The Obama Obesity Proposals: The Good, The Bad, The Missing

With a flourish of his pen, President Obama signed an executive order this morning creating yet another national anti-obesity strategy. He was flanked by gaggle of usual suspects -- and his wife, Michelle Obama, for whom combating childhood obesity is a cause. First ladies, you see, have "causes."  (Barbara Bush's was literacy. Laura Bush's was literacy.)  Childhood obesity prevention needs a mission manager.

Researchers aren't sure why, but the growth rate of childhood obesity has slowed in recent years as state and local governments ramped up the attention they paid to the type of food kids are served at schools and the food industry instituted a number of largely prophylactic but cumulatively contributing steps to reduce food consumption by kids. But celebrating a plateaud or slowed growth rate is akin to cheering flood waters that have stopped rising.   (Adult obesity? The problem can't be solved. That's a sad reality -- and why the White House isn't focusing on obesity per se.)

Michelle Obama wants to be the leader of a movement that ends childhood obesity in a generation. What that means is unclear. What is clear is that she has a sophisticated understanding of the socioeconomic dimensions of the problem. One thing the White House won't tell you is that because she is the nation's most admired black woman, Obama hopes to be able to speak directly to African American mothers about their responsibilities. There is a fascinating but difficult to simplify literature on weight stigma in the black community, and how that contributes to -- or takes away from -- the environmental triggers of obesity.

A fascinating new study by the CDC figured out that childhood obesity growth rates could be curbed by three behavioral changes: eat dinner as a family, make sure kids get 8 hours of sleep a night and reduce the amount of TV that kids watch.  Unfortunately, in the communities where obesity is most problematic, family structures aren't intact (either because mothers are raising their children without fathers or because both parents work, many parents don't pay attention to their child's weight gains or losses and the health infrastructure is poor; television and Internet are ubiquitous).  Neither a lecture from the government nor a laissez faire approach will solve this inherent gap between what works and what people can actually do. If you're prepared accept the fact of childhood obesity in society as a given, then you can move on. If you're not -- if you see a moral dimension inherent in the question, you cannot treat this policy issue like others; it is not matter of choice for the people who are hurt the most by it.

The Good: A 90-day review of every government obesity program.  Absolutely long overdue and needed.  Better food labeling via the FDA. (Science is unclear on whether food labeling initiatives matter, but the efforts haven't been comprehensive enough to really test.) The American Beverage Association says it will adopt a uniform soda calorie labeling standard within two years. (Reducing soda calories actually, really, maybe, makes an impact.)   $1 bilion per year into the federal programs that fund school breakfasts and lunches for poorer children and tighter nutrition standards.  Using the power of the White House to coax school food providers like Sodexho, Aramark, and Chartwells into meeting Institute of Medicine recommendations to reduce the amount of bad things they serve and increase the amount of good things they serve within 10 years. A large public awareness campaign, with help from big media companies.  Organizational coherence: the administration will help create a Partnership for a Healthier America to bring together the various anti-obesity non-profits on a regular basis and help them better coordinate programs and goals.  These words in Obama's speech:

Many kids today aren't so fortunate.  Urban sprawl and fears about safety often mean the only walking they do is out their front door to a bus or a car.  Cuts in recess and gym mean a lot less running around during the school day, and lunchtime may mean a school lunch heavy on calories and fat.  For many kids, those afternoons spent riding bikes and playing ball until dusk have been replaced by afternoons inside with TV, the Internet, and video games. 

And these days, with parents working longer hours, working two jobs, they don't have time for those family dinners.  Or with the price of fresh fruits and vegetables rising 50 percent higher than overall food costs these past two decades, they don't  have the money.  Or they don't have a supermarket in their community, so their best option for dinner is something from the shelf of the local convenience store or gas station.  

The Bad: Government website. Well designed; probably a waste of time. (The Department of Agriculture food atlas is a great idea, however.)  The relatively small amount of money being earmarked to reduce the number of food deserts -- those areas where access to quality, nutritious food products in under-served. But $400 million isn't going to cut it.  The geography of food production, distribution and delivery is a major contributor to urban childhood obesity, and this money -- assuming it all gets funded -- is barely going to make a dent. Each quality supermarket costs about $5 million to build.  The Obama plan models its efforts after the Pennsylvania Fresh Food Financing Initiative, which has spent in excess of $40 million over the course of five years to solve the urban and rural grocery gaps and provide better food to under-served communities. Evidence that these efforts are worth the expenditure -- that they causally reduce childhood obesity -- is, as of yet, lacking, but that's largely because the program is barely a decade old.

The Missing: The man in government who knows more about the politics and policies than just about anyone else -- Dr. Thomas Freiden of the Centers for Disease Control and a former New York City Health Commissioner.  Freiden speaks frankly about the obligation that producers of American food and American culture have -- and his organization seems to be playing a minor role in this initiative.  Also: a focus on early childhood development and funding for basic obesity researchAlso: any discussion of television advertising and its effects on kids. Any discussion of the harmful effects of weight stigma.