Everyone’s concerned about the epidemic rise in childhood obesity. A recent study may point the way to a deceptively-simple yet powerful solution.
The statistics are overwhelming. According to the Alliance for a Healthier Generation (a partnership between the American Heart Association, former Pres. Bill Clinton and Gov. Arnold Schwarzenegger), this is what we’re up against:
– The number of overweight children and adolescents ages 6-19 has nearly tripled in the last forty years.
– More than 10% of children between the ages of 2 and 5 are overweight, up from 7% in 1994.
– Overweight adolescents have a 70% chance of becoming overweight or obese adults.
These statistics and others referenced on the AHG web site point to a growing health problem among children and adolescents, with a disparate burden on populations of youth at high risk. The obesity epidemic, if unchecked, will be one of the U.S.’s costliest environmental health problems as we near 2010, despite being a leading indicator for the ironically-named “Health People 2010” initiative.
Research studies have evaluated nutritional and fitness interventions, which have yielded modest success. Clearly, on an individual level, targeting diet, exercise and the mind-body (psychological) aspects of obesity and corresponding metabolic syndrome (high lipids, high blood pressure, type II diabetes) makes sense. But lifestyle change is always difficult. Despite the emergence of promising techniques like motivational interviewing to encourage folks to change their ways, simply put, a child is not an island unto themselves. Pediatrics, and specifically integrative pediatrics, has always focused on family-centered interventions. It does take a village – which is what is so encouraging about the “Shape Up Somerville” (SUS) program.
Developed by Dr. Christina Economos and associates at the Tufts Friedman School of Nutrition Science and Policy, SUS is a truly holistic environmental approach to the obesity conundrum. Somerville, Massachusetts is a socio-economically, racially diverse community near Cambridge and Boston. The SUS initiative recognizes that a multi-modal approach to weight reduction in children is crucial, and it involves the entire community (families, schools, healthcare providers, city government, restaurants/merchants) in the battle. The “intervention” is simply this: changing the way of life in one entire community. Not “just” school lunches or recess, not “just” family meals and exercise, not “just” public policies, not “just” educating healthcare providers – ALL of these things, ALL at the same time. As the research abstract notes, the study was “designed to bring the energy equation into balance by increasing physical activity options and availability of healthful foods within the before-, during-, and after-school, home, and community environments.” The advantages of this approach are not only will individual children benefits, but so will families; and the idea of increasing energy expenditure (walking or biking to school, for example) has profound positive implications for the environment at large.
The main outcome measure, comparing children (grades 1-3) in Somerville to two other matched, control communities, was change in BMI (body mass index) score, the gold standard of weight for height measurements. At baseline, 44% of children in Somerville were above the 85% for BMI, not statistically different from the two control areas. The study lasted 3 years (2002-2005), and analysis of BMI z-scores at the endpoint revealed a significant reduction in BMI for the Somerville group versus the two control groups. The authors state, in conclusion: “This study demonstrates that it is possible to address the alarming rise in the prevalence of overweight in children through a multifaceted environmental change approach that involves the community, schools, families, and students.”
The Shape Up Somerville initiative is a beginning. Communities that band together and recognize the value of working together to improve children’s health through family and community partnership, led by motivated and well-directed healthcare practitioners, can make a difference. And we need to start now.