Jul 23 2014
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TEDMED Great Challenges: A Candid Conversation About Childhood Obesity

A 2012 report from the Robert Wood Johnson Foundation (RWJF) and Trust for America’s Health concluded that if the adult and childhood obesity rates in 2011 continued to increase at their steady paces, then by 2030 nearly two-thirds of U.S. adults would be obese and every single state would have obesity rates above 44 percent.

Data now show that childhood obesity rates have stabilized. In fact, for the first time in a decade the obesity rates among young children from low-income families in many states is trending down.

Helping lead the way in this important public health issue has been the city of Philadelphia, Penn., which has worked to improve access to healthy foods and opportunities for physical activity.

“We were very fortunate in Philadelphia to have colleagues...who have developed a better understanding of childhood obesity,” said Don Schwarz, former Health Commissioner and Deputy Mayor for Health and Opportunity, City of Philadelphia, and will also soon take on the role of director for RWJF’s Demand Team. “What that has meant is that Philadelphia was able to take a body of knowledge and bring it to scale. The partnership in Philadelphia that has allowed that to happen goes across government and between government and the private sector and community organizations—just everyday Philadelphians. So that kind of partnership, that wonderful knowledge base, has I believed turned the corner on childhood obesity, particularly for children who are of disadvantaged communities.”

Schwarz’s comments came during the Tuesday, July 22 Google Hangout TEDMED Great Challenges: A Candid Conversation About Childhood Obesity. The panel was moderated by Richard Besser, Chief Health and Medical Editor for ABC News.

Every member of the panel echoed the importance of partnerships, and Besser succinctly explained their critical role in not just obesity prevention but all public health efforts.

“The more creatively you can think and the wider variety of partners you can pull in, the more likely you are to be successful,” he said.

At the heart of Philadelphia’s success has been the important role that schools play in that community partnership. According to Schwarz, for the past decade the city’s schools have worked to reshape how they approach children’s health and wellbeing, including comprehensive nutrition policies, a new food environment that emphasizes healthy choices and more opportunities for kids to be physically active. One can’t be successful without the other.

Risa Lavizzo-Mourey, RWJF’s president and CEO, also touched on this pairing, noting how the progress that’s been made (“It’s fragile in many ways, but it’s progress nonetheless”) is rooted in an overall change in the attitude and values over how to approach the issue of childhood obesity as a nation. Where before it was viewed as an issue of personal responsibility, more and more people are realizing that parents, schools, public organizations and private organizations must all come together to investigate, implement and expand healthy policies and practices for all kids. What’s more, people are also expecting and demanding these resources from their communities.

“We have the real beginning of a change in values that will, I think, accelerate the move to a healthy weight for all children,” she said.

Nancy Brown, CEO of the American Heart Association, discussed the importance of coupling effective medical treatment with surrounding a child with a culture of health, saying in particular that a culture that rewards individual successes is one that will see the greatest success overall.

“We need to stress whether for kids or for adults the importance of incremental change,” she said. “If we’re able to create an environment where...losing even 5, 7, 10 pounds, beginning to walk, starting to eat healthier—if we can have an environment where those things are rewarded, we will see continued, longer-term progress for that child and for their family.”

Businesses can also play a role in reinforcing this culture of health, according to Brown, especially has the health and wellbeing of employees and their families has slowly transitioned from an HR-only subject to more prominence. Wellness programs improve personal health while reinvigorating the surrounding community, which in turn helps ensure a stronger return on investment.

But just as Lavizzo-Mourey noted the fragility of the progress so far, Elissa Epel, an Associate Professor at the UCSF School of Medicine, spoke about the continued stigmatization of obesity, which can impede efforts to reduce rates, both because overweight and obese children can feel needlessly and wrongfully shamed and because other facets of the community don’t fully understand the difficulties that many people can face when it comes to getting and staying healthy.

With research and data producing more evidence every day underlining how stress, genetic predispositions and other factors can limit control under certain conditions, when it comes to childhood obesity—and to obesity in general—we need to keep shifting from the entrenched model of personal blame to one of understanding the power of the food environment. This is especially important because stigma leads to stress leads to poor eating leads to more stigma...a cycle that a quick glance at the numbers shows far too many people suffer in.

“Stigma is toxic,” she said. “Stigma is a source of chronic stress.”

Hearkening back to the particular progress Philadelphia has made in reducing childhood obesity rates in disadvantaged communities, Epel also spoke about how low socioeconomic status also brings with it the unfortunate pairing of more toxic stress and more opportunities to turn to junk food as a coping mechanism—or at least far less access to healthy alternatives than you might see in other communities.

Epel also spoke to the core concept of public health—not being content with treating the disease, but treating the sources of the disease before symptoms such as obesity can manifest and cause harm. In that way, communities need to look at childhood obesity as a trans-generational problem that begins incorporating community players, ensuring food security and implementing other practices to improve the health of future mothers and their future children.

Still, despite all the successes across the country that were discussed, much more is needed, with an eye toward prevention as “the name of the game,” according to Lisa Simpson, President and CEO of Academy Health. That begins with a focus on a research community that continues to dig down into the risk factors and that is supported by the entire community.

“We need to continue to have these kinds of discoveries that help us understand obesity...and very importantly how to intervene to prevent it, and if the child does become overweight or obese how to treat it,” said Simpson. “At the same time, the research community—and here also the policy and practice communities—need to come together to then, once we do know what works, partner and work on the dissemination and implementation of good evidence.”

>>Read more in a blog post on TEDMED's platform, co-authored by Risa Lavizzo-Mourey, RWJF president and CEO, and Nancy Brown, CEO of the American Heart Association, about obesity decline success stories in Philadelphia and New York.

Tags: Childhood Obesity, Culture of Health, Obesity, Pediatrics, Public Health Departments, Public Health Informatics, Public Health Questions