|
Critique of article published March 3, 2000 by WebMD:
'Baby Fat' Cute, but Contributes to Adult Heart Disease--
Even Lifestyle as a Toddler Matters, Researchers Say"
(read the article here)
This article pairs two unrelated research studies. The first is of a group of 1200 Head Start
preschoolers, measuring statistical markers of growth and health. The second is an unrelated study of 92 parents
(not parents of children in the first study), examining attitudes toward weight and food. The two studies have
nothing in common except that they deal with the subject of fatness. Grouping them together under a single headline
has the effect of tricking the reader into thinking that one study supports the other, when no relationship exists
between them other than public relations marketing.
Let's look at the first study. In scientific research an association between two things does
not prove cause and effect. This study found "obesity in the very young is linked
to high blood pressure" and low HDL cholesterol, but this does not prove that
fatness caused these effects; it could just as easily be theorized that high blood pressure and low HDL caused
the kids to gain weight, or that an unknown factor--genetic predisposition, poor nutrition, stress, another health
condition--caused all three effects. There is no indication that this study made any attempt to eliminate such
factors, and the choice of study subjects is particularly suspect in this regard. By requirement, children who
qualify for the Head Start preschool program are already at risk, health-wise. They are, by definition, kids who
live in poverty--who can't even count on a nutritious breakfast to start the day at home. Lack of access to preventative
health care, medical insurance, prenatal care, and infant nutrition, the stresses of living in dangerous neighborhoods,
and discrimination are all factors militating against the health of poor and minority American families. There
are other problems with this study. People who are economically disadvantaged in general are more likely to be
fat than the population as a whole, and in addition 75% of the kids in the study were African American or Hispanic,
two populations with strong genetic tendencies toward fatness. African Americans are also predisposed to having
high blood pressure. These two facts alone muddy the study's conclusion that "Obesity
begins to threaten the health of the heart as early as age 2." This is like jumping
from point A to point Z. If the researcher had concluded that "poverty threatens the health of the heart as
early as age 2," she might have been on more solid ground. Marketing this study to the readers of WebMD, a
site considered reliable for medical information, is unethical in our opinion. Parents who use the internet as
a source of medical information are far more likely to be consumers of diet services and products than the parents
of the study's actual subjects. To take a study using subjects representative of a special segment of the population
and generalize conclusions based on flimsy evidence to the entire population is extremely poor science, to say
the least. To use it to coerce parents already indoctrinated into the diet mentality into putting their toddlers
on diets to prevent heart disease in later life is simply an outrage.
The report of the second study, which measured parental attitudes toward weight and food, directly contradicts
the effectiveness of putting babies on diets, unless the goal is producing fatter adults. The article states that
the study found "the children most at risk [of becoming
fat] are those whose parents fluctuate between being very concerned about food intake
and weight to tendencies of impulsive eating or loss of control". In lay language,
this describes the diet/binge phenomenon--alternating periods of weight loss with the inevitable binging and weight
gain that follows--or as it is known medically, "weight cycling." Weight cycling in most people has been
shown to result, over a period of years, in a higher weight than they started at. It is not at all surprising that
children of parents who are chronic dieters grow up to become the same, ending up fatter in later life than they
would have been naturally. Conversely, parents in the study who "were not likely
to indulge in impulsive eating"--i.e. who did not diet compulsively and therefore
binge--had kids who were not likely to gain weight. These findings hardly support a policy of putting infants on
diets as a preventative measure. On the contrary, dieting from an early age--the proposed solution to the "problem"
of obesity ["prevention must begin at the cradle"]
is more, not less, likely to result in fat kids and subsequently fatter adults. This illustrates a common problem
with obesity research: when the data contradicts the anti-fat, pro-diet biases of the researchers, all too often
they ignore their findings and base their conclusions on their opinions instead. It is therefore very important
when evaluating these studies to look at the actual findings, not the researchers' or other "expert"
interpretations.
What some of our experts say:
...The obesity experts like Dietz [a prominent researcher] have been harping on the link between
blood pressure and body weight in kids for decades. One important point is that these levels of blood pressure
and cholesterol are NOT HIGH by adult standards! They are just slightly higher (by about 10% or so) than the skinny
kids. Another point is that blood pressure and cholesterol rise with age during childhood and adolescence--all
within normal limits. Fat kids mature early by any standard you care to use, such as age of puberty. What the data
really show is that chubby 2-year-olds have the blood pressure of a skinny 3-year-old--which might be expected
because chubby 2-year-olds are bigger and more physically mature in other ways.
There is no evidence linking childhood levels of risk factors to adult disease. There is, however,
a powerful link between growing up in poverty and developing premature heart disease as an adult.
--Paul Ernsberger, PhD
Department of Nutrition
Case Western Reserve School of Medicine
10900 Euclid Ave.
Cleveland, OH 44106-4906
http://www.cwru.edu/med/nutrition/ernsberger.htm
Email: pre@po.cwru.edu
Fax: (216) 368-6644
This business of identifying and "preventing" toddler "obesity" (which in most
cases is just a child tracking normally on a higher weight curve) is terrifying indeed. It's horrid for children
not to get enough to eat and horrid for parents feel they should be police officers rather than simply nurture.
Of course, many parents are already tacitly restricting their children's food intake for fear they will get fat,
and this sort of thing only fuels the tendency. There is so much naivete about size, shape and normal growth that
it boggles the mind...Children who are TALL when they are young tend to be taller when they get older, as well.
That's just normal growth. If you follow that logic, 100% of children growing at the 95th weight percentile would
still be there when they are 6 and 16 and 26. It doesn't follow. Only about 30% of them will be in higher percentiles
when they get older. The tendency is to slimming. So, (tongue in cheek), what is happening to our children that
they are falling off their growth curves? Aren't they getting enough to eat? That's the puzzling question. If we
get out of this control mentality and trust kids to eat and grow the way they need to, other questions emerge.
--Ellyn Satter, MS, RD, CICSW, BCD
Ellyn Satter Associates
4226 Mandan Crescent, Suite 50
Madison, WI 53711-3062
Phone 608-271-7976
http://www.ellynsatter.com
Books include Secrets of Feeding a Healthy Family (Kelcy Press, Madison, WI) and Child of Mine
(Bull Publishing, Revised 2000).
|