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Seinäjoki's lauded childhood obesity figures under scrutiny

The Finnish city became world famous for slashing childhood obesity rates in 2015, but experts say that didn't happen.

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The city registered the trademark "Healthy Kids of Seinäjoki" in 2018. Image: Päivi Meritähti / Yle

The city of Seinäjoki and the region in which it is located, South Ostrobothnia, has struggled for some time with having the highest levels of obesity-related diseases and illnesses in the country. More than a decade ago, that situation led local officials to examine ways to reduce childhood obesity.

A joint investigation by Svenska Yle and Sweden's public broadcaster Sveriges Radio found that Seinäjoki's anti-obesity strategy was not as effective as it was claimed.

In 2015 the city announced that its efforts managed to halve the obesity levels of five-year-olds. The World Health Organisation, WHO, even published an article on the apparent success story.

Suddenly, the western Finnish city found itself in the international spotlight for being among the best in the world at promoting kids' health. The city registered the trademark "Healthy Kids of Seinäjoki" in 2018.

Dealing with similar problems related to excess weight, health officials in South Korea started using the model too - something the Finnish city has not been bashful to point out.

Jae-Heon Kang, a South Korean professor of medicine at Sungkyunkwan University, recounted how he learned about Seinäjoki's approach.

"Several years ago I heard about the Healthy Kids of Seinäjoki's success story. So I thought it was one of the best models for health promotion in children and adults... I knew that childhood obesity was halved among five-year-olds [over the course of] six years, that's truly incredible and excellent work," Kang said.

Correct intentions, wrong analysis

However, closer examination by researchers at Sweden's Uppsala University, the Finnish Institute for Health and Welfare (THL), and a physician in Seinäjoki, found that the statistics behind the success told another, less victorious, story.

According to Uppsala University professor Peter Bergsten, obesity rates of the youngsters were not halved, but rather the levels remained steady.

"There was absolutely no halving of [the number of] overweight children, but instead [the statistics showed] minor fluctuations over what is in fact a horizontal graph over time," Bergsten explained.

Seinäjoki's chief medical officer, Arja Lassila, also analysed Seinäjoki's child obesity data from 2009-2016, and backed up Bergsten's conclusions.

"It is not 'minus-50 percent,' this we know. Maybe people will ask 'what have you done? Have you lied to the whole world about this?' But I don't think that they lied but rather got the results and did the best they could [with them]," Lassila said.

She said the 2015 data which attracted global attention had simply not undergone scientific analysis, leading to inaccuracies.

Officials aware of misleading stats

At the same time, despite the discrepancies in the data analysis, the Healthy Kids' concept was marketed to other municipalities in Finland as well as abroad - as journalists around the world reported about the city's success story.

Bergsten announced his suspicions about misinterpretations of the data at the Healthy Kids of Seinäjoki conference in the spring of 2018.

However, Seinäjoki's vitality director, Erkki Välimäki, said the city has always delivered the message that the Seinäjoki model is based on what measures the municipality is actually taking to reduce child obesity. According to him, the various trends seen in the city's obesity rate graphs have never been relevant and he said that all of the figures released by the city are accurate.

"The Seinäjoki model is a comprehensive model to improve health and well-being, we believe that, and we're promoting that like we've always done. We have no plans of changing our own perceptions. Excel tables are Excel tables, and research is research," Välimäki said.

His reference to the spreadsheet application Excel was directed at the figures and graphs that Seinäjoki officials include in health and welfare reports, which showed a significant decline in overweight children in many age groups.

New analysis on the way

Those involved in Seinäjoki's obesity reduction programme have in all likelihood known since 2018 that the statistics included in the Excel tables that the city has officially released do not meet scientific standards. The city workers have also probably been aware since then that the area's childhood obesity rates did not decrease as advertised.

"We obviously do not control how the international media writes their news. That's their job," Välimäki said, adding that the city did not release their figures in a manner suggesting that child obesity rates were halved.

"We have consistently spoken about the work [we do] to promote health and well-being. That's our message," he said.

When asked why the city has not chosen to remove the misleading statistics that put Seinäjoki on the world map, Välimäki pointed out there are a number of various graphs that show how trends have developed over the past several years.

He added that the city has not hidden the fact that the childhood obesity rate has recently risen marginally.

City medical officer Lassila and public health authority THL said that the city did not analyse the data in a scientific way from the beginning. The health agency suggested that the city should correct the 2009-2016 data results it published, according to THL research professor Tiina Laatikainen.

"Obviously if in fact the statistics are not reliable, but rather some kind of preliminary analysis, then it would be good if they removed them [from the website]. But it is definitely Seinäjoki's responsibility," Laatikainen said.

On behalf of the WHO, Francesco Branca, the director of the health organisation's department of nutrition for health and development, said the statistics need to be reviewed again and accept that the results can be different when analysing a larger group of children.

In a joint effort, Uppsala professor Bergsten, Lassila and THL are currently carrying out a scientific examination of all of the data from 2009-2016. The results of this re-evalutaion are expected to be presented at the end of this month, around the same time as the city's annual Healthy Kids of Seinäjoki seminar is slated to begin.

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