It makes intuitive sense: If you want to want to tackle the epidemic of obesity among adults, try stopping it in childhood.

Around the country, hospitals and other health care providers have set up intensive six-month programs to treat obese children as young as 6. Children and their parents get dietary training, exercise regimens, and weekly family counseling about healthier lifestyles. The idea is that children will not just slim down but also develop healthier habits that will stay with them well into adulthood. The U.S. Preventive Services Task Force, a panel of independent health care experts convened by the government, recommends such treatment for all obese children 6 years or older.

But a new Stanford study ― drawing on health data going back 40 years, as well as some more limited data on the results of treating obesity in children ― suggests that this head-on treatment of youngsters will have a surprisingly meager impact on reducing obesity-related illness in adulthood.

The problem, in a nutshell, is that people go through a great many changes as they grow up. Many obese children slim down without any special treatment, and many thin children become overweight as adults. Even if children get treatment at the age of 6 or 8 that’s considered successful, the researchers say, many will be obese again by the time they are 30 or 40. And many who weren’t obese at young ages will be obese later.

The new study, “Analyzing Screening Policies for Childhood Obesity,” appeared in the April 2013 issue of Management Science. It was conducted by Lawrence M. Wein, a professor at Stanford’s Graduate School of Business; Yan Yang, a recent graduate of the doctoral program at Stanford’s Institute for Computational and Mathematical Engineering; and Jeremy Goldhaber-Fiebert, assistant professor at Stanford’s School of Medicine and a core faculty member at Stanford Health Policy, a research center at the university’s Freeman Spogli Institute for International Studies.

Some of their findings:

• Intensive obesity treatment has very little impact on the likelihood that obese 6-year-olds will suffer from hypertension as adults. A full 25.1% of those who receive treatment will have hypertension by the time they are 40, for example, compared to 26.8% of those who don’t get treatment.
• Early childhood screening for obesity has limited predictive value for health in adulthood. The researchers  calculate that 18.8% of 6-year-olds who are not obese will suffer from hypertension by the time they reach 40.
• You would have to provide intensive treatment to 20 obese 6-year-olds to get just one less case of adult hypertension when those individuals are 40.
• Intensive treatment has a more significant long-term impact for 16-year-olds, but even that effect may be modest. The researchers predict that about 34.9% of obese 16-year-olds who get treatment would still develop obesity-related illnesses by the age of 40, compared to 39.4% of those who didn’t get treated at age 16.

No one disputes that obesity is an epidemic health problem in the United States. About 35% of American adults are obese, a two-fold increase since 1980. Roughly 17% of children are obese, about triple the rate in 1980. Estimates of the cost of treating Americans of all ages for obesity-related illnesses, such as diabetes and cardiovascular disease, range as high as $190 billion per year.

While educating children and families about exercise and diet might be useful to individual youngsters, the issue under study at Stanford was whether widespread, intensive treatment for obese young children offers much bang for the buck. A six-month program can easily cost $3,500 per child, so treating every obese child in the United States would cost billions, and the number of service providers needed would probably far outstrip the number who currently offer treatment. At the moment, relatively few obese children get such treatment, because both public and private insurance programs are reluctant to cover it.

For any given amount of money spent on treatment, the Stanford researchers estimate, concentrating on teenagers who are 16 or older would produce a slight increase in health benefits compared to treating all obese children from the ages of 6 to 18. Alternatively, the cost of obtaining the same long-term reductions in adult obesity-related illness could be reduced by 28% by focusing on 16-year-olds.

An even smarter strategy from a public policy standpoint, the researchers argue, could be to put more money into universal efforts aimed at all children ― better nutrition in the schools, better playgrounds and fitness programs in the schools, and public efforts to reduce consumption of junk food ― rather than focusing on just obese children.

“There are a lot of good things we can do in the schools, in the supermarkets of big cities, in the food industry, and in the beverage industry,” says Wein, an affiliated faculty member at FSI's Center for International Security and Cooperation. “From a cost-effectiveness standpoint, I believe this would be a better way.”

The new study is likely to be controversial. Because almost no children received intensive obesity treatments back in the 1970s or 1980s, the researchers used statistical modeling to infer the long-term benefits. It sounds highly theoretical, but the approach is analogous to predicting the trajectory of a hurricane and then estimating how much a change in conditions would knock the hurricane off the path originally predicted.

The researchers began by getting a baseline for what happens to children in the absence of treatment, drawing on two national data sets that tracked the health conditions of children and adults over several decades. That allowed them to estimate the likelihood that children of particular weights and ages will suffer from diabetes or hypertension by the time they are 40. The researchers then combined those long-term probabilities with shorter-term results from studies of children who did and who did not receive treatment.

Businesses have used similar types of statistical modeling for years to make decisions about the timing of production, inventory acquisition, shipping, and many other issues. Wein, who began his career by using mathematical tools to optimize manufacturing systems, has used them for more than two decades to analyze potential social and health challenges: responding to disease pandemics, optimizing emergency nutrition during famines, dealing with bioterrorist threats.

The researchers emphasize that there may still be important short-term reasons to intensively treat obesity in some younger children. They also caution that their study doesn’t imply that parents should stop worrying if their children are seriously overweight. But if a prime goal of intensive childhood treatment is to reduce chronic disease in adults, they say, there are better ways to tackle the problem.

Edmund L. Andrews is a freelance writer.

Mariano-Florentino Cuéllar, a Stanford law professor and expert on administrative law and governance, public organizations, and transnational security, will lead the university’s Freeman Spogli Institute for International Studies.

The announcement was made in Feb. 11 by Provost John Etchemendy and Ann Arvin, Stanford’s vice provost and dean of research.

“Professor Cuéllar brings a remarkable breadth of experience to his new role as FSI director, which is reflected in his many achievements as a legal scholar and his work on diverse federal policy initiatives over the past decade,” Arvin said. “He is deeply committed to enhancing FSI’s academic programs and ensuring that it remains an intellectually rich environment where faculty and students can pursue important interdisciplinary and policy-relevant research.”

Known to colleagues as “Tino,” Cuéllar starts his role as FSI director on July 1.

Cuéllar has been co-director of FSI’s Center for International Security and Cooperation (CISAC) since 2011, and has served in the Clinton and Obama administrations. In his role as FSI director, he’ll oversee 11 research centers and programs – including CISAC – along with a variety of undergraduate and graduate education initiatives on international affairs.  His move to the institute's helm will be marked by a commitment to build on FSI’s interdisciplinary approach to solving some of the world’s biggest problems.

“I am deeply honored to have been asked to lead FSI. The institute is in a unique position to help address some of our most pressing international challenges, in areas such as governance and development, health, technology, and security,” Cuéllar said. “FSI’s culture embodies the best of Stanford – a commitment to rigorous research, training leaders and engaging with the world – and excels at bringing together accomplished scholars from different disciplines.”

Cuéllar, 40, is a senior fellow at FSI and the Stanley Morrison Professor of Law at the law school, where he will continue to teach and conduct research. He succeeds Gerhard Casper, Stanford’s ninth president and a senior fellow at FSI.

“We are deeply indebted to former President Casper for accomplishing so much as FSI director this year and for overseeing the transition to new leadership so effectively,” Arvin said.

Casper was appointed to direct the institute for one year following the departure of Coit D. Blacker, who led FSI from 2003 to 2012 and oversaw significant growth in faculty appointments and research.

Casper, who chaired the search for a new director, said Cuéllar has a “profound understanding of institutions and policy issues, both nationally and internationally.”

“Stanford is very fortunate to have persuaded Tino to become director of the Freeman Spogli Institute for International Studies,” Casper said. “He will not only be an outstanding fiduciary of the institute, but with his considerable imagination, energy, and tenacity will develop collaborative and multidisciplinary approaches to problem-solving.”

Cuéllar – who did undergraduate work at Harvard, earned his law degree from Yale and received his PhD in political science at Stanford in 2000 – has had an extensive public service record since he began teaching at Stanford Law School in 2001.

Taking a leave of absence from Stanford during 2009 and 2010, he worked as special assistant to the president for justice and regulatory policy at the White House, where his responsibilities included justice and public safety, public health policy, borders and immigration, and regulatory reform.  Earlier, he co-chaired the presidential transition team responsible for immigration.

After returning to Stanford, he accepted a presidential appointment to the Council of the Administrative Conference of the United States, a nonpartisan agency charged with recommending improvements in the efficiency and fairness of federal regulatory programs.

Cuéllar also worked in the Treasury Department during the Clinton administration, focusing on fighting financial crime, improving border coordination and enhancing anti-corruption measures.

Since his appointment as co-director of CISAC, Cuéllar worked to expand the center’s agenda while continuing its strong focus on arms control, nuclear security and counterterrorism. During Cuéllar’s tenure, the center launched new projects on cybsersecurity, migration and refugees, as well as violence and governance in Latin America. CISAC also added six fellowships; recruited new faculty affiliates from engineering, medicine, and the social sciences; and forged ties with academic units across campus.

He said his focus as FSI’s director will be to strengthen the institute’s centers and programs and enhance its contributions to graduate education while fostering collaboration among faculty with varying academic backgrounds.

“FSI has much to contribute through its existing research centers and education programs,” he said. “But we will also need to forge new initiatives cutting across existing programs in order to understand more fully the complex risks and relationships shaping our world.”

In addition to Casper, the members of the search committee were Michael H. Armacost, Francis Fukuyama, Philip W. Halperin, David Holloway, Rosamond L. Naylor, Douglas K. Owens, and Elisabeth Paté-Cornell.

The decision by voters in Colorado and Washington state to legalize the recreational use of marijuana has “changed the rules of the game” for the administration of Mexican President-elect Enrique Peña Nieto in the U.S.-backed drug war, according to a report by the Washington Post’s William Booth.

Applying for a Rhodes Scholarship gave Margaret Hayden a chance to talk about her quest to better understand mental illness.

Hayden, whose older sister committed suicide after a sudden and severe depression, wrote in her essay that she "could not begin to craft a meaningful life without acknowledging and trying to understand her [sister's] experience."

In the spring quarter of her freshman year, she enrolled in a class on the anthropology of mental illness. Later, she began pursuing research related to mental illness, working with faculty at Stanford Health Policy at the university’s Freeman Spogli Institute for International Studies.

Now a senior, Hayden is one of two Stanford students joining 30 other newly minted Rhodes Scholars from the United States who will receive full financial support to pursue degrees in England.

The Rhodes Scholarships are the oldest and most celebrated international fellowship awards in the world. Scholars are chosen for their outstanding scholarly achievements as well as their character, commitment to others and to the common good, and potential for leadership in whatever careers they choose.

Hayden, 21, of Brunswick, Maine, is majoring in human biology. She is writing an honors thesis in the Program in Ethics in Society, with an emphasis on the art and ethics of patient care. She plans to pursue a master's degree in medical anthropology at Oxford.

Margaret Hayden

Margaret Hayden

Her honors thesis, "The Ethical Implications of Biological Conceptions of Mental Illness and Personhood," explores the consequences of viewing mental illness as solely a matter of the brain.

In her Rhodes Scholarship application, Hayden said that approach to mental illness may alleviate responsibility from patients, but it also introduces troubling implications: What kind of person do you become when your brain is "broken?"

"It is here I envision my intellectual future – working at the interface of medicine, anthropology and ethics," she wrote. "Anthropology grounds my ethical investigations, because I believe that without the context of the everyday moral experiences of individuals, without attention to emotional, social and political setting, the practice of ethics risks becoming an abstract academic exercise with little relevance to the day-to-day struggles of real people trying to craft lives in this tenuous, unpredictable world. It is these people and their struggles that motivate my own intellectual ambitions."

Hayden is a co-author of "Parents' Perceptions of Benefit of Children's Mental Health Treatment and Continued Use of Services," published Aug. 1, 2012 in Psychiatric Services.

In one of her studies at Stanford Health Policy, she analyzed Latina women's perceptions of post-partum depression. In another, she assessed the success of a program to improve outcomes of low-birth-weight infants by analyzing the mothers' use of and attitudes toward a web-based information portal and social network.

Since the fall of 2010, Hayden has served as a patient advocate at the Mayview Community Health Center in Palo Alto. At the clinic, she conducted a research project on available mental health resources for clients. Since the fall of 2011, she has been a clinic coordinator at the center, serving as a liaison among student volunteers, Stanford program staff and clinic staff.

Hayden was a member of Stanford's varsity squash team and its varsity sailing team.

Hayden will be studying at Oxford with Rachel Kolb, '12, who is currently pursuing a master's degree in English at Stanford

Kolb, 22, of Los Ranchos, N.M., earned a bachelor's degree in English with honors and a minor in human biology in 2012 from Stanford.

Rachel Kolb

Rachel Kolb

Kolb, who was elected as a junior to Phi Beta Kappa, wrote an honors thesis titled, "Grains of Truth in the Wildest Fable: Literary Illustrations, Pictorial Representation, and the Project of Fantasy in Jane Eyre."At Oxford, Kolb plans to pursue a master's degree in contemporary literature and a master's degree in comparative social policy.

In her Rhodes Scholarship application, Kolb, who was born with a profound bilateral hearing loss, wrote: "As someone who understands the different forms communication can take, from spoken to sign language, I understand the value of flexibility in transmitting ideas.

"I see well-rounded, effective communication as essential to ideas, creativity and progress. I want to be a writer committed to exploring issues of access, equality and difference, and the nature of communication itself. Our world often does not know how to talk about these things, just as it does not know how to talk about disability, about differing abilities and strengths, distinct personal styles and challenges."

Kolb, who was active with Christian ministries, wrote a weekly opinion column for The Stanford Daily in 2011. She is the managing editor of Leland Quarterly, a campus literary magazine.

She is a member of the on-campus student advocacy group, Power to ACT: Abilities Coming Together, and was one of several students featured in a new video that welcomes students with disabilities to Stanford. The university's Office of Accessible Education released the video last month.

Kolb won several prizes for her writing at Stanford, including the Marie Louise Rosenberg Award for her honors thesis and the 2011 Creative Nonfiction Prize for her essay, "Seeing at the Speed of Sound."

Kolb is co-president of Stanford's equestrian team and represented the university at the 2010 and 2011 Intercollegiate Horse Show Association National Finals.

Kathleen J. Sullivan is a writer for Stanford's University Communications.

A government-backed panel of medical experts says everyone between the ages of 15 and 65 in the United States should be tested at least once in their lives for HIV, a policy that Stanford’s Douglas K. Owens says could have a substantial impact on the course of the epidemic.

Owens, a professor of medicine and director of Stanford Health Policy at the university’s Freeman Spogli Institute for International Studies, is a member of the U.S. Preventive Services Task Force, which issued its draft recommendation on Nov. 19.

Currently, there are an estimated 1.2 million people in the nation infected with HIV, and some 20 to 25 percent of them aren’t aware they carry the virus that causes AIDS. If they were diagnosed, they could get into treatment programs, which would benefit them as well as helping to prevent the spread of the disease.

“We think it’s important for everyone to be screened once because treatment helps people live longer, healthier lives and also prevents transmission to others,” said Owens, who is also a senior investigator at the Veterans Affairs Palo Alto Health Care System.

Those at very high risk, including gay men and injection drug users, should be tested every year, while others considered at increased risk also should undergo repeat testing with the frequency depending on risk, the task force recommends. In addition, the panel said practitioners should screen all pregnant women for the virus; the practice, now common in this country, has helped virtually eliminate the incidence of mother-to-child transmission, Owens noted.

In 2005, the task force strongly recommended HIV screening in adolescents and adults considered at increased risk for HIV, but it stopped short of recommending a universal testing program.  The new recommendation for widespread screening reflects the changing world of AIDS science, Owens said.

For instance, studies have shown that an early diagnosis — even before symptoms begin to emerge — followed by effective antiretroviral treatment, can help prevent individuals from developing life-threatening complications. Moreover, HIV-infected individuals who are treated with antiretroviral drugs are much less likely to pass on the virus to others. A landmark study published in August 2011 and involving 1,763 heterosexual couples (in which one was HIV-positive and the other was not) found that treating the infected partner reduced his or her chance of transmitting the virus by 96 percent.

In addition, once people are diagnosed, they can be counseled about changing their behaviors to help prevent the spread of the disease. Observational studies have shown that people who know their HIV status are more likely to take precautions, for instance, by using condoms, avoiding sex with sex workers or having sex in exchange for money or drugs, the task force noted.

In 2006, the federal Centers for Disease Control recommended routine voluntary screening for everyone aged 13 to 64, but allowed them to opt out of testing. Many other professional groups, such as the American College of Physicians, also advise routine patient screening. Yet universal screening, followed by treatment, has never been achieved in this country.

Owens said the task force did consider the potential harms of screening and testing. One potential drawback is a false-positive test result, though the screening test is highly accurate, so this risk is quite small, he said. Treatment also may carry side effects, including the possibility of a slightly increased risk for heart problems. Stigmatization and labeling are other potential downsides of testing, he said.

But on balance, he said, “We feel the benefits are so substantial that they far outweigh the potential harm.”

He said the task force also emphasized the importance of prevention: “The best way to reduce HIV disease and death is to avoid becoming infected. So we want people to take actions to reduce their risk behaviors, such as using safe sex practices and avoiding other behaviors that put them at risk.”

The task force’s draft recommendation has been posted for public comment on its website at http://www.uspreventiveservicestaskforce.org. Comments can be submitted from Nov. 20 to Dec. 17 at www.uspreventiveservicestaskforce.org/tfcomment.htm. The panel then will finalize its recommendations, which will be published in the Annals of Internal Medicine.

Ruthann Richter is the director of media relations at the Stanford School of Medicine.