Coronavirus Chronicles — Human Dilemmas

The previous post listed the very few reasons why a bariatric procedure would be considered an emergency. That word comes into play when something goes wrong with a surgery that has already been done, causing a situation that threatens the patient’s life.

Otherwise, metabolic/bariatric patients are expected to stay out of hospitals until further notice. The facilities and the personnel are needed to fight the COVID-19 pandemic, and for anyone who had scheduled elective surgery it is much safer to stay home.

Physical safety is desirable, of course. But what about the costs that transcend the physical? The obese person who signed up for a gastric sleeve or bypass has generally been thinking about it for years, and the preparation probably took months. A good deal of mental and emotional energy has gone into the steps that lead to such a radical choice.

The lives of bariatric surgery candidates had already been placed on hold, in anticipation of the operation itself and the drastic lifestyle changes that must follow. When a person has gotten all psyched up for a momentous event, delay can be very stressful. And… we’re talking about people who, all their lives, have dealt with stress by eating.

And who knows where history’s current trajectory will lead? These hopeful patients are stranded in a nerve-racking limbo for an indeterminate amount of time. It could be months or years until the circumstances are once again favorable and, in the end, it may turn out that they have missed their moment.

Extreme custody

We also talked about parents in the unenviable position of needing to be round-the-clock watchdogs, making sure their children are not exposed to the coronavirus, while also trying to keep them from turning into slugs because of enforced inactivity, and incidentally, to keep them from doing serious damage to each other while confined.

One challenge faced by the grownups is determining how far to go toward the ideal of avoiding all human contact. There are cultural pressures, like an expectation that the family will go to church.

Maybe the neighbors wanted to invite themselves over, and now they think the isolation routine is just a transparent cover for being stuck-up. Or the sister from out of town wants to seize the opportunity and make the trip. She’s off work anyway, and it could be a long time before the chance comes again. Dad’s friends want to defy fate and have a poker night, and when he declines the invitation, they mercilessly impugn his masculinity. People are having to cope all day long with unprecedented annoyances and aggravations.

Where the sharp things live

Pediatrician Daniel Summers is hyper-aware of how scary a medical visit is, and has always gone the extra mile, with patience and humor, to make kids comfortable. In a piece called “Under a Face Mask, My Patients Can’t See That I’m Smiling,” he wrote,

All they know is that an already frightening place has become more off-putting because of all the weird things I have to wear now. And smiling from within all of it doesn’t work as well as it usually does, no matter how warm and kind I try to make the tone of my voice.

Dr. Summers has performed the mental and emotional triage procedure to make some decisions about priorities, and these are the answers he came up with:

I tell parents they’re off the hook for trying to accomplish anything beyond the necessary. If they don’t have the bandwidth to potty train or work on getting their toddler to sleep through the night in their own bed, they can hit the COVID button as many times as they need. There will come a time when trying to get your picky child to tolerate cucumbers will once again seem worth tackling. Now is not it. Bring on the macaroni.

Your responses and feedback are welcome!

Source: “Under a Face Mask, My Patients Can’t See That I’m Smiling,” ArcDigital.media, 04/04/20
Image by Ivan Radic/(CC BY 2.0)

Coronavirus Chronicles — Bariatric Surgery

Currently, institutions must limit themselves to the most basic functions, and cast others by the wayside. For instance, Denver Health announced that its Bariatric Surgery Center had to cancel both its monthly seminar and support group for April, and to cease all nutrition and psychology clinic appointments until further notice.

The Centers for Disease Control and the Centers for Medicare and Medicaid Services announced in mid-March that elective surgeries should be delayed. Hospitals need the beds, as well as the masks and other personal protective equipment. In the area of equipment that should be reserved for coronavirus patients, ventilators are the obvious leading candidate. But hospitals use many different machines and devices, all of which have to be assigned to priority usage, moved around, kept track of, cleaned, maintained, calibrated, and operated by professionals who know what they are doing.

Equipment is of course not the only resource that needs to be protected. Many healthcare providers from various specialties are being drafted into service against the COVID-19 pandemic. In addition to doctors and nurses, hospitals need custodians, clerical staff, kitchen and cafeteria workers, security personnel, IT specialists, and many others.

Some have died, while others are sick or soon will be. Since the ability to test individuals for the illness is drastically limited, the possibility even exists that patients who are hospitalized for other reasons could catch it from medical personnel, which would be terribly and tragically ironic. Anyone who does not absolutely need hospital care during this period is much better off at home.

The T word

Triage is a frightening word. It means assigning urgency ratings to the needs of suffering people, and allocating the available resources accordingly. It demands that judgments be made; it creates losers and winners. To help figure out how to manage this process during the current crisis, the American College of Surgeons published its seven “overarching principles,” along with more detailed recommendations for a number of surgical specialties, including metabolic and bariatric surgery.

An emergency situation is one that needs immediate intervention because of imminent death or permanent organ damage. For bariatric patients, this would almost exclusively apply to post-operative patients who are affected by:

Perforated marginal ulcer, bleeding, anastomatic or staple-line leak, obstruction particularly internal hernia, gastric band perforation or prolapse…

The next most serious category includes patients whose surgeries can be put off for a few days or even weeks, and those conditions include:

[…] revisions for dysphagia, severe gerd, pain, dehydration/malnutrition, slipped band, anastomotic strictures at risk for aspiration…

At a time like this, elective surgeries (which includes first-time bariatric procedures) should not be performed, and even if a patient feels inclined to insist, it is unlikely that any institution would admit them.

The Obesity Action Coalition has issued a letter to “those who are currently engaging in insurer or employer-mandated weight management prior to bariatric surgery or other obesity care,” urging them to cooperate in certain ways. Insurance providers are asked to make sure their processes for approving and completing bariatric procedures stay fully operational. If you are an insurer, they request that:

You not deny patients for missing required monthly weight checks, as many people are being asked to limit travel, self-quarantine due to age, and delay non-essential medical visits.

You waive any requirement for weight-loss (or no weight gain) during said required medical weight management periods due to the limited food environment, lack of fitness facility availability, individual counseling sessions being cancelled, stress, etc.

All pre-authorizations be processed recognizing that some information may be limited due to current restrictions and patients not be penalized for missing such information.

If surgery is delayed by a facility having to limit care due to public need (capacity issues/limiting of non-emergency procedures, etc.) that those pre-authorizations be honored as soon as such capacity issues are addressed.

Your responses and feedback are welcome!

Source: “Bariatric Surgery Center,” DenverHealth.org, undated
Source: “Coronavirus: Follow 7 Overarching Principles for Delaying Elective Surgery,” HealthLeadersMedia.com, 03/27/20
Source: “COVID-19 Guidelines for Triage of Metabolic and Bariatric Surgery Patients,” FACS.org, 03/24/20
Source: “Insurance Provider Letter,” NetDNA-ssl.com, 03/19/20
Image by ScienceDirect.com

Coronavirus Chronicles — Them As Has, Gets

In the previous post, we mentioned that, contrary to what common sense might suggest, school-age children do not become more fit during the summer break. Instead, they often experience weight gain inappropriate for their growth stage, and are unable to shed those extra pounds when the fall term commences. The increase just carries over into the next year. As we also mentioned, quoting an upcoming article in the journal Obesity,

[…] weight gain over the summer school recess is particularly apparent for Hispanic and African American youth, and children already experiencing overweight.

The folksy saying, “Them as has, gets” referred in the Depression era to money, but it is equally true of fat cells. Children who were already at a disadvantage, whether from inherent genetic traits, perinatal circumstances, or environmental influence, tend to be more closely bound by inertia. They are overweight, and are destined to become even more overweight.

In much of America, premature summer vacation is in effect, but a bizarre and perverse type of vacation that strips away the usual seasonal opportunities for exercise. We don’t have team sports or water-based physical activities or hours-long hikes, not even the kind that result from trekking around a theme park all day.

Because of stay-at-home orders, except for rare circumstances, kids can’t play outside. We have even seen some over-enthusiastic rule enforcement, like the arrest of a Colorado father for playing catch with his six-year-old daughter in a public park.

As the authors of the Obesity article state,

[…] the COVID-19 pandemic exacerbates all the risk factors for weight gain associated with summer recess.

If kids were not getting enough activity in ordinary times, the need for isolating and social distancing really puts the whipped cream on that hot-fudge sundae. Depending on where children live, there might possibly be a playground still open, but nobody is out there scrubbing down the swing chains or the monkey bars.

Faced with emergency conditions on every hand, which government bureau has the resources to worry about kids not getting enough exercise? The authors say,

As schools build their remote teaching capacity we should make physical education a priority. Where schools are sending home lesson plans for math and English, they could also send home lesson plans for physical activity…

There are several exercise programs designed for use by business travelers in hotel rooms and with limited gym equipment; such exercise programs could be adapted into at-home lesson plans. For schools that have the capacity to online stream classes, physical education teachers could stream exercise classes.

But what about the parents who are already stressed almost beyond endurance, who can’t escape from the noise that physically active kids inevitably make? What about the neighbors in the next apartment and downstairs, who are possibly sick and suffering already?

What about the already obese?

Returning to the “Them as has, gets” theme, let us spare a thought for another class of humans — the already obese. The Obesity authors say:

Individuals around the world with obesity are at high risk for severe complications of COVID-19. This may be due to the associated chronic diseases associated with obesity or due to the inflammatory and immunologic issues associated with obesity per se. In addition, patients with obesity may have increased viral shedding and be more resistant to effective vaccination. These issues and others mandate that we all conduct research to better understand the implications of COVID-19 in persons with obesity.

Your responses and feedback are welcome!

Source: “COVID‐19 Related School Closings and Risk of Weight Gain Among Children,” Wiley.com, 03/30/20
Source: “Colorado Police Apologize…,” Newsweek.com, 04/08/20
Image by Jason Shultz/(CC BY-ND 2.0)

Coronavirus and the Grave New World

The title of this post has a double meaning: The COVID-19 crisis is creating the need for thousands of literal graves, and the situation is grave in the sense of having serious and harmful significance. Many types of humans are threatened in ways that are particularly harmful, for one reason or another, to specific groups.

For the young, this shapes their childhood in the same way that the assassinations of John F. Kennedy and Dr. Martin Luther King Jr. impacted the childhoods of older generations. It’s a 9/11, a Pearl Harbor, a Vietnam War, a Cuban missile crisis.

The attention of Childhood Obesity News, of course, is focused on a subgroup of children — those who either are obese, or who are at risk. In the previous post, we mentioned the factors contributing to friction in households where everybody has to be there all the time. People are getting cabin fever. They’re going stir crazy. This quotation capsulizes the problem:

Studies show that abusers are more likely to murder their partners and others in the wake of personal crises, including lost jobs or major financial setbacks. Mounting data suggests that domestic abuse is acting like an opportunistic infection, flourishing in the conditions created by the pandemic.

As New York Times writer Amanda Taub points out, isolation is one of the traditional weapons of the domestic abuser. In a way, the requirement to stay at home is a gift to some of the worst people alive. It gives them an excuse to practice their other favorite aggressions: “[…] constant surveillance; strict, detailed rules for behavior; and restrictions on access to such basic necessities as food, clothing and sanitary facilities.” This is very bad news for the parent — usually, but not always a woman — who is frantic to protect the children from harm.

Adults and children have numerous reasons to be stressed right now, and as we have established, stress is a major cause of disadvantageous eating habits at any age. The upcoming publication in the journal Obesity, titled “COVID-19 Related School Closings and Risk of Weight Gain Among Children” points out a factor we have also mentioned before. Counter-intuitively, and contrary to popular belief, kids are unlikely to become more fit in the summer.

While much has been said about the less-that-perfect food and the inadequate physical activity requirements (or even opportunities) in schools, the data show that children do not experience unhealthy weight gain chiefly during the school year. No, it is during the summer months, during the break from school, when the pounds tend to pile on. The authors note,

This and subsequent work has found that weight gain over the summer school recess is particularly apparent for Hispanic and African American youth, and children already experiencing overweight. Importantly, the data show that the weight gained during the summer months is maintained during the school year and accrues summer to summer.

This topic will continue to be discussed here, and we add a note for professionals:

As the official journal of The Obesity Society and the premier source of information for obesity research and discovery from basic to population science, Obesity seeks submission of scientific data on the following topics:

• risks of COVID-19 infection and the risks of COVID-19 related hospitalization and death for individuals with obesity, as well as mechanisms underlying this association;
• response to therapy, based on obesity status, in patients undergoing investigational treatment and prevention protocols;
• psychological impact of the pandemic on those with obesity; and
• other aspects of the relationship between obesity and COVID-19 that would be of interest to our readers.

Please submit your work here: https://mc.manuscriptcentral.com/obesity

Your responses and feedback are welcome!

Source: “A New Covid-19 Crisis: Domestic Abuse Rises Worldwide,” NYTimes.com, 04/06/20
Source: “COVID‐19 Related School Closings and Risk of Weight Gain Among Children,” Wiley.com, 03/30/20
Image by Andrew Gustar/(CC BY-ND 2.0)

Coronavirus and the Cave New World

As the Earth’s people endure varying degrees of enforced isolation, we have a lot to think about. Which is worse, to be in an area of intense activity, like a medical emergency room, or in an eerily silent ghost town that used to be a thriving tourist attraction? Who is less fortunate, the person stuck in an overcrowded apartment with five annoying relatives, or the one who hasn’t seen another human for days or weeks? In the suspension of normality under special conditions, everything is up for reassessment and reexamination.

Two things about childhood obesity must be repeated constantly. First, the earlier in an individual’s life it begins, the more difficult it is to arrest. Second, the longer it continues, the less likely it is that the person will be able to escape adult obesity. These two principles underlie every effort that is made by professionals in many fields connected with helping these children.

Whether their perspective is grounded in the hard sciences or the soft sciences, everyone involved knows those basic facts. Even if their theories, methods, beliefs, and concerns branch out and differ from that point, they all understand that the top priority is to keep childhood obesity from ever setting in or, failing that, to limit it to the shortest possible time.

Whittled-down choices

But what happens when a planet-wide medical crisis keeps parents from observing many of the preventative measures? When it is impossible to follow the recommended daily habits that stave off childhood obesity, then what? Those habits are hard enough to practice faithfully in normal times.

We will be looking at an article that has been accepted for publication by the journal Obesity, and has undergone full peer review, but as always, there may be some final tweaking and polishing before the Version of Record appears. The official citation is given as doi: 10.1002/OBY.22813, and the title is “COVID‐19 Related School Closings and Risk of Weight Gain Among Children.”

The five authors — Andrew G. Rundle, Yoosun Park, Julie B. Herbstman, Eliza W. Kinsey, and Y. Claire Wang — are from four different institutions. In these pages, their interest is in the effect that the current health crisis is having on children with obesity issues whose lives were already difficult and complicated enough. Because of the necessity to stay home, even if the illness itself does not touch individual children or their families, the coronavirus pandemic will have long-term effects their health. The authors say,

COVID-19, via these school closures, may exacerbate the epidemic of childhood obesity and increase disparities in obesity risk. In many areas of the U.S., the COVID-19 pandemic has closed schools and some of these school systems are not expected to re-open this school year.

The implications are staggering. Parents, stuck at home, out of work or worried about imminent joblessness, may not be their Best Selves. In addition to putting up with the kids being home all morning, all afternoon, all evening, and all night, they are expected to facilitate home schooling, possibly via the Web.

What if there is no computer in the home? What if there is one, and Mom and/or Dad are desperately dependent on it for their own informational needs? Nobody is prepared for this kind of inconvenience, and some people are online giving advice, while others are online seeking it.

A grownup can get very stressed about giving kids the chance to leave sticky residue on the keyboard, or to do something unwise and catch a computer virus (how ironic). That computer may be the tool that allows the kind of meticulous financial management that is more crucial than ever before.

And speaking of homeschooling, how many parents are mentally and emotionally equipped to teach their children math, or anything at all, in an atmosphere already fraught with anxiety, where everyone is trapped and nobody can get away for a cooling-off period?

Families must deal with massively changed plans. Long-anticipated vacations have to be cancelled. Meticulously-planned weddings are thrown into chaos. Children were looking forward to going away to camp, or visiting a theme park. Teens had summer jobs, internships, or gap year travel itineraries lined up — not to mention proms and graduation parties. A whole generation is missing its traditional milestones.

(This topic will continue, mentioning the Obesity article again, along with other news references, all hovering around the general topic of how this crisis affects kids, especially those with weight issues.)

Your responses and feedback are welcome!

Source: “COVID‐19 Related School Closings and Risk of Weight Gain Among Children,” Wiley.com, 03/30/20
Image by Rob Briscoe/(CC BY 2.0)

The Smarter Lunchrooms Sphere of Influence

This post follows “Who Hates Online Activism?” in chronicling the disappointing history of Brian Wansink, Ph.D., a man entrusted by the U.S. government to psychologically manipulate the behavior of children and teenagers in school cafeterias, and influence them to choose healthful foods that do not promote obesity.

No fault is to be found in any of this… if the Smarter Lunchrooms theories actually play out. Do they? And if this very soft science knows what it’s talking about. Does it? Through the efforts of Bettina Elias Siegel, the public has learned about a complicated and perhaps shady situation.

Siegel notes that members of the School Nutrition Association receive regular newsletters whose contents include hints on how to inspire better eating habits at school meals. Who could be mad at that? One might wonder. Of course, for anyone who presumes to hand out tips, a problem is inherent. Saying “Try this… or this… or this…” cannot help but attract a certain amount of negative emotional fallout. Many friendly pieces of advice for parents are launched, and not all of them will land.

People are different, and so are families, kids, mothers, fathers, cultures, neighborhoods, finances, schools, and numerous other factors. No advisor or life coach can guarantee that all their helpful tips will be effective. A lot of things don’t work, and nothing works for everybody. But as any baffled and beleaguered parent will acknowledge, when something does work, it can be a life-changer.

How influential is the Smarter Lunchrooms creed?

Regarding the research from which its wisdom nuggets are mined, critics of the Smarter Lunchrooms movement have been pointing out with increasing frequency that it is, in some instances, embarrassingly threadbare. Also, despite calling itself one, Smarter Lunchrooms is not a movement — not in the sense of an innovative idea that sparks the imaginations of various interested parties who clamor to join up.

No, it’s a top-down thing, not decreed but strongly urged by the Department of Agriculture, as Siegel reminds us:

[T]he USDA has invested millions more in the program, including offering individual grants to schools to help them implement Wansink’s findings. The USDA holds Wansink’s ideas in such high esteem that his Smarter Lunchroom Initiative has even been woven into federal regulations.

This refers to the sections of the Healthy, Hunger-Free Kids Act of 2010, which warned local schools that the minimum expectation was for them to review the Smarter Lunchrooms materials because they are…

[…] shown to improve student participation in the school meals program while encouraging consumption of more whole grains, fruits, vegetables, and legumes, and decreasing plate waste.

Public Schools pretty much have to participate in such programs, and when they do, they are under an obligation to follow the guidelines and uphold the tenets. It’s fine to try things out, but government fiat tends to prematurely enshrine a philosophy’s ideas as the ultimate criteria for goodness, which is perhaps not such a great idea. Siegel writes,

Similarly, the USDA’s HealthierUS Schools Challenge, launched in 2010 to encourage healthier school environments, is now called “HealthierUS School Challenge: Smarter Lunchrooms,” and to qualify for bronze, silver or gold certification, schools must now demonstrate that they’re using Wansink’s techniques in at least six areas in their cafeterias.

Also, Wansink controlled the narrative around children’s school food by being director of Cornell University’s Food and Brand Lab. The institution studies, and often influences, “how people perceive, consume, and think about food.”

(To be continued…)

Your responses and feedback are welcome!

Source: “BREAKING: Can We Trust the Data Behind ‘Smarter Lunchrooms?’,” TheLunchTray.com, 02/14/17
Source: “Local School Wellness Policy Implementation Under the Healthy, Hunger-Free Kids Act of 2010,” FederalRegister.gov, 07/29/16
Source: “A Popular Diet-Science Lab Has Been Publishing Really Shoddy Research,” TheCut.com, 02/08/17
Image by Indi Samarajiva/CC BY 2.0

Who Hates Online Activism?

There is more to say about Brian Wansink, Ph.D., the chief inventor and proponent of Smarter Lunchrooms, which took over the presentation aspect of lunch in about 30,000 American public schools. Independent columnist Bettina Elias Siegel became very interested in examining Wansink’s work.

Siegel put a lot of thought and experience into zeroing in on a very specific aspect of his research, and his regressive attitudes about ordinary people who are picky about what kinds of junk they eat. Rather than encourage the curious and the concerned to educate themselves with the marvelous resources of the Internet, he grouched, “Reading about food ingredients on the Web. It’s one of the worst things you can do if you want the facts…”

Really? Could it be that parents, educators, policymakers, and other interested parties who look for nutrition information at the websites of the Robert Wood Johnson Foundation or the Mayo Clinic are misguided fools? In fact, Wansink’s own multitudinous studies are published via the Web. As a researcher and writer, how does it make any sense for him to diss the very medium that brings his work to the world’s attention?

It’s all about controlling the narrative

Honestly now, who is it that really hates the Internet? Actually, that attitude belongs more appropriately to Big Junk Food, as Siegel points out. Online sources are where citizens get all the inside information about things like how the world was lied to for years about the damage done by sugar, and the sleazy practices of fast-food merchants.

Online is the place where outraged citizens can band together to create change. Let’s go to Siegel’s endorsement:

To the great consternation of the processed food industry, it is becoming ever more apparent that the Internet and social media are extremely powerful tools for advancing various food-related causes, from aiding grassroots activism, to spreading viral videos promoting sustainable food practices or decrying children’s junk food advertising, to making possible online petitions like the one I started in 2012, which garnered a quarter of a million signatures and within nine days led the USDA to change one of its school food policies.

Anyone with a food-related sense of mission would do well to take cyber-activism lessons from Siegel.

The wellsprings of power

But how did one man, Dr. Brian Wansink, gain so much control over what goes on in public school cafeterias? Again, Siegel has a viable theory. It was mainly due to fortuitous timing. In 2010 The New York Times published an opinion piece written by Dr. Wansink, David R. Just, and Joe McKendry which, Siegel says…

[…] happened to appear in the Times just three months before President Obama signed the Healthy, Hunger-Free Kids Act, a new law that would greatly improve the nutritional standards for school meals around the country…

A low-cost way to boost student acceptance of healthy food couldn’t have come at a better time, and just one month after the Times piece appeared, the U.S. Department of Agriculture (USDA) announced that it was giving Wansink and his team $1 million to “lead, coordinate and disseminate” more of this highly promising cafeteria design research.

Wow! Talk about a lucky break! Meanwhile, the stars were aligning to provide Dr. Wansink et al with even more good fortune a few years later. In 2014, Agriculture Secretary Tom Vilsack announced that the kitchens of at least 90% of American public schools were successfully meeting the new nutrition standards. An additional $5.5 million grant would help them keep on doing this. The USDA, which had helped to fund the development of Wansink’s program, would continue its financial support:

The grants focus on implementation of Smarter Lunchrooms strategies, a broad toolkit of easy-to-implement, evidence-based practices designed to increase consumption of healthier foods and decrease plate waste…

The Smarter Lunchrooms movement applies practical, research-based principles and strategies that have proven effective at creating an environment that encourages kids to make healthy choices…

These funds may be used to assist the state agency in providing training and technical assistance to school staff in creating Smarter Lunchrooms.

Ironically, the justifications that Vilsack gave for sticking with Smarter Lunchrooms included the same dicey claims that multiple critics later disputed.

Your responses and feedback are welcome!

Source: “Moms, “Food Fears” and the Power of the Internet,” TheLunchTray.com, 07/08/14
Source: “BREAKING: Can We Trust the Data Behind ‘Smarter Lunchrooms?’,” TheLunchTray.com, 02/14/17
Source: “USDA Announces Support for Smarter Lunchrooms,” USDA.gov, 03/12/14
Image by U.S. Dept. of Agriculture/Public Domain

Doubtful Authorities

People have been objecting to the content, methodology, and what they deem the low publication standards of work by Dr. Brian Wansink, in combination with various research partners. These scholars are shaping public opinion, and government funding, around such topics as school gardens, professional chefs in schools, chocolate milk, what is sold by concessions stands, the measurement of food waste, nutrition report cards, and sliced fruit versus whole fruit.

Many of their subjects coincide with the interests of childhood obesity specialists, and are or could be quite useful. Why would a child pick a cupcake instead of a whole apple? We probably know the answer to that. But would a whole-apple-refusing child happily eat a sliced apple?

It depends. The researchers did what Dr. Pretlow always recommends — they asked the kids:

Interviews with children reveal that eating whole fresh fruit can be difficult for those with small mouths or braces. Older girls find whole fruits messy and unattractive to eat.

The idea of supplying each child with a “nutrition report card” may sound good at first, but the cumulative effect of that much surveillance — and that much reporting back to parents — would probably be detrimental. Some ideas that sound unnecessary or absurd to the taxpayer might prove very helpful in preventing obesity.

Others, even if they seize public imagination, might turn out to be useless or worse. Even the craziest notion could lead to an amazing revelation. But the weirder the idea, the more important a solid scientific investigation would be.

The Lunch Tray lady

Let’s get back to Bettina Elias Siegel, the citizen blogger who became seriously interested in Dr. Wansink about 10 years ago. In 2014 she reviewed one of his studies (with two co-authors) titled “Ingredient-Based Food Fears and Avoidance: Antecedents and Antidotes.”

Why do consumers, and especially mothers, develop strong negative feelings about certain ingredients including, but not limited to, “sodium, fat, sugar, high fructose corn syrup, MSG and lean finely textured beef”? The first five on the list are amply familiar to Childhood Obesity News readers.

The other part of the researchers’ curiosity, and rather ominously, related to “what the food industry and government can do about it.” (Why the food industry and/or the government should do anything, one way or the other, about these largely justifiable food fears is a separate question.)

And isn’t the whole attitude rather patronizing? After all, plenty of experts have spoken out against HFCS, sugar, and many other substances, with what appears to be good reason. Oh, by the way, the study was partly funded by the Corn Refiners Association. Siegel writes,

While the study never takes a position on whether that particular “food fear” is legitimate […] Wansink’s own statements in the media would certainly be reassuring to anyone worried about HFCS — and that alone is troubling given the CRA’s financial ties to the study.

What was Wansink saying to the media? Disingenuous baloney like,“It’s kind of crazy. How do these things get started and get traction without really any evidence at all?” But we are not here to steal Siegel’s thunder. This treatise of hers really deserves to be read and fully appreciated, containing as it does a sterling example of why many professionals look upon Wansick’s studies with a jaundiced eye.

Your responses and feedback are welcome!

Source: “Smarter Lunchrooms Movement (SML),” SnapedToolkit.org, undated
Source: “Pre-Sliced Fruit in School Cafeterias” AJPMOnline.org, 05/01/13
Source: “Moms, ‘Food Fears’ and the Power of the Internet,” TheLunchTray.com, 07/08/14
Images (left to right): Marco Verch, Frédéric Bisson
, Rodrigo Denúbila/(CC BY 2.0)

The Hinterlands of Science

The childhood obesity field does not generate many scandals, but when one occurs, somehow it seems worse than the disreputable doings in other areas of research. In the previous post, we learned that Smarter Lunchrooms co-inventor Brian Wansink has been called out for, among other things, reverse-engineering data from a “failed study which had null results” into a half-baked research paper. Wansink has also been criticized for possessing a “cavalier attitude toward theory and apparent willingness to hack statistics into something publishable.”

Those phrases came from Elizabeth Nolan Brown, who expressed great concern over the fact that by the time some 29,000 public schools in America had adopted the Smarter Lunchrooms game plan, only one outside study of it had appeared in the literature. She also found it upsetting that Wansink had agreed to review the data from what some critics regarded as questionable studies, then deleted his blog post where that offer was on record.

Another of Brown’s points is that although the method is touted as low-cost, “we are shelling out all sorts of money and government resources to incentivize activity with no measurable benefit (all while creating new administrative positions and layers of bureaucracy to oversee these efforts).”

Other critics of Smarter Lunchrooms

There is a general feeling, among Smarter Lunchrooms dissidents, that settling on that paradigm has stalled or prevented research into other modalities that might more effectively persuade children to choose nutritious foods. In particular, universal acceptance of Smarter Lunchrooms might not be the optimal path toward reducing obesity in children.

In the larger arena of psychological research, naysayers have been picking away at all kinds of studies whose conclusions were once considered acceptable. Psychology is, after all, a “soft” science, and its practitioners, and especially its innovators, must undergo very strict scrutiny from the “hard” science scholars. They want research that can be verified and reproduced. They especially want numbers to add up, which is unfortunately not always the case in papers published by Wansink and various collaborators.

One special critic

Here is where the story gets really interesting. One of the earliest skeptics was not an accredited scientist, but a citizen blogger (and mother of school-age children), Bettina Elias Siegel. Her online activity has demonstrated the power that “ordinary” parents and caring members of the public can wield.

As far back as 2010, Siegel’s blog, The Lunch Tray, mentioned Smarter Lunchrooms in a neutral, reportorial context. But then, she got to thinking about it, and in the following year, emailed a question to Brian Wansink. The “nudges” his team had invented may have inspired kids to put more fruits and vegetable on their plates — and that sounded intriguing — but were those healthier items actually consumed?

The result was a phone interview, from which these replies are quoted:

BW: In some lunch room studies we did also do plate waste studies, but looking at aggregate trash isn’t really instructive since, for example, we don’t know how many people took all those green beans we find in the trash can. So instead we’ve also done some individual plate waste studies, but [for practical reasons] we do it on only a sub-sample of the population.

Siegel said that she had personally observed elementary school children who voluntarily chose fruits and vegetables in the lunch line, only to ignore and discard them.

BW: Oh, well elementary kids are a different animal. They don’t have any frontal lobe. They just randomly do things and certainly there’s no self-reflection of attribution there. That kicks in big time in junior high and high school and then we see huge effects. It’s so much more rich then because older kids are thinking, so then you can use the thinking in your favor. In elementary school there are certain things that can be done, but a lot of them won’t work.

Wansink mentioned that he himself had three children, all under five years old, and that his methods did help at home.

(To be continued…)

Your responses and feedback are welcome!

Source: “The Junk Science Behind ‘Smarter Lunchrooms’,” Reason.com, 08/29/17
Source: “Interview with Dr. Brian Wansink, Master of Lunchroom Trickery,” TheLunchTray.com, 03/31/11
Image by Bettina Elias Siegel

Smarter Lunchrooms Accused of Junk Science

In the context of the school cafeteria, we have been considering the concept of psychological manipulation. It is considered morally superior to other kinds of manipulation, but there is room for discussion about that, especially when the issue is the presentation of illusory choices.

Given enough power, rulers can ratchet up the consequences of noncompliance. The king can persuade the nobles to go to war, and the nobles can persuade the serfs to enlist in the army. At each level of society, the use of various arms of the EAST formula may be so effective it is indistinguishable from coercion.

Corporations would be happiest if consumers would simply drive by and toss bundles of currency on the headquarters front lawn. But consumers demand to be treated with a little more class. The wise manufacturer will not try to make them accept a product through brute force. They are entitled to be wooed, and persuaded, by advertising. It goes back to FOMO.

To activate people’s Fear of Missing Out is a science, a manipulative dark art that is ruthlessly exploited by advertisers. With so many negative examples in the world’s archives, it is not surprising that people revolt against attempts to mold them.

And this connects with Smarter Lunchrooms how?

There are angles of the whole school lunch topic that many Americans find off-putting, such as whether the federal government should have any place in this at all, and how much say the locals should have, and who should pay, and when and how and why. This is about the very basis of the particular program, which is portrayed as wobbly.

Although Smarter Lunchrooms is touted as social engineering with a light touch, some ask if that is necessarily a good thing. Others say, in effect, “We would like to endorse it, but its basis looks pretty weak.” And then, there are outright critics.

Elizabeth Nolan Brown goes so far as to call choice architecture, and every other aspect of the program, a bunch of “feel-good fairytales about banana placement.” She explains in great detail the logistical shenanigans the originator went through in order to come up with something that would meet publishers’ criteria.

Just the facts, ma’am…

Brown was not the first to say harsh words, by the way. The terminology used by the director of Columbia University’s Applied Statistics Center, Andrew Gelman, was “run-of-the-mill, everyday, bread-and-butter junk science.”

Brown refers to a paper by a team of researchers which, for the academic-minded, breaks down the problems in excruciating detail. Childhood Obesity News will not go into it here, but one highlight is, “In total, they found approximately 150 inconsistencies in reported statistics from the four papers.” They also used the phrase “a breach of good publication ethics practice.” Brown writes,

Smarter Lunchrooms, launched in 2010 with funding from the U.S. Department of Agriculture (USDA), is the brainchild of two scientists at Cornell University: Brian Wansink, director of the school’s Food and Brand Lab… a former executive director of the USDA’s Center for Nutrition Policy and Promotion and a drafter of U.S. Dietary Guidelines, and David Just, director of the Cornell Center for Behavioral Economics.

Far from being a well-tested approach, the Smarter Lunchrooms program was implemented in schools across America before the first randomized control trials on its effectiveness were even begun.

There has been talk of “errors and inconsistencies going back decades,” along with explicit descriptions of certain troubling historical events. Brown references Prof. Eric Robinson, who has written about “problems ranging from simple sloppiness to errors that seriously call into question the integrity of all of Wansink’s work.” Even a graduate student called him out for questionable practices related to the accepted conventions of writing scientific papers.

Your responses and feedback are welcome!

Source: “The Junk Science Behind ‘Smarter Lunchrooms'”, Reason.com, 08/29/17
Image by Bread for the world/CC BY-ND 2.0

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The Book

OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:

Presentations

Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

Food & Health Resources