Waddling Through The Ages
The Institute of Medicine (IOM) released a report on the ever growing problem of obesity in kids this week. One in five kids will be obese by 2010. Despite the horrified reaction by commentators to the press, this is not a new concern. Fitness and sports goals for kids have long been promoted but obesity has only grown more prevalent despite a sharp increase in attention to the problem over the last couple of decades. The attitude was different in 1981 when a Washington Post headline claimed "Fat children found to have higher IQs than their leaner peers". The article reported on a study done from 1959 through the 1970's, on over 20,000 children whose IQ's and bodyweight were measured. We're not sure of the reliability of this report (the original or the WP one) , but we don't think the same headline would be published today.
By the late 1980's doctors worried loudly about obesity in kids, heightening public awareness. But the concern didn't compare to today's outcry, because the problem was still a bit obscure. For instance a New York Times article from 1989 titled "Eat Well" opened by observing that obese kids suffer from image problems, even though they no longer need to go to a "chubby" department to buy clothes. Obesity was viewed as someone else's issue -- those poor kids who had to spend their summers at those camps that are listed one after another in the grim black and white classifieds at the back of the New York Times Magazine. But this opening paragraph belied the more serious problem. The article went on to review a study on obesity in 22,000 children done at Harvard by Dr. Dietz and Steven Gortmaker:
"'The study, published in the American Journal of Diseases of Children in May 1987, showed that since the 1960's, obesity had increased by 54 percent among children age 6 to 11 years old and by 39 percent among children age 12 to 17. Of all the nation's children, about 23 percent are obese, Dr. Dietz said."
Other studies conducted in the 1980's, including ones by the Department of Agriculture and a National Health and Nutrition Examination Survey from the National Center for Health Statistics from 1988 to 1994, found that one in five children in the United States could be considered overweight. People uniformly blamed the problem on television, fast food, and sedentary lifestyles.
The latest report says that one in five children will be "obese" by 2010. These children will be over the 95th percentile of Body Mass Index (BMI) for their age. The CDC defines obese and overweight for adults differently then children. For adults, overweight means being having a BMI of 25-29.9, and obese means having a BMI of greater than or equal to 30. Children are categorized according to their percentile weight for their age group. They are considered "at risk of overweight" at between 85th-95th percentile of their ideal weight according to Body Mass Index (BMI), and "overweight" when they fall into the 95th percentile of greater. The current report uses the terms "obese" and "risk of obese" instead of "overweight" and "risk of overweight". Some reports used the adult definitions for children¹.
Over the past 20 years the redundancy of these studies and their alarming tenor has become almost monotonous. While the adrenaline rush stimulated by the headlines may cause people to throw their arms up in the air, it hasn't stimulated the flight response necessary to burn calories. Apparently there's no distress that can't be soothed with a nice snack.
The Recommended Solutions
So Americans get fatter. Kids spend hours watching TV or sitting at the computer. They drink soda, they eat junk food. They don't walk to school, in fact many communities don't even build sidewalks anymore. Phys-ed classes fall victim to budget restrictions and after school recreation programs ask parents for donations. 
Optimistically, we recognize that for each of these problems, scores of public health organizations and legislators are acting to counter with solution. Last May the beverage industry agreed to voluntary limits on sodas in schools. Non-profits givegrants to communities for building sidewalks to "promote physical activity". Budget cuts tend to spare core subjects like math but decimate health, art, phys-ed, and music, so Congress introduced bills S.1276 and H.R.4359 to amend No Child Left Behind to include physical education as a core subject.
However change does not come easily. S.1276 was introduced in June in 2005, and now, millions of pops later, it's still in committee. S.799, which targets childhood obesity is also in process. Industries have tenaciously fought all measures to limit kids' access to junk food, as we mentioned in a June 2005 post. Organizations like Consumer Freedom", funded by the soda and fast food industries, distort and mock the science and motivations of public health advocates.
In Mississippi, where 1 in 3 adults is obese and 25% of the children are overweight, competing interests fight about soda pop. State Senate Bill 2602 introduced a proposal that the Department of Education to set the "vending machine policy". Some school board members oppose the bill because they say it will decrease profits used to support expenses and activities. Milk companies don't buy scoreboards they say, but soda companies are good stewards. Meanwhile another paper reports that parents' back-to-school shopping lists now include candy and snacks and suggest sending children to school with some sugary "rewards".
Efforts to regulate fitness and health become fiery debates with no lack of irony. Vending machines didn't used to exist in schools. Over the last year, the Mississippi School Board has debated what the vending machines will sell, has defended the sale of soda in schools, has voted against an outright ban, has asked for public comment, and will vote again on the "vending machine policy" in October. A school board that spends its time debating the virtues of pop seems like a school board that has lost its way.
Sidewalks used to be built so that people more easily avoid the mud and horse manure, then so they wouldn't be hit by cars walking in the street. They were a safety feature to accommodate bipedal transportation. Now the funding of sidewalk building is relegated to foundations like the Robert Wood Johnson foundation in hopes that the presence of sidewalks will encourage our obese, sedentary society to walk.
The Systemwide, So-Called Solutions
The IOM report, while critical of the lack of progress, acknowledges that there has been a lot of work done to try to improve kid's diets and exercise. "Given the numerous changes being implemented throughout the nation to improve the dietary quality and extent of physical activity for children and youth, an overarching assessment [is complicated]"
The subliminal suggestion of fast food ("overarching") is no-doubt coincidental, but marketing seems to be key to both the obesity problem and its solution. How is fast food faring? Perhaps the *uproar* against fast foods will have hurt sales? No, apparently "systemwide sales for McDonald's restaurants worldwide increased 8.6% in August, or 7.1% in constant currencies". It's common parlance but "systemwide", used here, conjures up images of global "systems" rapidly spitting out greasy little beef patties. Sales are up on all continents.
The company's revenues were $20,460,000,000 in 2005. In 1995 revenues were half that, $9,795,000,000. An extraordinary increase in salad revenues no doubt. Clearly, the industry is recognizing the windfalls of its advertising campaigns. This IOM report recommends some familiar measures that the fast food industry should take to promote healthy fast-food eating:
- Make sure that nutrition information is "clear and useful"
- "Expand healthier food options"
- "Strictly adhere to marketing guidelines that minimize the risk of obesity in children and youth."
The food industry naturally stalls or complies begrudgingly with these pleas while putting up a good false front for health.McDonald's, for example, routinely issues press releases about adding healthier choices as well as nutritional information to its products. However when its first nutritional labels appeared they were in small print on the back of the food trays; nice if you want to tip your food onto the floor after buying it, but hardly useful for choosing a "healthy" option before your purchase. The company announced in 2002 that they were cutting the fat in their fries in half, in 2003 they announced delays to their plans. In 2006 studies found that the U.S. McDonald's fries contain more fat than anywhere in the world. Furthermore the company had been underreporting the grams of trans-fats in its fries.
The fast food industry spent 10 billion dollars marketing food beverages and meals to children and youth in 2004, according to the IOM report. Their profits show that they reap the reward of this investment. You wouldn't guess how sedentary McDonald's customers are though, given the maniacal action oriented verbiage on their investment page:
"In each of the Plan's five areas of focus - people, products, place, price and promotion - we're energized and in a constant state of motion, innovating for our customers. That's why the Plan to Win is vibrant and alive. That's why the plan to Win is working. That's why the Plan to Win is Forever Young."
Seems like this clown pillaged the medicine cabinet and is high on amphetamines. $5 billion of the $10 billion dollars spent advertising snacks, soda and food to children was spent on television advertising. The audience is children who watch up to 4 hours of TV a day. The fast-food and soda industries often defend their high calorie offerings by saying that exercise is the problem, not soda or burgers and fries. But the more TV kids watch, the more fast food ads they see, the more they eat, and the less they walk on sidewalks. McDonald's high octane pitch seems oriented to sell a wind-up action figure that orbits the living room seventy-five times before shooting off to the moon --but it's selling chocolate milk shakes and fries, and the target audience is sedentary.
The success of this advertising points to a possible solution however. The Center for Disease Control CDC's VERB: It's What You Do" campaign, uses social marketing to promote activity in 21 million "tweens", aged 9-13. This successful (CDC) program used "smart marketing and branding techniques that speak directly to tweens' motivating factors". While the benefits of many programs are unmeasured, this one had documented benefits. The IOM report stressed the success of this report, however the government cut funding for the VERB campaign. This is discouraging.
However the success of VERB proved that children do learn and adapt healthy behaviors -- we apparently needed to be reminded of this. VERB may have seemed like an expensive campaign -- it's budget was $125 million, plus an additional $75 million in custom programming and events donated from key media partners". But it leveraged the same dynamic motivators (cool, fun) that fast-food companies do with their far more enormous 10 billion dollar budgets. We can predict where this leads. Promo Magazine, an online publication for the advertising industry, juxtaposes the competing agendas. In one article, "Food Marketers Rally to Avoid Kids' Marketing Bans", (July, 2005), the magazine writes about advertisers protesting Senator Tom Harkin's bill to regulate junk-food advertising through the FTC -- banning advertising is "unconstitutional", executives cry. In other headlines, the magazine touts awards received by CDC's VERB program. It seems incongruous to me that what used to be plain old fun (playing with the neighborhood kids outside), needs a multi-million dollar ad campaign to promote. Moreover, while a 10 billion dollar market aimed at getting kids to consume fast-food and soda is a revenue bonanza for some, it is also an obesity problem that cost an estimated $11,000,000,000 in medical expenditures in 2003. These two multi-billion dollar industries, a 10 billion dollar investment for an 11 billion dollar problem seem to be opposing, unless the goal is simply to pour money into the economy. The effort to ameliorate health costs of obesity and to compete with the immense fast-food marketing budgets that promote high calorie food, will need to employ both innovative and inevitably expensive means to turn around the obesity trend --or "epidemic"-- as they say. But whatever the risk may be of promoting an arms race between the opposing forces, obesity can't be taken lightly.
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¹ The interchange of the two terms makes it seem like this 20% overweight/obesity problem has been looming for the last decades. In reality different studies use different terms, then the media amplifies this ambiguity by interchanging the terms overweight, obese, heavy. (updated 091906)
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Acronym Required previously wrote about obesity in kids here, about exercise recommendations for obese adults here, and about soda in schools here.