American women weigh as much as 1960 man

July 13th, 2016 No comments »

According to an article in the Washington Post, the average woman today weighs the same as the average man, circa 1960. The average American woman now weighs 166.2 pounds and the average man 195.5 pounds.

Staggering Cost of Global Obesity May be Underestimated

July 13th, 2016 No comments »

According to an analysis by the McKinsey Global Initiative, obesity ranks third, behind smoking and armed violence, war and terrorism, in its global social burden, or about $2 trillion or 2.8% of global gross domestic product (GDP) approximately equal to the GDP of Russia or Italy. Lost productivity may be responsible for 70% of total costs. “In the United States, armed conflict (and especially spending on the military) has the highest social and economic impact, and obesity is second; obesity generated an impact in the United States of $664 billion a year in 2012, or 4.1% of GDP.” As jaw-dropping as that analysis, the situation may be worse. A new paper by Hruschka and Hadley posits that worldwide variation in human body weights are far more widespread that previously thought. The use of standard cut-offs might lead to underestimating global obesity levels by 400-500 million while also incorrectly prioritizing high-risk areas for undernutrition in children.

What Leveling of childhood obesity?

July 13th, 2016 No comments »

Much has been made recently of a purported drop in childhood obesity, particularly among children age 2 to 5. (See my Oct. 2015 blog, Did the White House Spin CDC Study to show progress in childhood obesity?”) Now, a new study finds “no evidence of a decline in obesity prevalence in any age group, despite substantial clinical and policy efforts targeting the issue.” The paper by Ashley C. Skinner, Eliana M. Perrin and Joseph A. Skelton in Obesity used NHANES data from 1999-2014 and found, “A clear, statistically significant increase in all classes of obesity continued from 1999 to 2014.” They also reported that severe obesity (class II and III) showed a significant increase in adolescents and non-Hispanic black children.  They state, “By including severe obesity, our results also highlight particular areas of concern. In 2013-2014, nearly 10% of adolescents met criteria for Class II obesity, and nearly 5% also met criteria for class III obesity…The 4.5 million children and adolescents with severe obesity will require novel and intensive efforts for long-term obesity improvement. With scarce resources, and increasing costs of comorbid conditions, there is an urgent need for targeted interventions to stem the rise in severe obesity among children, in addition to policies and clinical efforts designed to prevent obesity. Policy efforts are yet to yield substantive changes in obesity prevalence but few have specifically targeted severe obesity.” Amen

Debunking ‘progress’ on childhood obesity

May 2nd, 2016 No comments »

Much has been made recently of a purported drop in childhood obesity, particularly among children age 2 to 5. (See my Oct. 2015 blog, Did the White House Spin CDC Study to show progress in childhood obesity?) Now, a new study finds “no evidence of a decline in obesity prevalence in any age group, despite substantial clinical and policy efforts targeting the issue.” The paper by Ashley C. Skinner, Eliana M. Perrin and Joseph A. Skelton in Obesity used NHANES data from 1999-2014 and found, “A clear, statistically significant increase in all classes of obesity continued from 1999 to 2014.” They also reported that severe obesity (classII and III) showed a significant increase in adolescents and non-Hispanic black children.  They state, “By including severe obesity, our results also highlight particular areas of concern. In 2013-2014, nearly 10% of adolescents met criteria for Class II obesity, and nearly 5% also met criteria for class III obesity…The 4.5 million children and adolescents with severe obesity will require novel and intensive efforts for long-term obesity improvement. With scarce resources, and increasing costs of comorbid conditions, there is an urgent need for targeted interventions to stem the rise in severe obesity among children, in addition to policies and clinical efforts designed to prevent obesity. Policy efforts are yet to yield substantive changes in obesity prevalence but few have specifically targeted severe obesity.” Amen

Is CDC Massaging the Obesity Stats?

November 22nd, 2015 No comments »

The world was positively giddy this week following the release of a new CDC Obesity prevalence report. There was so much self-congratulation going on in the childhood obesity world I was afraid of an outbreak of carpal tunnel syndrome.

The headlines shouted that the childhood obesity numbers had stabilized and many groups claimed credit for the success. The CDC reported that, “the prevalence of obesity among U.S. youth was 17% in 2011-2014. Overall, the prevalence of obesity among preschool-aged children (2-5 years) (8.9%) was lower than among school-aged children (6-11 years) (17.5%) and adolescents (12-19) (20.5%).” The report goes on to state, “Between 2003-2004 and 2013-14, however, no change in prevalence was seen among youth.”

Hey, great news, no?  Well, the 17% figured was derived from averaging three groups: 2-5YOA, 6-11 YOA and 12-19 YOA. I question of including 2-5 year olds. The prevalence for this group is about half for the other age groups. And, frankly, they are toddlers. Their prevalence figure probably represents parental panic at the prospects of raising an overweight child. This panic may lead to restrained eating strategies which often fail as the child grows up. As soon as the child starts to exercise more control over their own feeding and behavior, the prevalence rate doubles. Doubles! Taking the 2-5 years old out of the equation, the youth prevalence rate is 19%, not 17%. , 19% is not leveling off. (Truth be told I did not attempt to re-calculate the historical figures without the 2-5 age group.) Keep in mind that CDC views obesity as a binary switch. You are either obese or not. They do not take into account the growth of body weights within the obesity category, i.e. class III or severe obesity growth.

Finally, the CDC does note, “The prevalence of obesity among U.S. adults remains higher than the Healthy People 2020 goal of 30.5%. Although the overall prevalence of childhood obesity is higher than the Healthy People 2020 goal of 14.5%, the prevalence of obesity among children aged 2-5 is below the goal of 9.4%.”

Before popping the champagne, advocates and the media should consider that we are moving further and further away from the targets of Healthy People 2020, not to mention Healthy People 2010. Therefore, it is reasonable to ask if self-congratulation based on failure is an appropriate response.

Did White House Spin CDC study to show progress in childhood obesity?

October 20th, 2015 No comments »

The Daily Caller reports receiving emails under the Freedom of Information Act purporting to show White House influence to spin CDC prevalence figures to support Michelle Obama’s Let’s Move initiative. This does not come as a big surprise. We have been reporting here on the over-optimistic predictions of the end of the obesity epidemic. See here, here, here, herehere and here.

 

Global Obesity Targets Will Not be Achieved

October 10th, 2015 No comments »

The World Obesity Federation [formerly the International Obesity Task Force (IOTF)] has published new data on global obesity prevalence prediction through 2025. The data indicate that the global targets, set by the World Health Organization to hold obesity rates to the 2010 level will not be met. See article from The Guardian.

 

Campaigns to Ban Food Marketing are a Dead End: Supreme Court

September 4th, 2015 No comments »

Regulating food companies marketing to children has had a mantra-like appeal to advocates of reductions in childhood obesity. In 2004, Congress directed the Centers for Disease Control and Prevention to examine the role of food marketing in the development of childhood obesity. The result was a thorough report from the Institute of Medicine in 2006,  Food Marketing to Children and Youth: Threat or Opportunity.

Subsequently, advocates began to talk about specific restrictions. Dr. Marion Nestle, for example, proposed restrictions or bans on the use of cartoon characters, celebrity endorsements, health claims on food packages, stealth marketing  and marketing in schools. Dr. Nestle held up some 50 other nations that restricted food marketing to children, “Although such actions have not eliminated childhood obesity-rates in these countries are increasing, although they remain lower than the US rate- they may help to slow current trends”.

While the experience of other countries is informative, the United States has different legal principles. Of particular relevance is the evolving jurisprudence around the First Amendment and its application to commercial speech. Over several decisions, the Supreme Court has expanded First Amendment protections for corporations whose speech (read marketing) comes under governmental regulation. This summer the Supreme Court has expanded the scope of this protection. This has raised a host of issues surrounding the future of governmental restrictions on corporate speech.

The case, Reed v. Town of Gilbert Arizona,  involved a code regulating signs put up in the township according to content, size and time restrictions. A case challenging the code was brought by a church who used lawn signs to indicate where their services were being held. The code was struck down by all nine judges, although there were different rationales from different judges.

The majority of the justices agreed with Justice Clarence opinion. Under his analysis, the First Amendment applies to the states, including municipal governments. Content-based speech, which is based on its communicative content, i.e. the topic discussed or the idea or message expressed , is presumptively unconstitutional and may only be justified if the government can prove that they are narrowly tailored to serve compelling state interests. When the town of Gilbert argued that such restrictions are needed for public safety, the Court rejected the argument that signs of ideological content were different, in terms of public safety, than are temporary signs. This is the problem of the over-inclusiveness and under-inclusiveness in such First Amendment cases. (For more information on this component, see my post on the proposed New York City ban on large soda cup sizes.)

Justice Breyer, who concurred in the Court’s opinion, opined that content-based speech regulation by the government should not always require the strict scrutiny. Breyer observed, “virtually  all governmental activities involve speech, many of which involve the regulation of speech”.  “And,” Justice Breyer added, “to hold that such content discrimination triggers strict scrutiny is to write a recipe for judicial management of ordinary government regulatory activity.” He offered several examples: securities disclosure regulation, energy conservation labeling, advertising prescription drugs, the confidentiality of patients’ medical data, commercial airplane safety briefings, and, even requiring petting zoos post signs recommending handwashing on exiting the zoo. He might have added  the nutrition label, as well.

It is also worthwhile to review what Chief Justice John Roberts had to say, as obiter dicta, on hypothetical regulation for the purpose of obesity prevention, in the landmark ruling upholding the Affordable Care Act.

Bottom line: efforts to restrict food advertising to children are bound to fail without much more compelling evidence of a causal and exclusive relationship to the development of mortality and morbidity as adults, than we now have. Proposed restrictions, like those proposed by Dr. Nestle, would certainly be struck  down by the courts. But, the issue would not even get that far. The regulatory work would have to be carried out by the Federal Trade Commission and the Food and Drug Administration. Congress would surely yank their funding for such efforts if they proposed such regulations. It is time for those of us who want to slow the rise in childhood obesity rates, as well as in adult rates, to realize the approach of regulating food marketing is a dead end.