Childhood Obesity Month

(Diagram of childhood obesity prevalence by state from March Health Affairs. Red is significantly higher than US, Yellow is higher but non statistically significant, Blue is lower, and Green is statistically signficantly lower)

I'm long overdue for a posting - and I've been thinking a lot about childhood obesity lately.

I'm not the only one - Michelle Obama is evangelizing to take action to increase activity and decrease kids' caloric intake.  There are efforts to impose sweetened beverage taxes in New York and elsewhere.  And this month's Health Affairs has a whopping 80 pages in the March issue on this topic.  (Health Affairs just changed to a larger format.  The new version looks absolutely beautiful, and allows printing useful color graphics like the one at the top of this posting.

I'd like to mention two efforts, both from the Boston area, to address childhood obesity.  Health Affairs published a study of a multidisciplinary team approach to childhood obesity at Boston Medical Center.   The team included a pediatrician, a nutritionist, and a case manager - and was based at community health centers. It incorporated health care IT, and children and their parent(s) attended sessions every 1-2 months for six sessions and early results suggested that of the 174 children who had at least two visits, 80% made at least one improvement in lifestyle (less screen time, better nutrition, more exercise) and 50% had a lower BMI.  This is preliminary  - and it's exciting, because so little about treating childhood obesity seems to work.

The other effort is not based on the medical model, but is rather based on a public health model.  Shape Up Somerville,

Here are two paragraphs from the Boston Globe describing the program:

Pedestrians in this city of 77,500 stride onto bright, recently striped crosswalks. Bicyclists, who until this year navigated traffic aided by a single bike lane, enjoy 2 additional miles of designated lanes, and almost 4 more are planned. In school cafeterias, fresh produce has replaced canned fruits and vegetables, and the high school retired its fryolator. The Neighborhood Restaurant now serves wheat oatmeal waffles with bananas in addition to bacon and eggs. Budding salsa dancers step-two-three in a new Recreation Department class that costs just $10 for two months of twice-a-week lessons.

These scenes might seem to be mere background noise to the bustle of a diverse city of artists and immigrants, laborers and lawyers. Yet changing the background noise has placed Somerville in the vanguard of communities putting environmental and policy changes - rather than exhortations to modify individual behavior - at the center of their fight against obesity. 

Essentially, the idea is to make it easier for people to live healthier lifestyles - not merely to pester them to improve their individual behavior.   Shape Up Somerville has one excellent statistic - the Tufts University researchers who helped set up the program say that kids have gained 15% less weight (one pound) compared to a control group.  That's a big deal with huge potential implications.

The real social question is which of these approaches is sustainable.   We will need the medical model for a select few children - but we need to set up more public health approaches.   And yes, let's tax sweetened beverages too!

I'll be taking a break from Managing Health Care Costs for the next two weeks - I'm now in Los Angeles on my way to Hanoi to cycle to Luang Prabang Laos.  If you're interested in reading about this adventure, I'll post at (assuming I find internet cafes!).