Fixing Fat

Combatting America’s Childhood Obesity Epidemic

Madison McKenna

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May 2015

Table of Contents

Executive Summary 3The Epidemic 4Causes 4

Diet 5Fast Food Marketing 6Lack of Physical Activity 7Limited Access to Healthy Foods 8Family Life 8School Food Options 9

Detrimental Effects 9Health 9Mental/Emotional 10Financial 10

Current Initiatives 11Let’s Move! 11Fresh Food Financing Initiative 12ChildObesity180 12Bank of America / Merril Lynch 14

Actions Required 14Mandating Physical Activity 14Healthier Foods in Schools 15Taxing Unhealthy Foods 16Limiting Kids’ Exposure to Food Ads 16Increasing Nutrition Education 17

Conclusion 18Figure 1 19Figure 2 19Figure 3 20Figure 4 20Figure 5 21Works Cited 22

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Executive Summary

Childhood obesity rates in the United States have been rising at an

overwhelming speed. This rapid increase in obesity has created a public health

crisis. Childhood obesity cannot continue to increase at these rates without action.

Something needs to be done.

Intended for legislatures, school administrators, and parents, this report

highlights the alarming facts about the childhood obesity epidemic currently

happening in America. It will explain the contributing factors to the rise in obesity as

well as touch upon several consequences. There are some initiatives combating the

epidemic taking place. I will discuss the objectives and impacts of these initiatives

and suggest further actions.

This epidemic is threating the future of American children. Steps need to be

taken in order to preserve the health and well being of kids. My recommendations

will help make a shift towards enforcing healthier lifestyles among young children

and in schools and society.

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The Epidemic

The United States is experiencing an epidemic of childhood obesity. The rates

of obesity among American children have skyrocketed. In the twenty-five years that

elapsed between surveys conducted in 1971–1974 and in 1999–2000, the

prevalence of obesity rose from 5 percent to 10.4 percent among two-to-five-year-

olds; from 4 percent to 15.3 percent among six-to-eleven-year-olds; and from

6.1 percent to 15.5 percent among twelve-to-nineteen-year-olds (Cawley). Obesity

is now the second leading cause of death in the U.S. and is likely to become the first.

Today, 17 percent of our children are obese (Johnson). This has been an increasing

issue for the past 30 years. In the past three decades, the obesity rate in the U.S. has

tripled. See Figure 1 for increases in the percentage of children who are overweight

or obese. The U.S. is suffering greatly, but childhood obesity is making an impact

internationally as well. See Figure 2 for global increases in the prevalence of

childhood obesity. In 2010, 43 million children (35 million in developing countries)

were estimated to be overweight and obese; 92 million were at risk of

overweight. Increases in this trend suggest that in 2020, 9.1% of children, or

approximately 60 million, are expected to be overweight and obese (Onis et. al).

Causes of Childhood Obesity

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The cause of childhood obesity is, without a doubt, multifactorial. The rapid

increase in severely overweight children can be attributed to not only diet and

physical activity, but factors such as family influence and fast food marketing as

well. The prevalence of childhood obesity in the United States can be accredited to a

number of moving factors, but I will highlight the main contributing factors in our

society today.

Diet

A poor diet is one of the main contributing factors of childhood obesity.

Children whose diets are high in fat and carbohydrates and low in beneficial

nutrients are more likely to be overweight. Sugary soft drinks, for example, have

been the target of studies linking consumption to weight gain. “Findings of a

prospective observational study indicated a 60% increased risk of development of

obesity in middle-school children for every additional daily serving” (Ebbeling et.

al). Excessive consumption of these soft drinks can result in weight gain because of

the high glycaemic index. “Consumption of meals composed predominately of high

glycaemic index foods induces a sequence of hormonal events that stimulate hunger

and cause overeating in adolescents” (Ebbeling et. al). It is evident that this can

trigger a cyclical effect in children. They consume foods that essentially promote

more hunger and more consumption. The increase of high-energy-dense food is

definitely a contributing factor. Like sugary soft drinks, these high-energy-dense

foods are packed with calories. “A recent study among children showed that a high-

energy-dense diet is associated with a higher risk for excess body fat during

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childhood” (CDC). In addition to the increased consumption of these unhealthy

foods, the portion sizes of meals have been increasing as well. Large portions of

high-calorie food have seemed to become more of the norm (CDC). The 2013

national Youth Risk Behavior Survey indicated that among U.S. high school students

5% did not eat fruit or drink 100% fruit juices during the seven days before the

survey, 7% did not eat vegetables during the seven days before the survey, 11%

drank a can/bottle/class of soda three or more times per day during the seven days

before the survey. This indicates there is prevalence of unhealthy dietary behaviors.

Fast Food Marketing

Fast foods are high in trans and saturated fats, high-energy-dense, high

glycaemic index, and come in large portion sizes, while providing little nutrients.

Fast food is convenient, and consumption is on the rise. It is not only the increase in

fast food intake, but it is also the increase in fast food marketing that is influencing

the lifestyles of the youth in the U.S. The Institute of Medicine states “Food

marketing… intentionally targets children who are too young to distinguish

advertising from truth and induces them to eat high-calorie, low-nutrient (but

highly profitable) “junk” foods.” Studies show that the branding of certain fast foods

influences a child’s taste preferences. One study in particular present 2 sets of foods

to children. One set of food was presented in McDonald’s packaging, while the other

set (of the same food) was presented in plain packaging. The results showed that

children preferred the food with the McDonald’s labeling (Robinson et. al). (See

Figure 3). Because of the prevalent impact of food marketing on children’s’ taste

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preferences, the amount of television a child watches is crucial. Children eight to 18

years of age watch approximately four and a half hours of TV every day. “Between

the ages of 2 and 17 years, US children spend an average of more than 3 years of

their waking lives watching television” (Robinson). This provides constant exposure

to food advertisements. “British children are exposed to about ten food commercials

per hour of television time (amounting to thousands per year), most for fast food,

soft drinks, sweets, and sugar-sweetened breakfast cereal” (Ebbeling et. al).

Lack of Physical Activity

According to the Center for Disease Control, children between eight and 18

years old spend an average of seven and a half hours every day using entertainment

media. This means that they are spending seven and a half hours every day not

doing physical activities. It has been found that children who engage in the most

television watching and least physical activity tend to be the most overweight. In

fact, obesity risk can be decreased by as much as ten percent for each hour per day.

The 2008 Physical Activity Guidelines for Americans recommends at least 60

minutes of physical activity everyday. However, a majority of children and teens fall

below this minimum. Children who don’t get adequate exercise are at a greater risk

of developing obesity (CDC). The 2013 national Youth Risk Behavior Survey

indicated that 15% of U.S. high school students did not participate in at least 60

minutes of physical activity on any day during the seven days before the survey, and

that 52% did not attend physical education classes in an average school week. It also

showed that 33% watched television three or more hours per day on an average

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school day as well as 41% used computers for three or more hours per day on an

average school day. A sedentary lifestyle like this is one of the main causes of

childhood obesity.

Limited Access to Healthy Foods

Many Americans have limited access to healthy, affordable foods. Access to

supermarkets can reduce the risk of obesity. However, there are certain areas that

have less access to food stores that carry healthier foods, and are overwhelmed with

fast food restaurants or convenience stores that sell less healthy options. This is

especially prevalent in low-income areas. “Low-income neighborhoods frequently

lack full-service grocery stores and farmers’ markets where residents can buy a

variety of fruits, vegetables, whole grains, and low-fat dairy products” (FRAC).

Because these resources are unattainable, some people are unable to adjust their

lifestyle and remain at risk for obesity. If these healthier options do become

available in these areas, often times they are more expensive. These disparities in

food access exist, and contribute to the increasing rate of obesity in the U.S. (FRAC).

Family Life

Family influence is a huge factor in childhood obesity. A family environment

that facilitates an unhealthy lifestyle puts the child at risk of obesity. There has been

a shift away from meals eaten at home and a shift towards meals eaten at

restaurants (including fast-food establishments). Children consume more high-

energy-dense foods when eating away from home. The family does not only impact

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the food intake of the child, but also has an impact via social support. There are

parents who do not promote physical activity, and encourage or allow increased

entertainment media use. These factors can increase the child’s susceptibility to

excessive weight gain (Ebbeling et. al).

School Food Options

The food provided for school lunches has been linked to childhood obesity.

“A study of more than 1,000 sixth graders in several schools in

southeastern Michigan found that those who regularly had the school

lunch were 29 percent more likely to be obese than those who

brought lunch from home” (Rabin). Many schools offer lunches that

are high in energy density and low in nutritional value. The main

reason schools choose to provide these options is because they are

cheap. The overwhelming availability of junk food in schools is

unacceptable. Children who constantly eat these unhealthy school

lunches are at risk of developing serious health issues. The lack of

nutrition in these school lunches is a contributing factor in the obesity

rate of children, and there is opportunity to change that.

Detrimental Effects

Health

Obesity can cause serious health issues in affected children. The immediate

health effects include increased risk factors of cardiovascular disease, like high

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blood pressure or high cholesterol. It is also more likely for obese youth to have a

condition called prediabetes, which is a result of high blood glucose levels and can

lead to further development of diabetes. Children who are obese are also more

susceptible to bone and joint problems. Obese children are at risk for more long-

term health effects as well. For instance, children who are obese are likely to be

obese adults. This puts them at risk for serious complications such as heart disease,

stroke, and type 2 diabetes. Furthermore, obesity can increase the risk of cancer in

the long run (CDC). See figure 4 for more complications of childhood obesity.

Mental/Emotional

In addition to the health effects mentioned above, children can suffer from

mental and emotional issues due to obesity. Being severely overweight can have

detrimental impacts on a child’s self-esteem. Obesity can cause children to develop a

negative self-image, resulting in depression or sedentary behavior. This

psychological impact can facilitate a further increase in excessive consumption, in

order to cope with the mental effects. School can become a hostile environment due

to bullying. Obese children who are subjected to teasing or bullying can suffer from

even further emotional turmoil. (Healthy Children). Children, as young as five years

old, can begin showing signs of suffering from these detrimental effects on mental

health.

Financial

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“Childhood obesity comes with an estimated price tag of $19,000 per child

when comparing lifetime medical costs to those of a normal weight child” (Duke

Global Health Institute). Because of the associated health implications, childhood

obesity results in an increase in medical care spending. Current childhood obesity

implies future direct costs given that overweight children and adolescents may

become obese adults. Results suggest that currently existing levels of adolescent

overweight will result in close to $45 billion in direct medical costs later in life

(Hammond & Levine). In addition to these direct medical costs, obesity also results

in productivity costs. The increase in obesity has resulted in an overall productivity

loss. There is a statistically significant correlation between obesity and absenteeism.

When individuals do not attend work, productivity is lost. Obese adults are also

more likely to have more total lost productive time. Essentially, there are high

indirect costs associated with obesity as well as the high direct medical costs. “Total

nonmedical costs of obesity among US businesses were $5 billion in 1994. Of that,

$2.4 billion was spent on paid sick leave, $1.8 billion on life insurance, and $0.8

billion on disability insurance. The health insurance-related costs of obesity were

estimated to be $7.7 billion” (Hammond & Levine).

Current Initiatives

Lets Move!

The First Lady, Michelle Obama, has launched the Let’s Move! campaign. This

initiative is dedicated to solving the challenge of childhood obesity in this

generation. The objective is to pave the way for a healthy future for American

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children. It encourages the involvement of parents, schools, health care

professionals, community-based organizations and even private-sector companies.

It uses comprehensive strategies to promote and encourage a healthy lifestyle. Let’s

Move! facilitates parental/family support, provides healthier options in schools, and

helps kids become more physically active. These factors will aid in the reduction of

childhood obesity rates in the U.S. Since the 2010 launch, Let’s Move! has made many

accomplishments thanks to substantial commitments from parents, business

leaders, childcare providers, chefs, physicians, and kids themselves (Let’s Move!).

Fresh Food Financing Initiative

According to the U.S. Department of Agriculture, approximately 23.5 million

persons in urban and rural areas of the United States live in "food deserts". These

are low-income areas that do not have access to healthy foods. The Fresh Food

Financing Initiative (FFFI) was a public-private partnership in Pennsylvania that

aims to provide access to healthy foods in these areas. Improved access to healthy

foods will help decrease obesity. FFFI used one-time loans and grants to serve the

financing needs for supermarket development in these low-income areas

throughout Pennsylvania. “ As a result of FFFI, approximately 500,000 persons now

have access to healthy foods who did not have it before, nearly 5,000 jobs have been

created or retained, and approximately 1.5 million square feet of retail space has

been created or saved.” The initiative implemented 83 projects ranging from

supermarkets to farmers markets. As of 2011 there was replication of FFFI under

way in six more states (Bell et. al).

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ChildObesity180

“Based at Tufts University’s Gerald J. and Dorothy R. Friedman School of

Nutrition Science and Policy, ChildObesity180 merges the best in public health

research and practice with the expertise and experience of business, government,

and nonprofit leaders” (ChildObesity180). The organization uses its cross-sector

composition to develop a diverse portfolio of initiatives to drive national change.

ChildObesity180 currently focuses on four initiatives. The first is the Active Schools

Acceleration Project (ASAP). This initiative aims to increase quality physical activity

in American schools. It awarded $1 million in acceleration grants to 1,000 schools

nationwide. In 2015, ASAP will bring a groundbreaking national mileage challenge

to thousands of schools across America to unify and celebrate schools across the

country prioritizing physical activity (ChildObesity180). Another initiative of

ChildObesity180 is called Healthy Kids Out of School. This program drives home

three important principles: “Drink Right, Move More, and Snack Smart.” It strives to

help build healthy, sustainable habits for children. The third initiative is the

Restaurant Initiative. The goal of this program is to reduce excess calorie

consumption when children eat at restaurants. “Our research shows that more

healthy kids’ meals were ordered after a regional restaurant chain added more

healthy options to its kids’ menu, highlighting the promise of efforts to make

healthier options the new norm. Offering healthier menu options could play an

important role in reversing the epidemic” (ChildObesity180). The last initiative is

the Breakfast Initiative, which actually concluded its work in 2014. The Breakfast

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Initiative evaluated the impact of a healthy breakfast and provided resources to

support the adoption and expansion of school breakfast programs

(ChildObesity180).

Bank of America / Merril Lynch

In 2012, a Bank of America Merrill Lynch Global Research report called

“Globesity – The Global Fight Against Obesity” was released. The financial

institutions identified that certain investments may be able to tackle the challenge of

increasing global obesity. The report focused on four main areas: Pharmaceuticals

and Healthcare, Food, Commercial Weight Loss, Diet Management and Nutrition,

and Sports Apparel and Equipment. These sectors are capable of developing long-

term solutions to obesity. The report is encouraging investments in these

companies and industries as an effort to combat America’s obesity problem. BofA

states, “investors should take a long term view and a broad perspective in selecting

stocks as part of the globesity theme, in our view.”

Action Required

Mandating Physical Activity

As mentioned before, a sedentary lifestyle is one of the biggest contributors

to childhood obesity. Children must exercise in order to lower the risk of developing

obesity. Physical education classes in schools are absolutely necessary. Every school

should require at least one physical education class. For many students, this could

be the only time they would exercise throughout the day. It is crucial that physical

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activity in schools is mandated. As of 2011, ”only six states — Alabama, Georgia,

Mississippi, North Carolina, Illinois and Iowa — adhere to standards from

the National Association of Sports and Physical Education that schoolchildren

participate in 150 minutes a week of physical education. And just three states —

Delaware, Virginia and Nebraska — have 20 minutes of mandatory elementary-

school recess a day” (Rochman). By mandating these standards for schools, it is

ensuring that children not only have the opportunity to exercise, but are required to

do so. This will make a huge impact on the lifestyles of children and help reduce the

seemingly ever-increasing obesity rate in the U.S.

Healthier Foods in Schools

School lunches should include more fruits, vegetables, whole grains, and low

fat foods. Providing healthier alternatives to the high energy dense, low-nutrient

foods that are currently offered will greatly impact the energy intake of young

children at risk of obesity. “Researchers from Michigan State University found that

when mostly or entirely healthy foods are offered either a la carte or through

vending programs at schools, middle school-aged kids ate 26 percent more fruit, 14

percent more vegetables and 30 percent more whole grains over the course of a

day” (Huffington Post). By limiting unhealthy vending machine options or lunches,

schools can support a healthier lifestyle for their students. Good nutrition is

essential to the health of these children. Schools should support higher nutrition

standards for their lunch options to promote a healthier diet. Introducing more

produce and nutrients into the school lunches will greatly benefit American

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students. When the options are available, kids will choose them, improving their

diets.

Taxing Unhealthy Foods

Just as the U.S has cracked down on tobacco sales, we should do the same

with junk foods. Imposing a tax on these unhealthy foods will provide subsidies to

help make the healthier alternatives more affordable. There needs to be more

regulation of the food system. A tax on soda, for example, could reduce soda

consumption by eight to 10 percent (Huffington Post). Taxing unhealthy food and

drinks can deter people from consuming these products. Many Americans settle for

this type of junk food simply because it is cheap and convenient. If there were a tax

on unhealthy food, people would be less likely to buy it. The tax would cover more

promotion of fruits and vegetables as alternative options, and would allow more

access to healthier, more beneficial foods.

Limiting Kids’ Exposure to Fast Food Ads

Food advertisements directed at children should be limited and more strictly

regulated. Children’s food preferences are highly influenced by what they see in the

media. “In Quebec, for the last 32 years, it has been illegal for fast-food companies to

advertise to kids in print or electronic media. Researchers estimate that, as a result

of this ban, children in Quebec consumed 13.4 to 18.4 billion fewer fast food calories

per year, and spent $88 million less on fast food than they otherwise would have”

(Imus). Banning, or at least limiting, fast food advertisements to children is a step in

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the right direction toward slowing the climbing obesity rates in America. Because

children today spend so much time on entertainment media, this type of regulation

can have a huge impact. In addition to the general limitations on fast food

advertisements directed at children, it would be beneficial for parents to limit their

children’s time watching television or playing video games. Limiting their

entertainment usage will limit their exposure to any ads that might be present. It is

important for children to have a reduced exposure to fast food marketing so that

they can have a hopeful, healthy future. Fast food advertisements have too much of

an influence on young children and should no longer be targeted directly at kids.

Increasing Nutrition Education

In addition to requiring physical activity and healthier food choices, schools

should also require a standard of nutrition education. Teaching children about the

importance of nutrition and wellness from an early age will help them grow into

overall healthier adults. Schools should implement nutrition education into the

curriculum to ensure that the students are receiving minimal knowledge about

nutrition. This standard can provide students with the skills, opportunities and

encouragement to adopt healthy lifestyles. It will help them understand the benefits

of a balanced diet and regular exercise, and promote these behaviors. By

implementing this early on, it may reduce the risk of the students developing

obesity in adolescence or even adulthood. This, alongside the physical and dietary

requirements for schools, will pave the way for healthy habits of children and

reverse the trend of increasing childhood obesity.

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Conclusion

It is evident that childhood obesity has become one of America’s greatest

public health challenges. The increasing rates obesity among children is quite

concerning. The research on this crisis shows the upward trend of obesity rates in

the United States and attributes this to numerous factors. Many of these

contributing factors can, and should, be changed. By reducing the rate of childhood

obesity, we can ensure a bright future for our society as a whole. There are

attainable steps towards a solution. See figure 5 for common sense approaches for

prevention and treatment of childhood obesity. Current initiatives are already

making an impact on the younger generation. If we can encourage and uphold

healthy life habits in children, we can improve the chance of a bright and healthy

future.

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Figure 1. Percentage of Children Who Are Overweight or Obese

Figure 2. Global Increases in Prevalence of Childhood Obesity

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Figure 3. Children’s Taste Preferences

Figure 4. Complications of Childhood Obesity

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Figure 5. A Common Sense Approach to Prevention and Treatment of Childhood Obesity

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