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

The Physical Activity Pandemic – Round 2

Today I attended an event launching a special issue of The Lancet on Physical Activity. It was the second such event, 4 years on from the first. The event was well organised and well attended. So, how did it go?

Judging a book by its cover …  yes, it’s a better cover image than last time. Well done there ; )

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Pamela Das opened proceedings by warning the audience that this was “not [only] about sport”.

The presenters all spoke well on their areas of expertise. Ding Ding highlighted the enormous economic cost of inactivity (after a paper in 2012 highlighted life years lost to inactivity). She also compared and contrasted the economic and disease burden between low/middle and high income countries. It did make me think that after the medical and economic arguments have been made, it will surely be time to bring discussion of the social to the fore. Next time!

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Ulf Ekelund discussed links between PA, sitting time and mortality. A range of interesting questions followed culminating in musing about the differences between squatting and sitting. Pedro Hallal and Rodrigo Reis spoke well about progress over the last 4 years and the potential to “scale up” interventions. This did make me think about the specific lack of published physical activity policy literature, and how there is a need for robust analysis of PA policy processes. This is especially true given Reis pointed out that “political support” is considered by stakeholders both important and very difficult to obtain.

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The panel discussion which followed produced some of the more provocative exchanges. Richard Horton warned against being overly positive about the speed of change, and he asked some challenging questions, in the form of “What is the biggest challenge and biggest opportunity?” Here the presenters allowed their passion about PA to be displayed. Pedro Hallal in particular noted that there was not enough “indignation” about the current state of affairs. Interesting stuff. Richard questioned the Sport England term “customer” … “Do you mean people?”

It was incredible to hear Coca Cola referred to in discussion about “toxic” private interests. Nobody in the room disagreed. How the world has changed from Rio 2014, when the ISPAH conference was literally festooned with Coca Cola sponsorship! It was also fascinating to hear from one panellist who was extremely disappointed at the attempts by physical activity advocates to cooperate with Nike and the Designed To Move initiative … saying it did not work at all. His conclusion was that “their interests are not our interests”. Great critical analysis.

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Richard Horton concluded by encouraging the audience to be more involved in advocacy, with opportunities for researchers and students to be spokespeople for PA in a variety of advocacy roles. He also noted that we should have an element of humility about our advocacy. People sometimes value things other than “health”, and we all might “trade off” some health for other experiences. It reminded me of what Alan Bairner once said about the physical health benefits accrued from walking. They ‘may well be of secondary importance to the lessons that can be learned from the pedagogies of the street’ (p. 373).

Looking forward to the next one (2020?), I think I understand the reason for publishing the Special Issue just before the Olympic Games. But perhaps the next issue should be moved away from the Olympic month. Using the Olympics to capture attention is one thing, but I suspect it also serves to conflate the issues for many people.

Joe Piggin

Reference:

Bairner, A. (2012). Urban walking and the pedagogies of the street. Sport, Education and Society, 16, 371–384. doi:10.1080/13573322.2011.565968

Ethics in sport, exercise and physical activity scholarship

Ethical principles are clearly very important in sport, exercise and PA research and practice. Here are some possible ways of addressing a variety of difficult ethical issues:

REFLECTION: Academics should be committed to considering their ethical positions with regard to the funding they receive.

DECLARATIONS: Academics should be committed to making explicit their ethical positions with regard to the funding they receive.

DISCLOSURE OF FINANCIAL GAIN: Academics should be committed to disclosing fees received from private funders for their research, even in cases where this is not a requirement to do so through contractual arrangements.

HUMAN RIGHTS: Academics should be extremely wary of engaging with funders from states / governments and NGO’s which are criticised by human rights organisations. If academics do become involved with such organisations, they should articulate their reasons for their involvement explicitly.

DUE DILIGENCE: Academics should critically investigate the background of the commercial partners they engage with.

IMPLICATIONS: Academics should reflect on the possible use of research data, particularly when it might be used in the manipulation of an organisation’s public image.

Academics should reflect on the motives of research funders and the wider implications of potential involvement with corporate partners, who promote goods, services and ideas to vulnerable populations.

SCEPTICISM: As producers of knowledge, sport and PA academics are in a powerful, privileged position. They should automatically treat funders with scepticism.

EDUCATION: Academics involved in sport, exercise and physical activity curriculums should give attention to “ethics” in their courses. They should emphasise ethics throughout the qualification and find suitably qualified people to teach this.

PROMOTION: Through their involvement with academic journals, professional organisations and conferences academics should promote discussion themes of “ethics”, “conflicts of interests” and “vested interests”. Academic journals, professional organisations and conferences should promote these discussions too.

Note: I appreciate the helpful contribution of my peers in forming these proposals.

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.

 

Active and Inactive People in Policy

Health policies are often thought of as text-heavy documents combining aspirational rhetoric with references to “stakeholders”, “step changes”, “targets” and “outcomes”. Of course, it is through words and numbers that resources and budgets are decided. However, imagery plays an important (subtle) role in shaping how policy problems and solutions are defined in the first place. I offer a few examples of how imagery in physical activity policy documents can powerfully (but subtly) affect how readers of policy understand an issue.

Healthy Weight Health Lives, UK Department of Health 2008

This was a major “anti-obesity” policy in the UK, written by the Cross-Department Obesity Unit, Department of Health and Children School and Families.

Picture1
Cover Page of Health Weight, Healthy Lives, UK Government, 2008.

The front cover connotes leisure, pleasure, 2.0 children, freedom, fashion, and a local council with immaculate greenkeeping. A slim, active life is a good life. Now, compare that to how “THE CHALLENGE” is visualised (p. xvi).

Challenge
Image from Health Weight, Healthy Lives, p. xvi.

This image (subtly) tells UK policy readers many things. We are encouraged to look at the anonymous bodies with disgust, and to judge their ill fitting clothes, their gorging, their loitering. Why are these women not frolicking on a grassy field? Rather than judging these people, we should ask questions about the process of image production.

Q: How could “THE CHALLENGE” be framed differntly? Is it obesity? Or is it economic poverty?

Q: Why are we looking at these bodies without faces? One might argue removing the heads is conscientiousness, ensuring the anonymity of those in the photo. However, there is another reason. Deborah Thomson refers to this practice as spectacular decapitation – a powerful shaming practice. It encourages the viewer to assimilate all the surrounding signifiers (the clothes, the gorging) with the shape of the bodies to make a judgment about those bodies.

Q: Does it matter that this image is not from the UK? Tracing the photo credit reveals the image is actually from the USA. The photo is of “Overweight New Yorkers eating ice cream on West Fordham Road at Grand Avenue in the Bronx, NY on Tuesday, August 12, 2003.”

Q: More importantly, was permission sought and received from the three women involved? I suspect permission was not sought. The photo, like many others on the site, is clearly taken in a public place. If permission was not gained, does this make it ethical?

Of course, these images are only two of many in the document, but it should encourage us to consider how people are presented in official policy.

Joe Piggin

For more see,

Piggin, J. & Lee, J. (2011) ‘Don’t mention obesity’: Contradictions and tensions in the UK Change4Life health promotion campaign. Journal of Health Psychology, 16, 1151-1164.