A study in Madrid of 2,000 preschoolers compared those who received special education in heart-healthy living with those who didn’t – and showed a modest improvement for children who received the lessons. An editorial used the word “groundbreaking” for the study, but the numbers seemed quite modest. The release could have provided context to try to justify the excitement.
Changing people’s habits is a vital part of reducing the chronic diseases, including obesity and heart disease, that are epidemic in industrial societies. If making health part of the preschool classroom can accomplish this, it would be big news. This news release overstates a study that is mostly showing a proof of principle and will require much follow-up and analysis before one can say the educational intervention made these children any healthier or produced a durable change in their habits.
The news release does not talk at all about costs, and this three-year intervention including education for 3-5 year-old children sounds as if it could have had substantial cost.
The release does quantify benefits – but it leaves readers a bit underwhelmed. The numerical differences shown are rather small for the conclusion that the release trumpets. We would have liked some context to justify the excitement about this study.
Children who received intervention scored 5.5 percent higher in “knowledge, attitude and habits” than the controls, after the first year. However, that difference lowered to just 4.9 percent after the third year of intervention. We suspect that quantifying the “knowledge” of a 4-year-old is tricky and perhaps a bit more subjective than a blood test or other study data.
Children who received the intervention had obesity rates of 1.1 percent in the group compared to 1.3 percent in the control group. The release should have explained why the authors believe the difference of only 2/10 of a percent qualified as “groundbreaking.”
In addition, we’d note that the release touts reductions in body fat, measured through skinfold measurements, as a positive outcome. But skinfold measurements are a questionable marker of body fat given not only risk of inter-, but intra-operator error in terms of landmarking the exact same skinfold location for repeated measurements.
Because the interventions are largely educational and don’t include drugs or therapies, we’ll say that harms are unlikely. But is it theoretically possible that the intervention could have some unforeseen impact on these children that shows up years later? Fear of fat? Anorexia? We won’t penalize the release for not raising the issue, but saying something about downstream potential would have added depth and insight.
This study of 2,000 children appears to have a high quality of evidence in the study itself, and the release does a Satisfactory job of summarizing what the researchers did and what they found. But the news release could have gone further. It could have noted, for example, that schools were randomly assigned to participate or not in the intervention — and that this helps assure that the findings represent an isolated effect of the intervention itself rather that other factors that could have had an impact. There is similarly no discussion of potential limitations of the study, nor does the release give us any specifics as to what kinds of education and lifestyle interventions were offered to the children. As we said above, we wish the release had included some context by which to judge the small difference between study subjects and controls.
There is no disease mongering in this release.
The release does not mention the funding sources for the study, which was supported by government and foundation grants. Although there are no obvious conflicts of interest here, we always ask that news releases provide funding information about studies so that readers and journalists have easy access to this information.
The use of education for preschool-aged children to prevent cardiovascular disease appears novel, and we are not aware of a direct alternative “education” that exists. We’ll rule this one Not Applicable.
The release mentions that the intervention is part of the SI! program — but it doesn’t establish what that is or whether it’s something that the wider public has access to. One might presume that the program is used only in a research setting at present, but we don’t know that for sure, and the release should have made this clear.
The release establishes the novelty of this prevention intervention with a quote: “There is a need for a complete change in the timing of when we deliver care,” said Valentin Fuster, M.D., Ph.D., senior author of the paper. “Until now, the clinical community has focused on cardiovascular disease, which typically manifests in the later stages of life. Now, we need to focus our care in the opposite stage of life–we need start promoting health at the earliest years, as early as 3 to 5 years old, in order to prevent cardiovascular disease.”
The biggest claim is that the intervention “improves their [preschoolers] knowledge, attitude and habits toward healthy diet and exercise and can lead to reduced levels of body fat.” That claim is not unjustified, but rather the data seems to show the improvement is slight.
But we think it’s unjustified to predict that these results will “translate to a lifelong understanding of healthy habits” as the release claims. There’s no data at all to suggest that these changes would be sustained beyond the active intervention period.
We’re similarly concerned with a quote pulled from the accompanying editorial which states that there is a need to pinpoint the mechanisms through which the intervention “achieved positive effects on young children’s health.” We’re not at all sure that a slight increase in knowledge a very small reduction in bodyfat represent “positive effects on health.” Health encompasses much more than these things.