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Childhood obesity is bad news for heart disease in the future

Carl Heneghan
Last edited 26th September 2012

Apart from stating the obvious, we are in big trouble. Health services costs are rising and we can’t afford it. There are no new drugs to counteract the growing increase in chronic disease which cost us a fortune. Yet, to counteract all this we are getting fatter and fatter, and presenting a future steeped with dire consequences for our children.

Results from 63 studies of 49,220 children aged 5 to 16, published in today’s BMJ by our group, starkly illustrates the effect obesity has upon increasing risk of cardiovascular disease for future generations of children. We know that being overweight in adulthood increase your risk of heart disease and stroke, we now know that for children, these very same risk factors are increased markedly at a very young age.

Obese children have a blood pressure greater by 7.5mmHg than normal weight children. This rises to 11.5 mmHg when the more accurate ambulatory blood pressure readings are used. The increase seems to be greater for girls than boys: but the reason for this additional increase is unknown. Also, other important risk factors for heart disease are raised in obese children: blood lipids (cholesterol and triglycerides) are raised; fasting insulin and insulin resistance are worse and the left ventricular mass of the heart is increased when compared to normal children.

Being overweight as a child corresponds to a Body Mass index (BMI) of 25 to 30 and obesity as a BMI of over 30. BMI is a number calculated from a child's weight and height, and is weight in kg divided by height in metres squared (kg/m2). Although BMI does not measure body fat directly, it correlates with accurate measures of body fat, such as underwater weighing, and can be used as a simple measure for screening children.

Many countries use reference points in children to classify obesity, taking into account age, sex and a reference population. Whilst this data calculates an average for the population, and classifies obesity according to the degree of variation from this mean it may mask worrying trends due to increasing average weight of children over time. In 2007, the US obesity rates have nearly quintupled among 6- to 11-year-olds since the 1970s. Worryingly, in the UK school year, 2010/11, one third of children aged 10 to 11 were overweight or obese.

Like climate change, we know the problem is coming, but because the effects are at some point in the future, we are burying our heads in the sand, hoping the problem might just go away. For what is an easy situation to prevent: we need concerted action now. Jamie Oliver, once said "we're losing the war against obesity," We may have already lost it: 1 in 3 adults and 1 in 6 children are currently obese.

Research misconduct: 'alive and well'

Carl Heneghan
Last edited 12th January 2012

BMJ research misconduct survey results are released today online and were discussed at the BMJ meeting today on research misconduct.

Sara Schroter, senior researcher, at the BMJ sent an email to 9,036 authors and reviewers on the BMJ database of which 2,782 (31%) replied.

The results show that 13% have witnessed or have had first-hand knowledge of UK based scientists or doctors inappropriately adjusting, eluding altering or fabricating data during their research or for the purpose of publication. Six percent were aware of any cases of possible research misconduct at their institution, that in their view, have not been properly investigated.

Rewards and incentives to conduct research occur at the individual, institutional, national and company level, and misconduct occurS at all of these levels. In a previous survey of 3,247 US researchers, 16% admitted to altering design, methodology or results of their studies due to pressure of an external funding source. In addition, researchers involved with industry were more likely to report one or more of ten serious misbehaviours, to have engaged in misconduct and less likely to report financial conflicts.

As the BMJ survey shows research misconduct is 'alive and well'.

At the BMJ today research misconduct in the UK was discussed amongst academics, journal editors, policy makers and others.

Why does scientific fraud occur? Among the incidents of scientific fraud that David Goodstein has reviewed, three motives are more or less always present. In all the cases individuals were under career pressure, thought they knew what the result would be if they went to all the trouble of doing the work properly, and were in a field in which studies are not expected to be precisely reproducible.

A case of prolonged research fraud by Diederik Stapel in the Netherlands highlights the closed culture that aids such deception: simply misconduct is more likely when there is less scrutiny.

Peter Wilmhurst, in the morning, talked about the case of Eastell who was suspended from Sheffield University, whislt Professor Clara Gumpert of the Karolinska Institute talked about the case of Suchitra Holgersson: a Karolinska scientist who tried to mislead with false documents.

Iain Chalmers talked about the extensive problems of research that remains unpublished “50% of results remain unpublished.” As far back as 1990, in JAMA, Chalmers published on this exact topic:

“Substantial numbers of clinical trials are never reported in print, and among those that are, many are not reported in sufficient detail to enable judgments to be made about the validity of their results. Failure to publish an adequate account of a well-designed clinical trial is a form of scientific misconduct that can lead those caring for patients to make inappropriate treatment decisions.”

Fiona Godlee, editor of the BMJ, is instrumental in the BMJ's ongoing commitment to identifying and reporting on research misconduct. She spoke recently on the importance and relevance of this exact issue on the BBC: should all medical research be published?

Who can sort the problem out? Journals and their editors are not in a position to be the custodians of integrity. “Editors are not the individuals to investigate cases of research misconduct and the responsibility lies with the institution,” said Elizabeth Wager, chair of the committee on publication ethics. COPE as it is known is a forum for editors and publishers of peer-reviewed journals to address aspects of publication ethics. It also advises editors on what to do in cases of research and publication misconduct.

The morning meeting also discussed policies in the US, Sweden and Germany and their different approaches to research misconduct. It seems there is alot of it going on at the professorial level but also within Phds. Watch out for the BMJ survey coming this afternoon on research misconduct in the UK amongst clinical researchers. I bet it shows there is substantial misconduct going on. It seems to me the incentives are so great for academic to publish, or not in some cases, that it will be a hard problem to solve.

Thomas Kuhn, in 1962 wrote, scientific advancement is not evolutionary, but is a "series of peaceful interludes punctuated by intellectually violent revolutions", and in those revolutions "one conceptual world view is replaced by another". What he referred to as a 'paradigm shift.' A shift that is needed to force action and find solutions to research misconduct.

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