How to use misleading statistics in a bid for government funding - the LGA and public health at their finest

Terrible:

Council chiefs have warned of a ‘childhood obesity crisis’ as new figures reveal that the number of young people being treated for Type 2 diabetes has increased by nearly 50% in five years.

Not the statistic but the spectacularly misleading way in which this scary paragraph is framed. It is, I'm afraid, an absolute classic of the public health scare story genre - guaranteed to get media coverage but utterly deceptive.

So let's look at the numbers:

Figures from the Royal College of Paediatrics and Child Health show that 745 children and young people under the age of 25 received care for Type 2 diabetes in Paediatric Diabetes Units in England and Wales in 2017/18.

The first point here is that we're not talking about children here - unless we've begun categorising those aged 18-25 as children? Of the cohort in question (under 25 years old), a third -32% to be more precise - are adults i.e. aged over 18. Some of them may be obese and may have Type-2 diabetes but using these figures to claim an increase in child diabetes is simply wrong.

And that cohort? There are 17.4 million of them meaning that the 745 who have 'received care' for Type-2 diabetes represent a massive 0.004% of the population. There may have been an increase since 2015 of 50% but this is still not in any respect a crisis (except perhaps for the individuals most of whom will be over 18). Even with the more inflated Diabetes Association estimate of 7,000 under 25s who have received support for 'diabetes-related' conditions, the problem still only affects 0.04% of the cohort.

There has been a trend in public health using secondary factors to substantiate proposals for either new regulations, new taxes or more local government funding. Mostly this is because there's not really any evidence that child obesity is rising:





That's from King's College - here's the latest from the NHS itself:



Again no indication that child obesity is rising (indeed it has fallen for children arriving in primary school). So public health look for other statistics to peddle their hysterical fussbucketry, most commonly statistics like these on Type-2 diabetes that, while interesting, suffer from a whole load of flaws (changes in referral practice, greater awareness of symptoms, new centres and facilities to support diabetes) that mean the increase could be entirely unrelated to changes in the number of obese children and relate more closely to better diagnosis and more provision in the NHS system - both good things but no justification for advertising bans or bunging millions for local councils to splurge on useless obesity programmes.

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Why has diabetes increased? The answer may be economics rather than lifestyle

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Over the last couple of days we've seen reports that the numbers of diagnoses for diabetes in the UK has risen by 60% over the last decade.

The number of people living with diabetes has soared by nearly 60% in the past decade, Diabetes UK warns.

The charity said more than 3.3 million people have some form of the condition, up from 2.1 million in 2005.

There's no disputing the accuracy of these figures or indeed the impact of the increase on the NHS (although claims it will 'bankrupt' the service are stretching the point a little). And we obviously need to know what it is that's causing the increase so as to try and prevent or mitigate those causes.

The most common 'cause' fingered in the reports is "lifestyle":

Martin McShane, national medical director for long term conditions at NHS England, said: “These figures are a stark warning and reveal the increasing cost of diabetes to the NHS. Evidence is piling up that added sugar and excess calories are causing avoidable increases in obesity and diabetes.

“We’ve said it before and we’ll say it again, it’s time to get serious about lifestyle change. Prevention is better than treatment for individual health as well as the health of the NHS.”

And let's be clear here about lifestyle. There's a well established link between morbid obesity and type-2 diabetes (which makes up 90% of the increase):

The relationship between obesity and diabetes is of such interdependence that the term 'diabesity' has been coined. The passage from obesity to diabetes is made by a progressive defect in insulin secretion coupled with a progressive rise in insulin resistance. Both insulin resistance and defective insulin secretion appear very prematurely in obese patients, and both worsen similarly towards diabetes.

So if there has been a significant increase in obesity, we would expect a comparable increase in type-2 diabetes. The problem is that this dramatic increase in diabetes has come during a period when the UK's rates of obesity were pretty stable (perhaps rising slightly):

If obesity is the main cause of new diabetes cases, this graph suggests that the increase should have been significantly less than 60%. So we have to look for another cause - perhaps it's something specific in the diet - sugar is the usual culprit here (mostly because diabetes is all about blood sugars and stuff like that so it stands to reason, doesn't it). Listening to a radio report on the story, I heard the interviewer ask something like "but it's not every kind of sugar is it, there are good sugars like the ones in fruit" - receiving a response all about 'five-a-day' rather than an accurate answer explaining how there's a link between fructose and type-2 diabetes (fructose being the dominant sugar in fruit).

It's worth therefore looking at whether sugar makes up more or less of our calories than it did a decade age - if there has been a substantial increase in sugar as an element in our diet and especially fructose then we might be able to point at that as a reason for the huge increase:

So here are some facts about the consumption of "non-milk extrinsic sugars" (this is all the added sugar as well as honey) in the UK. The figures come from the National Nutrition and Diet Survey (NNDS) conducted by the Government to provide a nationally representative snapshot of the nutritional intake and status of the UK population.

In 2000/01 NMES consumption in daily grammes was:

Male: 79
Female: 51

In 2008-20011 the average is:

Male: 70
Female: 50.1

So our sugar consumption has fallen. And this includes ALL forms of added sugar - the scary hidden stuff in processed food and the spoonful of lovely honey you stir into your hot toddy. Other than for women over 65 every category of consumption has fallen - with the biggest fall being among children.

We still eat a lot of sugar but there's no indication that it can be blamed directly for the increase in diabetes and especially type-2 diabetes. Despite all the shouting about diet and obesity, all the damnation of 'lifestyle', we're not really any closer to understanding why the last decade has seen such a big increase in diabetes. There is, however, one other thing that changed in 2004:

The new GP contract has been quoted as the most radical change to health care since the advent of the NHS in 1948. A major component of the contract is the Quality and Outcomes Framework (QOF). This offers a scoring system for achievement of health-care targets which is linked to financial rewards.

Put more simply - from 2004 family doctors were given a direct financial incentive to diagnose conditions that were within health-care targets and this included diabetes. Prior to 2004 few GPs ran routine diabetes tests - afterwards, with a direct financial incentive, loads more cases were identified. Don't get me wrong here, I'm not suggesting the incentive was a bad thing (it did mean lots more people got their diabetes treated who didn't before) but that it was perhaps the main reason why we saw a steady increase in diagnoses for diabetes.

Finally there's the matter of demographics - or to put it another way, how we're living longer:

You can see (perhaps) the impact of the rapid increase in obesity during the 1990s but look at the prevelance in the over-65s. Combine an incentive for GPs with an ageing population more likely to be visiting those GPs and we can see the source of our 60% rise. And this means that, rather than shouting about lifestyle, we should be celebrating just how well we've done in identifying diabetics - the task is to get that diabetes managed so as to avoid the expensive clinical interventions that are the big drivers of cost.

But then shouting about fat people and blaming sugar is much easier isn't it!

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In which George Monbiot lets his dislike of fat poor people - and their food choices - get the better of his grasp of facts

OK let’s start with George Monbiot’s assertion that Alzheimer’s Disease is just another form of diabetes (although what seems to be said is that having diabetes – including diabetes linked to brain sugars – significantly raises the risk of getting Alzheimers Disease which isn’t quite the same thing).

There’s a problem with George’s assertion that this is entirely down to diet – and crucially the evils of junk food:

A scarcely regulated food industry can engineer its products – loading them with fat, salt, sugar and high-fructose corn syrup – to bypass the neurological signals that would otherwise prompt people to stop eating. It can bombard both adults and children with advertising. It can (as we discovered yesterday) use the freedom granted to academy schools to sell the chocolate, sweets and fizzy drinks now banned from sale in maintained schools. It can kill off the only effective system (the traffic-light label) for informing people how much fat, sugar and salt their food contains. Then it can turn to the government and blame consumers for eating the products it sells. This is class war, a war against the poor fought by the executive class in government and industry.

Let’s take this diatribe piece by piece and see whether it stacks up.

“A scarcely regulated food industry”.

This is a statement of mind-blowing ignorance. Or maybe just deliberate misinformation from George.  I’m not going to list all the controls and regulations governing food production, food processing, distribution and retailing of food. You can experience the joy of knowing these regulations here at the Food Standards Agency. And that’s before we look at the control and regulations governing the sale of food for consumption on and off a given premises.

“...loading them with fat, salt, sugar and high-fructose corn syrup.”

Here George picks up every food scare going – the lies and myths about too much salt, the largely disproven attacks on saturated fats and the nonsense about sugar:

This week a meta-analysis of seven studies involving a total of 6,250 subjects in the American Journal of Hypertension found no strong evidence that cutting salt intake reduces the risk for heart attacks, strokes or death in people with normal or high blood pressure.

In 2000, a respected international group of scientists called the Cochrane Collaboration conducted a "meta-analysis" of the scientific literature on cholesterol-lowering diets. After applying rigorous selection criteria (219 trials were excluded), the group examined 27 studies involving more than 18,000 participants. Although the authors concluded that cutting back on dietary fat may help reduce heart disease, their published data actually shows that diets low in saturated fats have no significant effect on mortality, or even on deaths due to heart attacks.

A new study says that childhood obesity is not caused by soft drinks and sweetened beverages. The study, undertaken by researchers at the University of Saskatchewan, Canada and published in the journal Applied Physiology, Nutrition, and Metabolism, reports that most children who consume such drinks are at no greater risk of obesity than those of their peers who do not.

 As you can see, most of these scares are nonsense.

“..to bypass the neurological signals...”

Nope. This doesn’t happen either. Or not at least outside the pages of junk science and public health campaigns. And even if it did (the argument is essentially that eating is pleasant and that this is why we eat passed being full), it applies to a whole host of other foods than burgers, chips and cake. Try some of that wonderful sourdough bread with butter and a selection of good English cheese – tell me you’re not going to eat passed being full!

“It can bombard both adults and children with advertising”

How many times can people like George get away with parading their ignorance of advertising? It is a fact – not a question of debate or discourse but a fact – that in mature markets (and food markets are all mature) advertising is about brand equity, protecting market share and occasionally switching. After all we didn’t start eating because a food company advertised did we? And before you all start correcting me, I really am much more of an expert on advertising and marketing than George.

“This is class war...”

And George does a triple back somersault over the shark. Because poor people are more likely to be obese (and only yesterday George’s friends were telling us the poor didn’t have any food), it is the food industry waging a class war!  I’m sorry George but you are completely wrong. Indeed, the opposite is true. It is you and your middle-class fussbucket friends who are waging the class war. It is you who is trying to take away little pleasures from people who aren’t fat, don’t have diabetes and won’t get Alzheimers. It is you who wants to ban McDonalds but haven’t even taken a peep at the fat, salt and sugar laden wonders in the Michelin starred restaurants your Guardian-reading pals like to frequent.

To be fair to George he tells the truth right near the end of his snobby bigoted rant:

We cannot yet state unequivocally that poor diet is a leading cause of Alzheimer's disease..

Absolutely. The truth is that Alzheimer’s, like type 2 diabetes, like many cancers, like coronary heart disease is overwhelmingly a condition associated with old age. And the main reason why there are more of these conditions is because we are living longer.

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People who live on the streets more likely to be smokers (and other unsuprising facts)

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Mind you this doesn't stop homelessness charity Thames Reach from getting all hot and bothered about the fact:

More needs to be done to help the homeless population quit smoking as a high proportion of those in hostels are found to be smokers, a survey has found.

Research by homelessness charity Thames Reach, released only to Inside Housing, shows more than 73 per cent of service users were smokers.

The idiots at Thames Reach then go on to talk about diabetes (which isn't closely linked to smoking in the way that it is to poor diet). It seems to me that the least of our worries about the street homeless is whether or not they smoke - we should bother instead about the factors behind their situation whether that be mental health difficulties, breakdown or simple economics.

Tobacco might be expensive but for these people that little warm buzz from a fag might be the only little pleasure they get on the average evening. And these nannying fussbuckets at Thames Reach want to take that away from them.

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Sorry Tim but every day's a feast day in our house!

For lots of trendy foodie types – the locavores and such – Tim Lang is the man. This Professor churns out media friendly material that is seized on by the advocates of “meat free” and vegetarian lives. Now this man wants us only to eat meat on feast days - for the good of our health!  Professor Lang is wrong – massively and monumentally wrong:

Prof Lang, who advises the World Health Organisation, as well as the Department for Environment, on food policy, said eating too much meat can lead to serious health issues such as obesity, heart disease and type 2 diabetes.

Taking these things in order:

Eating “too much meat” isn’t the cause of obesity. Even the dear old NHS doesn’t list meat as a cause of obesity. In pretty general terms obesity results from ingesting more calories that you can use. And the main source of those calories isn’t meat, it’s processed carbohydrates – bread, pasta, pastry, cake, chocolate bars.

Eating “too much meat” isn’t a major risk factor in heart disease. Here from Scientific American:

Now a spate of new research, including a meta-analysis of nearly two dozen studies, suggests a reason why: investigators may have picked the wrong culprit. Processed carbohydrates, which many Americans eat today in place of fat, may increase the risk of obesity, diabetes and heart disease more than fat does.

OK that focuses on how saturated fats aren’t the culprit. But nowhere, not one jot, of evidence exists that shows meat to be a serious risk factor in heart disease.

And neither is meat the main risk factor in Diabetes 2. As Diabetes UK point out the risk factors for the condition include:

1. A close member of your family has Type 2 diabetes (parent or brother or sister).
2. You're overweight or if your waist is 31.5 inches or over for women; 35 inches or over for Asian men and 37 inches or over for white and black men.
3. You have high blood pressure or you've had a heart attack or a stroke.
4. You're a woman with polycystic ovary syndrome and you are overweight.
5. You've been told you have impaired glucose tolerance or impaired fasting glycaemia.
6. If you're a woman and you've had gestational diabetes.
7. You have severe mental health problems.

Nowhere there does the word “meat” appear.

The problem isn’t just that Professor Lamb is wrong but that his nonsense (and I’ve focused on the idiocy of his health claims – the same could be said of his economic and environmental arguments) is regurgitated by the media without challenge or criticism. The Professor is an “expert” and not to be questioned.

It really is time journalists began to do their job. Like asking people like Professor Lang to provide some real evidence for their claims rather than just giving them a great headline and a thousand uncritical words.

And here every day is a feast day!

 

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