Tuesday, 10 March 2015

Couch potatoes and hunter-gatherers

Further to Aseem Malhotra's absurd claims about obesity not being linked to physical activity, here he is at a recent conference last month making another of his frequent assertions—that there has been "little change in exercise levels in the past 30 years".


Ignore the silly stuff about the Big Sugar 'playbook' for a moment. (It is, incidentally, not true that the tobacco CEOs swore under oath that they didn't believe smoking caused lung cancer. They famously said they didn't believe nicotine was addictive. The bit about cancer has been added by Malhotra.)

I want to focus on the second point on the slide.

Little change in exercise levels in the past 30 years whilst obesity has rocketed

Perhaps because this is a counter-intuitive claim in an era of office drones and couch potatoes, Malhotra goes to the trouble of providing a reference. It is a reference I have come across before because Action on Sugar cited it in a briefing paper sent to politicians.

The title of the study - 'Hunter-gatherer energetics and human obesity' - provides a clue that it is not going to offer much evidence about changes in Western levels of physical obesity in the last thirty years. And it doesn't. It actually looks at a hunter-gatherer tribe in Tanzania, whose members apparently have similar levels of energy expenditure as that seen amongst a sample of Americans.

What is the relevance of this study? Presumably Malhotra's thinking goes like this.

1. The lifestyle of hunter-gatherers in Africa is similar to that of Westerners in days of yore.

2. Hunter-gatherers in Africa are no more physically active than Westerners today.

3. Levels of physical activity have not changed for thousands of years and therefore cannot have changed in the last few decades.


Hmm. This theory is problematic for a number of reasons. For a start, the study of Tanzanian bushmen actually did find higher levels of physical activity ("As expected, physical activity level, PAL, was greater among Hadza foragers than among Westerners.") It also found higher levels of physical activity amongst peasant farmers, in line with previous studies. It was only total energy expenditure after adjusting for height, weight etc. that was similar in both societies—a finding that appears to be due to physiological differences between the two groups.

(Incidentally, the authors note that "many hunter-gatherers seasonally consume a large portion of their daily calories as honey, which has high concentrations of glucose and fructose". This poses a bit of a problem for people like Malhotra who see fructose as the main cause of obesity and diabetes, both of which are vanishingly rare amongst tribesmen.)

But even if taken at face value, this is still only one study. If you look at the the evidence in the round, a rather different picture emerges... 

Most analyses of hunter-gatherer diets assume caloric intakes of approximately 3000kcal day, a surprisingly large figure that exceeds typical contemporary intakes. The level of energy expenditure necessitated by pre-agricultural lifestyles, however, was much greater than that for average modern individuals. For instance, total energy expenditure in the !Kung and Ache peoples averaged 206kJ/kg/d, compared to roughly 134kJ/kg/d for contemporary humans.

Hunter-gatherers who consume 3000 calories a day rarely, if ever, become obese. Westerners who eat 3000 calories a day frequently become obese. The difference is that hunter-gatherers burn off all those calories whereas Westerners generally don't.

What does this tell us about physical activity levels over the last 30 years? Not very much, to be honest, but it is worth noting that in the mid-twentieth century the UK government recommended people eat 2,900 calories a day, based on good evidence showing that if people consumed less than that, they lost weight. Today, the government recommends people consume 2,250 calories a day (more for men, less for women). Why, if there has been no decline in energy expenditure, has the advice changed so much?

The fact is that the average Briton who consumed 2,700 calories in the 1940s would lose weight. Today, the average Briton who consumes 2,700 calories gains weight. Conversely, if the average Brit in the mid-twentieth century followed today's guidelines they would lose weight to a rapid and dangerous extent. The only rational explanation for this—supported by masses of empirical evidence—is that physical activity has declined over the years.

As I mentioned in a previous post, the decline in physical activity in the West is acknowledged by the World Health Organisation, Public Health England, the NHS, the Harvard School of Public Health and countless other organisations. If you want to challenge that view, you'd better have some pretty compelling evidence. Malhotra's killer piece of evidence—the one study that he repeatedly cites and puts up on slides at conferences—is not only of little relevance to the claim he is supposed to be debunking, but is an outlier even within its own narrow field.

All of which is a good indication that he hasn't got much evidence at all.

Posted by Christopher Snowdon at 9:39 am 3 comments

Monday, 9 March 2015

Temperance cry babies

The Alcohol Health Alliance, the neo-temperance coalition, has been promoting this infographic recently in a desperate bid to stop the government cutting beer duty by one pence.



Just look at this rubbish. Firstly, it directly compares a (dubious and obsolete) £21 billion figure which is largely made up of lost earnings and internal costs with £12 billion of real money that drinkers pay in alcohol duty. If AHA wanted to create a halfway decent comparison of economic costs and benefits, it would either compare the costs to the state (about £6 billion) with the benefits to the state (£12 billion), or it would compare the costs to the wider economy (supposedly £21 billion) with the benefits to the wider economy (£30 billion). For obvious reasons, it does neither.

AHA then refers to a tiny cut in beer duty as a 'tax break to the alcohol industry'. In fact, insofar as it's a tax break for anyone, it's for drinkers, not the industry. I don't have the figures to judge the claims about the equivalent nurses, hospital beds etc. that could be afforded, but they look suspiciously high for a 1p per pint tax cut. I suspect AHA has estimated how much more drinkers would be paying if Osborne hadn't frozen wine and spirits duty. Obviously, a tax freeze is not a tax break.

Finally, it tells us that the price of a pint has risen by 3p in a year. The implication is that the evil booze industry has not only pocketed the 1p but has exploited drinkers with a further 3p increase. Apparently, AHA has never heard of inflation. (But if they really think a 1p cut led to a 3p rise, what are they moaning about? They want higher prices.)

They repeated much of this drivel in a newspaper advert recently and have since been whining on Twitter about having to resort to the mass media...




It jerks on the very strings of your heart, doesn't it?

Look, there is no reason whatsoever why the treasury should want a meeting with a temperance group. The Department of Health, perhaps (and they get plenty of them). But not the treasury. On the other hand, there are lots of reasons why the treasury should want to meet industries, particularly industries which are responsible for very large sums of tax revenue.

As it happens, the government has a particularly good reason for not wanting to meet the Alcohol Health Alliance. Remember this from 2011?

The Coalition Government’s alcohol policy has come under sustained attack by the Institute of Alcohol Studies and other health aligned organisations, which have decided to boycott the Government’s Responsibility Deal with the alcohol industry.

Six alcohol and health organisations, led by the British Medical Association, that had been involved in a Coalition Government policy initiative, the Responsibility Deal for Alcohol (RDA), did their best to wreck its official launch by very publicly walking out of it. In briefings to the media they accused the Deal of being no more than diversion from the evidence-based alcohol policies likely to achieve a real reduction in alcohol harm, such as policies on pricing and availability of alcohol.

The other five organisations are the IAS, Alcohol Concern, the Royal College of Physicians, the British Liver Trust, and the British Association for the Study of the Liver.

"Did their best to wreck its official launch" is not tabloid sensationalism. The text above was written by one of AHA's members at the Institute of Alcohol Studies who was well placed to know what the strategy was.

Here's a little bit of advice for private interest groups who want to influence government policy. If you want to have meetings with government, don't "very publicly walk out" of the meetings you've already been invited to. Don't deliberately "wreck" official launches. Don't throw your toys out of the pram when the government refuses to capitulate to your every demand.

If you can behave like grown ups, maybe you'll be invited back. But if you insist on behaving like arrogant, self-entitled toddlers, don't storm out in a blaze of publicity and then complain that you're not being allowed back in.

Posted by Christopher Snowdon at 9:42 am 4 comments

Friday, 6 March 2015

The sock puppet state in action

Government self-lobbying doesn't get much more blatant than this.

The Irish government has put forward a bill—the Public Health (Alcohol) Bill—which includes minimum pricing and various other temperance policies. Alcohol Action Ireland, a state-funded lobby group, has been pushing for this legislation for some time and has now set up another lobby group to campaign for its passage through parliament.

The Alcohol Health Alliance is new [sic] initiative to support the Public Health (Alcohol) Bill, a new piece of legislation that has the potential to significantly reduce the harm caused by alcohol consumption in Ireland, has been launched today.

The Alcohol Health Alliance will work together to:

Highlight the rising levels of alcohol-related health harm

Propose evidence-based solutions to reduce this harm

Campaign for the implementation of the Public Health (Alcohol) Bill 2015

Advocate for positive action to address the damage caused by alcohol misuse


The Alcohol Health Alliance, which was set up by The Royal College of Physicians of Ireland, and Alcohol Action Ireland, will bring together a wide range of public health campaigners including medical professionals, NGOs and charities whose mission is to reduce the damage caused to health by alcohol misuse.


Alcohol Action Ireland is a 'charity' which acknowledges funding from Ireland's Health Service Executive. It is not clear from its accounts how much it receives from the state, but it gets a laughably small amount from public donations (just €200). Indeed, it gets just 0.07 per cent of its income from voluntary contributions. This is what passes for a charity in the sock puppet state.


This government front group has campaigned for the legislation to be put on the books despite a conspicuous lack of support for minimum pricing amongst the public. They have now created a new sock puppet to act as its chief cheerleader.

As in the UK, the Irish government and its quangos are well practised at these kind of campaigns. In the splendidly titled World Health Organisation document—Making Unpopular Decisions in Public Health—Irish NGOs explained their tactics (in this instance, for the smoking ban).

Tactics and strategy to ensure success: the Irish way

Political consensus: all parties reached a consensus that action was required. The Minister for Health got passionately involved in the cause and made tobacco the top item on his agenda. Thus, the only blame the decision-makers actually got was that they were not implementing quickly enough.

Publicity campaigning: there was huge mass-media interest, with features, whole pages and discussion programmes. A separate mass-media campaign focused on the support for people who want to quit.

Preparations were made to confront business, with plans for how to do this, so they did not get too strong.

Mobilized opposition: there was a strong alliance of nongovernmental organizations, prominent in organizing actions, with which the health authorities linked up in advance. They mobilized considerable mass-media work and covered quite a wide variety of backgrounds in the public consensus-building.
 
Public opinion surveys were not conducted before the decision was launched. It was a purely political judgement that the health authority must act on smoking in workplaces. Surveys were carried out only after the launch and revealed that most of the population approved.

If you are in any doubt that 'public health' is an elitist, undemocratic political movement, you should read the whole document. From its title on, it is remarkably candid.

It is no wonder politicians need to create astro-turf groups to campaign for decisions that have already been made by the elite. They are openly contemptuous of the public, as one member of the Irish parliament, Mary Mitchell O’Connor, made clear today.

A south Dublin TD has expressed her “alarm” at the volume of messages she has had from constituents against Government plans to end the availability of cheap alcohol, including some from parents arguing their teenagers should have access to inexpensive drink.

Mary Mitchell O’Connor, Fine Gael TD for Dún Laoghaire-Rathdown, was speaking at the announcement of a new alliance of health professionals and NGOs, the Alcohol Health Alliance.

Its primary aim will be to support the Government’s Public Health (Alcohol) Bill to be published in coming months and enacted by the end of the year.

Among its key measures will be the introduction of a minimum per-unit price for alcohol to end the sale of cheap alcohol.

Ms Mitchell O’Connor said she had been “getting loads of messages against the Bill” and appealed for constituents to contact her supporting it.

“I have been alarmed at some of the messages, including from parents. I have had fathers contacting me arguing that their 16-year-old daughters should be allowed access to cheap drink. That is how daft some of the thinking is out there on this.”

She said she had also received personally abusive messages from constituents saying the Bill was interfering with their freedom to pursue lifestyles as they wished. 

 “They are annoyed they might have to pay more for alcohol. It does surprise me when you think of the sort of constituency I represent.”

Poor bewildered woman. You get the impression she thinks politicians should be able to elect a new public which, in a way, is what the sock puppet state does.

Posted by Christopher Snowdon at 2:31 pm 2 comments

Thursday, 5 March 2015

Aseem Malhotra's war on reality

Our old friend Dr Aseem Malhotra of Action on Sugar was feeling pleased with himself on Tuesday after rubbing shoulders with the public health minister Jane Ellison. Read about it and weep.




It is not clear whether she said 'yes' because she fervently agrees with his anti-scientific clap-trap or if she said 'yes' to humour him before wandering off to find someone else to talk to, as you would with a mentalist at a bus stop. All we know is that he was so delighted with this coup that he was still banging on about it yesterday...



Physical activity not linked to obesity? Physical activity no good for weight loss? As fact-checking goes, this is real fish-in-a-barrel stuff. Do we really need to cite evidence for the laws of thermodynamics? If people like Malhotra are being taken seriously, perhaps we do. So let's go.

Here's what Public Health England says:

The link between physical inactivity and obesity is well established... People in the UK today are 24% less active than in 1961

Here's what the Harvard School of Public Health says:

Obesity results from energy imbalance: too many calories in, too few calories burned. A number of factors influence how many calories (or how much “energy”) people burn each day, among them, age, body size, and genes. But the most variable factor—and the most easily modified—is the amount of activity people get each day.

...Despite all the health benefits of physical activity, people worldwide are doing less of it—at work, at home, and as they travel from place to place. Globally, about one in three people gets little, if any, physical activity. Physical activity levels are declining not only in wealthy countries, such as the U.S., but also in low- and middle-income countries, such as China. And it’s clear that this decline in physical activity is a key contributor to the global obesity epidemic, and in turn, to rising rates of chronic disease everywhere.

And here's what the World Health Organisation says:

Global increases in childhood overweight and obesity are attributable to a number of factors including:
  • A global shift in diet towards increased intake of energy-dense foods that are high in fat and sugars but low in vitamins, minerals and other healthy micronutrients;
  • A trend towards decreased physical activity levels due to the increasingly sedentary nature of many forms of recreation time, changing modes of transportation, and increasing urbanization.

Here's a study from 1996:

In recent times, affluent societies have become less physically active, and this has undoubtedly contributed to the increased incidence of obesity. 


Here's a study from 2000:

Weight loss induced by increased daily physical activity without caloric restriction substantially reduces obesity (particularly abdominal obesity) and insulin resistance in men. 

Here's a study from 2005:

Regular physical activity 45-60 min per day prevents unhealthy weight gain and obesity, whereas sedentary behaviors such as watching television promote them. Regular exercise can markedly reduce body weight and fat mass without dietary caloric restriction in overweight individuals.

Here's a study from 2008:

Physical inactivity in adolescence strongly and independently predicts total (and especially) abdominal obesity in young adulthood, favoring the development of a self-perpetuating vicious circle of obesity and physical inactivity. Physical activity should therefore be seriously recommended for obesity prevention in the young.

Here's another study from 2008:

Persistent participation in leisure-time physical activity is associated with decreased rate of weight gain and with a smaller waist circumference to a clinically significant extent even after partially controlling for genetic liability and childhood environment.

Here's one from 2009:

Sustained PA [physical activity] for at least 30 min d(-1), particularly if more intense, is associated with a reduction in long-term weight gain, and greater duration is associated with less weight gain. Sedentary women of any baseline weight who increase their PA [physical activity] will benefit, but overweight women appear to benefit the most.

Here's a study from last year:

Men and women who commuted to work by active and public modes of transport had significantly lower BMI and percentage body fat than their counterparts who used private transport.

I could on, so I will.

Here's another:

Obesity appears when energy intake exceeds energy expenditure. The most important variable compound of energy expenditure is physical activity. The global epidemics of obesity seem closely related to reduced physical activity and sedentariness widely increasing nowadays.

Here's a study from 2006:

We confirm that there is irrefutable evidence of the effectiveness of regular physical activity in the primary and secondary prevention of several chronic diseases (e.g., cardiovascular disease, diabetes, cancer, hypertension, obesity, depression and osteoporosis) and premature death.

 Here's a study from 1999:

Summary results for all outcomes except cancer were generally consistent in showing that active or fit women and men appeared to be protected against the hazards of overweight or obesity.

Here's a study from 2003:

There is compelling evidence that prevention of weight regain in formerly obese individuals requires 60-90 minutes of moderate intensity activity or lesser amounts of vigorous intensity activity. Although definitive data are lacking, it seems likely that moderate intensity activity of approximately 45 to 60 minutes per day, or 1.7 PAL (Physical Activity Level) is required to prevent the transition to overweight or obesity. For children, even more activity time is recommended.

Here's another from 2003:

We found that in the National Weight Control Registry, successful long-term weight loss maintainers (average weight loss of 30 kg for an average of 5.5 years) share common behavioral strategies, including eating a diet low in fat, frequent self-monitoring of body weight and food intake, and high levels of regular physical activity.

Here's a study from 2007:

Exercisers with greater increases in pedometer-measured steps per day had greater decreases in weight, BMI, body fat, and intra-abdominal fat (all p trend < 0.05 in both men and women). Similar trends were observed for increased minutes per day of exercise and for increases in maximal oxygen consumption.


And here's one from last year:

The proportion of adults who reported no leisure-time physical activity increased [between 1988 and 2010] from 19.1% (95% CI, 17.3-21.0) to 51.7% (95% CI, 48.9-54.5) in women, and from 11.4% (95% CI, 10.0-12.8) to 43.5% (95% CI, 40.7-46.3) in men. Average daily caloric intake did not change significantly. BMI and waist circumference trends were associated with physical activity level but not caloric intake.

I don't want to labour the point here folks, but seriously. "Physical activity is not linked to obesity"?! This guy is regularly presented on television as an expert on this subject. He now has the ear of government. Is it asking too much for his views to be on the same planet as mainstream science?

As I said three years ago, when I first came across this guy, Aseem Malhotra doesn't know what he's talking about. He really should not be taken seriously by anybody.

Posted by Christopher Snowdon at 7:37 am 5 comments

Wednesday, 4 March 2015

Unpublished letter to The Times

The latest in my growing list of unpublished letters to newspapers is below. I sent it yesterday in response to this misleading article in The Times about a modest attempt by Eric Pickles to limit political campaigning on the taxpayers' shilling.

Jill Sherman's article about state-funded activism ('Charities told to toe government line', Tuesday 3rd March) claims that charities will be "stripped of grants if they campaign against the government". This is not true. Charities are free to campaign on any issue so long as they are not party political. All that the Department for Communities and Local Government requires is that political activism not be financed by the taxpayer. This is a reasonable demand which should not be conflated with the "gagging" of charities that could result from the Lobbying Act (which the Institute of Economic Affairs has opposed from the outset).

Government grants should only be given to third parties to provide services that the government would otherwise provide itself. It should be a basic principle that they are not used to hire lobbyists or campaign for legislation.

Christopher Snowdon
Institute of Economic Affairs

I suppose 'government bans charities from attacking it' is a better story than 'government department refuses to pay for lobbying'. Trouble is, it's not true.

Incidentally, The Times story was inspired by a letter of complaint to Pickles from Stephen Bubb of the Association of Chief Executive of Voluntary Organisations (ACEVO). Bubb is a former trade unionist and was a member of the notoriously loony-left Lambeth Council in the 1980s. He now picks up £105,000 a year, plus pension and benefits, as head of ACEVO, an organisation which gets hundreds of thousands of pounds from the taxpayer because, apparently, chief executives can't afford to fund their own trade association.

Posted by Christopher Snowdon at 2:55 pm 0 comments

Tuesday, 3 March 2015

Sound people saying sensible things about a stupid policy

The videos from the recent Stop the Nonsense drinks reception have gone online. As always at FOREST events, I was struck by wit, intelligence and joie de vivre of the people present, in stark contrast to the milk-curdling misery and misanthropy of the 'public health' lobby.


And these are my remarks in full...




Posted by Christopher Snowdon at 12:41 pm 0 comments

Monday, 2 March 2015

The Total Consumption Model again

I recently came across a House of Commons briefing paper titled 'Alcohol policy and the effects of the Licensing Act 2003'. It is undated, but seems to come from around 2009. Almost in passing, it puts the lie to the Total Consumption Model of alcohol consumption...

A chief problem for policymakers is that many of these problems arise from particular drinking behaviours, rather than alcohol consumption in general: for instance, there is not a particularly strong association between alcohol-related death rates and per capita consumption across Europe (see chart 2)


It then says:

Given the subtleties of the problem, general taxation of alcohol is seen as a rather blunt policy instrument (there is a similar lack of correlation between taxation levels and consumption in Europe).

Indeed. As I showed in the IEA report Drinking in the Shadow Economy, there is no correlation between affordability and consumption at the population level.


So, to summarise. There is no correlation between taxation levels and per capita consumption, and there is no correlation between between per capita consumption and harm.

And yet the Total Consumption Model somehow survives in 'public health'.

Posted by Christopher Snowdon at 11:43 am 1 comments
Subscribe to: Posts (Atom)