The Childhood Obesity Quick Fix

April 11, 2008

The obesity epidemic – Approximately 27% of kids in Hancock County are “overweight” or “obese” (defined as body mass index percentile for age greater than the 85th and 95th percentile for age and sex). This epidemic of obesity has been on the rise at about 1%/year for the last 10-20 years. Nationally, the rate of diabetes is chasing the increasing rate of obesity. Insurance rates are too high today, but they will only be driven higher with the expected complications of obesity seen tomorrow.

Unfortunately, the solution is not simple. It will need to be led by multiple influences on a child’s life, including the doctor’s office, the schools, the environment, the home, and their peers, and legislation. No one solution will work for all children.

Unfortunately, educating the public as to the unhealthy effects of obesity has been proven to not change a child’s behavior. Until we have mandated many public health changes, effective change not be achieved. This has been shown with most public health interventions, including seat belts, speeding, bicycle helmets, vaccinations, and smoking, among many more.

So the “Just Fix It” approach is to change environmental norms by forcing environmental changes and legislating many of them.

At School:

Provide a fixed menu for all schools in the state that has been defined by a dietitian.
Allow for only 3 types of drinks: skim milk, 1% milk, and water (no chocolate or strawberry additives) at school lunches.
Legislate and enforce keeping unhealthy foods off of school grounds, out of the classrooms, and away from “special” school events.
Require schools to provide 30-60 minutes of exercise each day for all students grades k-12.
Hold school principals and superintendants responsible for measuring and making healthy changes to the lives of students while they are at school. Tabulate and track an entire schools’ average BMI.

At Work:

Incentivize healthy employees through discounted insurance for those who exercise, just as we do for those who don’t smoke.
Create “optimal defaults”. Set basic work environments to healthy defaults, where one needs to actively remove oneself from the healthy alternatives.
Stack the snack room’s vending machine with healthy choices at eye level with discounted prices, with the less desirables in corners with gouging rates.

At Stores:

Tax unhealthy foods with funds going towards either environmental health improvements such as sidewalks or offsetting the higher price of fruits and vegetables. Could tax sugar sweetened items per gram.
Ban sales of whole milk in stores.
Legislate zoning in school areas to require businesses to have a minimum percent of sales be healthy foods.

In Communities:

Provide safe, well lit, environments for exercise to occur, and require such improvements planned into all new construction projects, such as sidewalks in front of businesses/communities, and green space in all new housing developments.
Hold the advertising industry responsible. Avoid advertising unhealthy foods to impressionable children.

Some may argue that it is the individual’s choice as to what they eat, how they exercise, and if they put themselves at greater risk for comorbidity of obesity. However, children are products of our environment and reflect the habits that we teach them.

Some may argue that this is a job of the parents. However, parents have difficulty making change in their homes when the environment doesn’t support those changes. Many obese children have obese parents. Obese parents have 3 times the probability of having an obese child.

Some may argue that this is not the job of the schools. However, healthy students perform better in the classroom. Furthermore, schools need to role model the behaviors that they desire to teach their students.

Lastly, some may argue that these changes are too costly for the community. Regardless of whose job ultimately is, everyone will share the eventual medical costs of those who get complications from obesity. Fixing the environment now will prevent the price tag tomorrow.

-- Jonathan Fanburg, MD, MPH, FAAP
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