Last year, Robert Wood Johnson Foundation (RWJF) scholars Rachel Tolbert Kimbro and Elizabeth Rigby waded into the debate over childhood obesity when they published a groundbreaking study that found that some federal food assistance programs helped young children maintain healthy weights.
Before they knew it, they were awash in a wave of charges accusing them of supporting “nanny state” reforms to improve the nation’s health.
The flare-up was one of the first signs of the import of the study. Another sign came earlier this year, when their article was ranked the second most influential study funded by the Foundation in 2010.
Both Cohort 3 (2005-2007) alumni of the RWJF Health & Society Scholars program, Kimbro, Ph.D., an assistant professor of sociology at Rice University in Texas, and Rigby, Ph.D., M.A., an assistant professor in the Trachteberg School of Public Policy and Public Administration at the George Washington University, published the study on federal food policy and childhood obesity in the March 2010 edition of the health policy journal, Health Affairs.
It found that federal food assistance programs are—contrary to conventional wisdom—part of the solution to the childhood obesity epidemic rather than part of the problem.
It may be counterintuitive that increasing access to school food—widely considered to be unhealthy—may prevent obesity, Kimbro said. But in low-income families, meals served at school that meet minimum federal nutrition guidelines are likely more healthful than home-prepared meals. “People were stunned at the concept that school meals could actually be good for children,” she said.
For the study, Kimbro and Rigby explored the link between food assistance programs and body mass index levels among young children in low-income families. Using data from longitudinal studies, they examined the effects of federal food program participation on children’s weight from age 3 to age 5. Participants were recruited in 1998 and 1999 and lived in 20 different U.S. cities.
Program Originally Designed to Alleviate Hunger Now Helps Combat Obesity
The research team found that subsidized meals at school or day care help young children in low-income households maintain a healthy weight as they grow up. Ironically, expanding access to subsidized meals—initially designed to alleviate hunger—may be an effective tool to combat obesity, Kimbro and Rigby argue.
The finding, however, depends on the type of food assistance and the family’s location; in cities with high food prices, children in families that receive food stamps rather than free meals may actually be at greater risk of obesity. “When the local cost of food is higher, the same food assistance benefit simply buys less food. This may lead to substitution of less expensive, unhealthy food for more expensive, healthier food.”
After the findings appeared in Health Affairs, Kimbro and Rigby wrote an op-ed that appeared in the Houston Chronicle that called on policy-makers to focus on obesity prevention and stiffen federal nutrition standards in the Child Nutrition Act, which provides millions of children with breakfasts, snacks and lunches at school.
The editorial drew fire from some newspaper readers who questioned calls to increase federal involvement in individual eating habits, especially during a recession when policy-makers are under pressure to cut—rather than expand—food assistance programs. “This is just one example of the nanny-state run amok,” one commenter wrote in response to the editorial.
But food assistance programs can prevent obesity problems before they begin, Kimbro and Rigby responded.
“We question the assumption that providing meals (particularly healthy meals) to hungry children crosses over into ‘nanny state’ territory,” they wrote in an online column in response to the criticism. “First, as shown by our research and that of others, children who receive school meals are healthier, less hungry and better able to learn—this benefits us all. Second, rather than fostering an unhealthy dependence on government, providing food to hungry school children serves as a critical ingredient in providing children an opportunity to develop as healthy, educated and self-sufficient citizens.”
The study sheds light on how the federal government can help combat the growing epidemic of childhood obesity. Roughly one-third of all children in the United States are overweight, and an estimated 16 percent are obese, according to the study. Overweight children are prone to more health problems than children whose weight is in the normal range.
To reduce and prevent childhood obesity, Kimbro and Rigby argue that the federal government should increase access to subsidized meals among low-income families with young children, and stiffen nutritional standards for food assistance programs, which serve one-half of all U.S. children at some point in their lives.
The federal government did just that last year when it reauthorized the Child Nutrition Act—yet another sign of the significance of the report’s findings. But the public debate on this issue is certain to continue.
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
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