TCS Daily

Pseudoscience and Globesity

By Sandy Szwarc - January 22, 2004 12:00 AM

When the Bush administration announced last week it will demand significant changes to the World Health Organization's initiative against global obesity, it sparked a flurry of international protest from special interest groups accusing him and the food industry of putting corporate interests ahead of the obesity crisis. The WHO report, Obesity - Preventing and Managing the Global Epidemic, was produced with the International Obesity Task Force, whose stated mission is "to convince world leaders that something can be done to address the problem [of globesity]." The Administration stated the plan was based on faulty scientific evidence and succeeded in blocking its approval. Tuesday, WHO decided to table it until the end of February to allow for changes to the text.

In developing WHO's global strategy, a joint WHO - Food and Agriculture Organization of the United Nations (FAO) report, Diet, Nutrition and The Prevention of Chronic Diseases, was released April 23, 2003. It made prevention of obesity in infants and children a high priority. Among their strategies were promoting exclusive breastfeeding among infants; limiting television viewing for children and adolescents; and restricting intake among children and adolescents of added sugars and low-nutrient, energy-dense foods.1

Flawed Strategy: Breastfeeding to Prevent Obesity

Certainly breastmilk is well-established as an ideal and most economical food for babies and the safest choice in developing countries with poor access to safe, clean water. But whether it prevents obesity is another issue.

While in support of this strategy, the report asserts "breastfeeding as a protective factor against weight gain has been examined in at least 20 studies involving nearly 40,000 subjects" even as it admits most of the studies "found no relationship." In fact, no definitive link has been established. Researchers, including Tammy J Clifford, director of epidemiology Children's Hospital of Eastern Ontario Research Institute and editor of the British Medical Journal (BMJ), caution that the conflicting studies could be the result of confounding factors or associations.

Two studies published in the October 2003 issue of BMJ provided further support to question the link. One of the studies was even funded by WHO and Canada's International Development Research Centre and was released as "the largest such study done in the developing world." It showed no association -- breastfeeding did not protect against obesity later in life. The researchers added: "Secular trends do not suggest a protective effect: in both Britain and the United States the incidence of breast feeding has increased since 1990, but so has obesity."2,3

Flawed Strategy: Restrict Sugars and Energy-Dense Foods to Prevent Obesity

Maureen Storey, PhD, Richard A. Forshee, Ph.D. and John A. Knubel, M.A. of the Center for Food and Nutrition Policy (CFNP) at Virginia Polytechnic Institute, a nonprofit organization whose "mission is to advance rational, science-based food and nutrition policy," commenting on the draft report said: "many of the policy recommendations were not supported by the scientific review that noted equivocal or disparate results in the links between dietary components and obesity."4 They noted that the WHO report supported claims of possible causes of obesity on aggregate level data, but such data suffers from the well-known statistical phenomenon called the ecological fallacy. For example, while the population as a whole is eating fast food more and gaining weight, the people eating out and the people gaining weight may not be the same people.5

Research dispels the popular myth that people and kids are fat because they eat too much, or too much bad foods.6 In fact, researchers have found that consumption of high-calorie, low-nutrient ("junk") foods is high among children and teens, regardless of their weight.7,8 And the amount of junk food consumed or frequency of fast food restaurant use is unrelated to BMI [body mass index] or overweight among school children.9.10

This month, a study in Pediatrics claiming fast food leads to obesity in children shows just how weak such scientific support is. The researchers gathered data from two dietary surveys, but no weight or BMI data was collected and they didn't weigh a single child. And their conclusion was filled with so many weeny words as to be laughable: "Consumption of fast food among children in the United States seems to have an adverse effect on dietary quality in ways that plausibly could increase risk for obesity." [emphasis added]11

The sugar industry has been especially proactive in fighting the WHO's initiatives. The Sugar Association issued a paper in October noting the weaknesses of the scientific studies cited in the WHO initiatives.12 "A large body of literature shows carbohydrates, in general, and added sugars in particular, are not associated with overweight and obesity," said Storey and colleagues.13,14,15,16,17

Flawed Strategy: Limit Television Viewing to Prevent Obesity

Despite what may seem intuitively correct, the evidence linking television watching to obesity is far from conclusive. After reviewing the evidence, the American Heart Association concluded in their Medical/Scientific Statement Understanding Obesity in Youth: "Although some studies suggest that obesity is associated with increased sedentary activity, particularly watching television...these differences have been inconsistently demonstrated."18 They went on to caution that obese children may be socially stigmatized leading to less participation in athletics or structured exercise programs but that that didn't translate into dramatic differences in daily energy expenditure as compared to their slender counterparts.

Colin MacDougall, MD, of Flinders University School of Medicine, Australia, and colleagues with the South Australian Human Services have extensively studied physical activity among children found that television watching and computer games can actually encourage children to become more active by inspiring play and copying what they've seen.19 Children get most of their physical activity from child-centered play that's fun to them, they've found.

Storey and colleagues undertook an extensive study of children, 6 to 11 years old, to determine what lifestyle factors impacted children's BMIs. They found that "combining seven variables, including total energy, total fat and added sugars, with age, race, gender and TV hours explained only 6% of the variation in children's BMI" -- with only 1.4% of that variation attributable to hours watching television, Storey testified before the US Dept of Agriculture Dietary Guidelines Advisory Committee, March 8, 1999.20 Interventions targeting the modifiable variables will no doubt have limited influence on childhood obesity. Other factors appear far more significant such as genes, prenatal influences and poverty.

When it comes to environmental-based interventions, there is no evidence that they have any effect on obesity prevalence, said Storey. In fact, WHO's report noted that of 24 school-based interventions, only one showed any effect on obesity and that program only influenced girls, increasing their weight-consciousness. Other researchers agree. With that single exception, stated researchers at Children's Hospital Boston in a recent Lancet article, these "interventions, involving multiple sites, have not reduced obesity prevalence, despite their intensive and in some instances, multi-year design."21

Misplaced Priorities

"The narrow focus on weight obscures the bigger picture of children's health... and confuses symptoms with underlying causes," wrote Nancy King, MS, RD, CDE and Dayle Hayes, MS, RD. "It is critical to remember that weight, nutrition and physical activity are pieces of the overall puzzle of children's health." We do children "a disservice by presenting 'simple' solutions to these complex issues."22

"The epidemiological triad model unfortunately oversimplifies the etiologies of extremely complex, multi-factorial diseases and conditions like obesity, and in addition, ignores the undernourished, and the poverty that they live with on a daily basis," said the CFNP researchers. They criticized the WHO initiatives for avoiding "mention of the more than 800 million victims of food insecurity," noting that "many of the recommendations would most hurt the subsistence populations" in developing countries. "The production of a safe and nutritionally adequate food supply for all must remain the priority [of WHO]."

When officials, diplomats and countless lobbyists gather again next month to duke it out, a lot of money and power will be at stake. But ignored by these misguided priorities will be the 174 million children under-five around the world suffering from malnutrition with stunted growth and developmental deficiencies; the over 5 million children who will die of preventable infectious diseases such as diarrhea and malaria; and the some 15 million children who die of hunger every year -- 40,000 little ones every single day.23


1. Diet, Nutrition and The Prevention of Chronic Diseases, Report of a Joint WHO/FAO Expert Consultation, Geneva 2003.

2. L Li, T J Parsons, and C Power. Breast feeding and obesity in childhood: cross sectional study. BMJ 2003 327: 904-905.

3. Victoria, Cesar, etal. Anthropometry and body composition of 18 year old men according to duration of breast feeding: birth cohort study from Brazil. BMJ; 2003: 327: 901.

4. Storey, M, R Forshee, and J Knubel. Diet, Nutrition and the Prevention of Chronic Diseases -- Comments to the WHO and FAO, May 2002.

5. Forshee RA. Nutrition Research and the Ecological Inference Problem: Determining the Causes of Obesity and Poor Nutrition. North American Association for the Study of Obesity, Long Beach, CA, October 29-November 2, 2000.

6. Samuel S. Gidding, MD, etal., American Heart Association (AHA) Medical Scientific Statement, "Understanding Obesity in Youth," Circulation, 1996; 94: 3383-3387

7. Bandini, LG, etal. Energy expenditure in obese and nonobese adolescents. Pediatric Research; 1990; 27: 198-203.

8. Brady, LM, etal. Comparison of children's dietary intake patterns with US dietary guidelines. British Journal of Nutrition; 2000; 84: 361-7.

9. Kant, Asha. Reported consumption of low-nutrient density foods by American children and adolescents. Arch Pediatric Adolescent Medicine; Aug 2003; 157: 789-796.

10. French SA, etal. Fast food restaurant use among adolescents: associations with nutrient intake, food choices and behavioral and psychosocial variables. International Journal of Obesity & Related Metabolic Disorders: Journal of the International Association for the Study of Obesity; December 2001; 25(12):1823-33.

11. Bowman, Shanthy A. etal. Effects of Fast-Food Consumption on Energy Intake and Diet Quality Among Children in a National Household Survey. Pediatrics; January 2004; 113 (1): 112-118.

12.The Sugar Association, Analysis of Bulletin of the World Health Organization, October 2003.

13. Glinsmann WH, H Irausquin, YK Park. Report from FDA's Sugars Task Force: evaluation of health aspects of sugars contained in carbohydrate sweeteners. J Nutr; 1986; 116(11S): S1-216. 14. The Surgeon General's Report on Nutrition and Health. Public Health Service, U.S. Department of Health and Human Services. Washington, DC: U.S. Government Printing Office, DHHS(PHS) Publication No. 88-50210, 1988.

15. National Research Council. Diet and Health: Implications for Reducing Chronic Disease Risk. National Academy of Sciences; 1989: 273-290.

16. Clydesdale FM. Nutrition and health aspects of sugars. Am J Clin Nutr; 1995; 62:161S-296S.

17. Food and Agriculture Organization/World Health Organization. FAO/WHO Expert Consultation on Carbohydrates in Human Nutrition. Carbohydrates in Human Nutrition. 1998: 1-129.

18. Gidding, MD, Samuel S. etal., American Heart Association (AHA) Medical Scientific Statement, "Understanding Obesity in Youth." Circulation, 1996; 94: 3383-3387.

19. MacDougall, Colin, W Schiller, P Darbyshire, M Williams. Listening To Children's Voices: The South Australian Physical Activity For Children Campaign. South Australia Department of Human Services Abracts.

20. Storey, Maureen. Statement before US Dept of Agriculture Dietary Guidelines Advisory Committee, March 8, 1999, pg 47-49 of recorded transcripts.

21. Ebbeling, CB, DB Pawlak, DS Ludwig. Childhood Obesity: public-health crisis, common sense cure. Lancet, August 10, 2002; 360: 473-82.

22. King, Nancy and Dayle Hayes. Shame, Blame and the "War on Childhood Obesity": Confronting the real problems, identifying the positive solutions. Healthy Weight Journal; Feb 2003; 17 (2): 28.

23. World Health Organization Fact Sheet and World Bank, World Development Indicators, 1998.


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