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Susan Blumenthal, M.D. Headshot

Weighing in on Childhood Obesity Prevention

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Co-authored with Kate Pitts and Anita Verma

Imagine that there's a killer on the loose in communities across the United States, threatening the health and well-being of 67% of our population. Is this enemy on the FBI's Most Wanted list? Not exactly, because this killer is obesity. We've heard the statistics. The prevalence of obesity is increasing at an alarming rate in the United States. For the first time in American history, the number of obese people outnumbers those who are overweight. Adult men and women are on average 25 pounds heavier than they were in 1960. Magazine and newspaper stories focus on this public health problem, and television shows that deal with weight issues such as The Biggest Loser and Food Revolution have topped prime time ratings. Obesity is taking a significant toll on America's health and is threatening an especially vulnerable population, our nation's children.

Childhood obesity in the United States has tripled since 1980. A recent report from the Centers for Disease Control and Prevention (CDC) indicates that 16% of children (9 million), ages 6-19 years old, are overweight or obese in the U.S. This startling statistic, when analyzed by age, reveals some very troubling trends. Over the past 30 years, obesity rates for preschool children (aged 2-5) and adolescents (aged 12-19) has doubled and for elementary children aged 6-11, have risen three-fold. These trends also have significant long-term impacts. Overweight adolescents have a 70% chance of becoming obese adults. If one or more parent is overweight or obese, that number jumps to 80%. If this trajectory is not changed, one in three children born today will develop Type 2 diabetes as well as other obesity related illnesses, and as a result, this generation of children may become the first that is less healthy than their parents.

Why has this happened? The answer lies in the American lifestyle and environment. While more than fifty genes have been identified linked to obesity, our genes have not changed over the past three decades, but our lifestyles have. The simple fact is that most Americans are consuming far too many calories and are not getting enough physical activity.

The number of calories consumed by Americans has increased over the past several decades, contributing to significant weight gain in the population. Behavioral and environmental changes in the American way of life as well as media influences and alterations in the diet of people are all factors that have contributed to the 25% increase in the average daily caloric intake (roughly 530 more calories) per person between 1970 and 2000 in the U.S. Increased calorie consumption has occurred partially as a result of the proliferation of "fast-food" eating venues as well as increases in portion sizes in the United States. Additionally, the food industry spends approximately $33 billion annually on advertising to market food products to the public. American children are especially vulnerable targets. Every year, children are exposed to over 40,000 advertisements, of which 72% are for candy, cereal, and fast foods.

The second major contributing factor to the spike in obesity rates is the decreased physical activity of Americans, in part, as a result of increased reliance upon technology such as cars, television and computers as well as reduced physical education in schools. Only 31% of children walk to school if the distance is one mile or less, and only 2.4% bicycle when the distance is less than two miles. Furthermore, children spend, on average, 7.5 hours daily using media including television, computers and video games. Recent studies have found that reducing television-viewing actually resulted in a lower body fat percentage in the children studied as a result of a combination of factors including increased participation in physical activity, decreased food intake because of reduced snacking and less exposure to food advertising.

If we don't act now to prevent obesity, the costs associated with this condition will devastate the health of Americans, as well as our nation's economy. In 2008, medical costs and those related to lost productivity associated with obesity were $147 billion, 9% of all medical spending. Fast forward 10 years where predictions are that 43% of the U.S. population will be obese with costs more than doubling to $344 billion or 21% of all medical expenditures.

That's why recent actions taken by President Obama, First Lady Michelle Obama and Surgeon General Benjamin to promote health and prevent obesity are so important. A Presidential Memorandum issued in February, 2010 has mobilized all federal agencies in the fight against childhood obesity, by establishing the first ever Task Force on Childhood Obesity Prevention emphasizing "health in all policies" of government including the U.S. Department of Health and Human Services, the U.S. Department of Agriculture, and the U.S. Department of Transportation, among others.

The recently released Surgeon General's Vision for a Healthy and Fit Nation provides cross-cutting strategies for promoting health and decreasing obesity rates in America through a broad range of public health interventions. It underscores the importance of creating healthy environments within homes, schools, and communities to prevent obesity. One critical component of the Surgeon General's report includes recommendations for parents and communities to improve nutrition at home, in schools, and in child care settings. It's currently estimated that 12 million children under the age of 6 are enrolled in child care programs. With many parents working, establishing a healthy child care environment is an important step to establish healthy food habits from a young age. By targeting all early learning environments, children will receive important guidance for a "healthy and fit" future.

The "Let's Move" initiative to eliminate childhood obesity within a generation, launched by the First Lady in February, puts into action some of the recommendations from the Surgeon General's report by encouraging healthier and more affordable food choices in schools and communities, as well as increased physical activity. One target area of the initiative involves consumer empowerment through clear food and beverage labeling on packages and in cafeterias, obesity screening of children by pediatricians, and parental involvement through education and on-line tools. For example, a recent study shows that when provided caloric labeling on menus, people consume 14% (250 calories) fewer calories than when this information is not on labels. By providing such information, parents are better equipped to make healthier decisions for their children when purchasing food at the grocery store and at restaurants. Another major component of this initiative encourages children to get up and move. Currently, only half of students in the U.S. are enrolled in a physical education class, and only one third of high school students take gym class daily. The CDC recommends that children participate in 60 minutes of vigorous exercise each day, an amount that many children do not end up fulfilling.

The 2009 stimulus package, the American Recovery and Reinvestment Act, and the recently passed health care legislation, the Patient Protection and Affordable Care Act, have made a vital financial and structural down payment to achieve a healthier America by emphasizing and investing in the power of prevention. Furthermore, a cross-cutting research initiative is underway at the National Institutes of Health to increase understanding of the biological, behavioral and environmental factors contributing to obesity and to translate this knowledge into effective interventions. The CDC supports numerous programs that address this public health problem. However, sustained funding will be needed to enhance research as well as innovative interventions to prevent childhood obesity at the local, state, and federal levels.
Reducing childhood obesity rates requires action by all Americans. To make significant progress, Federal leaders, public and private sector organizations, individuals, parents, health care providers, teachers, scientists, employers, foundations, the media, and communities, all must work together to promote healthy nutrition and physical activity to break the childhood obesity cycle instead of the scale. Our future -- our nation's children -- depends on it.

Rear Admiral Susan Blumenthal, M.D. (ret.) is the Director of the Health and Medicine Program at the Center for the Study of the Presidency and Congress in Washington, D.C., a Clinical Professor at Georgetown and Tufts University Schools of Medicine, and Chair of the Global Health Program at the Meridian International Center. She served for more than 20 years in health leadership positions in the Federal government, including as Assistant Surgeon General of the United States, the first Deputy Assistant Secretary of Women's Health, as a White House Advisor on Health, and as Chief of the Behavioral Medicine and Basic Prevention Research Branch at the National Institutes of Health. Dr. Blumenthal has received numerous awards including honorary doctorates and has been decorated with the highest medals of the US Public Health Service for her pioneering leadership and significant contributions to advancing health in the United States and worldwide. She is the recipient of the 2009 Health Leader of the Year Award from the Commissioned Officers Association.

Kate Pitts, a Master of Public Health candidate at George Washington University, is a Health Policy Fellow at the Center for the Study of the Presidency and Congress.

Anita Verma, a recent graduate of Stanford University, is the Special Assistant to Dr. Blumenthal and a Research Associate at the Center for the Study of the Presidency and Congress.