Government as Savior: Feed the Hungry, Slim the Obese

Pic from a 1949 'Life Magazine' article on obesity

It's ironic: the poorest Americans, the ones on government food stamps, tend to be the fattest. Which calls for another government program to get them slim.

Reading a fascinating series of articles in the Washington Post by Eli Saslow about poverty and obesity, I was struck by the underlying assumptions fueling many expensive, publicly-funded efforts to "save" the obese poor.

Everyone wants to spare people illness and pain. Everyone wants to enhance longevity and add to quality of life. No one wants to pay for medical services for poor people if their illnesses can be avoided. In fact, with the laughable state of Obamacare in its first roll-out weeks, it appears no one wants to pay for governmentally-required health plans.

But we're paying for a lot of health-oriented programs, anyway. One Post article describes ignorance and incapacity in nutritious food preparation of residents in Hidalgo County, Texas, near the Mexican border. Forty percent of the population there relies on federal programs to pay for comestibles, a percentage nearly the same as the area's 38% obesity rate. Local food stores don't offer many vegetables, but do a brisk business in Cheetos smothered in melted cheese. Is it greedy grocers who are pumping pounds onto hapless neighbors, or, could it be that if these outlets offered veggies, neighbors would still opt for Cheetos?

A slide show with the Washington Post series offers a rather disheartening, though honest answer. One photo shows a portly woman guffawing in a nutrition class when the teacher suggests serving smaller portions. "Yeah, well, try telling that to my husband!" she retorts.

In Chicago, where Mayor Rahm Emanuel boasts city efforts brought a 21% decline in "healthy food deserts" in the last two years, obesity remains high. Childhood obesity rates are notably higher than the national average; overall, 27% of Chicagoans are obese, 34% overweight, and 38% of "normal" BMI. Reporting on a study that made national projections, the Chicago ABC affiliate last year headlined, "Half of Illinoisans to be Obese by 2030."

A conundrum that health experts ponder is that food stamp recipients--whose need for sustenance is great enough for the government to step in--are disproportionately obese. As I frequently note, more and more non-gluttony causes of obesity are surfacing. Offering vegetables to the poor obese, even with education explaining how and why to cook them, can't affect most causes being discovered. It's condescending and silly to think that government-programs for classes, gyms and markets with produce can have much effect on the poor's collective girth.

That relates to the "government will provide" mentality inculcated in the public by Obama's Supplemental Nutrition Assistance Program (SNAP), the values-free new moniker for Food Stamps.

Under Obama-administration direction, taxpayer-funded "outreach" workers infiltrate low-income pockets to sign-up as many candidates as possible. One illuminating Washington Post article follows a recruiter as she approaches residents of a shabby central Florida trailer park, pursuing her quota of 150 seniors per month. Her method is to bring piles of free food to attract a crowd, and then lure them to enroll, using a set of SNAP-provided talking points crafted to silence listener's doubts.

If a prospect hesitates because of welfare stigma, the recruiter responds, "You worked hard and the taxes you paid helped create SNAP."

If a candidate's embarrassed, the recruiter soothes, "Everyone needs help now and then." If accepting denotes failure, the recruiter just normalizes the experience: "Lots of people, young and old, are having financial difficulties." The recruiter might add that with the step-up in loading people to the dole, fellow recipients likely live next door. In Florida, the setting for the story, food stamp enrollment soared in just the last 5 years from 1.45 million to 3.35 million beneficiaries.

The whole effort riles me, not only because of the increase in federal tax burden, but because stifling moral objections scoots a vulnerable population down the chute to permanent dependence. Of course, the presently-empowered political party gains supporters when more voters rely on them rather than on family, church or self-starting entrepreneurship. It's a smart move for Democrats to ease in as many new SNAP dependents as possible, because they form the voting bloc guaranteeing support for politicians who guard their entitlements. Challengers who would rein in government largess become the bad guys grabbing food away from the hungry.

Clever strategies cajole low-income elders with salesmanship and persuasion. The stigma of ripping stamps or paper slips from a coupon book is gone. Now, recipients swipe a cute little card called an EBT, for Electronic Benefits Transfer. Looks just like a credit card, but you never get the bill.

In an astonishing reversal of right and wrong, recruiters claim that taking federal assistance is actually altruistic, because it brings money into the local economy and thereby creates jobs. Despite the appeal to civic responsibility, seniors are reticent to sign up, and only 38% of eligible Floridians have, a rate half that of other age groups. "That means about 300,000 people over 60 are not getting their benefits, and at least $381 million in available federal money isn’t coming into the state," spins the Post article. Mr. Low-Income Senior, it's your duty  to, well, snap it up.

The article describes the moral dilemma of one older Florida resident who prided himself throughout his life in being one of society's "makers" rather than "takers." He resists shifting to a new demoralizing status that confirms his failure, but the implication is that sooner or later, he will succumb.

While certainly some assistance to people in need is important, the search-and-SNAP effort brings two kinds of harm. First is replacing initiative with entitlement. And the second is the intrusion of public agencies' tentacles into the crevices of families' lives, all the way to their dinner plates. Cheetos smothered in melted cheese are awful as daily fare, but the issue isn't lack of broccoli, but the desire and energy to create vegetable-laden dishes--that children eschew anyway. Poor single parents, especially, are exhausted, and they'll never pay six dollars for salad when the Cheetos their kids crave cost just two. And once again, obesity can be driven by chemical, genetic or environmental causes that fruit and veggies can't cure.

 Government-as-savior's response is to do something. Subsidize greens for poor people. Install basketball hoops in every cul-de-sac. Send nutrition educators to every low-income home. Help these poor people!

Concerned legislators began throwing money at obesity ten, fifteen, twenty years ago, and even with Mrs. Obama's "Let's Move!" campaign, it seems obesity outruns it all. Mrs. Obama seems to see the futility in her efforts; last week she officially turned her focus from pummeling childhood obesity to encouraging college. Her new cause is a more constructive direction, because the college message says "you can make something of yourself." Much better than "we can make less of you."

The Very Fattening Drink Kids Guzzled Before the "Obesity Epidemic"

All the outcry about sugary drinks' caloric damage--blaming them, really, for the so-called "obesity epidemic"--got me wondering what people drank before 1980, which is when obesity rates started rising.

I went on a trip down memory lane and realized that as a Baby Boomer kid, my cohort, svelte as we were, operated under a wildly different set of "healthy diet" rules. There was indeed one non-soda liquid that we drank in immense quantities. Not water. Not even lemonade or iced tea. No, what we drank, every day, was--whole milk.

Dietary recommendations for children and teens emphasized that we each needed to consume a quart of milk every day. At 146 calories per cup, mothers were governmentally advised to feed their children 584 calories of bovine secretion every 24 hours. How do I know? I inherited my mother's Parents' Magazine Family Cookbook by Blanche M. Stover, copyright 1953.

Whole milk, by the way, has far more calories than regular Coca Cola, which (according to the company website) provides 88 calories per cup, and thus a "mere" 352 calories per quart.  My mom's cookbook quoted the US Department of Agriculture's calculations of "soda, cola type" in 1949 at 105 calories per cup, while "milk, whole" boasted 165. Guess milk was richer, and cola weaker then.

In pre-obesity epidemic days, skim milk was considered far less healthful for children than whole (which, by the way, has 3.25% fat). Nowadays, the USDA is calling 2% milk "not low fat" and "a poor choice." In school, every cafeteria meal came with a pint of milk; it was expected that kids who brown-bagged their lunches would bring "milk money" to purchase it fresh to accompany their sandwiches.

It's true that milk provides nutrients and protein, so it's more valuable than carbonated drinks.  But when the cholesterol scare occurred, milk and eggs' disappeared from favor. And once schools phased out milk sales, those cute little juice boxes became the go-to drink for moms packing lunches--convenient with no worries about spoilage or leaks.  Those were the days when we thought 100% fruit juice was the healthy option, offering the vitamins of fruit without the "added" sugar.

Now, we're told--at least by the recent HBO series "The Weight of the Nation"--that fruit juices are just as sugary and useless as pop. Even though Mayor Bloomberg isn't restricting big cups of juice the way he's banning servings over 16 ounces of soda, the word's out that every day should be "a day without sunshine." That's a reference to the catchy marketing line of the Florida orange juice producers, singled out for disdain in the HBO series.

It's enough to make you wish environmentalists hadn't made those little bottles of water taboo.

Actually, some sources insist kids need the fat in milk, saying it's essential for brain development. Breast milk, after all, is fattier than whole milk--often 5% fat. And it's sweet--some would even call it "sugary." Lucky for New Yorkers it doesn't come in a container larger than 16 oz.

It's unlikely we'll return to the days when children received their lunch trays sporting a full-fat pint with a cheery, "drink your milk!" But how are concerned parents to wean their kids from Snapple, Capri Sun and Dr. Pepper? To what? "Enjoy your skim!" just doesn't have the same ring.

Health educators are missing a great opportunity: they should teach children the distinction between hunger and thirst.  Thirst is your body needing hydration--water. Hunger is when you need energy--real food. Kids need to learn the difference, and not blow their chance for real nutrition by getting full on a Frappuccino. Or worse, imbibing the 700-calorie Starbucks drink and then dinner, too, without even considering if they're hungry.

I find amusing the tack taken by soft-drink makers defending their products. Coca-Cola's Katie Bayne, in an interview responding to Mayor Bloomberg's proposed big-cup ban, said, "What our drinks offer is hydration. That's essential to the human body. We offer great taste and benefits whether it's an uplift or carbohydrates or energy. We don't believe in empty calories. We believe in hydration."

People who drink tap water believe in hydration, too.

I don't think that drink-makers or the mayor are "bad guys," by the way--I just think all the "experts" ought to step back and allow people to reclaim sensitivity to their bodies' own signals. Not likely to happen.

The dietitians who touted whole milk to a generation of (slimmer) children sincerely wanted those kids to live a long, disease-free life, and of course that's the goal of Mayor Bloomberg and all the authorities who are floundering to find an obesity preventative and cure. Unfortunately, neither are available yet, since more needs to be known about the real causes of the BMI leap between 1980 and 2000. Until the facts arrive, New York's mayor and the rest of us need to relax a bit, listen to our internal cues, and raise our water glasses in a hopeful toast to our health.

Junk Food in Schools Doesn't Affect Childhood Obesity--Despite New School Meals Regulations

Just catching up on the newspaper and came across two items that show that all the tax dollars and excitement funnelled into curbing childhood obesity goes largely to waste. Both appeared in the New York Times--one reports on a study that compares students in schools that sell junk snacks with kids whose schools didn't, and it followed the ones who moved from one type of school to the other.

The second item was a front-page story discussing the merits of bariatric surgery--stomach stapling or banding to reduce the amount that can be consumed--for obese teenagers. It followed 17-year-old New Yorker Shani Gofman through the process until she was 20, and along the way weighs the pros and cons of this type of obesity treatment.

Both suggest the same conclusion: Childhood obesity rates won't respond to conventional, ie current (expensive, extensive) efforts to to lower them.

Results of research at Pennsylvania State University about the effects of junk food in schools are especially pertinent this week as the White House, in concert with the USDA, announced its new regulations for the food content of school breakfast and lunch programs. The rationale for this aspect of Michelle Obama's $4.5-billion, 10-year Healthy, Hunger-Free Kids Act is that tweaking the formulation of foods required for school meals will make kids thinner and therefore healthier, as well as model menus they'll emulate later.

What Michelle Obama ate at Parklawn Elementary when announcing the new school lunch requirements Jan. 25, 2012

That's kind of the idea behind replacing sugary, salty snacks sold in school vending machines with healthy alternatives. To see if this made any difference in middle and high-schoolers' girth, sociologists looked at students' longitudinal profiles, following them in and out of "competitive food environments" (ie schools with vending machines selling junk food). They also investigated whether gender, socio-economic status and race/ethnicity played into the vending machine-obesity issue.

Answer: No. Children's BMIs had no relationship to any of those factors. The study's lead researcher, Jennifer Van Hook, said, "Food preferences are established early in life. This problem of childhood obesity cannot be placed solely in the hands of schools."

Ahh, but those are the only hands the Feds can control.  So they've now constrained local schools' freedom to decide what's good and feasible for their populations.  And what are these enlightened changes?  Not much, except now lunches will have more.  More fruits and veggies specifically, moving from a half-cup to a cup of veggies per meal, for example, (with types of veggies now specified) and adding to that same tray a half-cup of fruit.  Starting this year, half of bread stuffs will be whole-grains, moving to all whole-grain by July 1, 2014. And no more whole milk allowed; low fat only.

The feds know adding all these extra requirements is expensive, so they've agreed to spend six cents per meal of your tax dollars to subsidize the changes.  If you look at the USDA's comparison of what those menus look like compared to the old ones, you'll see--there's basically just a lot more food.

Take any menu they offer as an example--say, Tuesday. The old, supposedly obesity-producing lunch offered: Hot Dog on a Bun with ketchup, 1/4 cup canned pears, raw celery and carrots (1/8 cup each), 1.75 tablespoon ranch dressing, and 1% chocolate-flavored milk.

Now look at its superior replacement:  Whole wheat spaghetti with 1/2 cup meat sauce, a whole wheat roll, a half-cup of cooked green beans, a half cup raw broccoli, a half-cup raw cauliflower, a half-cup kiwi halves, 1% milk, an ounce of low-fat ranch dressing, and 5 grams of soft margarine.

Think of how eagerly those elementary school kids will be gobbling up all those cooked green beans, and that raw broccoli, cauliflower and those coveted kiwi halves! The children's delight in two cups of greens, perfectly complimenting their (whole wheat) spaghetti, will surely create little fiber-philes who will happily eschew (and not chew) the candy and baked goods youthful generations before them have craved.

I am impressed that federal nutritionists think schools can deliver kiwi halves, not to mention cauliflower, for a mere 6 cents extra per plate.  Peeling the fuzz off kiwis is going to add substantially to preparation costs.

Michelle Obama eats at Parklawn Elementary, Alexandria, VA

The second news story that convinces me that well-meaning efforts to curb childhood obesity are doomed describes Shani Gofman's experience with "laparoscopic adjustable gastric banding," a surgery that limited the size of her stomach.  She weighed in on the day of her operation at 271 pounds, a BMI of 51.  Two weeks later, she was down 20 lbs, and after six months reached 237 lbs.

Then she graduated high school and took a summer Israel tour with a group of her peers.  She "would wolf down her food and then she would run to the bathroom to vomit or sit in pain waiting for it to make its way through the band." About nine months after surgery, she'd gained back half of what she'd lost.  Even enduring the pain and discomfort of surgery does not guarantee that a motivated teen can conquer obesity.

"Most of us have witnessed the medical establishment provide the same advice over and over again to kids who are overweight--they just need to diet and play more outside," said University of Cincinnati pediatrician Thomas Inge. "I wish it were that simple."

And that's the point. It's not as simple as whole grain rolls or even cutting into a young woman's abdomen to shrink her stomach.  The wrongly-named "obesity epidemic," a phenomenon that began in 1980 and peaked in 2000, is complex.  There's precious little concrete data to explain it, and every effort to turn it around has failed. Why, for example, have obesity rates remained at the same (high) levels for the past ten years? Perhaps instead of throwing more money and regulations at this broadening target, it would be prudent to pull back and see exactly what's going on.  Better to deal with the difficulties of obesity--health, emotional, financial, inter-personal--on an individual basis, where compassion and tailored solutions have at least some chance of bringing improvement, if not cure.

Why Childhood Obesity-Fighting Programs Fail, and What they Should Do

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.

At this point, until science catches up with some definitive information, we also need to discuss and to some extent embrace the reality that overweight (not obesity) is actually the most healthy status. Paul Campos, in his 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.

Veggies in "Healthy Food Deserts" Won't Cure Obesity

Hand-wringers in universities and government care-for-you offices have rearranged urban geography to stop the obes-ifying of America's children--by deeming certain neighborhoods "healthy food deserts." That's deserts, like the Sahara, not desserts, like what kids are actually eating.

They say that communities lacking large supermarkets, but boasting a plethora of convenience and corner stores, prevent residents from consuming the veggies and fruits that would keep them svelte.  Time and cash-strapped neighbors feed their families the fried chicken, corn dogs, chips and soda these mini-marts sell--but the experts insist that if the same stores featured cucumbers and apples front-and-center instead, parents would opt for the healthy choice.  And they, as well as their children, would be thinner.

This speculative chain of thinking led the "do something" activists--progressively-bent feds, local governments, university researchers and foundations-- to attack the problem the only way they know how: by throwing money at it.  Pres. Obama's stimulus package--our tax dollars at work, through the Centers for Disease Control bureaucracy-- has awarded thirty communities $230 million in grants to prevent childhood obesity.  Local United Way offices have funded "healthy corner store initiatives," like $50,000 to three stores in Franklinville, Ohio, and an unspecified amount in Seattle to upgrade the healthy-food stock and displays in 22 convenience stores in the Delridge neighborhood.  In addition, the W. K. Kellogg Foundation in Battle Creek, Michigan, funded nine sites nationally, including $500,000 to Seattle's King County. In Pennsylvania, $30 million of state grants over three years was triple-matched by $90 million more in grants and loans from The Food Trust, used for 78 grocery outlets in poor neighborhoods.

But the front-page lead article in this week's Sunday Seattle Times paper, combined with its Sunday magazine cover story (funded as a grant project by a California endowment through the University of Southern California) exposes how ineffectual throwing money at fat-causing behaviors really is (even as the feature lamely offers sidebars advising parents on curbing kids' expansion).

The article says that here in my state of Washington, the feds and foundations tossed mega-bucks ($15.5 million from stimulus funds alone) at the "food desert" problem without results. It describes how food-access advocates finally convinced the Delridge "Super 24" corner store to revamp its stock, adding refrigerated cases with an assortment of fruits and veggies. A KOMO TV news story features United Way rep Lauren McGowan pointing to the new cases effusing, "you've got lettuce and limes and lemons and cucumbers, and stuff that families can go home and make a salad, make a fresh meal for their family!"

The news video laments that small convenience stores don't take food stamps, suggesting illogically that this forces homeless customers like Jose Lopez to buy junk food instead: "Oh, I like to have these fruits..." Mr. Lopez, holding a freshly-purchased large coffee says, pointing to a basket of apples, oranges and bananas by the cash register.  He's cut off mid sentence by reporter Elisa Jaffe who finishes, "but they don't take your food stamps."  Lopez shrugs. "They don't."

It's wonderful that kindly community members want their poorer brethren to eat well. But the brethren themselves don't choose to. Bhim Singh, the Delridge store's owner, was lauded in December, 2009 when his new refrigeration units and "healthy choice!" signs touting nutritious items went up. This week's newspaper article, however, provides an update:  "We would spend $200 on vegetables and make only $10," he admits.  He's back to stocking only the longer-shelf life produce he carried before the hoopla, like potatoes and onions.  His clientele, it's clear, keeps him afloat with their fried-food-and soda purchases.

"Officials say they have learned valuable lessons," says the Seattle Times story. "Maybe they didn't spend enough time selling the idea.  In any case, they've budgeted another $1.8 million in hopes of enlisting at least 25 stores."  Don't bore them with facts.

The research considered most definitive on the question of access to healthy food was conducted by the US Department of Agriculture, published in June, 2009.  In it, a national questionnaire (which, when examined, is a pretty poor measure of food access) found that 81 percent of respondents "always had the kinds of food they want to eat."  Sixteen percent had enough, but not "always the kind of food they want to eat." Of that 16%, five percent said they didn't "always have the kinds of food they want to eat" because "it was too hard to get to the store, or the kinds of foods they wanted were not available."  Elderly or infirm people, and those who didn't have the money for food--even if it were easily available--made up more than half of those people--leaving less than 3% of respondents overall who don't "always" have what they want because "the kinds of foods they want are not available."

This calls for another government grant.

Now, nowhere in the study does it ask exactly what are the kinds of foods that respondents wanted.  Might be hallal food, or kosher food.  Might be gluten-free, or sugar-free foods. Might be gourmet cheeses or craft beers.  And of course the questionnaire asked if their desired foods were "always" available. If your market runs out of your brand of cereal or the kind of milk you like, then you aren't "always" able to get what you want.

There's an assumption that people in low-income areas crave fresh fruits and vegetables, but that a nefarious capitalistic force thwarts their innate healthy-food proclivities.

There are indeed market forces at work, and what they do is push shop-keepers to provide their local clientele what that clientele wants--or risk going under.  It's an insult to suggest that poor people don't know the difference between healthy and junk food.  Anyone with a television hears the news stories about Michele Obama's "Let's Move!" program, and watches reports like the video of the Delridge Super 24's new offerings. In 2007 alone, the USDA spent $697 million in classroom education, and every child in school over the last 20 years has, usually by government mandate, learned about good nutrition--but it does no good.  Ask the convenience-store patron buying grease-fried chicken wings about his purchase, and he knows darn well it's less beneficial than the apples he ignored near the cash register.

In fact, that's the exact scenario on the KOMO TV video about the Delridge store.  It opens as heavy-set Joseph Munnerlyn is selecting his purchases. Caught in the act buying junk, he explains, "I'm hungry, I'm trying to get something fast and quick, so I..." A voice-over then interjects that he's "a connoisseur of corner-store meals." Voice up. "Oh, I love it all," Mr. Munnerlyn intones with affection, waving his hand by the fried offerings in a heat-lamp-warmed glass case. "The wings, I mean come on! The breasts, the burritos, the Jo-jos...!" (Jo-jos are breaded and fried potato wedges.)



Bhim Singh owns "Super 24" store

 He gives a sly smile. "I know it's not healthy, but at the same time..." He lifts up an apple from the basket of fruit in front of him at the register. "...It's hard for me to pick up an apple when I've only got two bucks and I've got to feed myself for the rest of the day."  The unchallenged assumption there is that he gets more satisfying food for his money buying Jo-jos than a Jonathan.  It's not his fault.

When it looked at healthy food access by social variables, that Department of Agriculture national study about Americans' access to food found some astonishing conclusions--about supermarkets, typically stocked with a wide assortment of produce-- that the reform-corner-stores crowd might want to consider, such as:

"Overall, median distance to the nearest supermarket is 0.85 miles. Median distance for low-income individuals is about 0.1 of a mile less than for those with higher income, and a greater share of low-income individuals (61.8 percent) have high or medium access to supermarkets than those with higher income (56.1 percent).

"Overall, ethnic and racial minorities have better access to supermarkets than Whites. Median distance to the nearest supermarket for non-White individuals is 0.63 miles, compared with 0.96 miles on average for Whites.

"Similarly, a smaller percentage of non-Whites (26.6 percent) have low access to supermarkets than do Whites (48.2 percent)."

Given failure to influence purchases when corner stores feature fresh fruits and vegetables, and the fact that poor people and minorities have better access nationally to supermarkets than the financially better off and whites, why are anti-obesity experts so gung-ho on watering so-called "healthy food deserts" with tax money and foundation donations?

Because they're desperately searching for do-able solutions to a problem whose cause has still to be defined, and which has foiled all efforts to solve.

It's really not as if gluttony, sloth, inactivity and even childhood obesity are novel foes. According to CDC statistics, the steep increase in childhood obesity began in 1980 and after reaching an alarming peak a few years ago, has leveled off.  Throughout those years, and particularly since 1990, attention at all levels has focused on the issue.  It's just that these problems have proven resistant to even the most expensive and valiant efforts to overcome them.

For decades, millions of dollars have poured into nutritional education.  At the same time that carbonated soft drink consumption declines (every year for the past six!) organic food options burgeon, gaining by 20% every year in the last decade.  Health food stores, once a niche market, have gone mainstream; a case in point--the Whole Foods supermarket chain, begun in 1980 in Austin, now boasts more than 300 outlets.

Still, the mantra throughout professional obesity-world literature is that the problem requires still more investment of public funds. A 2007 book by the Food and Nutrition Board, Progress in Preventing Childhood Obesity: How Do We Measure Up? notes that "Government, industry, communities, schools, and families are responding to the childhood obesity epidemic by implementing a variety of policies, programs, and other interventions," but decides "the current level of investment by the public and private sectors still does not match the extent of the problem."

Of course, its main finding is that we just don't know if all the spending and talking and teaching and fruit-and-veggie-touting is making a difference, phrasing this conclusion in admirably academic terms: "Current data and evidence are inadequate for a comprehensive assessment of the progress that has been made in preventing childhood obesity across the United States."  Ahem.

Obesity in children--and adults--is a far more complex phenomenon than well-meaning agencies and pundits are willing to admit.  And because its causes are not yet understood, creating innumerable boards and bureaucracies to eradicate it (and make food deserts bloom) have failed. To be sure, some money must go toward innovative medical research to tease out the true sources of obesity--and whether the future generation is as doomed by it as alarmists insist.

I suspect that genetics and environmental influences (A virus, like the Adenovirus 36? An "obeso-genic" substance or situation that, like carcinogens, throws cells out of whack?) will prove contributors to the problem, and that unfair stereotypes that suggest all fat people are ignorant, have no self-control and need patronizing interventions will be squashed like the unsold tomatoes at Super 24 in Delridge, Washington.

More Food Choices, More Obesity?

Some of us are old enough to remember when supermarkets didn't offer anywhere near the variety they do now.  Probably all of us remember.  Starfruit. Purple potatoes. Gnarly heirloom tomatoes. Hot sauce-flavored dark chocolates. Sage-flavored grapefruit juice. Yes, it's true.

 Choices in the cereal aisle are now staggering (check out Wikipedia's list of them), the number of teas and coffees mind-boggling, the bottles, cartons and cans of waters and juices (acai, pomegranate, passion fruit, anyone?) towering.  It's enough to paralyze shoppers, and selecting products has become a lengthy process of squinting at labels, noting price-per-ounce on shelves, calculating cross-brand sizing and wondering which of those strange ingredients are benign or worrisome.  Is this just a new chore of modern life, an expansion of taste enjoyment--or a threat?

Research now suggests the dizzying array of products in supermarkets is actually harmful. It's making us obese.

  In Los Angeles, when I grew up, our Safeway and Ralphs chains offered only classic pasta shapes (spaghetti, macaroni, lasagna), no exotic fruits (and none out of season) and a handful of ice cream flavors from a few manufacturers (Neapolitan was a boon because it combined all three top flavors).

  In those "good old days," obesity was rare, and the percentage of overweight citizens low.  US Center for Disease Control statistics show that in 1962, 13.4% of adults were obese (BMI between 30 and 40), and .9% "extremely obese" (BMI more than 40).  This compares to 2005-6, years of the highest rates recorded, when 35.1% of adults were obese, and 6.2% "extremely obese"(since then obesity rates have declined slightly). Men's average weight shot up 30 pounds, and women's about 25 between 1960 and 2002 (average height increased 1.5 inches for men and an inch for women in the same period).

Those who blame plenty for increasing obesity argue that easy access and food's very deliciousness causes people to over-ride bodily cues. With so many gourmet foods appealing to the most specific tastes, each person in the household can maintain a personally-pleasing stash of favorite indulgences. 

Yummy foods beckon between meals when boredom or stress plead for a distraction, and the mere existence of a plethora of delights is therefore the source of deleterious girth.
Studies show that "salience" of food increases consumption.  In other words, if it's right there, especially if it's visible, it calls to you.  Also important is its convenience--food easy to procure and prepare, like the burgeoning number of ready-to-eat goodies increasingly populating store shelves, according to data, increases the amount of food munched.

Other research shows that awareness of abundant food options encourages eating:  More foods on the plate, in fancier presentations.  More brands of more new items in the stores, of multiple flavors and colors.  More depictions of food, touted by "celebrity chefs," advertised everywhere you look--at prices easy to afford--hammer the mind, offering constant enticement to own, manipulate, and ingest.

A front-page story in the New York Times this week said that retailers are returning to cluttered, high-shelved, abundant-product displays because a clean, pared-down shopping environment, while deemed more pleasant by customers, hurt the bottom line.  More stuff, says the article, gives shoppers the idea they're getting a better deal, as well as offering more sources of temptation.

So, in the days when tiny mom-and-pop stores commonly provided one's comestibles, and when supermarkets offered an average of 9,000 items (1974), people went to the grocer looking for ingredients rather than immediately edible satisfaction.

No more, now that the average number of items in a supermarket has climbed to about fifty thousand.  And routinely, food emporiums include delicatessens with glass cases showing prepared salads and main courses, bakeries wafting their warm cookie fragrances, salad and olive and cheese bars where you can fill plastic containers yourself.  Rows of bins and crocks, with handy clear bags and little shovels, and dangling pens to write ring-up codes.
 
And all this food is cheap.  It may feel like the price of food is high and becoming ridiculous, but the proportion of household income devoted to it is far less than in the days when choices were more limited.  In 1950, Americans spent about a fourth of their income on food; by 2009, they spent less than 10%.

Can we really blame what overwrought pundits call "the obesity epidemic" on greater food options?  Are retailers' ads, media's ubiquitous images, and stores' bounty so effectively brainwashing us that we've allowed this massive expansion?

Easy access and ability to afford all these wonderful choices have contributed to the problem, but don't explain it.  Mainly because schools and government have vociferously discussed nutrition, for decades.  For example, the federal "Expanded Food and Nutrition Education Program" taught millions of low-income youth and young adults about good food choices--for forty years! It started in 1969; surely by the time the obesity epidemic started--about 1980--and as it escalated to its peak in 2000--the national program would have disseminated its message about healthy eating.  Yet obesity kept growing.  (Despite its title, I doubt the program educated toward "expanded food and nutrition...")

And 45 of the 50 states require students take a health course, usually three, during elementary, middle and high school years. Even states that don't require a course have support programs on healthy eating, obesity-prevention and exercise.  We know what to eat.  But it seems the "new normal" has inflated anyway.

In previous posts, I've discussed parents' inability to curb their kids' intake of sweets, despite healthy food alternatives, incessant inculcation and even personal vigilance, such as the Philadelphia parents who stood outside corner stores between their homes and their children's schools.  Could it be that all this focus on "healthy diets" switches people from the "eat to live" orientation to the "live to eat" push-pull between tasty treats and the "you shoulds" of educators and experts?

Naturally thin people who eat when they're hungry and stop when they're full aren't compelled to "take advantage" of the bountiful food in their paths.  They eat what their bodies suggest would be most pleasing, and listen when they feel full.  Why does it seem there are there fewer such people around nowadays to emulate?  Answering this would be key to knowing why the rate of adult obesity jumped between 1980 and 2000 and since then has remained level.  And it might help examine why childhood obesity also increased in that time period.

I wonder about the impact of the Adeno36 virus, as well as genetically-related changes we haven't investigated. Some researchers suspect air conditioning, maternal age, or medication for the bulging figures.  In the meantime, I consider the dazzling choices in the supermarket evidence of our flourishing economy and creative product innovation, not evil sources of decay and obesity.

Kids Like Candy, and Breast Milk is Sweet--Is Sugar the Enemy in Obesity?

The New York Times today had a story about a vigilante group of Philadelphia parents in "bright-colored safety vests and walkie-talkies" gathered to admonish children entering a convenience store on their way to school against buying junk food.  They think they're going to keep these kids from becoming obese.

All I can say is, "good luck."

You can food-pyramid kids to death (in my generation it was a square), trying to educate them to eat nutritionally, but they're going to like sweets.  And even if they avoid sugar, we really don't know if any of these efforts would reduce the swelling child obesity rate.

The underlying assumption is that kids gorging on contraband is fattening them up, but apparently there's scant research data to support this.  "Specific causes for the increase in prevalence of childhood obesity are not clear and establishing causality is difficult since longitudinal research in this area is limited," admits a report on childhood obesity from the US Department of Health and Human Services.  It continues, "Several studies have been published that attempt to link children’s diets with the onset of obesity. However, none have been able to show a causal link between diet and obesity."

Nevertheless, the report gives us graphs and pie (!) charts illustrating changes in kids' diets over the years.  For example, children in 1977 used to drink 1.5 times as much milk as any other drink.  By 1996, they drank twice as much sugar-sweetened beverages as any other drink. Between those years, of course, we were bombarded with anti-cholesterol information, and school milk cartons downsized, down-fatted and up-priced.  And also, those convenient, inexpensive "sugar-sweetened" boxed juices became very popular for sack lunches.

There are 100 calories in a Minute Maid box of enriched vitamins and calcium orange juice, 100 calories in a Minute Maid pouch of "Coolers" (sweetened) fruit punch.  There are 100 calories in a cup (8 oz.) of 1% low fat milk, and 120 in a cup of 2% low fat milk.  Which makes kids more obese?

But there's little to suggest that eating sweet things, per se, is the cause of obesity.  We know that children like sweet tastes, though.  If you've ever sampled breast milk (okay, I tasted a few drops of my own while nursing) you know it's surprisingly sweet.  And it's loaded with fat--whole cow's milk is just 3% fat, but mother's milk, according to the first definitive study, is 5% fat in the first few months, and keeps getting richer--to a whopping 17.5% fat for moms nursing 1-3 years.  The researchers speculated that these intense amounts of cholesterol at an early age accustom the body to it, and actually protect against future heart problems.

Could it be that young kids love sweets because they're naturally programmed to prefer mother's milk?

The Health and Human Services report then goes on to suggest that sitting is the culprit in kid obesity.  After all, now children park in front of computer screens playing video games and doing Facebook.  But the government report doesn't address new media--first, they admit they haven't got trend figures on children's physical activity.  The best they've got is a one-shot study suggesting adolescents get less exercise than recommended.  Then they resort to saying kids spend a quarter of their waking hours watching TV.  That's bad--but this isn't any different than kids spent two decades ago, as I reported in a book on childhood co-authored with my husband.

The most convincing arguments regarding elevating obesity rates in children relate to genetic causes.  Fat parents usually produce fat offspring, and I don't believe it's only due to learned sloth. Certain people have family dispositions to obesity, as a CDC research-overview report puns:  "These investigations suggest that a sizable portion of the weight variation in adults is due to genetic factors."

Also, obesity statistics vary by racial groups, with black and Hispanic Americans experiencing significantly higher rates of obesity than other groups (51% and 21% more respectively, according to the CDC).  New census data show that the US Hispanic population has increased 46.3% in the last decade, from 35.3 million people in 2000 to 50.5 million in the 2010 census.   States which have increased Hispanic populations exhibit growths in obesity rates, and those with highest African-American populations also show highest obesity rates.

Another non-volitional explanation for increases in childhood obesity, perhaps related to familial connections, is that an obesity virus alters the way people process calories.  Studies have found a greater likelihood of the adenovirus AD36 marker in the blood of obese children and adults.  The virus, of the type that produces the common cold, was isolated just at the time that obesity rates took a steep climb.  Animal studies on the virus found some shocking results: "Chickens, mice, rats and monkeys infected with the virus all get fat even though the animals don’t eat more or exercise less than they did before they were infected."

Today's article describing the Philadelphia parents' protective vigils at mom-and-pop stores was perplexing on several levels.  Apparently, the kids have school breakfasts awaiting them, but prefer to stop at the corner store for candy.  The article's highlighted student, Tatyana Gray, comes from a caring home, where her mom keeps a basket of fruit on the dining table.  Tatyana eschews the fruit for morning cereal, and then "stops for a snack on the way to school."   Her school, William D. Kelly, "has expelled soda and sweet snacks," and the nurse "pushes water" instead of fruit juice.  The first-graders sing "Old MacDonald" with vegetarian lyrics: "and on his farm, he had some carrots," while skipping around a gym.

Still, the corner store lures these health-educated kids.  "Ha, ha, ha!" one child teased a parent as she emerged with "the usual fare."  "I bought everything!" another "bragged."  "After several weeks of parent intervention," the article notes, "more children were skipping the corner stores, showing progress against the pull of sweet snacks."

I wouldn't count on it.  Kids like sweets, and for some reason, sweet fruits aren't good enough.  Michelle Obama's campaign to fight childhood obesity is benign and might even benefit some people--certainly fresh foods and movement are worth touting.  But I think we have to look beyond the "sugar is bad, exercise is good" obesity antidote and realize the problem has yet to be defined, much less solved by a bunch of well-meaning parents in florescent vests standing guard at the corner store.