Lessons Learned

evaluation-lessons-learned

Back in 2003, the state of Arkansas embarked on an exceptional project whose object was to really do something about childhood obesity. Laying the groundwork was a huge job in itself. It required the cooperation and coordination of the legislators, their advisory body, school administrators, teachers, nurses, Phys Ed teachers, and cafeterias. And parents, of course, and definitely the students. The ambitious goal required everyone to be on board.

The idea of tracking such a project from its inception was music to the ears of the Robert Wood Johnson Foundation (RWJF). Here was a solid and irresistible opportunity to chart the progress of big, wide-ranging program, right from the jump.

RWJF funded “an evaluation of the process and impact of the law’s implementation.” They wanted to know in real time whether the blueprint was viable, and whether it was working. A research team scrambled to design the paradigm and parameters of the evaluation, and take care of all the other preparatory steps that result in a useful study.

What was proposed?

Act 1220’s original intention was to provide body mass index screenings for all students every year, and to have the parents notified of the BMI scores. Seems pretty straightforward. But resistance was immediate, vehement, and multi-faceted. The press contributed to misunderstandings and mistrust, with headlines seemingly designed to trigger the “Don’t tread on me” American.

The concept was to have the BMI score hand-carried home by the kids, and it met with objections on privacy grounds. It would be too easy for a bully to snatch a chubby kid’s report card and flaunt it around. Consequently, money had to be found to pay for postage to mail the reports, and the Arkansas Center for Health Improvement stepped up. Some critics felt that every year was too often, and that requirement was changed for older kids.

A belief that BMI scoring was mandatory angered many parents. The report explains:

The original legislation did not speak of parents’ ability either to opt in or out of their children’s participation in the school-based BMI assessment program; thus, parents and students always had an implied ability to opt out of the program. However, because the Commissioner of the ADE had issued several advisory letters to school district superintendents instructing them to comply with the mandates of Act 1220 and assess all students, there was at least some perception that participation was mandated.

In practice, parents who did not want an assessment and students who refused to participate were allowed to make that choice without consequence.

A number of school districts developed parental consent forms, which were completed by parents as a part of the annual registration at the beginning of each school year. However, a minority of school district officials and parents remained opposed and vocal in their dissatisfaction with the lack of a specific ‘‘opt out’’ provision in the statute.

This is the kind of roadblock the anti-obesity efforts ran up against, and it illustrates how complicated the quest for change can become. Even in one basic, seemingly unquestionably necessary part of the program, there was a lot of stuff to wade through. The example shows why it is so beneficial to have reports like this one.

(To be continued…)

Your responses and feedback are welcome!

Source: “Evaluation of Act 1220 of 2003: Lessons Learned, 2004-2012,” RWJF.org, Feb 2014
Image by Robert Wood Johnson Foundation

Obesity, Quality of Life, and China’s One Child Policy

kid-in-stroller

China’s One Child Policy was introduced in 1979, technically applying only to ethnic Han Chinese, and with a gradually-increasing number of exceptions permitted. The government decided that making women give birth without anesthetic would encourage compliance, because who wants to go through that twice?

The carrot-and-stick approach included both incentives for people who obeyed the law, and punishments for those who did not, including forced sterilizations and late-term abortions. A couple of years ago, the law was changed to allow two children.

Are Chinese singletons obese?

A study of the influence of China’s one-child policy, by researchers from four universities, was released recently. Its conclusions are summarized by these points:

Being single-child was associated with high risk of childhood obesity.

Single-child status and childhood obesity association became stronger over time in China.

Single urban children were more likely to have excess energy intake than those with siblings.

The obesity trend was exacerbated by other cultural factors, like a suspicion toward fresh groceries that lingered for a while after a series of contamination scandals and scares. Despite being laced with sugar, salt, and chemicals, processed food items were perceived as more healthful.

As the country’s prosperity increased, people shunned the traditional bicycles for cars, and burned fewer calories. Rather than doing farm work, millions of Chinese found themselves sitting at desks to earn their livings. When families were forced to limit the number of progeny, attention became focused on a limited pool of children eligible for spoiling, and a sort of competition took place among relatives to see who could most successfully fatten up a lone child.

Are obese Chinese kids miserable?

That depends on how you define misery. Millions of kids have enjoyed sumptuous early childhoods of being treated like “little emperors,” overfed by both their parents and grandparents, showered with gifts of computers, play stations, and other gadgets that foster a sedentary existence.

Inevitably, it all caught up. “Internet addiction” became a genuine concern, as grownups blamed online gaming for the extra pounds the kids became encased in. This resulted in the establishment of harshly administered “fat camps” and of specialized institutions for treating internet addiction with methods as extreme as electric shock.

Despite the fact that many concerned parents made efforts to encourage contact with other children, the outcome of the One Child Policy was found to be negative by a 2013 study by researchers from three universities:

Results indicated that individuals who grew up as single children as a result of China’s OCP were significantly less trusting, less trustworthy, more risk-averse, less competitive, more pessimistic, and less conscientious individuals.

Those qualities seem destined to create a life experience which, while it may not reach the “misery” benchmark, is nonetheless unhappy.

Hong Kong footnote

In 1997 Hong Kong became one of China’s Special Administrative Regions. Although it was exempt from the One Child Policy, Hong Kong faces its own obesity epidemic. Presently, about 40% of adults are overweight or obese, along with about 20% of the school-age kids, and this is definitely considered a public health problem.

Your responses and feedback are welcome!

Source: “9 things you didn’t know about China’s One Child Policy,” Sbs.com.au, 08/17/16
Source: “Are single children more likely to be overweight or obese than those with siblings?,” ScienceDirect.com, 07/21/17
Source: “China confronts problem of obesity,” Independent.co.uk, 01/01/13
Source: “Effects of China’s One Child Policy on its children,” ScienceDaily.com, 01/10/13
Source: “Quality of life in overweight and obese young Chinese children,” BioMedCentral.com, 03/06/13
Photo credit: robot42 via Visualhunt/CC BY-SA

More Quality of Life Studies

happy-teens-jumping

In 2011, Britain’s National Obesity Observatory announced that the negative impact of obesity on children’s mental well-being increases with age. While the friendships of younger children may barely be affected, in the teen years “peer relationships can become more problematic, leading to obese adolescents being more at risk of marginalization and victimization.”

Obese teens also tend to be depressed, and…

[…] there is strong evidence to suggest that by adolescence, there is increased risk of low self-regard and impaired quality of life in obese individuals, particularly in the perception of physical appearance, athletic competence and social functioning.

Researchers found that people from lower socioeconomic backgrounds are hit harder by the negative emotional effects of obesity, such as depression. At the same time, obesity probably also increases the risk of depression, although not to such a degree, among the economically and socially privileged.

But those are adults. The impact on children and adolescents is less clear, because of inconsistent data. This much is known:

Being overweight as a child or adolescent has been found to have an adverse effect on a young person’s self esteem, self image, and self concept, with physical appearance and athletic/physical competence being most affected…

However, literature reviews have concluded that in spite of adverse social and interpersonal consequences, obese children may only have moderate levels of body dissatisfaction and few are depressed or have low self esteem. Evidence also suggests that obese children are not pre-destined for depression and do not see themselves without merit.

The 28-page report restates the idea that weight management programs have the potential to help obese youth even if there is no weight loss in the short term, and confirms that obesity and impaired mental/emotional health can be mutually reciprocal in perpetuating each other.

In 2014, another meta-study appeared, based on data derived from “the ERIC, FRANCIS, MEDLINE, PsycARTICLES, PsycINFO, and Academic Search Premier databases” and limited to “articles reporting cross-sectional QOL studies in obese children and adolescents published in English before January 2013.” They looked not only at weight status but such varied factors as parental education level, self-image, bullying, bodily pain, quality of food intake, physical activity, and time spent with TV and computer screens.

According to the study:

Among the 34 articles retained for the analysis, only three did not report lower QOL among obese youth.

Only three out of 34 did not find some manifestation of a lower quality of life for overweight/ obese kids. Those numbers seem significant. But a critic could ask, “Is there confirmation bias? After all, who decided which studies to include?” Because of the actions of some corporations and some shady scientists, we have all learned to be more cautious, and the innocent get the side-eye along with the guilty.

A recent British study found that overweight/obese 5- and 6-year-olds in the United Kingdom are pretty much as happy as their normal-weight schoolmates.

Last year, Egypt’s National Nutrition Institute, employing the PedsQL (Pediatric Quality of Life Inventory version 4.0), examined the physical, emotional, social, and scholarly functioning of 111 children age 6 to 12, and found that:

There was a significant negative correlation relationship between total quality of life scores and BMI, waist circumference and weight.

Your responses and feedback are welcome!

Source: “Obesity and mental health – National Obesity Observatory,” Khub.net, March 2011
Source: “Quality of life in overweight and obese children and adolescents: a literature review,” NIH.gov, May 2014
Source: “Is utility-based quality of life associated with overweight in children?,” 7thspace.com, 12/16/15
Source: “The health-related quality of life in normal and obese children,” ScienceDirect.com, June 2016
Photo credit: dolgachov/123RF Stock Photo

Quality of Life Studies

smiling-girl-in-the-field

At the recent International Conference on Childhood Obesity where Dr. Pretlow presented a workshop, he, of course, also took advantage of the opportunity to hear others speak. He was particularly interested in a presentation by Dr. Tommy Visscher, who referenced a 2003 University of California study that was the origin of the widely-quoted finding that “obese children rate their quality of life with scores as low as those of young cancer patients on chemotherapy.”

Lead author Dr. Jeffrey Schwimmer characterized this result as striking and profound. The subjects were 106 children ages 5 to 18 and their parents, who all filled out questionnaires. Interestingly, the parents rated their children as being even more deeply unhappy than the children themselves did.

A 2005 Australian study with around 1,500 subjects also questioned both the children and their parents. The objective was to see if community population-based samples lined up with clinical samples:

The effects of child overweight and obesity on health-related QOL [quality of life] in this community-based sample were significant but smaller than in a clinical sample using the same measure.

Previously, the only two relevant population-based studies had been less than totally useful because there was no tool for self-reporting by children, so everything came from the parents. Another difficulty in comparing studies is that some concentrate more on the physical aspects and others focus on mental and emotional health and relationships with others. They might take different factors into consideration, or use different methodologies.

There is also the ancient “Which came first, the chicken or the egg?” problem. Is there a “transactional relationship mediated by the presence of co-morbidities or by factors extrinsic to the child, such as parental mental health”? In other words, does the quality of life decline because the child is overweight/obese, or do children become overweight/obese in reaction to lives that are already messed up?

An American study published in 2005 looked at a “nationally representative sample of adolescents” and found a “statistically significant relationship between BMI and general and physical health but not psychosocial outcomes.” However, in the 12-14 year age group the deleterious impact of overweight and obesity was more pronounced in the areas of depression, self-esteem, and functioning in school and other social settings.

A 2010 German study followed children through a year of treatment for overweight/obesity. Even though the majority remained overweight, they seemed to benefit from the intervention in terms of subjective health, emotional well-being, and quality of life both in general and in relation to their weight.

The researchers felt this information could be useful for helping patients deal with chronic obesity, even if the impact on their weight was not impressive. The degree of impairment to quality of life can be influenced, and people can learn better coping skills.

The report on a 2010 meta-study began by noting the following:

Although an increasing number of children and adolescents are becoming obese, the psychological morbidities associated with obesity are not well established. Existing reviews report modest associations between obesity and global self-esteem. However, none have examined how this affects multi-component assessments of self-esteem and quality of life in young people with defined obesity.

The researchers looked mainly at physical competence, appearance, and social functioning. While there are “significant reductions in global self-esteem and quality of life in obese youth,” they found that improvements occurred both in the presence and absence of weight loss.

Your responses and feedback are welcome!

Source: “Obese Children Rate Their Life Equal To Cancer,” Forces.org, 04/08/03
Source: “Health-Related Quality of Life of Overweight and Obese Children,” JAMANetwork.com, 01/05/05
Source: “Overweight, Obesity, and Health-Related Quality of Life Among Adolescents: The National Longitudinal Study of Adolescent Health,” AAPPublications.org, Feb 2005
Source: “The impact of overweight and obesity on health-related quality of life in childhood — results from an intervention study,” BioMedCentral.com, 12/23/10
Source: “Self-esteem and quality of life in obese children and adolescents: a systematic review,” NIH.gov, August 2010
Photo via Unsplash via Visualhunt

Sorrow and Silence

gagged

Dr. Pretlow has said many times that when children and teens suffer from obesity their lives can be as miserable as the lives of youngsters afflicted by cancer. At the recent International Conference on Childhood Obesity, he heard this confirmed by a like-minded colleague, Dr. Tommy Visscher.

In the soft sciences, research depends heavily or exclusively on self-reporting. When subjects are reticent, little progress is made. Thousands of kids have shared their experiences and feelings via Dr. Pretlow’s interactive website Weigh2Rock. Yet, during the various studies concerning W8Loss2Go he noticed that they do not like to talk about their unhappiness — at least not in person.

Dr. Pretlow says:

In our three studies involving 143 overweight/obese young people, we’ve observed a striking disconnect between their anonymous voices and their face-to-face voices, in terms of what they say about their lives and their struggles with their weight. Anonymously, they write heart-wrenching stories about their lives. Face-to-face, or even on the phone, none (zero!) in our three studies admitted to being unhappy about being overweight or that they struggle to resist overeating.

The reluctance to “open up” may result from a lifetime of being judged and shamed. In his book, Overweight: What Kids Say, Dr. Pretlow quotes a 15-year-old girl who shared this online:

My mom said to me today “Melissa… if you just lost some weight, you’d be drop-dead gorgeous.” Comments like that don’t help one’s self-esteem.

At some point, people simply are not willing to hear any more criticism, or even any more well-intentioned but clueless concern, and build a virtual wall around themselves. Fortunately for the professionals trying to figure this out, some people talk later, when all the adolescent tumult has settled down.

Scott “Q” Marcus told readers of the Ukiah Daily Journal about his 9 lb. 14 oz. birth weight which progressed into obesity despite constant negative attention from his parents and an unspecified number of doctors. No reducing diets worked, and having to shop for “husky” clothes was humiliating. As a 230-pound high school freshman, he was “the second fattest” of more than a thousand.

Marcus describes being ignored by the female students, harassed by the males, and chosen last in team sports.

Teased and humiliated, I was shoved into lockers naked while pushed from jock to jock down the narrow aisles until finally, I could put my clothes on and run from the gym, seeking respite from the merciless cruelty for 24 hours; knowing it would resume the next day.

Remarkably, the story of Marcus took a turn. He later wrote this account, titled “Striving for Imperfection,” to celebrate 20 years of life as a person whose weight is appropriate to his height. He is quick to admit that he still occasionally slips and stumbles on the path, and forgives himself:

Our “inner jerk” is not helping us. After all, if guilt and shame were motivational, we’d all be skinny. It doesn’t work. Instead of bullying ourselves into submission, we must look at flubs in the same fashion a toddler views falling down while learning to walk. “Oops, that didn’t work. Let’s try again.”

Your responses and feedback are welcome!

Source: “Striving for Imperfection — Twenty years hence,” UkiahDailyJournal.com, 10/08/14
Photo credit: Jerry Daykin via Visualhunt/CC BY

Dialogue at CIOI 2017

staged-withdrawal-phone-screenpics

In July, Dr. Pretlow travelled to Lisbon, Portugal, for the International Conference on Childhood Obesity where he attended and participated in a workshop about which he says, “It was an epiphany for me.” A talk by Dr. Tommy Visscher was followed by a discussion, and Dr. Pretlow found a great deal of value in both.

Dr. Visscher is an associate professor at the Windesheim University of Applied Sciences in The Netherlands, where he specializes in biomedical health sciences and epidemiology. His particular interests are the public impact of obesity and the promotion of health.

Dr. Pretlow says:

In his talk, Dr. Visscher described the terrible lives of obese young people. He said that obese children and adolescents are teased unmercifully, are unable to experience life fully, and have a quality of life rating at the same level as of young people with cancer on chemotherapy. Thus, he proclaimed that they are extremely motivated to lose weight.

Given this extreme motivation, what are the factors that stand in the way of losing weight, and, especially, of maintaining weight loss? Dr. Visscher names genetic and cultural factors, and the determination of food manufacturers to flood the market with cheap foods that are purposely engineered to be irresistible.

When the discussion opened, Dr. Pretlow had a question: “Do you agree that if obese young people simply ate less that they would lose weight?” This was Dr. Visscher’s answer:

No, I do not agree. When they eat less, their bodies go into starvation mode, which shuts down their metabolism, preventing weight loss. Also, their natural weight set point would prevent weight loss and especially maintenance.

The basic concept of the set point is that the body cannot distinguish between a famine and a reducing diet. All it knows is to make the defense of its fat stores a top priority. Consequently, the more strenuously a person tries to limit caloric intake, the more stubbornly the body fights back against what it perceives as a hostile attempt to starve it.

The seemingly intractable problem

This is why even successful weight losers will eventually “plateau out,” and why the great majority of weight losers regain the same amount they lost, or even more. Set point theory also explains why early-onset obesity is so much more difficult to overcome. Researchers now look back even further than infancy, to investigate whether in utero exposure to certain chemicals can influence the set point.

Dr. Jules Hirsch and Dr. Sandra Aamodt are two notable proponents of the set point concept. The eminent Dr. David Ludwig proposes that the body can be convinced to accept a new, lower set point. Some practitioners believe this can be accomplished through the practice of mindfulness.

To Dr. Visscher’s explanation of how the set point prevents weight loss and the ability to maintain it, Dr. Pretlow remarked that it seemed to imply that people in concentration camps and in famines would not lose weight. Dr. Visscher’s reply was:

Okay, if obese young people ate a lot less, eventually they would lose weight, but this is extremely difficult to accomplish, because of all the tempting food in our society, their genetics, and cultural factors.

Dr. Pretlow:

But if obese young people are so miserable and so highly motivated to lose weight, why aren’t they able to resist the tempting food, eat less, lose weight, and not be miserable anymore?

Dr. Visscher:

Well, I guess it’s like sort of like an addiction.

At this point, another audience member spoke up to say that addictions are treated by abstinence, and people cannot abstain from eating. Dr. Pretlow replied:

That is not entirely true. You can abstain from eating between meals, and you can abstain from eating excessive amounts at meals.

And, indeed, in his own workshop which he presented on the following day, Dr. Pretlow presented the addiction treatment techniques which make these very things possible.

Your responses and feedback are welcome!

Image by Dr. Pretlow

How About Those Phthalates?

baby-on-deck

The obesity epidemic continues to thrive, and studies suggest that we do massive damage to ourselves by filling the environment with phthalates. They are in cosmetics, fingernail polish, perfume, lotions, shampoo, self-tanning potions, soap, and in the coatings of pharmaceutical and nutritional pills.

They are in toys and even in baby pacifiers. They are in all sorts of cleaning products, scented candles, and air fresheners. They are in flooring, wall coverings, and varnishes. They are used in food processing and packaging. Phthalate molecules are found in the water and in the air, and there is no escaping them, but we can at least make a conscientious effort not to absorb any more of them than the absolute minimum.

But why do so many anxious worriers want to avoid phthalates? A lot of evidence points to these chemicals being endocrine disruptors. Their presence is associated with allergies, asthma, type 2 diabetes, some kinds of cancer, and obesity.

As we have already noted, obesity is well known to occur in the same children who suffer from asthma and allergies, and of course the link between obesity and diabetes is well established. All in all, there is good reason to suspect that phthalates could be the root cause of all these things.

The BBP menace

It appears that the presence of these chemicals in the body can tip the epigenetic balance of stem cells toward adipogenesis. A good case can be made for their agency in fat formation. In fact, researchers at Texas A&M Health Science Center found that exposure to one particular substance, benzyl butyl phthalate (BBP), probably influences lipid accumulation and fat storage in a fetus by altering the epigenome of stem cells.

Journalist Bailey Kirkpatrick phrases the process in technical language:

An epigenetic balance between histone acetylation and histone methylationin mesenchymal stem cells (MSCs) can dictate whether the stem cells are destined to be fat cells, known as adipocytes, or cells that help form new bone, known as osteoblasts. Hypoacetylation and hyperacetylation has been shown to favor osteoblast formation, but any disruption of this balance could lead to unwanted consequences. In their study, they discovered that “BBP increased acetylation and decreased dimethylation of lysine 9 on histone 3” which tipped the balance “towards an adipogenic fate.”

As if fast food did not already have a bad enough reputation, its processing and packaging adds phthalates, which are found in significantly higher levels in the bodies of habitual fast food consumers. Scientists have found a strong correlation between the chemical DEHP and diabetes, and also allergies, and elevated BMI measurements.

Roberto A. Ferdman reported on pertinent work done at the Mount Sinai Medical Center:

Researchers working on this study measured phthalate concentrations in the urine of 387 children plus recorded body measurements including BMI, height, and waist circumference one year later. Children exposed to the highest concentrations of chemicals also had larger BMI results and larger waist circumference results.

Your responses and feedback are welcome!

Source: “Could Common Chemicals Tip the Epigenetic Balance and Program Someone for Obesity?,” WhatIsEpigenetics.com, 05/24/16
Source: “Researchers have found a ‘striking’ new side effect from eating fast food,” WashingtonPost.com, 04/15/16
Photo credit: David Goehring (CarbonNYC [in SF!]) via Visualhunt/CC BY

What Are Phthalates and Why Should We Care?

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Well, for starters, maybe we shouldn’t care. Although phthalates are blamed for causing obesity, these chemicals may or may not be guilty. In some cases, the connection seems clear.

DEHP, for instance, is identified as a hormone disruptor that affects far more than weight, and it is found in the bodies of children with higher Body Mass Index scores. Some authorities have gone so far as to name phthalates as potentially the most dangerous ingredient found in many preparations that people use every day.

If the label of a cleaning solution or beauty product contains “fragrance” that means phthalates. If the potion is “unscented” it likely contains phthalates too, as a masking agent. Products such as air fresheners might present a double whammy, layered with one chemical to numb the olfactory receptors and blot out unpleasant odors, and another to supply the allegedly fresh scent. The thing about phthalates is, no matter how you feel about them, they are almost impossible to avoid.

Let us count the ways

The graphic on this page, showing a printed list gleaned from an old textbook by a defunct website, dates from back when there were only 15 satisfactorily confirmed causes for obesity.
Four years ago, the Downey Obesity Report listed 98 putative causes for obesity. A less extreme number was arrived at by Dr. Lee Kaplan, director of the Weight Center at Massachusetts General Hospital, who counted 59 types of obesity.

The finger of blame has been pointed at many apparent causes. Some may be little more than guesses, and some may appear downright silly. They may be erroneous, derived from faulty or insufficient research. The difficulty with multi-factorial phenomena is the old correlation/causation problem.

Too often, conclusions are jumped to because a very important rule has been forgotten: Correlation does not always equal causation. When it comes to a behavior engaged in by every human, like eating, an enormous and very reliable sample of the population is needed before any pronouncements should be made.

Ideally, a great deal of conscientious cross-checking is done. The fact that this does not always happen could be responsible for quite a few alleged causes of obesity. In the case of phthalates, the matter is complicated by their presence in food, water and air. They are, to all intents and purposes, unavoidable.

A trio of knowns

Three things about obesity are unquestionably known. First, far too many people have succumbed to it.

Second, successful treatment is hit-or-miss. Dr. Kaplan is quoted by Gina Kolata of The New York Times:

It makes as much sense to insist there is one way to prevent all types of obesity — get rid of sugary sodas, clear the stores of junk foods, shun carbohydrates, eat breakfast, get more sleep — as it does to say you can avoid lung cancer by staying out of the sun, a strategy specific to skin cancer.

Dr. Frank Sacks, a professor of nutrition at Harvard, tells the press that obesity, like cancer, is not one disease but many; and causation is the question “at the center of obesity research today.”

According to Dr. Sacks:

Two people can have the same amount of excess weight, they can be the same age, the same socioeconomic class, the same race, the same gender. And yet a treatment that works for one will do nothing for the other.

Third, obesity needs to be addressed extensively, affordably, and promptly. No matter what brings people to obesity, and regardless of what they have tried before (including surgery), one thing is true of everyone. People need to examine their relationships to food, and figure out how to self-administer that vital commodity without killing themselves, which is why Dr. Pretlow has spend an entire career helping them do this.

Your responses and feedback are welcome!

Source: “98th Cause (that was fast),” DowneyObesityReport.com, 09/01/13
Source: “One Weight-Loss Approach Fits All? No, Not Even Close,” NYTimes.com, 12/12/16
Image by unknown; fair use

More on Keeping an Eye on the CDC

surveillance-camera-mounted-wall

We left off noting that relationships between government agencies and industry groups that step in to offer them funding may not always deserve the suspicion heaped upon them. After all, cooperation is good, and letting Big Soda pay some of the bills is not necessarily evil. Unfortunately, and especially in times of scarce government funding, accepting financial help from the private sector is sometimes the only way to get anything done.

While watchdog groups that scrutinize these relationships are justified in wanting to keep a vigilant eye on things, it may be that the public should just stop being so paranoid and simply say “Thank you.” But it is difficult to relax. Past experience tells us that when corporations offer financial aid, they may have shady motives, and the intent to exert improper and harmful influence on the political side.

Writing for The New York Times, Sheila Kaplan says:

The growth of public-private partnerships, as they have come to be called, in the health field has raised ethics alarms among those who believe many corporate gifts are designed to help donors as much as recipients, by enhancing their reputations or promoting their legislative agendas.

It is easy to see how corporations actually have a stake in encouraging the government to do less and less. When agencies lose their funding the industry benefits, because if the government will not fund research, guess who will? The friendly soda pop pushers. So, why not help that process along?

If, for instance, a MegaFizz executive happens to be playing golf with a government official, why not drop a hint that the government need not worry about funding a proposed anti-obesity program? MegaFizz picks up the tab, and next thing you know, scientists-for-hire are cranking out fallacious journal articles proving that kids are fat because the planet Mercury is in retrograde orbit.

On a national level

The Times journalist zeroes in on an example of the suspicious-looking behavior that has caused critics to narrow their eyes and get their backs up. In 2010 through 2012, the Coca-Cola Company gave the Centers for Disease Control (CDC) more than a million dollars. When that money ran out, former director Dr. Thomas R. Frieden said, “I don’t think it’s justifiable to have Coca-Cola run an obesity campaign that had an exclusive focus on physical activity.”

Kaplan writes:

But Dr. Frieden said that after he ended the Coke-funded C.D.C. health initiative, he approached the soft drink company with other programs in need of funds. He met with Dr. Applebaum and Muhtar Kent, the chief executive of Coke, but was unable to persuade the company to donate… They talked about transportation safety and water programs, Dr. Frieden said, but “nothing ever came out of those ideas.”

Coke’s willingness to subsidize research or programs appears to extend only to obesity. In other words, Coke money comes with strings attached, and to critics of public-private partnerships, that looks like the proverbial smoking gun. It looks like the corporation’s goals are at cross-purposes with the CDC’s goals, which could potentially undermine the government agency’s integrity.

During Dr. Brenda Fitzgerald’s tenure as Public Health Commissioner in Georgia, that department’s relationship with the Coca-Cola Company was regarded by some as improperly close. When she was appointed head of the CDC earlier this month, the health bureaucracy had been relatively free from corporate influence for a few years. But Dr. Fitzgerald has indicated willingness to bring Coke money back to the CDC, and consequently will now be closely watched.

Your responses and feedback are welcome!

Source: “New C.D.C. Chief Saw Coca-Cola as Ally in Obesity Fight,” NYTimes.com, 07/22/17
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Photo credit: Frederic Bisson (zigazou76) via Visualhunt/CC BY

Coca-Cola and the Government — Why So Suspicious?

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We were talking about the International Food Information Council (IFIC), a propaganda arm of the Coca-Cola Company (and the American Beverage Association and a few other entities). Sourcewatch.org characterizes it as a front group, and says:

Its staff members hail from industry groups such as the Sugar Association and the National Soft Drink Association, and it has repeatedly led the defense for controversial food additives including monosodium glutamate, aspartame (Nutrasweet), food dyes, and olestra. It also runs the corporate-friendly website, Kidnetic.com, with games and recipes for kids.

Just a quick glance at the IFIC homepage detects a bit of a red flag. It invites us to “join the facts network” because “the web is full of misleading info on food.” Visitors are encouraged to fight all that misleading information with the help of alternate facts that are, according to the IFIC, totally science-based.

It seems that only Coke knows how to locate the real scientists, and only Coke is capable of determining the legitimacy of those scientists’ methods. Prof. Marion Nestle notes a repeated pattern of Coke responding to certain studies with accusations of flawed science.

Rob Waters interviewed many academic researchers who are not happy with any of this, and he wrote about their discomfort in a series for Forbes.com.

If the Centers for Disease Control officials don’t already know about a particular industry-sponsored study, Coke never fails to alert the government agency. Time after time, when Coke or its allies provide financial support for studies, the results that show up coincidentally happen to agree with whatever Coke had hoped to establish.

If weight loss is the desired outcome, they have a study “proving” that diet soda is better than water. A consulting firm called Exponent is particularly adept at discrediting any research which does not conform with the beverage industry’s wishes.

Waters writes:

Exponent has been criticized for consistently producing findings supportive of industries that hire it. Its research has been used to cast doubt on a relationship between secondhand smoke and cancer, to dispute a link between red meat consumption and prostate cancer and, in research performed on behalf of the National Confectioners Association, to suggest that frequent candy consumption doesn’t boost the risk of obesity.

Apparently, the only thing that IFIC members love more than issuing propaganda to reporters is bragging amongst themselves about the effectiveness of their efforts. This propensity for self-congratulation was noted by the U.S. Right to Know organization, which used the Freedom of Information Act to obtain pertinent emails.

This can be seen from another perspective. Sometimes, people who used to work for the government take a different career path and accept employment with, for instance, the Coca-Cola Company. Conversely, people who used to work for Coke move into government positions.

Either way, personal ties and friendships that have naturally formed might carry over. There is nothing inherently sinister about that, but it may be that people in both camps need to police their own basically innocent behavior more closely, in order to not give a bad impression to outsiders.

(More next time…)

Your responses and feedback are welcome!

Source: “International Food Information Council,” undated
Source: “The Coca-Cola Network: Soda Giant Mines Connections With Officials And Scientists To Wield Influence,” Forbes.com, 07/11/17
Photo credit: Meena Kadri (Meanest Indian) via Visualhunt/CC BY

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