Obesity before the age 5 TOS seminar

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This is my last post from Boston, the meeting is winding down. Thank you to everyone who has been part of making this a really great gathering!

Dr Kirsten Davison: New avenues in the treatment of obesity before age 5 in families are being discovered. Intervening early is a key strategy for achieving long-term reductions in BMI, and there is rapidly expanding interest in this very promising area. A key strategy is the promotion of healthy lifestyles (limit added sugars, limit TV time and so on), as is parenting skills, and interventions that target broader family aspects, such as reducing stress and disharmony. The greatest intervention effects were seen in socioeconomically challenged families, for example where there is parental mental health issues and financial strain.

Dr Cynthia Ogden: epidemiology of obesity in children 2-5 year old with data from NHANES. 7-8% of US toddlers have obesity, with huge ethnic disparities (lowest in whites and highest in Hispanic children). There are no major difference between boys and girls. The increase in excess weight really increases rapidly with age. Obesity rates have levelled off since 2003-2004, and could even be declining. Extreme obesity, however, has increased from 3.6% in 2000 to 5.4% in 2012, which is reflected in the distribution histogram for BMI with a much longer right hand tail. No increase in obesity in children <24 months. Energy intake in 2-5 year olds has been stable in both boys and girls. As children grow older, their intake of added sugars increases. Strikingly, for any given day, 15% of 2-5 year old US toddlers will consume a pizza.

Obesity prevention: what on earth are we waiting for?

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Please allow me to start with a little name dropping here (sorry): my PhD opponent was professor Steven Blair from the Cooper institute in Dallas, notably of fitness/fatness fame, and his really groundbreaking research on fitness and numerous health outcomes. I am sure Steve’s work has helped to save countless lives and will continue to do so. Anyway, one of the things I clearly remember Steve saying was how we (in medical science) have all been led to worship at the shrine of the randomized controlled trial. And if your research is not founded on a randomized controlled trial then work is so flawed, so biased, that you may as well quit and do something else entirely.

His point was very clear: it is far too easy to discredit sound studies that do not use a randomized design. Most people who critique or even completely discard science have never done any science themselves, let alone a randomized controlled trial, and are employed as full time bureaucrats, or work for big pharma, and so they lack the understanding that such evidence is often utopian and oftentimes makes very little sense. In other words, good science is many times discredited for very petty reasons.

But here is my point: we can easily become very stupid if we insist on scientifically proving everything that we want to do. Not only is it utopian for many reasons such as cost and time, it’s often completely unnecessary. We don’t need, for example, a randomized trial to prove beyond any meaningful doubt, that certain things are either good or bad for us such as exercise, junk food or stress.

So far there are very few examples of obesity prevention programs that have been scientifically proven to be effective. That does not mean that we should refrain from very commendable initiatives such as building more parks and bike lanes, taxing junk food much more severely, banning junk food marketing, reducing harmful chemicals from our food such as steroids, preservatives and antibiotics, etc. There is no need to validate all these preventative measures in a gargantuan randomized controlled trial that will take years, if not a decade, to design, fund, carry out, analyze and publish.

The burocrats can always find things to nitpick at if they so wish (they usually do) and use this as an excuse for their inertia. Everyone should know, however, that science is never perfect. We have to trust and use our common sense when it comes to tackling the epidemic, just as much as we have to let good science guide us when we design programs that reduce obesity.

So what are we waiting for? Why is there so little action to prevent obesity? The numbers are getting worse by the day it seems, partly because we are in fact allowing the epidemic to run around more or less unchecked. It’s time to get serious about prevention, and do all these things that can start to slow it down, and don’t sit around waiting for the perfect study to show us exactly what to do, because that could be decades. We can’t afford to sit around any longer hoping that someone else is going to solve this for us.

Erik Hemmingsson

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Gutless and disloyal “revolving door” politicians/lobbyists perpetuate the obesity epidemic

Let me be clear here from the outset: I don’t particularly like most politicians, and I certainly don’t trust them, especially those higher up in office. They usually say one thing and then do something completely opposite, and they generally don’t act as their voters would like them to act.

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Quite frankly, their lack of voter loyalty is nothing short of mind boggling, just look at the US congress. Marion Nestle’s recent post on “revolving door” politicians outlines this very nicely:

http://www.foodpolitics.com/2014/09/the-infamous-revolving-door-two-recent-examples/

Too many politicians are only too happy to go straight to well paid industry jobs, usually as lobbyists or consultants for big tobacco, big pharma, big oil, or any other “big” you can think of, once they end their time as elected officials or civil servants. The many mega junk food corporations have certainly been very well served by this group of politicians/salesmen/lobbyists, at the expense of the wishes of ordinary people.

Given the wealth of scientific evidence conclusively showing that junk food is very detrimental to our health, it’s a scandal that it’s not countered more than it is, including rules for their very aggressive marketing. Most of that marketing is aimed at children to boot. This lack of action certainly serves to perpetuate the stays quo and indeed ever increasing waistlines, see this recent report in JAMA (this report is also a wake up call for all those who think that the obesity epidemic has plateaued):

http://jama.jamanetwork.com/article.aspx?articleid=1904816

Obesity rates (and rates of many forms of cancer, diabetes, depression, etc) could certainly be slowed down and possibly reduced by our elected officials through banning and taxing junk food much more severely. So why don’t they? If you ask me, there are too many revolving doors, too many corporate loyalties, and too many gutless politicians who dare not rock the boat.

The price for all this corruption at the hands of all those who should be serving the public interests first are ever increasing rates of obesity and other non-communicable diseases. This will certainly please big pharma but very few others. How much longer should we tolerate this?

 

Erik Hemmingsson

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When will the obesity epidemic go away?

Today’s post is going to be another one of those interviews where I, er, interview myself. The topic is when we can expect the epidemic to be a thing of the past (easy theme, that…). Let’s get stuck in.

The Hobbit: An Unexpected Journey - Andy Serkis

 

Q: So, let’s jump straight in. When do you think obesity will be no more?

A: Don’t know. Could be a while. Depends.

Q: On what exactly?

A: On many things, such as how much longer we are going to allow the junk food industry to market and sell their garbage to children, families, etc, and things like when we wise up generally to issues like the importance of eating healthy and organic food free of pesticides, preservatives, steroids, antibiotics and lord knows what else, when we stress much less than we do today, when we create a more equal society, when we take care of our children much better, when we integrate physical activity into our everyday lifestyles, when we stop polluting the planet, when the whole world is at peace, when we place much greater emphasis on prevention as opposed to giving drugs or surgically operate on those with already quite severe illness, when we stop photoshopping already ridicuously slim models, when captain Haddock stops drinking whiskey, when…

Q: Alright, steady on, I get it. So, you think it might be a while then?

A: Possibly, but I am going to stick my neck out a little here and say that it could be much quicker than people think, say 2-3 decades, or possibly even less.

Q: To do all those things you mentioned? Surely not.

A: It obviously remains to be seen, but I would not be so pessimistic. We could actually be close to some kind of tipping point where enough people are getting utterly fed up with the whole mess – runaway mega food corporations that want to own everything (including the earth’s supply of water), pollution, out-of-kilter lifestyles, debt, dysfunctional health policies, inequality that went from bad to worse etc – that this current situation kickstarts a lot of energy to do things in a much better and more balanced way.

Q: Are you suggesting some kind of overnight revolution, or something…

A: Not really, but I definitely see better things ahead, although the whole process could be likened to a massive ocean liner that needs to change course. It’s not going to happen overnight, but the intention to change – really change – can be a much quicker thing. Once the intention is there, then good things will start to happen in a more concrete way.

Q: Can you give an example?

A: OK. Basically much of our economy is founded on oil, and this is still so (which is pretty embarrassing), but people are obviously realizing that renewable energy is making so much more sense. So, we have the intention to change the old way of doing things to something infinitely better (the oil industry might not agree here though), but we need to get to grips with the new system, to get it on-line and working, if you like. Just like oil needs to go, so does junk food, stress, inequality, debt and sedentary lifestyles. There probably needs to be more awareness among the general population just how harmful those listed things are, but more and more people are waking up and want a change. Awareness is key, and it is growing, especially in social media, less so in mainstream media.

Q: Where do you see changes happening quickly, and where will it be more slow?

A: I think North America and Europe will struggle the most, simply because the environment is so obesogenic there, and will therefore take longer to change than Asia and Latin America, for example, where the epidemic is much less established. Both Europe and North America are mustering more and more powerful initiatives to counter the epidemic, however, so let’s hope that improvements in those regions do not take too long.

Q: Yawn, I am out of questions. Anything else? 

A: Next time I get to ask the questions.

 

Erik * 2

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Polarity abounds and why it’s time for a new way of doing things

It appears to be a human condition to react very slowly, if at all, to adverse changes that happen very gradually (think the obesity epidemic). If bad things happen very quickly, then we have no problem mobilizing at all, such as what happened during the SARS outbreak just over a decade ago. Moreover, the factors that are feeding the obesity epidemic, such as processed junk food, stress, and socioeconomic adversity, have changed steadily but very gradually as well, making for one gigantic slippery slope that we have apparent problems reacting to.

It seems as if many things in society, including the drivers of the obesity epidemic, are now reaching some kind of peak polarity, i.e. you are either very poor or very rich, you either eat only nutritious organic food or only junk food, and you either exercise 7 times per week according to the latest hype, or you refuse to exercise at all. In terms of socioeconomics the middle class is disappearing fast, and the 1% seemingly flourishes at the expense of the rest of society.

Polarities abound in the present time, and this makes it very difficult to make any inroads into creating the conditions we need in order to produce successful obesity prevention and treatment programs. In short, it is very difficult to separate the fortunes of the individual from the rest of society, and society is not in a happy place right now.

http://www.motherjones.com/politics/2011/02/income-inequality-in-america-chart-graph

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Politically, there is much current upheaval in the world, possibly with some kind of peak fear with war in the middle east, ebola outbreaks, water shortages, extreme weather, and an economy in tailspin – can it get any worse?

The good news is that more and more people are waking up to the fact that the current systems, i.e. politics, finance, food environment, lifestyles, etc, are obviously in need of major reform. Maybe we are even getting close to some kind of breaking point for the current dysfunctional way of doing things. I thick that we are, and when enough people wake up to this reality, that is when we can create the conditions we need for preventing obesity globally.

Do we, for example, want to keep eating junk food when it is abundantly clear that such food is very harmful to our health, do we want to keep the current financial system that only seems to work for the 1%, and do we want politicians that are heavily influenced by corporate interests. Or do we want something better? It’s not as utopian as many people think that it is.

 

Erik Hemmingsson

 

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