Maybe you and your kids are already on the right track. Your own eating habits are good, and you have acquired the skills and the resources to become an adept food shopper, stocking your kitchen with healthy items your children enjoy. You are physically active and enjoy playing vigorous games with your family and spending time with them walking, biking, and swimming. You keep track of what your children eat for lunch at school, and as a PTA member you’ve been active in improving the school’s snack and drink offerings. You try to limit the amount of time your kids spend watching television or sitting at the computer. You figure you’re doing just about all you can to prevent your family from becoming overweight. But what about your neighbors’ children? What about your coworkers and their families? What about the other children in your community?
In Chapter 1, I told the story of Bruce, an overweight teenager who developed high blood pressure. Bruce’s mother, Lottie, recognized that in order to help her son she needed to change the behavior of her entire family. She and her kids gave up habits they had previously consid-
ered “normal,” like buying large botttles of regular soda and eating pizza several times a week. They adopted a new definition of normal that included eating more vegetables for dinner, watching less television, drinking more water or diet soda, and going for walks together around the track at the high school. Actions like Lottie’s are what our nation needs on a grand scale. If the epidemic of childhood obesity is to be halted, large social changes are required. They will not happen unless people who care about children’s health are willing to become active at the community, state, or national level, working to create a healthier environment for kids by changing social policies.
Major economic forces—among them food manufacturers, restaurant chains, automobile makers, real estate developers, and the entertainment industry—have strong financial interests in maintaining various aspects of the status quo. No single one of these industries or sectors deserves the blame for our nation’s obesity epidemic, but together, many of their products and services (and the ways they are marketed) have contributed to Americans’ unhealthy lifestyle. Each of these groups has political clout that it can bring to bear on government officials to oppose policy changes that are against its own interests. That is one reason why many obesity experts believe that it will take determined, well-organized efforts by concerned citizens and advocacy groups to bring about health-promoting change in our communities and our nation. “Indeed, it is difficult to think of any major industry that might benefit if people ate less food; certainly not the agriculture, food product, grocery, restaurant, diet, or drug industries,” writes nutrition professor Marion Nestle of New York University. “All flourish when people eat more, and all employ armies of lobbyists to discourage governments from doing anything to inhibit overeating.”
Psychologist and nutrition activist Kelly D. Brownell of Yale University coined the phrase “the toxic environment” to refer to the many factors in American society that combine to promote unhealthy weight gain. He believes that grassroots action offers the best hope of detoxifying that environment. “If we ask whether this obesity problem is going to be won from the top down or from the bottom up, it’s very clear,” Brownell recently told an audience at the Johns Hopkins Bloomberg School of Public Health. “Very little is happening at the top. A lot is happening at the bottom.” An Institute of Medicine report,
Preventing Childhood Obesity: Health in the Balance, urges Americans to recognize the need to work together to combat this urgent threat to our children’s health. “Preventing childhood obesity should become engrained as a collective responsibility,” the report states. Individuals, families, communities, corporations, and governments must all accept some share of the task of meeting this challenge.
But what should a concerned citizen do? Obesity is a dominant topic in the news media these days, and the cacophony of advice and policy initiatives issuing from health officials, politicians, and activists often seems overwhelming. From a “junk food tax” to mandatory nutrition labels on restaurant menus, from reform of federal policies on farm subsidies to required daily physical education classes in schools, state and federal legislators have proposed hundreds of bills offering possible remedies. Many of the policies being considered represent strategies for changing our shared environment. Giving each family the knowledge and skills needed to develop healthier habits is certainly desirable, but realistically, even if families become better informed about how to improve kids’ diets and encourage them to be physically active, this may not be sufficient to prevent the spread of obesity among our children. Changing our common environment in ways that will foster healthier food choices and greater access to physical activity is likely to have a broader and more rapid impact.
In this chapter I try to provide some guidance to readers who want to work to prevent obesity in their communities or to become politically active on issues related to childhood obesity at the state or national level. I have already discussed school food policies and physical education programs in previous chapters, so I will not do so again here, although these may be areas where many parents will want to focus their efforts first. After some general suggestions about how to get started, I will offer more specific points of contact for three possible areas of action: the growing movement to limit or regulate food and drink advertising that targets children; efforts to make neighborhoods more walkable and bikeable and to increase other local opportunities for physical activity; and strategies to increase access to fresh and healthy foods in underserved communities, which include many low-income urban neighborhoods and rural areas.
If you have children in a public school, you may already have talked with others in your community—parents, teachers, a principal, or a school nurse—who are concerned about the obesity epidemic and about children’s health. These people can serve as your initial contacts. Your pediatrician or family physician may also be able to tell you about local community efforts to combat obesity. Find out whether a childhood obesity task force has been formed in your city or town. Such committees are being established in many communities and typically include representatives from the health department, school system, parks and recreation department, PTA, public transportation department, and other organizations such as consumer groups working on issues of zoning, bike lanes, and sidewalks for pedestrian safety. At task force meetings, people with different areas of expertise can share information and come up with a range of ideas for improving the situation in their city or town. Probably the best way to find out whether such a task force exists in your area is to contact your local health department.
Read the newspaper and check the Web sites of local and state governments to learn whether your elected representatives have sponsored any programs or legislation related to childhood obesity. Let elected officials know of your concern about this issue. Contact community organizations that may be working on the topic, such as food banks or the YMCA. If there is a school of public health in your city or town, researchers there may be studying strategies to reduce obesity in the surrounding community.
Scores of bills addressing various aspects of the obesity epidemic are introduced in state legislatures each year. Nonprofit organizations working on obesity-related issues have found that legislators are especially likely to respond when contacted by constituents who can cite statistics indicating a possible link between specific health problems—such as a high local prevalence of childhood obesity, adult diabetes, or high blood pressure—and local conditions in the community, such as a shortage of supermarkets or safe places to play.
The Web sites listed on page 271 in Resources may provide helpful information on a range of obesity-related policy initiatives.
The advertising and marketing of products to American children have increased dramatically during the past two decades, with foods, beverages, and fast food restaurants accounting for the lion’s share of products and services promoted to kids. Nutrition researchers estimate that food and beverage advertisers currently spend between $10 billion and $12 billion each year to reach children and youth, partly in an effort to get children to buy their products, but also because demands from children can greatly influence the purchasing decisions of adults. In 2002 annual sales of foods and drinks to children and adolescents in the United States totaled more than $27 billion.
Much of the promotion of foods, drinks, toys, and other products to children takes place on television. The average American child now sees an estimated 40,000 television commercials each year, twice as many as during the 1970s. Reviewing the past decade’s research on child-targeted TV advertising for its report on preventing childhood obesity, a panel of experts assembled by the Institute of Medicine concluded that “more than 50 percent of television advertisements directed at children promote foods and beverages such as candy, fast food, snack foods, soft drinks, and sweetened breakfast cereals that are high in calories and fat, low in fiber, and low in nutrient density.” Children see one food commercial, on average, during every five minutes of television that they watch. Athletes and pop stars admired by kids receive lucrative contracts to endorse products and to appear in food, soda, or restaurant commercials. Foods are also increasingly marketed to children through strategic “product placement” on television shows and in children’s movies, video games, and interactive Web sites. In this strategy the product literally becomes part of the story or game: often a popular actor or a video character is shown eating the food being promoted.
Children are also exposed to food, drink, and restaurant advertising in schools. Channel One, a daily broadcast that reaches an estimated eight million teenage students in more than 350,000 classrooms throughout the United States shows 10 minutes of news and 2 minutes of commercials each day; schools receive free video equipment in ex-
change for requiring students to watch the program. In a study conducted during a four-week period in the early 1990s, researchers found that more than two-thirds of Channel One’s commercials were for food products, including fast food, soft drinks, chips, and candy. Candy, cereal, and pizza makers also offer schools free “educational materials” featuring math or science lessons that use their products, and some donut, pizza, and fast food chains offer academic incentives that include free food for students with good records for attendance, behavior, or homework completion.
Although advertisers maintain that the purpose of advertising food products to children is to attract them to specific brands rather than to influence their diet as a whole, studies clearly show that food advertising prompts children to nag their parents to buy heavily advertised products, and some evidence indicates that it also affects their overall consumption of various categories of foods and beverages. Advertising’s specific impact on children’s diets has been difficult to quantify because so many factors influence food choices. After reviewing the available research, the IOM panel of obesity experts concluded that the effects of advertising “are unlikely to be limited to brand choice. Wider impacts include the increased consumption of energy-dense foods and beverages and greater engagement in sedentary behaviors, both of which contribute to energy imbalance and obesity.”
Young children lack the thinking skills needed to evaluate an advertisement’s claims. Child development research indicates that before the age of about 7 or 8, they don’t even understand that the purpose of an advertisement is to persuade, rather than to entertain or to inform. For this reason, the American Academy of Pediatrics in 1995 issued a policy statement saying that “advertising directed toward children is inherently deceptive and exploits children under 8 years of age.” Advertising industry executives apparently share some of the medical profession and the public’s concerns about marketing products to very young children. In a 2004 poll of youth marketers conducted by Harris Interactive, 61 percent of respondents agreed with the statement that “advertising to children begins at too young an age.”
Some advocacy groups have called for a federal ban on all advertising directed at children younger than 8 years old. Others are urging
Congress to reauthorize the Federal Trade Commission (FTC) to regulate advertising and marketing to children, as well as calling for an end to marketing in schools and for restrictions on the advertising to children of foods high in fat, sugar, and total calories. “There’s no question that the current marketing practices take unfair advantage of children and are exploiting them,” says Susan Linn, an instructor in psychiatry at Harvard Medical School and a leader of the Campaign for a Commercial-Free Childhood (CCFC), a coalition of groups advocating restrictions on marketing to kids. “We have to take it on as a societal issue.”
The FTC’s mandate includes regulating advertising to ensure that it is not unfair or deceptive. The agency tried once before, in 1978, to use that authority to restrict television advertising to children, on the grounds that all advertising that is directed at children too young to understand an ad’s intent is inherently unfair and deceptive. Responding to fierce opposition to the proposed ban by the business community, Congress passed a law in 1980 withdrawing the FTC’s authority to restrict children’s advertising and prohibiting it from adopting the proposed rules. A renewed effort by the FTC to limit advertising to children would likely suffer from the same drawbacks as the 1970s effort, in terms of being impractical, ineffective, and likely unconstitutional, FTC associate director Mary K. Engle told the IOM expert panel at a workshop held in 2003. “The FTC is not a public health agency” but a law enforcement agency, Engle told the committee. To issue new rules restricting advertising to children, the FTC would have to be able to point to research indicating a direct link between the marketing of certain products to kids and an increase in childhood obesity and, furthermore, demonstrate that the proposed restrictions would substantially alleviate the obesity problem. In addition, advertisers would be likely to challenge any marketing restrictions in court. Engle noted that the U.S. Supreme Court has ruled in recent years that the government should attempt to limit free speech (which includes advertising) only as a last resort. Advertisers have already signaled their intention to fight any proposed action by Congress or the FTC. “As an industry, we strongly reject the claims that advertising causes childhood obesity and the related premise that new government restrictions or bans on ad-
vertising to children should be imposed,” said Bob Liodice, chief executive of the Association of National Advertisers, in a statement quoted in the Wall Street Journal.
As an interim strategy, CCFC and some other advocacy groups have called on advertisers to establish a more vigorous system for policing the ways they market products to children. The current system of self-regulation is completely voluntary and relies on the Children’s Advertising Unit, or CARU, a body established in 1974 by the industry-supported National Advertising Review Council. With a staff of only six full-time employees, CARU is charged with monitoring advertising to children in all media and responding to consumer complaints—a seemingly impossible task for such a small agency.
In its report the IOM panel concluded that even though advertising to children under the age of 8 is inherently unfair, “there is presently insufficient causal evidence that links advertising directly with childhood obesity and that would support a ban on all food advertising directed to children.” The report also says that such a ban might not be feasible because of legal concerns about freedom of speech. It calls instead for the development of new, tougher guidelines that would be voluntarily implemented by the advertising industry. The report also recommends that the FTC be empowered to monitor the industry’s compliance with the new guidelines, thus leaving open the possibility of government regulation in the future if the industry fails to cooperate. However, considering advertisers’ record of strenuously opposing any limitations on marketing to kids, it seems unlikely that they will dramatically change their practices unless they encounter strong public or political pressure to do so.
Meanwhile, what can people do about marketing to children that they believe is harmful? They can and should monitor the content of the shows, ads, and movies their children watch, the video games they play, and other forms of entertainment, staying alert for product placements embedded in the film, show, or game. They can express their concerns both to marketers and to their own elected representatives. As consumers, they certainly can also complain to CARU about practices they feel are unfair or deceptive. Parents should find out whether Channel One and other sources of advertising are present in their local
schools, and they can urge school officials, as the IOM report recommends, to make schools “advertising-free to the greatest possible extent.” Parents and teachers can make a point of talking with kids about how advertising works, helping children to critically examine specific commercials or advertisements and to identify how ads try to persuade the viewer. They can also urge schools to include lessons on “media literacy” in their curricula, teaching kids to become more knowledgeable and skeptical users of media.
People concerned about marketing to children can monitor the progress of legislation and other proposals at the federal and state levels and can add their voices to the public debate either individually or through advocacy groups. Doug Wood, a New York–based attorney for the advertising industry, predicted in a recent interview with an online investors’ newsletter that the National Association of Attorneys General might be more likely than the FTC to take legal action to restrict marketing to kids. He cited the association’s successful suit several years ago against tobacco companies, in which the companies agreed as part of a settlement to stop marketing their products in ways that would appeal to children. Voters interested in that strategy might consider contacting their state attorney general.
On page 272 in Resources you’ll find a partial list of organizations and Web sites that can provide further information on marketing to children and on the possible links between advertising and the obesity epidemic.
The typical American suburb seems designed to discourage physical activity. Many developments are built without sidewalks or crosswalks. Schools, especially recently built ones, are often large complexes on multiacre sites located on the periphery of neighborhoods, frequently on major roads with heavy traffic. Shops, libraries, cafes, and markets are often several miles from people’s homes, difficult or impossible to reach on foot or by public transportation. Parks, playgrounds, and community centers also may not be within convenient or safe walking distance. People living in such neighborhoods often feel they have “no
place to walk to.” Whenever they want to go somewhere, they are forced to go by car. Studies suggest that the layout of such communities is contributing to the obesity epidemic. People who live in mixed-use neighborhoods with access to shops and public transportation tend to walk more, and to weigh less, than those who live in sprawling, automobile-dependent suburbs. The realization that people’s body weight and overall health are influenced by the “built environment” is one factor behind the “smart growth” movement, which favors planning new development in ways that both protect the environment and create communities whose local resources are easily accessible on foot and by public transportation.
Most of us cannot easily change where we live, but there may be things we can do to make our communities more walkable and to improve local opportunities for physical activity available to children. In Charlottesville, Virginia, one of the first projects launched by the city’s newly formed task force on childhood obesity after it began work in 1999 was the establishment of regular “walk-to-school” days in some neighborhoods. The suggestion came from a parent who knew about the national Safe Routes to School Programs, a collection of community-based efforts to make it possible for more of America’s children to walk or ride their bicycles to school. On the first Friday of every month, children and parents were encouraged to walk to school. A local hospital paid for some of the initial expenses, such as hiring extra crossing guards. The health department gave a bandanna to each child who participated. A volunteer from a local transportation advocacy organization taught lessons to middle school students on pedestrian and bicycle safety in urban and suburban neighborhoods. Children who had to ride the bus on walk-to-school day took a walk around the track when they arrived, accompanied by their teachers. Parents were surveyed about available walking routes in their neighborhoods, and their suggestions about improving crosswalks at certain intersections were passed on to the city council.
The Charlottesville walk-to-school program is expanding to additional schools and has generated demand for road improvements that will make the city’s neighborhoods more walkable for everyone. Other communities around the nation report similar results from walk-to-
school programs. Parents who are fearful at first of letting their children walk to school will often accept the idea of a “walking school bus,” in which several adult volunteers walk a large group of children to school. Many parents become enthusiastic about walk-to-school programs and begin agitating for traffic lights, sidewalks, speed bumps, and bike lanes or paths to make streets safer for pedestrians and cyclists. A Safe Routes to School program can help provide the motivation for “retrofitting” an existing community to make it more walkable and bikeable. In California’s Marin County, the percentage of children walking or biking to school increased from 21 percent when the program started to 38 percent two years later. Page 275 in Resources contains helpful information sources for people interested in starting a Safe Routes to School program.
As physical activity expert James Sallis points out, decisions about where to locate schools in neighborhoods are a key factor in determining walkability. “Nothing is going to substitute for organizing schools so that they’re not on the periphery,” he says. “They really need to be in the middle of communities, planned so that it’s easy to walk and bike there…. Parents need to advocate for these sorts of things.”
In a report issued in 2000, the nonprofit National Trust for Historic Preservation found that state and local policies often work against the preservation of small or historic neighborhood schools. State education departments may require or recommend unnecessarily large acreage standards for school sites, forcing towns to close existing schools and to build larger ones on the edges of the community, where land is more easily available. State and local governments do not always provide adequate funding for routine school maintenance, and building codes are sometimes biased toward new school construction rather than renovation or upgrading of existing schools. School districts are exempt from zoning and planning laws in many states, and real estate developers sometimes donate parcels of land in new subdivisions to the school district, thereby increasing the value of lots in the subdivision but also influencing policies on school location. If local residents educate themselves about zoning and school district policies, they can become advocates for the preservation of existing schools and the optimal planning and location of new schools.
Community residents can take other steps to make their neighborhoods more walkable and bikeable. On page 274 in Resources, I list organizations and Web sites that can provide suggestions, tools, and training.
Another important focus for activism to reduce childhood obesity rates is improving children’s access to local recreational facilities and making sure that opportunities for physical activity are available after school. Once school is dismissed for the day, children in the United States spend the hours until dinnertime in a bewildering variety of settings. Some attend publicly or privately funded after-school programs, often at a local school or community center, where the primary focus is often on sitting and doing homework. Some go home to a parent, a relative, a babysitter, or an empty house or apartment. Some go to a licensed child-care center or family child-care facility. Some stay at school for sports practices or extracurricular activities. Part-time jobs, private sports leagues and teams, lessons and tutoring programs are also among the many other possibilities.
James Sallis considers the after-school hours a prime time for building more physical activity into children’s day. There’s no simple way for school or health officials to make this happen, though, because after-school care is so varied and decentralized. Pressure from parents and from other knowledgeable adults is the best way to change community norms to ensure that kids have the chance to play outside and to be physically active after school. Community activists can help both by raising awareness of the importance of physical activity among providers of after-school care and by taking inventory of the kinds of programs and recreational facilities available to children. In Charlottesville, members of the city’s childhood obesity task force conducted a survey of more than 900 children in the fifth through eighth grades to find out what kinds of activities interested them and compared their responses with what was offered. They learned that the city’s African American children wanted to take classes in hip-hop dancing; the girls also expressed interest in roller skating and cheerleading and the boys in basketball and wrestling. These activities either were not being offered or were not sufficient to meet the demand—for example, P.E. teachers did not feel qualified to teach dance,
and local schools and playgrounds did not have enough basketball hoops. The Charlottesville task force has since formed a separate physical activity subcommittee that includes the city’s director of parks and recreation. The subcommittee plans to survey after-school programs and sports leagues about their current offerings and to see what activities can be introduced or expanded. Some of its efforts will also focus on improving opportunities for children who are considered at high risk of becoming obese because they are already overweight, because they live in low-income neighborhoods with few recreational facilities, or because they do not consider themselves athletic.
An alternative strategy for mobilizing community and political support is to map a city or town’s recreational opportunities and identify the gaps. In the Play Across Boston project, researchers from the Harvard School of Public Health and Northeastern University conducted a comprehensive, community-based assessment of parks, playgrounds, recreation centers, and other exercise facilities available to Boston’s youth. They found that girls participated in sports and activity programs only half as often as boys and that African American and Hispanic youth were underserved relative to their share of the city’s population. They also identified some significant and sometimes unexpected disparities in sports and recreational facilities among the city’s neighborhoods. The Play Across Boston project provides a “playbook” of what the city can do to improve the activity environment for its children and reduce their risk of obesity, said Steven Gortmaker, one of the researchers who led the project. Similar playbooks could be compiled for other cities and towns across America.
See page 274 in Resources for information on initiatives to promote physical activity in communities.
American communities do not offer everyone equal access to healthy foods. Supermarkets and grocery stores are more plentiful in suburbs and in high-income neighborhoods; low-income enclaves in urban areas are much less likely to have supermarkets and well-stocked grocery stores, and residents of such areas may not own cars or have easy access
to a supermarket via public transportation. This is why people in poor urban neighborhoods often must rely on convenience stores and fast food restaurants. The choices available in these settings are usually processed foods and meals or snack products high in calories, sugars, and unhealthy fats; there may be few fresh fruits and vegetables or whole grain items for sale. Many rural residents face a similar shortage of local grocery outlets. Ironically, despite our country’s unequaled agricultural productivity, researchers have designated large swaths of the rural United States as “food deserts” because supermarkets and grocery stores are so sparse. Finding ways to make healthy food choices available to everyone should be a central part of our efforts to combat the epidemic of childhood obesity.
It’s easy to see why supermarket companies might want to locate stores in high-income suburbs, but income differences don’t fully explain why grocery stores and supermarkets are so unevenly distributed in American communities. The flight of supermarkets from city centers to suburbs began in the 1960s. In recent decades, as stores have grown in size, they have developed a format best adapted to areas offering large tracts of land and a relatively homogeneous population of consumers who can drive to the grocery store. In rural areas companies try to maximize sales and reduce overhead by increasingly locating their stores in large “supercenter” outlets, which many rural residents must drive long distances to reach. Sociologist Troy C. Blanchard of Mississippi State University has found that, in at least half of all nonmetropolitan U.S. counties not located adjacent to a large city, residents do not have ready access to a supermarket.
Although people’s food purchases are undoubtedly influenced by food costs, there is also evidence that the types of food outlets available in neighborhoods influence local residents’ diets and may affect their risk of obesity and of diet-related diseases. North Carolina researchers used census and survey data from several states to examine possible links between dietary intake and the local “food environment,” including supermarkets, small grocery stores, convenience stores, fast food restaurants, and full-service restaurants. They found that, particularly for African Americans, living in a census tract with a supermarket was associated with a healthier diet in terms of fruits and
vegetables, total fat, and saturated fat—and this association seemed to be independent of participants’ level of income and education. There was even a “dose-response” effect: African Americans’ intake of fruits and vegetables increased by 32 percent for each additional supermarket located in their census tract. A similar although smaller dose-response effect of supermarkets on fruit and vegetable intake was also seen for white Americans.
Health researchers and activists in some communities have used the implications of findings like these to launch ambitious efforts to improve the local food environment. One of the most exciting such projects is under way in Philadelphia. There, the Food Trust, a local nonprofit organization, issued a comprehensive report in 2001 that mapped the locations of supermarket sales within the city and compared them with a map of mortality rates from diet-related diseases. The report found that supermarkets were very unevenly distributed, with low-income areas particularly underserved. Within the most underserved sections of the city there were pockets where residents had especially high mortality rates from diet-related diseases, and these neighborhoods were designated as the areas with the greatest need. After the report’s publication, Philadelphia’s city council asked the Food Trust to help form a food marketing task force to address the problem of supermarket access. The group included representatives from the supermarket industry, city government, the financial sector, the real estate industry, and other members of the business community, as well as charities and community nonprofits. The task force recommendations included urging the city to target areas for new supermarkets, assist in finding parcels of land, and reduce regulatory barriers to investment. State government was also asked to establish a financing program to support local supermarket development.
The issue attracted the support of key state legislators from Philadelphia and Pittsburgh, who saw supermarkets as a source of jobs as well as a way of improving the health of city residents. In 2004 the state legislature appropriated $100 million for planning and low-interest loans to aid in supermarket development in underserved areas. Although politicians and activists have successfully fought for new supermarkets in other cities in the past, Pennsylvania’s action represents
the first time a state has put substantial public funding into supermarket development, according to Hannah Burton of the Food Trust. Burton said that planners hope to open four new supermarkets in Philadelphia within two years. Burton adds that a critical ingredient in Philadelphia’s success was bringing representatives of various sectors together on the task force and getting them to work cooperatively. “They each contributed a piece of the answer,” she says. Representatives of the supermarket industry, initially skeptical about the potential market for their stores in the target areas, became eager participants in the process.
Burton notes that community activists in other cities can pursue a similar strategy by trying to bring together local government officials, economic development groups, and representatives of the supermarket industry. The Food Trust found that providing mortality data for specific neighborhoods from diet-related diseases helped impress Philadelphia residents and their elected representatives with the importance of access to healthy foods. “You have to give people a reason to be interested in the issue. We found the public health data to be very important,” Burton says. “We were able to cite specific addresses” for each diet-related disease death.
Concerned citizens can also work to change the local food environment on a smaller scale. An approach being tried in several locations is the Healthy Stores program, in which researchers and local activists work with food stores to increase the availability of healthy foods on shelves and promote their purchase. Public health researcher Joel Gittelsohn of the Johns Hopkins Center for Human Nutrition, in Baltimore, has conducted such programs in the Marshall Islands and on two Apache reservations in Arizona and is starting Healthy Stores programs in inner-city Baltimore, in Canada, and in Hawaii. In each case public health researchers work with store owners and with members of the local community to determine what kinds of healthy food options could be offered and marketed. When introducing new foods, workers in each local Healthy Stores program promote them with posters, cooking demonstrations, and taste tests to try to make sure they are accepted. “A lot can be done, but it takes time to work in stores,” Gittelsohn points out. “Their primary motivation is to remain profit-
able. We’re not there to make them lose money. They have to be convinced of that.”
Another way to boost the local availability of fresh fruits and vegetables is to establish a farmers market. Many states, as well as the USDA, offer assistance in planning, developing, and operating farmers markets. Grant money may also be available. The number of farmers markets in the United States increased by more than 75 percent between 1994 and 2002 and currently totals more than 3,100. Local nutrition advocacy organizations in many areas have established such markets in urban neighborhoods and other settings.
The Food Trust offers suggestions for anyone interested in developing an outdoor farmers market:
Find a site with good visibility from streets and walkways, such as a park or a shaded parking lot. “It should be a frequently traveled location, someplace where people are going past,” says the Food Trust’s Brian Lang.
Find a sponsor, such as a local community organization or redevelopment agency. Such agencies may be able to provide some money to help pay for start-up costs.
Get permission from the local government and the support of local elected officials.
Recruit farmers through the state department of agriculture, farmers organizations, 4-H clubs, or local nutrition advocacy groups. Lang has found that publishing a listing or advertisement in a local newspaper or farming newsletter is an especially efficient way to recruit. The Food Trust asks participating farmers to pay a market fee that is between 3 percent and 5 percent of sales to help defray the cost of administering the market.
Establish procedures to ensure an efficient and orderly market, such as requirements for participation, types of products to be sold, and signage. You may be able to get local real estate developers or redevelopment agencies to pay for permanent signs announcing the market’s location and schedule.
Once your market is ready to open, advertise it in the local newspaper and send out press releases to get local media to run news
stories about it. “Often, sales will lag for one or two months and eventually a community newspaper will do a story,” Lang says. “There’s a noticeable difference in the number of people there the next week.”
On page 275 in Resources you’ll find a list of organizations and Web sites offering information on becoming involved in improving your local food environment.
The childhood obesity epidemic has its roots in many aspects of our biology and modern lifestyle. It threatens the future health of millions of children, not just in our own country but around the world. And because it is a problem that has been decades in the making, overcoming it—if indeed that is possible—will take decades as well. If obesity rates continue to rise on the trajectory they have followed in recent years, the epidemic and its inevitable medical consequences will impair the health and shorten the lives of today’s children and of those yet to be born.
Americans have seen heartening evidence, in the recent history of our nation’s relationship with tobacco, that large-scale social, political, and behavioral change is possible. We all have a part to play in combating the obesity epidemic. The more we learn about the fascinating interplay of biology, environment, and behavior that governs the human body’s control of appetite and body weight, the greater will be our chances of helping our children maintain a healthy weight. The better we, as consumers and citizens, understand the factors within modern American society that influence our personal food and activity choices, the more we will become empowered to transform our shared environment into one that no longer produces a nation of ever-fatter children.