More Evidence…

…that there’s no evidence behind the War on Fat Kids.  According to a review of weight monitoring in children published in Health Technology Assessment:  

No sound evidence supports weight monitoring to identify and treat obese children, according to a review of worldwide research published this month in the United Kingdom.The relative benefits and harms of monitoring have not been determined, and the effectiveness of current treatments is doubtful,” say review authors led by Marie Westwood, Ph.D., of the University of York.

Also the press release points out another admission – this time by the American Academy of Pediatricians – that there was no evidence behind the AMA’s recently released weight loss protocol for kids. (Which, to review, instructs doctors to use increasingly aggressive weight-loss “interventions” for 15% of children, including dieting, “behavioral modification” and “consideration of” very low calorie diets, medications and surgery):

The American Academy of Pediatricians, members of which served on the expert committee, acknowledges the lack of evidence on prevention and early identification of obesity in children. Their policy statement adds, “The enormity of the epidemic, however, necessitates this call to action for pediatricians using the best information available.”

Let’s set aside that it’s completely disingenuous to imply that “the best information available” suggests that either “prevention” or enforcing weight loss on children works (just the opposite, actually). What’s phenomenal is that in one fell swoop both the rules of evidence and the principle of “do no harm” have been tossed aside.

And how do they justify this suspension of the normal checks and balances? “The enormity of the epidemic necessitates” it. What they’re really saying is: “the sheer size of the population who will be affected by our recommendations means we don’t need any evidence.”

Come again? With any other “condition” the size of the affected population is precisely what restrains public health officials from making recommendations without solid evidence. If millions of patients (especially children) will be affected – that’s when they are ordinarily compulsive about evidence – because the potential for harm if you’re wrong is staggering.

I have never heard of – nor can I really imagine – another situation where the size of the target population alone was the only reason given for not using caution and not waiting for evidence.

It is a mind-blowing abandonment of both restraint and logic.


8 Responses to “More Evidence…”

  1. kateharding Says:

    Mind-blowing, indeed. I have nothing to add, but this is an awesome post.

  2. Tracy Says:

    Truly boggles the mind. It’s escaped their notice that they’ve been wrong about the whole low-fat paradigm…the potential for harm (physical, emotional) from these recommendations is pretty damn high.

  3. spinsterwitch Says:

    I think I remember reading the quote from the recommendations that they could not wait for evidence in order to begin proposing interventions. I know of very few things which are so dangerous that they justify experimentation on children.

  4. Neel Says:

    The bottom line here is that kids in rich countries are eating more than they need and what is needed is parental intervention rather than pediatric fat police.

    Thanks for the thought-provoking post.

  5. Meowser Says:

    Not every child in this country is eating more than they need, Neel. Some get a lot less than they need. And it’s that food insecurity that makes many of them fat, because their metabolism slows down when they are undernourished and makes them pack on weight when they finally do get enough to eat.

    Anyway, Sandy on Junkfoodscience makes a pretty good case that kids overall, aside from those living in poverty, aren’t eating significantly differently or “worse” from 20 or 30 or 40 years ago. Life in the ’60s and ’70s wasn’t all organic veggies and brown rice, I can tell you that from experience.

  6. fatfu Says:

    spinsterwitch – yeah this admission was also made in the conference that spawned the recommendations. This is just the admission reiterated.

    Neel – meowser’s right. It’s not at all clear that kids are eating more. The biology here is *really* complex. I’m not going to say you’re wrong. Because nobody knows what’s going on. But what I do know is that anybody who’s been studying it who’s even a little bit honest will admit: nobody knows why kids are heavier than they were. Everybody’s heavier, by the way – by like 5 to 10 lbs. And there are hundreds of theories, no joke. But it’s not as simple as it looks, i guarantee you.

  7. Fat a Greater Threat than Drug Abuse, Smoking, or Alcohol at Hoyden About Town Says:

    […] corporations with a tremendous financial interest in promoting weight loss; for reporting that the American Academy of Pediatricians admits there is no evidence that “childhood obesity interven…, then says we can’t wait for evidence, and not batting a goddamned eye; for continuing to […]

  8. JenK Says:

    People are 5-10lbs heavier, yes – and remember that the BMI thresholds for “overweight” and “obese” were lowered in 2000. Not that BMI is perfect, but still, a BMI of 30 was not obese in 1999, but is “officially” obese now.

    Of course the number of “obese” Americans has gone up in the last 10 years! We changed the definition to include more people!

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