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Or: How Parents Learned to Stop Worrying and Start Loving Sugar, Fat, and Salt

 The percentage of overweight children in the United States is growing at an alarming rate, with one out of three juveniles now considered overweight or obese (Ogden 2012). Our country has earned the distinction of being the heaviest of thirty-three economically advantaged countries. This data isn’t merely interesting or amusing; it is suggestive of an overall trend that will ultimately lead to more health-related issues and higher medical costs for those who are overweight. In late 2010, San Francisco’s Board of Supervisors, cognizant of the fact that obesity is a major health concern, enacted an ordinance which prohibits restaurants from offering toys with meals that fail to meet basic nutritional standards for fat, calories, and sodium. In banning meals like the Happy Meal, the city of San Francisco has publically acknowledged the growing problem of obesity-related medical conditions such as heart disease, stroke, type 2 diabetes, and cancer. In addition, the health risks associated with obesity have financially impacted the lives of many overweight Americans. In 2008, the medical costs of this health care crisis were estimated at $147 billion. This data suggests that health care expenditure for people who are obese is $1,429 higher than those of normal weight. While we may not be able to completely rule out a biological basis for certain types of obesity, especially as it concerns phenotype, we can’t dismiss the fact that overeating, or unhealthy eating, for the most part, is a learned behavior. In the U.S., the typical fast food restaurant markets unhealthy meals to children through the carrot of the toy. Today’s busy parents have less free time to devote toward preparing nutritious and healthy home-cooked meals, and they are extremely susceptible to intensive junk food marketing. Banning toys in unhealthy children’s meals will help both parents and children make healthier dining choices, and may help fight childhood obesity.

Childhood obesity has more than tripled in the past 30 years. The percentage of children aged 6–11 years in the United States who were obese increased from 7% in 1980 to nearly 20% in 2008. Similarly, the percentage of adolescents aged 12–19 years who were obese increased from 5% to 18% over the same period (Ogden 2010). Nearly 40% of children’s diets come from added sugars and unhealthy fats. The top sources of energy for children tend to be cookies (Grain-based desserts.), pizza, and sugar-sweetened beverages such as sodas and fruit drinks. Nearly 40% of the total energy consumed by children is in the form of empty calories. The consumption of these empty calories far exceeds the calorie allowance for all sex and age groups. Half of empty calories came from six foods: soda, fruit drinks, dairy desserts, grain desserts, pizza, and whole milk (Reedy 2010). Compounding the problems associated with an unhealthy diet is the fact that today’s children tend to spend less time exercising and more time in front of the TV, computer, or video-game console. And today’s busy families have fewer free moments to prepare nutritious, home-cooked meals. The trend toward increased childhood obesity doesn’t just result in chubby children; there are many serious immediate and long-term health risks associated with being overweight.

Obese children are more likely to have risk factors for cardiovascular disease, such as high cholesterol or high blood pressure. In a recent population-based sample of children and adolescents aged 5-17, 70% of obese youth had at least one risk factor for cardiovascular disease. Additionally, overweight adolescents are more likely to have pre-diabetes, a condition in which blood glucose levels indicate a high risk for the development of diabetes. Children and adolescents who are obese are also at greater risk for bone and joint problems, sleep apnea, and social and psychological problems such as stigmatization and poor self-esteem. Long-term risks associated with childhood obesity suggests overweight children will likely be obese as adults, and are therefore more at risk for adult health problems, such as heart disease, type 2 diabetes, stroke, several types of cancer, and osteoarthritis. A recent study indicated that children who became obese as early as age 2 were more likely to be obese as adults. Obesity is associated with increased risk for many types of cancer, including cancer of the breast, colon, endometrium, esophagus, kidney, pancreas, gall bladder, thyroid, ovary, cervix, and prostate, as well as multiple myeloma and Hodgkin’s lymphoma (Freedman 2005). While genetic factors may contribute slightly to the overall risks for childhood obesity, many individuals who have a genetic predisposition toward obesity do not become overweight. Healthy lifestyle habits, including healthy eating and physical activity, can overcome these genetic effects and actually lower the risk of becoming obese and developing related diseases (“Genes Are Not Destiny”). In addition to the myriad of health risks confronting the obese, there is also a direct correlation between rising rates of childhood obesity and rising medical spending.

In 1998 the medical costs of obesity were estimated to be as high as $78.5 billion, with roughly half of this amount being financed by Medicare and Medicaid.  A recent study suggests an increased prevalence of obesity is responsible for almost $40 billion of increased medical spending through 2006, including $7 billion in Medicare prescription drug costs. At the time of this study, the medical costs of obesity were projected to rise to $147 billion per year by 2008 (Finkelstein 2009). A more recent report by the American Journal of Preventive Medicine estimates about 42% of the U.S. population will be obese by 2030. This newest report by Finkelstein suggests an additional 30 million Americans will be obese in 18 years. This would cost an additional $549.5 billion in medical expenditures making his previous report’s medical expenditure projections pale in comparison (Finkelstein 2012). These cries for preventative health care by organizations like the Centers for Disease Control and Prevention, and a growing number of health care professionals have gone largely unnoticed by a public which seems practically oblivious to the risks associated with consuming large quantities of junk food. While the average American consumer may have set reports like Finkelstein’s to “ignore”, a growing number of communities across the United States are not just taking notice; they are taking decisive legislative action. Any fast food restaurant that chooses to aggressively market their meals to children should take note of San Francisco’s model legislation.

In listening to detractors of the San Francisco legislation, one could almost conclude that having fat, unhealthy children is practically a constitutional right. The food and beverage industry claims parents didn’t ask for this sort of legislation and they suggest the dining choices for their customers have been severely curtailed. Never mind the fact that overweight children can still order an unhealthy meal laden with fat, salt, and sugar, or that they can purchase a toy separately for  a measly 10 cents. To the fast food industry, this reeks of government encroachment and a stifling of the free market. Historically Americans seem to have a love affair with the free market and they tend to embrace the idea that those with the most capital will always do that which is in the best interest of society. Yet absent government regulation, seat belts, airbags, and anti-lock brakes would have never been incorporated into the design of automobiles. It turns out that some governmental regulations are actually good for consumers and not so detrimental to big business. In this case, it’s practically inarguable that the harm to the child greatly exceeds the benefits for the fast food industry. In spite of all of the rhetoric, San Francisco’s model legislation seems to be working. Fast food restaurants in the city are still doing a booming business, and a recent study suggests affected restaurants may be offering healthier children’s menus.

In late 2011, Dr. Jennifer Otten and associates conducted a study that focused on the responses of fast food restaurants affected by the San Francisco legislation. She compared children’s menu items, child-directed marketing, and toy distribution practices to nearby restaurants unaffected by the ban. The results indicate affected restaurants showed a 2.8- to 3.4-fold improvement in Children’s Menu Assessment scores from pre- to post-ordinance, with the unaffected restaurants showing minimal to no changes. The study suggested responses to the ordinance varied by restaurant, but overall there were statistically noticeable improvements in the form of on-site nutritional guidance, the promotion of healthy meals, beverages, and side items, and toy marketing and distribution activities which tended to focus on healthier menu items (Otten 2012). Otten’s initial study suggests legislative measures aimed at fast food restaurants really works. Much like the U.S. government’s 1968 requirements that automobile manufacturers include seat belts in their automobiles, San Francisco is requiring fast food restaurants to meet certain nutritional guidelines whenever they choose to actively market their meals to children. For parents who never bargained for overweight and unhealthy children, the move must be seen as a small step forward.

There is a children’s health crisis looming in this country. A startling one in three children in the United States will develop diabetes, and the experts all agree that excessive sugar, salt, and fat are at the heart of the problem. Chain restaurants put sugar, salt, and fat into practically everything they sell. Recognizing that the problem is endemic in our culture of marketing, The American Academy of Pediatrics recently called for a ban on fast food advertising during children’s programming. The food and beverage industry claims to be on the side of children, all the while asserting it is ultimately up to parents to make smart decisions regarding the meals their children eat. Yet each year they spend approximately two billion dollars on marketing unhealthy food and drinks to children. If these powerful junk food companies and restaurant chains really do have our children’s best interests at heart, then they certainly have a peculiar way of showing it. More recently, the industry has begun lobbying the White House and Congress to stop even voluntary nutritional guidelines for food marketed to children. Fast food restaurant chains have taken to suing local health departments and backing state laws that prevent parents from protecting their children in their own communities. Through intensive lobbying efforts by the food and beverage industry, several state legislatures are currently passing laws that prohibit municipalities and other local governments from adopting regulations aimed at curbing rising obesity and improving public health, such as requiring restaurants to provide nutritional information on menus or to eliminate trans fats from the foods they serve. San Francisco’s Board of Supervisor’s recent ban on free toys in fast food meals that fail to meet basic nutritional standards is just one small step toward fighting childhood obesity and the health crisis that has entailed. This is a problem of immense proportions, and common sense nutritional laws in a smattering of cities across this great land will not suffice. In order to effectively deal with this crisis, additional communities will have to muster up the courage to stand up to big business and finally hold them accountable for marketing unhealthy meals to children. Otten’s study of fast food restaurants affected by the San Francisco model toy ordinance is suggestive of an overall trend in these restaurants toward promoting healthier meal options. The initial results of these nominal legislative measures bode well for the future health and well-being of our nation’s children.

Works Cited

Finkelstein, E.A., et al., “Annual Medical Spending Attributable To Obesity: Payer and Service-Specific    Estimates.” Health Affairs, 28, No. 5. 2009: W822-W831. Published online July 27, 2009. Web. 12       Nov. 2012. <http://content.healthaffairs.org/content/28/5/w822.full.pdf+html>

Finkelstein, E.A., et al., “Obesity and Severe Obesity Forecasts Through 2030.”American Journal of         Preventive Medicine. Volume 42, Issue 6, Pages 563-570, June 2012. Web. 17 Nov. 2012.                 <http://download.journals.elsevierhealth.com/pdfs/journals/0749-  3797/PIIS0749379712001468.pdf>

Freedman, D.S., et al., “The Relation of Childhood BMI to Adult Adiposity: The Bogalusa Heart Study.”    American Academy of Pediatrics. Pediatrics, Vol. 115 No. 1 Jan, 1, 2005 pp. 22 -27(doi:             10.1542/peds.2004-0220). 2005. Web. 17 Nov. 2012.                 <http://pediatrics.aappublications.org/content/115/1/22.full.pdf+html&gt;

“Genes Are Not Destiny – Obesity-Promoting Genes in an Obesity-Promoting World.” Harvard School of Public Health.2012. Web. 17 Nov. 2012. <http://www.hsph.harvard.edu/obesity-prevention-             source/obesity-causes/genes-and-obesity/index.html>

Ogden C.L., et al., “Prevalence of high body mass index in US children and adolescents.” 2007–  2008. Journal of the American Medical Association., 2010:303(3):242–249. Jan. 2010. Web. 17               Nov. 2012. <http://jama.jamanetwork.com/article.aspx?articleid=185233>

Ogden C.L., et al., “Prevalence of obesity and trends in body mass index among US children and               adolescents, 1999-2010.” Journal of the American Medical Association., 2012:1;307(5):483-90.          Epub 2012 Jan. 17. Web. 19 Nov. 2012. <http://www.ncbi.nlm.nih.gov/pubmed/22253364&gt;

Otten, J.J., et al., “Food Marketing to Children Through Toys – Response of Restaurants to the First U.S. Toy Ordinance.” American Journal of Preventive Medicine, 42(1):56-60., 2012. Web. 12 Nov.                 2012. <http://www.ajpmonline.org/webfiles/images/journals/amepre/AMEPRE_3267-           stamped.pdf>

Reedy, J., Krebs-Smith, S.M., “Dietary sources of energy, solid fats, and added sugars among children and adolescents in the United States.” Journal of the Academy of Nutrition and Dietetics., Oct;110(10):1477-84. Oct. 2010. Web. 17 Nov. 2012.                 <http://www.ncbi.nlm.nih.gov/pubmed/20869486&gt;

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