My son's second grade teacher "rewarded" the kids with candy and never allowed them to go outside for playtime. We had just moved to the area and I had never heard of teachers handing out candy for correct answers in class. In two months, my little boy became a fat kid. He still struggles with his weight thirty years later.
115
I think Carroll is misunderstanding the "differences in nominal significance" error. That problem is not so much comparing the treatment and control groups to themselves, but rather in using statistical significance to do so. That is one of the reasons that leading statisticians now recommend against significance tests (see Ronald L. Wasserstein, Allen L. Schirm & Nicole A. Lazar (2019)
Moving to a World Beyond “p < 0.05”, The American Statistician, 73:sup1, 1-19, DOI:
10.1080/00031305.2019.1583913),
37
NYT article: Many studies of obesity interventions are deeply flawed. We can do better.
Reader comments: Oh, woe is me! Nothing works.
34
We need children to over consume to maintain and grow the profits of our overlords businesses. It is the real purpose of the vast majority of people. To be childlike in mentality and ever needy of more and more for it is more that will fill you with happiness, just like on TV.
110
Children shouldn’t be allowed to eat “Reece’s for breakfast”. This is criminal activity and should not be allowed. How is it that advertising for these toxic “foods” is allowed.
Ultimately it’s education. Look at the map. Those places with higher education have lower obesity rates.
91
I'd like to know who decided goldfish crackers (and their knock-offs, organic or otherwise), are health food. They are served or offered to small children all of the time as a "healthy" snack. They're just not.
238
Consider the epigenetics. Grand ma fat? then grandchildren prone. Due to activity of genes.Fat mom or dad can change child's metab and they absorb more energy, have different fat storage etc. Yes, born to be fat is true.
24
Do we really need studies on childhood obesity? We need government/corporate responsiblity is what we need. Big Ag has a lot of money involved in processed food production/promotion- perfectly legal advertisement of consumables known to be nutrition free AND harmful. Add to this presence our change in activity level and it is a recipe for how to eat more than you need and create chronic disease
84
Even as little as sixty years ago, excess weight in children was regarded as healthy, a sign of prosperity and the likelihood that such care would continue. A swath of reasons, very different now, keeps kids and their parents in the same obesity loop, and these underlying reasons, some of them pretty unreasonable, need to be the focus of any attempt to curb childhood obesity.
The advertising and prevalence of snack foods and high-calorie sodas, along with the increase in childhood screen time (what we used to blame television for) are only part of the reason child obesity continues. We need to confront the dull fact that such snacking and such foods are not just available, but that generations of Americans have absorbed them into their daily routines. I maintain that childhood obesity has its roots in the same reasons why most Americans only use their microwave ovens to cook -- convenience and quick preparation time have reduced the time and effort that used to be spent on cooking, learning to cook, and the value of food in minerals, vitamins, and other essentials for good nutrition. Today that impulse is quickly satisfied by reading the nutrition label on the side of an instant dinner.
In short, we are facing a cultural crisis, one not limited to children. We cannot hope to reduce childhood obesity without addressing how easy and convenient it has become for families to overeat overprocessed foods and to forget how to feed themselves properly. Or at all, really.
77
Thank you for mentioning lack of sidewalks. I might add to that few and far between crosswalks. Walking to a store is dangerous now in many places in this country, impossible in some, and often distressingly circuitous where it is possible.
167
@Observor we have similar problems in the U.K. : very poor conditions for walking in our towns and cities. The young and the elderly are the most vulnerable. Pavements ( sidewalks ) can be dirty and broken. Cars , increasingly, park on them. Uncalmed, speeding traffic with its noise, pollution and danger is only feet away. Hedges often overhang the safe side. Fewer people are walking and the population is getting fatter. Elsewhere in north west Europe - Holland, Germany, Denmark and the Scandinavian countries - action has been taken : safe, pleasant walking routes have been developed. Their populations are visibly slimmer and healthier.
93
I was a child in the 60s and 70s. There was usually one fat kid in a class of 30 kids. Most people ate home cooked meals. Sodas, sweets and restaurant food were rare. I didn't exercise, but had to walk everywhere. I ate large portions of home cooked food, and didn't put on weight.
I joined a gym, and they asked about weight loss plans They suggest eating out less than two times per week. I've started packing a lunch and trying to exercise more regularly.
92
@Mary I admit I'm ancient, but when I was a kid, soda's came in bottles of six and a half ounces. Now the smallest size for many name brands in a convenience store is 20 ounces, and free refills in fast food restaurants ...
Also, the only beverages available in my schools were milk and water. And there were no vending machines selling candy, cookies and chips, either.
Cut the sugar, people.
229
I had no conception of how difficult is is to feed children until I had a couple. When they turned 4 or 5 they just stopped eating nutritional foods. I think this is partially because they see what the other kids eat, try it and like it. After a few years of battling with them I kinda gave up. Now I'm just happy if they eat. I know what my Dad would have done but I don't want to make mealtime into into the Eastern Front like he did.
Healthy food is more expensive and it has a short shelf life. Honestly, I just got tired of throwing away expensive fruits and fresh veggies. And who has time to cook?
My advice? Don't let a child ever choose anything. Don't give them the least bit of control over food, that road leads to ruin. It's tempting when they're 2 to let choose between apple sauce and banana, but do not do it.
204
I think the best way to confront childhood obesity is to confront the fast food, beverage and snack businesses and to force them to make changes. These foods are more addictive than tobacco and they should be regulated.
70
Universities too have signed up to poison students. Many have turned over their food halls to fast food company halls, like in shopping centers. Where once there were food kitchens run by the university or private businesses now there are only fast foods with little choice for students to buy from: one junk food or another, Taco Bell or McDonalds or the usual line up and the local versions. They get commissions from these companies and students like that food. Unethical bottom line choices made by universities, both private and public, run like profit market operations. Perhaps the Ivy Leagues with a wealthier more sophisticated palate have avoided this catastrophe, able to cater to the more demanding tastes of their upper class students, but flagship universities and second and third tier ones have capitulated to this trend.
111
As a PhD in Statistics, I am surprised to see basic design and analysis issues of concern in obesity studies. Let's hope for better peer review of these studies in the future and the inclusion of a statistician at the design phase as well as the monitoring and analysis phases.
50
@DKB I was going to say the same thing. What happened to peer review? My PhD isn't in Statistics but all students in my field in grad school had to take a year of Stats at a minimum, even for an MS.
27
One issue is definitely poverty - if there are no fresh produce markets in sight and all your family can afford is the $ menu at McDonald's the causes are obvious. But there are lots of overweight and obese middle class kids, too. Having young kids and being around young families a lot, what I notice is that kids are just constantly being fed nowadays. There are snacks at very juncture of their day. Also, at home, having kitchens "stocked" with every variety of snack is a point of pride. Sorry, but how many snacks does a person need? My kids are 3 and 4 and even at this age rarely have a snack between lunch and dinner. If you train kids to expect food all day, they will learn that it's normal to eat all day.
147
@Kas
I agree. Here in Wales you barely ever see a toddler in a pushchair or a teenager outside school without a bag of crisps in their hand. Snacking is becoming an epidemic here and crisps sweets and chocolate are available and cheap in every kind of shop.
65
Also, when children see that their parents or other caregivers are overweight, their image of themselves stays inline with what they see from their mentors.
By the time they grow to realize, if they ever do, that fat is not good, it takes a mighty intervention to lose extra pounds they have carried all those years.
Parents: Look in the mirror before you scold your child for being overweight.
39
More could have been said about the need, when designing a clinical trial, to control for as many variables as possible. Unfortunately, we don't know what all the variables might be that affect body weight (eg, individual influences on metabolism). Also, any off-site study that measures the effectiveness of lifestyle changes is subject to self-reporting biases. The cost of conducting a well-controlled study of the effect of an intervention on body weight would be prohibitive.
3
I took a trip late last year and ate very healthy the entire trip. Zero junk food, fresh vegetables, very little meat (by choice), not a lot of cheese, plenty of wine, soups, very little bread (by choice). No extra condiments like butter, sour cream, etc. (by choice). Did a lot of walking but I am very active even at home. But I lost 8 pounds in two weeks and I was not trying to lose weight. A healthy diet with no junk food, no sugar, little bread and meat will do wonders for your waistline.
87
Poverty in the built environment matters too. When I was in middle school and high school, there were two bike racks outside both schools, always empty. Why? Any bike chained up to them was, inevitably, stolen. Better to ride the bus and save the bike for the weekend, when you could safely keep an eye on it.
Similarly, if your neighborhood is built without sidewalks, playgrounds, or public sports fields, or if those outdoor spaces are neglected and crime-ridden, people will not use them.
There is a reason that states with high poverty have higher obesity, and I doubt that the whole of it is that children in wealthier states simply find cupcakes less delicious.
98
We all know the dietary solution: cut out the sugar; eliminate all processed carbs; eat whole foods; less meat and more plants. But, the solution cannot come from the government or external guidelines. A community based approach is necessary. This means community gardens, meals, cookbooks and recreation centers. People need to feel empowered before they can gain control and make measurable changes. Poverty often means living in a chaotic and dangerous environment. In America, obesity is one of the consequences of poverty.
61
The answer to most major chronic illnesses is clear - a low carb diet. Clearly, our species is not adapted to living on grains, and sugar is a powerful drug that has never been in abundance.
Just as the reporting of statin effects (before side effects) are a major fraud that represented a 1% risk reduction as 10%, with the AHA almost criminally negligent for supporting that, what is the harm in identifying the situation. Anybody who can search YouTube with the word KETO can educate themselves and return to their historic weights.
Then they can search for AUTOPHAGY and discover the master healing power everybody can incorporate through modest fasting.
14
Don't overcomplicate this problem. Obesity was solved over 100 years ago with a low-carb diet and popularized by Banting and then later refined by Atkins, Eades, Phinney & Volek etc. Just eat a natural, whole foods diet, prioritize protein and cut the carbs if you need to lean out. Obesity is a problem in the U.S. because of all of the highly processed junk food consumed. Also, the low-fat propaganda of the USDA steered people into high-carb, processed foods. Americans were in general not obese until the U.S. Government got involved in dietary recommendations. Go back to the seven ancestral foods: meat, fish, eggs, nuts, seeds, vegetables, and fruit. Limit fruit and root vegetables if you need to lean out. Problem solved!
44
@AmateurAsian I often shop at Walmart where I see families shopping. Their carts are loaded with giant bags of chips, dips, Little Debbie snack cakes, tons of sodas and bottles of sweetened juices. Ice cream, candy and frozen dinners. People need to learn to eat and mostly they just do what their parents did which was no better. Keeping the fat off kids starts with being a role model and controlling what comes out of the refrigerator and kitchen cabinets.
Therefore, I am talking a major national project to educate and rein in the junk foods industry. I think part of this is that working people are just too tired to prepare healthy food. It takes time that most don't have. And that is a major issue in our culture.
39
The problem can be placed squarely at the feet of the parents no one else. Children are not something just to have they require a lot of time, money and effort and sadly most people are not willing. Parents are the ones responsible for the nutrition of their children, giving them a fast food kids meal and your smart phone so they are quiet is not meal time. Perhaps it is the rise of single parent or dual income families where there is no time to cook healthy meals and take your children outside to burn some calories that is the culprit ( please don’t lecture me on poverty or urban living I grew up poor in the East Village in the 70s) yet my mother always had a meal for us that was at least some what healthy , or perhaps it is that in trying to better their children adults would have to make better life choices. Starting a young child towards a life of obesity only sets that child up for a difficult and unhealthy adulthood, not to mention the cost to society in terms of medical expenses and lost productivity. In my opinion allowing your child to be obese is a form of child abuse and neglect
43
@EAH Many people aren't so much unwilling as unskilled, uneducated, and exhausted. Poorer schools are less likely to have home ec classes to teach people to cook. They're lucky if they're taught about any nutrition at all. Poor areas tend to be food deserts where it's difficult to buy fresh fruit and vegetables, not to mention that they go bad easier which in a family struggling to pay its bills is hard to justify.
There's a NYTimes article about a woman who was only able to buy broccoli when her employer accidentally started paying $2/hr more. Cooking takes time and energy and many parents work more than one job or long hours. I've seen many parents who explain they get up at 5, take the bus for an hour to work and don't get back home until 7 or 8 pm. I will add that from my mother's experience there ARE people who are used to eating McDonalds every day and having soda every day who are resistant to healthier food. The solution isn't scolding, it's hiring people who can actually cook for school meals and serving healthy, but TASTY food and teaching people to cook so they can make those dishes themselves.
44
If you grow up in a family that doesn’t have healthy food habits, it’s not easy to learn them on your own. We have a young adult friend who grew up in a non-cooking, junk-food eating home. She has no vocabulary for cooking or nutrition and is overwhelmed in a supermarket. She has a lot of other challenges in her life that she feels are (and may be) priorities over learning to eat well. It’s easy to blame her parents, but they never had the tools to teach her because of their own issues with food and dealing with life’s challenges. And if she doesn’t learn, and she has children, she won’t have the tools to teach either. Why should we blame them, when the cheapest most available most in-your-face food is junk food and fast food? It seems to me that our society is to blame for allowing this to happen.
36
Spent a lot of my career telling grad students, statistically not significant is not significant. I hate it when people tell me there is a 'trend' in their data.
28
Look at any documentary on some unrelated subject that filmed a crowd of ordinary people in the USA up until the 60-70s. For example, we saw one the other day about the launch of the Apollo moon shot in 1969. We remarked that none of the people in the crowd watching the take-off were fat. How many of them would be so today? It's not heredity. What has changed? Food, and quite possibly the additives and hormone disrupters, and activity levels. I love Michael Pollan's advice "Eat real food (nothing, or as little as possible, your grandmother (at this point maybe your great-grandmother) wouldn't recognize, not too much, mostly from plants". It's not extreme, improve what you can. Just common sense.
82
No more studies! The evidence is overwhelming. People who engage in regular, vigorous exercise (not step counting!) are not obese and don't need to nit pick at what they eat. Real fitness is darn near a cure all. Get fit and eat real food. Problem solved.
26
@Teal
Not true—some of us can’t do “vigorous” exercise due to exercise migraines. It really is portion control and cutting waayyy down on carbs.
25
Parents, don't keep junk food in the house!
53
Michael Pollen knows exactly what is wrong with the majority of Americans. Read on, my friends. https://www.goodreads.com/book/show/315425.In_Defense_of_Food
I don't know any fat vegans!
13
it is astonishing how much cognitive dissociation exists in the obesity problem. Obesity is a very complex hormonal disease, where insulin plays a key role. Genetics is 70%, habits 30%. The mayor problem it is not the obesity. The mayor problem is the wrong way of thinking of the main stream of medical community, politics, journalists, nutritionist, etc. "Eat less, move more" is wrong. "all calories are equal" also wrong.
19
Maybe it's time for researchers to ask:
How many obese children are born to obese parents?
I think we're overlooking a genetic/hereditary component that may be the result of prevailing selective mating patterns.
Well-educated, relatively affluent people, for example, tend to marry other educated people from relatively affluent backgrounds and similar social strata -- people who also exhibit body weight characteristics that fall toward the middle of the bell shaped curve.
By the same token, overweight people may be discriminated against and their default mate selection may be confined to other overweight/obese people, which leads to more overweight/obese children.
Until we get to the point where we can tinker with DNA and design slimmer children, avoiding sugary drinks and eating more leafy vegetables won't be enough to solve the problem that genetic heredity may have encoded in it.
9
@bijom --
Don't assume nature when nurture explains so much. Diet and exercise are key, and if the parents have obesity-promoting diets, the children will too.
13
@pete mac
Genetics beats nurture all too often.
10
@bijom If the BMI of the whole country goes drastically up over the course of 20 years, it is not genetics. There is no natural selection in that short amount of time. The problems we are talking about are environmental.
116
These and other issues effect all research, especially using humans rather than say materials. Nothing new or special here. Now obesity has several factors, two that can be adjusted are eating and exercise. Unfortunately many don’t want to change these factors.
3
I babysat for over ten years for neighborhood kids, including just being a safe place for kids who just showed up. I fed them all. But hotdogs came without buns, chicken nuggets came from a bag from the freezer, vegetables were raw, and condiments were plentiful. Mostly, I kept the kids busy, as in active. Only one left my care still overweight. I think the kids being active is missing. I do get worried about chemicals in food and cooking ware changing our biology though.
17
Looking at the child obesity map, states with highest percentages of obese children are also the poorest. If families and individuals on food stamps cannot purchase alcohol with food stamps, why should they be able to buy chips, doodles and super sweetened cereals? Just asking...
19
@High chapparal --
It has little to do with food stamps, and much to do with how much various kinds of foods cost. In general, high fat and carb products cost less, both per pound and per calorie. The inevitable result is a fatty liver and more fat overall. The real issue isn't food stamp aplicability; it is which crops get heavy government subsidy. The answer is cereals (and soya beans.) But never, ever green vegetables.
43
I wish some of the science writers at this newspaper would read this article and understand the need for caution and care when interpreting the results of a study.
20
The major societal program is capitalism. As long as it is profitable to keep us fat and sick, and capitalism remains unchecked, we will continue to get fat and sick. And no one wants a well-formulated study that finds that food is the problem.
23
@Kathy Meyer capitalism doesn’t make you eat poorly nor exercise too little. And studies should never have a desired outcome, not that many don’t.
8
Maybe not, but capitalism makes fresh, healthy foods more expensive and harder to get. It keeps minimum wage down, which makes the lowest earners work more hours and gives them less time to prepare fresh, healthy meals for their families. It limits the lowest earners access to healthcare, preventing them from getting good advice and preventative healthcare. And it pushes our education system to a “results-based” system for earning federal dollars, driving out the classes that teach life skills such as home economics (cooking, sewing, home budgeting) and civics. So yes, capitalism can be held partially responsible.
48
@Kathy Meyer Calling “capitalism” the problem is just an excuse to walk away and do nothing.
12
Donald Trump’s move to relax school lunch nutrition guidelines is moving in the wrong direction.
43
@Laura Henze Russell schools can get advice or guidance from many sources, that which is being relaxed is control which should be at the local level, not the federal one.
1
I grew up in a small town,with many dirt roads, and not a lot of sidewalks. 40+ years later, the roads have been paved,but there are hundreds of streets with no sidewalks. No one wants to pay for them: the residents pay 7 figures for the homes(ca real estate) the city does not have a city tax,(by design) and state and federal funds were squandered on other projects. It can be as simple as adults not taking walks,or kids riding bikes.
17
I am a preschool teacher. I often see small children (ages 3-5) have 40+ grams of added sugar between morning snack and lunch. Yogurt smoothies (9 grams), fruit & grain bars (12 grams), muffins (12+ grams), and fruit gummies (10 grams). Who knows what they have for breakfast, afternoon snack, and dinner.
The American Heart Association recommends that women have no more than 25 grams of added sugar per day; 38 grams for men.
68
It’s the SUGAR. Change everything else, but keep the Sugar : same results. I’ve lost the same 30 pounds at least ten times, over the Years. First and usually only step : cut out 95 percent of the sugar, especially soda, cookies, candy and ice cream. In two months, it’s GONE. Time to do it again.
47
The neighborhood I live in is full of kids, but they never go outside. The days when kids played outside are many years gone.
62
Ok. How many readers know that the research standards described here are those used for the development of drugs. Yes pharmaceutical companies conduct ALL trials to these - the highest statistical standards. Yep we do good statistically valid work. Take your medicine and get vaccinated.
5
The hard rock Reality is , Evolution time scale.
Evolution happens very slowly, food surplus in developed and developing countries has a time scale average 60 to 80 years.
Means that, hundred of thousand years of evolution period homo sapiens are barely sustaining its daily caloric intake. Including our animal ancestors , genes were in favor of converting excess calories immediately to weight for lean times ( which is 99% of the time in ancient history) but then around 10 to 12 thousand years ago agricultural revolution in Levant and subsequently leaving nomadic life started to take its toll.
If you look older cave paintings humans never expressed as obese, contrary whenever the nomadic life ended and agriculture took place mural paintings to sculptures expressed obesity very clearly.
So obesity and obese people percentage in society is increased almost half last century and going on. Our body doesn't have enough time to show genetic evolution , for that with this obesity trends we need to live couple hundred if not thousand so the genes starts to show their adaptation, meanwhile significant number of people will be died ( this is in another saying eliminated from genetic pool and the genes which evolved and handle food excess become common place) and surviving people which healthy and lives longer become adapted to new condition.
in short adaptation process just started, this cannot be very fast except some genetic manipulation by us.
4
@SU
I like the evolutionary perspective, but no animal on its native diet overeats to the point of disability or disease. To do so would be just as maladaptive as undereating to the point of starvation.
More recently, our current obesity and T2 diabetes epidemic dates to only around 1980. Something(s) changed in the recent environment.
18
It's great to see a Times article getting into the underpinnings of what methods and discipline make up good research, and by what means they are commonly messed with.
The Times editorial staff (those who have survived various pluckings) need to be well-schooled in the methods and follies of scientific research so they can help reporters withstand the wiles of health research spinners. Covering medical science well is difficult and requires constant questioning of scientists and institutions one naturally inclines to admire rather than question. Mr Carrol does a good job here of laying out the kinds of hazards with which a medical science reporter''s job is strewn. Bravo.
7
How many interventions that focus on parents have been studied?
Are parents of obese children (usually obese themselves) told that they are burdening their children with a lifetime of struggle and illness? Are they asked what they have fed their kids lately and given ideas about reasonable alternatives?
A kid may be allowed outside unsupervised for a little bit or walks to school alone and child protective services is called. But a parent raising an obese child (which one could argue is abusive) is hardly talked to, except perhaps by the pediatrician.
Was in the doctor's office the other day - family with a 3-4 year old child, very overweight, parents themselves overweight, grandma overweight - chasing the kid around and spoon feeding her processed "kids food" from a jar - mostly sugar. The kid did not say she wanted food, did not express hunger, but was constantly shoveled garbage food into her face. Unless parents know otherwise and face any consequences once they do indeed know otherwise, nothing is going to change.
20
I tried to give home cooked lunch for my kid so he could be more healthy
After making cool home lunches and hearing for a couple of years that his home lunch is made fun of, he was starting to sit at different tables
I just gave up and he now eats what ever is served at school
11
The author is correct that most research on obesity is junk. (I've worked as a volunteer scientist for the Cochrane Collaboration on childhood obesity, and been published in the NEJM on the association between behavior and weight. And yes, much obesity research is utter garbage.)
However, better research will not help us find behavioral treatments for childhood obesity. There have been literally thousands of studies using diet, exercise, and lifestyle to try to reduce obesity. Every last one has been a failure. If obesity were caused by behavior, *some* of these methods would work. Obesity isn't caused by behavior.
Don't believe me? Let's leave aside obesity for a moment. Enormous increases have occurred in diseases in all three of the body's information systems -- the hormonal, neurological, and immune systems. Examples of disorders that have increased include Multiple Sclerosis, life-threatening allergies, autism, and malformed genitals in male infants -- all of these problems have soared. All of these problems seem to be related, and none of them seem to be caused by lack of exercise of overeating. Instead, they are caused bu something biological -- most likely environmental chemicals, although there are other theories.
The increase in weight (which is being found among many species, not just humans) is almost certainly also biological. That is why *none* of the behavioral methods for reducing childhood obesity work. It's not behavioral in the first place.
24
I live in Italy, a country where people aren't generally fat and very few are obese. People live long, relatively healthy lives here. Everything they eat and the way the eat flies in the face of all the research that inevitably gets published in the NYT and everywhere else. Why? It doesn't take a study to know that Italians eat better foods (more locally-sourced), a wider range of foods, and they are generally more active than their American counterparts. (If the didn't smoke, they'd live forever.) As for children: the Italian kids who are fat drink too much soda and eat American-style fast foods. They snack between meals (Italians don't tend to do so.) There's something fundamentally wrong with the "food" in the States. Something changed in the 70's with the advent of food sciences and the addition of specialty ingredients to the foods. Today, when you visit an American supermarket, many of the products there aren't "food," they are "formulations" sold as convenient, healthy and "home made."
176
The problem with obesity studies is they often look at bandaids like diets, as in "The Keto diet cures obesity" or "The low fat veggie diet cures obesity". The real problem is structural and thanks to the power of the agri industry, it won't be fixed easily. Given today's lifestyle (thanks to the corporate greed that has people working longer hours than people did in the 1920's), there isn't time to cook, there isn't a parent at home cooking meals, and family members eat on the run a lot, fast food, restaurant meals, pre made packaged foods from the store, all of which is made, not for nutrition, but to maximize profits by making cheap, mass produced foods using the cheapest ingredients possible, andmade possible by government subsidies to key businesses like factory beef production, corn production and cheap soy and wheat products. Michael Pollan did a documentary on Netflix (called like "Earth, Fire, Water and Wind", denoting different types of foods, and did a whole long thing about how Nestle and the like operate.
One of the real cures is an FDA that disseminates nutrition information based on fact, not boistering agri businesses, and also in supporting the production of health food and stripping the corn, soy and beef subsidies that go into creating the frankenfood most businesses produce. And oh, yes, getting rid of the notion this is about freedom, or 'body acceptance", this is about health and yes, the cost of healthcare.
14
As someone who became a first-time parent two years ago I've been astounded to find that literally every food past "infant" stage (and some "infant" stage stuff too) is full of sugar. If you had told me before I had kids that literally everything in the baby food section is full of sugar I would have thought you were exaggerating, but sadly this is no joke. My wife and I go through a lot of effort to find a make non-sugar foods for our daughter but I can only imagine this is near-impossible for families with fewer resources or understanding of the problem. What's especially gallling is that kids will eat and enjoy non-sugar foods just as much if you don't give them the sugar. Our daughter craves and loudly demands sweet potatoes, bananas, pasta, etc but I'm quite sure if we had been feeding her the crap on the baby food shelf and/or in happy meals she wouldn't give it a second look. Seems like eliminating subsidies for sugar would be the obvious starting point to address this issue and are a complete no brainer in my book.
133
Don't we already know the answer here? I mean, American kids in the 50s and 60s were a much healthier weight than American kids today. So let's just look at eating patterns of kids in the 50s/60s ( calorie intake, portion size, frequency of eating, etc) and activity level (frequency of activity, type of activity) ..... and go back to that. No need to "re-invent the wheel" when we had a "wheel" that worked beautifully just 60 years ago
72
Research cannot be expected to solve or even diminish this epidemic. Voluminous research has been and continues to be done, but results rarely figure into corrective steps. Some research and some researchers are compromised by funding from food and beverage industries. Research articles in respected journals can also be contaminated by such funding. Negative findings of some research funded by special interests are blocked from publication. The real culprit is Big Food and its enormous influence on State and Federal legislators. No amount of research will alter that unhealthy dynamic.
14
Make sure you are comparing apples to apples. I'd have been obese if I wasn't living rural as a kid as I was always hungry despite the meat & fresh veggies & fruit and so on. My hunger abated after 23andme showed me my genetic variations in the ability to process vitamin D, folic acid, and B12 & I supplemented where I needed too with the advice of a physician who knew the difference between thrive and survive when it came to nutrients. Now that I have the correct nutrients, I am not so hungry that I could be and maintain obesity.
4
I was born in 1963 so grew up when TV dinners and processed food were coming on the market and were popular. I loved them. I was also skinny as a rail, perhaps because I rode my bike everywhere and played outdoors, eating dirt. Too much couch time, TV time, social media time these days.
26
@PS
I was born in 1969. I lived on ginger ale, chocolate, cookies, pizza, and candy, but I rode my bike all over, played lots of pick up basketball, played tennis, and ran around all the time. I was as skinny as a rail too. Still am.
20
@Anti-Marx and @ PS,
I bet you both also had three squares a day at home with the family. Meat and threes. I am similarly demograph-icized and yes, I'd eat candy too, but definitely three squares and not near the amount of processed food we have now. And yes, the bicycle, playing, running, Friday night kick the can sessions, after school sports, in-school sports.
19
@Steel
No. After the divorce, my mom lived in bad food. Ice cream, ginger ale, chocolate. We had pale salad, but never any real vegetables, and the fruit was orange juice from concentrate.
I was sent to soccer camp and tennis camp. At soccer camp, we had to run 2 miles before breakfast. 2 miles isn't that far, but when you're 12 and haven't had breakfast, it feels arduous. I benefit from attending private school with great outdoor sports programs. Also, I went skiing with my dad and was a cub scout doing cub scout-y things.
3
Let me try putting my ideas another way. Thousands of studies have tried altering behavior to reduce weight, and *none* of these studies have found anything that works long term. The obvious explanation is that weight isn't caused by behavior in the first place.
In fact, obesity researchers (and yes, I am an one) have been saying this for decades -- weight is regulated by biology, not behavior.
We know that a number of chemicals -- BPA, arsenic, and many prescription drugs -- can increase hunger and slow metabolism. We should be trying to figure out how to reduce people's exposure to these chemicals. (And animals' exposure, too -- weight is up markedly in wild animals and in lab animals who are fed controlled diets, not just in humans.)
49
@Judy Shapiro To me, this comment makes the real issue pretty clear. If an obesity researcher can't even face the fact that we eat a poor diet, and that our behavior drives us to continue eating a poor diet, no studies that come from obesity researchers are going to produce any useful results. Which is why they haven't.
At this point, obesity is more of an advocacy issue. We need more people, non-profits, and government agencies advocating for eating a better diet and probably less research like that posted above, which will not produce results because they are sidestepping the real issue. We eat too much poor quality food and we are relentlessly marketed to so that our behavior and attitude perpetuate that bad behavior. No wonder obesity research is not providing useful results.
33
@Judy Shapiro
"...The obvious explanation is that weight isn't caused by behavior in the first place.
"In fact, obesity researchers (and yes, I am an one) have been saying this for decades -- weight is regulated by biology, not behavior."
I'm curious. Are you really telling me that if you take someone who is overweight/obese, they start limiting their food intake more and more, and simultaneously ramp up exercise to the point where they may be eventually be running marathons or bicycling 100+ miles a week, that they're not going to lose weight?
Or to take another example, a weightlifter who decides they're going to gain 50-60 lbs of muscle (without drugs) and remain at 15-20% body fat. Is that an example of someone whose "weight is regulated by biology, not behavior"?
11
@Paul B
What we're saying is that the body will respond to caloric restriction with increased hunger and decreased metabolic rate. Long before any marathon running goal is reached.
A century of obesity research refutes "eat less, move more" as a successful treatment. Recommend a read of Gary Taubes.
21
Does anyone else just really want to point out how good those slices of pizza all look? Those look like quality slices. I don't care what the problem is, they are definitely part of the solution.
25
@Justin Those pizza slices, DO NOT look good to me! They look like heart burn on a plate.
4
Those pizza slices look top-notch! A nice walk to and from the pizza shop on safe side-walks would be a good combination.
16
Telling us the obvious results aren't helping us - we know it.
What we need is to address the root cause of the issue and that is that the vast majority of parents are so stressed out with time and working multiple jobs and not having enough income (that's likely unstable) that they can't afford, in money and time, to feed their kids properly.
This is one reason I chose not to have kids. Yet, while I was not obese as a child, I am stuck in that same unhealthy trap and will accordingly die before retirement.
12
@VJR
Rice and beans are the cheapest and healthiest food. Non-fattening.
11
The problem is not "flawed research" or the need for more studies. The problem is that parents are eating too much of the wrong foods and they are feeding their children the same. The solution is: parents should eat healthier and feed their children healthier foods. See how easy that was? Everybody, and I mean everybody (every single one of us) knows what is healthy and what isn't, in their hearts. Is there any doubt that pizza, pasta, fried foods, sugary desserts and cereals, chips and sodas are not healthy? In any quantity? Is there anybody that doesn't know that green vegetables, fresh fruits and small amounts of meat and fish are healthy? Affording and getting those foods can be problematic and that's where the additional study should go - how to get people economical access to healthy foods. But we already know what's healthy and what's not.
20
@Billy Harris Good starting place of facts. You need to couple them w/the cost & availability of non-processed healthy food vs highly processed junk. There should also be more education done, at every level, on good nutrition. Most people don't want government to tell them anything though, so I doubt whether more education will happen. Michelle Obama's initiative was a laudable start, but our "stable genius" president is trimming it back. The issue starts w/the parent and family though.
6
@Billy Harris Everybody knows pizza and pasta are unhealthy? It's ain't true. Too large portions (of anything) are unhealthy.
About 1 in 10 people is obese in Italy, significantly less than the OECD average of 1 in 6.
Pizza and pasta in Italy are small and simple and delicious dishes, made with little to no processed foods. But prepared excellently so that they leave you satisfied.
To call "small amounts of meat and fish" healthy is a stretch - they are not needed at all. People would have better access to affordable food if they ate far less meat and fish. But for some reason many people think that every meal needs to include meat, thanks to the meat lobby.
You to claim " we already know what's healthy and what's not.", but I think your post proves your statement wrong.
8
Where I grew up there were no school buses. Even in kindergarten I walked more than a half mile to school. We all came home for lunch and then walked back to school for the afternoon classes. If we wanted to go somewhere we had to walk at least a half mile to the city bus. We walked to friends' houses blocks away. We were constantly moving during the day.
Today's idea of moving is a phys.ed class, which is a joke. The athletic kids play ball games while the rest of the class stands around at the edges of the game. Kids are mostly sedentary. Many schools don't have recess.
A visit to other countries shows that Americans have no idea what a portion is. A Danish pastry in Denmark is 1/3 the size of ours. Unfortunately, fast food is relatively cheap, and for a mother juggling two or three jobs, it is the easiest way to feed the family. It is also true that genetics plays a role, but obese families also have obese pets, where genetics is not a factor.
100
I think another problem is the media. Movies with over weight actors validates an unhealthy situation.
12
These are excellent points. I am surprised the author used the phrase "when trying to prove that subjects changed their diet or exercise habits, we simply ask them if they did." We cannot prove anything in science - all we can do is disprove. Scientists and laypeople alike fall into that trap all the time. This has huge implications for how one designs an experiment. In other words, a study designed to "prove" that subjects changed their diet is at the outset a really badly designed study.
7
@it wasn't me
Leaving out nutrition, which is a minefield, science doesn't just disprove things, that isn't true (that is basically what "creation science" believes, so if they can show holes in evolutionary theory that are well known, ipso facto they 'proved' that evolution is false). Proof in science is based on both data analysis and experiments to see if they support a hypothesis, and if they don't, the hypothesis is analyzed along with the data to see why it didn't work. Scientific theory itself can be validated, Einstein's special theory of relativity predicted that light would be bent by gravity and how much, observation showed he was correct. You are basically arguing if science cannot disprove something it must be true, but that is a fallacy, the fact that science cannot disprove something doesn't mean it is proven, it simply means it is possible, based on current knowledge, that it is true. String theory, the existence of tachyons, multi universes, all are possible based on the math and science has not been able to disprove them, but that doesn't mean they are proven, either. On the other hand, if science could develop a method to test string theory for example, as they did with gravity waves, and the test shows what the theory predicted within a certain bounds, then it would be proven. With nutrition, no one has figured out rigorous tests that can have such level, in part because of ethical concerns.
2
@music observer
Good try, but no cigar. You contradict yourself, saying first that failure to disprove (in a properly designed, rigorous test) does not prove a hypothesis (CORRECT), but then saying if a test shows (supports) a theory-based prediction within certain bounds (not clearly specified), the theory would be proven (INCORRECT). In the scientific method as generally understood, a theory can never be proven--there is always the possibility that another test could disprove it. Repeated tests of different hypotheses developed from a theory that fail to show the hypotheses to be false do not prove the underlying theory; they only increase the strength of (empirical) support for the theory and the confidence that future predictions will also be confirmed.
1
Statistical significance is based on arbitrarily imposed criteria for outcomes being "unlikely to arise by chance." It is not foolish to conclude that a given study cannot confirm that the hypothesis is supported, but still to maintain the hypothesis. If something is significant at the 92% level of certainty, but not at the 95% or the 99% level, one might legitimately say "we cannot confirm our hypothesis at our normal level of skepticism, but we still think our ideas are correct and we will undertake more experiments to test them further." Statistical tests are only part of the evidence that should move our ideas.
Too, consistently negative hypotheses tests should be as publishable as tests that confirm hypotheses. Both hypotheses supported by evidence and those rejected by evidence should be publicized. The publishing bias toward positive results lead to the experimental "fudging" discussed in this column.
3
Never trust a statistician not to make the numbers fit the story better. We're all guilty of bias by degree. Only academics are charged with making their bias explicit. Many fail even at that.
However, as a guide to useful analytics, Dr. Carroll offers sage advice. I wish he could present to a good number of managers, directors, and other high level business administrators I've encountered. People fighting over budgets and margins are among the worst numerical manipulators.
The question "compared to what" in particular sticks in my mind. How can you know whether a number is good or bad without a theoretical basis for good and bad? "Sir/Mam, we've seen one hundred thousand fruit flies die in Tapachula, Mexico today." Okay. Well, is one hundred thousand fruit flies dying good or bad? Is that normal? Do we even know?
There really is no end to the abuse applied to honest analysis. At best, statistics becomes a creative art form. At worst, you're dealing with a mathematical travesty. There is a bottomless pit where all good analysis goes to die when directors discuss their annual budgets. Why would obesity be any different?
76
To your list of suggestions, I would add one more:
6) Follow the money.
Too often such studies are funded by proponents with stakes in obscuring the solutions, even though the signature of Big Food, like Big Pharma or Tobacco, is difficult to ascertain.
Recommended reading is the book by Dr. Robert Lustig, pediatric endocrinologist, The Hacking of the American Mind.
22
@ChrisB great recommendation. I would also suggest Paul Farmer's work on structural violence. He talks a lot about how corporations, governments, etc. cloak themselves in invisibility while individuals are blamed for conditions that effect, marginalize, and oppress millions of people around the world.
8
When I moved to the US 30 years ago, I was surprised by how many parents bragged that their children were 'big' for their age. Although not all these children appeared to me to be fat, I did (and still) wonder if their diets were responsible for early growth (height) but setting them up for obesity because they were used to to large amounts of food.
10
Perhaps if America cared enough about their children not to feed them like cattle for their school lunches, we might have a different outcome. Anthony Bourdain visited a school in France and it was a delight to see what students ate for lunch, all healthy foods.
Meanwhile back in America the Trump administration has now torn Michelle Obama's healthy school lunch program apart so students can eat more burgers, fries, pizza, and little to no fruits and veggies.
It doesn't take a research study to see why kids are overweight.
It we continue to feed them junk that is the outcome.
317
@Jacquie, Not to denounce your argument, but inculcating healthy eating habits in children is the parents responsibility as well. Agreed, children who come from disadvantaged families only have school lunches as an option (so your argument is real), but for parents who can afford the time and money, why aren't they packing school lunches? (I have seen enough cases). A bigger issue might be that when the same parents with their kids gather to watch television in the evening and are bombarded by visuals of a juicy burger rotating on a plate or crispy fries falling in slo-mo all healthy intentions can come to naught.
14
@Sharad Yes, I agee healthy eating habits begin at home for those who can afford it. However, it seems many don't place much value on nutrition and how it relates to health.
On the other hand, many can't afford to hardly put food on the table so they eat what they can afford.
13
@Jacquie
School lunches should be healthy, but they seem to cater to children's tastes, serving what they are used to and minimizing waste. Children are used to just a few dishes (pizza, macaroni and cheese, hot dogs, hamburgers, chicken nuggets, cookies and other sweets) that are served to them at home and in restaurants, no variety at all. Parents do not cook, just buy processed ready food, complaining that they have no time or money. Even affluent parents do not want to antagonize their children by forcing then to try new dishes. Obesity or malnourishment, behavioral and learning problems are the result of such lazy and permissive attitudes.
16
These are the results that the incentive structure of capitalism produces. You and your colleagues have been “relatively unsuccessful” in treating obesity because it isn’t entirely or even predominantly a medical problem. It is a problem created by corporations to sell more highly profitable but nutritionally deficient product.
142
@Steve Bruns I agree with you. The "epidemic" is what Big Food is allowed to get away with, the predatory marketing practices in food deserts in this country and others, the vast sums of money that is spent on research and development in terms of new and ever more effective ways to get human beings hooked on junk food, the lobbyists they employ...it goes on and on. These companies are making human beings ill and they know. The same way Big Tobacco knew. Big Food uses the same playbook and even many of the same lawyers from the tobacco industry. One CEO at a major (junk) food company was also on the board of a medical device company that makes...wait for it...insulin pumps.
42
It all tied to the economy set up by "capitalistic" approaches. Companies make money off people getting sick. Healthy foods take a lot of time to prepare and cook. Today's economy, parents just don't have time as they are forced to work long hours to pay their bills. In response, companies create processed foods and people get sick so they end up paying hospital bills.
Lets not forget that a lot of these "research" are funded by these process food companies. Marketing people will cherry pick the data so they can advertise to consumer as "healthy alternate" or "promotes heart activity" etc...
13
@Nyu
"Healthy foods take a lot of time to prepare and cook." Instant pot anyone.... Beans rice throw in some vegetables not terribly expensive and definitely not terribly time-consuming. If we want to find excuses we should do so but if we wish to be successful and rear the children that we took the time to have then perhaps we can design good outcomes. This isn't rocket science folks! And as for exercise, you cannot chase excess non nutritive calories away
8
I've watched in wonder as parents and schools serve up fattening junk food to their children. There's no excuse for it, except it's easier than cooking or preparing a sack lunch for their kids.
My folks prepared lunch for me. There was not much fattening about it. A sandwich, an apple, or an orange. When they couldn't prepare lunch, they gave me lunch money.
My school cafeteria didn't offer much in the way of junk food. Sure, you could find a burrito in the vending machine, but there simply weren't any of the items we see offered now.
Sometimes, I find myself longing for the cinnamon buns that were made fresh each day. I know that's not a nutritious item, but it's the only thing I would go back to high school for.
21
When I was young, the most self indulgent food we could imagine was a banana split, which included a piece of fruit! Nowadays self indulgent foods pile sugar on sugar ( for example Blizzards) or fat on fat (burgers with cheese and bacon for heaven's sake). Our entire food culture has become so self-indulgent it's a parody of itself. We need to find a different way of filling the void in our lives.
57
@Lou Hoover
We used to go out for ice cream sundaes to celebrate a major event like a school graduation. Soda was rarely drunk; mostly we drank water. If we had a chocolate bar it was very small; way smaller than one today. I think that what was then considered a ''treat" and only for a special occasion is now a regular part of the diet.
62
@Lou Hoover
I'm 50. I grew up eating a lot of junk food. But I was always active. Also, we had stairs and no elevator, in my building. Now, I live in a building with elevators and no stairs.
I live in a very, very affluent area. Most parents are wealthy and highly educated. I see their children (age 4-8, I guess) skipping and running ahead of them. Also, thy ride those little scooters like crazy, but if they are not on a scooter, they are skipping and darting around. Always in motion.
Honest question: Do poor children skip and dart around? The rich parents in my area seem to say "wait at the corner. Wait for me" all the time. The kids appear to have boundless good energy and want to zip around. I think it's adorable and healthy. They're like little wind up toys.
9
Dr, Carroll ==> The chart used in your article uses the standard of "Definition of overweight or obese: B.M.I. at or above 85th percentile of C.D.C. growth charts for age and gender. " .
This is not the CDC approved standard for BMI-for-Age. According to the CDC "Interpretation of the plotted BMI-for-age is based on the established cutoff values previously shown" which is shown as "greater than or equal to 95th percentile Overweight."
The standard used in the chart in your essay includes those 85-95% -- which according to the CDC are at "Risk of Overweight" -- which is quite a different thing.
Can you comment on this?
10
So as we don't necessarily know all of the reasons for childhood obesity, and we lack the time to sit around and wait, why not just look at what is different now as opposed to decades ago when childhood obesity was pretty rare?
It could be termed "anecdotal" but I suspect the figures could be found to add credence to whatever is discovered. I know, looking at the difference between my own childhood and that of children today that a number of things have changed dramatically. For starters I'd suggest that these factors could play a role; increased addition of sugar, HFCS and other sweeteners to pretty close to most processed foods, the increase in processed foods and decrease in cooking from "scratch", the increase in fast food meals and eating out, the abundance of snack foods, increased "portion sizes", decreased outdoor play time and increased inactivity of children glued to their phones, video games, DVD's, TV etc, the reluctance of parents to let their kids walk places and the proliferation of plastic products with concurrent hormonal effects.
Sadly, I suspect one would have to change ALL of the factors listed above inn order to return to the conditions that were prevalent in my own childhood. I'm unsure just what would have to change to have it be more like my parent's or grandparent's time but I'm sure obesity was rarely an issue then.
25
While agreeing with your description of potential causes of error in analysis of these data, it would have been important to also raise the issues around the data collection and the concept of BMI as a standard for assessing child health in the 5 to 20 year old population. The survey instrument cited uses parental or guardian reports of height and weight; these are often estimates (I say this as someone trained in infant anthropometry and the grandmother of young children who have good pediatric care but whose parents do not always know their exact weight.).
More confusing, and possibly concerning, is the use of a ‘standard’, BMI, which is not used internationally in the assessment of child and adolescent nutritional status. A quick review of the CDC website brought up data tables (apparently based on 2000 data) for 2 to 20 year olds showing BMI values within percentile bands. Presumably these are based on a large data set of US children and adolescents. In that case, roughly 15% of the US population of children/adolescents should measure above the 85th percentile (being overwt/obese), the cut off cited in the story. How then can the US data show what is clearly, as per your discussion, a higher percentage [roughly 25 to 40%] of overwt/obese children (taking into account the differences in state populations)?
5
Stop subsidizing corn. Ban ads for processed food. Subsidize healthy food. Michael Pollan said it best. Eat food, mostly plants, not too much, no ingredients we can't pronounce .... Research that focuses on individual willpower over systems that lead people to eat unhealthy food (it costs less, it's sometimes the only option and Madison Ave bombards us with ads designed to convince our subconscious we want it) is not going to get us anywhere.
178
Cook with your kids. Garden with your kids, even pots in the windows. When they participate in the growing and the preparation they enjoy the food they grew and made. This goes a long way toward choosing healthful food. And don’t tell me you don’t have time. We all make time for things we want to do that are important to us. Raising healthy children should be a priority. I didn’t find out until I was in my 40’s that my dad really didn’t like certain vegetables. He ate them to set a good example.
26
@Wende In point of fact I think people like you are the problem not the solution. I'm a gardener and a cook but I get why people don't have the time.
Instead we should encourage solutions that use frozen vegetables. That used pre cut vegetables and pre cleaned meat. Recipes that simplify the process and are not for purists.
Also this idea that gardening will produce produce successfully that children will get into. HA and HA again. The cabbage that looks ready to eat until the groundhogs take it. The tomatoes that get blight. The zucchini that should be prolific but die of unnamed reasons. That's what really happens. Don't even get me started on pot on the window which usually wither and die leaving people inadequate.
14
I don’t think it needs to be either/or. There’s a rightful place for plain unadulterated frozen veggies and fruit. It can be very economical and handy to use them. But gardening with kids can be so positive. True, I was a farmer for a long time so I suppose it’s easy for me. But even farmers veggies get blight and eaten by deer and chucks. Still, I spent time gardening with my own child and with children in a school garden. The delight that kids take in growing fruit and veggies, harvesting what they grew and then eating it is heartwarming. If they grow it they will eat it.
8
For years, I've had the nagging concern that certain industries benefit from behavioral or environmental factors that exert detrimental effects on human health. Think big pharma using medications to mitigate the consequences of obesity from inactivity, highly processed foods or air pollution. One industry damages our health which creates new industries to treat us.
Some of these vicious cycles may be an inevitable fact of life, because one segment of society provides fodder for the success of other segments. If so, we need more conversations about ethics and morality.
12
It's not that we don't know how to solve this problem. Oh, we know. It's that we want an easy fix that doesn't require meaningful sacrifice. It's the new human mindset.
There has been plenty of research, as well as health data evidence since the 1800s when sugar first became readily available to the entire populace, showing sugar as the major culprit of the obesity, diabetes, and heart disease epidemics. And plenty of research proving the 1950s and 1960s focus on fat was entirely faulty, driven more by the meat industry than science. Yet today, the sugar industry and its powerful lobby again effectively stifle any meaningful action by governments to educate consumers or provide incentives to change behaviors by attacking science in its usual backhanded ways.
Everyone is waiting for the magic pill to solve the problem. Or some silly new diet or exercise regimen that is nearly impossible to follow for more than a few months. Funny, how the words diet and exercise have evolved into some temporary solution. Diet and exercise are ways of life, requiring discipline and sacrifice. It's how you live - for your entire life.
22
Good points, all. There is a lot of bad science in clinical studies. However, the author ignores a fundamental scientific and statistical problem with measuring obesity in America by using BMI (Body Mass Index). BMI is a crude assessment of an individual's ratio of weight to height and then placing that ratio on a standard curve (similar to a z-score or percentile). It does nothing to account for variances in body build, bone mass, etc. While BMI has legitimate value, it is badly misused by the "scientific" community. Thus, while it is highly likely that the obesity problem may be growing in America, the author would have to agree that we can't simply assume that's correct until we do the proper studies, with a modified BMI or some other more accurate parameter.
11
@MTDougC
BMI is a rough number and for example, an athlete like LeBron james is technically obese if you look at BMI, even though he is an elite athlete (I have had someone claiming obesity isn't a problem point to him and others; what they leave out is athletes body fat percentage is low, an obese person has a very high body fat percentage). It would be much better if instead of a scale, there was an easy, accurate way to measure body fat, because that tells the real tale. There have been studies of groups of people, and they found roughly the same percent of people were obese as BMI indicates.
It also doesn't take a study to figure that out, observation should tell you that. When you look around the number of people whose body has an excess of body fat has grown, and frame size and bone density has nothing to do with that. When I look at kids today,compared to when I was growing up (and note, I was one of the heavier kids), the numbers who show the signs of obesity are staggeringly higher, and that body fat is the problem, not the weight itself.
4
@MTDougC BMI as an absolute measure is problematic for the reasons you state, but as a measure of an intervention's effect it is valid. By looking at the change in BMI for an individual study participant, you eliminate the effect of bone mass variation.
2
On further reflection, however, an intervention involving resistance training could displace fat mass with denser muscle mass, and show less improvement in BMI than it would in body fat percentage.
For that reason, I agree that BMI is ultimately a poor measure.
6
The author writes: "If there are no sidewalks, you may be unlikely to walk to the store or to school, for example."
This is probably the single biggest impediment to making physical activity a daily, reflexive part of people's lives without the expense of a gym membership or the dedicated scheduling that going to a gym requires.
Outside a small group of cities (Boston and NYC come to mind first laid out as they were before the car), the typical American city pretty much requires a car and the layout of the city itself reflects the ongoing age of the automobile.
When I'm driving someplace here and elsewhere, sometimes I'll pay attention to the sidewalks. They're often cracked and pitted when they're there but more often they're non-existent.
Or a sidewalk will exist for 50 feet, vanish for the next 300 feet and then reappear immediately at a crosswalk (only to disappear again once you've crossed the street).
96
@LR
And biking can be really scary as well. You'd think that living in Vermont I could easily bike places but I just don't
due to the narrow roads, non-existent shoulders, speeding cars and all the rest. I biked more as a child growing up in NYC than I do as an adult in Vermont.
31
@LR
While moving and being active is important, one of the fallacies (spread I might add by the food industry and by people explaining their being overweight) is that it is because people are not active these days, with their electronic devices and social medial and streaming and such (with some older person nodding their head and saying "In my day, we walked 5 miles to school, uphill and down dale") is that physical activity is the cause, it isn't. You talk to any expert on health, nutrition and yes fitness, and they will tell you 90% of it at least is in nutrition. Eating a diet high in sugar, in saturated fat, in empty calories, no matter how much you exercise you won't be able to get into shape, it doesn't work. Athletes, even golfers these days, spend an inordinant amount of time on nutrition along with exercise, the days of Babe Ruth or Mickey Mantle are long gone. The key to healthy bodies is almost entirely nutrition, while exercise of course has health benefits, it is a parallel add on, not the replacement for good diet.
12
@LR No, the typical American city doesn't require a car, at least not to travel fairly short distances; it's the typical American suburb that requires a car.
5
The so-called solution, isn't one. "People on diets often gain weight." There's no "often" about it. It is more like "invariably" or "inevitably," but that remains the solution? In fact they invariably gain what they lost plus more. That's what studies demonstrate over and over. As someone recently pointed out, fat kids are told to adopt the food habits of anorexia. That's evidence-based medicine.
I have a solution. TEACH KIDS HOW TO COOK. STOP VICTIMIZING THEM!
And while you're at it. Stop putting growth hormones in farm animals and pesticides on crops. The growth of agribusiness and increased use of hormones and pesticides seem to have gone hand-in-glove with "childhood obesity."
29
With the current emphasis on “wokeness” it is hardly surprising that childhood obesity is a major problem.
The media, movies, ads and commercials are constantly giving everyone, children and adults, permission to be obese.
Broadcasting the message that it’s OK to be obese will only lead children (and adults) to overeat and expose themselves to a lifetime of easily-avoided disease and debility.
Why aren’t there equal or greater numbers of messages and exhortations about healthy eating and lifestyles?
For the vast majority of people, obesity is a choice, not an inevitability.
32
@Mon Ray
While I share some concerns with the 'fat acceptance' movement in that many people in that movement make absolutely bogus claims, like being obese or severely overweight is not unhealthy, that obese people can be fit (in the sense they walk a lot, do yoga, swim, etc, etc), and they are confusing being fit with being healthy (any more than that skinny fashion model who smokes, lives on a diet of junk food and probably uppers, is healthy). This isn't about how someone looks in tight clothing or images of 'beauty', it is about what is optimal for the body, and being severely overweight or obese is not good for the body.
I would argue about it being a choice, though, that is the old puritan "people are overweight because they are gluttons". A lot of the weight we see are societal factors, people don't have the time they once did to cook (only 15% of families with kids have a parent at home), and economically in our society the foods more harmful to you are cheap. That Big Mac meal has like 3000 calories in it, full of fat, sugar and other crap, and costs less than 5 bucks. Meals that are more healthy, whether prepared or take out, are expensive, produce is very, very expensive, as are whole grain foods and the like. The real problem is the government/food business alliance, that has created the packaged food monster and made sure it is dirt cheap, 98% of farm subsidies go to packaged food and other unhealthy food production, 2% goes to fruits and vegetables.
16
@Mon Ray - If what you say is true, why do so many kids develop eating disorders? You are wrong about how heavy kids are treated. In many situations, they are bullied mercilessly.
11
Access to real food, education, less screen time, addressing childhood obesity will require systems-level thinking approaches. The research will be limited and show limited effects because one intervention alone will not change the multitude of factors that will be required to reverse trends --- reduce poverty, change cultural eating habits in some populations, get rid of technology in others, increase access to sports for everyone, offer good jobs so parents can afford the sports, provide incentives in schools for kids to be active.... it likely will all help, when you look where obesity trends are the worst, it is in lower-income families- regardless of race/ethnicity. We need to be thinking about this holistically, and a p-value may not be the only way to show the statistical significance of interventions. We as public health practitioners are too dependent on these outcomes, and the incentives to publish what works keeps us from thinking holistically about complex problems with multiple origins.
6
All good comments here on this issue. I note two other things that have changed since I was a kid--
1. Not drinking water with meals and thruout the day. We didnt automatically turn to juice boxes, sodas or any kind of dairy based drink when kids needed a break playing sports or in between classes.
2. Way too much electronic screen time for both adults and kids, especially the kids. We need to get them off their devices and back outside to play in an unstructured way.
85
Too many gamers and not enough athletes.
I'm hesitant to blame food. When I was growing up, most kids had no problem devouring entire pizzas, subs, chicken fingers, etc. The main difference was that everyone was required to play sports. Lots of physical activity seems very important for children/adolescents.
With adults its a bit different because metabolism has slowed down substantially, which means dieting and eating healthy has a bigger impact regardless of how much you go to the gym.
25
@John
Well actually John half the population wasn't. Girls didn't play sport at all. And uncoordinated kids didn't do any exercise.
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@John Not every physical activity has to be a sport too- part of the problem is that movement for kids these days is so structured. Kids who love video games may not do well at competitive sports but could enjoy kicking around a ball in an unstructured way, riding bikes, or walking/running. But parks and playgrounds in the areas where people most need them tend to be run down and dangerous. Inner city playgrounds should be just as nice in the worst part of town as the best. We should focus on posting police officers (trained in working with children, no shooting kids with toy guns) at playgrounds to make sure they're a safe place to play.
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When I was parenting my young daughter, I was amazed at how every sporting event, such as a soccer practice, that might last 2 hours, had the obligatory "snack" break. It seemed as though these 7-8 year old kids could not be expected to last 2 hours of modest activity without a snack. Usually boxed juices, or other alternative. Same with elementary school. Between hanging up the coats, and all the snack breaks, not sure when my daughter learned to read. Birthday parties were celebrated with cake, at least 5-6 times/month during the school year. Many activities, even education, revolve around food, starting at a young age. Tough to combat that.
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@Glynis Scott - Thanks, Glynis, for your comment. The novelist Harlan Coban wrote a sharp, amusing essay on the topic of snacks and children's sports in 2006 called "Will Play for Food" - well worth reading: https://www.harlancoben.com/will-play-for-food/
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At one school I know, and most likely many others, the kids have snacks and juice around 10:30AM -- little popcorn bags, chips, cheese sticks, and whatnot.
I dunno. I daresay the administration and school nurse think it beneficial.
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Look at the parents. They are often obese. If the parents are struggling with obesity too they can’t teach their children the everyday habits and food choices necessary to avoid obesity. Just go in the grocery store and read the labels. You will see aisle after aisle of processed food full of sugar. Toxic. Change starts with the parents.
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I’d like to know if these summed up points are reviewed in greater depth in a more technical journal review article. If so, I’d like to get the reference.
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They are pretty standard rules for conducting clinical trials, and in some cases standard rules for the interpretation of data from any experiment. There are many reviews/books on experimental design and data analysis.
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@E yes! Follow the links.
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Thank you, Doctor. It must be disturbing as a scientist to see that tool corrupted and compromising efforts to understand and ameliorate the sad handicapping of our youth, and at great cost.
What comes to mind for me, more generally, is what I heard during a brief flirtation with Scouting, 'the boy needs the pack and the pack needs the boy'.
People are not entirely on the own, they rely on what they see around them to guide them.
'According to IRI, a Chicago-based marketing and data firm, the country's top-selling cereal is Honey Nut Cheerios, which raked in over $656 million for General Mills last year. Post's Honey Bunches of Oats and Kellogg's Frosted Flakes rounded out the top three.Mar 12, 2018'
Free market capitalism is not embarrassed.
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@William
And try to buy a healthy non-sugary cereal at a mainstream grocery store today! I just tried(and failed) to do that very thing. I have to go to a food-coop to do that. Why?
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@Greenie I am more fortunate. I just returned from Stop and Shop supermarket with Woodstock non-gmo 5 grain cereal. First time I have bought it, 0 grams added sugar. 13 servings, three dollars.
Haven't come across a food coop here. There are seasonal farmer's markets in the area.
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@Greenie I went to Shaw's Friday. They had Cheerios.
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As a pediatric NP primary care provider focused on health, trying to deal with obesity is a frustrating and often depressing aspect to my daily workload. The time required to actually educate parents/caregivers just does not exist in the time allotted for each patient. And frankly the parents/caregivers of obese children are often obese themselves and shut down when the obesity issue is addressed no matter how the issue is approached. Childhood obesity is nothing short of a crisis in this country as this article discusses. Who is going to be responsible for paying the "$150 billion in health care spending per year" for this health problem as there are some families who actually make their children's health and wellbeing a priority.
There are many questions that need to be addressed:
Are these families making the effort toward health now responsible for the healthcare costs of the obese families who are the consumers of fast /processed foods, and lack the motivation to get out and move ???
Like tobacco companies, are the producers of junk food liable in any way for the healthcare costs that result from the consumption of this junk?
Are we past the time when the government needs to start a mass education program, like educating against tobacco, to help stem this obesity epidemic?
Our government is now in the shameful process to allow more junk to be served to school children, what should the public response be to this move toward feeding our kids more junk?
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@AnnieNP
" The time required to actually educate parents/caregivers just does not exist in the time allotted for each patient. And frankly the parents/caregivers of obese children are often obese themselves and shut down when the obesity issue is addressed no matter how the issue is approached."
The parents don't just shut down--they file complaints against the provider. (And employers don't delve into validity of complaints, they simply count them.)
Couple that with the provider's "loss in productivity" by taking the time to give dietary advice and you'll find wise providers shut up, and passionate ones don't survive.
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We need real policy solutions---we can't use rely on folks to regale their eating. Tax and regulate junk food like we did with cigarettes; drive down prices of Whole Foods (they should be cheaper, not more expensive); get junk food out of sight etc. People also need to learn how to cook again through real public health campaigns.
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@Ellen Whole Foods has plenty of junk food.
Focus on underlying ingredients, not brands and marketing.
Tax added sugar, subsidize fruit, veggies and whole grains. It does not matter where they are sold.
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Mississippi, Kentucky, Tennessee, a lot of Trump voters there.
Supporting, I suppose, Trump's rolling back of school nutrition standards introduced under Obama, food stamps, take $7 billion away from the CHIP program, and so on.
For his supporters he can shoot someone on 5th avenue without losing a vote, can he destroy the health of their children too?
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A large part of the obesity crisis is due to our obsession with crunchy food. A pound of potatoes has 350 calories, and a pound of potato chips over 3000, and we’re much more likely to want more chips than more potatoes. Likewise corn and Corn Flakes, oats and Cheerios. Look at the pictures of the Mexicans who ate corn vs. the ones who eat tortilla chips. Disclosure: I love tortilla chips.
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American obesity is more a cultural problem than a medical one. We have an unhealthy food culture exacerbated by a junk food industry that churns out and promotes unhealthy products at an astonishing rate and volume. It is almost a given to indulge infants and small children with sweet drinks, ice cream, cookies and candy, establishing a life-long craving for junk food.
Unfortunately even cultures whose diets were traditionally healthier than those of the industrialized West are being seduced by the addictive pleasures of junk food...and its concomitant curse of obesity.
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@Reed Erskine also the constant “wine” break from parents. This makes me even sadder that they cannot go to an event w/o wine.
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A “diet” to lose weight is a recipe for failure. It implies that once weight loss has been achieved — if it ever is — the dieter will go right back to eating what they were eating, which is how they gained weight in the first place.
The best way to lose weight and keep it off is to change eating habits. For life. And one of the healthiest diets which also promotes weight loss and a healthy weight is whole food plant based. Avoid processed food — this is huge. And avoid animal products.
Michelle Obama’s goals were laudable, and exercise is important to good health. But the adage: Get Fit in the Gym, Get Thin in the Kitchen, is true.
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@Dr. J “Change eating habits” = diet=food restriction= weight gain over the long term. It’s really hard to get around that.
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@Bambam,
I’m not sure what you mean.
I lost weight 20+ years ago by practicing portion control and making healthier choices, about 25 pounds over 18 months. I’d already been exercising for the year before I started, with no weight loss (though I did get much more fit). I never went back to my old way of eating, and I kept that weight loss off.
Then a few years ago, I switched to whole plant food eating (I’d been a vegetarian, so I dropped the dairy and eggs, and I started avoiding processed food), and I lost another 10 pounds without even trying.
Both my brother and my husband had similar experiences, with greater weight loss. We do cook at home, though. But cooking is considered light to moderate exercise, so bonus!!
4
@Dr. J
Any "plant-based" diet that claims to prevent or reverse any disease always involves removal of _sugar_, refined carbohydrates, and other highly processed foods.
Yet you always attribute to the benefits to the veganism, while ignoring the sugary elephant in the middle of the room.
Humans in general are omnivores, and are not likely to thrive on vegan diets. There are lots of lean and healthy omnivores out here, and lots of unhealthy vegans.
9
Look at any kids menu at restaurants in the US. Then compare that menu to children’s menus (where they exist) in countries like Spain, France and Portugal. In the US they’re full of things like pizza, plain pasta and hot dogs. In Europe, its typically just smaller portion sizes of adult meals. The problem is staring us in the face, kids are not eating healthy. I have a toddler so I get that it’s hard to get kids to eat healthy, but if their only option is healthy- they will eat healthy because they don’t know anything else. Offer bread one day and they will only want bread. This can’t just be up to parents, this is bigger- any effective solution has to come from all sides. The community influences need to change, children’s menus need to change...
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@Teresa D’Anna
Look at what adults eat here as well. Adult portions are huge at restaurants. Generally you get a 2-3 portion meal, usually heavy on carbs and fat. I ordered one of those cooking boxes which is great but the portions are huge- I get 2 meals per serving. Unless you track calories, you have no way of knowing that meals that get tagged as healthy are 2X to 3X the number of calories you need.
Kids food is garbage and highly addictive- I watch my niece and nephew eat breakfasts of pop tarts and "go"gurt. They won't eat the healthy options. Their parents would NEVER eat this junk. It is bizarre. Their kids are not fat though, but one has digestive issues.
People and kids need to eat real food that has not been processed. Meat, fruit, veggies, eggs, more veggies, grains, healthy oils, dairy. Even what we target as "bad" whole foods are better than the best processed foods. Plus, whole foods are hard to overeat.
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@Teresa D’Anna My daughter attended school in Italy for a semester. The lunch cafeteria selection was extraordinary and healthy. Oh, and they also had two spigots of red and white wine available for general consumption. There was no one in line for them. There is a cultural difference in the consumption habits of nations. We have to build that here!
23
Spent time living overseas and when I returned to the US and went shopping at the grocery store I nearly cried. I still miss the entire stores devoted to fruits and veggies. Clementines so fresh they still had green leaves attached. Fruit and veggies grown locally and only sold when in season. Sigh...... And here we have so many aisles devoid of nutrition and filled solely with soda and snacks.
29
Yesterday I read an interview with someone who joked that his kids think he's evil for net letting them drink Coke with breakfast.
I wondered if they'd react the same way if he'd said they couldn't snort coke with breakfast? It is no exaggeration to say that these two white powders are similar in their destructive effects, but we tolerate one addiction, while we outlaw the other. I'm sure that he trolls are already firing up their 'personal responsibility' memes, and their 'everything in moderation' tropes, but the results are all we need to examine. Kids can not express personal responsibility, and moderation is a bad joke. What is the acceptable level of coke at breakfast? How do you 'moderate' a 64 ounce slurpee? Isn't it time to bring down the hammer on this white powder, and then follow through with all of the other fake foods that we're poisoning our kids with?
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@Sera
Parents need to decide food choices for children. Why is Coke even in the house? If it wasn't brought home by the parents, children wouldn't have access to it for breakfast. Long ago, when I had friends visit for a weekend, they kept trying to give their kids snacks constantly, which was totally against my approach to raising my child. Children do not need constant snacks throughout the day. When we went to our swim club, which had no snack bar at the time, their kids were constantly complaining and noting their home swim club did. And when we visited their swim club, there was an emphasis on buying snacks instead of playing in the pools. (Unfortunately the younger parents forced our swim club to have snacks and pushed for alcohol too against the older baby boom and elder generations which did not want food at the club and certainly not alcohol.)
You moderate a 64 ounce slurpee by buying the much smaller size or not buying it at all. Parents need to get much better about just saying no and not buying food as a substitute for love or attention, and not giving their kids money to constantly buy junk when they are not with their parents.
16
The biggest impediment to tackling this problem is magical thinking and a fear of 'words' and race.
Being overweight is a health risk - we have to treat it like a disease.
There is only one way to lose weight and become more healthy - expend more calories than are taken in - the basic and universal law of thermodynamics will not be overturned by magical calories - by magical foods - or by magical thinking or a magical Dr's intervention
Part of expending calories should be a basic level of physical activity.
All of these things belong to the parents - not the Dr's - it is folks like Carroll who somehow believe it is their task to accept blame for abysmal parenting and abysmal parental habits.
Shortly after parents comes school districts who seem to sacrifice basic physical activity at the altar of all manner of curriculum requirements that are somehow much more important.
Lastly we have to acknowledge a racial aspect to the obesity epidemic - believing that there are not racial components is going to cost many young women of color their lives - too young in childbirth or too early in old age due to the ailments of excess weight.
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@SteveRR
Thinking of weight gain or loss as "just thermodynamics" is part of why we have failed to understand and treat this epidemic.
You ignore the numerous roles of biology, including hunger/satiety, hormonal systems, fat storage, blood sugar balance, metabolic rate, etc, all of which _alter_ both calories in and calories out. Calories in and calories out are _interdependent_ and both are mediated by both amounts and _types_ of foods.
In short, calorie flows are _effects_, not causes, in a biological system.
We are not toaster ovens. Recommend a read of Gary Taubes to get caught up.
10
Well, we do have the Biggest Loser study, and we learned that resting metabolism decreases a lot with food restriction, even after the restriction is lifted. We also know that over 90% of people who lose weight gain it back, plus more. We also know that every eating disorder started as a weight loss diet. I’m not sure what the value is to tracking “childhood obesity,” except to report the scientific finding that bodies are bigger. An evidence based study of why instead of making assumptions about what people eat and how much they move would be most welcome. I’m reading a lot of assumptions in the article and comments that are not challenged.
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@Bambam
Studies that examine why people choose certain foods, or how people make food choices have already been done. The no. reason is taste, and food companies spend millions developing foods that are tasty difficult to resist.
The no. 2 reason is price.
Solutions:
1. Healthy food can be tasty, people needs to learn how to cook, society and work environment has to allow time for people to cook.
2. And perhaps some price subsidy for fruits and vegetables? (Doesn’t the farm bill subsidize corn production — might go into producing high fructose corn syrup?) How about using agricultural policies to reduce price of healthy foods.
3. Eliminate food deserts so people can have easy access to healthy food.
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The value of tracking childhood obesity, and looking at ways to intervene, is that childhood obesity is highly correlated with even worse adult obesity, which has a very large impact on public health and the costs thereof. Knowing the genesis of the problem and it’s penetration into the general population lends strength to arguments for improvements in such things as school physical education programs and food education. Otherwise what, we just throw up our hands and do nothing? The relationship between smoking and health took many hears to establish to a degree beyond rational criticism due to the intervention of the tobacco industry. Much the same industry pressure exists in the case of obesity in general and childhood obesity specifically. There is a lot of money to be made in selling junk food.
8
@VKG I’m not convinced that “obesity” is a health issue. I also reject any “interventions” since they’re disrespectful and condescending, but most importantly the main ones, diet and exercise, lead to weight gain over the long term.
5
Our children, at least suburban ones, live a highly structured life, compared to say 30 years ago. Their routine is choreographed by their parents down to the last minute before bedtime. After school activities, sports, Disneyland trips, youth theater, ball room dancing, even church. In this mad rush, both the parents and their children are constantly hurried and harried. Very little down time, even that is choreographed (my child takes a nap at 1 pm wakes up at 2 pm so I better have his snack ready to go before his play dates come over). Kids’ birthday parties now rival bar bat mitzvahs.
There is no time for the parents or the children to get in touch with themselves. To quieter their whirring brains, always chatting about the next activity planning choreographing executing.
This lifestyle has an impact of physical well being of both parents and children. Doctor, as a pediatrician you ought to counsel parents to slow down, allow children free play time preferably outdoors not on their screen devices.
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Right here in the Boston area, is an example of a town adopting a nutrition program for its children. Generations to come will surely benefit.
https://www.somervillema.gov/departments/health-and-human-services/shape-somerville
And
http://intersector.com/case/shapeupsomerville_massachusetts/
5
@petey tonei What makes you think the children you describe are the ones primarily suffering the problem? Are you reporting that among that group you are seeing a 25 to 40 percent obesity.
More likely their 'mad rush' life manifests other disorders.
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@petey tonei You're describing a sliver of the population. Privileged children from affluent families.
11
A little paralysis through analysis Dr. Carroll.
Let's bottom line it here what history has taught us about vices. dangerous objects etc. imo.
The cure is legality, regulation, responsibility and non promotion.
With obesity don't outlaw bad food but heavily regulated them, hold people responsible who abuse it and last but not least don't promote it.
The cure has worked wonders with drunk driving and cig. smoking , saving countless lives but has been a miserable failure with gun deaths since we have not employed it.
4
@Paul drunk driving laws have worked because of penalities and the cost of cigs have influenced their use. YOU suggesting jail time for that 3rd éclair or taxing them at 2000%? We most certainly have added tough laws as to gun usage and have somewhat limited access to them. In 1993, there were seven gun homicides for every 100,000 people; by 2013, that figure had fallen to 3.6, according to Pew Research. Much of what guns are used for is connected to drug usage and America's wanting them. Be it crime to pay for them or over drug territory and control of the drug marketplace.
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@JDSept "We most certainly have added tough laws as to gun usage " That is simply not true. Generally gun laws have been loosened in the last decades. And while drug gangs have contributed to increased violence, once again the violent crime rate has been decreasing, mostly due to demographic factors.
3
P-hacking and putting positive spins on negative outcomes might be lessened if the journal publishing industry and academic institutions were more amenable to publishing so-called negative results. Sometimes those"bad" results can tell us important information. But if you're coming up for tenure or you want to embellish your outcomes to appeal more to granting organizations, the temptation to make your work look better is great.
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@WhoZher If only we all published, the solution would be in our hands. Alas, all we have at hand is personal honesty.
4
@WhoZher - There was a journal dedicated to publishing negative results, but unfortunately it ceased publication in 2017. The articles are still available open access: https://www.ncbi.nlm.nih.gov/pubmed?term=%22Journal+of+negative+results+in+biomedicine%22
And @William - I hear what you are saying about personal honesty / integrity, but the truth is it is still a lot of work to write up, format, submit, and likely re-submit completed work without an "interesting" finding. Even with the best intentions, it takes an exceptionally dedicated researcher to not give up after a few tries.
6
@Diana Frame Let he who is without sin cast the first stone.
Quoted from the conclusion:
“ Major problems like poverty can’t be overcome with a couple of workshops in a school or a doctor’s visit. Obesity is a major societal problem that probably requires a major societal response.”
Exactly. Swapping out refined for whole grain and putting on trays unpalatable veggies kids just end up throwing away isn’t going to put a dent in childhood obesity rates. Getting kids to eat substantially better requires 1) menus that are both healthful and delicious; and 2) money to pay for this improved menu. “Healthful” isn’t minimally defined by macros but also determined by ingredients, which alter the gut microbiome, a known factor in weight gain.
Kids, just like adults, also need frequent breaks to get up and move and spend time outdoors, yet schools cut recess when test scores are down. While research shows caloric restriction to be far more effective than physical movement in successful weight loss, physical movement is vital for human health. Good public health polices respect the while child.
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@Jan Allen Given everything we know about dieters having poor long term outcomes, and how for some they lead to eating disorders, it would be unethical to impose calorie restriction on children. But, I agree that many would choose delicious vegetables and choose to eat nourishing food when it’s available, and naturally lose interest in over eating sugary drinks, sweets and snacks due to their body’s natural satiety.
5
"Pediatricians like me, and many other health professionals, know it’s a problem, and yet we’ve been relatively unsuccessful in tackling it."
But why is it a problem for the medical community to solve in the first place?
This is a problem of an economy on hyper overdrive, driven by profits, and the profit engine in this case is indisputably sugar. Doctors are correct to raise their hands and say "we have a problem here." But you can't say "just sip" from a fire hydrant.
Start with public education and then move on to lobbying. Just like we did with tobacco.
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@Steel
With the current emphasis on “wokeness” it is hardly surprising that childhood obesity is a major problem.
The media, movies, ads and commercials are constantly giving everyone, children and adults, permission to be obese.
Broadcasting the message that it’s OK to be obese will only lead children (and adults) to overeat and expose themselves to a lifetime of easily-avoided disease and debility.
Why aren’t there equal or greater numbers of messages and exhortations about healthy eating and lifestyles?
For the vast majority of people, obesity is a choice, not an inevitability.
25