BMI buster

Picture from http://www.cats-on-tshirts.com/

A new study from the Columbia University Mailman School of Public Health has revealed that the desire to weigh less was a more accurate predictor of poor physical and mental health than body mass index (BMI). This effect was also found to be truer for women than men.

Apparently, being happy with your weight is key.

The researchers point to the discrimination against larger people that occurs in social settings, the workplace and the home, suggesting that these processes can be internalised. The resultant negative body image can become a chronic source of stress.

The researchers emphasise that there is a large body of evidence suggesting that social stress adversely affects mental health as well as physical health.

Peter Muennig, MD, MPH, Assistant Professor of Health Policy and Management, explains, "The data add support to our hypothesis that the psychological stress that accompanies a negative body image explains some of the morbidity commonly associated with being obese. Our finding that the desire to lose weight was a much stronger predictor of unhealthy days than was BMI further suggests that perceived difference plays a greater role in generating disease."

More details can be obtained by following the source link below. For those wanting to read the paper in full, "I Think Therefore I Am: Perceived Ideal Weight as a Determinant of Health," will be published in the March issue of the American Journal of Public Health.

Source: Columbia University Mailman School of Public Health

An F for BMI

Switching the radio on in the car, I heard of plans to include body mass index (BMI) measurements on school reports. Later, when I looked around on the internet a little, it transpires that an expert has suggested this particular strategy as one tool in the battle against childhood obesity. The radio story made it sound like a done deal. Should BMI assessment be part of the school feedback system? Please take a moment to vote on the sidebar poll.

Of course, childhood obesity is a concern but strategies like this really concern me. I was horrified recently when all the children in my daughter's class were weighed in front of each other. Comments were made by some children to those who were heavier. Is this helpful? I think not and I really worry about the negative impact this could have longer term.

Apparently the report card thing is already done is some U.S. states and in Singapore. Does this happen in your particular part of the world? Would love to hear some feedback about your experiences.

Update: Poll results. Is including the BMI on a report card a good idea? 18% (2 votes) thought so, 18% (2 votes) highlighted some concerns, 64% thought it was a bad idea.

Chewing the fat over anti-obesity programs

Back on the subject of childhood obesity again.

I previously expressed concern that, while accepting that childhood obesity was a problem that needed to be addressed, I wasn't sure that some of the approaches suggested weren't likely to cause more problems than they actually intended to resolve.

The latest news from Singapore seems to confirm that the proof of the pudding is indeed in the eating (poor pun intended)...

For the past 15 years, Singapore has run an anti-obesity program in its schools. The "Trim and Fit" program required children deemed overweight or obese to do vigorous exercise during breaks and after school until they reached a desired weight.

While the program achieved a measure of success in that it reduced the number of overweight children from 14 percent in 1992 to 9.5 percent last year, it also had a negative impact. The program was seen to stigmatise overweight children and led to problems with teasing and bullying of children in the program by their non-affected peers.

Complaints from families have now seen a revision to the program. Singapore has decided to replace the scheme with a more holistic approach, required to be undertaken by all children, irrespective of weight. The aim is to raise fitness levels but to also address mental and social health by promoting a healthy lifestyle overall.

Food for thought for all those currently involved in developing such programs.

And you did realise it's International Bad Pun Day, didn't you?

*wink*

Resources
Singapore ending anti-obesity program after teasing

The O Word

" Finish your vegetables. There are children

in Beverly Hills with eating disorders."

The card above is by Callahan. If you like your humour on the black side, I urge you to check out his website.

I discovered Callahan when travelling in the U.S. a few years back and I came across this particular card when I moved my office on the weekend (who knew I had so much stuff?). It seemed appropriate to accompany this post.

Childhood obesity is the topic du jour these days. Every week, it seems a new study comes out to explain why we're facing this epidemic. This week's study highlights working mums as an underlying reason for childhood obesity. A case of 'too many hours working, not enough time to cook or supervise healthy activity', coupled with the 'working mum guilt factor'. Working mum is time poor and so 'treats' the child with all kinds of unhealthy food items. Notice working dad was missing in the equation. Hmm. Went down like a lead balloon in some quarters.

In the hands of the press, many studies serve only to fuel inflammatory headlines screaming of the dangers of the childhood obesity epidemic and to trigger over the top anti-obesity interventions. Remember the lunch box police? The ban on advertising cheese to children? The Supermarket Nutrition Nannies?

I'm not wanting to minimise the problem. It is an issue that will have serious consequences longterm if not addressed. Diseases commonly seen in middle age, Type 2 diabetes in particular, are now being picked up in adolescents. Scary indeed. The flipside, however, is where will all this hysteria will end?

I flicked on the television the other day and happened to catch Oprah's show about children becoming obesessed with weight and appearance. A four year old who asks constantly if she's too fat? Who refuses to eat breakfast because she doesn't want to add any weight? Another who worries she's not pretty enough? With talk of weighing kids in schools, my own daughter has come home and asked if her weight is okay? If you think this is an isolated problem, check out the increasing popularity of the pro-anorexia sites, as documented by Dr. Anonymous.

What the?

Will the upshot of this intense focus be a whole new set of problems, where we worry that our kids aren't eating, having driven our children towards to the other extreme of unhealthy eating?

Dial H-E-L-P-M-E-I-M-F-A-T

Everyone's read (and many ignored) the 'Smoking kills' type warnings on cigarette packets.

Health experts in the UK are now advocating applying a similar type of health warning to larger size clothing in an attempt to stem the obesity empidemic.

Professor Naveed Sattar, from the University of Glasgow, is advocating that oversized clothing should have obesity help line numbers sewn on to labels. It's proposed that such labels would appear on all clothes sold with a waist of more than 40in for men and 37in for boys, women’s garments with a waist of more than 35in or size 16 or above, and more than 31in for girls.

Granted, it's only one of several proposals put forward in the British Medical Journal on combatting obesity (full reference below although you'll need a subscription to read the article). Most of the suggestions don't really offer anything groundbreaking though, despite the author stressing the need to think outside the box. Another key suggestion is the taxation of high sugar, high salt foods. Given the limited success of a similar tax on cigarettes, the only consequence I foresee is the swelling of government coffers. It can be argued, of course, that this will counteract some of the additional health costs that accrue from obesity related conditions.

But back to the label.

What does it add?

People with weight issues often have a complex relationship with food and measures like this completely ignore the psychological aspects of weight gain. Many people who carry excess weight suffer from depression and low self-esteem. Struggling to find clothes that fit and then finding a helpline number attached, doesn't that have the potential to aggravate emotional distress and exacerbate the problem?

Personally, I think it will have little influence. I also think it's highly intrusive. What do you think? A much needed kick in the pants or overzealous?

I wanted to set up a poll but technical ignoramus as I am, I couldn't seem to generate the code.

Now, who's game to tell this guy?

Resources

Lean, M., Gruer, L., Alberti, G., & Sattar, N. (2006). Obesity—can we turn the tide? British Medical Journal, 333, 1261-1264

Obesity could bankrupt the NHS

The fattening of a generation

Photograph from the ABC

A confronting question from Sydney University's Dr Michael Booth, the state's top expert on childhood obesity, asks whether the greatest child abuse of our time will be the fattening of a generation?

Unless you've been under a rock, you can't help but be aware of the increasing rates of obesity in children and the potential costs in terms of increased rates of type-2 diabetes, hypertension, cardiovascular disease, cancer and osteo-arthritis. With 25% of Australian school-age children overweight or obese, the implications are enormous.

Dr. Booth says although there other issues to be taken into consideration, a diet of junk food could easily be considered a form of abuse.

"It is actually doing their life's chances very great harm. Failing to provide adequate nourishment to your children is a form of abuse, like failing to provide adequate shelter or education or sleep or safety."

Dr. Booth attributes this to parents being in denial about the effects of junk food, to laziness, to time-poor parenting, where it's often about getting food on a plate quickly rather than nutritional content.

The results of a new study by Dr. Booth are frightening, showing obesity begins to cause disease when Australians are still in their teens. Blood samples were taken from 500 Sydney year 10 students to assess risk of diabetes and cardiovascular disease and whether fatty liver disease was present.

15% had elevated insulin levels, a precursor to Type 2 diabetes.
10% of boys and 5% of girls had liver damage.
20% of boys had high blood pressure.

Importantly, the study showed that while children were actually increasing their amount of physical exercise, they were eating more junk food.

Earlier this year, the 10th International Congress on Obesity was held in Sydney. Dr William H. Dietz, director of the Division of Nutrition and Physical Activity at the United States-based Centers for Disease Control and Prevention, spoke about the worldwide problem of childhood obesity.

"Childhood obesity now constitutes a major threat to the health and welfare of populations worldwide. Sixty per cent of overweight five- to 10-year-old children have at least one additional risk factor for cardiovascular disease, and 25 per cent have two or more. Recent data suggest that 15 per cent of adolescents who develop Type 2 diabetes will have end-stage renal disease in 15 years."

Dietz outlined strategies the CDC have found to be useful including physical activity, reduced television viewing, breastfeeding, increased fruit and vegetable consumption, reduced sugar-sweetened beverage consumption, and reduced portion size.

Two approaches, largely based on common-sense practices, that address some of these strategies were also highlighted:

Weightwatchers' Healthy Parent Healthy Child

Weightwatchers is one of the best known weight-loss services but it's not as simple as rolling out the program to children. Research conducted in Sweden concluded that the adult-based program was not suitable. Therefore, Weightwatchers joined forces with pediatricians in the US to put together this pilot program, which puts the Weightwatchers program into a family setting. The basis of the program is setting up a healthy-weight home, a home where everyone who lives there has a lifestyle that encourages them to be at a weight that is right and healthy for them.

The program is based on five simple rules:

1) A focus on wholesome, nutritious foods.

2) Inclusion of treats.

3) A limit on non-homework screen time to two hours (or less) per day.
4) Increased activity - an hour or more per day.

5) The rules apply to everyone in the home.

While the program is not presently available in Australia, Weightwatchers hopes to roll it out within the next year. However, the book of the program is available.

The Mend Program

A healthy Mind, sufficient Exercise, good Nutrition and a balanced Diet. Developed by Dr Paul Chadwick and pediatric nutrition consultant Paul Sacher, the community-run program has had great success in Britain where it is running at 24 sites around the country. Sacher is also the author of From Kid to Superkid, a book which outlines the principles behind the MEND program.

"The key to MEND's success is its integrated approach, combining all the elements the medical community knows to be vital in preventing and treating obesity: family involvement, increasing physical activity and reducing inactivity, dietary education and behavioural modification. The challenge for us is how quickly we can bring MEND to Australia."

Paul Sacher

Resources
Child obesity frightening
Obese kids are headed for heart attacks

Latex and lunches

Do not adjust your sets.

Yes, this is TV celebrity chef Jamie Oliver and, no, he hasn't been digging into a little too much of his own "pukka tukka".

Jamie is publicising his follow-up to "Jamie's School Dinners", his series in which he persuades British schools to ditch processed, ready-made junk food and replace it with fresh, tasty, nutritious food, prepared from scratch every day.

By putting on a latex fat suit, walking around laden with boxes of junk food, he's hoping to drive home a message about the evils of fatty food. In the scene in the photo above, his trademark Vespa collapses under the burden of his weight.

Jamie is certainly commended for his efforts to transform the notorious British school dinner (spam fritter, anyone?) into a healthier option but is this an appropriate way to do it? It certainly has the potential to alienate or offend some people.

More importantly, healthy eating is about so much more than weight loss and this approach runs the risk of making that the sole focus.

Having said that, Jamie is a fun guy and, certainly, humour can sometimes get a serious message over better than the use of shock tactics. Compare this to the current anti-smoking campaign, highlighting mouth cancer (advertising image shown below). A common response to this kind of campaign is simply avoidance through switching the television channel.

So, Jamie. Funny or offensive? Effective or just a plain joke?

What do you think?

Resources:

Oliver sets up fat suit warning

The Lunch Police

I always wanted a Scooby lunchbox when I was kid. Scooby was considered to be very cool. More importantly, the possession of such an item meant my gastrointestinal system was spared the rigours of the British school dinner. Think Spam fritters, unidentifiable fatty bits of meat and copious amounts of spotted dick and custard for starters.

I never got the lunch box.

My gastrointestinal system never recovered.

Of course, with the increasing focus on childhood obesity and the appearance of Type 2 diabetes in adolescents, things have changed considerably in the school canteen. Out go the soft drinks and unhealthy food choices, in come more sensible offerings.

Not a Spam fritter in sight. Despite Monty Python waxing lyrical on "Spam, wonderful Spam", this has got to be a relief whichever way you look at it.

However, attention is now being turned to the content of lunch boxes. The Sydney Morning Herald reports that some pre-schools and kindergartens across Sydney and NSW are now checking lunch boxes and returning contraband items, such as chocolate frogs or fruit rollups, home uneaten.

Where were they when I wanted to be rescued from that Spam fritter?

Educating children to eat healthily from an early age is an excellent idea. There is no argument about that. However, I am not sure that banning certain items is a good idea. Good eating habits revolve around balance. Labelling an item "bad" is not necessarily a good thing. Everything in moderation after all. Banning an item could ultimately make it more desirable. Many of us want what we can't have.

My child receives one treat weekly in her lunch box. The rest of her lunch material is healthy. I would be pretty annoyed if someone went through her lunch box and sent that home.

Do you object to the lunch box police?