As preschool obesity rates dip, Boston Children’s expert suggests feds step to the plate

The scales may not be tipping quite so precipitously for some low-income preschoolers. So says a new report from the Centers for Disease Control and Prevention (CDC). Nineteen states saw small decreases in obesity rates among preschoolers between 2008 and 2011, while rates held steady in another 20 states. Is this cause for celebration, cautious optimism or concern?

Perhaps all of the above, says David Ludwig, MD, PhD, director of the New Balance Foundation Obesity Prevention Center Boston Children’s Hospital. “The report is a small, but encouraging, sign after nearly half a century of bad news.” The latest data, along with several other reports, suggest the era of continually rising obesity rates may be drawing to a close.

That’s the good news. But most epidemics aren’t halted by a crook in the prevalence curve. In fact, containing the obesity curve will require more muscle from federal decision makers.

Cautious optimism

The CDC Vital Signs analysis relates to low-income preschoolers enrolled in the Women, Infants and Children (WIC) program between 2008 and 2011. These data are not representative of all children between the ages of 2 and 5, explains Ludwig. And the analysis did not measure the same children longitudinally. Children enter and exit the WIC program at various times, so the data do not refer to same children in 2008 and 2011.

David Ludwig, MD, PhD

The dip coincides with the recession, which might mask some of the facts. That is, the declines could be related to a change in the sociodemographics of poverty in addition to or instead of a fundamental change in obesity incidence.

Plus, some sub-groups continue to pack on the pounds, so trends are moving in both directions, says Ludwig. Specifically, obesity rates have continued to swell among adults and the heaviest children. Finally, though the rates may be stabilizing, the new norms for both body mass index (BMI) and obesity rates are exceedingly high.

Overall, one in eight preschoolers is obese. The rates are even higher for black and Hispanic children, at one in five for the former and one in six for the latter, according to the CDC.

Obesity, explains Ludwig, can be viewed as a three-stage epidemic with ripple effects anticipated for many years. The first stage, which lasted from the 1980’s until the early years of the current decade, was characterized by a rapid increase in the prevalence of obesity.

It may take years for the defining features of the second stage to fully manifest. As the current generation of obese children ages, the incidence of obesity-related diseases, such as type 2 diabetes and fatty liver disease, will rise. An early warning of the magnitude of this wave is the increasing prevalence of these obesity-related diseases in adolescents. Previously, these had been considered adult conditions.

Ludwig predicts a third wave when individuals who have suffered years of weight-related diseases develop life-threatening complications like heart attack, kidney failure and stroke. “The population health burden of obesity-related disease will continue to swell until rates are brought down substantially.”

A recipe for change?

Federal decision makers might take a cue from their own cookbook and replicate changes they made in the WIC program. The improvement in preschool obesity rates might be related to WIC’s minimum nutritional standards, says Ludwig. WIC was revised in 2009 to incorporate recommendations published in Dietary Guidelines for Americans, which emphasize vegetables, fruits and whole grains.

Should SNAP have an established criteria for nutritional quality of food bought through the program?

In contrast, the Supplemental Nutrition Assistance Program (SNAP, formerly known as the Food Stamp Program) has absolutely no criteria for nutritional quality. “SNAP dollars can be used to buy fresh fruits, vegetables and beans. Or recipients can purchase sugary beverages with SNAP.”

The federal lawmakers’ failures to implement minimum nutritional standards in the $75 billion SNAP program, which is the largest federal food assistance program, is a missed opportunity, charges Ludwig. The program’s annual tab for sugary beverages weighs in at a hefty $4 billion, and these drinks fuel hunger, promote weight gain and increase risk for diabetes and heart disease.

In a recent commentary published in the Journal of the American Medical Association, Ludwig noted taxpayers are double-billed for junk food purchased with SNAP dollars. They pay for the initial purchase and then down the road through Medicare and Medicaid as patients seek treatment for diet-induced disease.

Washington’s complicity in the obesity epidemic extends to other policies as well, he continues. Under-funding school lunch programs, failing to regulate food advertising to children and funding farm subsidies that promote high calorie, low quality commodities over fruits and vegetables compound the challenges low-income families face.

The food industry should shoulder its fair share of responsibility, too, adds Ludwig. Incessant advertising of junk food and failure to market healthful foods create a toxic food environment for children.

Despite these ongoing challenges, Ludwig applauds the CDC’s findings, noting, “It is great news that even a small decrease occurred.”