Tuesday, October 09, 2018

About That New Lancet Study: Maybe Don't Expect 9 Year Olds To Change Their Own Food Environments

It's difficult for me to imagine what exactly researchers expected would happen as a consequent of this study's intervention which hoped to help children with obesity.

The Effectiveness of the Healthy Lifestyles Programme (HeLP) to prevent obesity in UK primary-school children: a cluster randomised controlled trial, enrolled 9 and 10 year olds from 32 different UK schools and randomly assigned some schools to deliver a year long curriculum to the children which included,
"dynamic and interactive activities such as physical activity workshops, education sessions delivered by teachers with short homework tasks, drama sessions, and setting goals to modify behaviour"
And while parents were involved, their involvement was dictated by their children primarily who in turn were instructed to "reflect on their own behaviours and goals" with their parents.

Various weight related outcomes, activity related outcomes, and dietary choices outcomes over 2 years were collected, and the results weren't in any way exciting, with pretty much no differences found between study and control groups on any weight related or physical outcome.

But should anyone have expected anything different?

Are there really those out there who believe that if you teach 9 and 10 year olds in school that they should eat less and better and exercise more, that they'll do so? Fully grown adults with newly diagnosed weight or diet related diseases rarely do, so why should children? Or that 9 and 10 year olds who themselves have zero responsibility for their food environments, even if they actually "reflected" on their behaviours and goals with their parents, could see their food environments appreciably and sustainably change?

And what of these kids, and especially of the kids who already have obesity? It does not appear as if this study even attempted to explore whether or not the 2 year long intervention had any negative psychological impact. But certainly, if the crux of the program is to teach 9 year olds that they are personally responsible for their lifestyle choices, I think it would be fair to consider the possibility that the program will lead some to question their self-worth, self-efficacy, body-image, and potentially affect their relationships with food and even risk disordered eating. It may have also been important to study whether or not there was any increase in weight related bullying in the intervention schools.

All this to say, relying on 9 and 10 year olds to modify what for them, given they're in charge of next to nothing related to when, where, and what they eat, are almost certainly unmodifiable food environments, wholly unsurprisingly, isn't an effective plan. While I am supportive of robust programs that work with parents to change their families' lifestyles (disclosure, I'm the medical director of just such a program), focusing just on the kids is akin to focusing all of your efforts on lecturing life's passengers and ignoring the drivers, and where the drivers aren't just the kids' parents, but their food environments as a whole.

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