Is Promising Prevention Good Enough for Childhood Obesity?

Back in February, we noted a study documenting the effects of a childhood obesity program that, according to its authors, “shows promise.” Since then, much has happened with this study. Scholars from the School of Public Health at Indiana University in Bloomington took a closer look at the statistics in this paper. The authors corrected their reporting errors. But the larger problem remains. After many, many years of promising prevention for childhood obesity, is the presumption that merely changing behaviors will be good enough to make a difference in child health?

Numbers That Made No Sense

Xingsheng Li and colleagues pointed out that the numbers originally reported in this paper simply did not make sense and must have been erroneous:

“The point estimate for the intervention associated with the primary outcome of change in BMI z-scores is reported in the abstract as β = −0.17, with a 95 % confidence interval (CI) of −1.92 to −0.36 and p = 0.057. This cannot be correct because the point estimate does not lie within the interval. The corresponding results for the intervention effect on BMI z-scores are reported in Table 2 as β = −0.17, 95 % CI (−0.36, 0.01), p = 0.059, but the CI and p-value do not match the abstract.”

Li et al also identified inconsistencies in numbers reported for the secondary outcome of behavior changes.

To their credit, the authors promptly corrected their errors and inconsistencies. In fact, the journal published their corrigendum a month before it published Li’s letter to the editor. All good.

The Larger Question Remains

But the fact remains that even in its corrected form, a meaningful health benefit of this intervention – sending community health workers to nudge kids and families toward heathier behaviors – is not evident. All we have is the promise of better health. It depends on an assumption that childhood obesity is merely the result of poor health and nutrition habits.

Obesity Is More Than a Behavior Problem

In our opinion, the insistence that nudging people toward better behaviors will solve the health problem of obesity reflects persistent, implicit bias. This stems from believing that if only people with obesity could be persuaded, nudged, taxed, or incented to adopt the behaviors of thin and privileged persons, then obesity would be less of a problem for them.

But research suggests that this is naive. Many factors are at work to promote obesity in the lives of these people. Biological susceptibility is important. Environmental stressors – like racism and other social and economic disadvantages – contribute. So do exposures to endocrine disrupting drugs and chemicals, impediments to active lives, and a food supply that promotes obesity.

Persisting in the pursuit of strategies based primarily on behavior change is not having much of an effect. So we should not be surprised that the problem of childhood obesity grows persistently worse.

Click here, here, here, and here to follow the chain of errors in this study. For more on diverse contributors to obesity, click here, here, and here.

Inês, photograph by Joaquim Alves Gaspar, licensed under CC BY-SA 3.0

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August 5, 2023