One of my recent blogs was a somewhat pessimistic response to the worldwide obesity epidemic and the continuing epidemic of new onset type 2 diabetes. I do try to find optimistic studies and articles as much as possible because it is important to be proactive and not lose hope and thus become despondent and complacent. I was delighted to find an article in the Philadelphia Inquirer, by Don Sapatkin, from September 8, 2012. The article discusses a study by the Philadelphia City Health Commissioner, who is a co-author of the paper published in Journal Preventing Chronic Disease. (The full paper can be read on the following website: www.cdc.gov/pcd.)
According to Mr. Sapatkin, obesity rates for the Philadelphia public school children “fell significantly over the last 4 years. The rate of obese local public students dropped nearly 5 percent between 2006 and 2010 when national obesity rates remained unchanged after tripling since the mid-1970s.” The declines were greatest in African American males and Hispanic females in Philadelphia. Other jurisdictions that have noted declines in obesity in the last few years include Arkansas, California and New York City. Rates of obesity (95 percentile of body mass index) dropped in all grades but declined most in kindergarten through 5th grade (by a decrease of 6 percent), 6-8th grades declined by 4.7 percent. Both drops were statistically significant. Grades 9-12 experienced a 2.4 percent drop that was not statistically significant. Rates of severe obesity (greater than 95 percent of body mass index) dropped 7.7 percent and there was a markedly significant drop in African American males (13.8 percent) and Hispanic girls (10.2 percent).
How did they do it?
- Removal of sodas and drinks with extra sugar from vending machines in 2004
- District-wide snack standards were developed in 2006
- Free breakfasts offered to all district students in 2009-2010
- Use of fryers in cafeterias was discontinued
- Switch from milk with 2 percent fat to 1 percent fat
- Philadelphia city government banned trans fats in all restaurants
- Philadelphiacity government mandated nutrition labeling (as doesNew York City) on chain restaurant menus
- The development of incentives for corner grocery stores to offer more fresh produce by thePhiladelphiacity government
Thus, it is clear, indeed, that it is possible to decrease obesity rates, and therefore lead to curbing the epidemic of type 2 diabetes in adults and children. The intervention, however, must be on a governmental level (city, state) and be officially mandated to make it possible. Vending machines that offer soda with sugar and candy must be removed from schools (at least). Efforts to improve food offerings in public schools must be improved and sanctioned by law. Following steps 1-8 as above would be a major inroad in inner cities. Why “invent the wheel” when there is evidence-based medicine to support the above findings? Change is hard and ingrained habits are very difficult to alter. Note the biggest changes occurring in the younger age groups. As that trend continues, older children will have developed improved nutritional habits that will affect obesity trends further and thus lead to a decrease incidence in type 2 diabetes.
Change needs to occur “where we live.” Interventions by the healthcare team are generally supportive of change, but do not effect change. Change must occur in the home, local neighborhoods, and clearly the school system, as children spend much of their day in this setting.
On a final note, just looking at the calories and carbohydrate content of food items can make a difference! While in New York City at the American Diabetes Association Scientific update last year, I had the opportunity to dine in one of the New York steakhouses. The menus documented the calories of each of the items, including desserts! I am proud to say, all of my dining colleagues made healthier choices (we still had dessert, but at least we knew what we were consuming). Even at my local Starbucks, I think twice before ordering the Mocha confection (saving the drink for my toughest days). Change is hard, but if it is in your face everyday, one is more likely to do it!
Published On: September 24, 2012