Slimming the Future
What should we do about childhood obesity?
A year ago, Michelle Obama announced her plan to end childhood obesity within a generation. She made it sound so easy. "This isn't like putting a man on the moon or inventing the Internet," she told an audience packed into the White House dining room. "It doesn't take a stroke of genius or a feat of technology. We have everything we need right now to help our kids lead healthy lives."
"Everything" may have been an overstatement, but Obama's Let's Move! campaign certainly has had the political good will to make things happen. The first lady's initiative has started with the area where the federal government has most direct control over kids' diets—school lunches. Let's Move! helped pass a bill that increases funding for healthy school cafeterias and gives the USDA the authority (for the first time ever) to set nutritional standards for all food regularly sold in schools. Another approach has been to work with chefs and farmers. Obama persuaded a coalition of fruit and vegetable producers to install 6,000 salad bars in schools across the country over the next three years. And nearly 2,000 chefs have volunteered for the initiative's Chefs Move to Schools program, which helps educate kids about healthy food choices. Of course Obama has not forgotten about the method du jour for creating social change: public-private partnerships. Last month, in concert with Let's Move!, retail giant Wal-Mart pledged to make its fresh produce more affordable and its store-brand foods healthier.
The impact of these efforts remains to be seen, but this is clearly the most attention the issue of childhood obesity has ever gotten at the national level. And there's good reason to address the issue now: As you've probably heard, the percentage of kids in the United States who are obese has more than doubled in the past three decades. (In children, obesity means having a body-mass index, or BMI, at or above the 95th percentile for age—or really, the 95th percentile for age in the 1960s and 1970s.) Granted, in recent years, that growth seems to have plateaued; 17 percent of children are now obese, according to a 2010 CDC report, and that number has stayed roughly the same for the past five years. But the proportion of kids who are extremely obese—and at highest risk for related chronic diseases—is still increasing. The heaviest kids are getting even heavier. While there is some evidence that kids have also gotten taller since 1960, a close look at the data shows that for the vast majority of age groups, increases in average height aren't statistically significant—meaning they're small enough to be explained by mere chance—but increases in average weight are significant. In other words, compared with his peers of 40 years ago, the average American kid has grown in only one direction: out.
The health effects of childhood obesity can be severe and long-term. Much like obese adults, obese kids are at greater risk of developing a host of metabolic and cardiovascular abnormalities that may lead to type 2 diabetes, heart disease, and stroke. Obesity in children and adults also increases the risk of gallstones and asthma. As if these diseases and risk factors weren't bad enough, obese children are also more likely to develop orthopedic problems including fractures, flat feet, and bowed legs. And don't forget the psychological effects: Low self-esteem and depression are also associated with childhood obesity, which isn't surprising given the shame and social isolation that fat kids often endure.
Even if an obese child manages to avoid developing any of these conditions in youth, odds are he'll grow up to become an obese adult, with all the health risks that entails. One large, longitudinal study found that 77 percent of obese children end up being obese as adults, whereas only 7 percent of the normal-weight children grew up to develop obesity. The researchers also noted that if obesity begins before age 8, adult obesity is likely to be more severe. Other research links obesity in adolescence with increased overall mortality, and specifically with an increased risk of developing cardiovascular disease and diabetes in adulthood. (It's possible that this association is mediated by other factors—for example, poverty, which is associated with both obesity and increased mortality.)
Michelle Obama's Let's Move! campaign is just one of many recent efforts to address the problem. The Alliance for a Healthier Generation, a nonprofit with a similar mission, was founded by the American Heart Association and former President Bill Clinton in 2005. Celebrity chefs including Alice Waters and Jamie Oliver have been working on well-publicized initiatives to improve school food. And earlier this year, a group of food and agriculture activists launched FoodCorps, an organization funded by AmeriCorps that aims to address childhood obesity by planting schoolyard gardens around the country.
These initiatives all focus on two broad categories of possible interventions: encouraging healthy eating and promoting physical activity. The specifics vary; healthy eating, for example, could mean eating more fruits and vegetables, or drinking less soda, or reducing dietary fat consumption. And promoting physical activity could play out in efforts to reduce time spent in front of the TV, or to engage kids in a structured exercise program, or to improve playground facilities. But the problem is, most interventions targeting diet and exercise haven't worked, at least not in the long term. Obese kids often stay obese or regain their lost weight, whether they're following programs developed by dietitians, fitness coaches, cognitive-behavioral therapists, or all three.
What's going wrong? It could be that our basic reasoning is wrong or incomplete. Yes, American kids may be packing on the pounds because they're lazy and eat too much. But there's a growing lineup of other potential culprits. One is their genetic predisposition, which might also explain why fat children tend to grow into fat adults. An inborn tendency toward fatness may also be triggered by perinatal environmental factors: Undernutrition in the womb or in infancy could program a child to have a "thrifty" metabolism that will squirrel away more excess calories as fat later in life. And if the kid grows up in poverty, calorie-dense foods—like refined grains, sweets, and fatty snacks—may be the only ones available. A child born into a low-income, food-insecure family may therefore be saddled with an obesity-inducing double-whammy of thrifty genes and a thrifty food budget. A very different cause of obesity could be intestinal flora, which help to extract and store calories from ingested food. Everyone has these microbes, but there is now some evidence that obese people have a different (and perhaps hyperactive) set. Another intriguing theory is that obesity is caused by the consumption of certain kinds of carbohydrates, as science writer Gary Taubes argues persuasively in his new book, Why We Get Fat. Of course, the problem may begin before a kid ever touches her first potato chip: Introducing formula-fed babies to solid food too early can raise their risk of obesity, but so might giving them a bottle (instead of breast-feeding) in the first place. Or maybe for some obese people, the cause isn't dietary at all: Research has linked obesity to lack of sleep and ADHD.
Some of these factors could turn out to be major causes of obesity, and others could be red herrings—or maybe all of them contribute a little bit. Considering all the possibilities, there are surely countless ways to reduce the incidence of childhood obesity that we haven't yet discovered. That's where you come in. Today Slate launches a project to crowdsource solutions to childhood obesity. In this "Hive," we're looking for your best ideas about how to slim down America's kids. Michelle Obama has worked with the American Beverage Association to create clearer calorie labels for soda; other food activists suggest banning all sugar-sweetened beverages from school grounds. Some school officials want to extend recess time so that kids can run around outside more; others want to get them inside for yoga classes. And one man actually thinks pull-ups are the answer. Now we're asking you what else might work. Should we mount a public-service campaign to encourage more sleep for children? Levy fines on people who are caught feeding their kids junk food? Subsidize bariatric surgery for the fattest 5 percent of America's schoolchildren? We want you to design a plan for tackling childhood obesity, drawing on everything you know about food, physical activity, medicine, policy, psychology, and parenting. We'll publish your ideas on Slate, and other readers will vote and comment on their favorites. Then our panel of expert judges will narrow the field down to the most original and intriguing user-generated ideas. In about a month, we'll announce the winning idea. Whether you're a policymaker, nutritionist, teacher, parent, or even a child, we're willing to bet you have creative, unexpected ideas that will help address obesity in America's youth.
To help get your wheels turning, in the coming weeks we'll have a group of well-informed writers and experts discuss various ways to approach the problem. They'll look at the effects of anti-obesity programs on kids, and explain why many current efforts to address childhood obesity—including Let's Move!—fall short. Respond to their arguments in the comments, and submit a proposal of your own by clicking the "Enter Your Proposal" button.
Christy Harrison is a writer and editor specializing in food, nutrition, and health. She is currently pursuing a Master's of Public Health and registered dietitian's license at New York University. Previously she was the online editor at Gourmetmagazine.
Illustration by Robert Donnelly.