Sometime over the next month or so, United Nations health and nutrition experts will convene in New York to begin discussing what many consider to be the pivotal medical issue of our day: obesity and its impact on children. For the U.N., traditionally concerned with starvation and malnutrition, it is a historic first, following up on an alarm it sounded about obese adults in 1999. 'Obesity,' the U.N. proclaimed, 'is the dominant unmet global health issue, with Westernized countries topping the list."
Solid epidemiological data drives the effort. In Canada, Great Britain, Japan, Australia--even coastal China and Southeast Asia--the rate of childhood obesity has been soaring for more than a decade. Closer to home, at least 25% of all Americans under age nineteen are overweight or obese, a figure that has doubled over the last 30 years and a figure that moved the surgeon general to declare childhood obesity an epidemic. The cost in health care dollars to treat obesity's medical consequences--from diabetes to coronary heart disease to a variety of crippling bone conditions--will eventually make the battle against HIV/AIDS seem inexpensive.
Yet in the U.S., the most important foot soldiers against obesity are increasingly paralyzed by years of media-induced food hysteria, over-generalized and outdated nutritional wisdom and, truth be told, an unwillingness to set firm and sometimes unpopular food parameters. That infantry is the much-strained American family and its increasingly harried commandant, Parentis americanus . What it needs to promulgate is dietary restraint, something our ancestors knew simply as avoiding gluttony.
This is not to say that parents should be blamed for the nation's growing dietary permissiveness. They are wary of confronting their children's eating habits for a reason: For years, conventional wisdom held that food should never become a dinner table battleground. 'Pressure causes tension,' write Harvey and Marilyn Diamond, authors of the classic "Fit for Life," which has sold more than 3 million copies. 'Where food is concerned, tension is always to be avoided.' The operative notion is that a child restrained from overeating will either rebel by secretly gorging when away from the table or, worse, will suffer such a loss of self-esteem that a lifetime of disastrous eating behavior will follow.
Of course, no one should be stigmatized for being overweight. But stigmatizing the unhealthful behaviors that cause obesity would conform with what we know about effective health messages. In both the campaign against unsafe sex and the campaign against smoking, stigmatizing such behaviors proved highly effective in reducing risk and harm. It's true, smokers--and homosexuals--may have experienced a modicum of stereotyping in the short run, but such is the price of every public health advance: short term pain for long term gain.
Another inhibition to imposing dietary restraint is the belief, promoted in handbook after handbook of parental advice, that 'kids know when they are full.' But perhaps not. In fact, new research suggests just the opposite: Kids don't know when they are full.
In a recent study, Pennsylvania State University nutritional scholar Barbara Rolls and her associates examined the eating habits of two groups of kids, one of three-year-olds, another of five-year-olds. The children were presented with a series of plates of macaroni and cheese. The first plate was a normal serving built around baseline nutritional needs; the second was slightly larger; the third was what might be called 'supersized."
What the researchers found is that the younger children consistently ate the same baseline amount, leaving more food on the plates with larger servings. The 5-year-olds, though, altered their eating behavior dramatically depending on the amount they were served, devouring whatever was on the plate. Something had happened. The mere presence of an oversized portion had induced exaggerated eating. The authors concluded that 'these early years may provide a unique opportunity for interventions that reduce the risk of developing overweight.' Those interventions 'should include clear information on appropriate portion sizes for children."
Theorizing aside, our disinclination to restrain eating flies in the face of overwhelming evidence that, of all age groups, children seem to be the ones who respond most positively to dietary advice. In four randomized studies of obese 6 to 12 year olds, those who were offered frequent, simple behavioral advice were substantially less overweight 10 years later than kids who did not get the advice. In fact, 30% of those studied were no longer obese at all.
The case for early intervention has been further buttressed by new studies on another age-old medical injunction: never put a kid on a diet. (The concern was that under-nutrition could lead to stunted growth.) But as the authors of a study of 1,062 kids under age three concluded in the journal Pediatrics, 'a supervised, low-saturated-fat and low-cholesterol diet has no influence on growth during the first three years of life.' Overweight kids who were put on such a diet ended up with better, more moderate eating habits.
Changing the eating habits of children, though, is antithetical to some notions many parents hold dear. And to some it seems a relic of an earlier, more religious era of moral certainties when gluttony was vilified as one of the seven deadly sins. Many boomer parents believe, as one parent and nutritionist said at a recent summit on childhood obesity, that 'kids have the right to make bad nutrition decisions.' That may be true. But ours is a world where at least a billion dollars a year is spent by just one fast-food chain to convince families to visit a crazy-looking clown with his own playground and purchase a thousand supersize calories for a mere $2.50. McDonald's official line today is that three meals a week at its restaurants are perfectly acceptable for an average kid. That's three meals a week of grease, refined flour and a jumbo shot of sugar.
Given today's bounty of cheap and unhealthful food alternatives, and given the inconvenience that goes with making good nutritional choices, one might wonder if a campaign against over-consumption, a campaign advocating restraint, could work. On this point, we might take a cue from the French. In the early 20th century France, in response to its first experiences with widespread child obesity, launched the puericulture movement, which focused on excessive weight gain in early childhood and adolescence. Its prescription: All meals should be adult-supervised; all portions should be moderate, with 'seconds' a rare treat. All but an occasional small snack were forbidden. As its historian Peter N. Stearns writes in "Fat History," puericulture's message was simple: Eating too much food is a bad thing.
Therein lies at least part of the explanation for the legendary leanness of the French: They were taught in childhood not to overeat. And it didn't seem to do much harm to their self-esteem.