[Pophealth] An interesting opinion piece int the Science Times

[Sam Crary]

Sorry, forgot to attach the link from the New York Times. It is
http://www.nytimes.com/2006/05/30/health/nutrition/30essa.html

-----Original Message-----
From: pophealth-bounces at mailman1.u.washington.edu
[mailto:pophealth-bounces at mailman1.u.washington.edu] On Behalf Of Sam
Crary
Sent: Wednesday, May 31, 2006 10:03 AM
To: pophealth at u.washington.edu
Subject: [Pophealth] An interesting opinion piece int the Science Times

So this is the kind of article that it might be nice to do a response
to. On the one hand, the author instinctively questions the mainstream
public health logic, which is good. On the other hand, she does not have
the population health perspective to support that view.

Sam


Well-Intentioned Food Police May Create Havoc With Children's Diets

By HARRIET BROWN
Published: May 30, 2006

Earlier this year, our small Midwestern school district joined the food
wars, proposing a new policy that would discourage all food in
classrooms, ban nuts and sugary foods and do away with vending machines.

So much for peanut butter sandwiches, snacks for kindergartners and
birthday cupcakes.

Like the policies put in place by school systems around the country,
this one was driven by anxiety - about food quantity, quality and safety
- and by the ever-increasing pressure for children to look a certain way
and to weigh a certain amount.

Unlike the earlier "mommy wars" or the "war on drugs," which centered
around simpler black-and-white divides, the 21st-century food wars are
fuzzier, though the feelings run just as deep.

Some schools say they are concerned about food allergies, and it is true
that for some children a stray bite of someone else's peanut butter
sandwich can mean anaphylaxis and even death. But I don't think
allergies are the main reason that districts across the country are
racing to put new food policies in place. After all, children are
allergic to strawberries, wheat and dairy, too, but there are no
proposals that I'm aware of to ban any of those foods.

I fear there's something else at work - a fear borne out by a flier my
fifth grader brought home saying that at the monthly pizza hot lunch, no
child would be allowed to buy a second slice of pizza. The district says
the new ruling is to avoid bad feelings caused by "inequities": if
everyone can't have extra helpings, no one can.

This solution may seem rather Solomon-like. But if equity is the issue,
I'll eat my lunch tray. I believe the schools are overreacting to the
so-called obesity epidemic, and in the process are doing our children
more harm than good.

Don't get me wrong: I'm all for good nutrition and exercise. I don't buy
soda for my own children or bring home fast food. But these food wars go
beyond good sense and good science. They're misguided and red herrings,
based more in conjecture and politics than on solid research-based
solutions.

They squander precious social and fiscal capital, and distract us from
more complex but reality-based approaches.

Leading the way is the Child Nutrition Promotion and School Lunch
Protection Act now before Congress, calling for updated definitions of
"minimal nutritional value" of foods served in schools, including those
sold in vending machines and at fund-raisers.

In theory, such legislation would improve the nutritional options. In
reality, it sounds like another call for the food police - highly
fraught and bound to backfire.

A look at what's happening on the state level confirms this. In
Arkansas, for instance, children's report cards now include their
B.M.I., or body mass index, along with their grades. The governor, Mike
Huckabee recently lost more than 100 pounds and is passionate about
stopping the "obesity epidemic." Maryland is considering a similar
standard.

Never mind that B.M.I. is only a measure of height against weight and
does not take into account muscle mass, body type or other factors. (Tom
Cruise has a B.M.I. of 31, which puts him in the "obese" category.)

"You're setting kids up to feel bad about how they are," says Dr. Nancy
Krebs, chairwoman of the American Academy of Pediatrics' Committee on
Nutrition and an associate professor of medicine at the University of
Colorado.

Such efforts usually fail, making weight problems and eating disorders
worse. A recent Internet discussion board among families with anorexic
and bulimic children identified middle school health classes, which
focus on weight, as the No. 1 trigger for their teenagers' disorders.

The food wars are being fueled by our emotionally fraught relationships
with food, and by increasingly hysterical rhetoric.

We often hear, for instance, of a rising tide of obesity and Type 2
diabetes, especially in children. But the science behind such
pronouncements is shaky. A study of nearly 3,000 children presented at
the American Diabetes Association's 2005 conference suggested that a
third of the children diagnosed with Type 2 diabetes, which is
associated with being overweight, were later found to have Type 1
diabetes, linked to genetics.

Abigail C. Saguy, a sociologist at the University of California, Los
Angeles, who studies media framing of obesity, says it's hard to know if
rates are truly rising, since no nationally representative data are
available.

One study of teenagers in the Cincinnati area found that the diagnosis
of Type 2 diabetes went from 7 per 100,000 teenagers per year in 1982 to
7.2 per 100,000 teenagers per year in 1994 - a difference that could
easily be a result of better diagnostics.

"The term 'epidemic' refers to the rapid and episodic onset of
infectious diseases and is associated with fear of sudden widespread
death," Dr. Saguy says. In reality, she adds, new research shows no
significant difference in death rates between "normal" and overweight
Americans; mortality rates rise only for those with a B.M.I. exceeding
35 - only 8 percent of the country.

What the food wars seem to reflect more than anything is our ambivalence
about eating and about our bodies. What they will do, I am afraid, is
create even more anxiety around feeding our children and ourselves -
anxiety that will, in turn, make it harder for all of us to be "joyful
and competent with eating," in the words of Ellyn Satter, the author of
"Your Child's Weight: Helping Without Harming" and a nationally
recognized nutrition expert.

Besides, like other misguided public health campaigns (remember "Just
Say No"?), putting children on de facto diets at school just doesn't
work. In a 2003 experiment involving 41 schools, more than 1,700
children - many of them American Indian - were served lower-calorie and
lower-fat lunches and were taught about healthy eating and lifestyles.

While the children took in fewer calories from fat at school, they
experienced no significant reduction in their percentage of body fat.

Another study, in rural Nebraska in the mid-1990's, put one group of
elementary school students on lower-fat and lower-sodium lunches,
increased their physical activity at school and offered more education
about nutrition. Compared with students having no special program, the
active, lower-fat group showed no differences in body weight or fat, or
in levels of total cholesterol, insulin or glucose after two years.

Researchers concluded that pupils whose school lunches offered 25
percent fat (compared with 31 percent in the control group) were
compensating for the reduction by eating higher-fat foods at home.

Big surprise. Anyone who's dieted for a day, a week, a month and then
overeaten to compensate is familiar with the
deprivation-binge-deprivation cycle - and with the weight gain that
often accompanies it. One Harvard study showed that 39 percent of nurses
who lost weight through dieting regained it, and in fact wound up 10
pounds heavier on average than those who didn't lose weight.

Early in my children's lives, I was a no-sugar, no-fat mom, the legacy
of my own childhood with a constantly dieting mother. I thought I was
doing the right thing, until a friend told me that every time my
children stayed at her house, the first thing they did was ask for ice
cream. With sprinkles. And chocolate chips. And gummy worms. By rigidly
restricting their sugar intake, I had made it a highly sought out
pleasure - the last thing I'd intended.

Ms. Satter recommends giving children regular access to treats, at
school and at home, by including those foods with more nutritious
choices at meals and snacks. "Avoid either extreme of forbidding
snack-type food or letting children graze on them," she says. "In the
long run, this makes children eat more, not less."

What worries me even more than the words being thrown about in the food
wars are the unspoken messages we're giving our children about their
bodies, themselves and the food they eat. Prohibiting that second slice
of pizza sends a message that pizza is bad, that there are good foods
and bad foods, safe foods and dangerous foods - a perceived dichotomy
that every anorexic is all too familiar with.

I can hear the howls of outrage, imagine the letters I will get as a
result of saying this. But I will say it anyway: We have nothing to fear
but fear itself. That is, our twin fears of fat and food, and the
consequent distortions in the way we feed ourselves and our children,
will damage us far more than a bowl of ice cream every now and again.

"Emphasize providing, not depriving," Ms. Satter suggests. "Maintain the
structure of meals and snacks so children can count on getting fed - and
fed enough."

So serve another slice of pizza. Bring on the chocolate cupcakes. Dish
up the broccoli soup and burritos, the strawberries and cheesecake. Give
kids more time to run around and play, and also more time to eat. Teach
them about the joys of food, not the terrors. And maybe they'll grow up
less ambivalent and healthier than we are.

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