Many Fronts In The Fight Against Obesity

Introduction:

In 1985, no state in the nation had an adult obesity rate above 14 percent. By 2010, every state had an obesity rate over 20 percent and 12 states had obesity rates over 30 percent. Child obesity rates have more than tripled in the past generation, from 5 percent to over 15 percent.

But fighting the disease isn’t just a question of what we eat — it’s also about how we live.

Paul Kuehnert, a senior program officer at the Robert Wood Johnson Foundation, and Cheryl Bartlett, the public health commissioner for the Commonwealth of Massachusetts, look at how to reverse the trend and build healthier, more active communities.

Paul Kuehnert is a senior program officer and the team director for the Public Health team at the Robert Wood Johnson Foundation.

If the obesity epidemic isn’t reversed, today’s young people could be the first generation of Americans to have shorter and sicker lives than their parents.

A Day In The Life

Think about a day in the life of the average American child and how it’s changed over the past generation.

Today, 85 percent of children ride to school on a bus or in a car, compared with less than 50 percent forty years ago.

We know children should have at least one hour of vigorous physical exercise every day. However, only 4 percent of our elementary schools have daily physical education.

When it’s time for lunch after sitting in a classroom all morning, too often it’s been a meal like corn dogs and French fries. It may taste good but it doesn’t provide the nutrition growing bodies need.

Recent evidence gives us hope that if we keep working at it, we will be able to reverse a 30-year trend and create a culture of health for our nation’s children.

After school the average child spends four and a half hours on “screen time,” playing with smartphones, computers or watching television. In too many cases that’s because there are no safe, available nearby places — parks, playgrounds, youth centers, etc. — for children to play.

When it comes time for supper, takeout from a fast food restaurant is often the only available, affordable option for overworked parents.

Just by looking at a day in the life of the American child at risk of a lifetime of obesity and related illnesses, we can see the barriers to good health. At the same time we can see ways to tear down those barriers.

Making Progress

At the Robert Wood Johnson Foundation our board decided seven years ago to set a bold goal of reversing the childhood obesity epidemic by 2015. We committed $500 million to the endeavor. Along with our partners and allies, we’re pleased to see that the nation is making progress.

One of our major investments has been the Healthy Schools Program that now involves 19,500 schools serving 2 million students. We’re seeing major changes in those schools as they cut out sweetened beverages, candy, and salty snacks and increase physical education and activity.

In 2008, 62 percent of policymakers believed obesity was solely the result of individual choices. By 2010 that number had dropped to 46 percent with the growing awareness that external factors also play a role.

Corporations increasingly understand that there’s a risk to their brand and their bottom line if they don’t wrestle with these issues. The Walt Disney Company recently announced it would stop taking “junk food” ads. McDonald’s recently announced it would market only water, juice and milk as drink options for their Happy Meals. Wal-Mart is working to make healthier food choices more affordable for families.

Consumer activism is making a difference, too. The online community PreventObesity.net educates and engages citizens to affect public policy. For example, when USDA asked for public comments on its proposed updates to standards for school meals, PreventObesity worked with allies to generate more than 130,000 comments.

All of these changes are making a difference in children’s lives. In California, child obesity rates have dropped 1.1 percent over the past five years. Mississippi is seeing a decline in obesity among elementary school students. Obesity rates among K-8 public school students in New York City are down 5.5 percent from their peak.

In 2005, 49 states reported a significant increase in adult obesity. In 2013 only one state did.

Recent evidence gives us hope that if we keep working at it, we will be able to reverse a 30-year trend and create a culture of health for our nation’s children.

Cheryl Bartlett is the public health commissioner for the Commonwealth of Massachusetts.

In Massachusetts, two-thirds of adults are overweight or obese. About 8 percent of our residents have diabetes. One in five suffer from hypertension, which can lead to heart and kidney diseases. One in six are smokers.

These chronic disease risk factors are not spread evenly across the population: Men more than women, African-Americans and Hispanics more than Whites and Asians, the poor and working-class more than the middle-class and wealthy, those without high school diplomas more than college graduates live with and suffer from chronic diseases.

If spending money on clinical care made people well, Massachusetts would be the healthiest place on earth. But we’ve learned that clinical care by itself isn’t enough. We also have to look at the social conditions that make people sick, and at what we can do to change those conditions.

If spending money on clinical care made people well, Massachusetts would be the healthiest place on earth.

It’s that understanding that led the Department of Public Health to launch “Mass in Motion”(MiM), a campaign to transform communities in the Bay State by promoting health and wellness. MiM is a multi-faceted initiative that aims to make the healthy choice the easy choice. There’s no single cause of the obesity epidemic, and there’s no single solution to it either.

Our public-private partnership began in 2009 with grants to 11 cities and towns to help them build policies, systems and environments that promoted wellness and healthy living. Massachusetts was awarded two federal Community Transformation Grants, and now MiM operates in 52 municipalities, covering one third of the state’s population.

Our first goal is to promote healthy eating. The explosion of farmers’ markets brings fresh, local produce into cities and towns. MiM grants get used to develop partnerships so that WIC and SNAP benefits can be used at farmers’ markets so that healthy food is more affordable.

In “food deserts” we work to get fruits and vegetables into corner stores. New school nutrition regulations are improving the quality of food children eat for breakfast and lunch. In New Bedford and other communities, we promote healthy dining in restaurants by getting the children’s menu to include a vegetable instead of French fries as the side dish.

Our second goal is to increase active living. The “Safe Routes To School” initiative makes it easier for children to walk to school. The “Complete Streets” program requires all transportation projects using state or federal funding to provide “appropriate accommodation” for pedestrians and bicyclists. In communities without adequate recreation facilities, MiM coalitions work with local colleges and universities to open their gymnasiums and exercise centers to local residents.

With another grant from the Affordable Care Act’s Prevention Fund, we’ve launched Mass in Motion Kids. This initiative — now up and running in New Bedford and Fitchburg — builds on our earlier work, but focuses on the institutions where children spend much of their time — schools, daycare, after-school programs, as well as at home. We want kids to enjoy exercising and we want to make it easier for them to eat healthy foods.

The goal of MiM is to reduce obesity, tobacco- and heart-related death and disability by 5 percent. Toward that end, we’re collecting and evaluating data to see what works, so that we can replicate those programs across the Commonwealth.

One of the most important public health lessons we’ve learned from other epidemics is that prevention and wellness programs work. Promoting healthy eating and active living are key to slowing and reversing the obesity epidemic. Through Mass in Motion we’re learning how to make that happen in communities all over Massachusetts.