The New Health Dialogue

Child obesity is the focus of the March edition of Health Affairs, and we heard a number of policymakers and health care leaders explore strategies for addressing the crisis at a Health Affairs briefing here this week.

Health Affairs Editor-in-Chief Susan Dentzer likened the obesity epidemic to child abuse. “It is one thing to be a nation that’s allowed two-thirds of its arguably ‘personally responsible’ adults to become overweight or obese. Kids are becoming obese or overweight at the ripe old age of four, meaning that they are already predisposed to shorter, sicker lives from diabetes, heart problems, even certain types of cancer. What is this crisis if not some national form of child abuse?”

We aren't going to try to capture everything said in a half-day briefing (audio and slides here), and you can read more about the March issue (funded by the Robert Wood Johnson Foundation) here. But we'll share a few things that struck us as particularly interesting. Joanne Kenen is traveling but she's going to post a short item, too, when she has a chance.

Dr. David Wallinga, Director of the Food and Health Program at the Institute for Agriculture and Trade Policy in Minneapolis, addressed agriculture policy and its role in the obesity crisis. Wallinga informed us that the average daily caloric intake jumped by 400 between 1985 and 2007 (and 600 between 1970 and 2007). Of those extra calories, 24 percent come from added fats; 23 percent from added sugars; and 46 percent from grains -- mostly refined. Why? U.S. agriculture policies are one place to survey. Farmers respond to incentives, too.

Since 1948, the U.S. has favored policies that promote the production of certain commodities. Corn. Wheat. Rice. Milk. Soybeans came later. In the full Health Affairs report (subscription required), Wallinga explains that in the post World War II era, “raising production of commodity crops and their associated fats and sugars was seen as an answer to undernutrition in the United States and throughout the world.” Some of these programs were stepped up in the mid 1970s.

As a result of farm subsidies, output grew 260 percent between 1948 and 2002. The subsidized products -- easy to mass produce, store and ship -- cost significantly less than healthier foods. But, as Wallinga explains, agriculture policy has been outpaced by science:

As a cheap calorie policy, it has been a success. Many more fats, sugars, and calories have been added to the American food supply. And foods high in fat, sugar, and calories, such as cooking oils, snacks, fast food, and sugared sodas, are some of the least expensive foods in the U.S. food environment. Simply put, sweets and fats cost less, while many healthier foods cost more. What has changed since agricultural “cheap food” policies were put in place is that obesity has overtaken hunger as the most prevalent nutritional problem in children -- too many calories, not too few. According to today’s science, the quality of the calories produced by U.S. agriculture may be at least as important as their quantity.

Wallinga points out that from 1985 to 2000, the inflation-adjusted price of soft drinks fell 24 percent, while the price of fresh fruit and veggies climbed 39 percent. Given the long and complicated history of agriculture policy, he warns against quickly eliminating commodity crop subsidies, and, instead, suggests we change U.S. agriculture policy and offer more incentives for farmers to grow fruits and veggies.

So it’s no surprise that Barry M. Popkin and Carmen Piernas of the University of North Carolina at Chapel Hill concluded in a paper that children snack almost three times a day on junk food. Data shows that 27 percent of their daily caloric intake comes from snacks.

“Our study shows that some children, including very young children, snack almost continuously throughout the day,” said Barry M. Popkin, a professor in the Department of Nutrition at the University of North Carolina at Chapel Hill. “Such findings raise concerns that more children in the United States are moving toward a dysfunctional eating pattern, one that can lead to unhealthy weight gain and obesity.” The researchers found that between 1977 and 2006, kids increased their daily caloric intake of snacks by about 168. Today, one in three American kids are overweight or obese -- more than twice as high as childhood obesity rates just thirty years ago.

One more thought. First Lady Michelle Obama brought her LetsMove! campaign to Jackson, Mississippi this week. Watch the video to learn more about Mrs. Obama's campaign and about the creative programming happening across the state.

So before you give your kid that treat -- and the one after that and the one after that and the one after that -- stop and think. Is it really a treat?