Friday, August 09, 2013

Broad Decline in Obesity Rate Seen in Poor Young Children

A change from the usual claims that obesity is an ever-increasing epidemic.  It may however reflect the economic downturn.  More people are poor and hence less able to splurge on excess food

The obesity rate among young children from poor families fell in 19 states and U.S. territories in recent years, federal health officials said Tuesday, the first major government report showing a consistent pattern of decline for low-income children.

The report by the Centers for Disease Control and Prevention is the latest to find declines in obesity among American children. Several cities have reported modest drops among school-age children, offering hints of a change in course. But gains were concentrated among whites and children from middle and upper income families, and were not consistent across the country.

Tuesday’s report covered the period from 2008 to 2011 and offered what researchers said was the clearest evidence to date that the obesity epidemic may be turning a corner for 2- to 4-year-old children from low-income families. Children from poor families have had some of the highest rates of obesity, which have remained elevated even as rates among more affluent children in some cities have started to drop.

One in eight preschoolers in the United States is obese. Among low-income children it is one in seven.

The cause of the decline remains a mystery, but researchers offered various theories, like an increase in breastfeeding and a drop in calories from sugary drinks. In interviews, parents suggested that they have become more educated in recent years, and so are more aware of the health issues associated with being overweight.

Health officials had noted a small decline in the national rate for low-income children for the first time in December, but they did not single it out as important because they lacked a geographic breakdown to show whether the pattern had taken hold in many states.

The new report provided the most detailed picture of obesity among low-income Americans, using weight and height measurements from 12 million children age 2 to 4 who participate in federally funded maternal and child nutrition programs. It included data from 40 states, as well as the District of Columbia, Puerto Rico and the U.S. Virgin Islands. Trained health professionals took the children’s measurements.

“This is the first time we have this many states in the U.S. showing a decline,” said Heidi Blanck, a researcher at the Centers for Disease Control and Prevention who is an author of the report. “This is really broad. Until now it’s been a patchwork.”

She added: “We really think this is how we’re going to curb the epidemic, by getting really young children.”

Researchers last analyzed these data in 2009, when only 9 states had obesity declines and 24 had increases. In the report on Tuesday, the proportions were reversed, with only 3 states experiencing increases and 19 showing declines; 20 states and Puerto Rico were flat. The declines were modest: No state dropped by more than 1 percentage point.

Researchers agreed that the decline was meaningful. Children who are overweight or obese between age 3 and 5 are five times more likely to be overweight or obese as adults, creating a higher risk of heart disease, stroke, diabetes and cancer. But there was little consensus on why it might be happening.

Dr. Blanck offered several theories. Children now consume fewer calories from sugary beverages than they did in 1999, she said. And more women are breastfeeding, which often leads to healthier weight gain for young children. C.D.C. researchers also have chronicled a drop in overall calories for children in the past decade, down by 7 percent for boys and 4 percent for girls, but health experts said those declines were too small to make much difference.

Another explanation is that some combination of the state, local and federal policies aimed at reducing obesity is starting to have an effect. Many scientists doubt that anti-obesity programs actually work, but proponents of the programs say a broad set of policies applied systematically over a period of time could have a chance.

Tom Baranowski, a professor of pediatrics at Baylor College of Medicine who has been skeptical about government interventions, said obesity has as much to do with genes as it does with behavior. “It could be that we are hitting some sort of a biological limit,” he said, in which “all those who are genetically predisposed to being obese already are.”

At the Union Baptist Harvey Johnson Head Start, a bright preschool in an area of Baltimore where more buildings are abandoned than occupied, the focus is on behavior. Children now get health lessons, field trips to a grocery store, healthier meals and an hour of exercise a day on a new jungle gym. Instructors measure children’s height and weight and a nutritionist counsels parents on what to change.

“A doctor has probably already told them, but when we reiterate it, they can’t run away from it,” said Sherise Yow, a family service coordinator at the preschool.

So when the share of the preschool’s approximately 250 students who were obese or overweight fell to 33 percent in 2013, from 35 percent in 2010, administrators credited those efforts.

Parents interviewed for this article agreed that pushing from childcare programs like Union Baptist, as well as warnings from doctors, had helped. But just as important, they said, was the frightening reality that has swept through low-income communities as the epidemics of obesity and diabetes have taken hold.

Shannon Freeland, a 35-year-old pharmacy tech instructor, said both her grandmothers died in their 50s, one from a heart attack after weighing 300 pounds, and the other from a diabetic coma, after multiple amputations that began with her toes, but ultimately took both legs.

“Grandparents aren’t supposed to pass like that,” said Ms. Freeland, whose first child, Iren, was overweight as a toddler. “They’re supposed to live into their 80s and 90s. But mine didn’t. That’s when it started to click for me.”

She added that, “we were pricking Iren’s finger at age 2and that was scary for me.”

Ms. Freeland said it is still hard to eat better, partly because it is expensive, but also because the pull of McDonald’s is strong with three children at home. She has tried Whole Foods, but can’t afford it. But since going back to college to get her associates degree in public health, she has become much more aware of her family’s food habits. Many of her friends are also back in school, avoiding a grim job market.

“People look at Head Start moms and say, ‘oh they’re just low income and that’s it,'” she said. “I think parents have changed. Our income may still be low, but we’re more educated.”


The lust for meddling in other people's lives goes on and on

The federal government has determined that obesity is a national health epidemic, and while obesity-prevention goals were established at the national level in 2012, the question now is how to determine if those goals are being met -- not just nationally, but in your very own neighborhood.

The federally funded Institute of Medicine (IOM) has just released a report listing 83 ways to "assess the progress made in every community"--and at the national level--in the fight against obesity.

Some of the benchmarks would require new legislation or executive action to change the way we live and work. (See below)

The Institute of Medicine is an independent federally funded organization that works outside of government to provide "unbiased and authoritative advice to decision makers," including members of Congress, and the public. Its 2012 annual report said that it received 78 percent of the funding for its programs from the federal government.

It was the IOM that controversially recommended what preventive health services -- including birth control, sterilization and abortifacients -- should be covered without charge under Obamacare.

"Let's Move!" on steroids

The IOM's 83 "indicators for measuring progress" in obesity-prevention include the following, in no particular order. This is  only a partial list.

-- Increase the proportion of walking trips made by adults for leisure or commuting to work;

-- Increase the proportion of recreation and fitness facilities per 1,000 people;

-- Increase the proportion of children aged 0–17 years living in safe neighborhoods;

-- Increase the proportion of trips to school made by walking 1 mile or less or biking 2 miles or less by children aged 5 to 15 years;

-- Increase the proportion of the nation’s public and private schools that provide access to their physical activity spaces and facilities for all persons outside of normal school hours;

-- Increase legislative policies for the built environment (where you live and work) that enhance access to and availability of physical activity opportunities;

-- Have states and school districts adopt policies that prohibit the sale of sugar-sweetened beverages in schools and require that schools offer a variety of no- or low-calorie beverage options that are favorably priced;

-- Reduce the relative price of low-fat milk (compared to soda/sweetened beverages);

-- Reduce caloric intake by children and adolescents in chain and quick-service restaurants;

-- Increase the number of states that adopt a law imposing an excise tax on sugar-sweetened beverages and dedicating a portion of the revenue to obesity prevention programs;

-- Reduce the density of fast-food restaurants (per 100,000 population);

-- Increase the proportion of physician office visits that include counseling or education related to nutrition or weight and physical activity;

-- Increase the proportion of worksites that offer an employee health promotion program to their employee;

-- Increase the proportion of children between the ages of 6 months and 5 years old who were exclusively breastfed or given breast milk for their first 6 months;

-- Increase the percentage of U.S. hospitals with policies and practices to support breastfeeding;

-- Increase the proportion of employers that have worksite lactation-support programs;

-- Increase the proportion of school districts that require schools to make fruits or vegetables available whenever other food is offered or sold;

-- Increase the proportion of schools with a School Breakfast Program;

-- Increase the proportion of college and university students who receive information from their institution on inadequate physical activity.

The IOM recommends that an "obesity evaluation task force or other entity should oversee and implement" the National Obesity Evaluation Plan. It says the national plan can be a model for state and regional evaluations -- "providing comparable data that can be used as benchmarks for progress over time."

And while a national plan can show changes in general trends over time, "state and community-level plans provide an additional level of detail," the report states.

Therefore, the IOM outlines a Community Obesity Evaluation Plan with four elements: community health assessment, surveillance, intervention monitoring, and something called "summative evaluation."

According to IOM, “assessment” means looking at the number and distribution of obese people within a community and at efforts to eliminate the problem.

“Surveillance” is the continuous assessment of progress over time.

“Monitoring” means tracking the implementation of various anti-obesity interventions;

And “summative evaluation” seeks to detect changes associated with particular interventions.


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