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Pursuing the first lady's goal may seem pretty straightforward. But it's not
By DEBORAH KOTZ
Posted: August 2, 2010
When Michelle Obama promised in January to attack childhood obesity, she declared, "We have everything we need right now—we have the information, we have the ideas, and we have the desire to start solving America's childhood obesity problem. The only question is whether we have the will." So conquering the nation's weight problem should be relatively easy, right? Her 70 recommendations, which include everything from more gym to encouraging women to breastfeed, are based on some science. But nobody knows if they'll actually work. "I'm sure the first lady has every sort of concern for this problem and the belief that it's in our hands, but we've been studying this for years and still don't have precise answers," says Rudolph Leibel, a professor of pediatrics and medicine at Columbia University College of Physicians and Surgeons who helped discover leptin, the hormone that regulates hunger. "We don't even know the precise causes." He and other experts believe a few steps must be taken before the mission can be accomplished:  
1. Make healthy behaviors the default. Public health officials have finally realized that it's not enough to tell people to eat at least five servings of fruits and vegetables a day and get 150 minutes of exercise a week. They have to set up a system in which it's almost automatic to opt for a juicy peach over a candy bar and to bike to work, and where it's as cheap to prepare a salad and grilled chicken as to grab a take-out burger and fries. Just as smoking bans have made it simpler to never start, "we have to make it easier for people to be healthy," says Surgeon General Regina Benjamin. Her plan for a "healthy and fit nation" includes improving access to sidewalks, bike lanes, and office building stairwells; adding gyms at the office; and stocking vending machines more nutritiously.

Kids are a prime target for prevention efforts, since habits established in childhood often last a lifetime. Congress is now considering legislation to improve the nutritional standards of the national school lunch program. And local prevention efforts are showing promise. A year-long intervention designed to improve the eating and exercise habits of elementary school students in Somerville, Mass., resulted in a small drop in body mass index among the one third of the kids who were heading toward obesity. A statewide effort started four years ago in Delaware has brought a host of healthful changes to the kids of the state, including the elimination of soda and chips in school vending machines; a new requirement in most elementary and middle schools for 30 minutes a day of exercise; and a program now in 81 percent of childcare centers that encourages preschoolers to snack only on fruits and vegetables, get an hour of daily activity, and drink milk and water instead of juice. So far, Delaware's childhood obesity rate, now at 37 percent, has stopped increasing, the same trend seen in other states without such programs. But "we're hoping that this leveling off will turn into a decrease in the future," says Debbie Chang, vice president of policy and prevention for Nemours, the nonprofit child health organization that runs the program.
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2. Turn back the calorie consumption clock. The average American consumes 600 calories a day more than people did 40 years ago, according to a 2009 report from the Department of Agriculture. The largest chunk comes from high-fructose corn syrup and other additives that weren't used much two generations ago. "The postwar farm policy has been to produce as many calories as possible," says David Wallinga, director of the food and health program at the Institute for Agriculture and Trade Policy in Minneapolis. That has resulted in a glut of corn, soybeans, and wheat that is cheaply made into the sweeteners, oil, and bleached flour used both in the processed products lining supermarket shelves and in the ever expanding "super-size" deals at the most popular chain restaurants. Posting calorie counts on restaurant menus, as is mandated by health reform, could slash Americans' calorie intake by 14 percent, say Yale University researchers, who demonstrated this result in a study published last year in the American Journal of Public Health. In May, a coalition of 16 food manufacturers promised that together they would cut a trillion calories out of their products by 2012, a move the first lady hailed as "precisely the kind of private-sector commitment we need."

But Kelly Brownell, director of Yale University's Rudd Center for Food Policy and Obesity, argues that what's really needed is an economic shift that makes nutritious foods relatively cheaper and processed junk food more expensive. At the moment, penny-pinching shoppers find they can make seven SpaghettiOs dinners for what it costs to buy a pound of fresh salmon or cherries. From 1985 to 2000, the inflation-adjusted price of soft drinks declined by nearly 24 percent, while the price of fresh fruits and vegetables rose by 39 percent, according to a recent analysis performed by Wallinga. He says farmers, who without government subsidies would lose money growing corn and wheat, need incentives like lower-interest loans to turn land into apple orchards, peach groves, and spinach farms.

3. Keep overweight folks from getting fatter. Weight loss efforts seldom work permanently—just ask the 90 percent of dieters who fail to keep it off. So researchers propose that the emphasis should be on keeping BMI stable. That may mean setting strict limits on kids' TV and computer time; the American Academy of Pediatrics recommends no more than two hours a day in front of any screen. As for Mom and Dad, they may need to step off the dieting track. Leibel's research has found that when overweight individuals diet down to a healthy body weight, they burn off 15 to 20 percent fewer calories every day than people at the same weight who never struggled to lose. "The body senses weight loss," he says, "and perceives it as a threat to survival, driving up hunger and slowing metabolism." For this reason, he counsels overweight folks to reduce their risk of disease by losing a modest 10 percent of their body weight. Those with 100 or more pounds to lose, however, might be good candidates for weight loss surgeries, which, for unknown reasons, don't seem to depress metabolism and increase appetite the way dieting does.
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4. Teach people to overcome emotional or mindless eating. The more people focus on their body weight, the more likely they are to starve and binge, a vicious cycle that can lead to even more weight gain, says Geneen Roth, an eating disorder expert and author of Women Food and God. Some rely on food as an emotional soother; Roth says they need to delve down to the root of their distress—Do I open the pantry when I'm bored? Anxious? Sad?—and then sit with those emotions rather than eat to avoid them. The government, meantime, may soon advise paying better attention while eating to avoid overdoing it. A draft of the 2010 Dietary Guidelines for Americans, to be published later this year, calls for Americans to "become mindful, or 'conscious,' eaters, that is, attentively choosing what and how much they eat."
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5. Be responsive to science. Obesity experts still can't fully explain how the nation became so overweight so quickly. What role, if any, do "obesogenic" chemicals, like bisphenol A in hard plastics, play in setting our appetites early in life? Why do immigrants who come to our "fatter" nation tend to gain extra pounds while Americans who emigrate to "thinner" nations like Japan tend to lose? "We don't have all the answers yet," says Brownell. "But we do know we have to intervene on multiple levels" if there's any hope of solving the obesity crisis in a generation.