Editor’s note: Everyone agrees that childhood obesity is an alarming problem. But not all agree how best to deal with it. The following is an editorial page exchange and accompanying reports that shed light on the topic. What follows is a letter to the editor of the Topeka Capital-Journal, the newspaper editorial that prompted it, and related reports.
Programs can work
By Candace L. Ayars, interim director of public health studies, Kansas Health Institute
July 30, 2007
We applaud the Editorial Board of The Topeka Capital-Journal for its editorial July 12 commenting on the report on the failure of government-sponsored programs to combat childhood obesity. The editorial correctly summarized many of the issues that continue to fuel the obesity epidemic.
However, we have some concern at the suggestion that government and policymakers should abandon funding for intervention initiatives. We agree a change in tactics is necessary. But we also strongly believe that more focused funding is needed.
A careful review of the failed initiatives reveals that many were based on the belief that if we can sufficiently educate people about the dangers of obesity they will take personal responsibility for changing their behavior.
It didn’t work. Americans just got heavier.
That’s not surprising given mounting evidence indicating the obesity epidemic is a result of multiple social and economic systems interacting in ways that overwhelm the ability of average people to make healthy decisions about their nutrition and activity. If policymakers continue to ignore this evidence and rely predominantly on programs that require individuals to prevail against all of the social and cultural barriers arrayed against them, we will continue to see disappointing results.
The good news is that there are newer models for childhood obesity intervention that are demonstrating promising initial results. This is a direct consequence of increased, not decreased, funding to examine the obesity epidemic with an evidence-based approach.
We remain encouraged that the right kind of interventions can help Americans shed weight and avoid the chronic and debilitating conditions – diabetes and cardiovascular disease to name a few – that are caused by obesity. More funding, not less, is needed so that we can continue to hone in on what works and what doesn’t. The alternative is to abandon our children to the disability, chronic disease, and early death that surely await them if we give up.
Childhood obesity Failing kids
Government’s attempt to teach children better eating habits is a colossal flop
The Capital-Journal Editorial Board
Published Thursday, July 12, 2007
It may be tough for taxpayers to swallow the results of a recent review of the federal government’s nutrition education programs.
Chew on this: The Associated Press reported that scientific studies examining 57 such programs showed all but four were failing. Considering the government will spend more than $1 billion on the programs this year, that’s a lot of money going down the disposal.
GETTING KIDS MOVING
The American Heart Association has these suggestions for parents to help their kids be more active, which can result in keeping off the weight:
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Help your children develop good physical activity habits at an early age by setting a good example yourself.
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Give your children some household chores that require physical exertion. Mowing lawns, raking leaves, scrubbing floors and taking out the garbage not only teach responsibility but can be good exercise.
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Observe sports and activities your children like, then find out about lessons and clubs.
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Discourage homework immediately after school to let children find some diversion from the structure of the school day. Kids should be active after school and before dinner.
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When your children are bored, suggest something that gets them moving, like playing catch or building a snowman in the yard.More at
www.americanheart.org
The AP report suggests that despite all the spending, the government is barely making a dent in the growing epidemic of childhood obesity.
“Any person looking at the published literature about these programs would have to conclude that they are generally not working,” said Dr. Tom Baranowski, a pediatrics professor at the Baylor College of Medicine in Texas.
Time for policymakers and lawmakers to take a look at the programs and either fix the ones that aren’t working or jettison them trim the fat, in other words. Not to suggest the battle of the bulge isn’t worth fighting. It definitely is.
According to the AP, obesity rates have ballooned nearly five-fold among 6- to 11-year-olds since the 1970s, according to the Centers for Disease Control. Among teenagers and kids ages 2 to 5, the rate has tripled.
Health problems stemming from obesity including diabetes, high blood pressure and orthopedic woes cost an estimated $100 billion a year.
It’s good to hear that Dr. James W. Holsinger Jr., a Kentucky cardiologist who has been nominated as the next surgeon general, says his top priority will be fighting child obesity.
But the AP study strongly suggests the government is waging the battle with the wrong strategy and with ineffective weapons.
Last year, for example, schoolchildren turned up their noses at a federal pilot program in which they received free fruits and vegetables. The program actually left fewer students willing to include the healthy food choices in their diet.
In Pennsylvania, kids took advantage of a program in which they received prizes for eating fruits and vegetables but only until the prizes ran out. Then, they went right back to high-fat snacks and soda.
Experts say there’s no easy answer for reversing the obesity epidemic. Health officials are facing a number of obstacles, including:
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A food distribution system in which unhealthy food is cheaper and more easily available than healthy food, a problem that especially affects those living in poverty.
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Parents with bad eating habits. Officials say parents are the greatest influence on the way kids eat.
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The pervasiveness of advertising aimed at creating demand among children for candy, snacks, cereal and fast food.
We certainly sympathize with government officials faced with overcoming these and other hurdles. But throwing money at the problem doesn’t seem to be having much of a slimming effect on obesity.
Failing to Fight Fat
Martha Mendoza, AP National Writer
Associated Press Archive – Published July 4, 2007
The federal government will spend more than $1 billion this year on nutrition education fresh carrot and celery snacks, videos of dancing fruit, hundreds of hours of lively lessons about how great you will feel if you eat well.
But an Associated Press review of scientific studies examining 57 such programs found mostly failure. Just four showed any real success in changing the way kids eat
or any promise as weapons against the growing epidemic of childhood obesity. “Any person looking at the published literature about these programs would have to conclude that they are generally not working,” said Dr. Tom Baranowski, a pediatrics professor at Houston’s Baylor College of Medicine who studies behavioral nutrition.
The results have been disappointing, to say the least:
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Last year a major federal pilot program offering free fruits and vegetables to school children showed fifth graders became less willing to eat them than they had been at the start. Apparently they didn’t like the taste.
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In Pennsylvania, researchers went so far as to give prizes to school children who ate fruits and vegetables. That worked while the prizes were offered, but when the researchers came back seven months later the kids had reverted to their original eating habits: soda and chips.
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In studies where children tell researchers they are eating better or exercising more, there is usually no change in blood pressure, body size or cholesterol measures; they want to eat better, they might even think they are, but they’re not.
The studies don’t tell Leticia Jenkins anything she doesn’t know. She’s one of the bravest teachers in America
not because she gave her seventh and eighth graders 30 sharp knives to chop tomatoes, onions, jalapenos and limes for a lesson on salsa and nutrition, but because she understands the futility of what she is trying to do.
“Oh, it’s so hard, because at the end of the day sometimes I take a moment, I think gosh, I did all this and we still see them across the street picking up the doughnuts and the coffee drinks,” she said.
Nationally, obesity rates have nearly quintupled among 6- to 11-year-olds and tripled among teens and children ages 2 to 5 since the 1970s, according to the Centers for Disease Control. The medical consequences of obesity in the U.S.
diabetes, high blood pressure, even orthopedic problems
cost an estimated $100 billion a year. Kentucky cardiologist Dr. James W. Holsinger Jr., nominated as the next surgeon general, says fighting childhood obesity is his top priority.
The challenges to changing the way children eat are as numerous as the factors that have prompted the obesity epidemic in the first place.
The forces that make kids fat “are really strong and hard to fight with just a program in school,” said Dr. Philip Zeitler, a pediatric endocrinologist and researcher who sees “a steady stream” of obese children struggling with diabetes and other potentially fatal medical problems at The Children’s Hospital in Denver.
What does he tell them?
“Oh God, I haven’t figured out anything that I know is going to work,” he said. “I’m not aware of any medical model that is very successful in helping these kids. Sure, we try to help them, but I can’t take credit for the ones who do manage to change.”
The obstacles are daunting:
PARENTS. Experts agree that although most funding targets schools, parents have the greatest influence, even a biological influence, over what their children will eat. Zeitler says when children slim down, it’s because “their families get religion about this and figure out what needs to happen.”
But often, they don’t.
“If the mother is eating Cheetos and white bread, the fetus will be born with those taste buds. If the mother is eating carrots and oatmeal the child will be born with those taste buds,” said Dr. Robert Trevino of the Social and Health Research Center in San Antonio.
Most kids learn what tastes good and what tastes nasty by their 10th birthdays.
“If we don’t reach a child before they get to puberty, it’s going to be very tough, very difficult, to change their eating behavior,” said Trevino.
POVERTY. Poorer kids are especially at risk, because unhealthy food is cheaper and more easily available than healthy food. Parents are often working, leaving children unsupervised to get their own snacks. Low-income neighborhoods have fewer good supermarkets with fresh produce.
“If Mom can’t find tomatoes in her local grocery store, nothing is going to change,” said Zeitler.
Meanwhile, it’s harder for children to exercise on their own. Parks often aren’t safe and sports teams cost money.
“Calorie burning has become the province of the wealthy,” said Zeitler. “I fear that what we’re going to see is a divergence of healthy people and unhealthy people. Basically, like everything else, it costs money to be healthy.”
ADVERTISING. Children ages 8 to 12 see an average of 21 television ads each day for candy, snacks, cereal and fast food
more than 7,600 a year, according to a recent Kaiser Family Foundation study. Not one of the 8,854 ads reviewed promoted fruits or vegetables.
There was one ad for healthy foods for every 50 for other foods.
Children may be the best sources to explain why lessons about nutrition don’t sink in.
“I think it’s because they like it so much, because like, I don’t know if you’ve seen the new hot Cheetos that are like puffs? Oh my God, they’re so good. Like everyone at the school has them and they’re so good,” said Ani Avanessian, 14, of Panorama City.
Her classmate George Rico, a 13-year-old whose mother is a manager at a McDonald’s, said he loves his nutrition class. But does it affect what he puts in his mouth?
“Well, no, but it makes me think about what I eat,” he said. “I think kids don’t change because they’ve been eating it for so long they’re just accustomed to eating that way.”
Their teacher, Jenkins, offers fact-filled and engaging nutrition lessons as part of a $7 million USDA program which reaches about 388,000 students a year in the Los Angeles Unified School District.
The most recent evaluation of the 8-year-old program was disheartening: no difference in the amount of fruits and vegetables eaten by kids participating in the program and those who weren’t. Teachers who spent more hours on nutrition education had no greater impact than those who didn’t. And parent behavior didn’t change either.
“It’s true, it didn’t change what they actually eat. But the program really made a difference in how kids were feeling about fruits and vegetables. They really had a more positive attitude toward fruits and vegetables,” said Dr. Mike Prelip, a UCLA researcher who headed up the evaluation.
Kate Houston, deputy under secretary of the USDA’s Food, Nutrition and Consumer Services, oversees most federal funds, $696 million this year, spent on childhood nutrition education in this country. Funding has steadily increased in recent years, up from $535 million in 2003. Houston insists the programs are successful.
“I think the question here is how are we measuring success and there are certainly many ways in which you can do so and the ways in which we’ve been able to measure have shown success,” she said.
But isn’t the goal of these programs to change the way kids eat?
“Absolutely that’s the goal,” she said.
And they’re successfully reaching that goal?
“We’re finding success in things in which we have been able to measure, which are more related to knowledge and skill. It is more difficult for us to identify success in changing children’s eating patterns.”
When asked about the many studies that don’t show improvement, Houston asked for copies of the research. And she said the USDA doesn’t have the resources to undertake “long term, controlled, medical modeled studies” necessary to determine the impact of its programs.
Doctors like Tom Robinson, who directs the Center for Healthy Weight at Lucile Packard Children’s Hospital at Stanford University, said those studies aren’t needed. The research has already shown they don’t work.
“I think the money could be better spent on programs that are more behaviorally oriented, as opposed to those that are educationally oriented, or studies that just describe the problem over and over again,” he said.
There may be pieces of solutions found in limited studies currently being tested around the country. In some situations, obese and overweight children can lose weight and get healthy through rigorous hospital and clinic-based interventions that involve regular check-ins, family involvement, scheduled exercise and nutrition education.
School programs that increase physical activity are also more likely to have an impact than nutrition education.
This spring the Robert Wood Johnson Foundation announced plans to spend $500 million over the next five years to reverse the trend of childhood obesity. It will fund programs that bring supermarkets into poor neighborhoods, studies that measure the weight of children who exercise more at school, meetings of advocates who are seeking to restrict junk food ads.
One thing it won’t fund: projects that only provide school nutrition education.
AP Finds Federal Nutrition Education Programs Producing Lackluster Results
July 5, 2007 (from the Robert Wood Johnson Foundation website)
The Associated Press this week released a review of studies assessing 57 child nutrition education programs, finding that few initiatives have significantly improved children’s eating habits. Noting that the federal government will spend $1 billion this year on nutrition education, the AP reports that just four of the studies indicate that nutrition programs had a lasting effect on children’s diets.
Most studies yielded disappointing results, with one analysis indicating that fifth-grade participants in a 2006 federal pilot program offering free produce in schools actually became less willing to eat fruits and vegetables after the initiative’s implementation.
Moreover, in studies assessing children’s self-reported exercise and nutrition habits, most children reported improved lifestyle habits but demonstrated no corresponding improvements in obesity indicators such as blood pressure, body size or cholesterol levels. During a recent evaluation of a $7 million federal nutrition education program launched eight years ago, a University of California-Los Angeles researcher found that Los Angeles Unified School District students who participated in the program did not eat more produce than non-participating students, but they did adopt more positive attitudes toward fruits and vegetables.
Kate Houston, deputy under secretary of the U.S. Department of Agriculture”s (USDA) Food, Nutrition and Consumer Services, maintains that nutrition education programs have successfully built children’s knowledge and skills. These gains, she says, are easier to measure than changes in eating habits. Houston adds that the USDA does not have the resources to study the long-term impact of all federally funded nutrition education programs.
Dr. Phillip Zeitler, pediatric endocrinologist from The Children’s Hospital in Denver, however, notes that the forces contributing to childhood obesity “are really strong and hard to fight with just a program in school.” Specifically, child health experts say family lifestyle habits, income level and geographic location have the greatest influence on childhood risk for obesity.
The AP adds that children in low-income families are at particularly high risk because unhealthy food is often less expensive and many low-income neighborhoods lack large grocery stores and safe outdoor recreation areas. The AP concludes that programs aimed at increasing physical activity are more likely to improve children’s health than nutrition education initiatives alone (Mendoza, AP/Yahoo! News, 7/4/07).
(Editor’s note: The AP story refers to the Robert Wood Johnson Foundation’s five-year, $500 million commitment to reverse the childhood obesity epidemic. For a complete overview of our strategy and approach, as well as to learn about what we do and do not fund, please visit:
http://www.rwjf.org/programareas/ChildhoodObesityFramingDoc.pdf
.)