
A school-based obesity prevention programme was ineffective - DanBC
https://discover.dc.nihr.ac.uk/content/signal-00581/a-school-based-obesity-prevention-programme-was-ineffective
======
chiefalchemist
To be clear, the only conclusion here is this program was the wrong approach
for the audience it targeted.

Diet, exercise and personal responsibility still do matter. This program was
not able to get the target to embrace such things.

That said, there must have been some successes. Who were those? And why? Why
was it effective? How can that be replicated and scaled to effect more?

Moi? I suspect too much was targeted at the kids and not enough at the
parents. The parents do the shopping. They do the cooking. The kids, by
definition, follow the lead of the parents. The kids adapt and conform to the
nurture provided to them. Not to sound harsh but how often do to see a (pardon
me) chubby kid and then see the parents are similar or worse?

Put another way, I'm willing to bet there was no change for the parents'
weight / habits either; in turn no change for the "culture." And so it
persists. This is what humans do. We conform to the norms around us.

~~~
GCU-Empiricist
>Diet, exercise and personal responsibility still do matter.

As an aging former military member it seems like personal responsibility is
becoming more and more a foreign concept. I'm saying this not to kvetch but to
get peer perception on the thought.

~~~
Balero
I feel this view is massively overblown in media. Do I read stories about
people blaming others for their problems, showing no personal responsibility?
Absolutely, all the time, especially in mass media.

Day to day, people I know, people I overhear. people I talk to , show lots of
personal responsibility. Sure they might skip the gym, or eat some cake. But
they take responsibility for that, and themselves at large.

Frankly its easier to sell newspapers or get views by talking about someone we
can look at and say "Wow, I know I skipped the gym today, but I'm not that
bad", than to hear an altogether more boring story of the 99% that are
basically the same as ourselves.

~~~
chiefalchemist
Ok. But the percentage of adults who are overweight or obese is somewhere
around 70%. If we presume 10% is not preventable - that is they have a med
condition - then what of the other 60%? Who is feeding those people? Who is
forcing them to the sofa?

I understand it's not that simple (e.g., gut bacteria has been tied to weight
control). None the less i know people who had what I would consider serious
med issues (e.g., cancer) and made no change in lifestyle.

Yes, I'm generalizing. I apologize. But the obesity rate doesn't match well
with self responsibility.

~~~
xtreme
Maybe they just don't see the value in losing weight? People smoke and drink
despite being well aware of the associated risks, what's so different about
food?

~~~
chiefalchemist
That's my point. We've nornalized the abnormal. We've turned (potential)
illness into a massive (pun intended) market for self help "gurus" (e.g.,
Oprah).

95% of the messages are: eat what you want, what matters is you still love
yourself." Too few add that the extra weight is unhealthy.

------
cies
From the web page:

""" What did this study do?

[...]

* an additional 30 minutes of physical activity each day

* a family cooking workshop each term

* in collaboration with local Aston Villa Football Club, three sessions of coaching in physical activities and two on preparing healthy meals, with weekly activity and healthy eating “challenges”

* information sheets about staying active during the holidays, with signposting to local facilities

"""

So 1.5/4 points about diet, and the rest about exercise. Thus mostly focused
on exercise. While diabetes is known to be preventable/reversible by primarily
diet. Specifically by removing processed foods (that includes oils, refined
starches and sugar) and animal(-derived) products (as they are high in
saturated fats), while adding lots of whole plant foods. And not only for
cooked meals, but for all meals and snacks.

Seems to me they've been trying to optimize the wrong parameters. Just my 2ct.

~~~
arkh
And the diet part is about healthy (at the time) meals.

Just learn to count calories, how much you need and avoid excesses. Bad food
in small portions is better than huge amounts of healthy calories.

~~~
SCHiM
Research is not yet clear, but not every calorie is the same!

The combination of nutrients in food can have a large effect on the efficiency
of nutrient extraction in your stomach and gut. For example, when you consume
alchol and a meal afterwards your body will store more fat than if you'd just
taken a (slightly larger) meal. This is because your body will prioritize
burning the acetate and alchol over anything else (including carbs, fat and
protein). Other foods or chemicals might have effects on the resource burning
allocation of your body.

~~~
RealityVoid
Even if you had definitive proof of this, I think OP's assertion still stands.

Concerning yourself with highly complex reactions that could happen between
foods, when we aren't even sure how/if those reactions happen is effort spent
unwisely, whereas calorie counting has a definitive effect and even if those
combinations can hamper or help you, even by ignoring them, you still have the
overall desired result.

I find that, as a model, calorie in - calorie out works well, even if at some
future time we would discover it's not fully accurate.

~~~
slothtrop
>Concerning yourself with highly complex reactions that could happen between
foods

This isn't necessitated at all. There's no mystery as to what overlaps between
what the most successful food regimens prescribe today: cut sugar, cut refined
foods, eat more vegetables and eat real food.

Counting calories is important when it comes to weight management, but optimal
health does not stop and start just at BMI. You might be thinner on a calorie-
restricted junk-food diet, but you won't be healthier. Your insulin would
spike all the time, you'd be nutrient-deficient, etc.

~~~
Double_a_92
What is real food? Plants, Fruits and Water? Everything else has to be
processed somehow.

~~~
cies
Yes.

> Plants, Fruits and Water

Also fungi. And fruits are plants so do not need a special mention.

Some would say meat can be "unprocessed", but its not part of the WFPB diet
that I mentioned earlier and it known for it's health (obesity reversing)
benefits. To the contrary.

------
Djvacto
Just some quick napkin math: In 2015 the US Defense spending was estimated
around $598 billion. [1] In 2014 we spent $12.7 million on the school lunch
program. [2] By reducing the defense budget a little under 5%, we could triple
the school lunch program. Reduce it a little under 9%, and we can spend 5x
more on school lunches. I'm not sure of the exact numbers behind an individual
school lunch, but from what I know about personal cooking, you can probably
spend 5x more and have menus put together for kids that are way healthier than
the "Pizza Dippers" I remember. I'm also not sure if school lunches are sold
at a profit, but here's what I found related to that [3]. Assuming they are,
do they really need to be, especially if the federal government can subsidize
it more?

What's really needed is a societal change with how food is treated. Someone
else mentioned a tax on sugar and processed foods, which could help. But
another big step would be trying to teach students about nutritious food and
living a healthy lifestyle. Of course, it's difficult if the school is the
only place they see this, but I don't think it would hurt to have more outlets
for healthy living in a student's life.

[1]
[https://en.wikipedia.org/wiki/Military_budget_of_the_United_...](https://en.wikipedia.org/wiki/Military_budget_of_the_United_States)
[2]
[https://www.cbo.gov/publication/50737](https://www.cbo.gov/publication/50737)
[3] [http://markbittman.com/health-vs-profits-in-school-
lunches/](http://markbittman.com/health-vs-profits-in-school-lunches/)

~~~
zajd
The problem isn't how food is treated, it's Americans unwillingness to use tax
dollars to help poor people(even children). Foods got nothing to do with it,
it's the same with their school supplies, technology, quality of education,
etc.

~~~
AnIdiotOnTheNet
Yeah, it's a cultural issue here. I sometimes phrase it as "nobody hates
Americans as much as other Americans".

------
megaman22
Breaking news! Schools can't fix suboptimal family life.

My mum is a special ed teacher in a poor, rural, redneck corner of New
England. Many of the students on her caseload only get anything approaching
decent food from the school lunch program. Their broken, mixed up, drunk and
drugged out parents can't even keep their own shit together, let alone bear
the responsibilities of raising a child. Not surprisingly, if tragically, the
child suffers.

------
btcindivist
For a country that is so weighed down by the health issues around obesity,
it's quite weird taxes/incentives based on calorie per gram isn't anywhere in
sight. The savings from not having to take care of so much sick people would
be enormous.

It's clear from the situation that the free market choices are suboptimal. Who
wants to suffer through most of their life and die early? Yet these choices
are still made. If you can't educate, then tax fairly and force them to make
the right choices.

~~~
ams6110
> Who wants to suffer through most of their life and die early?

Apparently the fat people. Otherwise they would change their eating habits.

Why do we want to force people to live some way they don't want to live? It
won't work, and it will just flush more tax dollars down the drain.

~~~
btcindivist
I'm pretty sure taxing by calorie density would make things better. There's no
cost in doing that, it would just shift people to eat less calorie dense food
like fruits, vegetables and leafy greens.

The main problem is that the current laws, taxes and infrastructure are
heavily optimized to produce calorie dense foods. Another is that people like
some of those foods on a regular basis in their diet, so they might complain.

I would say this would cost more in political points than in real money.

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tweedledee
Fat shaming is pretty effective. It worked on me and others in my peer group.
I don't like being fat and I don't like being around people who are fat. It's
unhealthy and unattractive and represents, to me, a lack of control and
discipline. I look at someone who can't give up Sugar the same way as someone
who can't give up cocaine, as a person who needs help. Possibly in the form of
an intervention.

~~~
mark_edward
Cite a study

~~~
tweedledee
[https://www.liebertpub.com/doi/abs/10.1089/chi.2014.0062](https://www.liebertpub.com/doi/abs/10.1089/chi.2014.0062)

~~~
mark_edward
How do you get fat-shaming from "peer and parental encouragement"?

------
smackay
Reading this I was shocked, shocked I tell you to learn that cookery courses
for adults and healthy eating "challenges" were ineffective. Actually if you
take the numbers at face value then perhaps the intervention made the problem
worse - there was a comment yesterday about how short-bursts of extra activity
actually made people less active outside their regular exercise times.

So the premise of the study seems to indicate that the problem is largely one
of education - I guess that's why they dropped this onto the school system.
Instead of playing with a few guinea-pigs on a small scale maybe it's time
think to think about the big picture:

1\. Get all the crap out of the food supply.

2\. Put an end, permanently with threat of severe sanctions, to all the fear-
mogering in the media that frightens parents into keeping their kids indoors.

3\. Deal with small-scale, crime, bullying, availability of drugs, etc. etc.
that keep kids inside in front of the games console or TV instead of getting
outside.

4\. Create spaces were kids can go outside.

5\. Get away from schools being places where kids sit on their asses for 6+
hours a day. For example in today' physics lesson on electro-magnetism we are
actually going to biuld a 50m maglev track. OK so this is a bit unrealistic
but it would be a hell of a lot more fun and everybody would be a lot more
active.

... etc. etc., rant, rant.

In other words, the solution to a complex problem which is poorly understood
is probably a whole range of solutions to create an environment where obesity
simply is not possible. But that would take a huge amount of money, a huge
amount of political will, a lot of creative thinking and a general re-wiring
of a large number of attitudes and expectations.

~~~
cies
> 1\. Get all the crap out of the food supply.

Additional taxes may do, it helped for smoking. Slap the same tax on sugar,
(processed) animal products, oils. And make a VAT exempt on whole plant foods.
That combined with updated nutritional education will save millions.

~~~
JoeAltmaier
Ooops - I had a different definition for 'crap'. Maybe we should instead use a
scheme that lets people choose their own food, like a free market or
something...

~~~
adrianN
That doesn't sound like an effective way to combat the obesity crisis.

~~~
JoeAltmaier
Its consistent with American values (personal freedom etc). So often the
idealist jumps straight to "Lets _make_ people do it my way, uh, the right
way! With restrictive intrusive laws! Or raids! Or some other totalitarian
tool! Because that'll work!"

I understand its hard to see folks making choices that diverge from my
personal sense of what's optimal. But it is a cost of living in a free
society.

~~~
cies
You're making up stawmans, nobody's talking about that. Just some extra
taxation like with cigarettes.

We're discussing ideas on how to get a hold on the obesity crisis. I suggested
some extra taxes. Yes some gov't regulation.

You suggested me to use the free market, but food is already on the free
market. So I fail to understand what you are actually suggesting.

At the same time you say "get rid of the crap", while not defining how to do
so (without gov't regulation accordin to your own preferences) and without
defining what in your eyes crap then means...

Please make a real argument.

And why should any solution be "consistent with American values"; obesity in
the US is VERY CONSISTENT with American values. Maybe to turn the tide on it
we have to look in a diff direction.

~~~
JoeAltmaier
To make it clear: what people eat and how they exercise is a very personal
matter. Social engineering is intrusive and objectionable. When done with a
shakedown its particularly intrusive.

I'm sensitive to this topic. Live in a University town. Periodically some
idealistic students petition the City Council for some totalitarian ban as
part of a social engineering agenda. The latest was, Permit only Organic
Coffee to be sold in the city limits.

This clueless banning/taxing/penalizing folks for living as they please is
inconsistent with American values. More typical of nanny states and other less
savory government styles.

~~~
cies
> This clueless banning/taxing/penalizing folks for living as they please is
> inconsistent with American values. More typical of nanny states and other
> less savory government styles.

Bollocks. Read your law books. Weed is only recently legal in some states.
Ciggies are taxed heavily, so is petrol. Try walking butt naked in the
streets.

My point: your values are arbitrary. And calling them American(TM) does not
give them any credibility in my eyes. In fact what you are doing is similar to
what you despise in others: setting some standard and calling it "universal"
(ok US-niversal)

> To make it clear: what people eat and how they exercise is a very personal
> matter.

Except:

When there is a public healthcare system that takes care of you fuck up.

When advertising is everywhere shoving "eat unhealthy crap" messages into our
collective sub-conscience.

When some sentient being needs to suffer/die/have-children-taken-away-at-
birth/is-forcefully-impregnated-(also-called-rape)...

What I'm saying is that I see cases around me of diet not being a strictly
personal choice. I think if you try hard you can see it too. It's not so
black-white as you make yourself believe.

~~~
JoeAltmaier
Food is different. Very different. Blurring that with strawmen is easy but not
helpful.

------
rossdavidh
Participation (permission to measure BMI) was around 60%. That seems like a
pretty low rate, and it is not too hard to imagine that parents who know their
child has a BMI problem might be more likely to not want it measured, for fear
of stigmatizing them or their child. So, while I don't doubt that a program of
this sort might not be the answer, I don't think their data is sufficient to
prove it one way or the other, unfortunately. I would expect you need well
over 90% compliance/permission to measure before you could say that.
Disclosure: I am not a statistician (and I would love to hear from one about
this issue).

------
internetman55
Unfortunately I doubt there are any good solutions to this. People become
obese because their lives are too fucked up to care for themselves properly.
If your parents are weak, you're at high risk of being obese. If too many bad
things happen to you at once you're at risk of being obese. Kind of fucked up
to think of society as fucked up hunger games where if you fuck up the bodies
of you and your loved ones are mutilated by this condition but that just seems
to be how life works

------
slothtrop
Offer free cooking and nutrition coaching for low-income families. They're the
ones with kids most likely to subsist on junk. Presumably if it proves to be
effective, the gains will eventually extent to the hold-outs in the middle-
class.

I would observe as much at the supermarket on the regular in an area I once
lived in, heartbreaking to see.

~~~
Double_a_92
They wouldn't go to such a coaching because of ignorancy. Most people are not
low-income for no reason...

If they really wanted the internet is full of freely available information.

~~~
slothtrop
>Most people are not low-income for no reason...

Low-income workers are as such because they're "ignorant"? Uh..

Why this would work is that free delicious food isn't likely to be turned
down. I think people are often creatures of habit and feel intimidated by
cooking, along with (as you suggest) disinterest. You don't just teach the
mechanics and call it a day, they can walk away with a cheap delicious food
and see how easy it is to put together. Ultimately also easier on their
wallets than a cart full of 2L soda bottles, frozen pizzas and chips.

------
ada1981
Without addressing the underlying developmental trauma this kind of program is
going to be very hard to do effectively.

------
JoeAltmaier
Ineffective?! It was positively corrosive. My growing Iowa farmboys were
starved nearly senseless. We sent lunches thru elementary school (which they
were stigmatized for bringing) but in middle school they had to use the
provided meal service. Nearly passed out by 2PM, they struggled thru till they
got home and we could put 1000 calories in them to tide them over until
supper.

This program was phenomenally clueless and ill-conceived. Instead of
patronizing inappropriate low-calorie choices (which drove students to
hoarding dingdongs in their lockers), how about providing plentiful good food?
That might have had a positive effect.

{edit: I thought they were talking about the federal school-lunch initiative,
sorry}

~~~
maxerickson
Doesn't the federal school lunch program mostly just provide funding for low
income students?

I think a requirement to eat the school provided meal would probably be local
stupidity.

~~~
JoeAltmaier
Rural community. Not a lot of resources or facilities. No place to put a lunch
from home (no refrigeration/storage). Not stupid, practical.

The school lunch program feeds anybody who shows up. Nothing to do with
income.

~~~
maxerickson
The federal school lunch program _is_ predicated on income. That's basically
all it is, a system for providing funds to schools with low income students.

It comes with things like minimum standards for the meals, but I don't think
it comes with a limit on how much food each student can be served.

~~~
JoeAltmaier
Every school in Iowa has a lunch program, even the wealthiest. Its subsidized
of course, but for everybody. True low income can get you a waiver, like many
other government programs, but the lunch is available to all.

There is absolutely a limit on food.

