5 Questions

An occasional feature in which a School of Medicine expert answers five questions on a science or policy topic of interest to the Stanford community

Thomas Robinson

Last week, the National Academies issued a report by the Institute of Medicine titled Preventing Childhood Obesity: Health in the Balance. Thomas N. Robinson, MD, MPH, associate professor of pediatrics and of medicine and director of the Center for Healthy Weight at Lucile Packard Children’s Hospital, was one of the authors. The New York Times, Washington Post, the Osgood File and ABCnews.com were among the many outlets that carried stories on the panel’s recommendations. The report provides a comprehensive list of steps to be implemented by all levels of government, the food industry, media, health-care professionals, schools and parents. Proposals include adding after-school programs, building more city parks and establishing media and advertising guidelines to promote healthy weight.

1 There have been many reports recently on childhood obesity. Why do we need one more?

ROBINSON: Congress requested a report that would deal exclusively with prevention among children and adolescents, acknowledging that prevention is the only way to truly turn back the epidemic of obesity. This report is the first to provide a comprehensive strategy based on an exhaustive review of evidence and focused on the most promising approaches.

A prior Surgeon General’s report sounded the alarm about the obesity epidemic and was a call to action. Here, we have a proposal for what can be done to turn things around, prepared by an independent committee of experts with a broad array of health-related, social science, business and governmental backgrounds.

2 The report is so comprehensive that it seems to expect action from every corner of our society. Is it realistic to expect so much?

ROBINSON: We are calling for nothing less than a revolution in the way we think about nutrition and physical activity in all aspects of our society, and how we raise our children and prioritize their health and well-being. This may sound too ambitious or unrealistic to some people, but that was the same type of reaction voiced several decades ago when people suggested the need to curb tobacco smoking, wear seat belts or add fluoride to the water supply – things that have become commonplace today.

3 But is there the political will to do that?

ROBINSON: When we briefed key congressional committees and administration officials last week, there was a lot of enthusiasm expressed about having an action plan as they move forward.

Individual members of Congress have already started introducing bills to address the obesity problem. Some federal agencies have started obesity prevention initiatives. And even more policy activity has occurred at the state and local levels. And now we are asking the president to convene a high-level task force that cuts across the multiple federal departments and agencies to ensure coordinated and consistent policies in all areas that influence physical activity and nutrition.

4 The report recommends that the food and beverage industries take more of a role in preventing childhood obesity. Why would restaurants replace profitable junk foods with healthier foods that are less popular with kids?

ROBINSON: We are hopeful that by encouraging the food and beverage industries to help address the obesity problem, regulation in this area won’t be necessary.

We know that there is tremendous creativity in these industries, and they can help to create profitable markets that promote healthy eating, including smaller portions and fewer calories. They have shown they could do this in the past. When there was a public-health call for lowering fat intake to reduce heart disease risk we saw a very rapid and dramatic increase in the availability of low-fat foods on grocery shelves and restaurant menus.

There is good evidence that children’s food preferences are shaped by marketing and advertising as well as by the contexts in which foods are served and consumed. Some recent demonstration projects have found that fresh fruits and vegetables are very popular and readily consumed when they are attractively packaged and offered as part of school meals. We’ve seen similar results in our own research studies.

5 The problem seems pretty intractable. If the recommendations are followed, can we expect obvious and dramatic changes in kids’ behavior?

ROBINSON: It wasn’t that long ago that most children ate breakfast prepared by a parent at home, walked or peddled to school and back, had recess and P.E. every day, packed a lunch or ate the one offered at school, and played outside after school. It is therefore reasonable to believe that we can change the current norms of driving to and from school, buying breakfast in a plastic wrapper from a vending machine or snack bar, sitting in class all day without P.E. or recess, purchasing fast food instead of the school lunch, and spending the afternoon in front of the television or computer.