“No country to date has reversed its obesity problem,” was just one of the grim pronouncements I heard at the Johns Hopkins Bloomberg School of Public Health “Obesity and the Food System Symposium.” This statement regarding the gloomy state of our fatness was offered by Dr. Martin Bloem, the new Director of the Center for a Livable Future and formerly a Senior Nutrition Advisor at the World Food Programme. Dr. Bloem wasn’t alone in his dismal appraisal. More than a dozen of the nation’s leading obesity researchers and experts presented similar views on what is arguably America’s biggest public health crisis.
Dr. William Dietz, the public health chair at George Washington University and formerly Director of the Nutrition Division at the Center for Disease Control ran the numbers down for the 75 academics, practitioners, and students gathered on a sub-freezing March day in Baltimore. Obesity rates have climbed from 10-25 percent of the population (the range reflects differences between age, gender, and race) between 1971 and 1975 to 29-40 percent today. He went on to say that 17 percent of children between 6 and 11 years of age are obese; the vast majority will become obese adults which Dr. Dietz characterized as a “major threat to our population.” And as man of reserved academic demeanor, Dr. Dietz did not appear prone to hyperbole.
Looking to blame “Big Food” or too much screen time? Think again. The causes are complex and woven intricately into this thing we call the food system. Looking first at historical and cultural factors, we can point the finger at such post-World War II phenomena as the increasing prevalence of home appliances (e.g. rather than hanging the wash on the clothesline, we merely move it from the washer to the dryer), suburbanization and its accelerating rates of car use, the number of TVs per household, elimination of physical education and home economics in schools, the avalanche of fast food, and the shift from high-calorie burning jobs in fields and factories to the sedentary life of the office.
Yes, our culture as well as our industrial models of food production and marketing have taken their toll on the human body. With a nod to Michael Pollan, Dr. Dietz noted that young men are consuming over 600 calories of sugary soft drinks per day, stemming of course from the high-fructose corn syrup connection and our “cheap food” crop subsidies that make healthy food more expensive. But one black and white photo of a 1950 household’s food supply put the story in perspective. A smiling family of four stood in the foreground, and behind them was arrayed a typical year’s worth of what they would eat. The only processed food item amid stacks of fresh produce, dairy, and meat were several boxes of corn flakes. That’s only 68 years ago!
The marketing of unhealthy food by the food industry, especially to children, was singled out as a leading culprit. Dr. Kelly Brownell, Dean of the Sanford School of Public Policy at Duke University and listed by Time Magazine as one of 2006’s “100 Most Influential People,” felt a more aggressive legal strategy targeting the food industry was necessary. While he suggested something akin to the state Attorneys Generals suing Big Tobacco, others were swift to point out the legal conundrum posed by the first amendment’s guarantee of free speech, which includes advertising. It was agreed that children are unable to defend themselves against the unhealthy food marketing that is carefully calibrated to penetrate their developing brains, but Dr. Shiriki Kumanyika, professor of epidemiology at the University of Pennsylvania Perelman School of Medicine said that the public health community would have to prove that advertising’s harm to children was great enough to warrant the neutering of the food industry’s free speech rights. Given that a thousand dead children have not been enough so far to override the second amendment, it’s unlikely that millions of obese children will be enough to squelch the first amendment “rights” of MacDonald’s and Coca-Cola.
Of course, we can always hope that we can beat Big Food at its own game. Believing that enough darts of healthy food information can stick to their intended targets, we continue to look to nutrition and food education for salvation. But as Johns Hopkins Visiting Scholar, Dr. Kate Clancy pointed out, “Advertisers know more about child psychology than child psychologists,” and with their multi-million-dollar marketing budgets, Big Food is always ten moves ahead of us. Yes, we’re itching to go to war with them, but instead we’re caught in a chess match where a stalemate is the most likely outcome.
“Surround sound” is how Dr. Ross Hammond, a Senior Fellow at the Brookings Institute and member of the Food and Nutrition Board of the National Academies of Science, described the approach that he and other presenters felt could stem obesity’s deadly tide. One way to prepare for such an audible assault is to first disabuse ourselves of the notion that there is one silver bullet – policy or program – that will reverse obesity. From the maxi to the mini, we often look for action items such as a major overhaul of our national crop subsidies, a sugar-sweetened beverage tax, or mega doses of nutrition education as the “one thing” we need to do. Instead, a holistic, systems-oriented framework that brings an array of interventions to bear in a coordinated fashion is what the data suggests is most desirable.
There was no lack of interventions offered at the symposium. The City of Baltimore, for instance, offers tax abatements on vacant land to promote urban farms; a beverage container tax, warning labels on sugar-sweetened beverage containers, and restrictions on carry-out food outlets (some neighborhood residents reported getting half of their daily calories from carry-out) are all part and parcel of the city’s obesity prevention efforts. Besides a sugar-sweetened beverage tax, Philadelphia has a healthy vending policy, but the increase in healthy eating associated with that policy has not been significant. Minneapolis has a staple food ordinance that requires stores to stock a minimum percentage of healthy food, but it hasn’t been easy working with retailers. SSB taxes are sprouting in cities, but the tax must be sizeable – 20 percent or more – to reduce soda purchases (according to Dr. Hammond, we don’t know yet how beverage substitution, e.g. giving up Coke but drinking more Gatorade, factors into measuring the impact). New supermarkets have opened in so-called food deserts, and farmers’ markets have added numerous lower income-targeted incentives such as the “Double-up Bucks” program. And the list goes on: labeling to identify calories in each menu item, promoting breastfeeding, and using public facilities, trails, rails, and streets to make us sweat profusely.
All of these interventions can make a dent in human behavior, but applied as stand-alone actions, their impacts are often marginal. That is why they must be applied together in an interactive and coordinated fashion, and that is why the gold standard for a comprehensive obesity prevention strategy, at least so far, is Shape Up Somerville (Massachusetts) https://www.somervillema.gov/departments/health-and-human-services/shape-up-somerville. This community level, highly coordinated initiative was begun in 2005 and continues to this day. From the city’s Mayor, to a wide swath of community residents, to all the usual institution and organization stakeholders, Shape Up Somerville has brought the community together to mount what can only be called a full court press against obesity. Among other positive measures, results so far indicate that body mass index (BMI) levels for children have declined. About Shape Up Somerville, Dr. Hammond has said, “There is a growing consensus that what we need to do to prevent obesity is to coordinate activity across different sectors and different levels of scale, or to take what is a systems approach.”
When it comes to slowing the runaway train of obesity and ensuring the health of this and future generations of children, collaboration is the noise that “surround sound” makes.