Last week I came across several news reports of a study that had me flummoxed.
The C.S. Mott Children's Hospital National Poll on Children's Health claimed to have found a "possible association between school-based childhood obesity prevention programs and an increase in eating disorders among young children and adolescents." The media coverage of this study (no doubt influenced by the study sponsors' own press release) invariably mentioned that 82% of parents surveyed with children aged 6-14 had such programs in their schools and 30% of these parents reported signs of eating disorders in their children.
This was an alarming finding, to be sure, and I initially assumed that the "school-based childhood obesity prevention programs," in the study must have been heavy-handed interventions where kids are overtly shamed or coerced into losing weight, or why else would eating disorders be on the rise?
But when I dug deeper, I shocked to find that the offending programs were these:
- Nutrition education at school;
- Limits on sweets and junk food in the classroom;
- Providing incentives for children to increase their physical activity; and
- The taking of height and weight measurements at school.
That's it. All positive programs, with the possible exception of taking body measurements, but those are needed so schools can identify students at risk of serious diseases like Type 2 diabetes, and monitor the overall effectiveness of any intervention. (Such measurements are also supposed to be taken under conditions to protect student comfort and privacy.) Meanwhile, health-concerned parents and childhood obesity experts are clamoring for the other items on this list -- nutrition education, limiting junk food in class, more physical activity -- that are supposedly at the root of a serious problem.
But what negative behaviors, exactly, are resulting from something as benign and helpful as nutrition education? Are kids running to the bathroom to throw up after lunch? Are they taking laxatives or exhibiting other symptoms of anorexia nervosa?
The "worrisome behaviors" observed by parents ranged from the objectively troubling -- "inappropriate dieting" -- to behaviors which could be signs of an eating disorder but which might actually reflect a child's heightened awareness about food's effect on health, like a new interest in vegetarianism, looking at food labels and or wanting to eat something other than the food served at family meals (which, of course, might not be healthful if the parents themselves are not educated about nutrition).
But there's actually no need to try to figure out it whether these reported behaviors are signs of an eating disorder or not. Why? Because the study did not find ANY of these behaviors to be correlated with school-based programs, with the exception of one:
In this study, we found only one worrisome weight-related behavior to be associated with school-based nutrition interventions: where there were school-based interventions for physical activity, more parents reported their kids to be "too physically active" . . . .
Otherwise we did not find school-based obesity prevention programs to be associated with the other worrisome eating and physical activity behaviors among children that parents reported.
So in the end, the only correlation between school-based anti-obesity programs and student behavior found in this headline-making study is that if you provide incentives to increase physical activity, some kids will become "too active." And how widespread is this "worrisome behavior?" According to the study, it was reported by 11% of parents whose children attended a school with an incentive program, versus 4% of those whose school did not offer such a program. And what did those extra 7% of parents mean when they reported "excessive physical activity?" Are their kids suddenly training for triathlons? Doing push-ups twenty times a day? Or are the parents themselves leading a sedentary lifestyle and therefore unable to objectively view what might just be a normal level of physical activity?
We'll never know, because the study designers admit that
[o]ur study was not designed to quantify the actual level of physical activity nor to understand what aspects of "too much" activity parents found most worrisome.
Now, no one denies that eating disorders are a serious problem, and if 30% of parents claim to be seeing potential signs of eating disorders in their children, that's a finding worthy of concern and further study. But the hollow attempt by the C.S. Mott group to link this phenomenon to school-based interventions (which I can only assume was motivated by a desire to make news) is highly counterproductive in an era in which 30% of our nation's children are overweight or obese.
Schools are where our children spend the bulk of their waking hours. They can provide kids with anywhere from one to sometimes three meals a day, they can allow junk food in the classroom or they can ban it, they can promote recess or they can take it away in favor of test prep, and they can teach children useful information about their bodies and nutrition or they can fail to do so. Accordingly, what happens at school undoubtedly shapes a child's lifelong health habits, for good or for ill. Misleading "findings" like those released by C.S. Mott, which can only discourage those schools trying to do the right thing, simply do not serve our children well.