Four girls in Åsgårdstrand

Childhood Obesity Campaigns: All Harm, No Benefit

We confess to being fed up with campaigns right now. But three articles in JAMA Pediatrics shine an especially harsh light on childhood obesity campaigns in two forms. One is the PSA approach exhorting families to beware of childhood obesity. The other is the practice of weighing and measuring kids in school and sending BMI report cards home to parents. Kids have a name for these reports – fat letters.

For years now, we’ve been telling you that these campaigns are worse than useless. They’re harmful. And now, JAMA Pediatrics seems to agree. Tracy Richmond, Idia Thurston, and Kendrin Sonneville write that these programs offer no benefit, only harm.

BMI Screening

Kristine Madsen et al conducted a randomized clinical trial of BMI reporting in California schools. Researchers randomly assigned students to three different groups. One group received screening for BMI, but no reports. The next group received both BMI screening and reports. Finally, the third group received neither. No screening and no reports.

BMI reporting had no effect on weight outcomes. None. However, it did have an effect on how kids thought about their bodies. They were more dissatisfied with their weight. They talked about it more. The authors concluded:

“Body mass index reports alone do not improve children’s weight status and may decrease weight satisfaction. To improve student health, schools should consider investing resources in evidence-based interventions.”

Clearly, it’s time for the American Academy of Pediatrics to update their policy on BMI screening at school. For too long, the Academy has given tacit approval to this noxious and useless practice.

Public Health Campaigns

The second study in JAMA Pediatrics dealt with campaigns to build awareness about childhood obesity in the UK. What has three decades of increasing focus on this subject yielded? Francesca Solmi et al found a growing prevalence of teens trying to lose weight through diet and exercise. They became more likely to overestimate their weight status and call themselves overweight.

Girls who believed themselves to be over overweight experienced more and more depression over the three decades of this analysis. But at the same time, prevalence of childhood obesity in the UK has grown. Of course, this is observational data, so we should interpret it cautiously. The fact remains, though, that we have no evidence that ginning up worry about overweight has done any good in the UK. The authors conclude:

“These findings suggest that an increased societal and public health focus on obesity could have had unintended consequences related to weight-control behaviors and poor mental health.”

First Do No Harm

We have learned over the last few years that people can rationalize just about anything in public policy. So it’s time to take stock of what we’re doing in childhood obesity. Policies that promote blame and shame are not helping. They’re hurting. At the same time, kids living with severe obesity can’t get good care. Health systems don’t have the resources to provide it because health plans won’t pay for it.

We must demand better care for kids living with obesity. At the same time, we must stop useless and harmful “awareness” campaigns and BMI screening in schools now. Public health campaigns should meet a standard of delivering actual benefits without undue harms.

Hyping a problem without offering solutions is simply unethical.

Click here for the editorial, here for the Madsen study, and here for the Solmi study.

Four girls in Åsgårdstrand, painting by Edvard Munch / Wikimedia Commons

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November 20, 2020

5 Responses to “Childhood Obesity Campaigns: All Harm, No Benefit”

  1. November 23, 2020 at 10:15 am, Allen Browne said:

    Yup!

    “Hyping a problem without offering solutions is simply unethical.” Very gentle way of describing it.

  2. November 26, 2020 at 10:07 am, John DiTraglia said:

    Bravo but –
    -schools should consider investing resources in evidence-based interventions.”

    and

    -At the same time, kids living with severe obesity can’t get good care. Health systems don’t have the resources to provide it because health plans won’t pay for it.

    and

    -Hyping a problem without offering solutions is simply unethical.

    sounds like there are ways to treat and prevent obesity. We need to inform up front that that is not so (short of surgery)

  3. November 27, 2020 at 4:37 am, Ted said:

    John, I agree with informing people up front. But not that surgery is the only option for preventing or treating obesity. The options for managing this chronic disease are far from ideal, but people do have options. What works for one will not work for all, and none of it is a cure. For now, these options are merely tools for managing a chronic condition. And they are a heck of a lot better than finger pointing and glib instructions to eat less and move more.

  4. November 28, 2020 at 9:34 pm, Valerie said:

    What are those evidence-based interventions that work for preventing and treating obesity (short of surgery)?

  5. November 29, 2020 at 4:43 am, Ted said:

    Valerie, some programs for prevention have shown promise, mainly by improving the environment for nutrition and physical activity. But, to be sure, the evidence is thin, because wishful thinking is common. This is worth a read: https://doi.org/10.1016/j.amepre.2018.08.023.

    For treatment, behavioral strategies can be helpful (https://doi.org/10.1002/ebch.462) if they are well-designed. Pharmacotherapy options are limited, with orlistat indicated for teens, setmelanotide recently approved for certain patients, and liraglutide showing promise (https://doi.org/10.1056/NEJMoa1916038).

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