Bethesda, MD -- How should America tackle an obesity crisis that is threatening the health and well-being of nearly one-third of its children? That is the subject of the March 2010 edition of Health Affairs, which both describes the root causes of this pathology and offers prescriptions for improving the health of America's children. The March issue is funded by the Robert Wood Johnson Foundation.
"Kids are becoming obese or overweight at the ripe old age of four, meaning that they are already predisposed to shorter, sicker lives from diabetes, heart problems, even certain types of cancer," writes Health Affairs Editor-in-Chief Susan Dentzer. "What is this crisis if not some national form of child abuse?"
A new study by Christina Bethell of the Oregon Health and Science University shows that the rate of childhood obesity continues to increase nationally. What's more, the highest combined rates of overweight and obesity are found among poor, black, Hispanic, and publicly insured children -- and the disparities in weight between these groups and other children are growing.
Dentzer says that recent developments offer modest cause for hope. First Lady Michelle Obama has taken on childhood obesity as one of her signature causes. Changes in federal policy -- to promote healthier school meals and eliminate the sale of junk foods at schools -- are in the making. But more is needed to put the health of America's children back on track.
Addressing the problem begins with understanding the multiple underlying causes. David Wallinga, director of the Food and Health Program at the Institute for Agriculture and Trade Policy in Minneapolis, reports that Americans' average daily calorie intake in 2007 was 400 calories higher than in 1985 and 600 calories higher than in 1970. How did we get to this point? Wallinga points to thirty-five years of agriculture policy favoring production of cheap sugars as a key driver of increased calorie consumption. Yet eliminating crop subsidies to commodity farmers is not the answer, he says. Instead, he favors managing commodity crop overproduction and supporting farmers who produce more fruit and vegetables to balance U.S. agricultural policy -- which, he adds, has as much to do with health as it does farming.
A study by Barry M. Popkin and Carmen Piernas, of the University of North Carolina at Chapel Hill finds that U.S. children are snacking more than ever -- almost three times a day -- on junk foods. As a result, they are consuming more than 27 percent of their daily caloric intake through snacks.
Marketing of these calorie-dense, nutrient-poor foods and beverages aimed at children is frequently cited as another factor in the obesity epidemic. Placing restraints on this type of advertising might help mitigate its influence on young people. Yet there is little political support for policies restricting food marketing to youth.
A new survey conducted by Amir Goren, of Yale University, and colleagues finds that even parents are not likely to support such restrictions unless they already feel negatively about current food marketing practices. The authors recommend increased public education on the negative effects of food marketing on children.
Some experts believe that government must take aggressive action to reduce childhood obesity. Kelly D. Brownell, of Yale University, and coauthors call on policymakers at all levels of government to help Americans make healthier choices by regulating food ingredients, labeling, and marketing; and by taxing unhealthy foods and beverages. Thomas R. Frieden, the new director of the U.S. Centers for Disease Control and Prevention, says reversing the epidemic will require multiple policy changes, including taxes on unhealthy foods and beverages, new incentives to promote healthy crop production, a ban on advertising that fosters bad eating habits, and sustained efforts to increase physical activity among children. "If we do not act now, the epidemic of childhood obesity will become increasingly difficult to address," says Frieden. "From the federal to the state and local level, in the public and the private sector, from Fortune 500 companies to families around their kitchen tables, there are simple things each of us can do to encourage physical activity, improve nutrition and help our kids live healthier lives. It will take us all working together to meet this challenge."
Other highlights from this edition of Health Affairs include:
• How does federal food assistance affect childhood obesity? Rachel Kimbro, of Rice University and Elizabeth Rigby, of the University of Houston, find that food assistance -- including, for example, the program formerly known as food stamps -- may be both part of the solution and part of the problem. Their study shows that food assistance may unintentionally contribute to childhood obesity in cities with high food prices, but that subsidized meals at school and day care have a positive impact. They argue that expanding access to subsidized meals may be the most effective tool to combat obesity in poor children.
• Data collected by the U.S. Centers for Disease Control and Prevention (CDC) have helped reveal the extent of the obesity epidemic at a national level and provided some insights at the state level. However, according to Matt Longjohn, of Northwestern University and colleagues, more information is needed at the state and local levels to track childhood obesity trends -- particularly concerning body mass index (BMI). To date, some thirty states have enacted or proposed BMI surveillance laws and regulations, many of them involving innovative systems that will increase the ability of public health agencies to contain the epidemic. In Texas, William M. Sage reports on how geographic information system (GIS) mapping identified two neighborhoods outside downtown Austin with high obesity rates. Armed with this information, community groups were able to design obesity interventions tailored to each neighborhood.
• States are employing a variety of tactics to reverse childhood obesity trends. For example, Debbie I. Chang describes how a statewide initiative in Delaware halted increases in obesity and overweight prevalence among children, by increasing knowledge of healthy eating behaviors and awareness of the need for more physical activity in school and child care settings. Pennsylvania has focused its efforts on increasing access to healthy foods by eliminating "grocery store gaps." To date, Pennsylvania's Fresh Food Financing Initiative, a public-private enterprise, has funded seventy-four fresh food outlets throughout the state, increasing fresh food access for 500,000 children and adults, according to Allison Karpyn, of the Food Trust in Philadelphia, and colleagues.
Meanwhile, Steve Bogira tells the stories of two young children living in different suburbs of Baltimore who are battling obesity with support from a behavioral intervention program called Weigh Smart, operated by Mt. Washington Pediatric Hospital. The goal is not short-term weight loss but a sustained change in children's and families' attitudes and habits regarding eating and physical activity. For kids, that means avoiding formerly beloved foods -- like macaroni and cheese -- and sweating more. For parents, it means supporting their kids' efforts by reading food labels more carefully, preparing healthy meals, and getting their children to be more active.
• Schools are a key battleground in the war on childhood obesity. One critical issue is the sale of junk foods at so many schools. Nicole Larson and Mary Story of the University of Minnesota find that junk foods are more consistently available than healthy foods at many schools. The authors call for continued action at the federal, state, and local levels to eliminate the availability of junk foods in schools. Such policies can make a difference, as Emma V. Sanchez-Vaznaugh, of the University of California, San Francisco, and coauthors found in California. Following implementation of stricter nutrition standards for snacks and beverages sold to children at school, the rate of increase in overweight children fell significantly among fifth graders in Los Angeles and among fifth-grade boys and seventh graders in the rest of California.
Yet implementation of policy changes to school meals and nutrition and wellness programs sometimes yield mixed results. In an examination of Pennsylvania's response to the federal WIC Reauthorization Act of 2004, Claudia Probart of Pennsylvania State University and colleagues found improvements to the nutritional quality of foods offered in conjunction with school meal programs. But they also found that several implementation steps were not followed, and that statewide enforcement was inadequate.
• How does the childhood obesity epidemic affect employers? Very few data exist to answer that question, according to Martin J. Sepulveda, of IBM, and coauthors. Yet they believe strongly that employers should be concerned. They cite data showing that the average per capita health insurance claims cost for children with type II diabetes, at $10,789, exceeds the $8,844 average claims cost of adults with the same condition. These and other data "provide a compelling basis for greater employer engagement in efforts" to promote healthy weight among young people, the authors write.
To access a full table of contents from this issue, please click here: http://www.healthaffairs.org/March2010_TOC.pdf