E. Michael Foster

Myths, Presumptions, and Facts about Obesity

BACKGROUND Many beliefs about obesity persist in the absence of supporting scientific evidence (presumptions); some persist despite contradicting evidence (myths). The promulgation of unsupported beliefs may yield poorly informed policy decisions, inaccurate clinical and public health recommendations, and an unproductive allocation of research resources and may divert attention away from useful, evidence-based information. METHODS Using Internet searches of popular media and scientific literature, we identified, reviewed, and classified obesity-related myths and presumptions. We also examined facts that are well supported by evidence, with an emphasis on those that have practical implications for public health, policy, or clinical recommendations. RESULTS We identified seven obesity-related myths concerning the effects of small sustained increases in energy intake or expenditure, establishment of realistic goals for weight loss, rapid weight loss, weight-loss readiness, physical-education classes, breast-feeding, and energy expended during sexual activity. We also identified six presumptions about the purported effects of regularly eating breakfast, early childhood experiences, eating fruits and vegetables, weight cycling, snacking, and the built (i.e., human-made) environment. Finally, we identified nine evidence-supported facts that are relevant for the formulation of sound public health, policy, or clinical recommendations. CONCLUSIONS False and scientifically unsupported beliefs about obesity are pervasive in both scientific literature and the popular press. (Funded by the National Institutes of Health.).

Duration of breastfeeding and childhood obesity: a generalized propensity score approach.

OBJECTIVE To estimate the effect of breastfeeding duration on childhood obesity. DATA SOURCE The Child Development Supplement (CDS) of the Panel Study of Income Dynamics (PSID). The PSID provides extensive data on the income and well-being of a representative sample of U.S. families from 1968 to the present. The CDS collects information on the children in PSID families ranging from cognitive, behavioral, and health status to their family and neighborhood environment. The first two waves of the CDS were conducted in 1997 and 2002, respectively. The data provide information on 3,271 children and their mothers. STUDY DESIGN We use the generalized propensity score to adjust for confounding based on continuous treatment, and the general additive model to analyze the adjusted association between treatment and the outcome conditional on the propensity score. The main outcome is the body mass index (BMI) directly assessed during the in-person interview in 2002. Covariates include family, maternal, and child characteristics, many of which were measured in the year the child was born. PRINCIPAL FINDINGS After using propensity scores to adjust for confounding, the relationship between breastfeeding duration and childhood BMI is trivially small across a range of model specifications, and none of them is statistically significant except the unadjusted model. CONCLUSIONS The causal link between duration of breastfeeding and childhood obesity has not been established. Any recommendation of promoting breastfeeding to reduce childhood obesity is premature.

Comparative Cost Analysis of Sequential, Adaptive, Behavioral, Pharmacological, and Combined Treatments for Childhood ADHD

We conducted a cost analysis of the behavioral, pharmacological, and combined interventions employed in a sequential, multiple assignment, randomized, and adaptive trial investigating the sequencing and enhancement of treatment for children with attention deficit hyperactivity disorder (ADHD; Pelham et al., 201X; N = 146, 76% male, 80% Caucasian). The quantity of resources expended on each child’s treatment was determined from records that listed the type, date, location, persons present, and duration of all services provided. The inputs considered were the amount of physician time, clinician time, paraprofessional time, teacher time, parent time, medication, and gasoline. Quantities of these inputs were converted into costs in 2013 USD using national wage estimates from the Bureau of Labor Statistics, the prices of 30-day supplies of prescription drugs from the national Express Scripts service, and mean fuel prices from the Energy Information Administration. Beginning treatment with a low-dose/intensity regimen of behavior modification (large-group parent training) was less costly for a school year of treatment (

Is Inclusivity an Indicator of Quality of Care for Children With Autism in Special Education

961) than beginning treatment with a low dose of stimulant medication (

Multiple Forensic Interviews During Investigations of Child Sexual Abuse: A Cost-Effectiveness Analysis

1,669), regardless of whether the initial treatment was intensified with a higher “dose” or if the other modality was added. Outcome data from the parent study (Pelham et al., 201X) found equivalent or superior outcomes for treatments beginning with low-intensity behavior modification compared to intervention beginning with medication. Combined with the present analyses, these findings suggest that initiating treatment with behavior modification rather than medication is the more cost-effective option for children with ADHD.

A Person-Centered Examination of Adolescent Religiosity Using Latent Class Analysis.

OBJECTIVE To determine whether the proportion of time spent in an inclusive educational setting, a process indicator of the quality of schooling for children with autism, improves key outcomes. METHODS Patients were 484 children and youth educated in special education with a primary diagnosis of autism in the National Longitudinal Transition Study-2. These individuals were ages 20 to 23 in 2007. We used propensity-score inverse probability of treatment weights to eliminate the effect of multiple confounders. A causal interpretation of the effect of inclusivity on key educational and functional outcomes still depends on a critical assumption, that inclusivity is not confounded by remaining, omitted confounders. RESULTS Compared with children with autism who were not educated in an inclusive setting (n = 215), children with autism who spent 75% to 100% of their time in a general education classroom (n = 82) were no more likely to attend college (P = .40), not drop out of high school (P = .24), or have an improved functional cognitive score (P = .99) after controlling for key confounders. CONCLUSIONS We find no systematic indication that the level of inclusivity improves key future outcomes. Research on educational and functional outcomes for children with autism can benefit from data on large samples of children educated in real-world settings, such as the National Longitudinal Transition Study-2, but more nuanced indicators should be developed to measure the quality of special education for children with autism.

Vulnerable Youth and Transitions to Adulthood

In suspected child sexual abuse some professionals recommend multiple child interviews to increase the likelihood of disclosure or more details to improve decision-making and increase convictions. We modeled the yield of a policy of routinely conducting multiple child interviews and increased convictions. Our decision tree reflected the path of a case through the health care, welfare, and legal systems and estimated the increased probability of conviction with additional interviews. We populated our decision analysis model using literature-based estimates. We simulated the experiences of 1,000 cases at 250 sets of plausible parameter values representing different hypothetical communities. Multiple interviews increase by 6.1% the likelihood that an offender will be convicted in the average community. We estimate that one additional conviction will follow if 17 additional children are multiple interviewed. Implications for the children, costs of care, protection of other children, and the risk of false prosecution are discussed.