FED UP!

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The childhood obesity epidemic poses a major threat to our nation’s future adults. Fed Up! comes none too soon as a guide to bringing this public health emergency under control. We have become one of the world’s fattest nations. No previous U.S. generation has raised children likely to have a shorter life expectancy than their parents. But we are not powerless to prevent obesity in our children. Dr. Okie’s book alerts parents to the dangers and the solutions. It does take a village to raise a child, so parents who want to provide their children with a healthy future will need to join together and fight for it from earliest childhood on.

Since obesity can be identified in early childhood and is easier to prevent than to treat, it should be a focus in every pediatric well-child care visit. Not all overweight children will become obese adults, but they are at greater risk. Obesity in childhood threatens our children’s future, increasing their risk for high blood pressure and heart disease, strokes, diabetes, lung problems, arthritis, and other musculoskeletal disorders. The potential for psychological damage to an obese child who faces teasing and rejection should also be in every parent’s mind. As the obesity epidemic captures the headlines, the stigmatization is only likely to intensify. Dr. Okie sensitively addresses this issue while pointing out that avoiding a child’s weight problem altogether will not protect his or her self esteem.

Obesity does not strike all equally. The tendency toward obesity is inherited, though poor nutrition and inadequate physical activity play an important role in turning this vulnerability into a reality. In the United States, Mexican American, African American, and Native American children are more likely to be obese than non-Hispanic white children. While genetics may play a role in some cases, higher rates of poverty and cultural values are embedded in these discrepancies. In certain cultures where poverty is associated with a food scarcity, parents may feel pride in providing their children with foods touted on TV. They may also value a well-padded child as one who is safe from the malnutrition that earlier generations have experienced or from violence on the street where the child lives. Poverty is a powerful factor, because healthy foods are more expensive and more difficult to find in poor neighborhoods.

Kelly Brownell, director of the Yale Center for Eating and Weight Disorders, calls our communities “toxic environments.” Our attitudes toward exercise are reflected in schools that are cutting out recess and physical education classes. Achievement test results are now the key to funding and have become the sole focus at many public schools. Too often children’s need for time to move about and play in order to learn is ignored. In many communities playgrounds and neighborhoods are no longer safe places for children to play and learn sports. As a result children invest most of their after-school time in passive activities with television and video games and so fail to get the exercise they need. The hours of television they watch correlates with the unhealthy, excess weight that they accumulate.

Marketing aimed directly at children and bypassing parents can also be toxic. Television programming for children is saturated with junk food ads. Marketers know that it pays off to disempower parents and push children to beg for the most aggressively advertised foods. The sweetest, saltiest, and fattiest products are the cheapest to manufacture and the most likely to exert an addictive pull—especially on young, inexperienced taste buds. Most working parents have limited time with their children and must compete with the marketers for their hearts and minds. They are forced to struggle against the tempting misinformation of advertisements and resist their children’s demands

for cereals or soft drinks or fast food “just like the ones on TV.” Psychologist Susan Linn has recommended a “commercial-free childhood” to protect our children from the toxic effects of the media around them.

Fed Up! is a hopeful book that shows how the battle against obesity can be won. As parents we must begin to fight for a healthy environment for our children. We need to stand up and voice our demands. Our communities need to stand together for a healthy future for all children.

As Dr. Okie’s book so clearly demonstrates, the occurrence of the obesity epidemic at the beginning of the twenty-first century, and its spread from the epicenter in the United States to countries with similar economies is no accident. It is rooted in the changed relationships of humans to sources of sustenance and to physical activities required for survival. The majority of our population no longer has a direct role in food production. For most, physical work to obtain food is no longer necessary and knowledge about food—what to grow and what is necessary for survival and health—is no longer handed down through the experience of one generation to the next. Instead, we eat our food—fast food, take-out food, catered food, frozen food, microwaveable food—without expending significant calories to obtain it. The kinds of foods that are available are dictated by marketing and profit margins. Our obesity crisis is unfolding in societies, like ours, that redirect human activity away from calorie expenditure and food consumption away from satisfying caloric and nutritional necessity.

The fight for affordable, healthy foods; safe opportunities for physical activity; and freedom from toxic marketing goes beyond what any one parent or family can accomplish alone. Together we must advocate for the following:

• Opportunities for physical activity—funding for daily physical education programs with qualified instructors and safe equipment in public schools; safe parks; neighborhoods suited for outdoor play such as walking, running, biking, and other sports; and community planning that allows inhabitants to safely walk rather than drive to school, work, and stores.

• Access to healthy food and protection against unhealthy food—

affordable fresh produce, grains, dairy products, fish, poultry, and meats must be available in local stores in every community, rich or poor. Huge megastores on the outskirts of towns have supplanted smaller shops in the town centers so that residents must drive rather than walk. Once there they’ll be more likely to buy longer-lasting processed foods in packages and cans (so they won’t need to return as often) that often contain higher levels of salt, unhealthy fats, and simple carbohydrates. In poor communities, cheaper processed foods are often all that are available on the shelves of local stores. School meals must be nutritionally sound. Limiting children’s access to unhealthy foods—as is done for alcohol and cigarettes—is also essential (for example, removing soda and candy machines from schools).

• An end to nutritional misinformation—food marketing found on television, radio, magazines, billboards, the Internet, and food packaging floods consumers with misinformation and deceptively positive associations to unhealthy foods, drowning out the effects of accurate information that is far less available. Children are especially vulnerable, yet are specifically targeted. Advertising for cigarettes, a public health hazard, was sharply curtailed several decades ago. It is time to do the same thing for nutritionally empty foods.

Without these changes we will lose this struggle. Alone, our power as parents will not suffice. We must work together for new political and economic priorities that put a healthy future for our children first. Dr. Okie’s important book is a battle cry, one that can lead us all to community action that will save generations to come from the threat of obesity.

T. Berry Brazelton, M.D.

Joshua Sparrow, M.D.

Children’s Hospital

Boston, Massachusetts

I wrote this book in the hope of empowering parents and others to respond to an epidemic that threatens children’s health. My own painful memories of being an overweight child provided emotional fuel for the project. I also brought to it my prevention-oriented training as a family physician, my many years of experience as a medical reporter for the Washington Post, and the lessons that I have learned as the mother of two boys.

To understand what might be causing an epidemic of childhood obesity, it is important for readers to gain a fundamental understanding of three key areas related to the crisis: how the human body regulates appetite and maintains itself at a constant weight; how the genes that children inherit from their parents contribute to their chances of becoming overweight; and how some environmental changes in the past 30 to 40 years may be interfering with our bodies’ ability to maintain a healthy weight, making more and more of us, young and old, store too much fat tissue. I provide readers with the information to develop a working knowledge of these areas with the help of researchers, specialists who treat overweight children, and other professionals from various disciplines who have shared their insights, discoveries, and concerns. I also describe the scientific evidence supporting assorted changes in diet or lifestyle as effective strategies for slowing or halting the rise in obesity among kids.

There is probably no single cause or simple solution to this obesity epidemic. Many factors are likely contributing, and we don’t yet know which are paramount. But parents and other adults are certainly not powerless. Researchers have already identified steps that can be taken at home, at school, and in the community to reduce a child’s risk of becoming overweight. There is much that we can do. This book offers the tools.

In researching Fed Up! I spent time with many children in a variety of settings. I talked with them, observed them in classrooms, ate lunch with them in school cafeterias, hung out with them on playgrounds, gardened and cooked with them, and accompanied them on visits to dietitians and clinics. All of the children, teenagers, and adults described are real individuals. No one is fictitious or a composite. I have referred to the kids and their parents by first names only to protect their privacy.

Many people helped me on this project, and I have tried to thank them all in a separate acknowledgments section. Above all, I am grateful to the children and families who let me into their lives and allowed me to write about their own struggles with obesity in order to help other kids.