The obesity problem in the U.S. has two distinct parts. One has to do with adults, and in an earlier editorial we described ways to change the prevailing food environment to encourage grown-ups to eat less and better.
Now the trickier side of the equation: children, whose food world is shaped at home, at school and by the commercial media. It is imperative that we address this complicated ecosystem for a simple reason: Obese children usually grow up to be obese adults.
Let’s back up. Well before they mature, obese adolescents develop unhealthy blood pressure, cholesterol and blood-sugar levels, as well as heart-valve damage and other signs of impaired heart function.
The good news is that by losing their excess weight, the young obese can return to good health. By adulthood, those who come down to a normal weight have no greater risk of diabetes, hypertension and cardiovascular disease than people who were never obese.
Nationwide, the prevalence of obesity in children has leveled off in the past few years at 17 percent, though it has increased a bit for boys, whose rate is almost 19 percent. The obesity rates among certain racial groups are stubbornly higher than average: 24 percent among black children and 21 percent for Hispanic kids.
Where do we go from here? Obesity researchers have intensified their investigation into weight gain in infancy and toddlerhood. This is important, because most of the excess weight kids gain before adolescence occurs before age 5. According to a 2006 study, children who are overweight in their preschool years are five times more likely than other children to be overweight at age 12.
Bottle-feeding, researchers have observed, for example, leads to greater weight gain than breast-feeding, even if breast milk is what’s in the bottle. Mothers of overweight toddlers have been found to view their children’s weight as normal, which perhaps keeps them from cutting back on calories.
From the time kids reach kindergarten, a significant part of their diet is determined by the food choices offered at school and what they see on TV. A 2011 study found that kids with relatively high exposure to food ads on television consume more soft drinks and fast food than other kids do. Among those already on the heavy side, increased watching of TV food ads is strongly associated with a higher body-mass index.
Grown-ups are already beginning to clamp down on school food. Many states, cities and school districts now ban sugar- sweetened drinks in schools. All of them should make sure the ban includes sugar-sweetened fruit drinks and sports beverages. Even juice itself is better replaced with fresh fruit or water.
New standards for federally supported school lunch programs require that fruits and vegetables be offered every day, that more whole-grain foods be made available, that milk be fat-free or low-fat, that water always be at hand and that meals contain a limited number of calories. Many school districts -- also the state of California -- now limit the calories, fat and sugar in foods on sale in school vending machines. For every school, these standards should be a floor, not a ceiling.
(In related news, Michael R. Bloomberg, principal owner of Bloomberg News’s parent company and mayor of New York City, this week proposed a ban on the sale of large-size -- more than 16 ounces -- sugary drinks at restaurants, delis, vending carts, movie theaters and sports arenas.)
Although food intake is the biggest contributor to childhood obesity, experts agree that physical activity plays some part; more active kids are less likely to be overweight and vice versa. Getting kids into a gym, outside, or just up and moving about the classroom is something every school can do, no matter how inadequate its fitness facilities. We agree with last month’s recommendation by the Institute of Medicine: All children should get at least an hour of physical activity during the school day, as well as access to after-school activities and programs that encourage walking or bicycling to school.
As for those TV ads for unhealthy foods, it may be unrealistic to think of banning them, but they can be discouraged. Here again, the Institute of Medicine has a smart suggestion: First, urge the food, beverage, restaurant and media industries to ensure that only healthy foods -- those that meet the Dietary Guidelines for Americans -- are advertised to children ages 2 to 17. If, after two years, this change hasn’t materialized, then local, state and federal policy makers should consider setting mandatory standards.
They should also consider barring food companies from claiming tax deductions for the costs of TV spots for fast food and sugary drinks, a strategy suggested by Inas Kelly, an economist at Queens College in New York.
Invasive? Consider that the annual bill for treating the medical problems of 12.5 million obese children in the U.S. runs to $14 billion. What’s more, children covered by Medicaid are almost six times as likely to be treated for obesity-related problems as children with private insurance.
The good news is that it appears we can change behavior. In eastern Massachusetts, obesity among girls and boys under 6 decreased significantly from 2004 to 2008. In New York City, obesity among schoolchildren declined 5.5 percent from the 2006- 07 school year to 2010-11 -- about 6,500 fewer obese kids. That’s the kind of progress we’d like to see accelerate, everywhere.
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