Saturday, August 02, 2008

The state-sanctioned bullying of fat kids

Why is Britain opening so many `fat camps'? The evidence suggests they don't work, and only make overweight children feel isolated and ashamed

Last year's erroneously titled Foresight report on obesity, published by the UK government, recommended `fat camps' for overweight British teenagers, because apparently radical strategies are necessary to avert a public health catastrophe. This draconian policy found its way into the government's evidence-free obesity strategy, Healthy Weight, Healthy Lives, which prescribes anti-obesity interventions at the local level.

Consequently, Rotherham Primary Care Trust, as part of the new Rotherham Obesity Strategy, has unveiled a three-year plan targeting families with overweight children. The Trust identified Rotherham's fattest children and this summer banished 38 of them to a fat camp, the Carnegie Residential Weight Loss Camp, in Leeds.

This is not the first time that fat British children have been sent away because they are aesthetically unpleasing to their parents, peers and the public health establishment. The summer of 1999 saw Britain's first residential fat camp (based on the American model) open its doors to 40 overweight children. The Too Fat to Toddle camp, the first British fat camp for under-fives, opened for business late last year.

This week, officialdom's war against fat children was stepped up a mark. The government revealed that, starting in the next school term, parents will be sent `fat reports' on their children. As part of the anti-obesity crusade, schools will weigh children at the age of four to five and again at 10 to 11 and send details about their Body Mass Index to parents, with advice on whether their child's weight is unhealthy. And Sunday's Observer reported that Britain's first live-in fat camp - a `boarding school exclusively for overweight and obese teenagers' - will open soon in the Lake District.

It is deeply frustrating that British policymakers did not heed the lessons of the American experience, where fat camps have existed for 45 years, before unleashing yet another futile childhood obesity intervention.

The first fat camp for children, New York State's Camp Napanoch, opened in 1963. Three years later, it was out of business. During the next 30 years, a large number of fat camps appeared across America. Eventually, the fat camp business turned sour and most camps went bust. By the mid-1990s, there were fewer than 20 fat camps in operation. Today, there are only a dozen left.

Why is business so bad in America, the world leader in fat children and obsessive parenting? Because the dirty little secret of fat camps is that they do not work. It is true that often a child will go to a fat camp and return home a stone or two lighter. At the UK's original fat camp in Leeds, obese teenagers typically lose 12lb over a one-month residential stay.

Chances are, however, that they will regain the weight in a few months. The Los Angeles Times reported that only one in 10 American campers actually keep the weight off. A New York Times investigation found that the majority of campers attending these programmes are repeat customers.

Individual camp's self-reporting success stories are littered with methodological problems, as most fat camps neither track nor report post-camp outcomes. Most do not remain in contact with their customers and camp `graduates' cannot be trusted to honestly respond to questionnaires that attempt to keep tabs on their weight history.

Most fat campers regain substantial amounts of weight within the first year. In a warning to parents, Dr Oded Bar-Or, director of McMaster University's Children's Exercise and Nutrition Center, said: `If you think the camp is going to solve the problem - the child will at long last lose weight and keep it that way - you can forget it.'

Therefore, it is unsurprising, yet deeply revealing, that the Rotherham Obesity Strategy provides information neither on the anticipated effectiveness of its own fat camps nor on the effectiveness of similar camps. To be fair, it cannot do so because there is no empirical evidence, as the Foresight report acknowledged, that government intervention in this area produces the desired outcome.

Most tellingly, perhaps, last autumn a qualitative study of the management of childhood obesity was published in the journal, BMC Family Practice. In this study, a representative group of primary care doctors in the 39 general practices that contract with Rotherham Primary Care Trust concluded that the evidence base for these programmes remains poor.

Earlier, the prestigious Cochrane systematic reviews of interventions for childhood obesity, which included 18 studies of various different treatments, found none of them to be effective....

Fat camps isolate children with a weight problem and add to the distress of an obese child. Professor Nick Finer of Luton and Dunstable Hospital's Obesity Research Centre, says: `You have to consider the psychological effects of sending your child away to such a place. Society already discriminates against fat people and I'm concerned that children might see being sent to these camps as a punishment for being fat.'

Fat children are expected to suffer, with stereotypical jolliness, the slings and arrows of a society dangerously obsessed with thinness. Probably, school playgrounds will always witness the bullying of fat children. But, as adults, we can and should eliminate fat-based bullying from government policy.


LA blocks new fast-food outlets from poor areas

Arrogant and ill-informed paternalism redeemed only by its total ineffectiveness

City officials are putting South Los Angeles on a diet. The City Council voted unanimously Tuesday to place a moratorium on new fast food restaurants in an impoverished swath of the city with a proliferation of such eateries and above average rates of obesity. The yearlong moratorium is intended to give the city time to attract restaurants that serve healthier food. The action, which the mayor must still sign into law, is believed to be the first of its kind by a major city to protect public health."Our communities have an extreme shortage of quality foods," City Councilman Bernard Parks said.

Representatives of fast-food chains said they support the goal of better diets but believe they are being unfairly targeted. They say they already offer healthier food items on their menus. "It's not where you eat, it's what you eat," said Andrew Pudzer, president and chief executive of CKE Restaurants, parent company of Carl's Jr. "We were willing to work with the city on that, but they obviously weren't interested."

The California Restaurant Association and its members will consider a legal challenge to the ordinance, spokesman Andrew Casana said.

Thirty percent of adults in South Los Angeles area are obese, compared to 19.1 percent for the metropolitan area and 14.1 percent for the affluent Westside, according to the Los Angeles County Department of Public Health.

Research has shown that people will change eating habits when different foods are offered, but cost is a key factor in poor communities, said Kelly D. Brownell, director of Yale University's Rudd Center for Food Policy and Obesity. "Cheap, unhealthy food and lack of access to healthy food is a recipe for obesity," Brownell said. "Diets improve when healthy food establishments enter these neighborhoods."

A report by the Community Health Councils found 73 percent of South Los Angeles restaurants were fast food, compared to 42 percent in West Los Angeles.

South Los Angeles resident Curtis English acknowledged that fast food is loaded with calories and cholesterol. But since he's unemployed and does not have a car, it serves as a cheap, convenient staple for him. On Monday, he ate breakfast and lunch _ a sausage burrito and double cheeseburger, respectively _ at a McDonald's a few blocks from home for just $2.39. "I don't think there's too many fast food places," he said. "People like it."

Others welcomed an opportunity to get different kinds of food into their neighborhood. "They should open more healthy places," Dorothy Meighan said outside a Kentucky Fried Chicken outlet. "There's too much fried stuff." Councilwoman Jan Perry said that view repeatedly surfaced at the five community meetings she held during the past two years. Residents are tired of fast food, and many don't have cars to drive to places with other choices, she said.

Los Angeles' ban comes at a time when governments of all levels are increasingly viewing menus as a matter of public health. On Friday, California became the first state in the nation to bar trans fats, which lower levels of good cholesterol and increase bad cholesterol.

The moratorium, which can be extended up to a year, only affects standalone restaurants, not eateries located in malls or strip shopping centers. It defines fast-food restaurants as those that do not offer table service and provide a limited menu of pre-prepared or quickly heated food in disposable wrapping.

The definition exempts "fast-food casual" restaurants such as El Pollo Loco, Subway and Pastagina, which do not have drive-through windows or heat lamps and prepare fresh food to order. The ordinance also makes it harder for existing fast-food restaurants to expand or remodel.

Rebeca Torres, a South Los Angeles mother of four, said she would welcome more dining choices, even if she had to pay a little more. "They should have better things for children," she said. "This fast food really fattens them up."


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