Monday, September 16, 2013

Ignore Obesity Research in the News, Please

Today there is yet another study demonstrating a decline in obesity in children. Here is the actual study and here is a news report.

This follows reports from several weeks ago that obesity among preschoolers was falling.

This on top of the most recent F as in Fat report, which emphasizes greater obesity in the South.

Let's get a few things straight:

Reporting obesity prevalence based on self-report is bad science.

Reporting obesity prevalence based on non-representative samples is bad science.

All reports of state comparisons are bad science.

In the United States, no matter what anyone tells you, we do NOT have any idea what the actual prevalence of obesity is by state. We have ONLY ONE survey that allows us to make good estimates of total prevalence of obesity, and it will not allow state-level estimates. Most states do not have good systems to estimate obesity prevalence within their own state.

Please, for the love of the Flying Spaghetti Monster, just stop reading news reports about obesity prevalence. We have no idea if it's improving or getting worse.

I have no idea why the journals don't send me THESE articles to review, but I would definitely have them temper their language. I've kept a few from getting out there, but I don't get to review everything. Even if I did, I can't control the press releases. There is lots of good obesity research. Unfortunately, the news seems to only pick up the small fraction that is bad science.

Friday, September 13, 2013

Low-Sugar Juice is Stupid

I've had multiple requests this week for donations to a local food pantry, which is great. But the featured request of the month is "low sugar juice boxes". I can't bring myself to donate anything because of this absurdity.

What is low-sugar juice?

I would think normal people would put these in that category:

Juicy Juice 100% juice “no sugar added”: 26g/8oz
Apple and Eve “1/3 less sugar”: 22g/8oz (Made with vegetable juice)

Let's compare to the evil drinks:

Hi-C Fruit Drink: 28g/8oz
Coke: 27g/8oz

Or we could (OMG!) poison them with chemicals and give them Splenda-sweetened drinks or (OMG even more!) diet soda.

Seriously? Can we just call a spade a fucking spade? Juice IS sugar. Deal with it. Argue that juice is fine, and serve juice. Argue that sugar is bad, and don’t. But don’t pretend like a “low-sugar” name makes things any better.

If you are worried about adequate nutrition in your population, give them 100% juice drinks. If you worried about obesity (probably a bigger deal for poor North Carolina), give them water or something with an artificial sweetener. 

There are plenty of reasons to argue for and against the juice box, and it's fine to want to get organic things (though I believe unnecessary). But you don't get to plop down "low sugar" and make things healthy. I'm not the only one who thinks juice and smoothies are as bad as other sugary drinks.

Even your organic, no-sugar added, hipster juice boxes are still just fucking sugar.

Tuesday, September 10, 2013

The Endless Stupidity of Wellness Programs

I could go on for hours about the ethical issues of "wellness programs" for employer-based health insurance. Most recently, Penn State began requiring employees to report a variety of health parameters in order to avoid a relatively large financial penalty.

Lost in that discussion was that North Carolina has just done a similar thing for their entire base of state employees (it does not require actually having a physical exam). The financial penalty is a bit smaller--on the order of $50--and requires completing a health assessment, attesting to being tobacco-free, and designating a primary care physician for everyone on the plan.

Let's set aside the fact that wellness programs don't work.

Obviously, I think requirements to report these things are wrong, but I thought I'd take out the "wellness plan" for a test drive.

I won't go into laborious details about the health assessment itself, because that's not what is most interesting. They asked my height and weight and waist circumference, the last of which I just guessed on because I don't typically keep a tape measure in my office. They asked about stress, drinking, tobacco, whether I take medications to sleep, details about my activity levels even I, an activity researcher, found difficult to interpret, and then a whole host of measures most people aren't going to know--blood pressure, cholesterol values, glucose values. Finally, they asked if I thought I would work on losing weight, eating better, and reducing stress.

So, I finish my assessment. Here's what I get:

First, take note of the little female icon. Just in case I forgot.

Okay, so I'm medium risk. Medium risk of what I'm not quite sure, but apparently something. Death? A cold?

Well, I don't want that! Surely they can help!


Well, if I scroll down, I get to learn the things I need to work on. "Work on"? Aren't I already working enough? And, hey, how do they know if I'm working on my depression or my "obesity"? Maybe I've worked my depression into submission and what I really need is to leave it alone.

Anyway, I'll bite. Let's find out how to cure my "obesity".

First, I suppose they need to tell me what obesity is.  Because that's never come up before.

Holy shit, I have SO MUCH FAT that my health is in danger. Okay, even if that WERE true, healthy diet and daily Jazzercise notwithstanding, is that the most appropriate way to tell me?

Well, let's find an action plan. Because I don't want my health in danger!


Oh, nothing. Darn. Let's click around and see if I can find a back door in. Well, no plan, but more details on my condition.

Are those really warning signs of obesity? Because I'm pretty sure I don't have any of those. I know, I know, they are warning signs of obesity-related disease. But I do believe all of those can happen to anyone. And who puts the "right before you die" symptoms of a disease?

Okay, back to the search for my action plan. Ooh, here are my action steps!


Disregarding that half of these are indecipherable, they are called HOMEWORK!! Not "good stuff to do", but actual fucking HOMEWORK. I've already sold my soul to you, and you give me homework--without directions, no less?

But we're trying to cure my obesity, no? Ah, I found it.

Are those really all my options?

Maybe the health action details will help.


My "educational tool" consists of three bullet points, the first of which is to remind me it looks like I have a weight management "issue". My response to it goes from was this helpful (um, no) to "how likely are you to have bariatric surgery?"

Let me just get this out there. My BMI puts me in the obese category, but my health is great and I'm in fabulous shape. I need a lot of things--more time, more sleep, more money, better fucking health insurance--but I do NOT need bariatric surgery.

These people still haven't told me what to do. Oh, look, I found something. Well, I sort of did, because I can't find it again. But I did get a lovely screen shot.

Who looked at that and thought it was a good idea? Besides telling me absolutely nothing I didn't already know (or that every fat person also doesn't already know), it's like painful, dense text. For the record, the depression action detail looks very similar. I don't want to read it now. I'm pretty sure if you showed it to me when I actually WAS depressed I probably would've just cried.

Speaking of depression, let's see what tools are available to help me "work" on that.


None of those are relevant to me, and they know that (because I had to tell them that I am not menopausal and currently not pregnant and presumably they are aware I am not a child). The only POSSIBLY relevant thing is that incredibly depressing sad face in the sand. I mean, that makes non-depressed me want to cry. But I sure as hell don't need to know if I have depression. I do. I have--with a diagnosis--for a decade, and the State Employee's Health Plan certainly knows that.

So, my sum experience with the NC Health Smart "Wellness Program"? Buggy. Insulting in its treatment of obesity. Naive in its effort to address depression. (I can only imagine how the other conditions get treated. I wonder how many times people who report hypertension get told to avoid salt.) Seriously offensive in its approach--making caring for my health "work", using thinsplaining, and potentially dangerous in implying that I need to "work" on things that are already under fabulous control. Worthwhile primarily as a great way for the state to collect private health data about me, under threat of punishment.

We can only hope this effort--and the enormous amounts of money I'm sure went into it--will fall apart as quickly as the last wellness effort in NC.

JAMA Pediatrics has posted an interview with me and Daniel Callahan, about our perspectives pieces in this month's issue.

You can listen here.