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February 09, 2011

Let’s Move (our thinking) on childhood obesity

Today is the one year anniversary of First Lady Michelle Obama’s Let’s Move initiative to blunt the epidemic of obesity in children. It marks an important fight against a wave of future chronic disease that threatens our national security, our economic growth and the solvency of our healthcare system.

The obesity epidemic began just about three decades ago. What I reflect upon this anniversary, however, is the much more recent sea change in public health thinking that Let’s Move signifies. 

At the core of the White House work to curb obesity – as well as the work of the Centers for Disease Control and the Robert Wood Johnson Foundation, – is the now accepted view that changes to our children’s environment, particularly around food and physical activity, have been key factors triggering the epidemic.

These include, for example, saturation marketing of unhealthy foods high in sugars, fats and calories, to the youngest of children – who, of course, lack the cognitive capacity to weigh the short-term pleasure of these snacks against the longer-term harm of diets so dominated by them. And they include school food environments which, while improving, still are not as healthy as they should be. They include community food environments for many children where convenient, walkable full-service supermarkets with fresh produce are a mirage. About 23.5 million urban and rural Americans live in these “food deserts,” without access to healthy foods

If environmental and policy change helped bring about this epidemic, then it makes sense that the CDC and other public health experts now see changes to government policy as one of the most effective ways to make sustainable, healthier changes to our children’s food environment. Change can be driven by policies at the local level, or at the national level like Let’s Move or the upcoming 2012 Farm Bill. Building support for these common sense policies in the health community is a key aim of an initiative I’m working on called Healthy Food Action.

Not everyone accepts the public health perspective. Sarah Palin, for example, has suggested that Let’s Move is tantamount to government interference in our lives. But it’s a core public health principle of the CDC and the world's leading obesity experts that individual eating behavior doesn't take place in a vacuum. Rather, unhealthy environmental and policy changes influence and constrain individual behaviors. One cannot walk to school when there are no sidewalks, where it’s unsafe, or where the neighborhood school has been closed. Similarly, school children are unlikely to choose drinking water where water fountains have been dismantled, vending machines only offer soda, or where the soda is cheaper than healthier alternatives.

Let’s Move has galvanized moms, doctors, school officials, Wal-Mart and soda companies to start acting as part of a community-wide effort to make our kids’ environments healthier. Voluntary efforts are great. But so long as public policy supports unhealthy environments, we will make limited progress. Now that we’ve moved our thinking, Let’s Move policy.

David Wallinga, MD


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