How They Try to Fatten Us Up

Suddenly, fat's hot.

Education Minister Christy Clark wants to hold a forum to review the sale of "junk food" in school cafeterias and vending machines. B.C. Green Party leader Adrienne Carr wants to impose a new tax on junk foods sold in schools. Provincial Health Officer Dr. Perry Kendall wants to develop "healthy school initiatives", focussing on better nutrition and more physical activity for students.

Obesity, especially childhood obesity, is the current buzz in health, educational and government circles. But it's not a problem that's going to be solved overnight, or by a few programs focusing solely on life at school. The issue of obesity is a complex one, in which home, school, community, government, media and the wider society all play a role.

Basically, the root of the problem is simple: the metabolism of the human body was designed for days when food was scarce and large amounts of physical activity were required just to stay alive (hunting, gathering, fleeing from beasts, for instance). The world most humans live in has evolved well beyond that - but metabolism has shown no signs of changing to keep up with it. In countries like Canada, food is now more abundant than ever before, and the need for exercise is less.

In the last few years, several societal factors have combined to worsen the problem further. Independent studies show that portion sizes at eateries have increased significantly. The increases always seem to be largest for foods high in fats, sugars and salt - the foods most likely to lead to obesity and related health problems. The size of an order of McDonald's french fries, for instance, has tripled in the past half century. Even worse, people who eat those portions begin to think of them as "normal," and up the amount they put on their plates at home as well. Advertisements on television glorify "super-sized" meals.

The ways to be a "couch potato" have increased. Fewer children are allowed to walk or bike to school, or even just play outside, because of fears of predators. So they sit before screens, watching tv, playing digital games, surfing the Net.

It's really little wonder that the number of people who are overweight or obese is growing in epidemic proportions. The latest studies in Canada show that just over one-third of Canadian children under the age of 18 were classified as overweight and 18 per cent as obese. Dr. Kendall cites a recent study in Richmond which shows that as many as 36 per cent of the 10- to 12-year-olds sampled were overweight or obese. Even at that, Canada remains much better off than the U.S. where as many as two-thirds of the population is now above their recommended weight. The question is whether we can begin to reverse the trend before it reaches those U.S. proportions.

Here, based on a variety of recent studies from Canada and the U.S., is how we can do it.

Self-propelled kids.

Require every school district to develop a "walking school bus" program for each of its elementary schools. The Ministry of Education should provide "seed money" for each elementary school at the outset, with more funding should be dependent on the program's success. Districts should receive a small amount of money for each child who participates.

Develop a series of incentives to encourage older students (middle and high school) to ride their bikes to school. Provide free courses on safe commuter-cycling to students. Let older students work with experts to determine the safest cycling routes from various parts of the school's catchment area. Ensure there are secure areas at the school for students to lock their bikes during the school day. Work with a local cycling advocacy group to develop a spring Bike to School Week, with schools competing to see who can have the highest percentage of students cycling to school. Again, seed money should come from the provincial government, but after that, funding should be dependent on success rates.

Stop body bullies.

Expand school district anti-discrimination and harassment policies to prohibit harassment of overweight students. While this may seem counter-intuitive, numerous studies have shown that teasing and social isolation of overweight boys and girls does not motivate them to lose weight but in fact often promotes further unhealthy behaviours. In particular, many such students begin to feel that "food is my only friend," and eat more to compensate for their unhappiness. Isolation is also likely to drive these students to more sedentary behaviour such as TV watching and computer games. Teachers, counsellors, and coaches must focus only on the health aspects of weight control, not on appearance or athletic performance.

While great emphasis has been placed on an increase in mandatory physical education time for students, this must be well-taught and managed to ensure it does not to turn many students off physical activity entirely, as it has in the past. Too great an emphasis on competition is likely to lower the self-esteem of those who are not athletically talented and especially of those who are already grappling with a weight problem. If possible, let students work in a group with others of similar skill levels, and emphasize participation and fun, not just winning.

Serve, celebrate good meals.

Provide funding for school districts, health authorities, and community groups to encourage healthy eating, especially for families who have trouble affording nutritious ingredients and/or finding the time to prepare meals that aren't "convenience" foods.

Unfortunately, many of these types of programs have been reduced or eliminated during the past 30 months of provincial cutbacks because they are seen by the government as "not essential" to its core mandate. Community kitchens are one example. If a group of lower-income parents can come together once or twice a month to prepare several healthful meals, the benefits are enormous. The meals prepared will be healthful and nutritious; the advantages of bulk buying will mean the participants will be able to afford more fresh produce, for example, than they would on their own; and with the help of a facilitator, portion sizes will be appropriate for each family.

Develop a program to reward restaurants or other food outlets that emphasize healthy food and appropriately-sized portions. It could be as simple as a sticker for them to put in their window saying "We support good health." Media could be encouraged to provide coverage to let the community know who have joined the anti-obesity campaign.

Address emotional troubles.

Ensure that the necessary services remain in place to help children who are suffering from behaviour and emotional problems. A study published this fall by the University of Michigan shows that children who have significant behaviour problems are nearly three times as likely to be overweight as other children, even when all other factors such as a child's economic status, TV-watching habits, and parents' educational level were factored out. Providing the services to help these children at an early age will not only reduce costs later for expenses such as welfare and the criminal justice system, but will also reduce long-term health costs if these children do not end up as obese adults.

Begin before birth.

Teach general nutrition for children in prenatal classes. Let parents-to-be learn not only about infant nutrition, but also about what's appropriate as a child moves on to solid foods, and then to pre-school. Some U.S. clinics are seeing children as young as nine months who are severely overweight from nothing more than overfeeding by their parents. Along with nutritional principles, teach those parents-to-be to become a little "media literate" so they won't be sucked in by the myriad of TV ads that appeal to their children from the time they're toddlers.

Fund food labs.

Provide R&D funding to the agriculture industry to encourage it to find ways of making healthful foods (vegetables, fruits, whole grains, lean sources of protein), more tasty and more convenient to prepare. Most "convenience foods" are currently high in some combination of sugar, refined flour and fat. Also use incentives to encourage producers and marketers to provide nutritious foods in smaller portion sizes (packages for one or two), given that the size of the Canadian household continues to decline. A single turnip, for instance, is a good and cheap nutritious vegetable, but will probably feed five or six -- far bigger than the average household.

Cut out junk ads.

Propose federal legislation that would outlaw ads for unhealthy foods (junk food, soft drinks, sugared cereals) on TV programs specifically aimed at children. At the moment, children watching many TV shows will see as many as 10 commercials an hour. Of those that discuss food, more than 90 per cent will be for junk or otherwise unhealthy foods.

Learn what works.

Study successful programs in other regions that will encourage individuals - both children and adults - to become more active, not necessarily through planned activities, but just in their day-to-day living. One example comes from Scotland, where health authorities took the ridiculously simple step of posting a sign between stairs and escalators at a subway station, reading "Stay Healthy, Save Time, Use the Stairs." The proportion of people who did in fact use the stairs doubled - from eight per cent to 16 per cent. Another successful example comes from California where some schools have begun to run gardening programs for students - with the produce then being served in the school cafeteria.

Controlling so-called "unhealthy" foods will prove a much more complex job than controlling other unhealthy substances such as tobacco. All tobacco is unhealthy, but few foods will cause health problems if eaten in small amounts and in moderation. The problem is overconsumption, not any consumption. As well, even the least healthy foods don't harm anyone other the person who eats them. That means authorities can't use the social-responsibility argument that surrounds issues of second-hand smoke in the tobacco wars.

So, in the long run, the problem of obesity will be solved only by a consistent and prolonged education program. Unhealthy food must ultimately be seen as socially unacceptable, just as tobacco is today. The education program would have to target children, students, and adults, and use the full range of social marketing techniques available. Eventually, celebrities might go public to explain why they won't make any more ads for junk-food products.

To a large degree, we've done it with drinking-and-driving. We've done it with smoking. Now it's time to turn our attention to the problems of obesity.

Barbara McLintock, a regular contributor to The Tyee, is a freelance writer and consultant based in Victoria and author of Anorexia's Fallen Angel.