This story is about a study comparing how fast heavy children normalized their weight in the Head Start program compared with low-income children who were recruited from primary care clinics and whose participation in Head Start or other preschool programs was unknown. The comparison group children were sorted into two groups: those with Medicaid and those without Medicaid insurance. The Head Start children were not similarly classified. The number of obese children was much higher in the Medicaid compared with non-Medicaid children, and the story should have questioned why the Medicaid/non-Medicaid distinction was not applied to the Head Start kids as well. Unfortunately, this issue was not addressed. In addition, only 12 out of 51 (23.5%) of the eligible Head Start programs chose to participate in the study. Therefore, it is not clear how representative the conclusions are about Head Start as a whole.
In short, the story overlooked significant limitations in the study: missing data (Medicaid status of Head Start kids), a retrospective/observational study design, and non-random selection of a few Head Start programs. It gives readers an inflated sense of the strength and importance of the findings.
As the study points out, it would be great if Head Start normalized body weight in addition to its known improvements in school performance. However, the quote from one of the researchers — “Participating in Head Start may be an effective and broad-reaching strategy for preventing and treating obesity in United States preschoolers” — represents an overreach. We still do not know.
The story states early in the article that the Head Start Program is free to impoverished children ages 3-5.
The story says that “obese and overweight kids [in Head Start] lost weight faster than two comparison groups of children who weren’t in the program.” It also says that “initially obese and overweight Head Start children were substantially less obese and overweight than the children in the comparison groups.” But how much weight did these children lose? How much did rates of obesity go down? The story doesn’t quantify what it means by “substantial.”
No harms were mentioned in this article. However, it is difficult to ascertain possible risks or harms in a case like this.
The story makes no attempt to describe any of the extensive limitations of this study. It leaves the reader with the impression that Head Start was responsible for the improvements in weight status, but this was an observational study that is only capable of establishing associations and cannot prove cause and effect. (See our tool kit for more on this topic.) Few of the eligible HeadStart Centers that were eligible to participate in this study chose to do so, which raises the possibility that the centers studied here are somehow different from your typical Head Start center. In addition, the research did not identify the Medicaid status of the HeadStart children in the study, even though Medicaid vs. non-Medicaid status was deemed an important difference in the non-Head Start children. In short, there could be important differences in the make-up of the Head Start group vs. the comparison group that contributed to the findings reported by the study authors. The story should have alerted readers to this possibility.
The reporter does not exaggerate the burden of obesity in children, especially those who are impoverished.
The story provides comments by a source who was not involved in the study, Dr. David Katz of Yale University, explaining the value of the Head Start Program.
The story does not place these findings in context with other obesity prevention and treatment initiatives for children. This is an area that has been studied extensively.
The story mentions that Head Start is available to children ages 3-5 who live in poverty. We’ll rate this good enough for a satisfactory grade. Detail about how to enroll in the program would have helpful.
Is this the first time that researchers have investigated the effects of Head Start participation on childhood obesity? The story doesn’t say.
Since the story includes comments from an independent expert, we can be sure it didn’t rely solely on a news release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
Comments (2)
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Wendy Repovich
January 19, 2015 at 10:57 amIt is quite likely that the “comparison group” children on medicaid were also in Head Start programs so the entire study is likely biased. Also, the expert stating that Head Start works for other things besides weight is not familiar with Head Start outcomes, the only study ever that has shown a benefit was a very small study done early on in the program but since then it has been consistently reported that there is no difference in student performance by grade 3. It seems someone is trying to convince Congress to keep funding this program.
Nancy Ortiz, MS, RD
January 19, 2015 at 12:35 pmWhen a fellow Dietitian went to assess our local Head Start menus, she found they were giving Pop Tarts for breakfast.
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