You can get garden variety health advice from the daily newspaper, the "health" section of most book stores, and of course thousands of web sites. I'm hoping to present thought provoking and maybe change provoking thoughts about individual and community health. This blog is not just what to do about health, but how to think about it. I'm looking forward to an exchange of ideas with readers. July, 2010


Wednesday, September 15, 2010

Overweight and Social Change

The U.S. Centers for Disease Control have produced a series of maps, showing state-specific obesity trends from 1985 to 2009.  You can flip through the maps, one year at a time, and get an animated view of the stunning progression of overweight in the U.S.  The two primary reasons for the change are that our food supply has become more calorie dense and we are less physically active.  If you zoom in on those two causes, many additional subfactors will come into focus, such as the shift from slow cooked home meals to now about a third of our food coming from fast food venues.  This is a topic I've discussed before, and it is widely highlighted in media, and yes, kitchen table discussions.  I want to talk about solutions.

The change depicted in the maps reflects profound changes in society.  It is not just that we need to spend a little more time talking about nutrition and beefing up PE.  Those may be part of the solution, but what will be required to reverse the obesity epidemic is sustained social change around food and physical activity and the way we live our lives.  We have learned a lot in this regard from the anti-tobacco campaign.  Smoking is down from the 1960s, not because of public education alone, but society has undergone signifant changes in attitudes and beliefs regarding smoking.  This has occured in fits and starts, as health promotion warriers tried many strategies, different venues for education and more aggressive regulations in the face of Big Tobacco.

We are really just at the beginning of the anti-obesity campaign.  I predict that changes will come sooner, because of the groundwork laid by the anti-tobacco campaign and because of new media which moves at speeds unimagined in the 60s, 70s, 80s and even 90s.  So what follows are some of the current proposals for policy changes to address overweight in our communities.

Several fast food chains target kids with the ploy of offering toys as a bonus with package meals - so called Happy Meals or other related labels.  These may be momentarily happy meals but we all know that long term they certainly are not healthy meals.  Some communities are beginning to say no.  If the venders want to use toys as a marketing gimmick, they must come with food items meeting nutritional standards, limiting calories, salt, fat and sugar.  Can McHealth do battle with McBurger?  We shall see, but this represents an increment of social change.

Another popular proposal is to put added tax on sugar sweetened beverages.  Children and adults comsume large quantities of sugar dense drinks, including regular soft drinks, fruit-flavored punches, and in my part of the world, sweet tea.  These bring large jolts of sugar, adding substantially to the calorie load of diets.  We've learned from the tobacco wars that taxing can be an effective tool: make something more expensive and people will buy less.  Around the country, health advocates are beginning to experiment with legislative proposals to make suger sweetened beverages more expensive.  This would represent more social change if it makes fundamental impact on our diets.

Some other ideas include menu labeling, zoning restrictions on the density of fast food venues in urban neighborhoods, requiring candy-free check out aisles in retail stores, banning infant formula giveaways by companies to new parents in hospitals, banning free refills of soft drinks, changing zoning restrictions to permit farmers' markets in city locations and making it possible for those markets to accept food stamps, promoting the development of community gardens, restricting the design and location of junk food billboards and out-door advertising, and putting nutritional rules on food purchasing by schools and other government agencies.  These are just a few of the proposals being discussed.  The legal and practical basis for some of them is still emerging.  It is also unknown what impact they will have.  It will take time to sort it all out.

Taken together, the policy changes are likely to mold and shape our culture, so that in 25 years, the food and activity environment will be unlike what we know today.  It is an exciting new frontier for health promotion.

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