Methods: Cluster randomized clinical trial. The Fit Study (2014-2017) randomized 79 California schools (n=28 641 students) to BMI screening and reporting (group 1), BMI screening only (group 2), or control (no BMI screening or reporting [group 3]) in grades 3 to 8. The setting was California elementary and middle school
Among 6534 of 16 622 students with a baseline BMI in the 85th percentile or higher (39.3%), BMI reporting had no effect on BMIz score change (−0.003; 95% CI, −0.02 to 0.01 at 1 year and 0.01; 95% CI, −0.02 to 0.03 at 2 years)
Weight dissatisfaction increased more among students having BMI screened at school (8694 students in groups 1 and 2) than among control participants (5674 students in group 3).
My take: Tackling obesity will require a lot more than measuring BMIs. An interesting follow-up study would be to see if schools who reported BMIs were more likely to take other measures, such as providing nutritional counseling, improving school lunch selection, and providing opportunity for more activity/exercise.
The war on childhood obesity reached its zenith with the 2010 introduction of the national “Let’s Move!” campaign, “dedicated to solving the problem of obesity within a generation.” It was a campaign against “childhood obesity” — not specific health conditions or the behaviors that may contribute to those health conditions. It wasn’t a campaign against foods with little nutritional value, or against the unchecked poverty that called for such low-cost, shelf-stable foods. It was a campaign against a body type — specifically, children’s body types.
In 2012, Georgia began its Strong4Life campaign aimed at reducing children’s weight and lowering the state’s national ranking: second in childhood obesity. Run by the pediatric hospital Children’s Healthcare of Atlanta, it was inspired in part by a previous anti-meth campaign. Now, instead of targeting addiction in adults, the billboards targeted fatness in children…The billboards purported to warn parents of the danger of childhood fatness, but to many they appeared to be public ridicule of fat kids…
Despite ample federal and state funding, multiple national public health campaigns and a slew of television shows, the war on obesity does not appear to be lowering Americans’ B.M.I.s. According to the Centers for Disease Control and Prevention, since 1999 there has been a 39 percent increase in adult obesity and a 33.1 percent increase in obesity among children.
Weight stigma kick-starts what for many will become lifelong cycles of shame..Yet, despite its demonstrated ineffectiveness, the so-called war on childhood obesity rages on. This holiday season, for the sake of children who are told You’re not beautiful. You’re indulging too much. Your body is wrong. You must have done it, I hope some parents will declare a cease-fire.
A recent study (LMS Carlsson et al. NEJM 2020; 383: 1535-43) was summarized in a quick take. Essentially, obese subjects who underwent bariatric surgery survived three years longer than a control group who had not undergone surgery but lived 5 years shorter than a reference group without obesity.
The authors speculate on the reasons why the bariatric subjects continued to have a lower life expectancy than controls after surgery:
Above-normal BMI even after surgery
Irreversible effects of obesity-related metabolic dysfunction
Higher risk of alcohol abuse, suicide, and trauma (including fall-related); these factors were identified in the SOS study more often than in those who had not undergone bariatric surgery
Since there have been improvements in bariatric surgery since the time of this cohort underwent surgery (1987-2001), it is possible that the average gain in life expectancy would be greater.
A recent pilot (n=22) double-blind study (JR Allegrett et al. Clin Gastroenterol Hepatol 2020; 18: 855-63) pours cold water on the idea that repopulating one’s microbiome would be helpful in treating obesity.
In this study, the authors examined obese patients without diabetes, nonalcoholic steatohepatitis, or metabolic syndrome. In the treatment group, patients received FMT by capsules: 30 capsules at week 4 and then a maintenance dose of 12 capsules at week 8. All FMT was derived from a single lean donor.
There were no significant changes in mean BMI at week 12 in either group.
Patients in the FMT group had sustained shifts in microbiomes associated with obesity toward those of the donor (P<.001). In addition, bile acid profiles became more similar to the donor.
My take: Though this was a small study, it suggests that changing the microbiome by itself is likely insufficient to result in significant weight loss.
To lessen obesity, three health risk behaviors have been targeted:
Sedentary behavior -goal is to limit to 2 hours of screen time in 24 hours
Physical activity -goal is 1 hour (or more) of moderate to vigorous activity
Sleep duration -goal is 9-12 hours (ages 6-12 years) and 8-10 hours (13-18 years)
A recent study (X Zhu et al. J Pediatr 2020; 218: 204-9) shows that <10% of U.S. kids meet these goals. The authors examined data (2016-17) from the National Survey of Children’s Health (NSCH) dataset (n=71,811)
80.9% did NOT meet physical activity goal
76.2% did meet screen time goal
581% did meet sleep goal
However, only 9.4% met all 3 goals
Not meeting these ‘movement’ guidelines was associated with obesity, particularly in females (aOR 4.97 compared to aOR 3.99 for males)
My take: We are all made to be different shapes and sizes. Nevertheless, we should strive for healthy behaviors and healthy eating which could improve outcomes.
The U.S. Department of Agriculture has proposed new rules for school meals aimed at giving administrators more flexibility in what they serve in school cafeterias around the country each day.
For instance, instead of being required to offer higher quantities of nutrient-dense red and orange vegetables such as carrots, peppers and buttternut squash, schools would have more discretion over the varieties of vegetables they offer each day. In addition, students will be allowed to purchase more entree items as a la carte selections…
Critics say the proposed changes from the Trump administration amount to further rollbacks of the nutrition standards put in place during the Obama administration following the passage of the Healthy, Hunger-Free Kids Act of 2010…
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I had the privilege recently of introducing William Balistreri as the keynote speaker for the Georgia AAP Nutrition Symposium. Dr. Balistreri is a personal hero for me; someone I admire greatly. Hopefully, if he reads this, he will forgive me for forgetting to mention in my introduction that he also is a Lacrosse coach for one of his grandchildren’s team.
He gave a tour de force presentation on the global challenge of obesity. In addition, he discussed undernutrition, endobariatrics, gastroenteritis, climate change and even food waste; 40% of U.S. food is thrown away. In Finland, there is a ‘Grocery Store Happy Hour‘ for distribution of reduced cost/free groceries which may help reduce food waste. In general, I try to condense what I read or hear –that was pretty much impossible with this lecture which was packed with information based on the latest research as well as information dating back to the 5th Century BC/Plato. What follows are some of my favorite slides.
A recent book (not discussed in lecture) provides related information. “We Are The Weather” by Jonathan Foer, was reviewed this past weekend in the NY Times: Meat is Murder: “[This book] has a point, and that is to persuade us to eat fewer animal products. Foer makes the case that, for Americans and citizens of other voracious meat-eating countries, this is the most important individual change we can make to reduce our carbon footprints.” However, the reviewer, Mark Bittman, states that “we’re not good at making positive decisions about our future. And we’re really not good at denying ourselves cheap pleasures like cheeseburgers.” He advocates for stronger laws, government leadership, and pricing the products to account for their true costs in terms of their contributions to climate change, public health, and environmental degradation.