Friday, February 12, 2010

Childhood obesity: More information isn't enough to solve the problem

This week, First Lady Michelle Obama launched "Let's Move," her intiative to end childhood obesity within a generation.

It's not about looks, she says. One out of three U.S. children are overweight or obese -- a rate that's three times higher than it was in 1980 -- and obese kids usually grow up to be obese adults, which means we could have a national health crisis on our hands. The U.S. currently spends about $140 billion a year on treating obesity-related illnesses like type II diabetes, certain types of cancer, high blood pressure, and asthma.

After a run-in with her kids' pediatrician, during which the doctor pointed out that their "busy, hectic lifestyle" was causing her daughters' Body Mass Index (MBI) to rise, Mrs. Obama cut out the juiceboxes, eliminated a few fast-food meals, and made other small changes to their routine. The results, she told PBS's Jim Lehrer on Tuesday, were significant.

Which is great, but I think most of the nation would agree that Malia and Sasha weren't in danger of breaking any scales. But, for the most part, parents of the kids who are at risk aren't the ones paying attention to Mrs. Obama's plan.

On Tuesday, President Barack Obama threw the weight of the White House behind his wife's initiative, officially creating a task force to address childhood obesity; he also plans to reauthorize the Child Nutrition Act, the first lady said, and is proposing to commit $10 billion -- $1 billion a year for 10 years -- to help provide more-nutritious school lunches to those who qualify for the program.

I'm not sure that more education or propositions are going to do the trick by themselves. The Centers for Disease Control and Prevention has been trying to educate at-risk people about nutrition and exercise for more than a decade now, and yet the obesity rate continues to rise. Though we know that the regular consumption of fast food can lead to all sorts of health issues (and Morgan Spurlock put it to the test by showing us what happens when you eat three fast-food meals a day in his documentary Super Size Me), the fast-food industry is hardly facing a lack of customers. In spite of everything, the popular focus still seems to be on searching for a quick fix: Reality television programs like The Biggest Loser on NBC show unsustainable weight-loss achieved by a soul-crushing, time-consuming regimin of trainer-driven exercise and extreme dietary changes; contestants who don't loose weight fast enough are booted off the show. Dance Your A-- Off (really, that's what it's called) on cable's Oxygen Network features overweight dancers vamping for the camera in a bid to drop pounds -- and are often still overweight by the end of the competition. There are "documentaries" like TLC's Half-Ton Teen, Half-Ton Mom, and Half-Ton Dad, which offer a voyeuristic look at the life of the morbidly obese, with subjects who literally weigh close to 1,000 pounds, can't physically move, and try to salvage their lives by undergoing risky surgery.

And there may be cultural issues at play as well: In places like Senegal and Mauritania, "overweight" is considered a desireable body size because it implies wealth and prosperity.

In the US, though, overweight can also imply neglect -- with criminal consequences. Last May, Jerri Gray was arrested when her 14-year-old son's weight reached 555 pounds. The boy was put in foster care; the South Carolina mom was charged with criminal child neglect for allowing his weight to become "serious and threatening to his health," placing the teen in "an unreasonable risk of harm." Other cases in Indiana, New York, Texas, Pennsylvania, and New Mexico prompted Time magazine to wonder if parents with morbidly obese children should lose custody of their kids. (Which begs the question: Should skinny parents of preternaturally thin kids or those with eating disorders like anorexia also be charged with neglect?)

In the end, the biggest hurdle parents may have to leap is their own perception of their kids. A 2007 study indicated that parents of overweight or obese children are often in denial about their children's true weight, possibly because they think that it'll change as the child grows older, according to Dr. Matthew M. Davis, a professor of pediatrics at the University of Michigan who led the study. Davis's study found that 43 percent of parents with an extremely overweight child who was 6 to 11 years old said their child was "about the right weight." Thirty-seven percent thought their child was just "slightly overweight," and only 13 percent said "very overweight." Others actually said they thought their children were "slightly underweight."

After spending years telling kids that they're just right the way they are, it can be difficult to admit that they've gained more than a pound or two. (The CDC uses a formula called the Body Mass Index, or BMI, to determine if a child is overweight. Click here to calculate your child's BMI.) Even Mrs. Obama was surprised when the pediatrician told her that her daughter's BMIs were creeping up.

"In my eyes I thought my children were perfect," Mrs. Obama said at the January launch of her initiative. "I didn't see the changes."

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