s largest health product company and parent company of RWJF). NikeGo co-founded Shaping America’s Youth in 2003, to coordinate the government’s childhood obesity goals and develop a national action plan. The full story was covered here.

Surgeon General Galson began his nationwide tour to highlight the “problem” of childhood obesity by telling media that childhood obesity has reached a “crisis point” and that he is alarmed by the magnitude and growth of the problem. In promoting “Healthy Youth for a Healthy Future,” he said combating childhood obesity will require efforts from “every level of government and every level of the community.” He said that school programs must carry over into homes in order to combat the number of kids with “weight problems.” He equated public initiatives to make physical activity and a good diet seen as citizen’s responsibility with “what we did to tobacco... and taking it out of society and acceptable social engagement in this country.”

According to Dr. Galson, more needs to be done about childhood obesity, claiming: “We may be facing the first generation, our children, who dies earlier and at greater risk of key diseases like diabetes, hypertension, heart disease, than we are. So our kids could die earlier than their parents if we don't do something about this.”

The mission of the nation’s Surgeon General is to “serve as America's chief health educator by providing Americans the best scientific information available on how to improve their health and reduce the risk of illness and injury.” As he described his duties in his college paper, his job is to communicate the best science, evidence and data to Americans.

As such, the country might reasonably expect their Surgeon General to know the government’s own statistics on child weights, as provided by the CDC’s National Center for Health Statistics. These have shown that there have been no significant increases in the numbers of U.S. children considered “overweight” since 1999-2000. There is no epidemic of childhood obesity.

The country might reasonably expect their Surgeon General to have read the Dept. of Health and Human Services’ own Health United States 2007 report, which found no medical evidence of a crisis of childhood obesity or for a critical need to address childhood obesity. Children are not expected to live shorter lives than their parents, but are actually healthier and expected to live longer than at any other time in our history. Babies born in 2004 can expect to live 75.2 years if male and 80.4 if female. Compared to babies born in 1990, boys today are expected to live 3.4 years longer and girls 1.6 years longer.

The country might reasonably expect the Surgeon General to have read the evidence provided by the U.S. Preventive Services Task Force, which is charged with issuing careful, evidence-based findings that are supposed to be used by federal government for sound public health programs. After a comprehensive review of 40 years of evidence on childhood obesity screening and interventions, it has found no quality evidence to support or recommend behavioral interventions (diet and activity) for overweight in children and adolescents or that such programs improve health outcomes or physiological measures, such as blood lipids (“cholesterol”), glucose tolerance, blood pressure or physical fitness. Childhood obesity interventions, however, do risk harming children, they warned. The USPSTF concurred with the American Heart Association’s 1996 Scientific Statement for Healthcare professionals in concluding there was no evidence that any interventions 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.

If the Surgeon General and the HHS are not actually following science or medical evidence, even the government’s own, what are these programs really about?

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War on childhood obesity is showing its desperation

How do we respond to those scaring children, becoming increasingly more hysterical and outrageous, in ways that might hurt them? If it was someone in your living room or your child’s school saying such stuff to your child, you would intervene to protect your child and other children.

What if it came from medical professionals behind a national political agenda and written by science journalists in the newspaper of our nation’s capital? As much as one might find it easier to play it safe, politically and professionally, and let it pass without saying anything, one can’t. History has shown us the costs of silence and complicity. It wouldn’t be right not to speak out.

The Washington Post began a week-long series on Saturday, seemingly to create panic over childhood obesity. It is so over-the-top, even Google News appears to have largely ignored it, and surprisingly few other publications across the country have picked up its syndicated series. Perhaps, to their credit, editors recognize that it is nothing more than a string of anecdotes, unsubstantiated claims and off the wall predictions — rather than credible science, evidence or balance. In fact, its sensationalized rhetoric is so wildly out of control, it betrays a desperation in trying to convince us all of the need to be freaked out.

Brief review with counter perspectives and a few missing pieces

The Washington Post series has used as its sole source of information the leaders in creating a childhood obesity crisis and behind the claims that have been repeated so often they’ve become gospel in the war on obesity, key among them Robert Wood Johnson Foundation (RWJF) and the Obesity Society.* Science writer, Rob Stein, was a panelist at last month’s RWJF “Active Living Research Annual Conference” that was themed around integrating RWJF ‘research’ into public policies. Stein’s panel gave the media perspective and talked about “what makes a good story.” While there is no transcript of his talk, might sensationalized wordsmithing been recommended for creating a story to bring people around to RWJF’s policies?

He and Susan Levine’s article accuses children of being afflicted with toxic fat that is destructive to their well-being and puts every major organ at risk with probably irreversible damage. The carefully chosen language manipulates emotions and elicits fears, rather than impartially and calmly presenting accurate scientific evidence as one might expect from science journalists. Fat children is a catastrophe that threatens to shorten the lives of an entire generation, they write. “The future health and productivity of an entire generation — and a nation — could be in jeopardy.”

Their series opens with a feature video from Risa Lavizzo-Mourey, M.D., president of RWJF, who had announced last year that RWJF was committing $500 million over the next five years with their goal to build “the missing sense of national urgency about childhood obesity.” Readers will remember that her claims were so extreme at that press conference, she actually said children were fat because they ate too much bad foods and were inactive and, by her math, this “energy gap” would mean the average teen would gain as much as 1,042.85 pounds over the next ten years. She had also admitted, by the way, there was no evidence in support for any of their far-reaching policy recommendations. She is quoted in the Washington Post as claiming: “Many of these kids may never escape the corrosive health, psychosocial and economic costs of their obesity.” In her video, she says that we have millions of kids whose future paints "a pretty bleak picture."

The Post’s article also reported claims of a “huge burden of disease” these children will bring to the population, by William Dietz, M.D., Ph.D., of the Centers for Disease Control and Prevention. He had partnered with Kaiser Permanente “to develop a national broad-based approach to the public health crisis of obesity,” and their “roadmap for advocacy and action” meeting was jointly sponsored by RWJF, CDC, American Association of Health Plans, Health Partners, and the National Business Group on Health. JFS readers may most remember when he organized that Expert Committee on Childhood Obesity which developed the new clinical guidelines for the management of child and teen fat children recently released by the AMA, CDC and HHS. Those guidelines received considerable negative feedback from readers and parents.

Then there’s our U.S. Surgeon General Steven Galson, M.D., MPH, who is quoted in the Post as claiming that child obesity is nothing less than “a national catastrophe.” JFS readers remember that his first news-making initiative against childhood obesity when he took office was to declare that Santa Claus is too fat to be a good role model for children and his second was his nationwide campaign, “Healthy Youth for a Healthy Future.” This campaign was born in the Childhood Overweight and Obesity Prevention Council he established, made up of stakeholders in the government’s healthy eating and physical activity programs. He is currently making his way around the country, talking to schools, politicians and even joining Lavizzo-Mourey and Dietz at CME programs for healthcare providers.

The Washington Post also quoted claims from Melinda S. Sothern, Ph.D., CEP, who they identified only as being from the Louisiana State University Health Sciences Center in New Orleans. What wasn’t disclosed, is that she is director of the pediatric obesity section and directs the Prevention of Childhood Obesity Laboratory at the LSU Pennington Biomedical Research Center in Baton Rouge. (Information on its founding, funding sources and research here and here). She is also a member of the Obesity Society, leading its 2007 scientific meeting in New Orleans on initiatives to prevent childhood obesity, and she served on that same Expert Panel on Childhood Obesity. In the Washington Post article, Professor Sothern said obesity exerts a cruel price that “robs children of their childhood...the natural enjoyment of being a kid — being able to play outside, run. If they have high blood pressure, they have a constant risk of stroke.” (Different perspectives and medical information on blood pressures in fat children here and here.)

Another unidentified member of both the Obesity Society and that Expert Panel, Jeffrey B. Schwimmer, M.D., a pediatric gastroenterologist at the University of California at San Diego, said in the article that “obese children are victimized and bullied” and treated differently by other children and teachers. But the Post authors didn’t follow through with this information or examine the role of anti-obesity scaremongering in fostering such harmful discrimination of fat children.

The claims, rather than the science, continued to come fast and furious, all of which have already been addressed here. One made by the Post authors warrants a special note. They blamed the epidemic of fat children for higher hospital costs and for potentially adding “billions of dollars to the U.S. healthcare bill.” (This myth turns out to be hype, too, as explained here and here.)

Finally, the Washington Post authors saved the most outrageous claims for the end, quoting from David S. Ludwig, M.D., Ph.D., identified only as an obesity expert at Children's Hospital in Boston. JFS readers will probably remember him as the originator of that illogical claim that “a single 12-ounce soft drink with sugar per day raises a child’s risk of obesity by 60 percent” — which, when the actual research was examined, was found not to be true at all. But the myth that soda pop causes childhood obesity was born and lives on. He made news last year telling kids at his pediatric weight loss program, Optimal Weight for Life Program, that fake foods are bad and make them fat and diseased. He is also recognized for making equally absurd claims in medical publications that a fat child will have a heart attack before age 30 and that childhood obesity is “a massive tsunami headed for the United States.” The Washington Post also failed to disclose that he’s with the Obesity Society and also served on that Expert Panel on Childhood Obesity.

According to the Post article, Ludwig now compares the childhood obesity crisis to global warming. “We don't have all the data yet, but by the time all the data comes in it's going to be too late,” he was quoted as saying. “You don't want to see the water rising on the Potomac before deciding global warming is a problem.”

After all of that piling on of a single viewpoint from people affiliated with one group of vested interests, the science writers then balanced it with factual information from medical, nutrition, child development, obesity and eating disorder professionals, and scientists, presenting other viewpoints, right? Readers also learned the potential harms resulting from these anti-obesity messages and of the proposed interventions, right?

Wrong and wrong.

[I am edited myself here, but regular JFS readers will understand exactly what merits saying.]

The most heartbreaking aspects of this series are the children, who’ve been indoctrinated by these scares. In today’s video, a boy said he believes that fat is like a “spread of the plague or something” and that he would have a heart attack and die unless he keeps his weight under control, exercises and eats right. He is concerned about his cholesterol because if it gets high it “blocks blood flow and you’ll die.” He is only 12 years old.

While it seems there will always be people who will readily believe whatever they’re told to think, and whatever slick marketing shows them on television; for growing numbers of thinking Americans, the claims about childhood obesity are becoming so unsound and exaggerated, they are seeing it for what it is: groupthink.

Propaganda.

© 2008 Sandy Szwarc. All rights reserved.

* The Obesity Society was formerly called the North American Association for the Study of Obesity. The American Obesity Association also merged with it on Sept. 5, 2006. Attorney Morgan Downey had been Executive Director/Chief Executive Officer of the AOA for a decade and since June 2006 has been Executive Vice President of the Obesity Society. “Recognition of obesity as a disease is a central goal of the AOA, founded in 1995,” according to its mission statement. This lobbying organization led the change of IRS rules (IRS Ruling 202-19), announced on April 2, 2002, which were reworded to say: "Obesity is medically accepted to be a disease in its own right," and enabled weight loss treatments to be claimed as a medical deduction. AOA was part of HHS Secretary Tommy Thompson’s obesity roundtable in 2003 and lobbied the FDA that “obesity is the most prevalent, fatal and chronic disease of the 21st Century.” It was instrumental in the FDA revising its guidelines for reviewing and approving weight loss prescription drugs to expedite their release. It lauded Secretary Thompson’s famous 2004 launch of the HHS campaign against obesity called “Healthy Lifestyles and Disease Prevention,” and increasing NIH annual funding for obesity research to more than $400 million. The AOA also successfully lobbied to have weight loss interventions covered by Medicare (and hence, by most insurers) and hailed HHS Secretary Thompson when he eliminated the Medicare policy that had said obesity is not a disease. The AOA-Obesity Society has been actively lobbying for coverage of bariatric surgeries, for the promotion of “healthy” foods and taxation of fattening foods. Since 2006, the Obesity Society has been a member of the National Committee for Quality Assurance (NCQA) Advisory Committee, which sets the clinical care guidelines healthcare providers must follow, and in recent months, the NCQA obliged by issuing two new guidelines calling for BMI assessment for all children and adults and mandatory reporting of counseling for nutrition and physical activity. “It will mean that thousands of patients in managed care plans, Medicare and Medicaid will have their BMI measured and tracked and that weight will become a topic for physician-patient interaction,” said Morgan Downey. [Click on image to enlarge.]

Much of the information we hear about obesity, healthy eating and weight control is driven by these dominant interests, yet it is also why we rarely hear contrary information. Few scientists or medical professionals dare speak out against them without risking their careers and reputations. We were poignantly reminded of this in February when the prestigious upcoming President of the Obesity Society himself, David Allison, Ph.D., made the mistake of saying that mandating calorie counts on restaurant menus wasn’t sound. He quickly found himself castigated and run out the door and replaced by Gary Foster, Ph.D., who authored that School Nutrition Policy study of the government’s healthy eating and physical activity guidelines. In a surreal irony, one of the largest special interest lobbies in the country came down on one of its own for having conflicts of interest by consulting for companies. As Dr. Roy Poses, M.D., of Health Care Renewal noted: “[D]id the Obesity Society cast out a leader because he was aligned with commercial interests opposed to the commercial interests that provide most of the society's support? That is, was he cast out not because he had conflicts of interest, but because he did not have the same conflicts of interest as the society?”

If this happens to one of its own biggest names, you can imagine how few little guys will risk their livelihoods to say anything against the groupthink.

Part Two on Washington Post series here.

Click here for complete article (and single page version).

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

Click here for complete article (and single page version).