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Sarah Gollust (Cohort 6) Hutchinson Leader

U of M researchers ask: Is healthy too hard?

The prevalence of obesity among American children has tripled in the past 30 years and has risen sharply among adults, according to government reports.

Obesity is linked to higher risk for conditions like type 2 diabetes, high blood pressure, breathing problems, and heart disease. So health practitioners want lowering the obesity rate, especially among children, to become a national priority.

But whose job is it?

Much of the onus seems to fall on obese children and their parents. But a recent report from the national Institute of Medicine, "Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation," made the case that responsibility for the health of Americans lies partly with systems like schools, workplaces, restaurants, and the media.

That theme struck home with Sarah Gollust, an assistant professor in the University of Minnesota's Division of Health Policy and Management. She and colleagues Colleen Barry of Johns Hopkins University and Jeff Niederdeppe of Cornell University, recently published an essay in the New England Journal of Medicine endorsing the IOM report and adding some data of their own.

In a 2011 survey, the researchers asked 439 respondents to place responsibility for childhood obesity on various groups. On a scale of 1 (not at all responsible) to 7 (completely responsible), "parents of obese children" scored highest, at nearly 6. "Joint societal responsibility" came in under 5, and "state and local government" and "federal government" another point lower.

"If the public sees it as our individual responsibility to eat right and exercise, it will be hard to change the environmental influences and harder to see progress in the health of the nation," said Gollust.

One such influence is "food deserts," areas in which the closest supermarket is far away. Then there are forces like ads for unhealthy food aimed at children's TV programs and placed in children's immediate environment.

"A lot of research shows exposure to unhealthy food during kids' TV programs has an impact on their food preferences," Gollust said. "And schools often sell less healthy food outside the cafeteria, such as in concession stands and vending machines.

"For instance, my old high school in Maryland had a store that sold snacks and candy, competing with what was offered in the cafeteria. More policy attention is needed to address these so-called 'competitive' foods."

Changing the conversation

One encouraging sign came this fall, when New York Mayor Michael Bloomberg moved to ban (unless blocked by a judge) the sale of sugary drinks in containers bigger than 16 ounces at restaurants, street carts, and movie theaters. Sure, anybody can order two drinks, but the well-publicized move is a conversation-changer.

Whether or not it has an effect on actual practices, "it raises consciousness about portion sizes of sugary drinks, which are needless calories," said Gollust. "Just identifying the size of drinks as something worthy of policy-makers' attention is important. There is growing strong research on the impact of sugary drinks on weight."

Mary Story, a longtime researcher in nutrition and weight issues, agrees.

"We have an 'obesigenic' environment, where food can overpower one's personal responsibility," said Story, a professor and senior associate dean of the U's School of Public Health.

Besides the high cost of diseases that often accompany obesity, it's a national security issue because excess weight is the primary medical reason for being rejected for military service, Story added.

Nonsugary solutions

The solution is to attack the source of the problem, rather than stigmatize those struggling with extra pounds, Gollust and Story noted. They advocate ensuring safe places for children and adults to exercise. And making fresh fruits and vegetables cheaper would help, as would limiting access to unhealthy food.

"Now, our agricultural policies aren't aligned with our public health policies," said Story. "What we subsidize is commodities like soybeans and corn, not fruit and vegetables."

Story said, "We need public officials to really embrace this because we have an obesity epidemic.”