Rarely has a small decline in the rate of an increase caused so much commotion. But the news, confirmed this past week, that obesity rates are not growing in certain cities, is an essential and necessary moment for public policy. The dirty little secret among obesity researchers is that many of them will tell you in private that no intervention short of the type of government intrusiveness that is intolerable for most Americans would actually have an impact on the problem. In that, they sound a lot like climate change researchers who despair that the damage done so far to the mechanisms of climate is beyond repair and that mitigation of future problems, rather than anything prophylactic, is called for.
So what's working? Nothing specifically but everything together. Obesity is defined in so many ways on so many levels; there is a physiological definition, a psychological definition, a social definition, and a systems biology definition, all describing the same thing but using different metrics to measure it and figure out what to do about it. On each level, there has been progress. Individual medical interventions, ranging from hormone therapy to bariatric surgery, are much more common and more effective. Support for obese people of all ages extends from Medicare to online support groups.
Companies are voluntarily reducing the bad stuff they sell to kids. State and local governments are experimenting with a bunch of different approaches, some of them intrusive, others more passive.
With a few notable exceptions, though, getting better at treating obesity and extending the lifespan of those who are obese will not lower the growth rates of obesity among young children.
We know that a bunch of things contribute to early on-set obesity, but we don't really know in what proportion they contribute, and it probably varies considerably from individual to individual. For a plurality, though, obesity appears to be locked in to a lot of kids by the time they are 3 years old. Think about that. If you believe, as I do, that obesity is a problem that implicates all of us, and therefore requires some sort of a collective solution, that in and of itself is cause for despair. What it means is that smaller changes like expanding recess or building more public parks or adding fruit to a diet won't amount to anything.
We then fall back on the research that tells us that television commercials aimed at small children and their parents have significant obesogenic effects; that social and chronic stress among poor parents in certain chaotic neighborhoods correlates significantly with early onset obesity; that the quality of food eaten by the parental generation of these kids may be toxic. What to do? The solutions aren't very easily digested: banning certain types of commercials, spending billions to ensure that kids under the age of 3, especially those from at-risk communities, are taken care by mothers and fathers who know how to parent and who themselves have health care and pre-and-post natal medical care; eliminating corn subsidies and increasing fruit and vegetable subsidies.
A solveable problem, a head start, a slowdown of an increase — this provides an access point for discussions about the big interventions that ought to be tried to see if they work. (It is certainly less expensive than guaranteeing free gastric bypass surgeries for everyone, I'll say that.)
I am aware that the best chances we have to significantly reduce the rate of childhood obesity require Big Government interventions. I am also aware that no amount of forced empathy, or scientific evidence, or even sound judgment will convince a lot of people who think that individual parents ought to be left to their own devices entirely, even if it means raising miserable children who are destined for shorter, miserable lives as obese adults; it's a "choice," you see, a "choice" that black and brown and American Indian people and Appalachian whites just happen to make more than you and I. Eat less! Exercise more! Willpower!
I worry a bit about the middle ground between these approaches: nutritional labeling and soda size bans and such — somewhat passive solutions — will lure policy makers because although unpopular, they are relatively harmless and require not a lot of lifting from the folks involved, like restaurants and grocery concerns. There really isn't much evidence that these things work in a vacuum. As much as I admire the NFL for its efforts to encourage exercise or Walmart for stocking healthier foods, the seductive power of these rather cosmetic changes might mean that these small but statistically significant down-tick in obesity rates is all there is.
I want to pose a question to my readers. Let's assume you've become convinced that obesity isn't a choice, and that there IS a way to reduce childhood obesity AND that it requires government intervention. I know I'm asking you to take my point of view, but I also want to hear what you have to say about what degree of government intervention is permissible, feasible, or something that you'd even experience yourself to help others less fortunate.
