Obesity: Less Talk, More Action

The CDC is wrapping up its first Weight of the Nation Conference in Washington, D.C. today, a meeting designed to discuss the prevalence and prevention of obesity in the United States. In a speech at the conference, Health and Human Services Secretary Kathleen Sebelius pointed out that more than two thirds of Americans are obese or overweight, and that obesity-related health problems now cost the nation $147 billion per year, far more than the $93 billion annual cost of treating all cancers. In her comments, Sebelius cited a Time Magazine poll that found that while most Americans say that they want to lose weight, far fewer Americans have any plan for losing that weight. These Americans know there is a problem, but the solution - and the motivation to make a change - has eluded them.

Obesity has complex sources and it requires a multi-faceted solution: first of all, better education about and access to healthy food and exercise, especially among the ethnic populations that have the highest rates of obesity. Sebelius hinted about an obesity prevention initiative currently in the works that will be funded by the stimulus package. This initiative would probably work on community-wide solutions (such as supporting local exercise programs and improving access to grocery stores and farmer's markets) and nation-wide solutions (such as pressuring the food industry to remove more fats and sweeteners from its products). But I think that these solutions should be combined with direct financial incentives for individuals. Maybe there could be an income tax credit for people who maintain a healthy body mass index (B.M.I.). What if health insurance under whatever new plan arises from the Obama administration were free for people who maintained a healthy B.M.I., and reasonably prorated for all other Americans? If the possibility of weight-related disease and disability won't make people lose weight - as it clearly hasn't - then financial incentives might.

Teen Safety Online and On the Road

How much freedom should teenagers have? They're certainly not children, but they're not yet adults either. Teens have less life experience and exercise poorer judgment than adults, even as they crave access to the adult world.

Experience and good judgement are especially critical in two areas that virtually define modern American adolescence: internet use and driving. The American Academy of Pediatrics' microsite on internet use for Internet Safety Month in June points out a range of problem behaviors that teens might encounter or engage in online, such as cyberbullying, online solicitation, and "sexting" (exchanging inappropriate or sexually explicit pictures of children and teens). The solution? Talking with your teenager about cyber safety and privacy, and monitoring and limiting the use of computers and cell phones.

Driving is also hazardous to teens' health, with car crashes the top cause of death in teens ages 15-19, according to Mothers Against Drunk Driving. Inexperience, distraction from other passengers in the car, cell phone use or texting while driving, and underage drinking all contribute to this problem. Graduated driver licensing (GDL) programs, now commonplace in most states, can make a difference in protecting teen drivers and others around them. For teenagers under age 18, these programs create curfews for night-time driving (when the risk for crashes increases in this group), limit the number of teenaged passengers in the car, and delay access to drivers' licenses if teens are cited for moving violations while they have their learner's permits. These rules force teens to build their driving skills up slowly until are mature enough for unrestricted driving. In some states, parents can also request a copy of their teen's driving record to see how they are doing.

Teenagers (and perhaps their parents) might chafe against restrictions and oversight, but these are the most effective ways to keep teens safe until adulthood. In one study in upstate New York, for example, a GDL program decreased injuries among 16-year-old drivers by 31%. These are also public health measures, protecting others from mistakes that teens might make. It's good to see American society figuring out practical ways to give adolescents both freedom and protection as they wend their way toward adulthood, a path that seems to become rockier with each new generation.