Let's Move! Can it make a dent in the childhood obesity problem? Hãy vận động! Có thể nó cải thiện vấn đề béo phì ở trẻ em?
Michelle Obama's public awareness program aims to improve the health of the nation's children, and maybe even their parents' health. Experts weigh in on its chances and the hurdles it must overcome.
Can childhood obesity be eliminated in a generation? Will we ever get our children away from video games and into the park? Is there anything to be done about neighborhoods with a plethora of fast-food outlets and a dearth of options for eating healthfully?
A year ago, First Lady Michelle Obama launched the Let's Move! campaign from the front lawn of the White House.
She outlined her plan to focus on four primary objectives: educating and empowering parents, providing more-healthful foods in schools, increasing access to healthful foods in underserved neighborhoods and encouraging more physical activity.
Among the specifics, Obama set the goal of doubling participation in the HealthierUS School Challenge, which recognizes schools in the National School Lunch Program that have worked to promote more-healthful school environments. She also announced her intention of working with food retailers to stock more-healthful fare, and challenged kids and adults to exercise five days a week.
Many childhood obesity and nutrition experts believe that the first lady's initiative is an important step in raising national awareness about childhood obesity, which in 2008 reached an all-time high of 17% among kids age 2 through 19, according to the federal Centers for Disease Control and Prevention.
"Let's Move! is first time food issues have had this kind of legitimacy at this high a government level," said Marion Nestle, nutrition professor at New York University and the author of the book "Food Politics." "Just doing that is an enormous, enormous contribution."
But in a culture where junk food abounds and outdoor play continues to lose ground to controllers and computers, some experts are skeptical as to how successful the public awareness program — which also works to allocate funding for government agencies involved in nutrition and health, such as the Department of Health and Human Services — can be.
We spoke to five specialists in the fields of nutrition and childhood obesity to get their take on each aspect of the Let's Move! campaign:
Empowering parents
In addition to purchasing food for the family, parents and caregivers serve as role models for healthy behavior. For that reason, said Dr. William Roberts, the president of the American College of Sports Medicine, reaching adults with information about good health practices, and encouraging them to examine their own habits, is a key part of battling childhood obesity.
"The apple doesn't fall far from the tree," said Roberts, who has a private practice in Minnesota. "I can often see who will have trouble with obesity and who won't from looking at the parents; obese parents have obese kids, and active parents have active kids."
According to a report by a task force implemented by President Obama to oversee Let's Move!, the campaign has worked with a handful of government agencies to help parents make more informed decisions. The Food and Drug Administration has begun to explore the effects of putting nutrition labels on the front of food packaging, and how it can be effectively implemented. The Department of Agriculture will soon release a new food pyramid, condensing its dietary guidelines. And Michelle Obama herself has urged restaurants across the country to provide nutritional information about their dishes.
Although the program is a good start, said James Hill, the director of the Colorado Nutrition Obesity Research Center, getting parents to change their behavior is likely to be much more challenging than putting numbers on menus and packaging.
"We're talking about changing what people eat, their physical activity levels," he said. "This has been very, very difficult to do and quite frankly, we have more failure than success."
A program like Let's Move! can help, he said, but "at the end of the day, it's a cultural shift, the way smoking is now unacceptable, not wearing seatbelts is now unacceptable. It's an amazing challenge and it's going to be a lot for any one program to do alone."
Getting healthful foods in schools
In December, President Obama signed the Healthy, Hunger-Free Kids Act of 2010, which provides funding for federal school meals and child nutrition programs and is reauthorized every five years. Informed, in part, by the Let's Move! objectives, the bill requires national standards to be set for food sold at schools, including meals and vending machine snacks.
Margo Wootan, director of nutrition policy at the Center for Science in the Public Interest, worked on the bill, and said that it's passage was a victory for Let's Move! program.
Getting junk food out of schools is "something we've wanted to do for decades," she said.
To ensure compliance with the bill, one school per district nationwide will be audited every three years, said Wootan.
"The review that they do is so comprehensive and labor intensive [that] it's hard for them to do many more schools," she said, adding that she'd like to see the review process more streamlined.
Some experts, however, see the bill as falling short of what kids need.
"I think we need universal school meals," said Nestle, referring to lunches provided to all children regardless of income, "and anything short of that is an enormous compromise."
Improving access to healthful and affordable food
Areas that are dominated by fast-food restaurants and have a dearth of healthful options are another target of the Let's Move! campaign.
The program made a significant stride in January, when Wal-Mart agreed to join Let's Move! by stocking its shelves with more-healthful more-clearly labeled products. The collaboration, said Nestle, represents an important step towards getting buy-in from the food industry, which has often viewed junk food as more profitable than more nutritious fare.
"Anything Wal-Mart does is going to have an enormous effect on other food companies, because they are going to have to follow suit," she said.
Still, said Hill, the effort within the food industry is "not as coordinated as we might like it to be." And it remains to be seen whether more-healthful options will lead to more-healthful choices.
"The question is, are people just waiting for healthy food, and once you bring it in they will eat it?" he said. "I suspect that's not the case. Getting people to make these healthy choices and sustain them over time is very much a challenge."
Increasing physical activity
Without an increase in physical activity, overweight kids are likely to remain that way. To that end, Let's Move! has teamed up with national sports organizations, including the National Football League and Major League Baseball, to develop public service announcements to motivate kids who may see professional athletes as role models.
But many believe that increasing physical activity represents the biggest challenge facing the program.
"I think it's going to be easier to solve the food problem then the physical activity problem," said Hill.
Roberts suggests that schools need to support gym and recess and that city planners should keep in mind the development of play areas when "building towns and living spaces." Ultimately, though, there's no proven way to entice the unmotivated to get off the couch, he said.
"I don't know how you can get people to exercise who aren't willing to or don't want to," Roberts said. "In the end, it has to be an individual decision that you're going to make the changes you need."
Looking ahead
As the Let's Move! campaign enters its second year, it's not without political detractors. Some have criticized the first lady and the program for what they suggest is an overstepping of government bounds.
On his radio program earlier this year, talk show host Rush Limbaugh said that Obama was "urging, demanding, advocating, requiring what everybody can and can't eat."
But health experts continue to suggest that Let's Move! is on the right track, if perhaps not far-reaching enough.
"The obesity epidemic is caused by a toxic environment," said David Ludwig, who developed the Optimal Weight for Life program at Children's Hospital Boston. To truly combat it, he says, government involvement needs to include providing subsidies for farms that grow nutritious foods, as well as better funding for schools so that food quality and physical education aren't sacrificed.
Wootan adds that marketing that targets children, such as television commercials and kid-themed packaging, also needs to be curtailed.
Hill believes that until more research is done to find creative solutions to the childhood obesity epidemic, the problem may not be going anywhere.
"I think things may get worse," he said, "before they get better."
The hospital’s director, Dr. Bui Duc Phu, recalled that initial meeting for us, obviously relishing the memory of a remarkable exchange. It started with Chuck inquiring: “What do you want to do next?” Dr. Phu replied that he wanted to replace the hospital’s paediatric wing. Chuck asked, “How much do you need?” and went on to say, “How quickly can you get it done?” That, as Humphrey Bogart says to Claude Rains in Casablanca, was the beginning of a beautiful friendship, mirrored in many of the nation’s other leading medical and educational institutions.
