War On Obesity: Part 12

Stanley Feld M.D.,FACP,MACE

Obesity is a major problem for the healthcare system. I am waging a War on Obesity. This article is Part 12 of my War on Obesity.

It is essential that a public service campaign at every socioeconomic level be mounted to explain the long term danger of obesity and how to combat its occurrence. Obesity is responsible for many chronic diseases and their complications. Its cost to the healthcare system is not sustainable. Diets might work short term. Lifestyle change is the only thing that will work long term.

The new administration should join me in my War on Obesity. It has been very responsive to the potential swine flu pandemic. The media has been very responsive to this important news story. Why can’t the administration develop a public service campaign to create an important healthcare story about the obesity epidemic? It might precipitate lifestyle change.

Neither President Obama nor the congress has suggested such a plan. The main message of my public service campaign would be:

2.2 pounds of fat equal 9000 calories

In order to lose 2.2 lbs weight you must eat 9000 calories less than you burn or burn 9000 calories more than you eat.

9000 calories is hard to lose and easy to gain

The federal government subsidizes school lunch programs in schools K-12. These school lunch programs were set up 50 years ago to counter malnutrition in under-privileged families. In 2009 the problem is childhood obesity. A new approach must be taken.

“The federal school lunch program, which subsidizes meals for 30 million low-income children, was created more than half a century ago to combat malnutrition. A breakfast program was added during the 1960s.”

The federal school lunch program is trying to produce healthy meals. They fail for two reasons. First, many schools do not control portion size. Second, those same schools still have snack bars, vending machines and à la carte food lines.

Federal rules that govern the sales of these harmful foods at schools are limited in scope and have not been updated for nearly 30 years. Until new regulations are written, children who are served healthy meals in the school cafeteria will continue to buy candy bars, sugary drinks and high sodium snacks elsewhere in school.

This is an example of a perverse outcome to a government mandate. The idea is good. The rules to execute the mandate are poor. The government will respond to people power (public opinion).

Public opinion can influence government policy and the media. If the people are passive they will have an environment that is good for vested interests. In the case of school food intake the vested interests are the candy, soda and junk food manufacturers and the school systems. The vending machines are a profit center for school districts that are underfunded by government. The profits are used to finance important school projects.

“Many states’ school districts have taken positive steps. But others are likely to resist, especially districts that sell junk food to finance athletic programs, extracurricular activities, even copier expenses.”

I did a Google search to see the breakfast and lunch menus of some independent school districts. Each has a disclaimer to avoid liability. Most provide between 650 and 1200 calories for lunch and 250 to 600 calories for breakfast depending on the portion size and the number of items a child can pick up.

Menus meet recommended dietary guidelines and may change due to product availability or other market changes. In accordance with Federal law and U.S. Dept. of Agriculture policy this institution is prohibited from discriminating on the basis of race, color, national origin, sex, or disability. To file a complaint of discrimination, write USDA,

Director, Office of Civil Rights, Room 326-W, Whitten Building, 1400 Independence Ave., SW Washington, DC 20250-9410 or call 202-720-5964. USDA is an equal opportunity provider and employer.

An obese child needs to burn 9000 calories in order to lose 2.2 pounds. An intake of 900 to 1800 calories for two meals is not going to help when a inactive obese child may burn only 1500 calories per day.

In an attempt to increase academic performance test scores, physical education has been eliminated from many school curriculum because of “school funding”. The lack of exercise increases the obesity epidemic.

It is going to take a national educational program for parents and children understand the basic etiology of obesity and caloric intake and output to conquer the obesity epidemic. It is going to take a coordinated effort by local parent teachers associations (PTA) to eliminate vending machines and snack bars from the schools. It is going to take a PTA protest to reinstitute rigorous physician education in school districts. It is going to take “People Power” with educational help from the federal government.

The federal government has the ability to do this in a public service educational campaign. It could use the money for this campaign from the money it saved using my universal EMR and my ideal medical savings account rather than wasting it on ineffective new bureaucratic institutions.

If President Obama doesn’t do something, chronic diseases resulting from obesity are going to continue to drive healthcare costs through the roof.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.