When the study was published in late February in the Journal of
the American Medical Association, no one had a ready explanation for
that astounding finding by researchers at the U.S. Centers for
Disease Control and Prevention. Indeed, it seemed to catch the
experts by surprise.
Anti-obesity campaigners credited everything from changes to the
federal nutrition program for low-income women and children to the
elimination of trans-fats from fast food, more physical activity in
child-care programs and declining consumption of sugary drinks.
First Lady Michelle Obama and others seized on the finding as a sign
that efforts to combat the national obesity epidemic were paying
But as obesity specialists take a closer look at the data, some are
questioning the 43 percent claim, suggesting that it may be a
statistical fluke and pointing out that similar studies find no such
decrease in obesity among preschoolers.
In fact, based on the researchers' own data, the obesity rate may
have even risen rather than declined.
"You need to have a healthy degree of skepticism about the validity
of this finding," said Dr. Lee Kaplan, director of the weight center
at Massachusetts General Hospital in Boston.
No evidence of the kinds of major shifts in the behavior among
preschoolers aged 2 to 5 exists which would explain a 43 percent
drop in their obesity rates, he said.
SMALL SAMPLE SIZE
The latest study is based a well-respected data set taken from the
National Health and Nutrition Examination Survey, or NHANES, which
has been conducted annually since the 1960s and involves in-person
interviews and physical exams.
The CDC defines obesity in adults as having a body mass index — a
ratio of weight to height — above 30, but in children it is defined
by where the individual falls on age- and sex-specific growth
The 2011-2012 version of the survey included 9,120 people; 871 of
them were 2 to 5 years old.
In some research 871 would be considered a large number. But when
the obesity rate is fairly low, having a sample of a few hundred
makes it easier for errors to creep in through random chance.
"In small samples like this, you are going to have chance
fluctuations," said epidemiologist Geoffrey Kabat of the Albert
Einstein College of Medicine in New York City.
To be sure, the CDC scientists were aware of the statistical
limitations of their data, and their paper clearly stated that the
findings were imprecise.
The 43 percent headline figure refers to the drop from the 13.9
percent rate in 2003-04 to the 8.4 percent rate in 2011-2012. The
change of 5.5 points represents a decline of 40 percent from the
original 13.9 percent. (The 43 percent trumpeted by a CDC press
release comes from rounding those numbers to 14 and 8,
The 13.9 percent obesity rate among preschoolers reported for
2003-2004 had a large enough margin of error that the actual rate
could range between 10.8 percent and 17.6 percent, the CDC authors
acknowledged. The 8.4 percent rate in 2011-2012 reported could range
from 5.9 percent and 11.6 percent.
Since the range for 2003-2004 overlaps with that of 2011-2012, Kabat
said, "that's another way of saying there might have been no change"
in preschoolers' obesity rate. Even an increase is a statistical
Indeed, the CDC scientists' conclusion is that "there have been no
significant changes in obesity prevalence in youth or adults between
2003-2004 and 2011-2012."
Even so, a CDC press release trumpeted in its first sentence "a
significant decline in obesity among children aged 2 to 5 years,"
with obesity prevalence for this group showing "a decline of 43
A CDC spokeswoman said the lead author of the JAMA study, Cynthia
Ogden, "is not doing any media interviews," but acknowledged that
"the sample size is somewhat small so the (ranges of values) are a
In addition, claiming a 43 percent plunge in preschooler obesity
"isn't really properly descriptive of the trend," because the rates
have bounced around over the last decade, the spokeswoman, Corey
[to top of second column]
DEARTH OF SUPPORTING EVIDENCE
A study of preschoolers in the federal WIC (Women, Infants and
Children) program, which provides food vouchers, nutrition classes
and counseling to low-income families, found virtually no change in
Rather than reducing the prevalence of obesity among 3- and-4-year
olds in the WIC program in California's Los Angeles County,
researchers found that the problem worsened from 2003 to 2011.
Obesity rose to 20.4 percent from about 17 percent, the researchers
reported in the CDC's Morbidity and Mortality Weekly Report in 2013.
In New York, the WIC study found that obesity rates fell to 15.5
percent in 2011 from about 19.5 percent in 2003, a much less
dramatic drop than the 40 percent decline.
"We agree there is a slight downward trend in obesity among
2-to-5-year olds," said Shannon Whaley, a co-author of the WIC
study. "But a 43 percent drop is absolutely not what we're seeing."
The WIC study included more than 200,000 children, while the CDC
researchers "looked at just a small population of 2-to-5-year olds,"
said Whaley, who serves as director of research and evaluation at
the Public Health Enterprises Foundation, a nonprofit group that
provides WIC services in Los Angeles. "Larger data sets are probably
Other studies also raise questions about the 40 percent claim. An
earlier CDC study, reported in JAMA in December 2012, found that the
prevalence of obesity among 2-to-4-year olds in low-income families
fell to 14.9 percent in 2010 from 15.2 percent in 2003. That
represents an improvement of less than 2 percentage points, based on
data for 27.5 million children collected at public health clinics.
The CDC researchers had earlier reported that the prevalence of
obesity among low-income preschoolers fell from 2008 to 2011 in 19
states. But the largest decrease was from 13.6 percent to 11
percent. In most states, declines were much less pronounced.
SCANT SIGNS OF BEHAVIORAL CHANGE
For obesity rates to drop, researchers reckon, young children have
to eat differently and become more active. But research shows little
sign of such changes among 2-to-5-year olds, casting more doubt on
the 43 percent claim.
Such a decline would require changes in exercise, food consumption
and sleep patterns, said Mass General's Kaplan "There is no evidence
of that," he said.
In 2010 Whaley and her colleagues examined the effectiveness of WIC
classes and counseling to encourage healthy eating and activities
for women and children in the program.
Their findings were discouraging: Television watching and
consumption of sweet or salty snacks actually rose, while fruit and
vegetable consumption fell — changes that could lead to weight gain.
One positive was a rise in physical activity.
Apart from the WIC program, few anti-obesity efforts target
preschoolers, Kaplan pointed out. That makes a precipitous decline
in obesity in that group highly unlikely.
"The programs that have been implemented, from changing what's in
vending machines to the Let's Move program, target school-age
children more than preschoolers," he said, referring to an exercise
initiative championed by Michelle Obama.
While experts have raised doubts that obesity among preschoolers has
fallen as much as CDC reported, no one can say for certain that the
claim is wrong. To resolve the controversy, scientists say they need
more data on both preschoolers and older children.
Until then, said Einstein's Kabat, "there are many reasons to think
the 43 percent claim is shaky."
(Reporting by Sharon Begley; editing by Michele Gershberg)
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