Tuesday, May 15, 2012


How many kids look overweight in this photo?

By Edward Copeland
One of my favorite memories involving the late, great Mike Wallace on 50 Minutes occurred when he interviewed people about the possibility the tobacco companies had the capability for lit cigarettes to stop burning if it sensed that the smoker had ceased to actively puff on it, the idea being that it would prevent people from falling asleep with a lit cigarette and starting a blaze as they slumbered. Activists accused the tobacco companies of refusing to do this because of the costs and Wallace asked the activist, "What about personal responsibility?" The outraged man replied, "We must protect the stupid consumer." I get the sense that could be the attitude of the makers of The Weight of the Nation as well. (My attitude always has asked, "Why should we protect the stupid consumer?" We should set more traps. That's evolution at work. Thin the herd.) On the official web site for The Weight of the Nation project, a new "fact" appears about every six seconds or so (including ones I questioned and/or debunked in Monday's review of the series' first two parts). Surrounding these informational nuggets of type include rectangular buttons above that lead you to either watch the films or take action, the familiar Twitter, Facebook and Google+ icons to the right, four photos and graphics below describing related activities and, finally, to the left a blood-red arrow emblazoned with the word FACT pointing at the constantly changing message in the middle of the page. Now, if I had a full-time staff of investigators and unlimited time, I could have all these assertions, none of which come with a source, checked and verified as to their accuracy. Unfortunately, it's just me, my computer and my very limited stamina doing its best to fight my M.S. fatigue. Since Part Three of The Weight of the Nation concentrates on "Children in Crisis," I thought I grabbed one of those "facts" relating to that subject. Remember, we don't have any sources — we're supposed to take their word for it when they say, "Nearly one-third of children and adolescents are overweight or obese." I'm going to dig further since my first response relies solely on anecdotal evidence. Asking a dozen or so acquaintances with children in that age range who attend schools in all parts of the country and in different economic circles as well, not one reported an uptick of heavyset kids in their child's school with the exception of one parent in Tulsa, Okla., who said that in her child's grade, she didn't see it, but she'd noticed heavier kids starting about third grade. That's it. Otherwise, parents would report one kid with a weight problem here or there, but certainly not a third of the students. Part Three, "Children in Crisis," debuts tonight on HBO at 8 Eastern/Pacific and 7 Central followed by Part Four, "Challenges," at 9:10 Eastern/Pacific and 8:10 Central. As with the first two parts of The Weight of the Nation, the films will play on all HBO platforms and stream free on HBO.com.

One curiousity before I start. For some reason, "Children in Crisis" happens to be the only segment that doesn't list Kaiser Permanente as a partner in the opening credits. I wonder why. Get to work, media.

Doing a Google search for the phrase "Nearly one-third of children and adolescents are overweight or obese" directed me quickly to the site that provided some of the other "facts" that rotated on and off The Weight of the Nation web page. It turns out to be the Childhood Obesity Facts page of the Centers for Disease Control and Prevention's online section on Adolescent and School Health, which lists a variety of subjects under its Health Topics index including the next immediate page, Nutrition, Physical Activity, & Obesity. Like well-trained journalists (and unlike documentarians — or at least the ones responsible for The Weight of the Nation), scientists tend to cite sources when they make declarations and each of the assertions they make in the graphic below come with numbers that refer you to footnotes that explain where they got their information. Now, not only did the makers of The Weight of the Nation decide that saying something with authority negated the need for verification, they also had no qualms about dropping or changing words that didn't suit their purposes.

1. Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in US children and adolescents, 2007–2008. Journal of the American Medical Association 2010;303(3):242–249.
2. National Center for Health Statistics. Health, United States, 2010: With Special Features on Death and Dying. Hyattsville, MD; HHS; 2011.
3. National Institutes of Health, National Heart, Lung, and Blood Institute. Disease and Conditions Index: What Are Overweight and Obesity? Bethesda, MD: NIH; 2010.
4.K rebs NF, Himes JH, Jacobson D, Nicklas TA, Guilday P, Styne D. Assessment of child and adolescent overweight and obesity. Pediatrics 2007;120:S193–S228.
5.Daniels SR, Arnett DK, Eckel RH, et al. Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment. Circulation 2005; 111; 1999–2002.
6. Office of the Surgeon General. The Surgeon General's Vision for a Healthy and Fit Nation. Rockville, MD, HHS; 2010.

The complete phrase "Nearly one-third of children and adolescents are overweight or obese" actually reads beneath Childhood Obesity Facts on the CDC page, "In 2008, more than one-third of children and adolescents are overweight or obese." Of course, government health entities can't agree. As I reported yesterday, The National Heart, Lung and Blood Institute, a division of the National Institutes of Health which itself falls beneath the auspices of the Department of Health and Human Services, while agreeing with the CDC's findings that "Childhood obesity has more than tripled in the past 30 years," also commented that, "Children have become heavier as well. In the past 30 years, the prevalence of childhood obesity has more than doubled among children ages 2-5, has tripled among youth ages 6-11, and has more than tripled among adolescents ages 12-19. However, recent data suggest that the rate of overweight in children did not increase significantly between 1999 and 2008, except in the heaviest boys (BMI for age greater than or equal to the 97th percentile). This rate, though, remains alarmingly high. Statistics show about 17 percent of American children ages 2 to 19, or 1 in 6, are obese. Further, the latest data continue to suggest that overweight and obesity are having a greater effect on minorities, including blacks and Hispanics.". Sadly, while I've been so kind about researchers citing sources, neither the CDC nor the NIH comes up with one for the 30-year statistic. I decided to take the 30-year question to Google and I found the answer in a posting on an HHS site on childhood obesity by the assistant secretary for planning and evaluation. Obviously, whoever penned this did not begin his or her professional life as a writer. I didn't attempt to clean it up. It reads, "Overweight and obesity in children are significant public health problems in the United States. The number of adolescents who are overweight has tripled since 1980 and the prevalence among younger children has more than doubled. According to the 1999-2002 NHANES survey, 16 percent of children age 6-19 years are overweight (see Figure 1). [1], [2],[3] Not only have the rates of overweight increased, but the heaviest children in a recent NHANES survey were markedly heavier than those in previous surveys." Hallelujah, we've come back to our good friends at NHANES and this link goes to their report. though this assistant secretary needs some help with adjectives, at least he or she included footnotes.
1. Childhood is defined for the purposes of this paper as 6-19 years of age
2. Overweight and obesity are used interchangeably and are defined as a BMI on or above the 95th percentile for gender and age (BMI-for-age). Downloaded from here. Accessed: February 2005. These terms have different connotations for adults.
3. National Center for Health Statistics. “Prevalence of Overweight Among Children and Adolescents: United States, 1999-2002” Downloaded from here. Accessed: February 2005.

Aside from my anecdotal evidence, which admittedly doesn't account for much, I keep coming back to several questions. First, why do the same organizations conduct and release studies that contradict other studies they've conducted? While the press material says that this project took four years to assemble, that doesn't mean they couldn't make last-minute changes if needed. What if one of the interview subjects or experts passed away in the interim? I bet that they would have been able to note that sort of thing. However, they go with this 30-year figure, provided by the CDC's NHANES group covering 1999-2002 and released in 2005. Then, in a New York Times article by Tara Parker Pope published May 28, 2008, that same NHANES group from the CDC, which conducts its surveys continuously and revises results accordingly, releases findings that cover a wider sample — 1999-2006 — to the Journal of the American Medical Association that The Times said, "Childhood obesity, rising for more than two decades, appears to have hit a plateau, a potentially significant milestone in the battle against excessive weight gain among children.…The most recent data is based on two surveys — one in 2003 to 2004 and one in 2005 to 2006 — that included 8,165 children ages 2 to 19. In that group, about 16 percent of children and teenagers were obese, which is defined as having a body mass index at or above the 95th percentile on United States growth charts.…(T)he good news is that from a statistical standpoint, obesity rates have not increased since 1999. Estimates for the number of children who fall into the overweight or obese category also have remained stable at about 32 percent since 1999.…In fact, the number of children who fall into the obese category decreased from 17.1 percent to 15.5 percent between the 2003 and 2006 surveys, but the decline was not statistically significant. So the researchers combined data from both surveys to enhance the statistical strength of the numbers." Good news makes lousy scare tactics, so the documentary hung on to the older, more pessimistic numbers. The other thing that bugged me about that 30-year number is that it covers my adolescence. I've been honest about myself — I wasn’t remotely in shape. There were people heavier than I was, but there were a lot more who weighed less. More importantly, the big concern at the time wasn't that teens could be eating their way to an early grave — the major worry was the possibility of teenage girls puking their way to an early grave. How is it that in the same era where eating disorders such as anorexia and bulimia dominated the spotlight, supposedly adolescents grew obese? Those images of the pencil-thin models still permeate the media. Do adolescent girls today ignore them? Are they packing on pounds out of spite? Something just doesn't make logical sense, especially since you still hear cases about it and in another New York Times article, this one from 2008, again by Tara Parker Pope, she reported on normal-weight teens who "feel fat." Her first three paragraphs read as follows: "At a time when much of the Western world is focusing on obesity problems, even teens who are at a healthy weight may develop a distorted body image. That’s what German researchers found after surveying nearly 7,000 11- to 17-year-olds, asking them to describe their bodies. Options included far too thin, a bit too thin, just the right weight, a bit too fat and far too fat. About 75 percent of the kids fell into the normal-weight category. However, half the normal-weight girls and a quarter of the normal-weight boys still described themselves as being too fat." When I read that, do you know what, of all images, popped into my head? Greg Kinnear's overbearing father trying to guilt his young daughter Olive (Abigail Breslin) out of ordering ice cream when they stop at a restaurant along the highway in Little Miss Sunshine. Sometimes, the well-meaning concern for people's health does seem to cross the line into bullying behavior.

Before I move on to some segments of "Children in Crisis" that most people will agree presents ridiculous situations, I need to backtrack to an issue that I didn't get a chance to cover Monday (but which gets mentioned so often throughout The Weight of the Nation that I bet some stressed-out college students already employ the word for use in a drinking game. Before I piss people off with my conspiracy theory on that subject though, I feel compelled to raise two more of the unsourced "facts: that appear on the series as well as its web page. Let's start with this doozy of an uncredited bit of information.I think I'll bring back their little arrow.

Some experts project that by 2030, between 32% and 52% of American adults may be obese.

Well, if the authoritative "some experts" employed the tried-and-true scientific method of prediction, this undoubtedly must be a fact, right? I've seen the slimiest political campaigns offer up more solid attribution for a claim than that. I attempted the Google trick again, inserting the exact phrase but all that came back was The Weight of the Nation site, Going vaguer, I typed, "U.S. adult obesity rate in 2030." That hit the mother lode as a seemingly endless array of recent news stories, blogs and marketers covered the announced result, though each place had a slightly different take and not one that I read mentioned a range between 32% and 52%, though I might hazard a guess as to where they came up with that. The Los Angeles Times used this headline on its May 8 story: 42% of American adults will be obese by 2030, study says with a lead-in below it that read, "Though the rate of the last 30 years has slowed, it's far from leveling off, and it's going to get expensive, say experts at the Weight of the Nation conference in Washington." Now that's intriguing. The conference from which the documentary series took its name admitted a slowing a week before The Weight of the Nation aired. The makers of the documentary did have time to add this fresh statistic, but not to acknowledge the slowing rate in the growth of obesity that has been occurring since prior to the start of production on the series. The body of the L.A. Times story by Melissa Healy said, "The ranks of obese Americans are expected to swell even further in the coming years, rising from 36% of the adult population today to 42% by 2030, experts said (May 7).…The sobering projections also contained some good news, the researchers said: Obesity's growth has slowed from the record pace of most of the last 30 years. If those trends were to continue, 51% of American adults would qualify as obese in 2030. Study leader Eric Finkelstein, a health economist at Duke University in Durham, N.C., said…(t)he forecast took into account a host of factors thought to influence Americans' eating and exercise habits, including the cost of groceries, the prevalence of restaurants, the unemployment rate, Internet access and the price of gas. Most important was the aging of the population, which tends to nudge many overweight adults into the obese category — and to push many of those who are already obese into "severely obese" territory. The number of severely obese Americans is expected to grow from about 5% today to 11% in 2030, the study said. The findings are based on data collected from 1990 through 2008 as part of the Behavioral Risk Factor Surveillance System, a survey by the CDC and health departments in the states." We now know someone from Duke University led the study using CDC numbers, but incorporating lots of factors the usual NHANES doesn't take into account. Where the documentary concocted the 32$ to 52% range remains a mystery, especially the 32%. The 52% could at least be a typo.


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Your two blogs were amazing. You might be interested in looking at the work of fat rights activists like myself and fat studies scholars who have provided criticism of the documentary. My blog fatbodypolitics.com has a post with not only my take on the films but links to other posts.

Thanks and I didn't even get to finish my second post. The M.S. fatigue will do that to me, but it's amazing how they label everything as "fact" but don't also say it is survey based and the guidelines from the CDC itself says there are sampling error and they have to take larger sampling errors. I didn't even get to the part about how over the decades doctors and pharmaceutical companies invented "borderline diabetics" and over the years keep lowering the blood sugar level as to what qualifies yet no reports get announced saying new studies lie behind this.
A lot of it has to do with the money that is funding all of this. They talked about the 60 billion dollar diet industry but not about the billions that the government throws into it for studies and 'cures.' Even with new findings every month that fat bodies can be healthy. The NIH has their obesity panel with people who get money from the company that makes lap-band. Studies are funded to find a 'cure' for diabetes that are actually trying to create weight loss drugs. There is money in making fat bodies diseased and any discussion about studies or perspectives that counter that are swept under the rug.

Look at the IOM report that was titled The Weight of the Nation. That report was why they kept saying that we would have 42% of the population obese by 2030. It looked at the rate of change for the cost of things like alcohol, gas, health food, 'junk food' etc and the amount of fast food restaurants that have tripled to assume that if prices continued in the pattern that they have and more fast food restaurants opened since 1970 that obesity would rise. This is even though the CDCs own website shows that body size leveled off in 2003. There was a study from the University of Michigan called 'F as in Fat' that came out last year that tried to say that in 16 states rates had risen to 30%, what no one noticed was that the rate of change and the margin of error were the same amount.
The show said "Some experts project that the rate by 2030 could be between 32 and 51" but when I ran out of energy, I couldn't figure out where that range was coming from but, again, they omitted the margin of error and the articles the day the report came out mentioned the leveling off and dropping of increases in some groups. To me, the big mystery of the documentary is why a health insurance company/hospital juggernaut like Kaiser Permanente would be one of the main sponsors and, more importantly, its name didn't appear in the credits of the "Children in Crisis" episode. I wish I'd had more time and research capabilites to really sink the whole thing when it aired, but I got way behind on other projects before I got to it.
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