Nutrition and obesity studies may overstate results, warn researchers

Many studies focusing on obesity and nutrition may overstate conclusions of their findings, which may lead to policy makers and other researchers basing decisions on inaccurate assumptions, according to new research.

The study, published in the American Journal of Preventive Medicine,  suggests that around one in 11 publications on nutrition and obesity in leading journals may overstate the results of their research findings – such as inappropriately describing a correlation as a cause-and-effect relationship and generalising a study’s claims to large groups of people even when the study population was quite different.

“This is troubling because such statements likely influence policymakers, clinicians, other researchers, and the public into making decisions without an accurate understanding of the supporting science, which may have unjustified costs,” said the research team – led by Professor Nir Menachemi from the University of Alabama at Birmingham in the US.

“They also have the potential to be amplified and disseminated to a larger audience when they are reported by journalists, who are a key source for public information about scientific discoveries,” said the team. “Given that, by and large, journalists dutifully convey the claims made in scientific papers, overstatement of results poses a concern.”

According to the results of the study, public health journals had a ‘significantly higher’ prevalence of publishing overreaching statements when compared to medical, nutrition, and obesity journals, “especially with respect to reporting associative relationships as causal or making policy recommendations based on observational data.”

Study details

Menachemi and colleagues tracked how often authors overreached in the summary of their findings by searching research articles published in eight leading journals in either 2001 or 2011, in order to examine changes in reporting over time. The team found 937 papers—377 from 2001 and 560 from 2011.

In 8.9% (around one in 11) of the studies, the team reported that findings had been overstated in the abstract – with studies from 2011 more likely to overreach than 2001 papers. 

Overreaching statements were also found to be more common in unfunded studies compared to funded studies, regardless of what type of group paid for the study; while a higher number of co-authors was also associated with a reduced likelihood of presenting overreaching statements.

“This trend may be because funded researchers are selected for superior knowledge or skills; have greater resources (as a result of their funding); or are subject to oversight from the funding agency, all of which may translate into a more straightforward presentation of their scientific work,” wrote Menachemi and colleagues.

Although those overstatements may be unintentional, they can distort what doctors, policymakers, and the general public know about nutrition, the researchers said.

The team noted that their work is an extension of a project originally funded by The Coca Cola Company, but noted that the Company had no role in the design, execution, or reporting of the current study.

Source: American Journal of Preventive Medicine
Volume 45, Issue 5, November 2013, Pages 615–621, doi: 10.1016/j.amepre.2013.06.019

” Overstatement of Results in the Nutrition and Obesity Peer-Reviewed Literature”
Authors: Nir Menachemi, Gabriel Tajeu, Bisakha Sen, et al

Why schools shouldn't report obesity

Most of us know schools as institutions of learning, usually associated with “the three Rs,” but now schools in 19 states are reporting progress on another subject: “BMI” — body mass index.

These schools are measuring the heights and weights of students to determine BMI, a measure of weight based on height, then sending home letters to inform parents of their children’s BMI status. As a pediatric nutritionist, I am not pleased.

Child obesity is at near epidemic proportions, with nearly one in three children overweight or obese. Obesity is a gateway disease to many chronic health problems, including type 2 diabetes, hypertension, heart disease and joint problems.

I don’t want to see kids struggle with obesity or become obese. Not only for those reasons but also because it adds to their physical discomfort. Most importantly, I don’t want children saddled with chronic health problems that they should not encounter for decades and that might be prevented altogether.

What? A specialist in child nutrition who doesn’t want parents to be aware of their children’s abnormal weight? No, I didn’t say that.

I spend a good portion of my clinical time counseling motivated parents (and often unmotivated parents, but that’s for another blog post) about making positive changes to normalize their children’s weight. The key word here is “school.”

Schools these days seem to be tasked with doing just about everything related to raising kids: feeding them breakfast and lunch, teaching them (not just general knowledge, but good habits, manners, social skills, etc.), helping them with homework after school and, often, administering medication.

So what’s the problem with these BMI letters? Several things:

  • Parents should be taking their children for physical exams at least annually. The BMI is part of a standard pediatric physical, so in all likelihood, this information is known to the children’s pediatricians. Let’s hope that better access to affordable insurance will make this even easier for parents to do. However, while such access may get children to see a pediatrician, it won’t solve the issue of childhood obesity. Read on.
  • Parents of under- or overweight children will likely need some sessions with a registered dietitian skilled in working with kids and parents. Few health plans currently cover weight management. If they do, it is often for fewer hours or visits than are needed to make permanent dietary and lifestyle changes. The schools are not referring parents to helpful resources or making help available—just telling parents that they need to get some help. That’s not the same.
  • This is a perfect trigger for bullying. The kids know they’re being screened and they also know who the fat kids are. (Even at that age, the eyeballs are a keen assessment tool.) You can almost hear the taunts directed at the heavier kids once parents start receiving the letters. This just draws more attention to the issue. Bad idea.

I heartily applaud the intent of this initiative by the schools (as long as the intent is truly to help children, and not just the work of some politician or school board wanting to score points with constituents). But schools should get out of this business and get back to what they do well: teaching children, feeding them properly during the school day (school meals have improved tremendously) and providing structure.

Schools have an important role in children’s lives; this just isn’t it.

And if politicians or school boards really want to fight obesity, they can make physical education a daily activity for all kids, kindergarten through grade 12.

Keith-Thomas Ayoob is director, nutrition clinic, Children’s Evaluation and Rehabilitation Center, Albert Einstein College of Medicine. He blogs at The Doctor’s Tablet.

Obesity Lessons for Liberals and Conservatives

In 2009, the U.S.D.A. made a major revision in the list of foods that could be bought with coupons from the federal program known as W.I.C. (short for the Supplemental Nutritional Program for Women, Infants, and Children). The new package included more healthy items (fresh, frozen, and canned fruits and vegetables, whole-grain breads and cereals, and low-fat milk) and fewer dubious ones (sweetened juices, cereals and breads that are not whole-grain). This was significant not only because the changes were so purposefully aimed at improving nutrition for low-income Americans but because W.I.C. serves so many of them—fifty per cent of American infants, twenty-five per cent of children under five, and twenty-six per cent of postpartum women are enrolled in the program.

In many of the low-income neighborhoods where women and children rely heavily on W.I.C., supermarkets are few and far between. Residents with limited funds for transportation are often forced to shop at the kind of gas-station quick marts and dusty-shelved corner stores where they can find plenty of beef jerky, chips, and soda and, other than a bruised banana or two, not much in the way of produce. But when a team of researchers from Yale University’s Rudd Center for Food Policy and Obesity studied W.I.C.-authorized stores across Connecticut, they found that the stores had responded to the new rules by “improving the availability and variety of healthy foods.” The businesses “found a way,” as the researchers from Yale put it, to make room for low-fat milk on their shelves, and to stock fruits and vegetables and whole-grain breads and other products they had not sold before. In so doing, they revealed a previously unsatisfied consumer demand. The researchers found that nearby stores that did not accept W.I.C. also started offering healthier foods, either because they now had new supply chains to take advantage of, or because customers were now asking for them, or both.

Marlene Schwartz, the director of the Rudd Center, thinks the W.I.C. reforms surely played a role in the reduction of obesity reported this week. The sheer number of families affected is part of the reason. And for two- and three-year-olds, who don’t need as many calories, a relatively small change—a switch to low-fat milk, a dip in the amount of sweetened juice they’re chugging—“can be pretty significant.”

In subsequent studies, says Schwartz, the Yale team has found that the W.I.C. reforms “really make a difference in what people purchase.” There were worries that families would drop out of the program or undermine the purpose of the changes by using their own money to buy lots of less healthy foods. But, by looking at scanner data from grocery stores, the Yale group has determined that this isn’t happening.

For years, the right has been in high dudgeon about almost any government program, any policy innovation that could somehow be disparaged as an excess of the nanny state. That’s been particularly true for public health and nutrition—think of the howl of libertarian outrage that greeted Mayor Michael Bloomberg’s doomed attempt to limit the size of sodas.

Schwartz and other nutrition advocates would like to see the W.I.C.-style promotion of healthy eating extended to the federal food-stamp program, known as SNAP. But, as Jane Black points out in Slate this week, there the opposition comes not primarily from the Republican right but from the food industry, which sells an awful lot of soda and snacks to people with food stamps—and, more surprisingly, from anti-hunger organizations. A host of mayors, including Bloomberg and Cory Booker, of Newark, have called on Congress to allow limits on the use of food stamps to purchase sugary beverages. A poll conducted by the Harvard School of Public Health showed that sixty-nine per cent of the general public and even fifty-four per cent of SNAP recipients agreed that such limits were a good idea. But anti-hunger organizations are firmly opposed to any such changes. Black quotes one advocate’s comment to Food Safety News: “Our view is that people have the smarts to purchase their own food, and we’re opposed to all limitations on food choice.”

The anti-hunger organizers probably worry—and with good reason—that in the current political environment, any move to reform what food stamps cover will morph into a they’ll-only-spend-it-on-junk-food excuse to gut the whole program. But the W.I.C. reforms show that that’s not an inevitable outcome.

And they show something else too: when the government creates incentives for private businesses to behave more responsibly, they often find a way. Information and moral suasion—Michelle Obama’s Let’s Move campaign and the like—are important, but in the salty-sweet sea of temptation we all swim in, they’re not really enough. Big Junk Food, with its ubiquity and its advertising juggernaut, will always swamp earnest nutritional pamphlets and public-service announcements. Unless, that is, there are rules and money on the other side. The Republicans have, by and large, taken to treating public health as a private matter—as though we could all count calories in a self-actualizing vacuum. And that’s too bad, because when it comes to battling obesity, we all need some of the will power that only government can provide.

Illustration by Nolan Pelletier.

Obesity and poor nutrition hurting world economy, UN warns | The …

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A young boy eats a hamburger. Photo: Shutterstock.com, all rights reserved.

The UN’s food agency on Tuesday said obesity and poor nutrition weigh heavily on the global economy and told governments that investing in food health would bring big economic as well as social returns.

Lost productivity and spiralling health care bills linked to malnutrition “could account for as much as five percent of global gross domestic product (GDP),” equivalent to $3.5 trillion (2.6 trillion euros) a year, the Food and Agricultural Organisation (FAO) said.

Improving nutrition would boost earnings, “with a benefit-to-cost ratio of almost 13 to 1,” it said.

In its yearly report, the Rome-based agency said 12.5 percent of the world’s population (some 868 million people) are undernourished in terms of energy intake, while 26 percent of children worldwide are stunted by malnutrition.

Some two billion people suffer from micronutrient deficiencies and 1.4 billion people are overweight — of which 500 million are obese. In low- and middle-income countries, a rapid rise in obesity is affecting associated costs, it said.

FAO said rising urbanisation, sedentary lifestyles and the increased availability of packaged foods meant policy-makers faced significant challenges in reversing obesity.

But “the returns are high,” the UN agency said.

“Investing in the reduction of micronutrient deficiencies, for example, would result in better health, fewer child deaths and increased future earnings,” it said.

Lack of micronutrients — such as vitamins, iron and iodine — are particularly common in developing countries, experts say.

The costs of undernutrition are estimated at two-three percent of global GDP, equivalent to $1.4 to $2.1 trillion per year, the FAO said.

Though no specific data on the economic costs of obesity exist, the cumulative cost of all non-infectious diseases, for which obesity is a leading risk factor, were estimated to be about $1.4 trillion in 2010, it said.

The agency urged global leaders to enhance nutrition in food systems — in part through agricultural policies — and promote behaviour change through education.

“Agricultural research and development priorities must be made more nutrition-sensitive, with a stronger focus on nutrient-dense foods such as fruits, vegetables, legumes and animal-source foods,” it said.

Proposals for positive interventions in the food system for better nutrition include changes in production “up to the farm gate”, with micronutrient fertilisers, bio-fortified crops and crop and livestock diversification.

Governments could also help consumers through subsidies, targeted food assistance for at-risk groups such as children and the elderly, and better product labelling to help shoppers choose more nutritious foodstuffs.

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Obesity and poor nutrition hurting world economy, UN warns | The …

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A young boy eats a hamburger. Photo: Shutterstock.com, all rights reserved.

The UN’s food agency on Tuesday said obesity and poor nutrition weigh heavily on the global economy and told governments that investing in food health would bring big economic as well as social returns.

Lost productivity and spiralling health care bills linked to malnutrition “could account for as much as five percent of global gross domestic product (GDP),” equivalent to $3.5 trillion (2.6 trillion euros) a year, the Food and Agricultural Organisation (FAO) said.

Improving nutrition would boost earnings, “with a benefit-to-cost ratio of almost 13 to 1,” it said.

In its yearly report, the Rome-based agency said 12.5 percent of the world’s population (some 868 million people) are undernourished in terms of energy intake, while 26 percent of children worldwide are stunted by malnutrition.

Some two billion people suffer from micronutrient deficiencies and 1.4 billion people are overweight — of which 500 million are obese. In low- and middle-income countries, a rapid rise in obesity is affecting associated costs, it said.

FAO said rising urbanisation, sedentary lifestyles and the increased availability of packaged foods meant policy-makers faced significant challenges in reversing obesity.

But “the returns are high,” the UN agency said.

“Investing in the reduction of micronutrient deficiencies, for example, would result in better health, fewer child deaths and increased future earnings,” it said.

Lack of micronutrients — such as vitamins, iron and iodine — are particularly common in developing countries, experts say.

The costs of undernutrition are estimated at two-three percent of global GDP, equivalent to $1.4 to $2.1 trillion per year, the FAO said.

Though no specific data on the economic costs of obesity exist, the cumulative cost of all non-infectious diseases, for which obesity is a leading risk factor, were estimated to be about $1.4 trillion in 2010, it said.

The agency urged global leaders to enhance nutrition in food systems — in part through agricultural policies — and promote behaviour change through education.

“Agricultural research and development priorities must be made more nutrition-sensitive, with a stronger focus on nutrient-dense foods such as fruits, vegetables, legumes and animal-source foods,” it said.

Proposals for positive interventions in the food system for better nutrition include changes in production “up to the farm gate”, with micronutrient fertilisers, bio-fortified crops and crop and livestock diversification.

Governments could also help consumers through subsidies, targeted food assistance for at-risk groups such as children and the elderly, and better product labelling to help shoppers choose more nutritious foodstuffs.

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Four-day diabetes congress begins in Kochi

KOCHI: Recalling the campaign that Diabetes UK had undertaken under his leadership during the period of Margret Thatcher, Sir Michael Hirst, president of International Diabetes Federation, said that campaigns in all fronts have to start now for the betterment of people with diabetes and to reverse the diabetes mortality clock. He was inaugurating the four-day world diabetes congress organized by Diabetes India at Hotel Le Meridian’s convention centre in Kochi on Thursday.

The diabetes clock is ticking at the rate of one death and two new entrants per every 8 seconds, and the objective of the world congress is to stall the epidemic and thereby stop the mortality clock, said Dr SM Sadikot, president of Diabetes India, who presided over the event.

Referring to the present scenario and concerns in diabetes in India, a country where contrasting population of under-nutrition and over-nutrition coexists, Jean Claude Mbanyn, former president, International Diabetes Federation, said that the congress have to focus on building a society where diabetic prone environment does not exist so that the baton is not passed on to next generation. Research and results should reach the patients, he said.

Dr SR Aravind, Dr Anad Nigam, Dr Johny Kannampilly, and Dr Jyothidev Keshavdev spoke.

The inauguration was marked by the Diabetes India declaration of metabolic syndrome as the biggest epidemic in human history with a clarion call for its prevention.

In the four-day world congress, more than 3000 expert medical practitioners, scientists and researchers from various states and world over, would chalk out decisive action plans to reverse the diabetes mortality clock. A wide range of topics touching diabetes, its monitoring, awareness, management, treatment, control and nutrition would be taken up at symposiums, workshops, debates and plenary sessions to be held.

Tackling childhood obesity: International health celebrity speaks in …

Two-pronged approach:

A pair of events on Saturday in Boise will feature a full day of lectures, discussions and fun activities aimed at promoting children’s health. Sponsors St. Luke’s Children’s Hospital and Blue Cross of Idaho Foundation for Health are teaming with Boise Parks Recreation, Let’s Move Boise, Boise State University and other partner organizations.

The doctor is in:

Dr. David Katz, the founding director of Yale University’s Prevention Research Center and a world-renowned expert on childhood obesity, nutrition and chronic disease prevention, will be the keynote speaker at a conference called “Taking Charge of Childhood Obesity: A Call to Action.” The conference, being held from 7 a.m. to 12:15 p.m. at Boise State’s Stueckle Sky Center, will also provide insight into other topics including pediatric diabetes.

Wait, haven’t I seen this guy somewhere?

Possibly. Dr. Katz has been a go-to guy when print media, radio and television need expert answers and opinions on health issues. He’s a medical contributor to ABC News, and when Oprah Winfrey needs nutritional advice, Katz writes columns for O, the Oprah Magazine. Katz also is a syndicated health/nutrition columnist for The New York Times. And he’s not the only one you’ll probably recognize: Boise’s own Olympic Gold medal-winning cyclist, Kristin Armstrong, will be among those who join Katz for a panel discussion.

Who can attend the conference?

Anyone who’s interested in the intervention and prevention of childhood obesity is welcome. The cost is $100 for those seeking continuing medical education credits, $50 to attend for no credits. Students can go at a discounted rate of $25. Register at www.regonline.com/childhoodobesity.

Get moving:

After the conference, kids and others are invited to join Boise Mayor Dave Bieter as he kicks off the free Be Well Now! Family Wellness Festival with a stroll along the Greenbelt at 1 p.m. The walk is part of Bieter’s Walk 150 campaign for the city’s sesquicentennial. The festival, which runs until 4 p.m. at Boise State’s Caven-Williams Sports Complex, also will include nutrition tips and demonstrations by the Summerwind Skippers, the Boise Bicycle Project, among others.

Sean Deter: 377-6450; @IDS_Deter

Fighting Obesity on the Playground

It’s no secret that obesity and childhood obesity is a problem in America, and Ebony contributor dream hampton writes how she and a group of mothers through the organization MomsRising.org are trying to transform America’s nutritional future.

In his partly autobiographical documentary, Soul Food Junkies, Byron Hurt investigates African-Americans’ attachment to food traditions, and challenges his audience to take a closer look at those relationships. He returns to his own father’s death, made premature by what he speculates was overeating brought on by deep depression.

Junkies isn’t all blues. Hurt offers a sometimes hilarious look at our affinity to foods like fried chicken, fat-flavored collard greens, and fried pork chops despite the knowledge that these foods increase risks for diseases like diabetes, high blood pressure, stokes, heart disease and obesity. 

What’s no laughing matter are the alarming statistics that predict that this generation of young people can expect to die sooner than their parents. African-American children suffer from obesity at a greater rate than white children. There are many complex factors that contribute to this epidemic. But one factor, junk foods sold in schools, is being tackled by parents nationwide. The USDA recently issued proposed nutritional guidelines on food sold in vending machines and à la carte lines. And a study by Kids’ Safe Healthful Foods Project, a joint project of the Pew Charitable Trusts and the Robert Wood Johnson Foundation shows that parents nationwide broadly support the creation of strong guidelines.

The organization I work with, MomsRising.org, is committed to food justice for our children and families. We believe in mothers uniting to take back control of our kids’ nutrition and of our family health. We believe that together we can break down the structural barriers that are keeping everyone from having access to healthy foods. Mothers voices together can have an incredible impact on everything from making sure healthier foods are served and available in schools, to making sure vending machines have nutritious options, to passing laws to support childhood nutrition, as well as to limiting the junk food marketing that’s aimed at our children. 

Read dream hampton’s entire piece at Ebony.

The Root aims to foster and advance conversations about issues relevant to the black Diaspora by presenting a variety of opinions from all perspectives, whether or not those opinions are shared by our editorial staff.

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Obesity Must Be Addressed on Multiple Levels | Timi Gustafson RD …

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Obesity has grown into an alarming public health crisis, and there is no telling when or even whether we will be able to get this epidemic under control. Over two thirds of Americans now struggle with weight problems, and there is no consensus among the experts over the precise causes. Recommendations for countermeasures range from calls for more government involvement to greater responses from food manufacturers and restaurant operators to better health education of the public.

Recent legislation for the improvement of nutrition standards of school lunches and initiatives like “Let’s Move” to reduce childhood obesity have gotten some traction, but progress remains slow and uncertain, according to the latest report by the Centers for Disease Control and Prevention (CDC). Overall, there is no significant change in the current trends, and so the battle for America’s health continues unabated. There is general agreement that more, much more needs to be done.

Demands for tougher regulation of industry and policies to influence the behavior of consumers have become louder in recent years, but we have not seen the results we had hoped for. In a recent op-ed articleNew York Times columnist Mark Bittman has faulted the current Surgeon General, Dr. Regina Benjamin, for being “missing in action” in the fight against obesity, especially childhood obesity. On this issue, he writes, “Benjamin, like most of her predecessors, is virtually invisible.” Even with regards to seemingly straight forward measures like curbing children’s exposure to junk food via advertisements on TV or banning soda sales from school campuses, the government remains inexplicably passive. Instead, it still lays most of the blame at the feet of the victims by overemphasizing personal accountability.

Voluntary commitments by food manufacturers and restaurant operators have not produced much success either, despite of ample promises to show more cooperation by making food labels less confusing, offering healthier alternatives on fast food menus, or limiting exposure of kids to food advertisements.

But there is another aspect to this discussion that is often neglected. It is people’s real life experience that is not taken enough into account. By this I don’t mean to lend credence to oversimplifying statements that people are responsible for their own actions and should not blame others for their demise. Those who read my columns and blog posts know very well that I am a strong supporter of many of the measures Mr. Bittman and others are proposing.

Asking folks to make better nutritional choices makes no sense if they live miles and miles away from food outlets that carry fresh produce or in neighborhoods where getting physical exercise is difficult because of safety concerns and lack of public facilities like bike paths and parks. It is also futile to make dietary recommendations that completely ignore financial limits or access to health education.

But still, no matter what we will try from here on in terms of legislation and policy making, changing individual behavior will always play a predominant role. Eating habits are rarely just about food. They are also about stress, anxiety, loneliness, boredom, addiction, past traumatic experiences, and more. By exclusively focusing on the quality and quantity of our food supply, we will not be able to really understand these concerns and make them part of the equation, as they need to be. As they say, all politics are local. And all health issues are personal.

Timi Gustafson R.D. is a registered dietitian, newspaper columnist, blogger and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog and at amazon.com.  For more articles on nutrition, health and lifestyle, visit her blog, “Food and Health with Timi Gustafson R.D.” (www.timigustafson.com). You can follow Timi on Twitter and on Facebook.

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