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Panic Button —

February 22, 2012

As we all know by now, 95% of Strong4Life loves a good statistic. If there’s a statistic proving that obesity requires shame and stigma, S4L will find it and promote the shit out of it.

In Phase 1, the now-infamous “Why am I fat?” ad included this stark declaration:

Since January 9, I have been calling on Children’s Healthcare of Atlanta to release the research on which this claim is made. It has now been 42 DAYS, or SIX WEEKS, since CHOA said they were “gathering” the research that proves 75% of Georgia’s parents suck.

But after the National Institutes of Health condemned Phase 1, Strong4Life “moved on” to Phase 2 (in most areas… poor, urban areas of Atlanta are still targets for stigma). This sleight of hand included a new commercial (not for those running short on Sanity Watchers points) that is only marginally better in that a fat child won’t necessarily associate the message with their body.

NewMe pointed out that the blog Obesity Panacea ran a post criticizing this new ad, and I plan to delve deeper into this ad in the near future, but for now, I want to focus on the fact that Strong4Life is back with a new statistic AND, guess what…

… this statistic is from the NEJM, so suck on that, Fatties!

I guess they didn’t really think we’d read the study, though.

Yes, this study does suggest that 80% of obese kids become obese adults, but is that the most startling revelation here? Or is the 80% statistic just the most eye-popping number they could find, so they ran with it.

Before you decide, check out the authors’ analysis:

The study cohort consisted of 6328 subjects with a mean age of 11.4 ±4.0 years at baseline, length of follow-up was 23.1±3.3 years. Among 5,554 subjects who had normal weight as children, 812 (14.6%) were obese as adults, 774 subjects who had been overweight or obese as children, 500 (64.6%) were obese as adults, among 147 subjects who had been obese as children, 121 (82.3%) were obese as adults.

Strong4Life wants this study to prove that they have to take such drastic measures because childhood obesity leads to adult obesity. Yet the studies authors say, “Childhood BMI is a predictor of adult BMI, and obesity is very hard to treat once it is established.”

But what do the authors mean by “established”? If you’re an obese baby who becomes an obese infant who becomes an obese adolescent, is that “established” obesity? And, if so, then would the obesity of that child be “very hard to treat”?

To understand what this study’s authors meant, I went to the source file attached to this claim: The Endocrine Society’s Clinical Guidelines on “Prevention and Treatment of Pediatric Obesity” (PDF).

The authors of this study acknowledge that weight loss fails for the vast majority:

Although the long-term outlook may appear bleak, some studies report long-term success in a significant subgroup of patients. The results of population surveys indicate that 25% of adults who had lost more than 10% of their body weight maintained their weight losses for more than 5 yr.

The study  on which this result is based (PDF) used telephone surveys, not actual measurements, which makes the results pretty questionable to begin with. And that 25% success rate is out of just 145 people who intentionally lost more than 10%. In other words, of 145 people, out of the 474 they surveyed, were able to lose more than 10% of their starting weight, and of those 145 people, just 36 were able to keep the weight off for five years. So, really, if you compare this group to the total survey population, instead of just those who lost 10%, it’s more like 7.5% of the population can lose more than 10% of their starting weight and maintain that loss for five years.

But I digress (as per usual)…

The Endocrine Society assures us that this failure rate doesn’t mean we should stop prescribing weight loss:

Although physicians generally strive to cure the great majority of their patients and may view a long-term success rate of 25% with despair, we should not retreat into a state of therapeutic nihilism. We are at a stage where we must treat overweight and obese patients, accept that perhaps only 25% may respond, but refine our techniques so that lifestyle modification will be effective in an increasing percentage of patients.

Instead, they recommend lowering our expectations of what is required for health:

In the more severely obese or in physically mature patients, moderate weight loss of only 7% was associated with a decrease in the incidence of T2DM. This may be a more realistic goal for the severely obese… Physical fitness, even without weight loss, may offer some health benefits. Improvement in cardiovascular fitness was associated, in young adults, with improvement in cardiovascular disease risk factors over a 7-yr period…

Furthermore, relying on BMI alone to measure the positive effects of exercise is wrong:

A meta-analysis of physical activity interventions, commissioned by this Task Force, found a moderate treatment effect when the outcome measure reflected body composition (e.g. fat percentage) (P = 0.00001) and no effect when the outcome was BMI; the difference in results was highly significant (P = 0.002). This would support the concept that exercise may affect cardiovascular risk factors by improving insulin sensitivity and adiposity, and by increasing lean body mass without affecting total body weight.

And finally, they suggest that rather than setting arbitrary caloric limits, there are natural differences in the appetite and caloric needs of infants:

Although healthy infants can differ considerably from one another in their caloric intake, appetite is the most efficient way to determine what an infant needs. Most infants instinctively know how much food they need and will not undereat or overeat unless pressured

So, let’s boil this down: The Endocrine Society says that treatment for pediatric obesity encourages exercise, but the benefits of exercise may occur whether BMI goes down or not. The authors go on to say that in spite of BMI being irrelevant to the effects of exercise, in spite of the fact that just 25% of patients (read: 7.5% of patients) can maintain more than 10% of their weight loss, The Endocrine Society thinks doctors should keep prescribing weight loss.

This conclusion is taken up by the original NEJM article (we’re coming back out of the rabbit hole now) that says 80% of obese kids become obese adults. And while they admit that “established” obesity is very hard to treat, they suggest that parents try to make their fat kids get thin anyway.

The authors stubbornly refuse to accept their own conclusion that weight loss is a futile pursuit, and they won’t even reference the research I outlined in great detail that says weight cycling leads to long-term weight gain. Instead, the continue to prescribe weight loss for obese children, which leads to weight cycling, which leads to long-term weight gain, and then act surprised when 80% of obesity kids become obese adults.

And this is the statistic that Strong4Life is now basing its new ad campaign on.

But I want to offer Strong4Life an alternative view of weight, and one that is accepted by mainstream healthcare organizations.

Healthwise, a content-services provider for healthcare professionals, has created a guideline called “Screening for Weight Problems” which I found on the website of Seton Healthcare Family, a leading provider of healthcare services in Central Texas, serving an 11-county population of 1.9 million. It’s used by many other leading healthcare providers as well, including:

The following is the most valuable section on screening for weight problems:

The U.S. Preventive Services Task Force (USPSTF) recommends using BMI to screen children ages 6 to 18 for obesity.1

  • If your child’s BMI has been high on the growth chart from birth, this may be his or her healthy size and growth rate. He or she may simply be bigger than other children of the same gender and age.
  • If your child’s BMI pattern has suddenly jumped from a lower range to a higher range on the growth chart, your child may be at risk of becoming overweight. Your doctor will carefully track growth over time, watching for a change in the rate of weight gain. Your child may need counseling and other help to make lifestyle changes for a healthier weight.
  • If your family has a history of obesity, your child has a higher risk of becoming overweight.

Sometimes a child’s BMI and weight can increase without a child being at risk of having too much body fat. For instance, before and during puberty it is normal for children to have a significant gain in weight before they begin to grow in height. Also, children who are very muscular (such as children who are very active in sports), may have a high BMI but have normal or even lower-than-normal amounts of body fat.

Rather than focusing on statistics, Strong4Life needs to focus on evidence-based treatments for actual healthcare problems like insulin resistance, rather than obesity. By focusing so much on startling people that 80% of obese kids become obese adults, they miss an even more revealing statistic.

You’ll recall that the NEJM study said, “5,554 subjects who had normal weight as children, 812 (14.6%) were obese as adults, 774 subjects who had been overweight or obese as children, 500 (64.6%) were obese as adults, among 147 subjects who had been obese as children, 121 (82.3%) were obese as adults.”

If we break that down, that means that of the 1,433 study subjects who became obese adults, 57% had a normal BMI as children, 35% had an overweight BMI, and just 8% were obese.

But I guess this…

… just wasn’t scary enough.

5 Comments leave one →
  1. February 22, 2012 12:45 pm

    Very nice. You’re getting at the heart of *medical science* and our culture’s worship of *scientific medical research*–aka S.O.C.I.A.L C.O.N.T.R.O.L.–and I’m loving this series. A population preoccupied with maintaining efficiency and control over our own bodies is a population that has no time or energy to examine their own oppression, no time or energy to feel pain and sadness for what humanity is doing with our precious planet, with our short existence here as individuals…so, THANKS again for resisting the status quo of cruelty and domination. (((hugs)))

  2. vesta44 permalink
    February 22, 2012 2:11 pm

    They’re totally ignoring the 20% who don’t become obese adults – they’re taking credit for their interventions stopping those obese kids from becoming obese adults, but as successful as they’ve been at turning obese adults into thin adults, I really don’t think they’ve managed to stop obese kids from becoming obese adults, not at all. They’re also ignoring the kids who weren’t obese who turn into obese adults – how do they account for them? And there are plenty of obese adults who weren’t obese as kids for them to ignore that statistic.

  3. February 22, 2012 2:52 pm

    Statistics were my least favorite part of A-level Psychology, mainly because they’re so much more complicated than the figures cited in reports like this suggest, so I salute you for tackling this.

    Looking at the original study, the most striking thing for me is the age range at which they started following the kids – I make that 7-15 year olds. Like the Healthwise guidelines say, puberty can lead to some fairly dramatic weight gain. Weigh a child during that time and you might well have an ‘obese’ kid by the percentiles who, a couple of years later and taller, might fall into the ‘normal’ category. The very way in which ‘obese’ is defined means these figures aren’t showing what they purport to show.

  4. hlkolaya permalink
    March 2, 2012 1:01 pm

    “This sleight of hand included a new commercial (not for those running short on Sanity Watchers points) that is only marginally better in that a fat child won’t necessarily associate the message with their body.”

    like hell they won’t! I was a fat kid before people targeted fat kids with anti fat commercials and such… just anti fat propaganda with adults… think I didn’t absorb that and realize that me being fat was just as horrible, just as hate inducing, just as *wrong* as an adult being fat? Oh hells yes I did. I think kids definitely associate adult fat hate with their own bodies.

  5. April 13, 2012 5:52 am

    Hilarious! Love the slide you concluded with. Amazing how stats can be worked to terrify people. Another consideration is that if only 80% of “obese” kids become “obese” adults, 20% of those obese kids experience a DROP in BMI from childhood. The rise in BMIs is coming mostly from kids of “normal” BMI, and second-most among kids of “overweight” BMI.
    I’ll post this, then go back and check out your data on weight cycling leading to weight gain. Great post. Thank you

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