Close Concerns Weblog

Was Gina Kolata in Barcelona? The NYT on the importance of waist circumference

The New York Times continues its excellent healthcare reporting in tomorrow's paper, with a section on personal health called "Testing: A User's Guide." The paper reports on six illnesses/conditions (asthma, bone disease, cancer, heart disease, obesity, and diabetes) and what people can do to avoid them. It's notable, of course, that fully half focus on metabolic disease. These are short, punchy pieces but very actionable. We have admired Gina Kolata writing for many years and are thrilled she seems to be focusing more on healthcare. Our current issue of Diabetes Close Up highlights pre-diabetes and a conference that just ended a few days ago in Barcelona. One of the major themes of the meeting was waist circumference and how meaningful that is in relation to visceral fat, the worst kind of fat. Reading this piece in the NYT will be instructive to people, we hope - how easy is it to go pull out a tape measure? In fact, we're headed to our tool closet right now, how about you! Clearly not every tool is perfect, but we hope the tape measure wll be used more and more. See below for the original pieces...and thanks to the NYT for starting to run such actionable pieces.

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May 1, 2007
Obesity
How Does Your Waistline Matter? Let Us Count the Ways.

By GINA KOLATA
AT age 39, with diabetes and high blood pressure in her family, Linda M. was starting to worry about her weight and its health consequences. She was 5 feet 6 inches tall and weighed 170 pounds, which placed her in the overweight category, according to the standard definition. Although she was not officially obese, she said, “I realized I was not at my ideal weight.”

But Linda was in for a surprise during an appointment last fall with Dr. Judith Korner, an obesity specialist at Columbia University. Instead of weighing her, Dr. Korner whipped out a tape measure and measured her waist.

It was 35 inches, putting her in a danger zone, Dr. Korner explained. An overweight woman with a waist 35 inches or larger, or an overweight man with at least a 40-inch waist, is at increased risk for diabetes and heart disease.

“That was an education,” said Linda M., who did not want her last name revealed because of her weight. “I did not realize that my waist determined my future risk.”

Obesity specialists differ on what measurements are best.

Linda’s body mass index, or B.M.I., for example, was 27.4, far from the obesity category, which starts at 30. She would have to weigh 185 pounds to have a B.M.I. that high. (For comparison, a man who is six feet tall and weighs 221 pounds is considered obese.)

If a doctor were to use B.M.I. exclusively to evaluate Linda, the conclusion would be that her weight was not a serious health risk. She had only one risk factor for heart disease — a high level of triglycerides — and the guidelines for B.M.I. say that overweight people need two factors, like high triglycerides and a high cholesterol or blood pressure levels, to be considered at serious risk.

B.M.I. has limitations. Muscular men might have high B.M.I.’s, which make them seem fatter than they are. Old people often have deceptively low B.M.I.’s because they have lost so much muscle in the aging process.

In Linda M.’s case, adding her waist measurement to her B.M.I. indicates a high health risk, according to guidelines published by the National Heart, Lung and Blood Institute. For Dr. Korner, the test is useful in assessing if people like Linda M. — overweight but in a gray zone — face a true health risk? If her waist had been less than 35 inches, Dr. Korner would have been less concerned.

Dr. Ned Calonge, chairman of the United States Preventive Services Task Force, said the panel preferred B.M.I. measurements to determine whether people are fat enough to place their health at risk. For most adults, he explained, B.M.I. “is more feasible or has better validity than other measures.”

But, Dr. Calonge added, it is not enough to simply diagnose someone as obese. The goal should be better health.

And the problem with testing for obesity, using B.M.I. or anything else, is that the sort of counseling most patients get from their doctors has not been shown to improve health, Dr. Calonge said.

“You now have a, quote, diagnosis,” Dr. Calonge said. And there is at least fair evidence from research that intense and expensive counseling about diet and exercise can help people lose weight and improve conditions that place them at risk for heart disease. But, he added, “it is uncertain whether less intense interventions have any impact at all.”

For Madelyn Fernstrom, the director of the Health System Weight Management Center at the University of Pittsburgh Medical Center, the goal of a medical exam is not to document how fat someone is but to rule out rare metabolic conditions that might be causing the weight problem. An exam also helps to determine whether there are associated medical conditions that should be treated, like diabetes or high cholesterol or blood pressure.

As for Linda M., waist measurement made the difference.

“After that, I got myself in gear,” she said. “I tried to eat less sugar and healthier snacks; I was more conscious of what I was selecting.”

She lost 20 pounds and a couple of inches from her waist. Her triglycerides are lower, yet still a bit high. But, she says, as she sees it, with a smaller waist, “I’m out of the danger zone.”

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May 1, 2007
Diabetes
Finding Whether Diabetes Lurks

By DENISE GRADY
MORE than six million Americans are walking around with no idea that they have an insidious disease with the potential to wreak havoc throughout the body.

The disease is diabetes, and it causes high blood sugar levels that can damage arteries and lead to heart disease, strokes, kidney failure, amputations and blindness. It is the sixth-leading cause of death in the United States.

The idea of so many people — roughly 30 percent of the 21 million Americans who have the disease — going without treatment is disturbing because diabetes can do so much damage. But in its early stages, people often do not realize they are ill, because the symptoms — if there are any — may creep up gradually or be attributed to overwork or aging.

“Certain signs are important,” said Dr. F. Xavier Pi-Sunyer, chief of endocrinology, diabetes and nutrition at St. Luke’s-Roosevelt Hospital in Manhattan. “If you have to get up a couple of times to urinate at night, and you didn’t before, that’s a suggestive sign. Also, vision blurring of any kind, suddenly beginning to lose a significant amount of weight without trying, frequent skin infections or vaginal infections. And this is nonspecific, but if you’re getting headaches and feeling kind of fatigued.”

Any of those symptoms should prompt testing for diabetes, Dr. Pi-Sunyer said. So should certain risk factors, especially if there are more than one. Aging and obesity increase the odds that a person will develop Type 2, or adult-onset diabetes, the most common form. Weight is a particular risk factor, especially if it is mostly in the belly — a waist over 40 inches in men or 35 inches in women. Blacks, Native Americans and Hispanics have a higher-than-average risk, as do people with a family history of the disease. Being sedentary may also increase the risk, though not all researchers agree about that.

People who appear healthy but have risk factors should be tested for diabetes every three years, Dr. Pi-Sunyer said.

The simplest means for earlier detection is a blood sugar test, measured after a person has fasted for at least eight hours. Readings above 126 milligrams of glucose per tenth of a liter of blood indicate diabetes; anything below 100 is considered normal. Intermediate levels reflect impaired glucose metabolism or “pre-diabetes.” People in this category need yearly testing, because up to 8 percent of them will become diabetic each year. About 54 million Americans are pre-diabetic.

Though many doctors in the United States like the fasting blood sugar test because it is quick and easy, some use another test, one that may pick up diabetes at an even earlier stage. This is a glucose tolerance test, in which the patient is given a fasting blood sugar test, drinks a glucose solution and then has another blood sugar test two hours later. People who test positive for Type 2 diabetes are generally advised to lose weight and exercise more, and some may also need drugs to help lower blood sugar. They will also usually be tested for conditions that often go along with Type 2 diabetes, like high blood pressure and high cholesterol and triglyceride levels.

A major study of people with impaired glucose metabolism found that among those who did moderate exercise, like walking for just 30 minutes a day, and who lost 5 to 10 percent of their body weight, there were 58 percent fewer new cases of diabetes than in a similar group of people who did not exercise or lose weight.

The study also found that a commonly used diabetes drug, metformin, could help lower the risk of the disease in pre-diabetics. But the drug did not work as well as weight loss and exercise, and it is approved only for diabetes, not for pre-diabetes.

In April a genetic test was introduced that can also identify people with an increased risk of developing Type 2 diabetes. The $500 test by DeCode Genetics cannot predict diabetes definitively, but it might motivate people with a high risk to exercise and lose weight. It can be ordered by doctors or from a company called DNA Direct.

Michael Pollen - Doth he protest too much? Today's NYT and his urge to vote with your forks ~

Today on our Revolution Health blog, we write about today's NYT magazine piece by Michael Pollen - "You Are What You Grow" - the original piece is below and at this link http://www.nytimes.com/2007/04/22/magazine/22wwlnlede.t.html?_r=1&oref=slogin&pagewanted=all ....our blog is at the following link.

http://www.revolutionhealth.com/blogs/kellyclose/michael-pollen---doth-3776

The Way We Live Now
You Are What You Grow

By MICHAEL POLLAN
Published: April 22, 2007
A few years ago, an obesity researcher at the University of Washington named Adam Drewnowski ventured into the supermarket to solve a mystery. He wanted to figure out why it is that the most reliable predictor of obesity in America today is a person’s wealth. For most of history, after all, the poor have typically suffered from a shortage of calories, not a surfeit. So how is it that today the people with the least amount of money to spend on food are the ones most likely to be overweight?

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Drewnowski gave himself a hypothetical dollar to spend, using it to purchase as many calories as he possibly could. He discovered that he could buy the most calories per dollar in the middle aisles of the supermarket, among the towering canyons of processed food and soft drink. (In the typical American supermarket, the fresh foods — dairy, meat, fish and produce — line the perimeter walls, while the imperishable packaged goods dominate the center.) Drewnowski found that a dollar could buy 1,200 calories of cookies or potato chips but only 250 calories of carrots. Looking for something to wash down those chips, he discovered that his dollar bought 875 calories of soda but only 170 calories of orange juice.

As a rule, processed foods are more “energy dense” than fresh foods: they contain less water and fiber but more added fat and sugar, which makes them both less filling and more fattening. These particular calories also happen to be the least healthful ones in the marketplace, which is why we call the foods that contain them “junk.” Drewnowski concluded that the rules of the food game in America are organized in such a way that if you are eating on a budget, the most rational economic strategy is to eat badly — and get fat.

This perverse state of affairs is not, as you might think, the inevitable result of the free market. Compared with a bunch of carrots, a package of Twinkies, to take one iconic processed foodlike substance as an example, is a highly complicated, high-tech piece of manufacture, involving no fewer than 39 ingredients, many themselves elaborately manufactured, as well as the packaging and a hefty marketing budget. So how can the supermarket possibly sell a pair of these synthetic cream-filled pseudocakes for less than a bunch of roots?

For the answer, you need look no farther than the farm bill. This resolutely unglamorous and head-hurtingly complicated piece of legislation, which comes around roughly every five years and is about to do so again, sets the rules for the American food system — indeed, to a considerable extent, for the world’s food system. Among other things, it determines which crops will be subsidized and which will not, and in the case of the carrot and the Twinkie, the farm bill as currently written offers a lot more support to the cake than to the root. Like most processed foods, the Twinkie is basically a clever arrangement of carbohydrates and fats teased out of corn, soybeans and wheat — three of the five commodity crops that the farm bill supports, to the tune of some $25 billion a year. (Rice and cotton are the others.) For the last several decades — indeed, for about as long as the American waistline has been ballooning — U.S. agricultural policy has been designed in such a way as to promote the overproduction of these five commodities, especially corn and soy.

That’s because the current farm bill helps commodity farmers by cutting them a check based on how many bushels they can grow, rather than, say, by supporting prices and limiting production, as farm bills once did. The result? A food system awash in added sugars (derived from corn) and added fats (derived mainly from soy), as well as dirt-cheap meat and milk (derived from both). By comparison, the farm bill does almost nothing to support farmers growing fresh produce. A result of these policy choices is on stark display in your supermarket, where the real price of fruits and vegetables between 1985 and 2000 increased by nearly 40 percent while the real price of soft drinks (a k a liquid corn) declined by 23 percent. The reason the least healthful calories in the supermarket are the cheapest is that those are the ones the farm bill encourages farmers to grow.

A public-health researcher from Mars might legitimately wonder why a nation faced with what its surgeon general has called “an epidemic” of obesity would at the same time be in the business of subsidizing the production of high-fructose corn syrup. But such is the perversity of the farm bill: the nation’s agricultural policies operate at cross-purposes with its public-health objectives. And the subsidies are only part of the problem. The farm bill helps determine what sort of food your children will have for lunch in school tomorrow. The school-lunch program began at a time when the public-health problem of America’s children was undernourishment, so feeding surplus agricultural commodities to kids seemed like a win-win strategy. Today the problem is overnutrition, but a school lunch lady trying to prepare healthful fresh food is apt to get dinged by U.S.D.A. inspectors for failing to serve enough calories; if she dishes up a lunch that includes chicken nuggets and Tater Tots, however, the inspector smiles and the reimbursements flow. The farm bill essentially treats our children as a human Disposall for all the unhealthful calories that the farm bill has encouraged American farmers to overproduce.

To speak of the farm bill’s influence on the American food system does not begin to describe its full impact — on the environment, on global poverty, even on immigration. By making it possible for American farmers to sell their crops abroad for considerably less than it costs to grow them, the farm bill helps determine the price of corn in Mexico and the price of cotton in Nigeria and therefore whether farmers in those places will survive or be forced off the land, to migrate to the cities — or to the United States. The flow of immigrants north from Mexico since Nafta is inextricably linked to the flow of American corn in the opposite direction, a flood of subsidized grain that the Mexican government estimates has thrown two million Mexican farmers and other agricultural workers off the land since the mid-90s. (More recently, the ethanol boom has led to a spike in corn prices that has left that country reeling from soaring tortilla prices; linking its corn economy to ours has been an unalloyed disaster for Mexico’s eaters as well as its farmers.) You can’t fully comprehend the pressures driving immigration without comprehending what U.S. agricultural policy is doing to rural agriculture in Mexico.

And though we don’t ordinarily think of the farm bill in these terms, few pieces of legislation have as profound an impact on the American landscape and environment. Americans may tell themselves they don’t have a national land-use policy, that the market by and large decides what happens on private property in America, but that’s not exactly true. The smorgasbord of incentives and disincentives built into the farm bill helps decide what happens on nearly half of the private land in America: whether it will be farmed or left wild, whether it will be managed to maximize productivity (and therefore doused with chemicals) or to promote environmental stewardship. The health of the American soil, the purity of its water, the biodiversity and the very look of its landscape owe in no small part to impenetrable titles, programs and formulae buried deep in the farm bill.

Given all this, you would think the farm-bill debate would engage the nation’s political passions every five years, but that hasn’t been the case. If the quintennial antidrama of the “farm bill debate” holds true to form this year, a handful of farm-state legislators will thrash out the mind-numbing details behind closed doors, with virtually nobody else, either in Congress or in the media, paying much attention. Why? Because most of us assume that, true to its name, the farm bill is about “farming,” an increasingly quaint activity that involves no one we know and in which few of us think we have a stake. This leaves our own representatives free to ignore the farm bill, to treat it as a parochial piece of legislation affecting a handful of their Midwestern colleagues. Since we aren’t paying attention, they pay no political price for trading, or even selling, their farm-bill votes. The fact that the bill is deeply encrusted with incomprehensible jargon and prehensile programs dating back to the 1930s makes it almost impossible for the average legislator to understand the bill should he or she try to, much less the average citizen. It’s doubtful this is an accident.

But there are signs this year will be different. The public-health community has come to recognize it can’t hope to address obesity and diabetes without addressing the farm bill. The environmental community recognizes that as long as we have a farm bill that promotes chemical and feedlot agriculture, clean water will remain a pipe dream. The development community has woken up to the fact that global poverty can’t be fought without confronting the ways the farm bill depresses world crop prices. They got a boost from a 2004 ruling by the World Trade Organization that U.S. cotton subsidies are illegal; most observers think that challenges to similar subsidies for corn, soy, wheat or rice would also prevail.

And then there are the eaters, people like you and me, increasingly concerned, if not restive, about the quality of the food on offer in America. A grass-roots social movement is gathering around food issues today, and while it is still somewhat inchoate, the manifestations are everywhere: in local efforts to get vending machines out of the schools and to improve school lunch; in local campaigns to fight feedlots and to force food companies to better the lives of animals in agriculture; in the spectacular growth of the market for organic food and the revival of local food systems. In great and growing numbers, people are voting with their forks for a different sort of food system. But as powerful as the food consumer is — it was that consumer, after all, who built a $15 billion organic-food industry and more than doubled the number of farmer’s markets in the last few years — voting with our forks can advance reform only so far. It can’t, for example, change the fact that the system is rigged to make the most unhealthful calories in the marketplace the only ones the poor can afford. To change that, people will have to vote with their votes as well — which is to say, they will have to wade into the muddy political waters of agricultural policy.

Doing so starts with the recognition that the “farm bill” is a misnomer; in truth, it is a food bill and so needs to be rewritten with the interests of eaters placed first. Yes, there are eaters who think it in their interest that food just be as cheap as possible, no matter how poor the quality. But there are many more who recognize the real cost of artificially cheap food — to their health, to the land, to the animals, to the public purse. At a minimum, these eaters want a bill that aligns agricultural policy with our public-health and environmental values, one with incentives to produce food cleanly, sustainably and humanely. Eaters want a bill that makes the most healthful calories in the supermarket competitive with the least healthful ones. Eaters want a bill that feeds schoolchildren fresh food from local farms rather than processed surplus commodities from far away. Enlightened eaters also recognize their dependence on farmers, which is why they would support a bill that guarantees the people who raise our food not subsidies but fair prices. Why? Because they prefer to live in a country that can still produce its own food and doesn’t hurt the world’s farmers by dumping its surplus crops on their markets.

The devil is in the details, no doubt. Simply eliminating support for farmers won’t solve these problems; overproduction has afflicted agriculture since long before modern subsidies. It will take some imaginative policy making to figure out how to encourage farmers to focus on taking care of the land rather than all-out production, on growing real food for eaters rather than industrial raw materials for food processors and on rebuilding local food economies, which the current farm bill hobbles. But the guiding principle behind an eater’s farm bill could not be more straightforward: it’s one that changes the rules of the game so as to promote the quality of our food (and farming) over and above its quantity.

Such changes are radical only by the standards of past farm bills, which have faithfully reflected the priorities of the agribusiness interests that wrote them. One of these years, the eaters of America are going to demand a place at the table, and we will have the political debate over food policy we need and deserve. This could prove to be that year: the year when the farm bill became a food bill, and the eaters at last had their say.

Michael Pollan, a contributing writer, is the Knight professor of journalism at the University of California, Berkeley. His most recent book is “The Omnivore’s Dilemma.”

A new area of medicine decides what it means to live well

We have come a long way from the old adage: An apple a day keeps the doctor a way. Today, it's quite unclear what the healthiest lifestyle actually is, and yet lifestyle is essential to health. In the Diabetes Prevention Program, changes in behavior produced the greatest risk reduction in the development of type 2 diabetes - a risk reduction that no drugs have yet matched. Obscurity about what the best lifestyle is - what to eat and how much, when to sleep and how much, how to exerise and how much - drove a group of doctors to create the American College of Lifestyle Medicine, with its own publication for peer-reviewed literature, the American Journal of Lifestyle Medicine.

The group was formed two years ago with the goal of encouraging doctors to educate patients about lifestyle in an effective way. This means providing scientifically-based (and that's key!) guidance not only on the content of advice but also how to advise in a way that optimizes patient adherence. Beyond this, there is some disagreement over the movement - for example, over whether lifestyle medicine should be incorporated into every area of medicine or be its own specialty? Leaders of the movement stem some controversy by emphasizing that it is not alternative medicine and they do not advocate non-evidence-based strategies like "strict vegan diets and daily saunas." This is a serious area of medicine, they say, and we have to agree.

 

The April 17 article in the Times mentions the statistic reported in 2005 by the New England Journal of Medicine that predicted that, in a reversal of a 150-year long trend, the life expectancy of Americans will begin to decline over the next 20 years. This makes us think of those T-shirts showing the ascent of man into homo sapiens and then back down into today's hunched, viscerally fat computer geek! The American College of Lifestyle Medicine may suffer from flippant associations with fad diets, but we applaud this move into the next era of medicine, which we foresee as a shift toward a chronic care and preventive model, if it is successful.

 

Read the article: 

You want a Revolution? Steve Case has started one.

As co-founder of America Online, Steve Case helped create the world’s largest Internet service provider, using technology to connect consumers and businesses around the globe. Now he has a similar vision for health care: to inform and connect consumers though the Internet about health and wellness.

This Thursday marks the official introduction of www.RevolutionHealth.com, which went online with a test version in January. The site is part of Revolution Health Group, which was founded by Mr. Case and includes Colin Powell as one of his partners.

We won’t pretend to be objective about the new Web site. Revolution Health asked us to write a personal blog for it about diabetes (i.e., personal experience, rather than blog about research), which we’ve done now for several months (www.revolutionhealth.com/blogs/kellyclose). Case’s goal – as he told The New York Times in a story on Monday – is “to create the most trusted brand in health,” akin to Starbucks in coffee or Nike in fitness.

What interests us, from our corner of the diabetes world, is the consumer movement in health care. Patients increasingly want to take control of their own well-being, and they are demanding – and through the Internet, getting – the tools to make their own decisions. As the Times points out, RevolutionHealth is not the first health care Web site; www.WebMD.com is already there, and Google has created “patient-friendly features.”

This is good news for diabetic patients. It’s a confusing disease, and even the most conscientious doctor, educator, or nutritionist can only spend so many minutes with you per visit. More information is needed. Before the Internet, finding that information was a daunting if not impossible task. Now, at least for online patients, the information is a few clicks away.

Therefore, what’s really important is finding quality information – for diabetes and every other malady – and Steve Case certainly has the resources get it. He’s invested more than $100 million of his own money into the company, which has received about $130 million overall. He envisions a Web site with information on more than 1,500 medical conditions; a directory of doctors, with short reviews from patients; and individual pages for personal health records, in which users can assemble their medical information.

As Case discovers what patients really want and need, we assume RevolutionHealth will evolve in ways that he himself cannot imagine. But we’re confident that diabetes will play a huge part for many years; and as long-time advocates of fundamental change in the health care system, we’re glad to be part of Steve Case’s enterprise.

Let the Revolution begin.

Weighing in on the stem cell type 1 research - Dr. Skyler speaks

Hi - lots of news swirling about the new type 1 research in the New England Journal of Medicine yesterday. As we wrote about in our Revolution Health blog (http://www.revolutionhealth.com/blogs/kellyclose/exciting-if-early-st-3594), Dr. Jay Skyler of the University of Miami, one of the country's leading thinkers about prevention of diabetes - and author of the editorial going alongside the research - emphasized in a note to us this morning that there are positives and negatives both - our interpretation was that it's too early to get wildly excited but it's definitely time to watch what's happening in this research. First, he says the work is promising due to the results that the group showed - most went off insulin for some period, and one has been off insulin for three years, without any major adverse events (yet). Dr. Skyler stressed, too, that there are unknowns - the trial had no control group, it was only 14 subjects, and the follow-up too short. As Scott Strumello points out in his comment, this also didn't work on the first subject - and clearly this research is all about newly diagnosed. More research is needed, says Dr. Skyler - now, hopefully, it can be funded in the US. Of interest is that J&J funded the study.  We'll see what else we can learn on this at the AACE, now going on in Seattle.

Food, food everywhere – but not a healthy bite to eat

We know that our environment plays a huge role in our decision-making. Brian Wansink, the director of Cornell University's Food and Brand Lab, has written about the effects on eating habits of details like plate size, where a candy dish falls in a room, how food is presented, and so on… And then, you may have heard about the current "obesogenic environment," which is making us all sedentary, fast-food-eating, and, subsequently, fat. So we support the motivation behind a Bloomberg push to shape a healthier environment for New Yorkers. Ultimately, solving the obesity crisis may take a village.

An article in today's New York Times describes Mayor Bloomberg's involvement in "food issues," not yet the focus of its own government department, but nonetheless an active area. After banning smoking and securing healthier food in school cafeterias, he's now looking at how to get healthy food to neighborhoods that lack it.

People aren't sure how much of a role he's playing – is he a leader of the revolution, or a pawn in the changing zeitgeist? We would think the latter, as finally the world has begun to realize what a predicament we're in – you may have seen our coverage of the UN's December resolution on diabetes. But, ultimately, we don't care so much, as long as he's getting on board. On the other hand, some aren't sure the government has fully committed to the initiative. Other cities actually have food policy councils – San Francisco, Portland, Hartford, and Toronto to name a few (though none has a "Department of Food" yet).  Dr. Thomas Frieden, who is apparently "as close as it gets" to the "Alice Waters of city food politics," has said the administration's response to obesity and diabetes, the only worsening US health problems, has been restrained. We're happy, though, to see people are thinking about it.

Read the article below:

The Robert Wood Johnson Foundation Tackles Childhood Obesity

The Robert Wood Johnson Foundation, a catalyst for successfully tackling public health problems like tobacco use, is now taking aim at childhood obesity. The Foundation announced today that it will spend $500 million over the next five years to reverse the epidemic – by 2015.

It’s an ambitious goal, to be sure, but the financial commitment represents the largest that any foundation has ever made to childhood obesity and one of the largest public health initiatives ever tried by a private philanthropy.

The Robert Wood Johnson Foundation has effectively thrown its lot in with other public health officials who are advocating profound environmental changes to curb the obesity epidemic.

We’re grateful that the Foundation recognizes the seriousness of problem: an estimated 25 million youths are overweight or obese, with health care costs of $14 billion a year, and, of course, a key contributor to the emerging problem of type 2 diabetes in youngsters. We are keenly interested in whether the Foundation can replicate its success from other public health areas. The Foundation, for example, played a key role in helping to reduce tobacco use, in introducing the 9-1-1 emergency response system, and in encouraging increased use of seat belts.

Smoking, it seems to us, shares many of the same attributes as poor eating – both have addictive and behavioral attributes, with socio-economic implications. But losing weight is more difficult than quitting smoking because you can’t quit food “cold turkey,” because weight loss usually requires exercise, and because obesity often has a genetic component.

In other words, reversing the obesity tide may be far more difficult than anything the Robert Wood Johnson Foundation has undertaken, but we think its approach makes sense. The Foundation wants to change the environment in which youths live, play, and learn. Specifically, it wants to improve access to healthy foods and increase opportunities for safe physical activity in schools and communities. The Foundation has already been involved in bringing supermarkets back to underserved communities and in researching which are the best ways to increase physical activity and improve nutrition for kids.

For its new commitment, the Foundation will place special emphasis on at-risk minority youths: African American, Latino, Native American, Asian American, and Pacific Islander.

In recent years, a small but growing chorus of doctors and public health officials has emerged to advocate for healthier communities – everything from taking soda machines out of the schools to building bike paths for cyclists. Most of these efforts will take money, leadership, and vision. We’re confident that the Robert Wood Johnson Foundation will help provide all three.

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April 4, 2007
$500 Million Pledged to Fight Childhood Obesity

By STEPHANIE STROM
The Robert Wood Johnson Foundation plans to spend more than $500 million over the next five years to reverse the increase in childhood obesity. It is one of the largest public health initiatives ever tried by a private philanthropy.

“This is an epidemic that is going to cost the country in terms of morbidity and mortality and economically,” said Dr. Risa Lavizzo-Mourey, the foundation’s president and chief executive. “The younger generation is going to live sicker and die younger than their parents because of obesity.”

The foundation estimates that roughly 25 million children 17 and under are obese or overweight, nearly a third of the 74 million in that age group, according to Census Bureau data and a 2006 study published in The Journal of the American Medical Association.

Many of those children are poor and live in neighborhoods where outdoor play is unsafe and access to fresh fruits and vegetables is limited. “In many cases, the environment makes it almost impossible for them to choose healthy lifestyles,” Dr. Lavizzo-Mourey said. “We’re going to try to change that.”

The foundation plans to invest in programs to improve access to healthy food, encourage the development of safe play spaces, increase research to enhance understanding of obesity and prod governments into adopting policies to address the problem, among other things.

Experts on childhood obesity welcomed the foundation’s plans.

“Government grants for biomedical research in general, including obesity research, are being funded at the lowest levels I’ve seen in my career,” said Dr. David Ludwig, director of the Optimal Weight for Life Clinic at Children’s Hospital Boston and author of a new book, “Ending the Food Fight.” “So we are especially dependent on philanthropic support.”

Philanthropy has long fueled improvements in health, from John D. Rockefeller, whose money produced a yellow fever vaccine, to Bill and Melinda Gates, who are underwriting new health technologies and vaccines to address a variety of global problems.

Robert Wood Johnson, who built Johnson & Johnson into one of the world’s largest health and medical care products companies, established his foundation at his death in 1968 with 10,204,377 shares of the company’s stock. He committed it to improving the health of Americans.

The foundation played a major role in curbing tobacco use in this country, spending $446 million from 1991 to 2003 toward that goal, and it plans to use those experiences to shape its attack on childhood fat.

Since 1995, the number of adult and teenage smokers has declined 12.6 percent and 18 percent, respectively.

“It was a very carefully thought-out strategic initiative,” said Joel L. Fleishman, a professor of law and public policy at Duke University. The foundation underwrote research, prevention and smoking-cessation programs, and increased awareness of smoking’s dangers.

Over the last few years, the foundation has pledged $80 million to childhood obesity programs, like grants to the Food Trust to persuade supermarket operators to return to poor neighborhoods.

Its new effort intends to capitalize on and enhance efforts by the food industry and school districts and governments to address the problem, Dr. Lavizzo-Mourey said. Several snack food producers are making changes in their packaging and ingredients, and three soft-drink companies said they would no longer supply sweetened drinks to school cafeterias and vending machines.

Several states have mandated changes in school menus, increased physical education requirements and begun reporting students’ body mass index scores to parents.

In Arkansas, which has one of the most comprehensive programs aimed at the problem, obesity among the 450,000 children in 1,300 public schools has plateaued.

Rhonda Sanders of Bryant, Ark., said learning that her daughter, Samantha, had a body mass index in the 95th percentile “was a wake-up call, really.”

Samantha, a 5-foot-tall, 137-pound third grader at the time, started jumping rope and bouncing on the trampoline, and the family banned eating in front of the television.

“We didn’t do anything life-changing, we didn’t take away every bit of candy and chips, we just put some limits on it,” Ms. Sanders said. Three years later, Samantha’s B.M.I. score is in the 50th percentile. She favors fruits and vegetables and is on the school dance team.

“I know it’s not as simple for every child,” Ms. Sanders said, “but because children’s bodies are changing so rapidly, a few changes in the way they eat and their activity level can really make a huge difference.”