The Int. Society for Physical Activity and Health Conference 2018 – An unofficial review

I have not been to an ISPAH conference since Rio, 2014. I have noticed quite a few changes since then. It seems more mature now. The talks I saw involved critical reflection, and there were entire sessions dedicated to health inequalities. And it was great to see far less Coca Cola, and much more “co-creation” (see what I did there).

Given the propensity for graphs at the conference, here is another one:

Presentation1What the chart above shows with magnificent precision is that after initial calls for and hopes for change at the start of conferences, research presentations often are forced to acknowledge a lack of policy traction, barriers to implementation and modest intervention success, as well as many arguments about what best practice actually is. Along with this is often palpable frustration about the “slow progress” of policy change and the subsequent hoped-for population change. Maybe this is an essential part of all conferences, especially ones which are associated with major public health goals.

Set in the Brutalist QE2 Conference Centre in the heart of London, it is clear ISPAH is becoming physically and politically closer to decision makers around the world. While intersectoral partnerships take time to cultivate, it seems progress is being made. Professor Fiona Bull, working for the WHO on disease prevention, is a spokesperson for the movement and a connected and successful policy entrepreneur in the realm of PA promotion. And it appears there is an ever-growing legion of evangelical enthusiasts making connections with the various sectors, from state to transportation and town planning.

“Systems approaches” continued to get a lot of air time throughout the conference. Mapping systems is a logical and noble pursuit, though the limitations need to be, and were, acknowledged early in the conference.

While a small point, I would encourage no one to call the Morris et al London busmen study (1953) the “birthplace of physical activity”. Two presenters seemed to do so. Perhaps it was a slip of the tongue(s), or clunky explanation, as I’m certain “physical activity” was born earlier than 1953.

chart
Milestones in knowledge according to GoPA

Overall, ISPAH 2018 was a slick affair, which ended with challenges and optimism. The WHO target of a 15% change in global activity levels by 2030 is a lofty goal – I suspect that aiming for less would not generate the political will to mobilize resources and change minds about the seriousness of the issue.

Conference
The launch of WHO’s “Active”

I have always intuitively favoured the social benefits that come from physical activity, as opposed to the changes in disease risk. Perhaps that is just my personal bias. Upon leaving the venue, one delegate, carrying a WHO football was accosted by one of the conference centre doormen, who enthusiastically exclaimed “Throw it here”. Two strangers briefly throwing a football to each-other might not lower the risk of anything, but it shows humans crave connection with one another. ISPAH are trying to make the world a better place, and it seems they are gaining traction. Maybe I should join?

Joe P

Academics, Physical Activity and Ethics: The Declarations

This post is written in haste but I have been thinking about ethics since I started this blog. In the last couple of hours an article has been exposing more than was previously publicly known about Coca Cola’s involvement with physical activity promotion. It is worth reading.

It is clear that the PA community is not currently united about ethical practice. Recent events give an impetus for the academic community to prioritise critical thinking about “advocacy”, “vested interests” and “conflicts of interest” in physical activity research and promotion.

Therefore, here are 4 declarations for ethical PA academic practice. I hope ideas like this guide the academic PA community. They are not exhaustive. I welcome additions.

1. Physical activity researchers and promoters must critically investigate the background of the funders they seek money from.

2. As producers of knowledge, PA researchers are in a powerful, privileged position.  The PA community must automatically treat funders with skepticism.

3. Those involved in PA curriculum design and teaching must give immediate attention to “ethics” in their courses. They must make ethics a compulsory component of the qualification and find suitably qualified people to teach this.

4. PA journals and conferences must foreground themes of “ethics”, “conflicts of interests” and “vested interests” in their publications and events.

 

Joe Piggin

For more, see:
Piggin, J & Bairner, A (2016) The global physical inactivity pandemic: An analysis of knowledge production. Sport, Education and Society. 21, 2. 131-147.

A response to an editorial in the Journal of Physical Activity and Health

We were very disappointed to read the editorial in the recent issue of the Journal of Physical Activity and Health, written by the journal’s Editor-in-chief. The editorial is entitled “Corporate-Sponsored Obesity Research: Is Sugar Really Coating the Truth?”.

The editor, Prof Dipietro, criticises a NY Times article which itself criticised the Global Energy Balance Network. In our view, her editorial contains an unfortunate mixture of hyperbole, poor logic and short-sightedness. We contend that the arguments presented by DiPietro do little to enhance readers’ understanding of the political and economic forces that are involved when corporations sponsor physical activity research and promote physical activity to populations. Here are our main concerns, underneath extracts from DiPietro’s editorial:

1.

DiPietro: “The [Times] article, titled “Coca-Cola Funds Scientists Who Shift Blame for Obesity Away from Bad Diets,” goes out of its way to discredit the GEBN due to its funding source” (p. 745, 2015).

Our Response: The article does not “go out of its way to discredit the GEBN”. It provides a variety of evidence and sources to highlight significant issues with the GEBN. This is investigative journalism. The journalist has quoted the GEBN and people affiliated to it; so for want of a better description, it is actually a “balanced” article.

There have been major ramifications as a result of the Times article being published. For example Steven Blair asked that his “video addressing energy balance be taken down from the GEBN website” … and wrote “My dismissal of diet as a cause of obesity did a disservice to [top nutrition experts’] work” (Blair, 2015). Also, Coca Cola has been pressured into being more transparent with regard to their sponsorship of research and promotion of PA and health.

DiPietro’s accusation actually impugns the integrity of those involved in the Times article, for which an apology might be appropriate.

2.

DiPietro: “The science leading to these [energy flux] conclusions was not funded by Coca-Cola or any other industry and it proposes that weight regulation is best achieved at levels of high energy expenditure plus matching energy intake and low energy storage. There are numerous scientists around the world who support this claim that are also not funded by the food or beverage industry. Sadly, this message was distorted rather remarkably in the Times article, which indicated that the GEBN feels that “diet is not important.” (p. 745, 2015).

Our Response: Given Steven Blair’s initial comments in the now-retracted video, and his subsequent statement about the disservice he had done, it is clear that Blair, not the Times article, was the source of significant distortion.

DiPietro fails to identify specific instances of where the “distortions” she claims actually occur in the article. We can find a reference to the GEBN’s Dr James Hill: “On its website, the group recommends combining greater exercise and food intake because, Dr Hill said, “ ‘Eat less’ has never been a message that’s been effective. The message should be ‘Move more and eat smarter.’ ” (p. 745, 2015).

So from our interpretation, the Times article does not distort a message about “energy flux” – it actually quotes the GEBN’s spokesperson James Hill making a statement about it. Therefore we suggest DiPietro might be (hopefully unintentionally) misleading readers.

Conclusion: We challenge DiPietro to identify specific instances of where the “distortions” she claims actually occur in the article.

3.

DiPietro: [Regarding weight loss and weight regulation] “If the Times article had solicited input from scientists not affiliated with the GEBN who were also experts in exercise and metabolism (rather than only experts in nutrition), this message might have been conveyed more accurately” (p. 745, 2015).

Our Response: The Times article actually featured responses from: Michele Simon, a public health lawyer; Dr. Yoni Freedhoff, an obesity expert at the University of Ottawa; Barry M. Popkin, a professor of global nutrition at the University of North Carolina at Chapel Hil; Professor Marion Nestle, professor of nutrition, food studies and public health at New York University; Dr. Anne McTiernan, a cancer prevention researcher at the Fred Hutchinson Cancer Center in Seattle; Professor Kelly D. Brownell, dean of the Sanford School of Public Policy at Duke University; Link to research from: Professor Aaron E. Carroll, a professor of paediatrics at Indiana University School of Medicine.

To suggest that the Times article needed “experts in exercise and metabolism (rather than only experts in nutrition)” does a disservice to the Times article, which was clearly not focused on ideas about energy flux, but rather the political economy of obesity and physical activity research. DiPietro focuses on micronutrient systems, rather than macro-political systems, while the Times article clearly focuses on the latter.

4.

DiPietro: “Another source of contention in Times article [sic] is the perceived conflict of interest as a result of taking money from an industry that may have a vested interest in the very nature of your findings. The implicit concern is that the scientific findings will waver from truth and toward benefitting that very industry” (p. 745, 2015).

Our Response: There is no “implicit concern” with conflicts of interest in corporate funded research. The Times article is explicitly concerned with conflicts of interest.

Further, there is no “perceived” conflict of interest in this case. There is an actual conflict of interest. To be clear, for a conflict of interest to occur, it is not necessary to show that a sponsor is using its position to further a particular cause. It is enough that there is a perceived conflict of interest before data is even gathered. We encourage PA researchers to act with extreme caution regarding sponsored funding. We wonder if the International Society for Physical Activity and Health might be able to provide ethical guidance to researchers who want to avoid such conflicts of interest.

5.

DiPietro: “The implicit concern is that the scientific findings [sponsored by the GEBN and Coca Cola] will waver from truth and toward benefitting that very industry. If that were really the case, however, why do we not express equal outrage and judgment of studies funded by pharmaceutical companies? (p. 745, 2015).

Our Response: Of all of DiPietro’s comments, this is the most concerning. DiPietro’s logic is faulty in several respects. Sound reasons why there might not be “equal outrage and judgment of pharma” include:

  1. A lack of transparency by companies leading to a lack of understanding by consumers
  2. A lack of perceived influence on the part of consumers
  3. Different tactics employed by concerned consumers
  4. A lack of resources available to citizens

There are a number of other concerns about DiPietro’s comparison. The two contexts of obesity research and pharmaceutical research need to be examined on their own merits. The pharma industry, despite profit motives and examples of dubious drug effects, has far more merit than Coca Cola as a mechanism for saving lives and reducing pain and suffering. The pharma industry has a long history of contributing to health and wellbeing, which can scarcely be said of the soft drinks industry.

Most importantly, downplaying conflicts of interest in obesity/PA research because consumer engagement in another industry is addressed differently is alarmingly simplistic. We wonder, therefore, if editorials in JPAH should be peer reviewed to avoid such worrying causal leaps. We certainly hope that this faulty causal logic is not endorsed by the Journal of Physical Activity and Health in its reviewing process.

Also, actually, for many years there has been protest directed at pharmaceutical companies, much of which is synthesised at Ben Goldacre’s website, Bad Science badscience.net and in Jacky Law’s (2006) book, Big Pharma. This protest may not be as large or as apparent as the recent Coca Cola scandal, but to downplay the protest that does occur, as DiPietro does, is problematic.

The Times article which DiPietro critiques clearly points out that “A recent analysis of beverage studies, published in the journal PLOS Medicine, found that those funded by Coca-Cola, PepsiCo, the American Beverage Association and the sugar industry were five times more likely to find no link between sugary drinks and weight gain than studies whose authors reported no financial conflicts.” We are amazed, and quite frankly alarmed that this extract from the Times article does not appear to resonate with DiPietro.

DiPietro’s conclusion is particularly alarming and we offer a challenge to her overly simplistic defence of corporate funding to be substantiated. We sincerely hope that students of physical activity, sedentary behaviour and exercise science do not draw the same conclusions about corporate involvement in health promotion as DiPietro does.

6.

DiPietro: “Although the funding disclosures were initially and unintentionally omitted from the GEBN website when it was first launched, they were added immediately when the GEBN was notified of the error.” (p. 745, 2015).

Our Response: DiPietro’s commentary here merely repeats information already in the Times article. We wonder if DiPietro is or ever has been a member of the GEBN. We seek clarity on this issue (and a response to our other challenges here).

7.

DiPietro: “Science advances in steps and the field of physical activity and health is still learning to walk. Maybe the real issue in the Times article is that one of the funders of GEBN research is Coca-Cola, the world’s largest producer of sugary beverages and in many people’s minds the source of all that is evil.” (p. 745, 2015).

Our Response: We think this comment is poorly thought out. We contend that few people think Coca-Cola is “evil”. We believe that most would acknowledge Coca-Cola for what it is, a global corporation with a stated aim and obligation to maximise a return for its shareholders. We contend that whether it is through greenwashing its products, promoting Coke to children, being charged with tax evasion, or sponsoring physical activity research (and ISPAH conferences), Coca Cola is simply acting as it is obliged to act. Therefore, accusing Coca Cola critics of thinking Coke is “evil” is a poorly thought out argument and does not give appropriate credit to the concerted efforts of activists who are concerned by the Coca Cola Company’s behaviour.

Note: DiPietro’s repeated use of the words “real” and “really” in the editorial suggest a limited understanding of the complex mechanisms to which she herself alludes in the article.

8.

DiPietro: “In today’s fiscal environment, it is extremely difficult for scientists to get their work funded. Hopefully, the government will soon decide that science is worth supporting again, and researchers will no longer need to turn to corporations with fat wallets for the funding of their ideas. Until that time, we must judge the quality of the science instead of baselessly impugning the reputations of the scientists.” (p. 745, 2015).

Our Response: If we conclude that the government implied by the Editor-in-chief is the USA government, then this is a particularly US-centric approach to editorial writing. It is unworthy of a journal that is claimed to be the “official journal of the International Society for Physical Activity and Health”. We encourage DiPietro to clarify which government she means.

At the same time, we also seek clarity on her suggestion that “science” is not currently being supported. This claim is vague.

Lastly, given the significant limitations of the editorial, we hope that DiPietro’s claim of scientists having their reputations “baselessly impugned” will be retracted in the same way that the founding editor of the JPAH (Steven Blair) retracted his video.

We welcome a response from Loretta DiPietro.

Dr Joe Piggin, with guest contributor Prof Alan Bairner

POSTSCRIPT – 2 December 2015. In an email to Prof. DiPietro, I asked:

1) Do recent media reports this week [showing internal Coke emails with Prof James Hill] lead you towards a different conclusion about Coca Cola’s involvement with the GEBN and the GEBN’s involvement with Coca Cola[?]

2) Would you consider writing a new editorial with these recent events in mind?

3)  Would you be willing to consider a short commentary for your journal on this topic? I have recently published about corporate lobbying in physical activity (see J Piggin 2014), and I would be willing to write a piece for your Journal. Please let me know.

I appreciated the response. I have reproduced the email below in its entirety:

 

No thank you.

 

PA Lobbying – Time for a radical change

Co-operating with corporations for health promotion is problematic, despite it being a practice endorsed by the World Health Organisation. While no stranger to criticism, Coca Cola is now trying is limit the damage from this latest New York Times investigation. The Times exposes some more links between corporations and health scientists. The accompanying video is also compelling viewing. One does not need to be a critical researcher to appreciate how the repetition of “balance” in the video appears somehow … unbalanced.

It reminds me of another example of how a corporation has ingratiated itself within academia (and how academics have ingratiated themselves with corporations). In 2013, the Journal of Physical Activity and Health published an article about the wide-ranging benefits of physical activity (Bailey et al, 289). The article proposed the Human Capital Model, which theorises that physical activity can contribute to various forms of capital for an individual, including emotional, financial, individual, intellectual, physical, and social capitals. The article is “aspirational”, though it is also troubling. The “Human Capital Model” was not produced by the authors of the article, but by Nike Inc. Why is Nike, a global sportswear company, interested in publishing a theoretical model in an academic journal? The Acknowledgements section in the article suggest how the model came to be: “In 2010 NIKE, Inc. developed the Human Capital Model, informed by more than 500 pieces of published research, and initiated a multidisciplinary input and validation process with a pool of experts.” (p. 302) Nike also holds the copyright to all the models and figures in the article including Figure 4, below, which claims that Financial Capital is “reliant on the other Capitals” (p. 301): Nike Figure 1: Reproduced from Bailey et al., 2013, p. 301.

The flow chart above contains many very troubling assumptions. First, there are surely many people around the world who have high levels of financial capital without having a significant amount of physical, emotional, individual, intellectual or social capital. Even a cursory analysis of one’s own social network and community (or personal introspection!) might provide examples to show the fallacy that financial capital is “reliant on all the other capitals”.

Second, it is readily apparent that many forms of capital depend on possessing or being born into families with financial capital to begin with. At least in Western neoliberal societies anyway. We are all born into already-constituted communities. The advantages and privileges afforded by having access to financial capital are clear.

Third, the elevation of financial capital to the pinnacle of the figure implies that money is the desired outcome to be attained. Framing financial capital as the outcome of various forms of capital is perhaps the most overt display of Western neo-liberal thinking articulated in a scholarly journal on physical activity to date. Possessing any or all of the forms of capital in the model is simply a way of acquiring something else – money. Of course, Nike is obligated to make a profit for its shareholders, but we need to recall what a singular focus on increasing financial capital can lead to. In 2005, Nike’s own report of the factories that made its shoes and clothing admitted “excessively long work weeks, wrong wage calculations, verbal abuse, curbs on toilet visits” and a pervasive culture of exploitation. Nike’s admission of worker abuses occurring shows how those with financial capital can exploit those without.

Fourth, nowhere in the article is any evidence provided for the claim: “Financial capital: reliant on the other Capitals.” Should we expect higher standards from a publication in the Journal of Physical Activity and Health?

Fifth, to whom do the authors encourage this financial capital to belong? Bailey et al emphasise individual financial capital accumulation by “highlight[ing] the ways in which engagement in physical activity can act as an asset that enhances career and financial success” (p. 301). I ask, is the accumulation of financial capital a worthy goal, especially when there are such stark differences in the current global distribution of wealth?

Coca Cola, like Nike, must not only make profit, but must continually try to grow profits. Physical activity researchers must give more critical attention to these corporate imperatives, and be prepared to reject their advances despite the lure of magnificent increases in personal financial capital! Perhaps the shame of being compared to “big tobacco” apologists might encourage others to reflect on their associations with “big sugar”. I encourage you to read this incisive account of Coke at the world’s largest physical activity conference in 2014. We will wait and see if ISPAH 2016 continues to be sponsored by Coca Cola. Popular rhetoric about PA promotion calls for radical change and revolution. I end this post by calling for a radical rethinking of corporate linkages.  Watch this space – literally! Joe Piggin

For more, see:

Piggin, J. (2014) Physical activity lobbying: A critical analysis of framing global solutions. Health Education Journal. 74, 1, 16 – 27.