Abstract
To the Editor:
We read with consternation and distress the Taveras and colleagues and Davison and colleagues articles published in the February 2015 issue of Childhood Obesity. Taveras and colleagues described the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project. MA-CORD is a 2-year multisetting childhood obesity intervention for 2- to 12-year-old low-income children to be implemented in primary healthcare, at the Women's, Infants, and Children (WIC) program, and at early child care, school, and afterschool and community-wide programs. The goals are to lower BMI, reduce screen time, and to promote eating more fruits and vegetables, increase physical activity, and increase appropriate sleeptime. 1 MA-CORD is part of a three-site national study that includes California and Texas. Davison and colleagues discussed the MA-CORD intervention plan (described above) and the 2012 baseline data: 16% of preschool-age and 25% of school-age children were classified as obese, 15–40% of children were not eating vegetables every day, 87% of children were not having enough physical activity daily, 50–75% of children were watching television before sleeping at night, and 50–80% of children were not sleeping enough time. 2
Interventions such as MA-CORD have been tried in the past and proven to be costly and poignantly ineffective. The Nutrition and Physical Activity Program in Kearney, Nebraska, Pathways study, and Child and Adolescent Trial for Cardiovascular Health (CATCH) are three of the most prominent health promotion and childhood obesity prevention interventions in the United States.3–5 These three interventions resulted in no significant changes in children's weight or lipid levels, 5 energy intake, 4 fat intake, 3 physical activity, or percentage body fat. 4 But the children participants, sensing what the adults expected them to say, reported that they learned about food and health 4 and ate less fat. 5 MA-CORD is including the same strategies as those used in Kearney, 3 Pathways, 4 and CATCH 5 (not surprisingly given that some of the researchers are the same). The new strategy in MA-CORD is to expand the intervention to all places where children are to receive care or education and to promote more sleep for children. 1
It is time to stop wasting money and resources on interventions that use ineffective strategies of the past. Wake and Lycett say that it is time to dismantle the “… ingrained overoptimism as to how much population change can really be achieved via educational and motivational means.” 6 It is time to recognize that the role of programs such as WIC, school, afterschool, and community-wide programs, as well as the role of society at large, is not to encourage, pressure, reward, or even educate children to eat certain foods (deemed healthier) or exercise in prescribed ways. The role of the WIC program and other food programs is to support the children's parents, especially low-income, to provide for their children enough good food, family meals, and sit-down snacks at consistent and reliable times, and fun opportunities to be physically active (through unstructured play and/or sports) to reach their potential. The role of schools and afterschool programs is to expose children to foods they do not get at home, teach and model food acceptance skills, foster a positive mealtime environment, expose children to play and sports, and collaborate with parents to extend these activities at home.
It is truly time to think differently, focusing not on weight, but instead on ways to help children become competent eaters who have a positive relationship with food, and who are parented so that they reach their individual potential socially, emotionally, and physically. We have beaten the dead horse that is pediatric weight loss and healthy eating for too long.