Doing something right on obesity -- Aug. 8, 2013 column

By MARSHA MERCER

In 1974, the federal supplemental food program known as WIC started providing poor women and their young children whole milk and cheese, cereals and other items. Conspicuous by their absence were fruits and vegetables.

 

By the 21^st century, obesity had replaced malnutrition as a public health problem, and the Institute of Medicine recommended in 2005 upping WIC’s nutritional content by adding fruits and vegetables, whole grain cereals, reduced-fat yogurt and other lower-fat dairy products. It also recommended cutting back on the amount of full-fat dairy. The healthier changes took effect in 2009.

This week we began to see the fruit of those changes. We are gaining ground in the war on childhood obesity

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The decline in child obesity rates is small, but the trend is encouraging. After decades of explosive growth, the obesity rate among low-income preschoolers has leveled off nationally and is starting to fall in some states, government researchers reported.

Among children 2 to 4, the obesity rate between 2008 and 2011 dropped in 18 states and the Virgin Islands, the Centers for Disease Control and Prevention said. Florida, Georgia and Mississippi were among the states with declines.  

The obesity rate for low-income preschoolers increased in only three states -- Colorado, Pennsylvania and Tennessee. And in 20 others and Puerto Rico, the rate was unchanged. These included Alabama and North Carolina. No data was available for 10 states – including Virginia.

Washington typically gets the blame, but this is a moment when the federal government deserves praise for doing something right. Changes in WIC – formally the Special Supplemental Nutrition Program for Women, Infants and Children – were cited as a major factor in the fight against child obesity.

WIC helps feed more than 9 million poor pregnant and postpartum women, infants and children under 5 a year. It provides nutrition education and referrals to health care and social services and promotes breastfeeding, which may help prevent child obesity, although that’s not certain.

First lady Michelle Obama has been derided for the White House vegetable garden and her Let’s Move! Campaign, but she is leading by example and deserves a shout out. In addition, child care centers around the country, following her lead, have adopted healthier food choices and exercise programs.

The government says simple things like breakfast, playground time and water fountains can help in the childhood obesity fight. Every little bit helps because children who are overweight or obese are five times more likely than normal-weight kids to be overweight or obese as adults and to suffer related health conditions – and higher health care costs.

       

We still have a long way to go to reverse the obesity trend. One in eight preschoolers is obese, and the problem is worse among black and Hispanic children.  

“Obesity remains epidemic,” says Dr. Tom Frieden, director of the  CDC, but “the tide has begun to turn for some kids in some states. While the changes are small, for the first time in a generation they are going in the right direction."

So, what’s next?

A new study led by Dr. Mark D. DeBoer of the University of Virginia found that little ones, like their older brothers and sisters, gain weight with sugary drinks. Two- to five-year-olds who drank one sugar-sweetened soda, juice or sports drink a day were more likely to be obese than other kids their age who had such drinks less frequently.

No big surprise there, but what are the policy implications? Food stamps – called SNAP – can’t be used for tobacco, alcohol or even soap products. What if SNAP benefits couldn’t buy sugary drinks?

In 2011, New York Mayor Michael Bloomberg tried to find out. He asked the federal Department of Agriculture for permission to prohibit purchases of sugary drinks with food stamps. No, the government said, Bloomberg’s request was too broad.

The makers of soft drinks and junk food argue rightly that no one item causes weight gain; it’s a matter of total calories, in and out. They’ve cut back on sugar, salt and package sizes. That’s good for health – and business.

But if we’re serious about improving the nation’s health and cutting health care costs, we should use food stamps to encourage healthy food choices. The new WIC evidence indicates it’s time to give revamping SNAP a try.   

© 2013 Marsha Mercer. All rights reserved.

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On sugary drinks and the right to be stupid -- March 14, 2013 column

By Marsha Mercer

Secretary of State John Kerry was right when he said, “In America you have a right to be stupid – if you want to be,” especially when it comes to drinking soda.

Kerry was talking to German students about political liberty, but we also take seriously our freedom to make bad food decisions.

Three-fourths of Americans disapprove of New York City’s ban on gigantic sodas, which a judge invalidated March 11, and about six in 10 say no to “sin” taxes on unhealthy foods and sodas, the Associated Press reported in January.

   

Downing the equivalent of 16 packets of sugar – the amount in a 20-ounce can of regular soda – is a personal choice, people say. OK, but where does personal freedom stop and public responsibility start?

Smoking was once considered a personal choice, but when the preponderance of evidence proved its health hazards, the government took action. Americans balked at first but then accepted warning labels on cigarette packages and higher taxes on cigarettes. Today, most people appreciate bans on smoking in offices, bars, restaurants, shops, movie theatres and sporting events. We’re glad not to breathe second-hand smoke or wear it in our hair and clothes.

Similarly, we’ve come to appreciate seat belts and, in all but a few states, motorcycle helmet laws that limit our freedom for the greater good of survival.

Mayor Michael Bloomberg’s soda rule has flaws, but its intent – “to address the super-size trend and reacquaint New Yorkers with smaller portion sizes, leading to a reduction in consumption of sugary drinks” – is sensible. There’s a consensus that Americans are getting fatter and sicker, and that soft drinks are partly – but not totally – to blame.

 “There is very real evidence now that soft drinks are related to weight gain and obesity and, most certainly, diabetes,” nutrition expert Dr. Walter Willett of Harvard School of Public Health told NBC News.

Diabetes is epidemic, Willett and others say. Among Americans 20 and older, 11.3 percent have diabetes, and among those 65 and older, nearly one in three have the disease, according to the American Diabetes Association, which says the cost of diabetes last year reached $245 billion, up 41 percent in just five years.

 

A 2004 Harvard study found that women who drank one or more sugary drinks per day had an 83 percent greater risk of developing Type 2 diabetes than women who rarely drank them.

Limiting consumption of sugary drinks in hopes of improving health is New York’s approach. But state Supreme Court justice Milton Tingling said it was arbitrary, capricious and full of loopholes. The rule applied to cafes and restaurants but not to convenience stores. It regulated sodas but not milkshakes or alcoholic beverages, which have more calories. It allowed unlimited soda refills, effectively gutting the restriction.

Portion control would create “an administrative Leviathan,” Tingling wrote a day before the rule was to go into effect.

Bloomberg, dubbed “Nanny B” by critics, is appealing the ruling. He says he’s confident the rule will stand and will become a model for other localities. New York was among the first to eliminate trans-fats in prepared foods and require calorie counts on menus.

The American Heart Association recommends that women have no more than six teaspoons and men nine teaspoons of added sugar a day. Americans eat about 22 ½ teaspoons a day in everything from soda and candy to cakes and sweetened yogurt.

Consumption of sugary drinks already has declined, says the American Beverage Association, which notes the average number of calories in a beverage serving has dropped 23 percent since 1998 because more people are drinking diet and low-cal drinks and bottled water.

If Bloomberg is right that sugar is the next tobacco, could a sugar tax be waiting in the wings? President Barack Obama has said a tax is worth exploring. Congress rejected a sugar tax as part of health reform because it’s so unpopular.

For now, we have the right to be stupid – without paying one penny more.

© 2013 Marsha Mercer. All rights reserved.

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