Currently browsing posts about: Children

The White House has announced the formation of a President’s Commission on Making America Healthy Again

It will be chaired by newly confirmed HHS Secretary Robert F. Kennedy Jr, and according to the The MAHA Commission Fact Sheet “is tasked with investigating and addressing the root causes of America’s escalating health crisis, with an initial focus on childhood chronic diseases.”

The Commission will include representatives of relevant agencies.  It is to:

• Produce a Make our Children Healthy Again Assessment within 100 days.
• Submit a Make our Children Healthy Again Strategy within 180 days.

Comment

Whew.  I can’t wait to see what this Commission comes up with.  But it sounds like nothing will be done, actually, for at least six months.

Oh.  Wait!  I’m having a deja vu.   Didn’t we already do this?

Isn’t this just what Michelle Obama’s Let’s Move initiative did in 2010?

• Recall: White House Task Force on Childhood Obesity Report to the President: Solving the Problem of Childhood Obesity Within a Generation.
• Also recall: Republicans pushed back so hard on this that hardly any of it could be accomplished.
• And: President Trump opposed her initiatives as late as 2017.

Don’t get me wrong.  I am totally for doing this and hope the Commission takes its mandate seriously.

Let’s Move got pushback for trying to take on the food industry.  If RFK, Jr’s Commission can do this, it will deserve much applause.

As always, stay tuned.

The headline in The Guardian: UK children shorter, fatter and sicker amid poor diet and poverty, report finds.

Here’s the report.

It’s principal findings:

• The height of 5 year olds has been falling since 2013.
• Obesity among 10-11 year olds has increased by 30% since 2006.
• Type 2 diabetes among under 25s has increased by 22% in the past 5 years.
• Babies born today will enjoy a year less good health than babies born a decade ago.

As it says in the introduction,

Crucially, the report not only highlights a deeply worrying increase in conditions driven by calorie dense diets such as obesity and type 2 diabetes, but also highlights the equally concerning and substantially less talked about results of poor-quality diets and undernutrition….All children should be able to eat in way that fuels their bodies and minds, giving them sufficient calories and nutrients to be free from hunger and diseases of nutritional deficiency, while being protected from the bombardment of ultra-processed, highly sugary and salty foods that most often contribute to excess calorie intake but lack vitamins, minerals, fibre, healthy fats and quality protein.

Comment

I’m guessing if a similar study were to be done in the United States, its results would be similar.  Children are the future of our nation and society; they deserve good health and protection against junk food.

Shannon Saia sent me copies of three books in the series, Gertie in the Garden, aimed at kids ages 6-9.  Here’s one:

The other two are Going Offbeet and Making Peas (puns intentional).

She asked if I would blurb the series.  Once I read them, I was happy to:

The Gertie in the Garden series is so engaging that kids will catch on right away to why growing vegetables and even playing with them will encourage kids to view healthy foods as helping them negotiate their way in the world.  Kids will love these books (and parents will too).

I have to admit to not liking most books aimed at getting kids to like vegetables.  But I liked these a lot.  For one thing, they are focused on Gertie’s struggles to figure out how to get along with others (not easy, in her case), and her social awkwardness feels real—and fixable.

For another, learning how to garden with her grandmother is a relief from those struggles and integrated into her life in a way that again seems authentic.

I think it would be fun to read these to young kids not yet ready to read them on their own.  And the stories raise plenty of issues to talk about as well as offering practical advice about how to grow these vegetables.

Shannon tells me these are available in the usual way through bookstores and online.

So many readers have asked me to comment on the American Academy of Pediatrics’ Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity that I thought I ought to say something about it.

The guideline report is so long and detailed that I cannot imagine anyone actually reading it.  I started with the introduction, which summarizes basic facts.

• 14.4 million children and adolescents are affected by obesity.
• Obesity is a chronic disease with potentially serious health consequences
• Childhood obesity is strongly affected by social determinants of health (poor education, poverty, racism, exposure to toxins, etc)
• Childhood obesity is stigmatized in ways that fail to acknowledge social determinants.

What got press attention—and the attention of readers of this blog—is the AAP’s endorsement of drug and bariatric surgical treatment of obese children.

I cut right to the chase and looked at Appendix I, which gives the AAP’s algorithm for deciding on treatment options.  

The report’s major conclusions expand on this chart (the report does not define KAS, but I think it means Knowledge, Attitudes, and Skills):

KAS 9.  Pediatricians and other PHCPs should treat overweight (BMI ≥ 85th percentile to <95th percentile) and obesity (BMI ≥ 95th percentile) in children and adolescents, following the principles of the medical home and the chronic care model, using a family-centered and nonstigmatizing approach that acknowledges obesity’s biologic, social, and structural drivers.

KAS 10.  Pediatricians and other PHCPs should use motivational interviewing (MI) to engage patients and families in treating overweight (BMI ≥ 85th percentile to <95th percentile) and obesity (BMI ≥ 95th percentile).

KAS 11.  Pediatricians and other PHCPs should provide or refer children 6 y and older (Grade B) and may provide or refer children 2 through 5 y of age (Grade C) with overweight (BMI ≥ 85th percentile to <95th percentile) and obesity (BMI ≥ 95th percentile) to intensive health behavior and lifestyle treatment. Health behavior and lifestyle treatment is more effective with greater contact hours; the most effective treatment includes 26 or more hours of face-to-face, family-based, multicomponent treatment over a 3- to 12-mo period.

KAS 12.  Pediatricians and other PHCPs should offer adolescents 12 y and older with obesity (BMI ≥ 95th percentile) weight loss pharmacotherapy, according to medication indications, risks, and benefits, as an adjunct to health behavior and lifestyle treatment.

KAS 13.  Pediatricians and other PHCPs should offer referral for adolescents 13 y and older with severe obesity (BMI ≥ 120% of the 95th percentile for age and sex) for evaluation for metabolic and bariatric surgery to local or regional comprehensive multidisciplinary pediatric metabolic and bariatric surgery centers.

What is not in this guideline is anything that addresses the social determinants of childhood obesity.  What we have here is a focus on treating the symptoms, but getting nowhere near the cause.

It is difficult for someone like me who is not affected by those determinants to even imagine how drugs and surgery could be thought even remotely acceptable for children, even those over the age of 12, but I am not treating these kids.

Providers who do treat obese children tell me they are relieved to be able to offer options that might help kids achieve healthier weights.

As I see it, these should be absolute last resorts if used at all. And this is without even getting into issues of cost or our dysfunctional health care system.

In public health terms, drugs and surgery are “downstream” solutions to a problem that began way upstream with all those societal determinants.

If ever we needed upstream approaches, chldhood obesity is a prime example.

Upstream means policy changes that make healthy eating more appealing, accessible, and affordable  That’s what pediatricians need to be calling for.

This AAP report deliberately separates treatment from prevention.  It promises a discussion of prevention in a subsequent report.  I hope it is as hard hitting as any AAP report has ever been.

If childhood obesity teaches us anything, it is that our society needs to change in ways that are healthier for our children.

Additional supporting documents

• Executive Summary: Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity
• Appraisal of Clinical Care Practices for Child Obesity Treatment. Part I: Interventions
• Appraisal of Clinical Care Practices for Child Obesity Treatment. Part II: Comorbidities

Thanks to all the people who wrote me about this.  Much appreciated.

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For 30% off, go to www.ucpress.edu/9780520384156.  Use code 21W2240 at checkout.

The White House Conference on Hunger, Nutrition & Health is convening today.  As a reminder of why it matters, here’s what’s happening with the much-needed reauthorization of the Child Nutrition Bill.

The reauthorization bill, required every five years, was introduced in the House in July as H.R.5919 – Early Childhood Nutrition Improvement Act of 2021.  If and when passed, it will:

• Increase kids’ access to free school meals
• Expand kids’ access to summer meals
• Expand kids’ access to day care meals
• Expand WIC (the Special Supplemental Nutrition Program for Women, Infants, and Children) benefits and access
• Enable Tribal sovereignty in program administration 

The Food Research & Action Center (FRAC) offers:

• A primer on the bill
• A full summary of the bill

I’m hoping the White House Strategy announced today will include these elements for reducing childhood hunger.

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Coming soon!  My memoir, October 4.

For 30% off, go to www.ucpress.edu/9780520384156.  Use code 21W2240 at checkout.

The World Health Organization has just published “Food marketing exposure and power and their associations with food-related attitudes, beliefs and behaviours: a narrative review”

This is an update of a review WHO published in 2009 on the extent, nature and effects of food marketing.

The update includes a review of studies from 2009 to 2020 of

• Where food marketing occurs
• How much there is,
• Which brands and products are marketed
• How they are marketed
• How consumers react to food marketing

The report, which covers digital and social media,  concludes

Food marketing remains prevalent

• It is especially prevalent where children are and what they watch on TV
• It predominantly promotes “fast food”, sugar-sweetened beverages, and chocolate and confectionery
• It uses a wide range of creative strategies  aimed at young audiences (celebrity/sports endorsements, promotional characters, games)
• Its exposure is positively associated with habitual consumption of marketed foods or less healthy foods

The report confirms what advocates have been saying for years

• Food marketing is pervasive
• Food marketing is persuasive
• Food marketing is bad for health

The bottom line: Food marketing, especially to children, must be stopped

Here’s what’s happening with kids and food these days.

I.  Amedeo Bettauer’s video on kids’ menus in restaurants: “Kids Menus Suck”

Amedeo Bettauer, a.k.a. Kid Pundit, is my 12-year-old neighbor in New York.  His opinion:

Kids menus are unhealthy, have no variety, and are teaching bad eating habits to young kids. Here’s why.

He would appreciate Likes if you are so inclined.

II.  The Robert Wood Johnson Foundation’s State of Childhood Obesity Report 2021

From the press release for this report:

One in six young people nationwide, 16.2 percent of youth ages 10-17, have obesity, according to the newest available data. The data reveal sharp disparities, with the highest obesity rates among youth of color and youth from households with low incomes. ..The report, available at www.stateofchildhoodobesity.org, includes the latest data on childhood obesity rates and offers policy recommendations for prioritizing health and equity.

III.  Center for Science in the Public Interest report on that status of kids’ meals in restaurants: “Selling Out Kids’ Health: 10 Years of Failure from Restaurants on Kids’ Meals”

Overall, 98% of the 9,556 children’s meal combinations across the 38 top 50 restaurant chains offering kids’ meals in 2018 failed to meet nutrition standards. When each restaurant chain’s evaluation was weighted by its number of outlets in the United States to reflect the likelihood of a family visiting any given restaurant, results were still poor, with 71.9% of kids’ meals failing to meet nutrition standards. These results are virtually the same as when this data was last collected in 2012, when 71.8% of meals failed to meet nutrition standards (when also weighted by number of outlets per chain).

Among the report’s dismal conclusions:

The most commonly offered beverage type was juice, with 76% of restaurants offering 100 percent fruit juice or juice without added sweeteners on the children’s menu. However, two-thirds of restaurants had soft drinks on their children’s menu, and few (26%) had water as an option.

IV.  Healthy Eating Research has feeding recommendations for kids ages 2 to 8.    The complete report is here.  

Here’s an example of its recommendations:

The US Agency for International Development (USAID) has issued two reports arguing that reduction of the prevalence of child stunting should no longer be used as the sole measure of success of nutrition intervention programs.

Background: Stunting is defined as low height-for-age.  It has long been used as a measure of nutritional deficiency due to inadequate diet in the presence of poor sanitation and other conditions.  Interventions focused on improving dietary intake rarely prevent stunting or affect it to only a small extent.

The first report: Stunting: Considerations for Use as an Indicator in Nutrition Projects

Emerging evidence supports the need to reexamine stunting as the primary indicatorof the success or failure of nutrition interventions.  Stunting should be interpreted not as an indicator of short-term programmatic success, but rather of the overall well-being of populations.  Not all nutrition programs, projects, or activities should be expected to reduce the prevalence of stunting… Failure to reduce the prevalence of stunting should not be interpreted as the failure of a nutrition program or project.  Nutrition programs should consider—and measure—a broader range of the many benefits that programs can achieve.

The second report:  Beyond Stunting: Complementary Indicators for Monitoring and Evaluating USAID Nutrition Activities

this guide shows how accurate and meaningful results, beyond stunting, can be captured through the use of more comprehensive and responsive indicators that directly link to an activity’s logical pathway…Measuring different types of indicators across the program’s impact pathway helps to understand how well programs are implemented and how results are achieved. Most important, measures like these allow for learning about what the program has, or has not achieved,
and why.

This second report provides a useful Table listing possible non-stunting indicators such as rates of breastfeeding, nutrient supplementation, home food production, participation in food assistance programs, and the like.

These are all downstream (personal) interventions.  I’d like to see USAID fund some more upstream (policy-based) interventions and see if those might do greater good for greater numbers of people.