4

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Institute of Medicine Annual Report (out 6/23/11) - Can you help me to parse this?

Answered on September 12, 2014
Created June 24, 2011 at 11:22 AM

Here is the Institute of Medicine of the National Academies early report on childhood obesity:

http://www.iom.edu/Reports/2011/Early-Childhood-Obesity-Prevention-Policies.aspx

Here are the recommendations:

http://www.iom.edu/Reports/2011/Early-Childhood-Obesity-Prevention-Policies/Recommendations.aspx

My brother-in-law and sister-in-law are both family physicians. My brother-in-law emailed this report to my husband last night saying that they are concerned - that it "bothers us that your girls (and you, for that matter) are eating a high fat diet that clearly is dangerous and WILL lead to future problems including heart disease." (quote from email).

Does this report (or its source - the supposedly independent review body IOM) hold any merit?

D30ff86ad2c1f3b43b99aed213bcf461

on June 24, 2011
at 02:19 PM

@Matthew, yea, if Go-Gurt and "yoghurt"-covered-raisins qualify as dairy, then really...how is that food?!!

0bc6cbb653cdc5e82400f6da920f11eb

(19235)

on June 24, 2011
at 02:16 PM

Also in the first table, what would be the reasoning behind putting "eggs, nuts, seeds and soya" all in the same catagory? :S

0bc6cbb653cdc5e82400f6da920f11eb

(19235)

on June 24, 2011
at 02:11 PM

I always wonder that catagories like "dairy" or "potatoes (white) and other starchy" contain such a wide variety of possible food products it seems questionable to draw any valid conclusions from them.

D30ff86ad2c1f3b43b99aed213bcf461

on June 24, 2011
at 02:04 PM

Thoughtful analysis here; thanks so much.

D30ff86ad2c1f3b43b99aed213bcf461

on June 24, 2011
at 02:03 PM

True...anybody taking a glance at the lunchboxes would realize that my girls still get a lot of carbs via starchy tubers, squashes, and fruits.

E35e3d76547b18096a59c90029e7e107

(15613)

on June 24, 2011
at 02:02 PM

Tbf it starts off saying "U.S. children of all ages are consuming diets that are too high in added sugar and fat" but I'm sure this was just a reflexive comment. Why one would think that whether the fat/sugar is "added" matters, I don't know...

3aea514b680d01bfd7573d74517946a7

(11996)

on June 24, 2011
at 01:39 PM

+1 for your last paragraph in particular, Dave. It's a fine line to walk between being convinced and being religious, but because the CW is so monolithic, it really helps to be firmly grounded in science and in direct personal experience.

D30ff86ad2c1f3b43b99aed213bcf461

on June 24, 2011
at 01:21 PM

Thanks for the encouragement. I didn't write up this question as a solicitation of personal attacks on my BIL/SIL, but more as a way of seeing if other PaleoHackers saw/read this report and had any commentary on its content. Fortunately for me, you understood the thrust of my question.

D30ff86ad2c1f3b43b99aed213bcf461

on June 24, 2011
at 01:21 PM

Thanks for the encouragement. I didn't write up this question as a solicitation of personal attacks on my BIL/SIL, but more as a way of seeing if other PaleoHackers saw/read this report and had any commentary on its content.

Ed71ab1c75c6a9bd217a599db0a3e117

(25477)

on June 24, 2011
at 12:16 PM

kinda amazing your BIL allows group opinion to usurp his thought process.....has he of his wife not thought about why we have 60 million type two diabetics? This is what is wrong with my profession. Head up the assitis.

Ed71ab1c75c6a9bd217a599db0a3e117

(25477)

on June 24, 2011
at 12:14 PM

go buy him a biochemistry book and ask him to read it for a change.

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5 Answers

5
1568416ef28477d1fa29046218d83ddd

(6235)

on June 24, 2011
at 02:07 PM

Let me start my making it clear I am snarky at times, but I suggest something like this

Dear Interfering Sibling (ok use his name),

I respect and appreciate your professional expertise so I evaluated the material you sent me. Naturally the recommendations for policy makers did not really apply to me in my role as parent, but I do think we can largely agree on the goals.

Because you expressed concern let me explain to you how I am taking steps to address each of these goals.

Growth Monitoring

Goal: Assess, monitor, and track growth from birth to age five.

I agree that I should pay attention to the size and shape of my children and consider further action if they appear to not be growing well or if they appear to be gaining too much weight. I assume that your concern is because you have not seen them recently, so I have attached a photo.

Goal: Increase physical activity in young children.

In this case I do have to assume that they are wanting young children to be more active then the norm. The following are the activities my children have engaged in this morning: Chasing the cat, climbing the furniture, wrestling each other, swinging on the swing-set and jumping up an down asking please please please can they have more beef jerky. While it is not a specific goal to increase this level of activity, I do think that it is a healthy level of activity for young children.

Goal: Help adults increase physical activity and decrease sedentary behavior in young children.

Well the kids seem active, but I want to set a good example (and keep up!) so I try to walk every day and engage in a strength training and other activities regularly.

Healthy Eating

Goal: Promote the consumption of a variety of nutritious foods, and encourage and support breastfeeding during infancy.

I counted and today my children consumed a total of 16 different kinds of food including 10 different kinds of veggies and 2 kinds of fruit. None of this was packaged, premade or fast food.

If you wish to argue with me about the nutritious aspect I will address that in a different letter, but I will note that the specific recommendations under this guideline suggest establishing these recommendations, which seems to indicate that they don't exist.

In deciding on a nutrition plan for my family I read the following materials (list) and as I found them credible and useful I adopted the recommendations. As a result I have seen the following changes in my health (list). I am unwilling to change to what policy makers might recommend some time in the future without solid evidence that these benefits will not go away.

Goal: Create a healthful eating environment that is responsive to children???s hunger and fullness cues.

I feed my children when they are hungry and no one has to clean their plate.

Goal: Ensure access to affordable healthy foods for all children.

It would be easier on the buy cheaper meat, fewer fresh veggies and more things in packages. Instead we spend more because we believe in the value of nutrition and are willing to put our money and our time in to feeding our children fresh, minimally processed food.

Goal: Help adults increase children???s healthy eating.

I know you care but getting scary warnings about the way we feed our children and ourselves is not supporting me in my choice to take time and effort in to feeding my family fresh natural foods. I have seen concrete benefits to all of our health and activity levels. Somehow that seems less important to you then the fact we are not following policy recommendations from the USDA, an agency that is more responsible for supporting agriculture than human health.

I respect your expertise but please respect my personal sovereignty to make decision for my own health and the health of my children. At least you can take comfort in them not eating McDonalds.

Goal: Limit young children???s screen time and exposure to food and beverage marketing.

(don't know what your TV computer policies are)

Goal: Use social marketing to provide consistent information and strategies for the prevention of childhood obesity in infancy and early childhood.

I use social media to explain what I feed my kids and why in hopes of inspiring other parents to make home-cooked meals from high quality ingredients.

Goal: Promote age-appropriate sleep durations among children.

I could not agree with this one more. Proper sleep is an important part of our overall plan. I have read a lot about this at my Paleo sites and as a result I have the following beadtime polices(list). This is how much sleep each child got last night:

5
0bc6cbb653cdc5e82400f6da920f11eb

(19235)

on June 24, 2011
at 01:44 PM

Firstly:

The report looks pretty good after a quick look through it. Lots of good sensible advise about breast feeding, activity and sleep. Limiting TV marketing exposure and sugary drinks. Parts of the healthy eating section seem the weakest bit as they mostly just repeat standard USDA recommendations.

"offering an age-appropriate volume of breast milk" - I found that bit amusing.

I'm not sure how your brother in law read all that and reached the conclusion "they are eating too much fat!". The recommendations don't even mention dietary fat.

Secondly:

Has your brother in law seen your blog?

If all school children ate as well as yours appear too at lunchtime I doubt there would be any childhood obesity. I'm sure very few children get so many fruits and vegetables or such a variety in their lunchbox. Few of the meals you have posted on your blog seem all that high in fat either.

There is just too much focus on macronutrients like "fat" instead of eating whole foods and less processed foods. Kids don't really need high or low fat, high or low carbs, they just need a variety of wholesome food or all kinds.

E35e3d76547b18096a59c90029e7e107

(15613)

on June 24, 2011
at 02:02 PM

Tbf it starts off saying "U.S. children of all ages are consuming diets that are too high in added sugar and fat" but I'm sure this was just a reflexive comment. Why one would think that whether the fat/sugar is "added" matters, I don't know...

D30ff86ad2c1f3b43b99aed213bcf461

on June 24, 2011
at 02:03 PM

True...anybody taking a glance at the lunchboxes would realize that my girls still get a lot of carbs via starchy tubers, squashes, and fruits.

4
E35e3d76547b18096a59c90029e7e107

(15613)

on June 24, 2011
at 01:33 PM

That isn't a document that is supposed to offer any support for the conclusions that one ought to eat low fat. It's just a guidance document supposed to summarise the current state of knowledge in a relatively basic form. The studies that it does cite are pretty limited.

For example, it cites this study in support of the claim that "U.S. children of all ages are consuming diets that are too high in added sugar and fat and too low in fruits and vegetables, whole grains, and low-fat and nonfat dairy products." But the actual findings of the study (which does indeed tout those conclusions) are pretty equivocal.

institute-of-medicine-annual-report-(out-6/23/11)---can-you-help-me-to-parse-this?

As you can see, this just compared the number of portions of various categories of foods typically eaten by the group with the highest waist circumference to those with the lowest. None of this, I think, is particularly revealing, but even where there are trends, all the normal criticisms of these mere associations apply. i.e. are the people eating lots of low fat dairy healthy because of the dairy or are they eating the low fat dairy because they're very health-conscious?

I think the previous table is even more confused: institute-of-medicine-annual-report-(out-6/23/11)---can-you-help-me-to-parse-this?

Quite often we don't see straight correlations here, but rather pretty erratic leaps up and down and up and down again between quartiles. The study doesn't offer any reason to think that high fat is objectionable or a cause of obesity, at best it shows that healthier people are eating more food rather than non-food.

0bc6cbb653cdc5e82400f6da920f11eb

(19235)

on June 24, 2011
at 02:11 PM

I always wonder that catagories like "dairy" or "potatoes (white) and other starchy" contain such a wide variety of possible food products it seems questionable to draw any valid conclusions from them.

0bc6cbb653cdc5e82400f6da920f11eb

(19235)

on June 24, 2011
at 02:16 PM

Also in the first table, what would be the reasoning behind putting "eggs, nuts, seeds and soya" all in the same catagory? :S

D30ff86ad2c1f3b43b99aed213bcf461

on June 24, 2011
at 02:04 PM

Thoughtful analysis here; thanks so much.

D30ff86ad2c1f3b43b99aed213bcf461

on June 24, 2011
at 02:19 PM

@Matthew, yea, if Go-Gurt and "yoghurt"-covered-raisins qualify as dairy, then really...how is that food?!!

4
A968087cc1dd66d480749c02e4619ef4

(20436)

on June 24, 2011
at 01:09 PM

I didn't see anything in there praising "healthy whole grains" or demoninzing saturated fat. They just mention healthy eating and obliquely refer to the dietary guidlines, suggesting that more guidance is required for children. I think the recommendations for more activity and quality sleep are actually pretty good. But its a typical agency hodge-podge of ideas with no coherent logical basis (or scientific references for that matter). It is about the quality level of a typical magazine article.

Totally agree with pointing them to the Denise Minger takedown, but it will probably fall on deaf ears. You should read the whole thing, twice, plus the coments.

The real key - is that you have to be totally convinced that you are doing the right thing. Because it flies in the face of conventional wisdom and the mainstream medical community - you must do the hard work and research necessary to understand the science and why high saturated fat is not dangerous (actually healthy) and why grains/fructose/omega-6 are unhealthy. Fortunately, PaleoHacks is a great place to start. I would also recommend looking up posts on the following blogs: Mark's Daily Apple, PaNu/Archevore/Hyperlipid/Protein Power and a few others, but that should be enough to start with.

D30ff86ad2c1f3b43b99aed213bcf461

on June 24, 2011
at 01:21 PM

Thanks for the encouragement. I didn't write up this question as a solicitation of personal attacks on my BIL/SIL, but more as a way of seeing if other PaleoHackers saw/read this report and had any commentary on its content.

D30ff86ad2c1f3b43b99aed213bcf461

on June 24, 2011
at 01:21 PM

Thanks for the encouragement. I didn't write up this question as a solicitation of personal attacks on my BIL/SIL, but more as a way of seeing if other PaleoHackers saw/read this report and had any commentary on its content. Fortunately for me, you understood the thrust of my question.

3aea514b680d01bfd7573d74517946a7

(11996)

on June 24, 2011
at 01:39 PM

+1 for your last paragraph in particular, Dave. It's a fine line to walk between being convinced and being religious, but because the CW is so monolithic, it really helps to be firmly grounded in science and in direct personal experience.

3
1d9af5db8833413037be3ac48964714f

on June 24, 2011
at 12:40 PM

I would point him to Denise Minger's excellent blog, and particularly this post eviscerating the latest U.S. dietary guidelines:

http://rawfoodsos.com/2011/02/04/the-new-usda-dietary-guideline/

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