Thursday, July 07, 2011

New Report Gives America A Failing Grade For Obesity, Recommends More Action

Obesity rate rises in 16 states, is above 20% in 49 states; First Lady's Let's Move! campaign has "raised the profile" to combat it, but Baby Boomers are "Time Bombs" and today's kids could fare even worse as they enter adulthood...
The Obama Administration's efforts to combat obesity are much needed, according to James Marks, M.D., M.P.H., Senior Vice President of the Robert Wood Johnson Foundation, and Jeff Levi, Ph.D., Executive Director of Trust for America’s Health, who briefed reporters this morning as they released the latest edition of their organizations' annual report, F as in Fat: How Obesity Threatens America's Future 2011, which tracks obesity rates by state and the policies in place to combat it. This year, for the first time, the report also examines how obesity rates have increased over the past two decades, and makes recommendations for Congress and policymakers.

Marks called the report "frightening and disturbing," because adult obesity rates increased in sixteen states in the past year, and did not decline in the rest of US states. Mississippi, at 34.4 percent, is the fattest state in the nation for the seventh year running, leading the South, which has nine of the top ten most obese states. Colorado, at 19.8 percent, has the lowest obesity rate and is the only state with a rate under 20 percent, but barely.

Download the full report [PDF]

Interventions are needed at every level, Marks and Levi said, in homes, in communities, through the state governments and with even more action on the federal level. The report also examines childhood obesity rates and policies, using data from 2007 and 2009. Combating childhood obesity, Marks and Levi said, is especially important, and hailed First Lady Michelle Obama for "raising the profile of obesity" with her Let's Move! campaign. Slightly more than 17 percent of US children, aged 6-19 are obese, according to the Centers for Disease Control and Prevention (CDC). Children with one obese parent are more than twice as likely to be obese themselves; if both parents are obese, the probability jumps above 70 percent.

Obesity is defined as having a body mass index above 30, and is calculated based on height and weight. A six-foot-tall adult man weighing 221 pounds or more is considered obese. An adult woman standing five feet, six inches tall weighing 186 pounds or more, according to the National Institutes of Health. People with obesity are at higher risk for diabetes and hypertension, according to the CDC.

Twelve states now have obesity rates above 30 percent; four years ago, only one state was above 30 percent. Non-white populations and those at or below the poverty level are the most obese among Americans. Adult obesity rates for African Americans topped 40 percent in 15 states, 35 percent in 35 states, and 30 percent in 42 states and D.C., according to the report. More than 33 percent of adults who earn less than $15,000 per year were obese, compared with 24.6 percent of those who earn at least $50,000 per year.

"These obesity rates are unacceptably high," Marks said.

Twenty years ago, no state had an obesity rate above 15 percent, according to the report. Today, 38 states have obesity rates over 25 percent.

“Today, the state with the lowest obesity rate would have had the highest rate in 1995,” said Levi. "We can’t afford to ignore the impact obesity has on our health and corresponding health care spending."

Baby Boomers as Time Bombs, and how did America get so fat?
The report graphically illustrates how rates of both diabetes and high blood pressure have risen dramatically over the last two decades. The Baby Boomer generation, Levi said, is a "time bomb" for the US healthcare system, because Boomers will be dealing with age-related diseases, such as arthritis, that are made far more complex when twinned with obesity and diet-related disease. Obesity, he said, doesn't necessarily shorten life; modern medical interventions make it possible to live for a long time with severe health issues. The Time Bomb Boomers, he said, will be followed by an even larger wave of obese adults, if the obesity rate among today's children is not significantly decreased.

Marks blamed the obesity rates on the fact that Americans are eating larger portions and getting less exercise, an increase in snacking, and on the fact that junk and fast foods are both cheaper and more widely available than healthier foods, such as fruit and vegetables. While saying that the causes of obesity are complex, Marks chastised federal farm subsidies.

"We have subsidized things like corn, and foods that have high fructose corn syrup are the cheapest, and have the highest calories," Marks said. Low-income people are more likely to purchase cheaper, high-calorie foods, he said, in part because that is all that is available if they live in areas identified as food deserts, where access to fresh produce is unavailable.

It should be noted that a number of studies have found slim connections between crop subsidies, food prices and obesity rates, but this idea has become almost a dogmatic belief among a cadre of food and nutrition advocates, writers and activists, and has gotten plenty of play in the food policy arena in the last decade.

Praise for federal policies...and a call for action
The Obama Administration, Levi said, has done the best federal policy making in years to combat obesity. The measures embedded in the President's healthcare act are significant, he said; these include things such as requiring insurance companies to pay for preventive healthcare screenings and requiring Body Mass Index measurements, as well as requiring chain restaurants to post calorie counts on menus. He worried that Congressional efforts to defund elements of the law will create higher rates of obesity.

The report recommends that the Prevention and Public Health Fund included in the President's legislation should not be cut, and says that a significant portion should be used for obesity prevention, and that it also not be used to offset or justify cuts to other Centers for Disease Control and Prevention programs.

Levi noted that while Mrs. Obama's Let's Move! campaign is aimed at children, it can impact adult obesity rates, because parents may well adopt the healthy eating and fitness practices they are being encouraged to enact for their children. Mrs. Obama's campaign has extended deep into the grass roots, and now has components located in communities and states across the US, as well as in twelve federal agencies.

That kind of multi-level action plan is what's needed to reduce the prevalence of obesity, Levi said.

"The most exciting [federal] development was the signing into law of the Healthy, Hunger Free Kids Act," Levi said. "This new law says that unhealthy foods have no place in America's schools."

The legislation is a cornerstone of Mrs. Obama's campaign, and was passed by Congress after major efforts on the part of the White House; President Obama signed it into law in December of 2010. For the first time, it allows the Secretary of Agriculture to set nutrition standards for America's schools, and increases the reimbursement rates for schools participating in the federally funded lunch and breakfast programs.

The proposed new lunch room standards are expected to go into effect in the Fall of 2012, but the report calls for USDA to "issue a final rule as swiftly as possible regarding school meal regulations."

Children get half their daily calories in school, Marks noted. The report also urges lawmakers to restore $833 million slashed from the FY 2011 budget for nutrition assistance programs and programs designed to improve nutrition in child-care settings.

Levi pointed to policy developments tracked in that report that indicate that change is at hand in America's obesogenic culture, thanks to Mrs. Obama and the work of people across the US. The downward slide of states that have increased their obesity rates point to this: This year's increase of obesity rates in 16 states is in contrast to 23 states in 2010; 28 states in 2009; and 30 states between 2006 and 2008.

"Five years ago, only New York had a farm to school program, and now twenty-six states and Washington, DC, do," Levi noted. Getting "competitive foods"--sodas, cookies and chips--out of schools has also gained traction, he said.

"35 states and DC have competitive food rules," Levi said. "Seven years ago, only six states had competitive rules."

The report calls on USDA to rapidly make competitive food rules mandatory across the nation, for all foods sold outside of school meal programs, through à la carte lines, vending machines and school stores.

"There are plenty of opportunities for leaders to come together to make healthy choices the easier choices," Marks said. "The movement is gathering force."

Efforts should incorporate things like communities creating walking routes and encouraging the use of public space for physical activity, planting gardens, and helping supermarkets get built in food deserts, Marks said. All of this is part of Mrs. Obama's Let's Move! campaign, which includes the Obama Administration's $400 million Healthy Food Financing Initiative, a tri-agency project (Treasury, USDA, HHS) created to encourage supermarkets to get built in food deserts, by providing things like new market tax credits for companies that locate in underserved areas. But HFFI was not funded in the 2010 or 2011 federal budgets, and seems unlikely to be funded in the 2012 budget, either.

"This is not the time to take the foot off the gas pedal," Marks said.

Marketing to children...
The report also calls on the food and beverage industry to adopt strong standards for marketing unhealthy foods to children. In April, the Obama Administration released "preliminary voluntary principles" for food and beverage companies to follow when advertising their least healthy foods to children. These should be adopted by the food and beverage industry, the report said.

Created by an interagency working group with members from the Federal Trade Commission (FTC), FDA, USDA, and CDC, the principles are not federal regulations. Rather, they are meant to "encourage stronger and more meaningful self-regulation by the food industry and to support parents’ efforts to get their kids to eat healthier foods," according to the FTC. They principles have been assailed by some critics for not going far enough, and assaulted by the food and advertising industries for going much too far.  Some Republican lawmakers are also denouncing the principles.

Rep. Jack Kingston (R-GA) told CBS News that the government is being hypocritical by seeking to limit the advertising of certain foods to children while simultaneously allowing those same foods to be consumed through the federal SNAP (Food Stamp) program and the WIC (Woman, Infants, Children) program, which provides grants to states for supplemental foods.

If the foods in question are "so bad and evil," Kingston said, "then by all means eliminate them from the federal government nutrition programs."

Rep. Jo Ann Emerson (R-Missouri) also opposes the guidelines, and said she is dubious about claims that the principles will remain voluntary.

"We all know that things that started as voluntary somehow become the rule of the land," Emerson said.

The American Academy of Pediatrics, a partner in the Let's Move! campaign, just released a policy statement calling for the total elimination of junk food and fast food advertising aimed at children.

"Sufficient evidence exists to warrant a ban on junk-food or fast-food advertising in children's TV programming," the Academy noted.

The group runs Let's Move! in the Clinic, which asks doctors and other health care providers to make a pledge to measure BMI and counsel patients about optimal nutrition and physical activity in the clinical setting.

The principles are still open for public comment.

Walmart...and the private sector...
Mrs. Obama's Let's Move! partnership with Walmart is also an unprecedented effort to pull the levers to combat obesity. The nation's largest grocer, which serves 146 million customers weekly, has committed to a five-point Nutrition Charter to make healthy food more affordable, boost food access in underserved areas, and provide nutrition education.

The White House is aggressively wooing other corporations to follow Walmart's lead.

But like Mrs. Obama herself, Marks and Levi noted that policies for reducing obesity are not all that is required. Personal responsibility is also a big part of the equation, both said. Policies can only go so far to make Americans less fat.

It should be noted that The Robert Wood Johnson Foundation is a founding member of and funds Partnership for a Healthier America, the non-profit foundation set up to continue Mrs. Obama's Let's Move! campaign after her White House years have ended.

*Photo by Eddie Gehman Kohan/Obama Foodorama