I hope you're still thinking of that child I wrote about yesterday. In my article on obesity, I tried not to bias the writing by unveiling my own set of policy preferences. There was plenty of Marc Ambinder in that thing. But I do have some ideas, actually, that flow from the reporting I did. And I have reason to want to circulate the ideas. It's not particularly because they are novel or profound, but because I sincerely believe that the problem I outlined is fixable. That's good news. Here's some more good news: I think we can significantly reduce the incidences of childhood obesity without too much sacrifice. We can make a difference within even the narrow confines of American politics. We can make a difference even though social inequality is a fact of life and even though the nuclear family has dissolved for many of us and even though the concept of a dinner table, of a family meal, is an artifact of an earlier era.
There will be trade-offs, and some people will have to do more to help other people, but there is nothing profoundly redistributive about these interventions, nothing terribly inconvenient, nothing that will impinge upon the choices that adults make -- nothing that's going to prevent a kid from eating an occasional Twinkie. Indeed, the fact that we can solve this problem fairly easily means that if we dawdle and don't, we ought to be ashamed of ourselves. So here's what I'd like to see:
1. Universal access to quality pre-and-post-natal care for mothers in chronically stressed, underserved communities. The correlations between a mother's nutrition consumption and how a child is nourished for the first year of life and obesity are quite strong. Pregnant women, particularly younger pregnant women, don't experience their pregnancy with any significant degree of social or community support; they don't nurse their child with access to health care, or to a support system or feedback system that guides them.2. Congress should ask the Federal Trade Commission to begin a rule-making process to ban food companies from advertising unhealthy food to kids under 10 or 12. The industry will probably respond by establishing (another set of) voluntary guidelines, which will progressively tighten as the rule-making progresses. Make the implementation of the rule contingent of the industry coming up and complying with its own set of rules, and perhaps monitored by an independent panel appointed by the Institute of Medicine. If the industry resists, ban all food advertising aimed at kids, and aggressively enforce the ban. Drawing lines with be difficult, because one person's advertising "aimed" at kids could easily be claimed to be "aimed" at teenagers or adults. Come down on the side of the kids. Prevent ads from airing during "family" hours. Be creative. Let's have this debate again. Marketing practices need to be revised.
3. The government already highly regulates foodstuffs and the content of school lunches. The political will exists to streamline and clarify these regs, and to prevent food companies from finding loopholes. No new regulations are needed; regulations that comport with the 21st century reality of education are required. We can regulate less, if we want to, but regulate better, if we want to.
4. Significantly increase training for all primary care physicians, OBGYNs, NPs and GPs in obesity prevention. Pay particular attention to cross-cultural differences in the perception of obesity, and drill into the heads of these docs that the WAY they interact with their overweight or obese patients has TANGIBLE effects on the quality of their health care.