Helping anyone who is obese lose weight is a long, difficult process of shedding fat in small increments. Efforts across the country to prevent and treat obesity are also long-term projects.
The most recent measure of whether those programs are working was released earlier this week, showing for the first time incremental improvements for low-income pre-school-age children.
The Centers for Disease Control and Preventions state-by-state comparison illustrates just how slow that process is, with 19 states and U.S territories showing only slight but statistically significant decreases in obesity rates. The CDC studied 12 million children from 2008-2011. North Carolina was one of 21 states and territories whose rates did not change significantly.
With a rate of 15.5 percent compared to the national average of 14.4 percent North Carolina has been trying out a range of childhood obesity programs for several years. Yet this is the only one among four Southern states measured that didnt see a decrease in the low-income childhood obesity rate the others being Georgia, Mississippi and Florida. South Carolina and Virginia were not included in the study.
Its a very difficult problem, said Kelly Brownell, the new dean of Duke Universitys Sanford School of Public Policy, and a leading authority on obesity. You have this cascade of factors: large portions, marketing of unhealthy food for kids any number of factors driving it, so even just stopping the increase represents a significant advance.
Brownell said the gradual changes are happening because states and the country as a whole have taken aggressive steps to change childrens eating habits. Were having success with kids before we are with adults, he said Wednesday.
Julia Wacker, program director of Bull City Fit, an outreach program in Durham that is part of a Duke Medicine weight-management clinic for children and adolescents, knows first-hand that quick results are not possible.
Its so hard to see, Wacker said. Every funder wants to see a BMI (body mass index) reduction of 30 percent in two weeks. Thats just not going to happen.
Bull City Fit is a free program staffed by volunteers that focuses on fitness, nutrition, gardening and support groups. The emphasis is on improving participants self-esteem rather than on weight loss.
If you lose weight, great. But the marker of success we see is in self-image, a desire to play, Wacker said. Just putting on shorts and being in public around peers working toward similar goals. A lot of these kids have been overweight their whole lives. They dont necessarily know another way.
The program has about a 70 percent retention rate after the first visit, she said.
Multi-prong attack needed
Kimberly Alexander-Bratcher, project director of an N.C. Institute of Medicine study of ways to reduce early childhood obesity that will be released in September, compares the issue to tobacco education, which took a multi-pronged approach over many years.
Change in these types of measures take quite a while, she said Wednesday. No one thing is going to fix the problem. Each one would make a small difference. We want a major impact like we had with tobacco.
Last month, a study presented at a conference on obesity in Sweden indicated community-based programs that involve schools, families and health-care institutions are the most successful helping children younger than 5, the Wall Street Journal reported. That idea is already driving childhood obesity efforts in this state.
Theres a lot of momentum in North Carolina, Alexander-Bratcher said.
A big part of that momentum has been the Blue Cross Blue Shield of North Carolina Foundation, which has put about $30 million into fitness and healthful eating programs over several years. Jennifer MacDougall, senior program officer for the effort, says the CDC data show North Carolina is doing well.
Its really exciting, she said. Even states that showed a leveling and not a decrease thats actually a marker of success, because what weve seen pretty much over the past 20 to 30 years is an annual rise in obesity rates. I wouldnt necessarily say lets celebrate but things are moving in the right direction for our state.
Children learn healthy habits
The foundation has financed programs focusing on three areas: making sure children in childcare have good food and get exercise; stocking schools with fresh, local food with the help of state agriculture officials; and working with churches to educate and encourage healthful habits.
Another program the foundation has supported is the Natural Learning Initiative at N.C. State Universitys College of Design that exposes children to nature in order to develop healthful habits. There are many more.
The state Department of Health and Human Services has also been involved on several fronts, including enacting day-care rules in 2010 requiring at least an hour of daily outdoor time, limited TV time, and space for breastfeeding. Earlier regulations required day-care centers to make sure children have water to drink throughout the day, and to limit sugary drinks.
In 2009, all of the states improved food available through the national Women, Infants and Children program. North Carolinas WIC program promotes breastfeeding for infants, low-fat food, more dietary fiber and less juice and sweetened drinks.
The public health agency says it is focused this year on a program with six community agencies covering a large part of the state to teach low-income families how to make smart choices in diet and get exercise.
Another priority for the department is a plan to increase the number of local farmers markets that accept coupons or benefit transfer cards for the purchase of fresh fruit and vegetables. Part of that effort includes providing coupons for pregnant, postpartum and breastfeeding women and their 3- to 4-year-old children.
Still, North Carolina has a higher rate of obesity than the U.S. average more than 100,000 children in 2011, according to the CDC report. James Zervios with the Tampa, Fla.-based Obesity Action Coalition advocacy group, says the improvements cited in the federal study show the effort is just beginning.
Theres still a large population of children who are affected by obesity, Zervious said. We need to make sure theres something out there for them to treat their obesity. Unfortunately, theres not a whole lot out there.