Sharing Solutionsrelated to environment and obesity. ThisPinpointing the Factorsfor Childhoodyear, the focus was on solutions. As several participants pointed out, humangenetics and biology don’t change quicklyObesityidentify the successful environmental inter-“The goal of the conference was to try to
ventions that have been developed across theenough to account for spiking obesity ratesof the past 30 years, so a complex array of
According to a 2004 report by the Institutecountry, and then to disseminate them moreenvironmental factors that influence indi-of Medicine Committee on Prevention ofbroadly,” said primary organizer Allenvidual behavior is clearly at the root of theObesity in Children and Youth, approxi-Dearry, NIEHS associate director for researchepidemic, in both children and adults. Atmately 9 million American children over 6coordination, planning, and translation. “Thea press conference announcing the forth-years of age are considered obese—that is,major accomplishment was to bring togethercoming awarding of $5 million inthey have a body mass index (BMI) equal toa very interdisciplinary group of experts inNIHor greater than the 95th percentile as calcu-environmental health sciences, and in fieldsobesity and the environment, Schwartz/CDC research grants addressinglated by the Centers for Disease Control andlike planning and transportation, and policysaid that defining the interface betweenPrevention (CDC). Yet most experts believemakers to work together and think collabora-environmental components and individualthe 9 million figure is minimal. Rates of obe-tively, and to be able to define what makeschoices will be crucial to building a solidsity also are much higher among some popu-one of these successful environmental inter-ventions work.” evidence base to support and refine effortsto stem the obesity tide.
tween the environment and the“There’s a fine balance be-individual that allows some peo-ple to make the choice for a moreactive and healthier life, and oth-ers to continue to eat the wrongtypes of foods or not be involvedin physical fitness programs,”Schwartz said. “That balance isvery difficult to understand, andthat’s the focus of this researchprogram and this conference.”Obesity greatly increases a child’sThe stakes involved are high.risk in adulthood of developingand dying from serious chronicconditions such as cardiovasculardisease, type 2 diabetes mellitus,and certain cancers. Further,many children already sufferfrom adverse health effects relatedto their obesity.
virtually unseen in young peo-Hypertension, until recentlyple, now strikes an estimated4.5% of obese school-age chil-dren. Type 2 diabetes, also once
lations and in certain geographic areas. Andthe prevalence of childhood obesity is grow-by the Robert Wood Johnson Foundation.The conference was supported in partnow showing up more frequently (theconsidered rare in youngsters, ising exponentially. In the past three decades,The planning committee included represen-CDC is currently investigating incidenceit has more than doubled in children agedtatives from the NIHand prevalence). In addition, obese youth2–5 and 12–19, and more than tripled inU.S. Department of Transportation, as well, the CDC, and theoften suffer from impaired quality of life,children aged 6–11.as from state and local health departments,emotional effects such as poor self-image,
academia, and the American Planningelevated cholesterol, orthopedic condi-
ty at all levels aimed at reducing the epidemicThere is currently a wide variety of activi-Association. Keynote speakers includedtions, liver diseases, sleep apnea, and meta-of childhood obesity, as shown by the gather-NIEHS director David Schwartz, U.S. sur-bolic syndrome (a cluster of disorders thating of more than 700 experts from manygeon general Richard Carmona, CDCincreases risk of heart disease and diabetes),fields in early June 2005 for Environmentaldirector Julie Gerberding, former Nationalamong other negative outcomes. If leftSolutions to Obesity in America’s Youth, aFootball League star Lynn Swann (who isunchecked, the public health burden ofconference sponsored by the NIEHS. Thenow the chairman of the President’schildhood obesity will only continue tomeeting followed up on the success of a simi-increase.
lar event held in 2004, which was aimed pri-Council on Physical Fitness and Sports),marily at identifying research opportunitiesU.S. Department of HFinding Common Groundand needs to help design a research agendaServices secretary Michael Leavitt, andealth and Human
Arkansas governor Mike Huckabee. Speaker David McCarron described thework of Shaping America’s Youth (SAY),
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a public–private partnership that recentlyGrowing Smarterconducted a national survey of programsdirected at physical activity and nutritionThe effect of sprawling development onin children. SAY has established a nation-sprawling waistlines was a subject of partic-al registry of such initiatives and is nowular scrutiny at the conference. Rolandapproaching 2,500 program entries, withSturm, a senior economist at RAND, pre-overall expenditures estimated atsented data from his recent unpublished$3.9–7.1 billion. SAY’s mission is tonational study of the impact of suburbandefine the scope of those efforts and tosprawl on the development of chronicmake its information widely accessible.health conditions, including obesity. HeThe goal is to foster dialogue at the com-found that greater sprawl was associatedmunity level, and ultimately develop awith an increase in chronic health prob-national action plan to combat childhoodlems, with the strongest associations withobesity. heart disease, abdominal and digestiveproblems, migraines and headaches, arthri-lem is [the effort to address childhood“People are committed, but the prob-tis and joint pain, and trouble breathing.obesity is] not organized, it’s not beingThe study also suggested a relation betweensustained, it’s probably not directed at thesprawl, reduced walking, and higher BMI.right age group, and we need to take thiscommitment and interest and really get itthat can help reverse these trends. Former“Smart growth” may be one approachfocused . . . on the very youngest childrenMaryland governor Parris N. Glendening,and their families,” said McCarron, who iswho is now president of the nonprofitexecutive director of SAY. “We have to getSmart Growth Leadership Institute,to common goals, common language,believes that incorporating opportunitiescommon standards.”for physical activity into built environmentbe modified community by community,He added, “They’lldesign is an important part of the mix toand for each family they may be different,fight childhood obesity. “If we continue tobut we have to get to some very funda-build environments that discourage physi-mental messages.” cal activity, we’re going to continue to con-tribute to the problem,” he said.town hall meetings over the next year inSAY will be conducting a series of
Memphis, Dallas, Philadelphia, and sever-Institute urges policy makers to take aThe Smart Growth Leadershipal California cities to get feedback frombroader, more long-term view of thedemographically representative communi-potential impact of their decisions regard-ty members. “It’s not so much abouting the built environment and health.teaching them something,” McCarronPolicy changes encouraging mixed-useexplained. “We need to hear at a localzoning and actual mixed land use—such aslevel from the communities and the fami-the shift of funds to public transit, the cre-lies as to what they see the problem as,ation of sidewalks and bicycle paths, andwhat the barriers are. Otherwise, whateverthe preservation of open spaces—are criti-we come away with from these nationalcal to the smart growth concept.
meetings might be totally disconnected.”activity variables a part of the planning and“If we can make the health and physicalwith often profound disparities in physicalThe local socioeconomic environment,land use discussion, we can have a signifi-and financial access to healthy foods andcant impact,” Glendening said. “It’s notphysical activity, may contribute to thegoing to occur overnight, but we can see allobesity epidemic, particularly amongacross the country whole communities . . .minority groups, who tend to suffer evenwhere this mixed-land-use urban walkabili-higher obesity rates than the general popu-ty is taking place, creating a fun communi-lation. Adam Drewnowski, director of thety where you want to be out and about.” Center for Public Health Nutrition at theA Variety of Venues
University of Washington, addressed thisconcept and showed that in his area ofThe battle against childhood obesity isWashington state, geographic informationbeing fought on many different fronts.system mapping of the distribution ofThe conference highlighted several non-obesity rates demonstrated an associationgovernmental initiatives that are address-of higher obesity rates with lower socioe-ing the problem in imaginative ways, withconomic status and limited access tothe goal of sharing what’s working andhealthy foods. Using that type of method-what isn’t.
ology to tease out associations at the locallevel will be critical to successfully com-egy of emphasizing prevention of child-Kaiser Permanente has adopted a strat-bating the problem, Drewnowski said. hood obesity in its programs. Amongother efforts, the company has trainedEnvironmental Health Perspectives?VOLUME113 |NUMBER8 |August 2005NIEHS Newsmore than 1,000 pediatricians and familyphysicians on ways to promote physicalactivity and dietary behavior change inpatients and their families. The organiza-tion is also actively engaged in anti-obesitycoalitions and partnerships through itsHprogram. ealthy Eating, Active Living (HEAL)aimed at third- to fifth-grade girls, com-Girls on the Run, a 12-week programbines training for a five-kilometer runwith life skills development and lessons toenhance self-esteem, all of which can helpreduce or prevent obesity. Founded byMolly Barker in 1996, the program is nowactive in 120 U.S. and Canadian cities,with more than 50,000 girls participating.tial element in the obesity landscape, inThe media environment is an influen-both negative and positive ways. Newopportunities to entice young peopletoward unhealthy food choices are prolif-erating. Patti Miller, vice president ofChildren Now, a national child advocacyorganization based in California, toldattendees that the latest such threat isfrom interactive marketing. This oftencomes in the form of “advergames,” onlinegames promoted during TV shows thatadvertise unhealthy foods as part of thegame. Children Now is lobbying theFederal Communications Commission toban such practices in children’s televisionprogramming.large audience of preschool children, hasMeanwhile, Sesame Street, with itslaunched a multiyear, content-driven ini-tiative called Healthy Habits for Life. Theprogram, which will be incorporated intoall of sion, video, books, magazines, andSesame Street’s media outlets (televi-online), promotes healthy habits as beingjust as critical to early development aslearning to read and write. recognized that there is a tremendous busi-Food and beverage giant PepsiCo hasness opportunity in offering consumersmore nutritious, healthful products,according to vice president of marketingfor health and wellness Ellen Taaffe.Health-oriented products are now the com-pany’s fastest-growing sector and currentlyrepresent almost 40% of the company’sportfolio. Taaffe described several initia-tives PepsiCo has undertaken to promotehealth and fitness, including the SmartSpot program, in which a symbol on aproduct’s packaging identifies it as ahealthy choice. communications at Stoneyfield Farm, theCathleen Toomey, vice president ofnation’s largest producer of organicA 521
yogurt, described that company’s success-ful efforts to launch the first organic andhealthy vending machines for schools.Produced in collaboration with theschools themselves, which receive theprofits from sales, there are currently 32machines in place at schools in sevenstates, with a waiting list of 930 schools. attention. These included state-levelGovernmental efforts also receivedefforts in California and North Carolinaas well as larger-scale programs such asActive Living by Design, a Robert WoodJohnson Foundation effort in 25 cities toincrease physical activity through changesin community design, and America on theMove, a program working at the local,state, and national levels to encouragepeople of all ages to make small increasesin walking and small decreases in caloricintake to prevent weight gain and improvehealth. In still another initiative, the SafeRoutes to School program, several federalagencies including the U.S. Departmentof Transportation are working to makewalking and biking to school safe andappealing to children.
new tools, measures, and methods thatAnother session highlighted severalhave been developed to help reliably assessenvironment–obesity connections, such asassessments of park characteristics, urbandesign walkability, and aspects of the“nutrition environments” (the quality andavailability of foods, and types of foodoutlets in discrete settings such as schoolsand neighborhoods). These methodologi-cal advances will help to provide a much-needed validated evidence base for use inevaluating the effectiveness of obesitytreatment and prevention programs. Manyparticipants commented that more longi-tudinal research is needed to see what doesand doesn’t work for preventing obesity. launch of a major new trans-NIHThe conference also marked thetive called We Can! (Ways to Enhance initia-Children’s Activity & Nutrition).Spearheaded by the National HLung, and Blood Institute, We Can! is aeart,national public education outreach effortthat will provide activities and programsthat encourage good nutritional choices,more physical activity, and less televisionand computer screen time in 8- to 13-year-olds.
Carmona, “is have the American public“What we’re trying to do,” saidappreciate that within their control, simplesteps such as more physical activity andeating a healthy diet will reduce risk intheir lives and improve their health status.”
A 522There was a broad consensus at the confer-ence that those simple steps are the bestgreat deal of interest,” says Kennethways to both treat and prevent childhoodKorach, program director of the NIEHobesity. Environmental Diseases and MedicineSProgram, who delivered the keynoteWhittling Away at Obesityaddress at the forum. “Now The Endo-Although reversing the epidemic of child-crine Society is taking a much more activehood obesity will require long-term effortsrole in expanding its interactions andand long-term commitments from alldevelopment regarding the endocrine dis-stakeholders, Dearry is optimistic that ifruptor field, and there seems to be acertain aspects of the environment can bestrong commitment for supportingsuccessfully modified, the explosiveendocrine disruptor research and estab-growth of childhood obesity can be atlishing a formal society program inleast reduced, if not eliminated, within theEDCs.” next 5–10 years. “I think these changes inthe environment are not impossible,” heby prominent EDC researchers AndreaAttendance at the forum—organizedsays. “They can start with small stepsGore, R. Thomas Zoeller, and Jerroldrather than needing to be large-scaleHchanges. Changes in the environment thatcologists, epidemiologists, clinicians, andeindel—included more than 200 toxi-enable people to have access to a betterother members of the endocrinology com-diet or more physical activity can start tomunity, indicating that the effort to reachlead to reversals in the trends we’ve seen.”across disciplines and encourage transla-tion has been successful. Korach believesencourage everyone to take away from thisAdded Toomey: “The message I wouldthat increasing awareness of EDCs amongconference is that you can make smallclinicians is particularly important. “Somechanges. You can start a Girls on the Runof the effects of EDCs that will be seen inprogram, you can apply for a healthyhumans will be picked up by . . . endocri-vending machine. You can make the doorsnologists in their diagnosis of disorders asopen, and we can whittle down childhoodthese patients present to them, so educat-obesity piece by piece.” ing them will be very worthwhile in terms–Ernie Hoodof translational research.” Growth Spurt forRetha Newbold and John McLachlanKorach and fellow NIEHS scientists(now at Tulane University) were amongEDC Recognitionthe pioneers in EDC research; today,Korach is encouraged by the field’sOnce in a great while, a scientific confer-progress. “Twenty-five or thirty years ago,ence takes place that later proves to haveit was a very small group, but now we’rebeen a turning point in a particulardrawing more and more people into itfield—a seminal event remembered longfrom other disciplines,” he said, “andafter the name tags have been discardedthat’s a real success in terms of the educa-and the posters recycled. Although it’s tootion taking place at this forum.”soon to be certain, participants say theIn Uteroand BeyondForum on Endocrine Disrupting Chem-icals, held 3 June 2005 in San Diego, mayKorach, Newbold, and several otherwell come to be seen as a landmark inspeakers familiarized attendees with theboth the growth of the discipline and thelatest and most significant concepts in theprogress of the science itself.field, focusing to a large extent on thegrowing belief that exposure to EDCs science of endocrine-disrupting chemicalsWith the stated intent of bringing theutero(EDCs) to the forefront, The Endocrineinteractions that will cause susceptibilitycan result in gene–environmentinSociety convened the workshop the dayto disease or reproductive problems laterbefore its 87th annual meeting. Althoughin life. The developing embryo is thoughtEDCs have been on the society’s agendato be particularly sensitive to exposure tobefore, the forum was its first day-long,even low doses of exogenous EDCs dur-formally organized event devoted to theing critical periods in early development,subject. especially during sexual differentiationand organ development. The synthetictions of results from the NIEH“We’ve had very scattered presenta-estrogen diethylstilbestrol, a well-knownEnvironmental Protection Agency at theS and thehuman carcinogen, is perhaps the mostendocrine meeting from time to time, butfamous example of an EDC with a poten-it was really hard in the past to produce atially devastating impact following fetalexposure. This compound was prescribedVOLUME113 |NUMBER8 |August 2005?Environmental Health Perspectives