The federal government has launched numerous programs and campaigns over the past few years, all aimed at convincing us to change our unhealthy lifestyles. In 2004, the Bush administration declared war on obesity, introducing grants and public education initiatives to address the problem. In 2005, U.S. Surgeon General Richard Carmona put obesity at the top of his list of national health priorities.
By Sandra Whitehead
Our society is "overwhelmingly designed to promote obesity."
David Ludwig, M.D., Optimal Weight for Life Program
The federal government has launched numerous programs and campaigns over the past few years, all aimed at convincing us to change our unhealthy lifestyles. In 2004, the Bush administration declared war on obesity, introducing grants and public education initiatives to address the problem. In 2005, U.S. Surgeon General Richard Carmona put obesity at the top of his list of national health priorities. Today:
- We have new federal dietary guidelines, recommending that we eat more fruits, vegetables, whole-grain breads and starches and less fast-food, juice, soda and sports drinks. The guidelines also direct us to exercise for at least one hour every day.
- Medicare has redefined obesity as a medical problem, opening the door to greater insurance coverage for the treatment and prevention of obesity.
- Even the Internal Revenue Service is involved, now acknowledging the importance of treating obesity and making physician-prescribed weight-loss programs deductible medical expenses.
Yet, despite the push for all of us to eat better and exercise more, government and private health experts concede that the nation's weight problem is getting worse - especially for kids.
Public health officials call it an epidemic. More than 60 million U.S. adults - nearly one in three - are considered obese. And more than 9 million kids - 16 percent of children ages 6 to 19 - are considered overweight or obese, according to the National Center for Health Statistics. Some experts believe that percentage may now be as high as 18 percent.
Are they being alarmist? Not when you consider that overweight and obese kids have a higher risk of heart disease, type 2 diabetes and cancer, among other serious health conditions. Even worse, a 2003 report in the Journal of the American Medical Association revealed that obesity actually lowers life expectancy by eight to 20 years. And a 2004 study by Norwegian researchers found that obese teens have a dramatically increased risk of dying in middle age - at an average age of 46!
All of which begs the question: Why, with all the headlines, government campaigns and general angst about obesity, haven't we made a dent in solving this problem?
Only You Can Prevent Obesity?
Childhood obesity remains an epidemic in the United States, and health experts say it's only getting worse. Until we can jump-start our sedentary culture and minimize the impact of aggressive marketing of sugary, high-fat food to kids, parents are on their own when it comes to keeping their kids healthy and fit. There's plenty we can do individually - we just have to get started.
It sounded a bit like cheerleading, with Thompson declaring, "Do you want to look better? Yes. Do you want to feel better? Yes. If you do, you lower your calorie intake, you lower your fats, your carbs, and you eat more fruits and vegetables, more whole grain, and you exercise. And that's as simple as it can be."
But obesity experts say it really isn't that simple. Winning the battle of the bulge involves a lot more than mere will power, especially when our daily reality contradicts the public health messages we're hearing:
- Fast-food restaurants continue to serve up huge portion sizes, with discounted costs for upgrading to larger meals. On the plus side, however, some chains have added healthier options to their menus. And McDonald's has actually eliminated its "super-size" portions.
- Fast food, snack food and sweets continue to dominate the food advertisements shown during popular children's TV shows. A 2005 study by University of Illinois researchers found that during TV programs heavily viewed by kids, 83 percent of the ads shown were for convenience food, fast food and sweets. The ads depicted snack-time eating more often than breakfast, lunch and dinner combined.
- The time kids spend in front of a TV, computer or video game has increased, while the time they spend in physical education (PE) classes and outdoor recess has decreased.
- Fresh fruits, vegetables and whole-grain foods remain expensive and hard to come by for lower-income families.
In short, for every government initiative aimed at reining in the obesity problem, there are food industry, media and lifestyle practices that exacerbate it.
A Multifaceted Issue
The biggest impediment to curbing obesity is the sheer breadth of the problem. The disease - and it is now almost universally being called a "disease" rather than a social problem - has multiple causes, says Walt Larimore, M.D., co-author of SuperSized Kids: How to Rescue Your Child From the Obesity Threat.
What You Can Do
- Deirdre Wilson
Along with a general trend of eating too much and exercising too little, some specific lifestyle changes over the last 30 years or so have also contributed to America's weight problem:
- Hectic daily routines, for kids and adults alike, have led many families to skip traditional sit-down meals and head for the fast-food drive-thru.
- Kids' days are filled with sedentary activities. On average, they spend 8.5 hours a day engaged in physically passive media play - including TV, computers, music and video games. This is a 13 percent increase in just the last five years, according to a 2005 study by the Kaiser Family Foundation.
- Even the lack of enough sleep has played a role. "We are learning that getting enough sleep makes a big difference," Larimore says. "Many children are only getting six and a half hours of sleep a night, when they need eight to nine hours. It's surprising, but we've learned that when they sleep more, they also lose weight."
Yet children's busy lives - school days followed by extracurricular activities, late dinners and hours of homework - often don't allow for adequate rest.
"There is no single villain behind America's weight gain. It's a combination of many things, and they all need to be addressed," says James Hill, Ph.D., director of the Center for Human Nutrition at the University of Colorado at Denver. "You can change one or two factors, but the problem won't go away until we address the situation as a whole."
That won't be a quick fix, particularly since - as Surgeon General Carmona sees it - our problems with weight and exercise have been in the making for some 50 years.
But the childhood obesity problem is getting worse because our way of life is not improving, declares Gerald Hass, M.D., a community health center director and assistant clinical professor of pediatrics at Harvard Medical School. "I've seen three generations of patients, and it is this new generation that is facing a significant weight problem."
Two Nagging Obstacles
Perhaps what frustrates public health experts most about this epidemic are two obstacles facing the most vulnerable among us: children and the poor.
1. The Economic Factor - When it comes to eating better, poor families have it particularly tough. Rates of obesity are much higher at the bottom of the socioeconomic scale, and in urban environments especially healthier diets cost more than many people can afford.
A recent report by Adam Drewnowski, Ph.D., director of the Center for Public Health Nutrition at the University of Washington and an expert on alternative approaches to fighting obesity, found that families who try to save money on food often buy less expensive food with more calories and less nutrients. Just educating them on what to eat is not enough, he writes. "On a per-calorie basis, diets composed of whole grains, fish, and fresh vegetables and fruit are far more expensive than refined grains, added sugars and added fats."
Meanwhile, a 2004 study by researchers at the University of Houston found that high-income urban neighborhoods are much more likely to have supermarkets with high-quality produce. Low-income neighborhoods are more likely to have small grocery stores with limited food options.
2. Marketing Messages - When it comes to children, the obstacle they face is the same across all socioeconomic classes: they are bombarded with ads that push sugary, high-fat, high-calorie snack and convenience foods.
David Ludwig, M.D., director of the Optimal Weight for Life Program at Boston's Children's Hospital, has been a vocal national critic of the mass exposure kids have to the very foods that put them at risk. Our society, Ludwig says, is "overwhelmingly designed to promote obesity."
"For the sake of short-term private profits, we allow food advertisers to sell sugary cereals and the like to children," he adds. "Against the recommendations of the American Academy of Pediatrics, advertising with manipulative intent is directed to young children who lack the ability to evaluate its messages."
Not My Problem
Perhaps the biggest single obstacle to a successful national policy to fight obesity is the value that Americans place on individual responsibility. Does a child's weight problem affect anyone else but that child and his or her family? What does obesity in 16 percent of the nation's kids have to do with the rest of us?
The answer is that obesity is expensive, for all of us. Annual medical spending for health problems caused by obesity is pegged at $78.5 billion per year, according to a 2003 study by economists and the U.S. Centers for Disease Control.
In a 2002 op-ed column, Hass did not mince words in putting the situation in stark perspective and challenging those who say personal responsibility should drive better health behavior: "That is a hard argument to make in the face of a depressed, obese child whose health is failing, who has no safe place to exercise, and is under siege by adults selling him salt, fat, sugar and a shorter, sadder life. As adults, we have an obligation to do better."
Schools on the Battleground
Still, the spotlight on the nation's obesity problem and the wealth of health and nutrition information now available because of it are steps in the right direction. They just don't go far enough, experts say.
In an effort to reach all children, schools have become major targets for change, including a push to:
- Oust soda and snack vending machines. Some schools have banned soda machines from school buildings. But for other schools, the revenue from vending machine sales is hard to give up in tight budget times.
- Overhaul the federal school lunch program. Some school cafeterias have revamped their lunch menus to offer fresher, healthier fare, emphasizing salads and fruit. But most, particularly the schools funded by the National School Lunch Program (about 100,000 schools and childcare centers nationwide), continue to rely on high-fat, high-starch, agricultural surplus food.
- Allot more time for physical education and recess. Budget shortfalls and the academic requirements of federal education reform have led to severe cuts in PE and recess. Many schools now offer only one hour of phys ed a week and 40 percent of the nation's elementary schools have either cut back or eliminated recess time in recent years.
Signs of Improvement
School lunch and PE programs are starting to change as a result of the increased focus on childhood obesity.
In 2004, Congress passed the Child Nutrition and Women, Infants and Children Reauthorization Act, which ordered schools that participate in federally funded meal programs to come up with plans to encourage more physical activity and reduce fattening foods in school lunches by this fall. Congress also created grants to help schools start or improve phys-ed programs by hiring qualified teachers or buying better equipment.
"Small inroads are being made in increased awareness of the problem," notes Ludwig. "Schools are taking field trips to organic gardens or are offering cooking classes where children are re-establishing relationships with healthy foods. Parent-teacher organizations are demanding healthy school lunches and physical-education classes."
Beyond schools doors, some health experts believe it's the overall environment we're living in that must change - to address the problems created by our sedentary and hectic lifestyles.
At a conference on Environmental Solutions to Obesity in America's Youth last June, David Schwartz, M.D., director of the National Institute of Environmental Health Sciences, pointed out that "there's a fine balance between the environment and the individual that allows some people to make the choice for a more active and healthier life, and others to continue to eat the wrong types of foods or not be involved in physical fitness programs."
Ludwig believes the biggest, most life-altering changes - such as regulating the food industry's targeting of kids - will need to come from government itself, with considerable prodding from American citizens and families. "Are we going to demand increased responsibility of government to address the needs of the population," he asks, "or will we accept the status quo?"
Sandra Whitehead is a freelance writer and a mother of three.
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