The failure of anti-obesity programmes in schoolsBMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k507 (Published 07 February 2018) Cite this as: BMJ 2018;360:k507
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Is a citizenship education resource equally beneficial to health compared with a healthy lifestyle programme? Reasons for supposing it may be: improved self-esteem? improved group cohesion? improved inclusivity? Morale matters.
Also: Did anybody measure the body mass index effects on parents, grandparents and other carers?
Has anybody yet systematically recorded opinions of involved teachers?
Against the background of deteriorating obesity levels in our society, are new primary school families already the best informed, and most idealistic about, exercise and good nourishment, as promoted from ante-natal care onwards?
Try again at entry to Secondary Education? With a true non-intervention control group?
Competing interests: Potential conflict of interest: author, a locum GP, is a parent and grandparent who thinks targeted health education can sometimes be welcomed and that citizenship could be much better taught.
The research and your editorial clearly identified that the particular approach to obesity did not work.
This is not surprising as childhood obesity is primarily an environmental issue rather than a disease or condition which requires therapy or medical interventions.
For countless generations children have played outdoors close to their homes at no cost to themselves or Government. This is so natural that we have taken it for granted and failed to recognise its importance.
Not only is the play beneficial exercise it is also when children learn how to take turns, reach agreements, settle disputes, reach compromises. All this without adult supervision.
Schools are only open half the days in the year and the school journey is only twice a day so it is obvious that initiatives based on schools are severely hampered.
The simple fact is that road traffic has so dominated residential roads that children can no longer pay out and get healthy exercise every day of the year. This fact has been ignored by the NHS, Public Health England, Chief Medical Officer for England, NICE, etc. The approach by PHE of blaming parents is misguided. Parents quite sensibly keep their children indoors because the roads outside have become too dangerous. Many do try to compensate by taking the children to clubs and classes but these can never be as beneficial as every-day play.
An approach which suggests that all children should go to organised activities every day would cost more than the total schools budget.
The obesity epidemic was predictable. We know from zoos that mammals need to run around just outside their houses if their health is to be maintained.
My research and experience (1) has found that children still play out as they always have done where traffic speeds are slow, particularly in cul-de-sacs, Radburn designed estates and similar where traffic is significantly calmed.
The vast majority of roads are residential side roads. We need to make them the equivalent of a zebra crossing along their whole length. Giving pedestrians priority will enable children to get out and play. A healthy environment will give us healthy children.
(1) Child's Play: Facilitating Play in Housing Estates, (with Dr Alison Millward) (1997) (reprint 98); pub. Chartered Inst. of Housing & Joseph Rowntree Foundation. Download free from http://www.jrf.org.uk/publications/childs-play-facilitating-play-housing...
In addition 12 unpublished reports based on the same methodology have been made to local authorities and housing associations. Also 25 years of assessing hundreds of children's playground each year.
Competing interests: No competing interests
This is not te first obesity prevention trial to have failed, and it is definitely not the last. I applaud this editorial because such trials are necessary elements of testing our understanding of obesity. Really, the common sense approaches endorsed by governments worldwide are mostly useless.
“But these are 'necessity driven' actions rather then evidence driven. Before children are denied access to television, games, and chocolates, let us look at the evidence. Although some interventions promise limited effectiveness in weight reduction, not one trial has shown prevention of weight gain in the population.” (PMID:10858053) The faith-based mass programs like changes in taxation and limiting access to soft drinks are impressive but costly and a total failure. Failures may make us angry, but instead of next trying "what if?” we need thorough testing of the proposed interventions, whatever they are and how reasonable they appear to common sense.
Competing interests: No competing interests
Excerpt: "It is time to step back, take stock, carefully examine longitudinal data from contemporary children, and generate new, solution focused approaches that could maximise health gain and be rigorously and speedily tested."
One approach, currently forbidden by National Health Service dietary dogma, is the high saturated fat/low linoleic acid diet. Increasingly, consumers are realizing they've been misled by proponents of the anti-saturated fat campaign. For example, "Consumers are making new choices, switching away from carbs to food containing fat such as red meat, butter and eggs. This trend offers powerful investment ideas, according to a study by the Credit Suisse Research Institute."(1)
One American family that stumbled on to the truth about saturated fats has taken advantage of the above-mentioned trend. Here's their story. "My husband and I are often asked how it is that we came to be in the snack food business. It is an odd business for a mom and pop start-up given that it’s dominated by major global brands. It’s a very personal reason with a complex backstory... We weren’t looking for a cure to our son’s undiagnosed disease – we were simply trying to make his quality of life much better and address what we thought was the biggest problem: inflammation. And we were able to do so by changing his diet. In fact, food was the only thing that was ever able to intermediate his disease process: good fats, grass-fed meats, fresh and fermented vegetables. We soon realized that almost everything we had believed about fats was quite wrong. We realized that traditional, healthy fats that had been consumed for centuries (like cod liver oil, tallow, lard, coconut oil, and unpasteurized butter from grass-fed cows) were a source of essential nutrition. And that man-made vegetable oils are the product of an industrial manufacturing process that was invented 100 years ago were a source of real nutritional aggravation."(2)
That those man-made vegetable oils have become ubiquitous in our modernized food supply has not gone unnoticed. "We now know that major changes have taken place in the food supply over the last 100 years, when food technology and modern agriculture led to enormous production of vegetable oils high in ω-6 fatty acids, and changed animal feeds from grass to grains, thus increasing the amount of ω-6 fatty acids at the level of LA (from oils) and arachidonic acid (AA) (from meat, eggs, dairy). This led to very high amounts of ω-6 fatty acids in the food supply for the first time in the history of human beings."(3)
Endocannabinoid system research suggests that changes in the fatty acid profile of ones diet can lead to obesity. Excerpt: Dietary intake of linoleic acid (LNA, 18:2n-6) has increased dramatically during the 20th century and is associated with greater prevalence of obesity. The endocannabinoid system is involved in regulation of energy balance and a sustained hyperactivity of the endocannabinoid system may contribute to obesity. Arachidonic acid (ARA, 20:4n-6) is the precursor for 2-AG and anandamide (AEA), and we sought to determine if low fat diets (LFD) could be made obesogenic by increasing the endocannabinoid precursor pool of ARA, causing excessive endocannabinoid signaling leading to weight gain and a metabolic profile associated with obesity."(4)
Thomas Brenna's research indicates that humans with the genetic mutation mentioned below are similar to the mice in the above experiment in terms of ability to convert 18 carbon chain omega-3s and 6s to the longer chain 3s and 6s. Consequently, they are more likely to become obese and diabetic when they use linoleic acid-rich culinary oils to prepare animal products rich in arachidonic acid.
In a new study published in the journal Molecular Biology and Evolution, researchers compared a primarily vegetarian population from Pune, India to a traditional meat-eating American population, mostly from Kansas. The researchers found a higher frequency of the mutation called "rs66698963" in the Indian population. This mutation helps people convert plant fatty acids into important nutrients, including omega-6 arachidonic acid. Arachidonic acid is important for muscle growth and healthy neurological function in humans and is usually contained in meat, eggs and dairy. However, arachidonic acid is also known for its pro-inflammatory and pro-blood clotting properties. Today, this genetic mutation can be a problem because omega-6 fats are readily available in an increasing number of foods and oils. Consequently, people with this mutation are retaining higher levels of arachidonic acid in their blood and tissues.(5)
In a 2003 Orlando Sentinel article entitled 'Hunger Confronts Bigger Issue', global obesity expert Barry Popkin repeatedly mentioned the global increase in meat and vegetable oil consumption.
"If you go back to those same villages or slum areas today ... their diet includes a lot of vegetable oil ... In China ... Rice and flour intake is down, and animal-source foods such as pork and poultry and fish are way up, and the steepest increase is in the use of edible vegetable oils for cooking ... People are eating more diverse and tasty meals; in fact, edible oil is a most-important ingredient in enhancing the texture and taste of dishes ... The edible-oil increase is found throughout Asia and Africa and the Middle East as a major source of change."(6)
Based on the assumption that saturated fats clog arteries because they raise cholesterol levels, the National Health Service advises everyone to "swap foods high in saturated fat for small amounts of foods containing unsaturated fats,"(7)
Is this sound advice. It would seem not.(8) Perhaps it's time to reject conventional wisdom and embrace the wisdom derived from experience.
Competing interests: No competing interests