Report Urges Broad Attack on Child Obesity

Experts Say a 'Revolution' Is Needed to Reverse U.S. Epidemic

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Sept. 30, 2004 -- Sweeping changes are needed in America to prevent the growing childhood obesityobesity epidemic from wreaking havoc on the nation's overall health and its medical system, concludes an Institute of Medicine panel.

Approximately 9 million U.S. children over age 6 qualify as clinically obese, while another 9 to 10 million are considered overweight, according to the Centers for Disease Control and Prevention. Obesity carries with it highly elevated risks of a host of chronic and expensive conditions, including diabetesdiabetes, heart diseaseheart disease, kidney failurekidney failure, and others.

An expert panel from the Institute of Medicine, part of the National Academies, says that a complex set of factors, including unhealthy eating habits, industry promotion of junk food, widespread elimination of school physical education classes, and a sedentary lifestyle marked by hours in front of television and video games, has helped 16% of the nation's children become overweight or obese.

Some suggested that the problem has become too large to counter with individual counseling or treatment of obese children.

"We're talking about something that's nothing less than a revolution in the way we address this problem," says Thomas N. Robinson, MD, an associate professor of pediatrics at Stanford University School of Medicine and a member of the committee issuing the 461-page report.

The committee urged parents to take a more active role in promoting healthful eating and exercise habits to their children, including limiting children's time in front of TV or video games to no more than two hours per day. At the same time, schools should provide kids time for no less than 30 minutes of vigorous physical activity per day, though the trend at many U.S. schools has been toward an elimination of gym classes and recess, they said.

The report also urges the U.S. Department of Agriculture to apply nutritionnutrition standards to all foods sold in public schools, including those dispensed from vending machines and snack bars. Many nutritionists have criticized the widespread presence of food and drink company advertisements and promotional programs in schools.

"Ideally schools would become commercial-free zones," says Shiriki K. Kumanyika, PhD, a University of Pennsylvania professor of epidemiology and panel member told reporters.

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System 'Not Working'

The panel also calls for stricter regulation of advertisements aimed at young children, urging the Federal Trade Commission to take a harsher line on food and media companies who fail to abide by voluntary standards limiting junk food promotion.

Grocery manufacturers already use an industry-controlled panel known as the Children's Advertising Review Unit to monitor advertisements aimed at children less than 12 years of age. But the IOM committee says that the panel has been ineffective and that the U.S. government should step in to come up with comprehensive but voluntary guidelines on food advertising product placement aimed at kids.

"I would say that the current system is not working," Robinsons says. "What we recommend is not more of the same current self-review system."

Food manufacturers reacted to the report, saying they supported the panel's broad societal view of the obesity problem. "It's putting every sector of society on alert," says Alison J. Kretser, director of scientific and nutrition policy at the Grocery Manufacturers of America.

Kretser says in an interview that food companies are "doing more and more in advertising and promotions [to] market healthy lifestyles."

The report also blames poor city and suburban planning environments that promote driving and sedentary activities instead of exercise. It concludes that local governments, private builders, and community groups should rethink development plans that would promote opportunities for physical activities such as biking and walking.

Medical schools should also make obesity evaluation and diagnosis part of their standard curriculum for all new doctors, states Kretser.

Experts acknowledged that their recommendations were extremely broad and that they would likely take decades to show a benefit in the health of the U.S. population. But they warned that until the changes are made, diseases once limited to adults, such as type 2 diabetes, will continue to grow as childhood illnesses, and obesity's current estimated $130 billion annual economic burden will also increase.

"We drifted into this," says Jeffrey Koplan, MD, a former CDC director who chaired the IOM panel. "We're not going to drift out of it. It's going to take work and it's going to take leadership and it's going to take resources," he says.

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Sources

SOURCES: "Preventing Childhood Obesity: Health in the Balance", Institute of Medicine, Sept. 30, 2004. National Center for Health Statistics, Centers for Disease Control and Prevention. Thomas N. Robinson, MD, associate professor, pediatrics and medicine, Stanford University School of Medicine. Shiriki K. Kumanyika, PhD, professor of epidemiology, University of Pennsylvania. Alison J. Kretser, director, scientific and nutrition policy, Grocery Manufacturers of America. Jeffrey Koplan, MD, vice president, academic health affairs, Emory University, Atlanta; and former director, CDC.
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