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Community fat fight

- The Washington Times - Friday, June 15, 2007

In a nation where french fries are the No. 1 vegetable consumed by America's children, tipping the scales on childhood obesity requires more than adding a few extra veggies to school lunches. Based on the latest scientific evidence, it takes the commitment of the entire community.

A recent study conducted in the city of Somerville, Mass., shows simple, low-cost solutions — when embraced by adults and children across a community — can help turn the tide on obesity, which is the second leading cause of preventable death in America.

In the "Shape Up Somerville" study, researchers from the Tufts University's Friedman School of Nutritional Science and Policy did more than revamp school menus to address childhood obesity. They also worked with restaurants to promote healthier fare, installed new bike racks and repainted crosswalks to encourage more physical activity, and hosted community health fairs, among other measures. The results showed that, during the course of the study, school children in Somerville gained less weight than children in two nearby communities that did not participate in the program.

Can this approach work elsewhere? The nonprofit Save the Children, which works with children in poor, rural areas across the nation, intends to find out. The agency has partnered with Tufts to adapt and test the Somerville approach in rural communities in California's Central Valley, Kentucky, Mississippi and South Carolina.

Supported by the Robert Wood Johnson Foundation, researchers are examining how factors at school, home and in the community affect the physical activity levels of rural schoolchildren. Their findings will support design of a program to break down the barriers to healthy lifestyles for children in rural settings.

The research is already demonstrating the tremendous challenges facing rural communities. Similar to kids in urban and suburban America, rural children have grown too accustomed to a sedentary lifestyle of watching television and playing video games while consuming high-fat, high-sugar snacks.

However, rural children often lack critical resources to ensure a healthy and productive life. Too many rural communities have too few parks, athletic programs or recreational facilities. Their grocery stores may not offer a diverse selection of affordable, fresh produce. With few schools within walking distance of home, many rural children must sacrifice playtime to long bus commutes.

Persistent rural poverty and lack of education about proper nutrition and the benefits of physical activity only compounds the problem. In families living paycheck to paycheck, children may overeat when food is available and rely on inexpensive, high-calorie and low-nutrient food as cash runs out. The cycle can lead to obese but malnourished children.

Crafting solutions is an enormous challenge we cannot afford to ignore. Over the last 30 years, the childhood obesity rate has nearly tripled for preschoolers and more than quadrupled for children ages 6 to 11. One-third of America's children are either obese or at risk of becoming obese.

The outcome for many of these children will be a lifetime of struggling with chronic diseases, such as heart disease, type 2 diabetes, asthma, depression and some types of cancer. If the obesity trend continues, some worry this may be the first generation of children that is not as healthy as its parents, resulting in lost opportunity, diminished productivity and dramatically escalating health costs.

To be sure, schools must play a significant role in the fight against childhood obesity. Initiatives such as Save the Children's physical activity and nutrition program in poor, rural schools are already proving the value of investing in obesity prevention.

But only so much can be done in the confines of a school day. When children step off campus, they are vulnerable to the lure of fast food, television and their video games. Clearly, we need more than a classroom session to convince an overweight and obese nation to get off the couch and out of the cookie jar.

The actions needed to reverse the childhood obesity epidemic must be robust enough to counteract the factors that led to this health crisis in the first place. Over the last 100 years, public health interventions such as improved sanitation, immunizations, food, water, tobacco and highway safety regulations have helped add 30 years on average to the life expectancy of Americans. Now, the country needs a similar multifaceted public health approach with broad civic engagement to modify behavioral, structural and environmental causes of obesity. This means mobilizing all sectors of society including families, schools, businesses, health-care providers, the media and policymakers.

To shape up, America's children need and deserve the support of their entire communities and country to ensure a healthier future for them in the 21st century.

Susan J. Blumenthal, M.D., a member of the board of trustees of Save the Children, was assistant surgeon general of the United States and deputy assistant secretary for health in the U.S. Department of Health and Human Services. She is a clinical professor of psychiatry at Georgetown and Tufts University Schools of Medicine and Distinguished Advisor for Health and Medicine at the Center for the Study of the Presidency.