Everybody wants to know: Is there anything that works to prevent childhood obesity? And if so, what is it? The Robert Wood Johnson Foundation wonders, too, and not only in a general, curious way. The Foundation has a specific goal, to reverse the growing obesity trend by 2015. Getting everybody slimmed down by then would be too much to hope for. They will be happy to just to see the line on the graph heading in the other direction. But how?
For The Wall Street Journal, Betsy McKay looked into the Foundation’s search for a good direction, and also studied up on similar efforts being made by the federal Centers for Disease Control (CDC). McKay says,
With the idea of providing a road map, the CDC recently awarded 39 U.S. communities $257 million to make environmental and policy changes and evaluate the impact of some on behavior.
Basically, they institute some kind of program, working with a factor that seems to be causing the problem. Then the results are measured to see whether there is a lasting change in the participants’ behavior. Of course, in this particular area of inquiry, it’s also important to know whether any of the participants have made progress in attaining a healthy weight. This is what is called an intervention study; in other words,
…testing an hypothesized epidemiological cause-effect relationship by intervening in a population and modifying a supposed causal factor and measuring the effect of the change.
One such plan is Let’s Go!, which has a presence in nearly 350 schools, childcare centers, after-school programs, and doctors’ offices in the state of Maine. Over five years, supporters from the health care and business communities invested around $3.7 million to see if it works. Let’s Go! promotes the 5-2-1-0 message. This means:
5 or more servings of fruit and vegetables daily
2 hours or less of screen time daily
1 hour of exercise at least, daily
0 sweet drinks
The 5-2-1-0 formula was adapted from an earlier project for the purposes of this study by pediatrician Victoria Rogers. Dr. Rogers has an impressive record in the childhood obesity field, and presently directs the Kids CO-OP at Maine Medical Center’s Barbara Bush Children’s Hospital, as well as filling the post of medical director for the Let’s Go! Initiative.
At a national level, she is involved with the Childhood Obesity Action Network. Most recently Dr. Rogers has been asked to participate in the American Academy of Pediatrics Obesity Leadership Workgroup. This workgroup is a cadre of expert consultants upon which the AAP calls on for expert opinion, review, and as spokespersons.
In addition to the clear, consistent 5-2-1-0 message, the voluntary program includes 10 key strategies for success, and is described as an easy and effective way to integrate healthful eating and physical activity into any school environment.
In a sidebar article, McKay follows the progress of one particular boy, born into a culture that sees a hefty body as proof of a well-fed, strong child. Still, wanting to cooperate, the family agrees to keep junk food, candy and soda pop out of their home, and accepts the advice that young Ayub needs to be more active. But he gains weight, and the family says it is difficult to find healthful foods that Ayub will actually eat. His father declines an offered referral to a dietician.
Then, the boy misses two appointments and the parents are reluctant to reschedule. Their program advisor decides to leave the obesity question aside and concentrate on health as a goal, and the mother agrees to give all her kids less juice. Meanwhile, Ayub still gains weight and begins to show signs of being prediabetic. Also, once they figure out that he is eating a breakfast at home and another one at school, the home breakfast is cut back to just a piece of fruit. Ayub develops a liking for some vegetables, but continues to gain weight. His BMI goes from 23.9 (February 6, 2009) to 27.4 (March 25, 2011).
For this child, the program does not show much effectiveness, and you can see that the peculiar dynamic of each family presents its own challenges. It might be said that the same thing is true of Let’s Go! as of Alcoholics Anonymous — the program doesn’t work unless you work the program. Where’s the motivation? How can a grade school kid be moved to experience the same fervent wish for change, as a burned-out alcoholic who has finally hit bottom?
On the other hand, a 17-year-old boy lost 80 pounds (going from 260 to 180) just with dietary improvements and increased exercise. But apparently that is rare. The progress is excruciatingly slow. An independent phone survey of 800 Portland area parents (who were familiar with Let’s Go!) found that in 2007, 22% of children had integrated 5-2-1-0 behaviors into their lifestyles. A 2009 survey established that 28% of children had changed their ways to some extent. In some eyes, the results are not very encouraging.
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