The scales may not be tipping up quite so precipitously for some low-income preschoolers. So says a recent report from the Centers for Disease Control and Prevention (CDC). Bucking the previous trend, 19 states saw small decreases in obesity rates among preschoolers between 2008 and 2011, while rates held steady in another 20 states. Is this cause for celebration, cautious optimism or concern?
Perhaps all of the above, says David Ludwig, MD, PhD, director of the New Balance Foundation Obesity Prevention Center Boston Children’s Hospital. “The report is a small, but encouraging, sign after nearly half a century of bad news.”
The latest data, along with several other reports, are raising hopes that the era of continually rising obesity rates may be drawing to a close. But most epidemics aren’t halted by a small crook in the prevalence curve. In fact, containing the obesity curve will require more muscle from federal decision makers, Ludwig contends.
The CDC Vital Signs analysis draws data from a specific population: low-income preschoolers enrolled in the Women, Infants and Children (WIC) program between 2008 and 2011. These data are not representative of all children between the ages of 2 and 5, says Ludwig, and the analysis did not measure the same children longitudinally. Children enter and exit the WIC program at various times, so the data do not refer to same children in 2008 and 2011.
The $75 billion Supplemental Nutrition Assistance Program (formerly known as the Food Stamp Program) has no criteria for nutritional quality.
The dip coincides with the recession, which might mask its origins. For example, rather than indicating a fundamental change in obesity incidence, the decline could reflect a change in the sociodemographics of poverty. That is, the recession might have prompted families of previously under-represented socioeconomic groups to enroll in WIC.
Nutrition programs: A recipe for change?
WIC, which allocates nearly $7 billion annually to target pregnant women and children up to age 5, may offer the right ingredients for halting obesity trends, says Ludwig. It was revised in 2009 to incorporate minimum nutritional standards, including recommendations published in the Dietary Guidelines for Americans, which emphasize vegetables, fruits and whole grains.
In contrast, the $75 billion Supplemental Nutrition Assistance Program (SNAP, formerly known as the Food Stamp Program), a broader program designed to assist households with incomes at or below the poverty line, has absolutely no criteria for nutritional quality. “SNAP dollars can be used to buy fresh fruits, vegetables and beans,” Ludwig says. “Or recipients can purchase sugary beverages with SNAP.”
Federal lawmakers’ failure to implement minimum nutritional standards in SNAP, which is the largest federal food assistance program, is a missed opportunity, charges Ludwig. Lawmakers could take a cue from their own cookbook and replicate changes they made in the WIC program to promote healthier habits among SNAP recipients. For example, SNAP’s annual tab for sugary beverages weighs in at a hefty $4 billion, and these drinks fuel hunger, promote weight gain and increase risk for diabetes and heart disease.
In a recent commentary published in the Journal of the American Medical Association, Ludwig noted that taxpayers are double-billed for junk food purchased with SNAP dollars. They pay for the initial purchase and then down the road through Medicare and Medicaid as patients seek treatment for diet-induced disease.
Washington’s complicity in the obesity epidemic extends to other policies as well, he continues. Under-funding school lunch programs, failing to regulate food advertising to children and funding farm subsidies that promote high-calorie, low-quality commodities over fruits and vegetables compound the challenges low-income families face.
The food industry should shoulder its fair share of responsibility, too, adds Ludwig. Incessant advertising of junk food and failure to market healthful foods create a toxic food environment for children.
The long view on obesity
The truth is that obesity rates overall have continued to swell among adults and the heaviest children, so trends are moving in both directions, says Ludwig. And while overall obesity rates may be stabilizing, the current rates of increased body mass index (BMI) and obesity are exceedingly high.
Overall, one in eight preschoolers is obese. The rates are even higher for black children (one in five) and Hispanic children (one in six), according to the CDC.
Ludwig sees obesity as a three-stage epidemic with ripple effects anticipated for many years. The first stage, which lasted from the 1980s until the early years of this decade, was characterized by a rapid increase in the prevalence of obesity.
The second stage may take years for its defining features to fully manifest. As the current generation of obese children ages, the incidence of obesity-related diseases, such as type 2 diabetes and fatty liver disease, will rise. The increasing prevalence of these obesity-related diseases in adolescents—previously considered exclusively adult conditions—is an early warning of the magnitude of this wave.
Ludwig foresees a third wave as people who have suffered years of weight-related diseases develop life-threatening complications like heart attack, kidney failure and stroke. “The population health burden of obesity-related disease will continue to swell until rates are brought down substantially.”
It’s unclear to what extent these waves can be halted. Yet despite the uncertainty and the ongoing challenges of obesity prevention, Ludwig applauds the CDC’s findings. “It is great news that even a small decrease occurred,” he says.