Globesity Awareness, Be Raised!

Here are the credits of a very timely report with five primary authors and 28 expert consultants from around the world, which looks at global childhood obesity from some angles that are not often considered:

With funding from the Robert Wood Johnson Foundation and in collaboration with WHO/Europe’s Behavioral and Cultural Insights Unit, the Vanderbilt Cultural Contexts of Health and Wellbeing Initiative uses cultural insights to help improve public health policy and healthcare delivery.

This 52-page document dives into various aspects of a problem that seems all too familiar. At the same time, it holds some lesser-known secrets whose exploration could make a significant difference. Over the last 40-plus years, “the prevalence of children classified as overweight or living with obesity based on BMI increased more than four-fold, from 4% to 18% globally.”

And yet, many professionals in the field now believe that Body Mass Index is not a good predictor of metabolic health for the individual. Japanese authorities have demoted BMI to only one risk factor among several. Since 2008, the “Metabo-Law” has required the waistlines of all adults over 40 and under 74 years of age should be measured annually. If the number does not fall within strict parameters, the people are referred to programs designed to help.

As of 2022, Japan is one of the 10 least obese countries in the world, with only less than 5% of its adults being defined as obese.

Heart of the matter

The core proposition of cultural awareness goes like this:

[R]ather than focusing on particular nutrients, acknowledge food as embedded in cultural contexts, allowing for creative adaptation to local circumstances…

It is hoped that consensus may emerge, regarding “the need to look beyond individual choices to address upstream cultural, commercial, and structural factors that produce obesogenic environments…” Cultural traditions are very stubborn, and if their energy and creativity can be captured:

We show how public health programs can work with, not against, cultural traditions and norms — harnessing local creativity to change nutritional outcomes.

Some societal norms probably have very little to do with culture or tradition, and increasing numbers of thoughtful individuals turn against the norms that have become destructive. Many of the earth’s people agree that children need to be protected from the marketing of ultra-processed foods with ultra-low nutritional value.

In South Africa, for example, the administration and the food corporations have worked out some limits and restrictions. In Mexico, reducing soda consumption is a major goal. Labeling guidelines and taxation are employed, along with regulations about marketing to children in school environments.

Your responses and feedback are welcome!

Source: “Reframing Childhood Obesity: Cultural Insights on Nutrition, Weight, and Food Systems,” Vanderbilt.edu, 2022
Source: “Obesity Rates by Country 2022,” WorldPopulationReview.com, undated
Image by Mark Licht/CC BY 2.0

Obesity Awareness and Mission: Readiness

At present, Mission: Readiness includes around 750 retired upper-echelon military leaders who stand for “evidence-based, bipartisan state and federal public policy solutions that are proven to prepare our youth for life and to be able to serve their nation in any way they choose.” The object is to help kids stay fit, in school, and out of trouble. Preventing malnutrition is one of the matters on the group’s agenda, and another very large concern is obesity.

Mission: Readiness is part of the Council for a Strong America, which also includes leaders from the law enforcement, business, health care, and economic development sectors of society. Their interests include not only military preparedness, but community safety, crime prevention, and the building of a competent and talented workforce to make sure every part of society achieves its potential. This can happen only by investing in the health, welfare, and education of the nation’s children, starting at a very young age.

In 2020, Mission: Readiness issued a report titled “Breaking Point: Child nutrition imperils America’s national security.” It revealed that weight issues would preclude almost one-third of America’s young people from military service. Even in the present era of voluntary enlistment, this is not good news, and if a national emergency necessitated reinstatement of the draft, it would be a disaster. The injury factor alone is forbidding. According to the report,

Army recruits in ten Southern states […] had lower levels of physical fitness, and were up to 28 percent more likely to be injured during basic training than their peers from other regions of the country. Another study found that active duty soldiers with obesity were 33 percent more likely to experience musculoskeletal injury, contributing to the nearly four million injuries that occurred among those on active duty between 2008 and 2017.

Ironically, the youth of Washington, D.C., the country’s capital, are the least fit of all. At the time the report was prepared, the estimated number of American children experiencing food insecurity was as high as 18 million. The authors warned that, although it may seem counterintuitive, the connection between food insecurity, malnutrition, and obesity is real because the lack of access to affordable, healthful groceries usually means that kids are eating the less costly and more accessible stuff, with a definite shortage of nutritional value but plenty of added obesogens.

Food insecurity, or the lack of access to affordable, healthy foods, can result in consuming cheaper and more accessible food, which often lacks nutritional value. The last sentence of the report’s Conclusion was,

Lawmakers must modernize federal nutrition programs, created out of concerns for national security, so that programs can continue to help prepare America’s children for strong futures throughout the COVID-19 pandemic and beyond.

Your responses and feedback are welcome!

Source: “Breaking Point: Child nutrition imperils America’s national security,” Strongnation, Sept. 2020
Image by Alachua County/Public Domain

Childhood Obesity and National Security

Childhood Obesity Awareness Month encompasses many areas of life, including military preparedness. NPR journalist Yuki Noguchi wrote,

Across all segments of the military, 31% of young adults ages 17 to 24 cannot enlist because they’re too heavy, according to the Department of Defense. The Army, the military’s largest branch, needs to recruit about 130,000 people a year to carry out its missions, and therefore faces the brunt of the recruitment challenge that childhood obesity presents.

Some experts even go so far as to predict that within a generation or two, the shortage of fit recruits could become an “existential threat” to the country. To complicate the problem, a disproportionate number of new military members come from the American South, where obesity rates are higher than in the North. Of course, when the COVID-19 pandemic came along, that did not help matters at all, on any front. People of all ages, from all parts of the country, have tended to put on pounds.

Taking responsibility

No official program is involved, but starting about 10 years ago, some individual recruiters have been taking it upon themselves to work with potential recruits in order to get them down to acceptable enlistment weight. They have seized the initiative to do things like start workout sessions in recruitment office parking lots.

The reporter spoke with one such mentor, Staff Sgt. Stephen Ahlstrom, who has even been known to pick up the teens he is trying to help at home and drive them to workout sessions. Some of the young folks will hang in there for months, determined to meet the standard. One of Ahlstrom’s mentees eventually dropped 100 pounds.

A recruiter might periodically record weights and measurements to monitor the progress of the young people who show up. They also listen and talk, helping with the various mental challenges involved in making such an extreme life change. They might remind a struggling overweight youth that having a weekly “cheat day” does not mean eating like a fool all day, but allows, for instance, one cheeseburger on Saturday night. Even small hints can help, like downing a daily gallon of water.

The brass get involved

Even for dedicated mentors, many factors are beyond their control, like low family incomes and lack of access to healthful foods. The reporter spoke with Maj. Gen. Malcolm Frost, who belongs to the nonprofit group Mission Readiness. He and others like him have been focusing on preventative measures, like championing food subsidies for low-income families so that basic nutrition can be assured.

Retired major general Jeffrey Snow is another high-ranking military person who issued warnings. Of him, Noguchi wrote,

“It’s a wicked problem,” he says, adding that he’d spent years “talking myself blue in the face” but without much success. “I can’t even tell you that I had an impact on this issue.”

Still, thanks to such organizations and to the recruiters’ unofficial efforts, it is estimated that between one and two thousand people per year are rendered fit for acceptance into the armed forces’ basic training programs.

Your responses and feedback are welcome!

Source: “Fighting Weight: How Military Recruiters Take On Obesity, Case By Case,” NPR.org, 05/17/21
Image by U.S. Army Europe/Public Domain

Awareness Month All Year

Earlier this year, the U.S. Conference of Mayors and the American Beverage Foundation for a Healthy America gave nine American cities awards of various amounts, totaling $745,000. The winners were recognized for supporting “programs to enhance health, wellness and environmental quality of life for children and families.”

Salisbury, NC, and Daytona Beach, FL, are both intensely addressing childhood obesity prevention. Denver, CO, is home to Food Matters: Solutions for Food Waste Reduction…

[…] an innovative two-part project that aims to address both environmental sustainability and food insecurity. The program will teach Denver residents to make full use of the food they purchase and consume and incentivize local restaurants to donate surplus food to those in need.

In Des Moines, IA, a program provides fruits and vegetables for children with diet-related diseases, “while delivering nutrition education and collecting and monitoring biometrics on a routine basis.” Baltimore, MD, focuses on gardening and cooking. Montgomery, AL, also concentrates on outdoor gardening for the sake of both fitness, and better food.

In Orlando, FL, a program trains young people to become certified beekeepers. Bridgeport, CT, wants to improve the public health and fitness facilities in two city parks. The program that won for White Plains, NY, sounds very serious:

Peer Advocates for Healthy Living (PAHL) will recruit 40 high school youth who will undergo rigorous 12-week (36-hour) training in nutrition; healthy cooking on a budget; barriers to achieving health (emotional, social, and/or physical); and public speaking and presentation skills.

For Physicians Weekly, Sara Karjoo, M.D., delineated several principles that are important for every doctor to bear in mind. Why? Because:

By addressing obesity in pediatric patient care, physicians can potentially slow the progression of metabolic disease, along with numerous serious chronic diseases. By taking these steps, we can serve as better advocates for our patients’ future health.

While other factors may come into play, healthful food and sufficient exercise are the foundation on which everything else rests. The societal, cultural, personal and medical risks of obesity are different for children and teens than they are for adults. It is definitely not a one-size-fits-all situation. And with children, it is not useful to make a big deal out of poundage:

Weight loss is not as critical a parameter in children. Rather than weight loss, the emphasis for children should be on promoting healthy habits and improving body composition.

Doctors are also advised not to ignore new tools or treatments, or advances in such formerly science-fictional areas as genetic testing, to identify traits that lead to obesity. Another suggestion is to take a second look at something formerly shunned, like bariatric surgery, which can greatly benefit a teen with multiple co-morbidities.

Your responses and feedback are welcome!

Source: “Nine Cities Share $745,000 in Grants to Promote Childhood Obesity Prevention…,” USMayors.org, 01/29/22
Source: “CDC Study Finds Alarming Increase in Pediatric Obesity Rates 5 Points for Physicians to Understand,” PhysiciansWeekly.com, 01/13/22
Image by Nicholas Wang/CC BY-SA 2.0

Awareness by the Numbers

Speaking of surveillance, the National Collaborative on Childhood Obesity Research (NCCOR) maintains a Catalogue of Surveillance Systems that provides access to more than 100 available datasets related to childhood obesity research in the United States.

The available information, gathered over the past 10 years, encompasses health behaviors, outcomes, and determinants, along with environmental factors and determinants. Users can search and filter the research by level, racial/ethnic groups, scope, sampling design, key variables, cost, age group, time frame, geocodes, sample size, and more.

The four NCCOR collaborators are the leading funders of childhood obesity research: the Centers for Disease Control and Prevention), the National Institutes of Health, the U.S. Department of Agriculture, and the Robert Wood Johnson Foundation. According to NCCOR,

This free online resource helps researchers and practitioners more easily investigate childhood obesity in America by increasing efficiency, effectiveness, and innovation in obesity research.

NCCOR’s most recent annual report is titled “Creating Environments to Grow, Move, & Thrive.” The featured projects include a report on how COVID-19 has impacted child care programs, along with potential solutions and emerging opportunities to better deal with the ongoing crisis. One report covers the difficult question of how better to surveil and measure youth active travel to school, and another identifies programs that promote trial use by the young.

This one sounds essential — “A Toolkit for Evaluating Childhood Healthy Weight Program”:

NCCOR developed this toolkit to help researchers, practitioners, and community programs gain confidence in conducting program evaluations. It reviews key concepts and provides detailed guidance on the core components of effective evaluations. It also features a resource library, with links to guides, databases, research articles, and other public health toolkits.

A report from the CDC suggests that the pandemic worsened the nation’s pediatric obesity rates. The percentage of children and teens with obesity accelerated from 19% before the pandemic to 22% today.

Some oldies but goodies

These are useful posts from Childhood Obesity Awareness Month in recent years:

Awareness Month — Settle in for a Read
Childhood Obesity Awareness Month Retrospective
9 Ways to Avoid Enabling
Passive Enabling and Child Obesity

Your responses and feedback are welcome!

Source: “Catalogue of Surveillance Systems,” NCCOR.org, undated
Source: “NCCOR’s 2021 Annual Report Looks at Strides Made in Promoting Healthy Environments for Kids,” NCCOR.org, 03/22/22
Source: “CDC Study Finds Alarming Increase in Pediatric Obesity Rates 5 Points for Physicians to Understand,” PhysiciansWeekly.com, 01/13/22
Image by Jim Rush/CC BY-SA 2.0

Cosy Up With COSI

The concept of Childhood Obesity Awareness Month contains a cruel irony. One might be tempted to say, “Oh, really? Childhood obesity is still a thing? Glad you brought it up. I wouldn’t have guessed, just from seeing all these, you know, severely obese and ominously overweight children everywhere.”

Are more children dangerously heavy than ever before?

“Surveillance” is not everyone’s favorite word, but the European Childhood Obesity Surveillance Initiative (COSI) is trying to do something useful.

The system was established by the World Health Organization with the intention of providing “regular, reliable, timely, and accurate data on children’s weight status.” This is accomplished by recording the weight and height of every child in 45 European Region countries, according to a standardized measurement system.

Much information is gathered, on the kids’ family backgrounds, school environments, diet, activity, proneness to a sedentary lifestyle, and so forth. The goal is to “standardize conditions around data collection as much as possible, while still allowing participating countries some flexibility to adapt the system to their national context”:

Data are collected according to a common protocol devised by the WHO Regional Office for Europe and Member States… The first five data collection rounds, between 2007 and 2021, yielded measured anthropometric data on over 1.3 million children…

The system they have worked out to avoid being rejected by some countries, while still keeping up the standard, is very interesting. Even the translation protocols are elaborate and demanding. COSI’s most recent research indicates that…

Overall, the prevalence of overweight (including obesity) was 29% in boys and 27% in girls aged 6 to 9 years; the prevalence of obesity was 13% in boys and 9% in girls.

The highest proportions of childhood overweight and obesity were observed in Mediterranean countries such as Cyprus, Greece, Italy and Spain…

The lowest […] were observed in central Asian countries such as Kyrgyzstan, Tajikistan and Turkmenistan.

Bear in mind that it takes a burdensome amount of time to collect and collate all the numbers involved, from so many different places and bureaucracies, and in various different languages. So, nothing about this is up-to-the-minute. But anyone who assumes that since the information was gathered, the situation has only become worse, will probably be correct.

Your responses and feedback are welcome!

Source: “Methodology and implementation of the WHO European Childhood Obesity Surveillance Initiative (COSI),” Wiley.com, 11/04/21
Source: “WHO Joint Session Including the Results of the Latest Childhood Obesity Surveillance Initiative (COSI) Report,” EASO.org, 04/11/21
Image by Mohd Fazlin Mohd Effendy Ooi/CC BY 2.0