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On Obesity: Public Health Final Paper

 
 
Reply Sat 3 Dec, 2011 11:26 am
Because I have struggled to fight obesity my entire life, a fight that I am currently winning, I have chosen to write on obesity. This paper will focus on solutions but, first, let us take a look at the scope of the problem.

Obesity in the United States

According to the Centers for Disease Control, “about one-third of U.S. adults (33.8%) are obese (>25% BMI.) Approximately 17% (or 12.5 million) of children and adolescents aged 2—19 years are obese.” As well, obesity has trended upward over the last two decades. (CDC.gov, 2011) A study by Wang et all (2008) predicted that if current trends continue “by 2030, 86.3% adults will be overweight or obese; and 51.1%, obese. Black women (96.9%) and Mexican-American men (91.1%) would be the most affected.” Astonishingly, this study predicts that by 2048, all American adults will be overweight or obese. (Wang, 2008) Other studies indicate that the trends have begun to plateau (Skinner, 2011) but regardless, obesity remains a major factor impacting public health today. This paper will be dedicated to the solutions that might a slow down this trend or even reverse it but next, we will look at the health consequences of obesity.

Health Consequences of Obesity

Obesity has been linked to a variety of health concerns. According to an article at the Stanford Hospital website, “each year obesity-related conditions cost over 150 billion dollars and cause an estimated 300,000 premature deaths in the US.” The health effects associated with obesity include: High blood pressure, diabetes, heart disease. Joint problems, including osteoarthritis, sleep apnea, many cancers, metabolic syndrome and psychosocial effect.

Although some would argue that the health consequences of obesity are overblown, few would argue that obesity is an enormous societal problem; in fact, according to Joel Fuhrman, M.D. the obese are at greater risk than those who smoke. (Fuhrman, 2011) So now, let us look at solutions.

Obesity is such a widespread and complex problem that exploring all or even some of the solutions is far beyond the scope of this paper, so I will focus on two of many strategies that might reduce obesity rates: modifying school lunch programs in general and adopting a diet that eliminates or severely restricts the consumption of meat, dairy and processed foods, in other words, a whole foods vegan diet.

History of the School Lunch Program

According to the USDA, the concept of combining childhood education and nutrition dates back to as early as 1790, when in Munich, Germany, American born Benjamin Thompson began feeding vagrant children. The program served food consisting of “mainly of soup made from potatoes, barley, and peas. Meat was not included in the diet because of its high cost.” Thompson, because of a lack of funding, was constantly struggling to “provide the best nutrition at the lowest possible cost”. Many early school lunch programs began cropping up in the United States in the early twentieth century, most, as In Europe, run by private philanthropists until,” …by 1937, 15 States had passed laws specifically authorizing local school boards to operate lunchrooms. Although the laws commonly authorized the serving of meals at cost…” The federal government under Franklin Delano Roosevelt began providing aid to state run school lunch program in 1932. Later, FDR’s Works Project Administration became more directly involved taking up tasks such as canning food during the summertime for later use in school lunches. In 1946, the National School Lunch Program (NSLP) was passed, providing federal aid to schools to upgrade infrastructure to provide subsidized lunches to those in need. In 1966, Congress enacted the Child Nutrition Act of 1966, which stated, "In recognition of the demonstrated relationship between food and good nutrition and the capacity of children to develop and learn…” The act also established the School Breakfast Program. (Gunderson, 2011)

The school lunch program has been embroiled in controversy since its inception. Currently, the debate about what kids eat involves a dichotomy between those who want to coerce children into eating “healthy” foods with those who want children to maintain their “right” to eat junk food. Congress recently passed legislation that classified pizza as a vegetable, harkening back to the days of Reagan when ketchup was classified as a vegetable.

Fig.1 Photo by Michael Patrick, knoxnews.com

Rebecca Williams writing for a website in Knoxville, Tennessee—a state which has the nation’s sixth highest childhood obesity rate—(NPT Reports, 2011) heralded the news, “Sorry, kids: Pizza is still not a vegetable in Knoxville-area schools, despite what Congress calls it. But here's the good news for starch lovers: Fried, baked or mashed, spuds won't be banned from school lunch trays. In November, Congress blocked several key proposals of the Obama administration's effort to improve school lunch nutrition…” (Williams, 2011) Good news! More obese kids in Tennessee!

Numerous Studies on the Efficacy of NSLP

Numerous studies have been conducted on the nutritional efficacy of the National School Lunch Program (NLSP). Robinson-O'Brien R , Burgess-Champoux T , Haines J , Hannan PJ and Neumark-Sztainer D (2010) report that “national data indicate that Fruit and vegetable consumption among school-aged children is below recommended levels, particularly among low-income children.” A study by Bhatia, Rajiv, Jones, Paula ; Reicker, and Zetta (2010) informs us that “Unsubsidized meals and food offerings competing with the National School Lunch Program offerings in school lunch environments may be lowering qualified student participation.” Good news comes from Texas in a study by Karen Cullen, (2010) she found that improvements in the NLSP resulted in low income students consuming “less fat, sweetened beverages, and candy and more vitamin C and calcium.” A study by Wojcicki and Heyman (2009) looked at San Francisco Unified School District 2003 implementation of “progressive nutrition” changes such “the removal of sodas, Twinkles, Slim Jims, and giant pizzas and their replacement with sushi, fresh soup, deli sandwiches, 100% fruit juice...” Participation in the NSLP increased and “among the 1500 students who reported regularly eating in the school cafeteria , 46% thought that the food offered in the cafeteria tasted better in the 2003-2004 school year than in previous years. Approximately 50% also thought that the cafeteria was serving more fresh fruits and vegetables than in previous years. Many students (70%) cited the fact that the food offered in the cafeteria was free or inexpensive as their main reason for choosing to participate in the school lunch program.

Closing Thoughts on NSLP

Public health professionals need to continue to study and look at ways that the NLSP can be tailored to address obesity. The rest of us should continue to exert pressure on our political leaders—letters, phone calls, emails—to make school lunch menus healthier.

The “New” Whole Food Vegan Revolution

I am Nicole A. and I am a compulsive overeater. For over six months, I have repeated these words at the weekly Overeaters Anonymous Meeting that I attend. Last spring, I wrote a speech that explored the theory that a whole foods vegan diet combined with moderate exercise could not only prevent but even reverse heart disease. In short, although I searched extensively for evidence that would refute the claim, what I found was a mountain of evidence that not only supported the claim but that this type of regimen may prevent and even reverse many of the world’s most debilitating diseases such as diabetes, many cancers, hypertension as well as heart disease. Last spring, having been convinced by my research, I began following Neal Barnard’ regimen as outlined in his book 21-Day Weight Loss Kickstart: Boost Metabolism, Lower Cholesterol, and Dramatically Improve Your Health, . My food cravings have all but disappeared and I am now but a few pounds away from my ideal weight all without “dieting,” counting calories or measuring and weighing food.

I have become so convinced that reducing or eliminating the consumption of meat, dairy and processed foods will combat obesity that I have become an activist. During break, I will resume my efforts to establish a new organization, a sub-group of Overeaters Anonymous. I put up a webpage OAvegan.org and soon, I will be organizing a cabal of activists who will help me launch this program nationwide. I have also ordered pamphlets from Dr. Neal Barnard’s group Physicians Committee for Responsible Medicine that encourage vegan eating. I will be distributing these at the college health care center. I also plan to do more volunteer work to help get the word out to “mainstream public health” that this “new” way of eating can save millions of lives and it is not radical. What is radical is having to cut someone’s chest open and perform surgery because he or she followed the typical Western diet!

After conducting massive research for previous works, the only credible counter argument I could find against the argument to adopt a whole foods vegan diet to improve health was that many considered this a radical change that was too hard to follow. (Stern and Kazaks, p.152, 2009) Pioneers such as Dr. Caldwell Esselstyn , of the Cleveland Clinic, counter that most of his patients have little trouble following the regimen once they realize its health benefits. (Campbell and Esselstyn, 2011) What may have seemed radical to many a few years ago is slowly gaining mainstream acceptance as millions have viewed documentaries such as Supersize Me, Food, Inc., Food Fight and Forks over Knives. In addition, luminaries such as Roger Ebert and Bill Clinton have reported nearly miraculous health improvements by adopting the whole foods vegan regimen.

In closing, eating whole food vegan may not be a panacea, but the more I talk to my peers in San Francisco, one of the major trendsetting cities, the more I hear about people being excited about adopting this regimen (or similar ones that severely restrict meat, dairy and processed foods) and the more I am convinced that this is a trend that might take hold across the country. If it does and we can continue to improve the NSLP, we may reverse the obesity trend, improve the quality of life for millions, and reduce health care costs. Add to that, eating less meat and dairy may reduce greenhouse gases but I will save that argument for another day.

References

Campbell, T & Esselstyn, C.B. “Forks Over Knives: How a Plant-Based Diet Can Save America”
13 May 2011 <http://www.huffingtonpost.com/t-colin-campbell/
forks-over-knives-how-a-p_b_861672.html>
Centers for Disease Control. “Overweight and Obesity” 11 July 2011
<http://www.cdc.gov/obesity/data/trends.html>
Cullen, K., Watson, K. B., & Fithian, A. R. (2009). The Impact of School Socioeconomic Status
on Student Lunch Consumption after Implementation of the Texas Public School
Nutrition Policy. Journal Of School Health, 79(11), 525-531.
doi:10.1111/j.1746-1561.2009.00444.x
Fuhrman, J. “3 Steps to Incredible Health! With Dr. Joel Fuhrman” PBS aired on KQED
San Francisco 11 Nov. 2011
Gunderson , W. “The National School Lunch Program Background and Development”
USDA Food Nutrition Service. Updated 30 Nov.2011
<http://www.fns.usda.gov/cnd/lunch/AboutLunch/ProgramHistory_1.htm>
NPT Reports: Children's Health Crisis – Obesity. PBS Documentary WNPT, Nashville, Tennessee
21 Nov. 2011 <http://www.wnpt.org/productions/chcv2/obesity/index.html>
Robinson-O'Brien, R., Burgess-Champoux, T., Haines, J., Hannan, P., & Neumark-Sztainer,
D. (2010). Associations between school meals offered through the National School
Lunch Program and the School Breakfast Program and fruit and vegetable intake
among ethnically diverse, low-income children. Journal Of School Health,
80(10), 487-492. doi:10.1111/j.1746-1561.2010.00532.x
Skinner, J. Website post. City College of San Francisco 18 Nov. 2011
<http://insight.ccsf.edu>
Stern, Judith S., Kazaks, Alexandra. Obesity : A Reference Handbook ABC CLIO 2009
Santa Barbara, CA
Wang Y, Beydoun MA, Liang L, Caballero B, and Kumanyika SK. “Will all Americans
become overweight or obese?”. Obesity (Silver Spring). 2008 Oct;16(10):2323-30.
Epub 2008 Jul 24. Department of International Health, Johns Hopkins Bloomberg School
of Public Health, Baltimore, Maryland, USA.
Williams, Rebecca. “Potatoes won't disappear from Knoxville-area school lunches, pizza
still considered a veggie.” Knoxville News 30 Nov. 2011 http://www.knoxnews.com/news/2011/nov/30/food-fight-potatoes-wont-disappear-from-school-a/
Wojcicki, J., & Heyman, M. (2006). Health policy and ethics. Healthier choices and
increased participation in a middle school lunch program: effects of nutrition policy changes
in San Francisco. American Journal Of Public Health, 96(9), 1542-1547.



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