Bill of health

As children prepare to return to school, spare a thought for how much healthier we were, how more active children were in our day and how childhood obesity was not the risk that it is now.

Today’s trend is alarming: one-quarter of Irish three-year-olds and one-third of seven-year-olds is overweight or obese. Ireland’s children now rank fifth among 27 EU countries for childhood obesity, and nearly half of adults will be obese by 2030 if the trend continues.

In the US, meanwhile, obesity has more than doubled in children and tripled in adolescents over the past 30 years, according to the Centre for Disease Control and Prevention. The percentage of children the ages of six and 11 who were obese has increased from 7 per cent in 1980 to almost 18 per cent in 2000. Over the same period the percentage of adolescents (aged 12 to 19) who were obese increased from 5 per cent to 18 per cent. Current Irish statistics are just as worrying.

Earlier this summer an Oireachtas committee was told that 19 per cent of boys and 18 per cent of girls from professional households are overweight or obese, but this increases to 29 per cent of boys and 38 per cent of girls from semiskilled and unskilled backgrounds.

With more than one-third of US children and adolescents and two-thirds of the adult population overweight or obese, Michelle Obama launched the high-profile Let's Move campaign three years ago, an initiative set up by the White House to combat childhood obesity. Robin Schepper, the first executive director of this programme, puts the increase in childhood obesity in the US down to a range of factors.

Portion sizes are one-third bigger than they were 30 years ago and people eat 15 pounds more sugar every year than they used to, says Schepper. People also snack far more than they once did.

On the level of physical activity, in the 1970s, 70 per cent of children walked or cycled to school while 30 per cent travelled by bus or car. “It is the exact opposite now,” says Schepper, who is a guest speaker at the Irish Nutrition and Health Foundation annual seminar in Dublin next month.

An “unintended consequence” of promoting maths and reading in US schools led to one hour’s worth of physical education a day being cut, while home economics, a subject taught in the 1960s, was also removed from school syllabuses, so two generations of families “don’t know how to cook,” she says.

Bone density
Two years ago Schepper accompanied Obama on a trip to a US army base in Fort Jackson, South Carolina, to see their "Fuelling Soldiers" initiative to improve nutrition. The army found that 19-year-old recruits had lower bone density than soldiers 20 years ago. The reason for this was less physical education in schools and that when they were around the age of 10 or 11 schools replaced milk with sugary drinks.

“In the army 64 per cent of recruits that go through a 10-week basic training programme cannot go to the next level of advanced training because of a dental issue,” says Schepper, with some surprise.

The modern design of American cities in the 1970s and 1980s also led to the rise of the suburbs, with fewer footpaths and more roads being built as a result of the changes in urban planning. This meant that fewer people were walking to work or school as before. Life became centred “around the car,” says Schepper. “This has meant the healthy choice is not the easy choice.” As a consequence, adults were not getting their 30 minutes of physical activity they should have every day, while children were missing out on their required 60 minutes a day.

Silver buckshot
The multifaceted causes of childhood obesity requires a multifaceted solution, so the campaign to tackle the problem in the US has not been limited to one single agency or area. "We have changed as a society so much. People like to think is there a silver bullet. What we like to say often is that we need silver buckshot," says Schepper.

The starting point for Michelle Obama’s campaign and within the public health sector was to attempt to trigger a cultural shift in people’s attitudes to nutrition, food consumption and physical activity that invested people in the idea that everyone had a role to play in the drive to make lives healthier. One example was an agreement reached in recent months involving the Partnership for a Healthier America, a nonprofit organisation set up independently from the Let’s Move campaign. It agreed a target with food and drinks manufacturers to reduce 1.5 trillion calories from their products by 2015.

Two restaurant chains, Olive Garden and Red Lobster, have changed their children’s menus so that certain dishes do not automatically come with fries but are instead served with vegetables and fruit.

Schepper believes that an organisation that tracks whether targets on food nutrition and other areas that combat child obesity are reached could reap rewards in the fight against childhood obesity.

"One lesson for Ireland could be, can some type of entity be set up so people can make commitments and those commitments be recognised and those commitments can also be tracked?" she says.

The Let’s Move campaign grew out of the domestic policy council in the West Wing of the White House and worked in tandem with the Childhood Obesity Taskforce. One initiative led by president Obama was his move to task 19 federal agencies to devise recommendations in their own respective areas. For example, the Department of Transport looked at safe routes to school and how federal funding could be used to increase the amount of footpaths that are built for cycle paths.

Schepper refers to one clever idea run by Mike Cornett, the mayor of Oklahoma City, to show how individual cities can make a difference. Cornette put the city on a diet in 2008 and challenged residents to lose a million pounds of weight over the course of the year.

Teaching children about the merits of gardening and growing their own food, as Mrs Obama has shown with the White House Vegetable Garden, is hugely beneficial. “The power of gardening is amazing because it gives children ownership of it,” says Schepper.

Since leaving the Let's Move campaign just over a year ago, Schepper has worked as a consultant at the Bipartisan Policy Centre, a think tank in Washington DC, and for the US Department of Defence. In her latter role she has seen the influence that US army generals can bring to the campaign, much like the profile that Michelle Obama brought to the campaign to fight child obesity. Mrs Obama had "the ear of the press" and was "a catalyst for change" in the Let's Move campaign, says Schepper; generals also have an important role to play in the debate. "When you have generals who say that our biggest national threat to security is obesity, then a whole different audience starts to listen," she says.
Unfit for military duty
Schepper cites a Department of Defence statistic that 27 per cent of young Americans who want to join the military cannot enlist because they have a fitness issue, usually because they are overweight. The US military also has to shed 2,000 active service members because they fail to pass a fitness test every six months, she says. This is costly as one soldier can cost between €100,000 and €200,000 to train.

“Those are millions of dollars that they are losing; they have to hire new people to re-train,” she says.

The US health system creates its own problems; it is focused on tackling illness rather than looking at preventative action to manage the onset of chronic disease. It is crucial for the system to change its focus in a country where Schepper says 78 million people are classified as “pre-diabetic”.

The medical community must look at how healthy eating and active living can change lifestyles, she says. This could include doctors giving “veggie prescriptions” to ensure patients eat five servings of fresh fruit and vegetables a day.

The two big costs to the US government are increasing healthcare costs relating to Medicare for the elderly and Medicaid for the poor. Of these costs, 75 per cent relate to chronic disease management, mostly as a result of obesity.

“This is an economic issue, essentially,” says Schepper. “If we don’t tackle obesity, we are going to go bankrupt.”

Schepper, who is 50, has used her planning experience working on four Democratic presidential campaigns, setting up consulting businesses and advising on the Athens 2004 Olympic Games to develop strategies and drives to help children be more physically active and to improve nutrition.

“You have to be passionate and for me personally if you are not healthy, you really cannot reach your full potential,” she says. “If Americans could reach their full potential, imagine what we could do.”

Robin Schepper will speak at the
Gibson Hotel in Dublin on September 12th at the Nutrition and Health Foundation's free annual seminar. The foundation has reserved places for the first six Irish Times readers to contact
muireann.cullen@ibec.ie