University at Buffalo - The State University of New York

Published: June 12, 2003

By SUE WUETCHER
Reporter Editor

Making physical activity an integral part of the daily school schedule, improving the nutritional quality of school lunches, restricting or banning sales of soft drinks in the schools and improving insurance reimbursement for obesity treatment were among the recommendations offered by UB faculty members testifying before a joint Senate and Assembly hearing on preventing childhood obesity.

Eight faculty members were among those who testified at a public hearing held on June 5 in Harriman Hall, South Campus, and hosted by the School of Public Health and Health Professions. The UB hearing was the first in a series of three public hearings held across the state by the Assembly Standing Committee on Children and Families, the Assembly Task Force on Food, Farm and Nutritional Policy, and the Senate Standing Committee on Children and Families, chaired by Sen. Mary Lou Rath. The purpose of the hearings was to assess the problem of childhood obesity, children's nutrition and physical activity status, and gather recommendations for changes in policy and programs in the schools, in the community and in the home.

UB faculty members—many using power-point presentations—provided startling statistics about the increasing prevalence of obesity among boys and girls, and the resulting risks for developing cardiovascular disease, diabetes and other health problems.

Leonard Epstein, UB Distinguished Professor in the departments of Pediatrics and Social and Preventive Medicine, cited what he called "environmental influences" that are causing the "obesity epidemic" in children. They include replacement of physical activity by such sedentary pursuits as watching television and playing computer games, and the "invasion" of fast food, soft drinks and high-calorie snacks into children's diets.

The risk for obesity in children doubles for every two hours of television watched each day, and decreases 10 percent for every hour of exercise each day, he noted.

Moreover, fast-food consumption is associated with increased weight and risk for diabetes in adults, and every additional daily serving of a soft drink increases the risk of obesity in children by 60 percent, he added.

Epstein suggested that food advertising directed at children be restricted, fast food and sugar-sweetened soft drinks be taxed, the quality of school lunch programs be improved, mandatory physical education classes be funded and access to food and soda be restricted in schools.

He also recommended that insurance reimbursement be improved for obesity treatment.

Anne Lockwood, clinical assistant professor of psychiatry and manager of the Outpatient Mental Health Clinic in the School of Medicine and Biomedical Sciences, agreed that there must be changes in insurance reimbursement.

Preventing childhood obesity requires children and families to change the way they eat and how much they exercise, said Lockwood, who prepared her remarks with the assistance of David Sandberg, associate professor of psychiatry and pediatrics. Both eating and exercising are behaviors, she said, noting that clinical and counseling psychologists are well-trained in helping people change their behaviors.

"Unfortunately, it is virtually impossible for psychologists to work with people who want or need to change their eating and exercise behaviors," she said, pointing out that health insurers restrict their payments to psychologists to diagnose and treat psychiatric disorders.

"As long as health insurers decline to pay for the services of a psychologist for anything other than the treatment of diagnosed mental disorders, psychologists will not be able to help families and children to change the behaviors that lead to obesity," she said.

Joan Dorn, assistant professor of social and preventive medicine, noted that cardiovascular risk factors have been found in children as young as 3 and 4, and these risk factors tend to track into adulthood. It's imperative, she said, that healthy behaviors be established and promoted when children are very young.

Dorn advocated two approaches to childhood obesity: the "high-risk approach" that identifies children who already are overweight, and therefore "at risk" for cardiovascular disease, and the "public health strategy" that addresses the issue in the public at large.

She echoed a 1999 statement from the President's Council on Physical Fitness and Sport that "only as schools, communities, professional associations and agencies work together can we impact the health and quality of life of children and adolescents in a way that can be adopted and maintained into adulthood."

Among Dorn's recommendations:

• Health-care workers and pediatricians should screen children for obesity and risk factors as part of "well-child" visits, provide counseling and educational information, and prescribe healthy diets and exercise for their patients.

• Schools should alter the physical education curriculum to include daily exercise and ensure that at least half of the P.E. class includes moderate-to-vigorous exercise. Schools also should provide more before-and-after school programs, intramurals and extramurals, and community recreation programs.

• Parents and other family members should act as positive role models, decreasing their own and the children's sedentary activities and planning more family activities.

• The community in general should improve safety and encourage neighborhood designs to facilitate walking, biking and outdoor play.

• Public policy makers should regulate food advertising to children, promote more public service announcements regarding healthy food and activity choices, require calorie and fat content be listed on menus, ban soft drink promotion in the schools and fund more research into childhood obesity to determine what works and how to properly evaluate it.

Teresa Quattrin, associate professor of pediatrics and chief of the Division of Pediatric Endocrinology at Women and Children's Hospital of Buffalo, pointed out the lack of community programs geared toward the prevention of childhood obesity. Such programs, she said, should be family-based, since family-based interventions are the only type shown to produce long-term weight control. The programs also should educate participants on how to achieve a healthy lifestyle, including appropriate changes in diet and physical activity, she said, noting that data in Buffalo indicate that of those children who are obese, 86 percent of them became that way before the age of 6.

Quattrin promoted the idea of forming partnerships between the health system and health-care insurance to create family-based, behaviorial-dietary activity programs. While such programs would require a financial investment on the part of government and the health insurance companies, the investment would translate into greater savings in future health-care costs, she added.

R. Seiji Ohtake, clinical instructor in the Department of Rehabilitation Sciences in the School of Public Health and Health Professions, laid part of the blame for children's lack of physical activity on the schools, noting that school programs do not recognize the importance of play and physical activity in the daily life of a child.

Children are born to be physically active, Ohtake said. "Their purpose in life is to be active, explore and experience their environment and to learn."

But when children start school, "they are told that they are to have 'quiet time' and they are to be task-attentive. They are told to stop fidgeting and to pay attention. By the time they are in the first grade, they are expected to have control of themselves and be able to sit through a day of important educational classes.

"The child learns not that physical activity is healthy, but that it is an unacceptable behavior and is not to be tolerated," he says. "The 'take-home' message is to be still—to be sedentary—unless the teacher allows you to move. Some teachers take it to the point of punishing unwanted physical activities by canceling gym."

Ohtake recommended that recess be reintroduced in those schools that have dropped it and be reconfigured to allow students to achieve "physical success, freedom and fun." Schools also should develop quality physical education programs that provide daily physical activity—a minimum of 30 minutes per day, 150 minutes per week—for students in K-12.

"If we are truly going to have an effect on the well being of our children and the health of our world, then physical fitness must be made a priority," Ohtake said.

Also testifying at the hearing were Mulchand Patel, professor of biochemistry and associate dean for research and biomedical education in the School of Medicine and Biomedical Sciences, and Carlos J. Crespo, associate professor of social and preventive medicine.

Patel's testimony offered what he called a "new perspective" on obesity: that metabolic programming early in a child's life may contribute to obesity. He focused his remarks on two topics: the possible role of early introduction of baby foods in the development of childhood obesity and the possible role of maternal insulin resistance—and obesity—in the development of obesity in children. His comments, Patel noted, were based largely on animal studies and must be evaluated further.

In his remarks, Crespo suggested that government incentives be offered to employers to promote healthful living among their employees and the employees' dependents, as well as to communities to promote active living. He also recommended that the schools address the issue of a healthy lifestyle within the K-12 curriculum, and that programs be family-oriented and culturally sensitive.