Preventing Childhood Obesity

Changing the American Culture of Obesity

By: Nancy Trout, MD, MPH

Our American culture promotes obesity. Environmental influences steer us to choose unhealthy foods and eat portion sizes that are far too large. Stores and restaurants are awash in highly processed junk foods that are high in calories and low in nutrients. Junk food is widely available, cheap, convenient and heavily marketed. Unhealthy foods such as candy are prominently displayed in high traffic areas such as check-out counters in stores and pharmacies. In a typical grocery store, entire aisles are dedicated to salty snacks, cookies and crackers, juices and juice drinks, and sodas. In addition, all-you-can-eat buffets and supersizing at fast food restaurants are an invitation to excessive eating.

Treating the Culture of Obesity

The most recent Robert Wood Johnson State of Childhood Obesity data shows that 19.3% of children between the ages of 2-19 in the United States have obesity. When I see children who have obesity in primary care or in the Connecticut Children’s weight management program, I take a diet history. Processed foods that patients often report as staples in their diet include hot ranch Cheetos or Doritos, Oreos, sugary cereals such as Frosted Flakes or Fruit Loops, Lunchables, Kraft Macaroni and Cheese, and pizza. Common beverages include sweetened iced teas, juices, sports drinks, sodas and chocolate milk. They will often run through an entire day of consumption without mentioning a single fruit or vegetable.

In addition to asking about diet, I also ask about their physical activity and their screen time. This statistic has surely been worsened by the COVID-19 pandemic, but many children report not engaging in any physical activity at all, and screen time outside of remote schooling is often greater than four hours daily, and is sometimes greater than eight hours per day. Kids are sedentarily on social media, streaming TV and video content, or gaming for significant parts of their day and night, which also consequently adversely affects their sleep.

Ending our Culture of Obesity

Promoting children’s optimal growth and health is challenging in our obesogenic environment. According to a report from the UConn Rudd Center for Food Policy and Obesity, Big Food and Big Beverage spend over $8 billion a year advertising and marketing unhealthy foods and beverages to children and adolescents, disproportionately targeting Black and Latino children and teens. This targeted marketing contributes both to poor diets and diet-related diseases in this population. We need to acknowledge that children and their parents are fighting a challenging uphill battle.

The American culture of obesity is a societal problem and needs comprehensive societal solutions. We need strong policies that help promote healthy eating and active living among families and that make healthy choices the easy choices.

Connecticut should pass a sugar sweetened beverage excise tax to decrease the consumption of sugary drinks that contribute to type 2 diabetes and fatty liver disease. The previously introduced healthy children’s meal bill, which makes the default drink on kids’ meals water, sparkling water, or unflavored milk in restaurants and fast food establishments, should be resurrected. And we should limit advertising of junk foods and unhealthy beverages to children, a policy that is supported by Senator Richard Blumenthal.

We must encourage children and their families to move away from sedentary behavior and become more physically active indoors and outdoors. Community interventions such as safe walkable communities, parks, bike paths, playgrounds, and accessible outdoor programming for kids and teens are essential. The Connecticut Department of Energy and Environmental Protection’s website has many options for getting outdoors for family walks and hikes in Connecticut.

If we are going to change the culture of obesity in our society, we need to first acknowledge it for the dire epidemic that it is with serious health consequences and costs. Then we must turn to serious policy, systems, and environmental interventions that remove barriers to healthy eating and physical activity and promote healthy decision making in homes, schools, communities and the nation.

Nancy Trout, MD, MPH is a primary care pediatrician and co-director of Kohl’s Start Childhood Off Right, which is a childhood obesity prevention initiative of Connecticut Children’s Office for Community Child Health.

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