TARGET: OBESITY Reshaping society

America's fight against obesity requires many approaches and much time.
By ELLEN CREAGER
KNIGHT RIDDER NEWSPAPERS
If you're an American, the statistics say you're out of shape -- and you don't need another study to tell you why. Your life is high in stress and calories, and low in free time and physical activity.
With two-thirds of adults overweight and 25 percent barely moving, the shape of America is not good. But now, experts looking at the bigger picture are becoming more convinced it's not all your fault. Obesity, they say, is not really caused by that extra Oreo. It's the result of urban sprawl, a frenetic lifestyle and global food policy.
And for the first time, public health, zoning, transportation, fitness, education, government, legal and business interests have aligned in determination to stop the runaway train of national disrepair.
These experts envision a time when more people will walk briskly to their destinations amid trees and shops, when gaggles of school children will trot home from school, energized by their daily PE classes. They see homes built not in distant, sprawling subdivisions, but in walkable towns and cities. They see more people eating fresh vegetables and fruits at family tables and fewer guzzling giant sodas and 800-calorie burgers.
"Right now, we have to realize that as a society, 80 percent of people are not ready to change," says Michael O'Donnell, editor of the American Journal of Health Promotion. "But if there are things in our society that are causing this, we need to figure out what they are and change them."
Health movement
There is groundswell movement to do both.
This spring, Minnesota Gov. Tim Pawlenty proposed making federal food stamps worthless for junk food. Congress allocated $60 million to boost physical education programs for children. A program called "Safe Routes to Schools," designed to get students walking, may get federal funding this year. A lawsuit by two obese teens against McDonald's dismissed earlier this year has been filed again, based on the claim that the company hid nutritional facts from consumers.
In recent months, the Internal Revenue Service designated obesity as a disease and expanded a medical tax deduction for weight-loss programs. Many school districts have banned soft drinks and snacks in vending machines, even though it will cost them much-needed revenue. The state of Maine is considering a broad anti-obesity bill to add physical education classes and to build more walking paths and bike routes. Under intense scrutiny, federal nutritional guidelines for school lunches and the food pyramid are being revised, with new versions set to come out in 2005.
"It's snowballing," says John Loving, public policy director for the Sporting Goods Manufacturers of America, of the movement. "It's finally in the public eye."
Individual concern
Yet the all-out effort has detractors. Restaurants and the food industry are on the defensive, saying they are being unfairly blamed for diners' sedentary habits and big portions. Others say eating and exercising should not be the province of a meddlesome "nanny" government.
"Government has sunk its teeth into this issue with the gusto of the famished devouring a juicy steak," complained free-market analyst Daniel Hager, writing for the Mackinac Center for Public Policy. "Obesity should disappear as a public policy issue."
Many agree, including two-thirds of the residents of Michigan, the country's most overweight state. A recent survey commissioned by Michigan State University found only one-third of respondents believed that overweight and obese citizens should be public health concerns; the rest would prefer government and the health care industry stay out of their eating and exercise habits.
"The health community and the government are saying this is a huge public problem, but people see this as more of a personal concern, more about individual choices, not something that impacts all of us," said report investigator Beth Olson, a Michigan State University assistant professor.
Confusing guidelines
But, says Mark Fenton, host of PBS' "America's Walking," "the people who make the 'personal responsibility' argument are usually white, wealthy and well-educated. And they don't have the personal experience of not having a club membership, running shoes, exercise gear and not being able to exercise at home. Not to mention the experience of living in a community where kids can walk on the streets and not be shot."
Still, frustrating examples bolster the position of those who believe obesity is beyond the reach of government. First, there is the puzzling paradox that the more nutrition information the public gets, the fatter it gets. The well-intended food pyramid backfired, with citizens gobbling too many carbohydrates. "Eat low-fat" advice led to misguided Americans pounding down boxes of "lite" treats in one sitting. Fickle exercise guidelines have confused the public.
An ambitious project uniting federal, state and nonprofit agencies, called "Healthy People 2000," failed to reduce obesity rates in a single state between 1990 and 2000. And government pressure for more rigid academic focus in local schools had the unintended consequence of cutting recess and physical education, the very things that experts say can keep children slim and fit.
Determination
But the new alliance of public policy experts is determined to make more focused, sweeping changes to encourage active living. They point to successful government efforts to cut smoking rates, reduce drunk driving and increase seat belt use. Why can't obesity be fought -- and overcome -- the same way?
"We need to make environments in which the prevailing circumstances at least assist you in doing the right things instead of discouraging you," says walking advocate Fenton.
"Whatever gets the money gets the cures," says Chuck Corbin, professor of exercise and wellness at Arizona State University in Tempe. "There has never been a large-scale effort to promote a healthy lifestyle."
But unlike fighting tobacco or just saying no to drunk driving, "The issue here is, we don't have a particular enemy. It's us against ourselves," says Richard Killingsworth, director of Active Living by Design at the University of North Carolina in Chapel Hill, a national program of the Robert Wood Johnson Foundation.
Peter Jacobson, an associate professor of public health at the University of Michigan in Ann Arbor, predicts the most likely policy changes will be in food labeling and advertising, food ingredients, a stronger public information campaign by the government, and changes in school nutrition and physical education.
Link to urban sprawl
Squelching urban sprawl also may play a role.
When researchers from Rutgers University and the Centers for Disease Control recently analyzed development, transportation and health data, they found a link between urban sprawl and obesity. The idea was to study whether people who live in counties with walkable neighborhoods really walk more and weigh less than their car-dependent counterparts who live in spread-out areas.
"The study is exciting because it is one of the first to bring together national data from the fields of urban planning and public health," says Barbara McCann, project manager and Smart Growth director of information and research, "and it shows a clear association between the way the community is built and the weight, as measured by Body Mass Index, of the people who live there."
Food policy
Another piece of the puzzle is food policy. Writer Greg Critser, author of "Fat Land" (Houghton Mifflin, 2003), connected the widening of Americans to the 1970s advent of cheap corn syrup sweetener.
That one event helped swell the number of available snack foods from 250 in the 1970s to 2,000 today.
Cries for changes in food policy also have come from national advocacy groups like the Center for Science in the Public Interest, which wants a controversial tax on non-nutritious foods.
Local communities are fighting to get more fresh produce into schools and inner-city markets, to make fast-food labeling more specific and to educate the public to eat smaller portions.
Thrown onto the defensive, PepsiCo -- whose biggest product is fat-laden Fritos -- went out and hired Kenneth Cooper, father of aerobics, to help it promote "nutrition, fitness and wellness." Kraft Foods, whose Altria Group sibling is tobacco giant Philip Morris, announced grants to fight obesity and in January rejected a television ad for Double Stuf Oreo cookies because it portrayed teens as too sedentary.
'Active living' trend
A third, large-scale front in the obesity wars is the "active living" trend. Both fitness professionals and urban planners believe it is healthier in the long run for people to be naturally active in their daily lives rather than trying to set aside hours in already full days specifically to exercise.
Right now, 75 percent of all trips less than a mile are taken by car. And only one American in 200 rides a bicycle to work.
Physical activity rates have remained constant over the past 20 years, experts say. About 25 percent of people are physically active. Another 50 percent do a little activity. And 25 percent do virtually nothing.
Getting that middle 50 percent to move more during the normal course of a day would be more effective in cutting obesity rates in the long run than nagging people to go to the gym, planners say.
But how? Killingsworth is running a pilot program following 25 communities that will attempt to incorporate activity into daily life.
Planners already know that mixing businesses, homes and apartment complexes, slow traffic, tree-lined sidewalks and real destinations can entice walkers and cyclists. But it takes more than that.
"The dilemma is, most people are suburbanites who don't know any other behavior than driving," Killingsworth says "They have to go through a cultural relearning."
"We can promote bicycling and walking until we are blue in the face," says Andy Clarke, executive director of the Association of Pedestrian and Bicycle Professionals, "but unless the government takes the position that they prefer people to walk and bike, then we won't make the political decisions necessary."
'HealthierUS' plan
There is some stirring in the nation's capital. In the 2004 budget, President Bush asked Congress for $125 million to promote a "HealthierUS" plan to fight obesity and other chronic diseases. The $100 million increase would fund state and local projects; one goal would be to prevent 100,000 Americans from becoming obesity statistics next year.
But battle-scarred planners are setting their sights farther down the road. Because change on this scale takes decades, they believe initiatives to help children have the best likelihood of gaining public support.
Most urgent for future generations, Corbin says, is for states and local school districts to return to regular recess and PE.
More importantly, the focus should be on teaching kids how to be fit for life.
"Things can improve," Corbin says. "But you don't change habits in 15 minutes that have taken 50 years of bad behavior to establish.
"Can the government do something? The answer, I think, is 'yes,'" Corbin says. "The question is 'what?' One lesson we can take from tobacco is you need to change social norms. Without adequate resources, it will take at least a generation."
But for experts and advocates who have been waiting for the national wake-up call, the time is here.
"Right now, we've got a lot more interest and a little more money," for tackling the issue, says James Corless of the Surface Transportation Policy Project. "If real change comes, it will not come from government. It will come from the ground up."
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