Childhood obesity has been called an epidemic, but in some ways, that’s wishful thinking. Because with an epidemic, you can usually pinpoint a cause and potential solutions. Childhood obesity is more like fighting a hundred infections at once and trying every medication you’ve got, hoping something sticks.
Worldwide, obesity among kids is 10 times higher than it was in 1975, and many experts believe it’s going to get much worse. The U.S. has some of the highest rates: According to the Centers for Disease Control, 1 in 5 school-aged children and adolescents in the United States are affected by obesity. The issue impacts kids as young as two years old.
Obesity rates among American children continue to rise despite widespread awareness of the associated health dangers — such as an increased risk of certain cancers, diabetes and heart disease, and obesity’s effects on hormones involved in controlling blood sugar and puberty.
To some degree, there has been modest progress toward healthier eating for kids in the U.S. — mainly through efforts to improve school lunches and tax sugary beverages — but this country is struggling just as much as everyplace else in the world, says Erica Kenney, a researcher in the department of nutrition at the Harvard T.H. Chan School of Public Health.
“Addressing childhood obesity is absolutely like playing whack-a-mole,” she said. “There are so many pieces to this, so many factors that are cultural, environmental, political and systemic. You target one or two pieces of it and then 10 more take its place. Obviously, everyone wants healthier kids. But no one has yet come up with the best strategy to make that happen.”
This issue is due to a mess of factors, from ineffective policymaking to socioeconomic inequality to a pervasive tendency to blame the individual. But small steps of progress — both in the U.S. and in other countries setting meaningful new precedents — offer some degree of hope that the right combination of strategies can add up to lasting, healthy change.
Addressing childhood obesity is absolutely like playing wack-a-mole. There are so many pieces to this, so many factors that are cultural, environmental, political, and systemic.
Erica Kenney, Harvard T.H. Chan School of Public Health
Why children gain weight beyond levels that are considered healthy — and then maintain or increase that weight into their teens and beyond — can be attributed to a wide range of confounding variables, Kenney noted. Those include genetics, the ubiquity of fast food, the broadly accepted value of sugar as a “reward,” parental eating habits, metabolism changes, sleep problems, childhood trauma, race, neighborhood design and safety, mental health concerns, chronic health conditions, economic disparity, school nutrition policies, stigma and bullying, social and cultural cues that determine food choices, and legislation at the federal, state and local levels.
Even malnutrition could be in play. When most people think of that word, severely underweight children come to mind, and that’s an accurate image, but it’s not the only one. The World Health Organization considers obesity a form of malnutrition as well, which can happen when people are consuming calorie-dense foods that have scanty vitamins and minerals.
And those are just the major factors.
Many kids are facing not just one or two of these challenges, but a bunch of them at once. Take a kid of color in an economically disadvantaged neighborhood, for example — already at disproportionate risk for eventual obesity, according to recent research. Not only will that child have genetic factors at play if their parents are overweight or obese, but they may not have access to healthy foods, they may be disproportionately targeted by unrelenting junk food marketing, and they may be affected by weak school nutrition efforts and a lack of safe places to play and walk for exercise.
But what if a kid is in a wealthy white suburb, born to parents who don’t carry a genetic push toward obesity, and has plenty of access to fruits and vegetables? Since socioeconomic factors play a huge role in childhood obesity, they would have a better chance of avoiding weight gain, but it isn’t a given. They could still be subject to stress, emotional issues, high sugar consumption and metabolism changes.
Once being overweight tips into being obese, the issue gets even tougher, because getting obese children back to a healthier body composition is significantly more difficult than trying to prevent weight gain in the first place.
“It’s like any chronic disease,” says Kenney. “Prevention is much easier than treatment. In the case of childhood obesity, that’s true at the highest possible level. There is a great deal of evidence that once obesity takes hold in the body, it’s hard to reverse. Once you’re a certain size, the body doesn’t like to let go of that.”
That’s one of the reasons obese children are significantly more likely to become obese adults. Another reason? Just take a look around.
“We are living in the most difficult food environment in history when it comes to nutrition,” Kenney states, referring to the overwhelming amount of cheap, energy-dense foods available pretty much everywhere. “I go to the hardware store to buy a hammer and at checkout, I have 50 different candy options. It is like that everywhere, as we all know, and it never used to be like that. The availability, and the cheapness, of the options is staggering.”
Yet, she adds, our culture tends to put emphasis on the individual, shaming them for not having enough willpower. “That’s not true,” Kenney says, “and it makes obesity prevention and treatment even tougher to roll out.”
And keep in mind that kids’ eating habits are strongly influenced by factors outside their control. They don’t buy and cook their own food, but rather are expected to eat what they’re given — at home, school, social events — and are highly susceptible to predatory junk food advertising. It’s not likely you’re going to see a middle schooler, alone, examining food labels in the supermarket to make sure she’s choosing a product without trans fats.
In reality, the problem is not personal, it’s systemic, and it’s becoming increasingly clear that effective solutions need to be comprehensive and have to come from the top. Some of the strongest (and, indeed, only) examples of programs that have actually lowered rates of childhood obesity among a broad population demonstrate this.
As part of a citywide program in Amsterdam, children are regularly weighed and fitness-tested. If they are determined to be overweight, they are referred to a child health nurse, who helps the child and her family learn to, for instance, shop and cook more healthfully or find physical activities to replace TV watching and video games. Between 2012 and 2015, the number of overweight children in Amsterdam dropped 12%, the BBC reports, bucking a global rising trend.
A program focused on helping parents set boundaries for their kids helped make Leeds the first city in the U.K. to lower its childhood obesity rate.
Chile has seen strides forward through regulations enacted in 2016 mandating warning labels on packaged foods high in sugar, saturated fats and sodium — similar to what you’d see on a pack of cigarettes — and prohibiting the marketing of these foods to children under 14 years old. The moves are already showing promising results, with Chilean parents reporting more awareness of the relationship between nutrition and obesity and an interest in changing to healthier eating habits.
“No country has reversed its obesity epidemic,” said Christina Roberto, assistant professor of medical ethics and health policy at the Perelman School of Medicine at the University of Pennsylvania. “But we can learn from each other and watch the effects of these specific efforts.”
That said, what works overseas may not always be viable in the States.
The sheer size of the U.S., the political wrangling that prevents more comprehensive policies, and the heterogeneous makeup of the population mean that efforts that work elsewhere may work only in small pockets of the U.S. — and only if they have a legislator, school superintendent or other advocate willing to stand up for big changes. But such changes are unlikely to be rolled out on a wide scale.
Policy changes at a local or state level can be met with resistance and cries of “nanny-state interference,” said Kenney. Parents may feel attacked for their choices, especially if education and programs are perceived as shaming them into compliance.
At the national level, you see the outsized influence of the food industry stymieing progressive health policies. That’s probably not surprising, given the high-profile role of former food industry lobbyists. The Project on Government Oversight has noted that snack food and corn syrup industry lobbyists have been appointed by the Trump administration to set food policy at the U.S. Department of Agriculture. Under Secretary of Agriculture George “Sonny” Purdue, the USDA has not been particularly supportive of stronger nutrition standards in public schools, Marlene Schwartz, director of the Rudd Center for Food Policy and Obesity at the University of Connecticut, told HuffPost. She pointed to recent pushback on changes that could bring more whole grains and vegetables into school lunches.
Another potentially big step forward — that’s facing huge hurdles from corporate lobbying — is taxing sugary beverages, says Roberto. Drinking soda and other sugary drinks is a contributor to obesity, and research published this month suggests taxing sugar-sweetened drinks can cut down consumption and thereby reduce obesity rates and the number of new Type 2 diabetes cases.
Roberto and her colleagues found that after Philadelphia put a tax in place on sweetened beverages at the beginning of 2017, there was a 38% drop in sales. The tax has not been in place long enough to show a significant effect on obesity, Roberto said, but it’s likely that data collection over the next few years could be promising.
No country has reversed its obesity epidemic, but we can learn from each other.
Christina Roberto, Perelman School of Medicine at the University of Pennsylvania
“Showing an association between something like sugar reduction and obesity takes time,” she said. “We would also have to connect that reduction to the beverage tax, so right now we don’t have the data, but it’s likely we will in the future.”
Sara Bleich, a professor of public health policy at the Harvard T.H. Chan School of Public Health, believes that a national soda tax is one of the best chances we have to lower childhood obesity. But the beverage industry has done a very good job of quashing state soda taxes, making a comprehensive national policy seem like a pipe dream.
Bleich also recommends restricting recipients of federally funded Supplemental Nutrition Assistance Program, or SNAP, benefits from using those dollars to buy sugary drinks and candy. She cites evidence that strengthening the nutritional requirements for foods that can be purchased by participants in WIC – the special assistance program for women, infants and children – lowered obesity risk for 2-to-4-year-olds.
Tightening control on how people spend their benefits is a contentious idea, with some arguing it’s overreaching and paternalistic. States that have tried to apply for waivers to institute such restrictions have failed to get them approved by the USDA, which runs SNAP. But Bleich argues that the potential health benefits outweigh the cons and that “SNAP is a critically important place to target legislation.”
Even the most notable childhood-obesity campaign, Michelle Obama’s Let’s Move effort, is seen as more of a win for awareness than as impetus for significant decrease in childhood obesity numbers. In fact, in the nearly 10 years since the program was first announced, the childhood obesity rate has ticked slightly upward, from 17% in 2010 to 18.5% in 2016.
That’s not a knock, though, because getting the issue to be so prevalent in the national conversation actually did begin to create some much-needed momentum, says Bleich, a senior policy adviser for the initiative.
“The program’s biggest effect is that it served as a lightning rod for state and local policymakers,” she says. “It also showcased activity and nutrition as positive aspects for children, rather than telling them what not to do. That put the focus on the benefits, and that’s an important distinction.”
Let’s Move, announced in 2010, also got some power from another huge initiative enacted that year that was less publicized but equally important: the Healthy Hunger-Free Kids Act, legislation that aimed to increase access to healthy food in public schools, particularly for children from low-income families.
“People may not realize it, but there’s been a massive amount of improvement in schools in the past couple years,” says Schwartz. “That is because that legislation was rolled out in phases and we’re seeing the benefit of that now.”
The act set maximum calorie amounts, mandated strong nutrition standards like having more whole grains, and set saturated fat limits for protein sources.
“Changes in policy like this act are useful not just because kids are eating healthier, but because they drive food producers to meet certain nutrition standards,” says Schwartz.
Case in point: Because of the act, Doritos sold in schools are formulated differently — baked instead of fried, and made with more whole grains than those you’ll find in stores. And yes, you might be wondering why there are Doritos in schools at all, but Schwartz says this is a good example of “baby steps” moves, because, until the past few years, schools were awash in chips, candy and soda, in part because it brought more funding to cash-strapped districts.
To be sure, addressing childhood obesity in the United States will likely feel like a whack-a-mole game for quite some time to come. You might get a whole public school district following stricter lunch nutrition guidelines, while the private school down the street serves whatever it wants. (And in either case, children are tempted by cheap candy, sugary beverages and junk food sold by the counter of every store on the walk home from school.) You could get state legislation passed that raises the accessibility of healthy food in poorer areas, only to see those laws get scuttled after the next election.
“To say this is a huge system to change is an understatement,” says Schwartz. “I really don’t think any country has this figured out. All we can do is keep trying, and keep hoping we make more progress.”
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