Policymakers say aggressive action is needed to stem the growth of the obesity epidemic in the United States, which is crippling the nation’s health-care system, pushing thousands of Americans into an early grave each year and jeopardizing the lives of millions of children, many of whom are overweight or obese before they enter kindergarten.
“One in five U.S. children, aged 2 to 5 years, is overweight or obese,” said Sohyun Park, Ph.D., an epidemiologist at the Centers for Disease Control and Prevention (CDC) Division of Nutrition, Physical Activity and Obesity.
Studies indicate that overweight children are more likely to become overweight teenagers, who have a 70 percent chance of becoming overweight or obese adults.
“The U.S. health-care system is going to fold with the burden of chronic disease management if we don’t take aggressive action to reduce obesity the same way we took aggressive action to reduce the tobacco problem,” said Ann Ferris, Ph.D., a professor of medicine at the University of Connecticut Health Center and director of the Center for Public Health and Health Policy.
Ferris is conducting a three-year intervention study, funded by the U.S. Department of Agriculture, of sugar-sweetened beverages, which are one of the main culprits behind the U.S. obesity epidemic. The goal of the study is to reduce consumption of sugar-sweetened beverages among low-income preschoolers, who have a higher prevalence of consumption and a higher obesity rate than children from higher-income families; although Ferris said the gap is narrowing.
Ferris and other researchers say the obesity epidemic is being driven by changes in the food market and the environment.
“In the 1960s, when I was growing up, there were one or two children in my classroom who was very overweight,” Ferris recalled, noting that her class had 60 students.
Sheanell Giraud, a kindergarten teacher at Rodney B. Cox Elementary School in Dade City, Florida, said she has 19 students in her class, and five are overweight. The school recently instituted a policy banning vending machines, and limiting snacks to fruits and vegetables, she said. “Students are not allowed to have soda, and teachers are encouraged not to use sweets as a reward in classes,” Giraud added.
Many schools, local governments and hospitals around the country have implemented similar policies to reduce obesity by banning the serving and sale of sugary drinks, which are high in calories and have little or no nutritional value, said Roberta Friedman, director of public policy at Yale University’s Rudd Center for Food Policy and Obesity.
Additionally, several state and local governments have proposed implementing an excise tax on sugar-sweetened beverages, a measure the Rudd Center endorses. “One of the government’s roles is to protect the public’s health, and given that we have clear evidence that the consumption of sugar-sweetened beverages is having a detrimental effect on people, the government should step in with policies to reduce consumption,” Friedman said.
Ferris, who supports the tax initiative, said, “There is very good data that show that as you increased the cost of cigarettes, the purchase of cigarettes went down.”
If a tax is high enough, Friedman contends that it would discourage the purchase and consumption of sugar-sweetened drinks as well. “A 10 percent price increase in the cost of a soda, according to the economic modeling we have done, would result in a 10 to 12 percent reduction in consumption,” she said.
Last year, about 17 states tried passing a tax on sugar-sweetened beverages, but Friedman said none succeeded. About 15 states are currently considering the measure, she said.
A tax on sugar-sweetened beverages would have the added benefit of generating revenues to fund obesity prevention programs and offset some of the obesity-related, health-care costs, Friedman said.
The CDC estimates that medical costs associated with obesity are $147 billion annually. “Half of these costs are paid for with taxpayer dollars through Medicaid and Medicare,” according to a Rudd Center report.
Governments can also help reduce obesity, researchers say, by providing supermarkets and farmers’ markets with incentives to offer healthier foods and establish their businesses in low-income areas. They say low-income families are more susceptible to obesity, because healthy foods like fruits and vegetables are more expensive and less accessible than high-fat, processed foods like fast food and sugar-sweetened beverages. Opportunities for physical activity are also more difficult in low-income neighborhoods, because recreational facilities and sidewalks are usually nonexistent or unsafe.
“When you are in an environment that makes it so hard to eat well and to exercise, because you have limited choices, it’s really hard. What do you do with your child, there is no place outside for them to play, so they watch TV,” Ferris said.
Another problem is that parents are oftentimes confused about what’s healthy, because many sugar-sweetened beverages are promoted as “natural” or being good for you. “In our low-income households, the young children are not getting soda, because the moms know that soda is bad for them, but they are giving the kids sugar-sweetened beverages, because they think they are equivalent to juice and they can’t tell the difference, but sugar-sweetened beverages are fake juices. They are mostly just sugar and water,” Ferris explained.
Given the drastic rise in poverty in America, which is the highest it’s been in 51 years according to the 2009 U.S. Census, Ferris said it is crucial that policymakers address the needs of low-income families and involve them in the decision-making process.
These initiatives will only be effective, however, if parents do their part. “If the nutritional habits are not good in the family, then the child will adopt that eating pattern.” said Dr. Robert Mendelson, a pediatrician and spokesperson for the American Academy of Pediatrics. Parents need to instill good nutritional habits in their children at an early age, he said. “It is much easier to prevent obesity than to treat it.”
The CDC recommends that parents, child caregivers and schools limit access to sugar-sweetened drinks, and replace them with fat-free or low-fat milk, water and a limited amount of 100 percent fruit juices. Although these juices contain natural sugar and lots of calories, Park said, unlike drinks with added sugar, they contain important nutrients.
Additionally, the CDC advises parents to encourage their children to live physically active lives and reduce television viewing to less than two hours a day, because children are influenced by commercials that promote unhealthy foods and beverages.