A front-page story in today's New York Times business section laments the lack of effective obesity-fighting programs for children. Many such programs have sprung up, in true entrepreneurial style, since the Obama health care law mandates reimbursement for obesity screening and counseling for children. The trouble is, these conventional-wisdom Kool-aid-slurping approaches are going about it the wrong way.
Calories in equal calories out? Family awareness about "good" versus "bad" foods? Encouragement to exercise? These have comprised kids' school health programs since the 1960s. Weigh-ins and group therapy? The article is accompanied by an adult peering over the shoulder of a chubby pre-teen to read the numbers on a scale. Does this warm-hearted and well-meaning supervision inspire a lean life?
There's no data supporting long-term positive outcomes for any of these programs, and indeed, for any of the thriving diet industry offerings for either adults or children. Knowledge doesn't bring long-term skinniness, even if will-power and "simple adjustments" slice off a few pounds. "If this were easy, if there were clear outcomes for success, we would be investing in these," confesses Dr. Samuel R. Nussbaum, chief medical officer for a huge health insurer.
You can bet more and more of these anti-fat education programs will proliferate, as long as big butts bring big bucks. But from the research I've been conducting for a book on the topic, they'll add to the national deficit, perhaps bring some short-term shape shrinkage, but won't return our population to slimness levels of past decades.
That's for two reasons. First, the shape of Americans has changed, and shoehorning Americans back into their sizes of yesteryear will be akin to putting toothpaste back in the tube. Average height has enlarged from 5-foot-six, which was the mean for men at the turn of this century, (a figure that fluctuated since 1700 reflecting disease as well as nutrition) to 5-foot-ten among Americans born here in 1970. The National Center for Health Statistics reports that in 2006, the average height for all American males (including immigrants) was 69.2 inches, a little over five-foot-nine. It's a major body expansion, but nobody is campaigning to reverse growth in that direction.
At the same time, bodies have ballooned outward. A CDC study found that between 1960 and 2002 the average weight of a man aged 20-74 rose from 166 lbs. to a more portly 191 lbs. Women similarly enlarged, from 140 lbs. to 164. In those same 42 years, life expectancy rose from age 66 for men and 73 for women (1960) to 75 for men and 80 women today (2010). Hmmmm. We're getting taller, fatter and living longer. Correlation does not imply causation.
And we're adjusting to our increased proportions. An article in the NY Times discussed "the New Calculus of Broader Backsides," as Transit Authorities replace their subway and train cars. Perhaps in honor of its governor, New Jersey Transit, the piece noted, has increased its seat width from 17.55 inches to a comfortable 19.75 inches. Connecticut Metro-North Rail Commuter Council chair Jim Cameron was most pithy in his approving self-interest: "Why subject my girth to other people?"
Yes, we all want to protect our girth, which is exactly why all these lauded weight-reduction programs are doomed to failure. Everybody's fat, including our icons like Oprah and Rush Limbaugh, and with a fourth of the nation (35% of blacks) self-reporting themselves obese (perhaps underestimating a bit?) "fitting in" means to a size 14 average for women--and those sizes have themselves become more, uh, roomy.
The second, and more crucial reason for the failure of these earnest efforts to stem childhood obesity (which in the past three years has leveled off, by the way) is that their tactics are wrong. Most big programs, like WellPoint, involve dietitians who instruct on creating healthy low-calorie meals, limiting portions and choosing wisely. Does this sound enticing? Exciting?
How about the programs where participants weigh in in front of an authority? Just what kids want to do. Weight Watchers tried a web-based course for youth that they scuttled "after discovering children were regaining their weight after a year, with some even gaining more than they might have had they not participated."
There's an elephant in the room, and it's not just the collective tonnage of overweight children. It's the fact that we don't truly know what makes people obese, and we haven't found any way--other than obsessive, life-long restriction and vigilance--to keep people thin once they lose weight. It's not a simple equation of calories in, energy out, as Tara Parker Pope wrote quite eloquently in a New York Times Magazine cover story a couple of weeks ago called "The Fat Trap." You see, there are a raft of hereditary and biological forces that not only conspire to bulk us up but to maintain fat on human bodies. She disclosed that exercising and eating properly haven't allowed her to lose the 60 extra pounds on her frame. Her research revealed that they're apparently programmed to stay there.
Telling that to pudgy kids and their families won't inspire much hope, however, and won't get them leaping onto the "Let's Move!" bandwagon. Instead, institutions and companies eager for Obamacare dollars mislead audiences into thinking their diets and measurements can solve the problem. "What we're learning about treating childhood obesity is that there is no magic bullet in dropping weight in kids," admits Roanoke, Virginia pediatrician Dr. Colleen Kraft, who's affiliated with the WellPoint program that tried.
We know that about 19% of children aged 6-18 are obese, but it's tougher to find the percentage that are morbidly obese, of whom Randy Seeley, associate director of the Obesity Research Center at the University of Cincinnati Medical School says in Time Magazine, "zero percent will grow up to be normal-weight adults." Googling "morbidly obese children" only yields hundreds of articles discussing the merits of snatching these kids out of their biological parents' homes into foster care--for their own good, of course.
If taxpayer-paid programs can't reverse childhood obesity despite financial incentives, what can we do? That desperate question underlies a progressive value that assumes intervention--anything--is required for every problem. Given that science has yet to understand whether it's DNA, stress, or even an adenovirus that has spiked rates of obesity over the past 20 years in both children and adults, it's naive to assume more instruction that repeats mandatory school health lessons about square, uh, pyramidal, uh plate-shaped diets combined with exercise, will work.
What will work is dropping all the federal funding in this squeezed economy for spongy, feel-good programs with no basis or track-record. Scale back on the school breakfasts and lunches, even the ones with the salad and apples designed to model healthy meals (that end up in the trash). Keep the health courses that offer basic nutritional information but focus not on some mythical ideal dinner plate but instead on learning what real hunger and satiation feel like, and why listening to those physical (and associated mental) cues--rather than emotional needs and ubiquitous come-ons of fast food and supermarket munchies--is the way people stay naturally healthy and in sync with their bodies.
book The Obesity Myth documents that greatest longevity accrues to those in the "overweight" BMI category. In an interview in The Atlantic, Campos, a law professor at the University of Colorado, Boulder, says "There is literally not a shred of evidence that turning fat people into thin people improves their health. And the reason there's no evidence is that there's no way to do it."
Do we want healthy Americans, or do we want fashionably thin ones? With Michelle Obama's chisled biceps as models, used as she gracefully shovels dirt for the White House vegetable garden, it seems the latter. There's no harm in recognizing healthy foods and activities, but insisting that over-riding our own intuitive means to know what's healthy for us individually, and what's satisfying to us physiologically, eliminates the most time-tested and simple means to stay our personal best weights, whatever the number on the scale.