Much of the public discourse about obesity has focused on the role of policy in the current epidemic. Policy issues at the local, state, and national levels have come under scrutiny, and policy changes at the various levels have been proposed to counter the growing obesity problem. At the local level, school lunch options, recess time, and funding for community parks and recreation are often among the topics of debate. At the state level, requirements for physical education and health education are relevant to pediatric obesity (American Academy of Pediatrics Committee on Sports Medicine and Fitness and Committee on School Health, 2000).
Nationally, dietary guidelines and physical activity recommendations have been put forth to encourage healthier behaviors among children and adolescents (United States Department of Agriculture, 2005). While there is little agreement among policy-makers and stakeholders on exactly what measures should be taken to curb pediatric weight problems, there is a building consensus that action must be taken and that policy shifts will be an important part of the solution.
Related to the discussion of public policy is the recent focus on the role of American culture in promoting and maintaining unhealthy behaviors.
Most pertinent to the obesity epidemic is the notion of a national culture that promotes unhealthy eating behaviors and a largely sedentary lifestyle (Nelson, Neumark-Stzainer, Hannan, Sirard, & Story, 2006).
Food manufacturers and fast-food companies have come under increasing political and economic pressures to offer “healthy alternatives” and to reduce the use of unhealthy substances (e.g., trans fats) in their products (Food and Drug Administration, 2003). Similarly, the sedentary lifestyle of many Americans has been cited as a major contributor to obesity, and initiatives to foster a culture of activity have emerged (American Academy of Pediatrics Council on Sports Medicine and Fitness and Council on School Health, 2006).
The ubiquity of unhealthy options in our communities demonstrates the challenge of promoting healthy behaviors in American society.
Providing a fitting metaphor for the degree to which convenient yet unhealthy options are integrated into the nation’s cultural and economic fabric, The New York Times (Santora, 2004) observed that even many of the premier hospitals in the United States have fast-food franchises in their cafeterias. The juxtaposition of healthy ideals and less-than-healthy realities is not limited to hospitals but can also be seen in countless schools across the country.
While children may learn the benefits of a healthy diet and vigorous exercise in health class, they often walk out of the classroom only to be confronted with vending machines selling high-sugar soft drinks and recess periods that have been shortened to make way for mandatory test preparation (American Academy of Pediatrics Committee on School Health, 2004; American Academy of Pediatrics Council on Sports Medicine and Fitness and Council on School Health, 2006). The common mixed messages presented to children and adolescents about diet and activity are a target for many reform efforts.
Elissa Jelalian, Ph.D.
Warren Alpert Medical School of Brown University
Providence, RI USA