Tackling obesity – if not in our schools, where?

I was thinking the other day that if I wished hard enough we could all burn calories by simply talking about obesity, Americans would take personal responsibility for their waistlines and lighten up, and my dog would get up off her butt and go rake the lawn.

None of that is working out the way I wished, however, so other methods must be used to get the jobs done. Toward these ends, Maine’s Legislature is currently considering proposals to help fight obesity in Maine, and I have a teenager who needs some quality time with a rake.

Key among proposed laws now being considered by the Maine Legislature are several aimed at making Maine schools a nutritionally healthier place for our children to spend large parts of their day. These include proposals to guarantee a minimum amount of physical education time for all students, remove foods of poor nutritional value from schools and to ban on-campus advertising of junk foods.

Another measure would require schools to measure each student’s Body Mass Index (BMI) – a key marker of whether a child is at a healthy weight for his or her height – every two years, and to report the results to parents. (This is the same BMI that the American Academy of Pediatrics recommends all children have measured annually.) Such rules now govern the school district of Los Angeles, but Maine would be the first state in the nation to pass such laws.

In an ideal world none of this would be necessary for our schools, our children, or our parents. In an ideal world, however, the percentage of American children who are overweight would not have tripled in the last 30 years to more than 30 percent. We would not have schools selling nondiet sodas, the consumption of which is an important contributor to excess weight gain in children, or selling other high-sugar, high-fat food to our children.

In an ideal world one in four obese adolescents would not already be showing the metabolic changes that lead to diabetes, a disease which is more deadly for more Americans than cancer. Diabetes would not affect more than 70,000 Mainers and cost this poor state more than $200 million a year in health care. In an ideal world parents would protect their children from the disease of obesity, and 60 percent of parents themselves would not be overweight. In an ideal world my dog would have opposing thumbs (green, ideally) and a strong drive for lawn work beyond soil fertilization.

It’s not an ideal world, however, and it is time to give up the fool’s notion that we will win the battle for our children’s weight, and therefore health, by doing nothing. If that worked, one in three children would not be overweight. In the face of a national passion for sitting on the couch and eating high-calorie fast foods, the 10,000 TV ads for food the average child sees each year, soda with a teaspoon of sugar per ounce of drink and so much more, we cannot win this battle for our children’s future without intervening as a society, and that means laws on the books to force incremental change.

Why are schools a place to fight the obesity war for our children’s health? They are our children’s second home. Schools are already regulated to reflect social priorities and values, to “parent”; the regulation of how they feed our children is not a substantial social stretch into brand new territory for schools. Schools are uniquely the other “parent” of our children and must therefore provide them with the best possible care, including nutritional care.

If we don’t fight the battle in schools, where do we fight it? We have, by tradition or inaction, placed much of the rest of society off limits for legislatively and systematically fighting the war on our children’s obesity. The home is sacrosanct – either parents fight the war there or no one does. We don’t fight it where we eat – we refuse to require restaurants to provide easily used nutritional information about foods they serve. We don’t fight the message to eat lots and eat poorly because we refuse to limit advertisers’ marketing of junk food to our children. And we don’t fight much, period; we refuse to finance a public war on obesity the way we have financed a war on terrorism. We have surrendered the other battlefields.

Schools, then, are one of the few places left that society can help parents and meaningfully intervene in the battle for our children’s bulge.

In the context of a losing social war against obesity in children, and a society in with few other places to fight the battle, limited interventions in the schools to pursue the crucial goal of healthy weights for our children are crucial. To fail to take such steps is to abandon our children to their weighty, deadly fates. In the face of a national epidemic of childhood obesity, schools must make an aggressive stand for the nutritional health of our children. Schools must be healthy nutritional safety zones for our children, zones in which the blizzard of messages to eat lots and eat poorly are replaced by messages to eat wisely and exercise appropriately.

Maine has special reasons to take the battle to the schools (and everywhere else it can); as a state we are heavier, older, and poorer than most other states in the country. Recent evidence also suggests obesity rates are increasing faster in rural areas such as Maine. In other words, we have a lot to lose if we lose this fight. If we don’t think that combination provides the moral, social and economic basis for adults to change the nutritional environment of our children’s schools, then we adults are the ones needing more time in school.

One day our children will look back at their school years and perhaps ask what we did in schools to keep them healthy. If they stand there as adults of healthy weight, will they think their schools did too much by providing them with nutritional information about school lunch, or providing them the one place in their world free from junk food and junk food marketing, or providing them phys ed classes and providing them with their Body Mass Index every two years? I doubt it.

In fact, I think they will be glad we cared enough to fight somewhere for their nutritional health.

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region.