Stopping Childhood Obesity

At the recent American Academy of Pediatrics' conference this past weekend, childhood obesity was a recurring theme. Obesity is primarily influenced by environment, something that parents have a fair amount of control over. What you feed your child, how active they are, whether you restrict screen time or not, and how much sleep they get all affect your child's weight. With one in three U.S. children now overweight or obese, though, clearly something has broken down.

In his session "Identifying and Treating Obesity Related Comorbidities," William J. Cochran, MD cited these jarring facts:

• Forty percent of children ages one to five years old have a television in their bedrooms, contributing to sendentary screen time
• About 20% of overweight and obese children get too many calories from sugary drinks such as soda
• Most parents and their children don't understand how big a portion of food is, making it hard for them to gauge their food intake
• If a child's parents are obese, that child has a 60% chance of becoming obese. If a child's parents are normal weight, that child has a 9% chance of becoming obese

The CDC states that our society is also "obesogenic," rife with unhealthy food choices and sedentary lifestyles. A family's lack of knowledge or tools to stop obesity just adds to the problem.

The question is what to do about obesity. Policy changes and initatives can help, such as Michelle Obama's "Let's Move" campaign to reinforce healthy behaviors in kids. There have been more extreme measures to stop obesity as well. Because obesity and its unhealthy extreme, morbid obesity, can cause a host of other health problems, such as Type II diabetes, sleep apnea, high blood pressure, and heart disease, on rare occasions parents of morbidly obese children or teens are charged with child neglect or abuse, as a single mother was in 2009 when her 14-year old son weighed 555 pounds. Most pediatricians are understandably reluctant to go down this path, since it would be best if the family could makes changes to help the child control or lose weight.

At the AAP conference, the Nestle Nutrition Institute and the AAP announced a new campaign to stop childhood obesity before it starts, by trying to instill good eating habits in children ages 0 to age 4. Their Healthy Living for Active Families (HALF) Project plans to distribute materials about healthy eating, serving sizes, and physical activity in pediatricians' offices, workplaces, and child care facilities.

Admittedly, Nestle is an odd partner, with its well-known candy brands and scandals over formula marketing in developing countries. Hopefully the AAP's voice will dominate the discussion, and get parents to take the threat of obesity seriously.

Egg Recall Reveals Larger Food Policy Problems

When I read about the recall of eggs shipped here to California, among other states, I printed out the list of the identifying numbers on the recalled cartons and opened my refrigerator. Lo and behold, there were two cartons of recalled eggs that we had purchased recently from the grocery store.

"We should become urban farmers," I told my husband, after he dispatched the eggs down the garbage disposal. At least then we would know where our eggs came from, instead of worrying about tainted eggs shipped from an Iowa mega-farm with a history of safety violations showing up in our West Coast home.

The Washington Post ran a fascinating article this week explaining how cost-cutting consolidation and growth in the egg industry have far outpaced regulation, which lead to the egg recall. "Just 192 large egg companies own about 95 percent of laying hens in this country, down from 2,500 in 1987," wrote the Post's Lyndsey Layton, and most of the eggs come from just five states. Although consolidation has accelerated over the past 20 years, regulation has not. Layton wrote that "the Food and Drug Administration, which has responsibility for the safety of whole eggs, had never inspected the two Iowa-based facilities at the heart of the massive recall that began 10 days ago."

Layton explained that different regulatory agencies divvy up who inspects chickens and who inspects eggs, and that some states do their own egg inspections while others (such as Iowa) do not. These circumstances make it easy for egg inspection to fall through the cracks. New legislation that would require yearly FDA inspections of egg producers is working its way through Congress now.

Unfortunately, legislation doesn't always protect public health. Take agricultural subsidies, for example. In a recent New York Times article about obesity in America, writer Natasha Singer explains that making healthier food cheaper could help Americans eat healthier and lose weight. Government subsidies for the products used in fast foods, though, make them more affordable for consumers than fresh fruits, vegetables, and healthier choices. Singer explains:

The inflation-adjusted price of a McDonald's quarter-pounder with cheese... fell 5.44 percent from 1990 to 2007, according to an article on the economics of child obesity published in the journal Health Affairs. But the inflation-adjusted price of fruit and vegetables, which are not subject to federal largess, rose 17 percent just from 1997 to 2003, the study said. Cutting agricultural subsidies would have a big impact on people's eating habits....

Government policies should support the health and safety needs of the majority of Americans, and we're clearly not there yet, as food recalls increase and healthy food gets more expensive.

Not that everyone has to start a backyard farm; I can't even talk the family into getting a beehive. But I think that we do need to question how our food is produced and where exactly our food comes from and, if necessary, pay more to support food that is healthier and safer until changes in regulations and subsidy policies make that a reality.

Causes of Early Puberty in Girls

Early puberty in girls is becoming a serious problem. A recent Pediatrics study of 1,239 girls found that the rates of early puberty, measured by breast development at age 7, has spiked over the past decade. The rates of early puberty have doubled for white girls (from 5% to 10%) and also increased for black non-Hispanic girls (from 15% to 23%). Fifteen percent of Hispanic girls also show signs of early puberty at age 7.

Along with large racial/genetic differences in early puberty onset in girls, there are two other potential causes. It might be caused by chemicals in the environment that mimic estrogen or cause other hormonal disruptions, triggering the body to begin puberty. Prime chemical suspects include pesticides and herbicides, flame retardants, and bisphenol A (BPA) (a chemical I've blogged about before), according to an article on early puberty by USA Today's Liz Szabo.

Weight also plays a role. The study found that obese and overweight girls, as measured by their body mass index (BMI), are more likely to start puberty early than normal-weight girls. Fat cells in their bodies create and release the hormone leptin, which can trigger puberty.

Puberty onset is a tricky thing, though, because it is also influenced by other medical, social, or environmental factors. Certain rare medical problems, such as a tumor or meningitis, can cause early puberty. Some studies have suggested that girls are more likely to start puberty earlier than average if they are adopted internationally, don't live with their biological fathers, or if their mothers are depressed.

Whatever the cause, early onset of puberty is both physically and emotionally unhealthy for girls. These girls are more likely to have low self-esteem, have a poor body image, become sexually active earlier, and develop certain cancers later in life, the Pediatrics study stated.

With one in three U.S. children overweight or obese, the rates of early puberty will probably continue to increase. Early puberty is yet another reason to substantively address the many causes of obesity in this country, and to substantively regulate how certain chemicals are used in the environment, food packaging, and foods.

Resources:

• The Environmental Working Group's Body Burden page contains extensive information on the toxic chemicals found in the human body, particularly BPA
• Follow this CDC link to calculate your child's BMI
  
  

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.

The Extra-Wide Chair

Yesterday, when I walked into my primary care doctor's waiting room with my children, my younger daughter asked me to share a seat with her. She plopped down on an extra-wide chair in the office, the sole standout in a sea of regular-width chairs there. She thought it was a small couch meant for two, when in reality is it there to accommodate obese patients. I see more and more of these chairs in doctors' offices, evidence of the high obesity rate in America.

At first glance, the extra-wide chairs would seem out of place here, because I live in a very health-conscious city. Many people here ride public transportation, a choice that guarantees some exercise as you walk to and from your bus stop. The Central Valley and local farmers' markets provide a steady stream of fresh produce, and outdoor activities ranging from mountain hikes to tidepooling are just a short drive away.

But it's not always easy to make healthy choices. The public schools promote a Walk to School Week every fall, for example, but this is a somewhat pointless program here. The public schools in San Francisco have been decoupled from their neighborhoods in response to a series of lawsuits about the uneven quality of the education they provide. As a result, many children from kindergarten on up have to commute to school by car (driven by a parent) or school bus across town every day. Even if they want to walk to school, it isn't a possibility for them. With funding cuts reducing gym to an occasional rather than a daily class at many schools as well, schoolchildren are getting less and less exercise.

When my own children were born several years ago, I began to notice what I called the "thin grandmother" syndrome. At follow-up doctor's visits after their children were born, many new mothers brought their own mothers along to help watch the baby. Most of the grandmothers were thin, but, increasingly, many of the mothers were not. No doubt they still carried some weight from their pregnancies, but I suspect lifestyle was also a factor - lots of driving, unhealthy eating habits, stress, and very little exercise. All of this happened in just one generation. The CDC's survey of obesity trends from 1985 to 2007, based on data collected from state health departments, shows a sharp increase in obesity rates during that time. In 1990, obesity rates topped out at 15% in a the states participating in the survey. By 2007, obesity rates had increased to 30% or higher in three Southern states, and over 25% in thirty states altogether. The CDC's data shows obesity rates creeping upward and westward state by state since the mid-1990s.

I understand how we got here as a society - the lure of convenience foods, the busy work schedules that allow little free time for exercise, the stress of getting everyone where they need to go each day, the time it takes to cook a healthy dinner at home or pack a healthy lunch. When I see the extra-wide chairs in the waiting rooms, though, I start to question to idea of a national health care plan, because access to health care won't solve the problem of obesity. Increasing obesity rates and the many expensive health problems linked to obesity, in fact, could bankrupt such a plan.

It's important to provide coverage for the uninsured, with states such as North Carolina recently making news headlines because a record 25% of the state's residents don't have medical insurance. But health care needs to be just one of the tools used to fight obesity. The country also needs better public policies relating to public transportation, employment rights, housing and urban planning, public education, and other issues that directly or indirectly affect people's health. Americans also need to take more personal responsibility for their health, mindful that their children are watching and learning from them. Last but not least, their choices have consequences not just for themselves and their families but for the country and its welfare as well.