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As
a physician and a member of my local school board, I am concerned when I
read about the epidemics of overweight and obesity in our adults and
children, and the increase in juvenile Type 2 diabetes and lack of fitness
in children. It concerns me to read of children with 25 hours of
screen time per week (including TV, computers, computer games) and the
belief of some children that a healthy serving of vegetables consists of
an extra large serving of French fries in a McDonald’s “Value Meal.”
Please don’t get me wrong. I believe deeply in freedom of choice. Any of
us can choose to eat anything, any time, in any amount. And Americans do
just that, but too many are choosing the wrong foods, in excessive
amounts, leading to the alarming rise in overweight and obesity in both
the adult and child population.
The Surgeon
General’s 2001 report stated that more than 60 percent of adults and
about 20 percent of children are overweight or obese. This is double or
triple the numbers of just a generation earlier.
As if poor diets
weren’t bad enough, more and more kids are becoming “couch potatoes”
and/or “screen addicts.” Sadly, according to the 2001 California
Physical Fitness Test, some 20 percent to 40 percent of the children
tested are unfit. I would hate to see the data on adults.
It is now common
knowledge that overweight/obesity and childhood Type 2 diabetes are at
epidemic proportions in the U.S. Moreover, many studies show a clear
relationship between obesity and increases in cardiovascular disease,
hyperlipidemia, hypertension, and strokes. There was a time when heart
disease was a disease of seniors but the age of these “seniors” has
crept down steadily during the last decade. People in their 30s, 40s and
50s are now having heart attacks and coronary artery bypasses. And to make
matters worse, many opt to treat or counteract these diseases with pills
rather than making lifestyle changes such as adopting healthier diets and
getting adequate exercise.
There is a big
price to pay for such poor choices, and it results in cruel and unusual
punishment for our kids. Childhood obesity and lack of fitness put
generation after generation at significantly increased risk of multiple
major diseases and medicine cabinets full of pills. For what is the fate
of the overweight/obese child? Unfortunately, 80 percent of these children
remain overweight or obese as adults. As for adults, the failure rate of
weight loss programs is 95 percent. So how do we address the problem? Can
the problem be solved?
Taking a
Hard Look at Junk Food
As a member of my local school
board, I have a great interest in what goes on in our schools and with our
students. I believe that one of the biggest reasons for the obesity
problem is fast or junk food. I define this as food that is high in
calories, low in nutritional value, and loaded with sugar, salt, and oils,
both saturated and unsaturated.
McDonald’s is
one of the worst offenders, a real junk food pusher. Their food fits my
aforementioned definition to a tee. McDonald’s serves super-size
portions that far exceed an individual’s dietary needs, and it offers
these portions at a bargain rate. A “Value Meal” includes a Big Mac, 7
ounces of fries, and a 42-ounce Coke, weighing in at a hefty 1,600
calories, more than most children need on a daily basis, and about 75
percent of most adults’ daily calorie needs. None of this food delivers
a nutrient value in proportion to the size of the serving.
Moreover, in order
to build consumer brand-name loyalty, McDonald’s targets children with
toys, playgrounds, all-you-can-drink sodas, and other manipulative
strategies that its marketing consultants dream up. McTeacher’s Night is
a particularly offensive example. Teachers serve junk food to their
students and parents at a local McDonald’s, with a small percentage of
the profits going to the school. It is a corporate strategy that misuses
the teacher role model to increase market share and build consumer
loyalty. What a message to deliver to our kids.
Another
junk food offender is the soda industry. Soft drink makers provide
soda-dispensing machines at no cost to the schools because the profits
made far exceed the cost of servicing the machines. These companies
literally buy their way into schools by offering a percentage of profits
to the school, or by offering sports uniforms, scoreboards, and other
incentives, in hopes of having exclusivity over other companies. As with
McDonald’s and other junk food purveyors, who brag about being valuable
“partners” to schools, a soda company’s healthy bottom line only
results in short-term gains for the schools and long-term punishment for
the unhealthy children, who become habituated to sugar, salt, fats, and
caffeine and hence gain weight.
Those of you who
really want to gather ammunition against the fast food industry should
check out the book Fast Food Nation: The Dark Side of the All-American
Meal, by Eric Schlosser. It is an easy weekend read, and I hope it
encourages individuals to become local champions in schools and the
community in addressing the problems of junk food and obesity.
A Local,
Grassroots Approach
I looked at the problem of
obesity and junk food and disease and I looked at the top-down approaches
of reeducation. Having raised four children and being very familiar with
the limitations of such an approach, I said to myself and to members of
this medical society, “There must be a better way.”
In 2002 the San
Francisco Medical Society introduced Resolution 112-02 at the CMA House of
Delegates, to initiate and promote a grassroots approach to addressing the
issue of overweight and obesity by reducing junk food in our schools. This
led to a pilot project, student based and student driven, which began in
March 2002, at the middle school in my school district in Moraga.
The project began
with me, as a volunteer and a community physician, talking to the students
about obesity and junk food, and their relationship to diabetes and other
diseases. I told them, “As a physician, I can lecture to you about the
problem, but I don’t want to. I want you to do the research, define the
problem, and address the problem. You have many resources and you can take
responsibility for the next steps.” To my delight, the students eagerly
took up the challenge.
Students
Take Charge
The class formed a health
committee that achieved a number of goals during the next 12 months. They
held student taste testings and analyzed the nutritional value of food
served at the cafeteria. They asked vendors to bring samples and provide
nutritional information. They had the snack offerings and lunch menu
changed to include more healthy foods and at least one vegetarian lunch
choice per day. They went so far as to get the prices of unhealthy drinks
(i.e., sodas) increased and the prices of healthy drinks (juices, water,
and milk) lowered. The students also held health awareness weeks, when
they educated other students about obesity, disease, and healthy foods.
Finally, the
students initiated removal of two soda dispensers and had a “Milk
Chug” machine installed to dispense milk, water, and juice. I recently
had the privilege of observing lunch hour at this school and saw kids
choosing the Milk Chug machine over the soda machine by a rate of 10 to
one. Students lined up 10 to 12 deep to purchase milk. I saw additional
milk purchases during the snack periods between classes. I learned that
the milk machine must be restocked daily, while the Coke machine needs
restocking only once a week, if that. The students plan to eventually
eliminate the remaining soda machine. What I observed was real
“buy-in” to a health program the students developed and are running
themselves.
The success of the
program, in just one year, lies in the fact that the students decide
whether there is a problem, what the issues are. They determine what
measures are appropriate and effective for their schools and their
community. They decide how to manage junk food in their schools and in
their lives, and how to improve their own health and the health of others,
including their families and friends. The principal of the school says,
“What I find exciting is that the kids are taking ownership, rather than
having it forced on them by adults, which in my experience never works
anyway.”
One Step
Further
I brought this student-based,
student-driven pilot project to the attention of the California Medical
Association Foundation earlier this year. The foundation chose to include
it in its major multiyear project to address obesity and childhood Type 2
diabetes. In addition, the SFMS advocated for this grassroots approach to
the San Francisco Board of Supervisors Task Force on Nutrition and
Activity and to the San Francisco Unified School District Task Force
addressing student health. Senator Tom Torlakson (D-Antioch) has taken a
great interest in this program and is helping to implement it at the state
level.
In conclusion, I
would like to remind readers that while the focus of this grassroots
approach must be on the students and their involvement, the program must
begin with a community physician. The local physician has a certain
credibility and respect, because he/she does not just talk about food and
obesity and disease; he or she is responsible for treating patients who
are obese or have associated diseases. It is my hope that community
physicians will volunteer to partner with a school. These physician
champions can anchor this grassroots program and engage and challenge the
students to take responsibility for their future health, to make the right
choices, and to teach others to make the right choices when it comes to
food and health. It is my belief that we will make a significant
difference, one school at a time.
Dr. Louie is an otolaryngolosist in San Francisco. This article first
appeared in the May 2003 edition of San Francisco Medicine.
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