August 8, 2008

Simple and Effective Changes Will Slow Obesity Epidemic

By Dan Foster

THERE IS a fascinating photo that always grabs my attention when I visit my parents. It is a 1943 picture of more than 100 employees, both men and women, leaving a wartime production plant, smiling, and walking toward the camera. Not only does it display fashions and hairstyles of the period, but it also typifies the enthusiasm and united commitment all Americans had during that era.

Yet, perhaps more compelling than history or symbolism is the fact that in this small but likely representative sample, no one appeared the least bit plump.

This could not happen in a random U.S. picture today. Almost two- thirds of Americans are now officially overweight and it is even worse for elementary and middle school students, with obesity rates now three times what they were in 1980. Because of this, the National Institutes of Health estimates that our life expectancy will drop by 5 years in the next generation if we don't begin to reverse this trend. From an economic standpoint, the CDC estimates that this fat epidemic will soon be costing us over $100 billion a year.

Over three years ago, I wrote about this dilemma and cited reasons why caloric intake has increased and physical activity has decreased. I mentioned frightening statistics found by Dr. Bill Neal's nationally recognized Coronary Artery Risk Detection In Appalachian Communities (CARDIAC) study in West Virginia elementary schools and the impending startup of Gov. Manchin's Healthy Lifestyle initiative.

Only last May, just as the new Robert Wood Johnson Foundation West Virginia project on child health was getting off the ground, two separate reports were released to the media. The first was a Journal of the American Medical Association study examining childhood weight data from 1999 to 2006. According to this well- respected analysis, the percentage of seriously overweight 6-to-11- year-olds, which had been 6.5 percent in 1980 and 11.3 percent in 1994, has stabilized around 17 percent in 1999-2006. Dr. David Ludwig, director of the childhood obesity program at Children's Hospital Boston, stated: "After 25 years of extraordinarily bad news about childhood obesity, this study provides a glimmer of hope, but it's much too soon to know whether this is a true plateau or just a temporary lull."

In the other study, Dr. Neal reported optimistically that numbers from CARDIAC for the latest school year showed declines in unhealthy weights throughout West Virginia's elementary school population, dropping between 5 and 20 percent. As he noted: "It's very encouraging to see this magnitude of decrease in the obesity and overweight rates. The state's investment in the prevention of obesity is paying off." Yet, ironically, recent statewide figures are still worse than the national average. So, what seems to have made a difference in the last few years, both here and around the country?

In addition to gathering and evaluating data from the blood testing of kindergarten, 2nd and 5th graders, CARDIAC has aggressively educated the public. There also seems to be little doubt that our Healthy Lifestyle legislation has led to improved cafeteria lunches, better options in school vending machines, and enhancements in K-12 physical education.

In Arkansas, a statewide obesity effort, also funded by the Robert Wood Johnson Foundation, was one of the first to enhance school food offerings and physical activity. As a unique part of the program, school officials in the past four years have tracked the weight and height of 475,000 children and then used the results to help parents guide their children. There have been many other policies considered nationwide, including reducing youth advertising, eliminating federal subsidies for unhealthy foods, taxing junk food, encouraging the use of locally grown produce, eliminating trans-fats, improving opportunities for community walkability and other physical activity, and governmental support for worksite wellness programs. Some have been implemented, while others have been only suggested.

It is obviously a complex problem, but there are many seemingly simple, yet effective options. For instance, the one that has gotten the most recent publicity is a requirement to post calories on menus and menu boards, mainly in fast-food restaurants. Such mandates now exist in Seattle, San Francisco and, most recently, New York City, but only after a lengthy legal battle.

We now know that from 1971 to 2000, Americans' daily intake has grown more than 200 calories. Fast-food consumption continues to increase and now represents approximately 74 percent of all restaurant traffic. Fast food typically confers more calories per serving than food prepared at home, and there is good evidence that frequent dining in these restaurants is associated with weight gain. Outside of the above cities, there is only one large fast-food chain that routinely lists calorie information at the point of purchase (Subway). A New York study found that the 32 percent of Subway patrons who saw calorie information purchased, on average, 52 fewer calories than did those who didn't see it.

Why businesses like McDonald's, that have provided an abundance of nutritional statistics for years, are so resistant to point-of- sale information is a mystery to me. Based on multiple reports, it appears clear that this practice helps fight the obesity problem and Subway has shown that the bottom line isn't harmed. Even if it would lead to some small financial negatives, isn't it worth the positive public relations for corporate America to play a major role in fighting this impending disaster? Also, from the perspective of individual rights and responsibility, remember that this is not an attempt to tell people what to eat, but rather a way to help them make informed personal decisions.

The latest state and national statistics may sound hopeful, but we can't relax now, just because we think what we have been doing is working. This war, which is just as real as any this country has faced, will have many fronts, and will require the same public commitment as exhibited during the one 65 years ago. I'm convinced that, although victory will ultimately require dramatic cultural and social changes, such straightforward policies as menu labeling, if implemented widely, may be the turning point in this conflict.

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