I know that some of you who read this are writers, and you know that everyone has a kind of process they have to do to write. Steinbeck used to write letters. I write e-mails to get warmed up. The writing is the last step after doing lots of research, and thinking about the research, and then thinking about how to frame it all into some sort of paper.
So, I did the research before the trip, but the thinking part happened during the trip. While traveling in Spain and Portugal, I started to miss salads and vegetables. Hard to believe, but there wasn't a vegetable or salad in sight. Vegetables were typically deep fried, and salads had to be special ordered, and even then they were topped with fish or meat. Yet, also no obese people anywhere. Hmmmm!
So here I am in Lisbon, I'm about to write a paper on obesity and built environments, so I've got that in the back of my mind. I notice lots of people out on the streets, walking. Ah yes, and then there are the stairs....
The United States is facing an obesity epidemic. While this paper focuses on children and adolescents, the fact that currently approximately 68% of US adults are overweight or obese (Cdc.gov, 2015) points to an alarming future trend. The American Health Association estimates that the national health cost associated with obesity and overweight is about $142 billion (Rahman, Cushing & Jackson, 2011).
In past years there have been massive efforts to educate children about good nutrition and the need for physical activity, yet this strategy has only shown limited success (Rahman, Cushing & Jackson, 2011). There is now a growing awareness that the built environment contributes to the obesity epidemic. “There is strong evidence to show that long-term solutions to the childhood obesity epidemic can be achieved by modifying the built environment to increase children’s physical activity and access to healthful foods, and reduce their access to unhealthy foods.” (Rahman, Cushing & Jackson, 2011).
The Farm to School program brings healthy foods into school cafeterias and provides education about health and nutrition, and it teaches children about the importance of supporting their local communities. As a result, children learn to make healthy food choices. While the Farm to School program does not directly change the built environment of children, it helps them make better choices in their current obesogenic environments by improving access to healthy foods.
According to Centers of Disease Control (CDC), more than one third of children and adolescents in the United States (US) were overweight or obese in 2012. CDC uses growth charts to determine body mass index (BMI) for children and adolescents (aged 2-19years). For children and adolescents of the same age and sex, overweight is defined as a BMI at or above the 85th percentile, and obesity is defined as BMI at or above the 95th percentile. BMI does not measure body fat directly, but it is a good tool to determine body fat status for most children and teens (Cdc.gov, 2015).
The immediate health risks for obese children are high blood pressure and cholesterol, which are risk factors for cardiovascular disease. Obesity increases their risk of insulin resistance and type 2 diabetes. They may develop breathing problems such as sleep apnea, and asthma. Overweight and obese children and adolescents are more likely to develop joint problems, fatty liver disease, gallstones and esophageal reflux. In addition, obese children are at risk of suffering from poor self-esteem and discrimination. They are more likely to become obese adults who will have a higher risk for heart disease, diabetes and some cancers than normal weight adults (Cdc.gov, 2015).
Physical inactivity and improper nutrition are two main contributors to childhood obesity and the level of exposure to these risk factors is determined by the built environment (Rahman, Cushing & Jackson, 2011). According to Rahman, et al. (2011), children and adults who have access to nutritious foods, walkable/bikeable neighborhoods, and who have less access to high-caloric foods and convenience stores, are at lower risk for becoming overweight and obese. Epstein, et al. (2012), who assessed the effect of built environments on pediatric weight management in four randomized, controlled studies, found that across all interventions, access to greater parkland and fewer supermarkets and convenience stores were associated with greater BMI reductions. Supermarkets provide more variety of foods, especially vegetables and fruits which are not usually available at convenience stores. However, unexpectedly, the presence of supermarkets had a stronger and longer lasting negative effect on weight control among overweight children, than convenience stores (Epstein et al., 2012). Epstein, et al. (2012) speculated that supermarkets provided more choices of unhealthy foods and noted that research shows that it is challenging to get people to buy more vegetables, fruits or healthier foods in supermarkets.
Children and youth living in low-income areas have less access to parks and recreational activities and are faced with a greater density of fast-food restaurants in their neighborhoods. Weight status of these children is highly dependent on their built environment. If they have safe access to a park, they have increased physical activity and lower risk of obesity. However, most kids growing up in low socioeconomic neighborhoods don’t walk to school or play in the neighborhood park, because these activities are not perceived to be safe. They spend much of their lives indoors and much of that sedentary, in front of some sort of screen (Razani & Tester, 2010).
Farm to School Program
The Farm to School program is one of several national initiatives that are fighting the childhood obesity epidemic. This program is community based and seeks to change children’s eating habits by improving the food served at school cafeterias. The Farm to School program brings locally produced foods to schools and supports local farmers and agriculture. Farm-fresh foods such as vegetables, fruits, eggs, honey, and meat are incorporated into the school breakfast and lunch. Schools also provide hands-on learning opportunities by engaging children and their parents in school gardens and recycling programs. Kids have opportunities to visit farms where farmers teach them about local food and agriculture. In the classroom, kids learn to recognize different vegetables and fruits and learn to prepare simple nutritious meals (Farmtoschool.org, 2015). Food Corps volunteers assigned to a school, teach children how to grow vegetables and then teach them to prepare simple meals with the vegetables the children raised in the school/community gardens (Foodcorps.org, 2015).
The Farm to School program provides healthy foods in school cafeterias and provides education about health and nutrition and teaches children about the importance of supporting their local communities. As a result, children learn to make healthy food choices. While the Farm to School program does not directly change the built environment of children, it helps them make better choices in their current obesogenic environments by giving them better access to healthy foods. More than 55 million children are enrolled in elementary or secondary schools in the US, and most children eat at least one meal per day at school (Rahman, Cushing & Jackson, 2011), this means that the Farm to School program can reach most children in the US. Unfortunately, most children also still have access to fast-food restaurants and stores that provide unhealthy options. Policies, restricting access to fast-food near schools could make the Farm to School program more efficacious.
An environment that promotes lack of exercise and an increase in high caloric food intake at the same time is an obesogenic environment. Many children have little access to parks and recreational areas but relatively easy access to high caloric junk food. However, built and food environments are modifiable risk factors. The causes of childhood obesity are complex and the solutions will have to address the root causes of obesity at the social, behavioral, environmental, and legislative levels. Children will have to be taught what good nutrition is, where it comes from, how it’s grown/raised and prepared. A program such as the Farms to School program does just that and may enable children to make better choices at their local supermarket, or they may learn that supermarkets are not the only place where food can be bought. They have an opportunity to learn that steaks come from cattle, not from the supermarket, and they learn that produce is also sold at their local farmer’s market.
Legislation will have to continue to address what foods kids can have access to via school vending machines and retail opportunities close to schools. California passed legislation in 2005 that established strict nutrition standards for all foods sold in K-12 school’s cafeterias and vending machines and banned soft drink sales in high schools. The sale of soft drinks in elementary and middle schools had been banned previously (Razani & Tester, 2010). The next step might be to regulate number and proximity of fast-food restaurants and convenience stores to schools.
Physical education needs to be back on the school curriculum and must become as important as reading, writing, and arithmetic. Neighborhoods should be made safe enough for kids to be able to walk to school and play at their neighborhood park. Future communities must be designed not to primarily accommodate automobiles but must be planned with healthy living as a goal. This means building walkable and bikeable communities with parks and recreation opportunities.
Today’s obese children are tomorrow’s obese and chronically ill adults. We cannot afford to live in an obesogenic environment.
Cdc.gov,. (2015). CDC - Obesity - Facts - Adolescent and School Health. Retrieved 25 March 2015, from http://www.cdc.gov/healthyyouth/obesity/facts.htm
Cdc.gov,. (2015). Obesity and Overweight for Professionals: Childhood: Basics - DNPAO - CDC. Retrieved 25 March 2015, from http://www.cdc.gov/obesity/childhood/basics.html
Epstein, L., Raja, S., Daniel, T., Paluch, R., Wilfley, D., Saelens, B., & Roemmich, J. (2012). The Built Environment Moderates Effects of Family-Based Childhood Obesity Treatment over 2Â Years. Annals Of Behavioral Medicine, 44(2), 248-258. doi:10.1007/s12160-012-9383-4
Farmtoschool.org,. (2015). Home Page. Retrieved 25 March 2015, from http://www.farmtoschool.org/
Foodcorps.org,. (2015). About Us â€” FoodCorps. Retrieved 25 March 2015, from https://foodcorps.org/about
Rahman, T., Cushing, R., & Jackson, R. (2011). Contributions of Built Environment to Childhood Obesity. Mount Sinai Journal Of Medicine: A Journal Of Translational And Personalized Medicine, 78(1), 49-57. doi:10.1002/msj.20235
Razani, N., & Tester, J. (2010). Childhood Obesity and the Built Environment. Pediatr Ann, 39(3), 133-139. doi:10.3928/00904481-20100223-04