Chicago’s Center for Behavioral Medicine Applauds Michelle Obama’s Childhood Obesity Initiative: Three Ideas to Accelerate the “Let’s Move” Program

First Lady Michelle Obama has placed the childhood obesity epidemic exactly where it belongs for the first time in US history – on center stage. The First Lady and the President have acknowledged that if we do not fix this healthcare crisis, we’ll keep spending 150 billion dollars a year on obesity related illnesses and we’ll keep wasting the quality and potential of millions of lives. Chicago’s Center for Behavioral Medicine & Sport Psychology (CBM) has specialized in treating obesity in children and adults for more than 25 years. CBM’s director has also served as the chief architect of Wellspring, the leading provider of treatment services for overweight young people in this country. CBM applauds this innovative and timely initiative. After describing the key elements of the “Let’s Move” program, we’ll suggest three ways to make this good thing even better.

Let’s Move
Michelle Obama’s “Let’s Move” program calls for a myriad initiatives that target what Mrs. Obama calls four key pillars: getting parents better informed about nutrition and exercise, improving the quality of food in schools, making healthy foods more affordable and accessible for families, and focusing more on physical education. In each domain, considerable efforts will emerge to provide tools and toolkits to families, schools and healthcare providers. For example, “the American Academy of Pediatrics, in collaboration with a broader medical community, will educate doctors and nurses across the country about obesity, ensure they regularly monitor your child’s Body Mass Index (BMI) provide counseling for healthy eating early on, and even write a prescription for parents laying out the simple things they can do to increase healthy eating and active play.” Let’s Move uses excellent principles of self-regulation by setting specific goals within each of its four pillars and enumerating strategies to reach those goals (e.g., to double the number of children that earn the President’s Active Lifestyle Award; to use the new “Healthy Food Financing Initiative” to bring more high quality fresh food to underserved communities).

Making a Good Thing Better: Three Ideas
Let’s Move is a dynamic initiative, equipped with a large government task force, and an emphasis on adding ideas as it grows. Wellspring’s experience and research suggests three ideas that could help:

• Emphasize Referral for Treatment as an Early Intervention: Previous studies support Let’s Move’s emphasis on more consistent diagnosis of obesity. Those studies indicate that when obese children are diagnosed as such based on their BMIs they become ten times more likely to receive dietary counseling compared to obese children whose doctors do not provide parents with their children’s BMI-based diagnosis(1). However, dietary counseling alone usually does not help. Such educational approaches rarely help overweight children and their families make the major changes in their attitudes and lifestyles required for successful weight change (2,3). Two expert groups have provided very useful sets of recommendations for treatment that healthcare providers can use to promote substantial change, and they can begin making such referrals when children reach the 85th% in BMI – the overweight level, rather than wait for those children reach the 95th% – the obese level (4,5). We favor the 7 Steps Model for the treatment of overweight young people because it strongly encourages pursuit of reductions in excess weight by adding greater intensities of interventions until success is achieved (5).
• Take a Stand Against Dietary Fat- Set a National Goal for Zero Fat grams per day: Goals for changes in eating are needed that clearly correspond to the overarching goal of reduction in overweight. The ideal goal might help overweight young people and their families focus on a key simple (easily remembered and readily understood) and measurable aspect of eating. This goal should, to maximize impact on weight, correlate with increased consumption of low caloric density high fiber foods (like fruits and vegetables), increase satiety, and help reduce consumption of total calories. A very-low fat goal satisfies those criteria (6). The vast majority of experts on obesity support at least a low fat goal, but in CBM and Wellspring we believe targeting as little consumption of all types of fat (not just saturated fats) produces the best outcomes. To support this position, tax incentives could be provided to restaurants that offer 5 or more entire meals that provide less than 10g of fat, tax levies could be added to high fat foods and so on. Encouraging everyone to set a goal for zero consumption of fat will help make the key point: Minimize consumption of fat every time you eat and you’ll find losing weight much easier (for those who are overweight). This goal will also help parents create a home environment conducive to preventing obesity in their children. This goal does not apply to babies, nor are we suggesting that people will succeed at eating zero fat per day. The goal will just help Americans get closer to the ideal – a very low fat diet.
• Provide Pedometers to All School Children: Using pedometers to measure steps promotes more activity and setting goals in addition to wearing pedometers encourages even more activity (7). As a society, we provide books to children in schools. Why not provide pedometers? In addition to the ideas on the Let’s Move website to get increased activities in the schools (and to and from school), how about acknowledging schools that offer principal’s walks before and after school – with pedometers, and targeting a mile walk around the school? Let’s make steps a focus in every family and every school.

Conclusions
CBM applauds Mrs. Obama’s incredibly important efforts to ameliorate the devastating problem of childhood obesity and looks forward to witnessing it mobilize our culture toward healthier lifestyles.

References
1. Kim C, Haemer M, Krebs NF. Parental and provider perceptions of children’s weight status: where and why the gaps. Obes Manage.2008;4:236-241.
2. Saelens BE, Sallis JF, Wilfley DE, Patrick K, Cella JA, Buchta R. Behavioral weight control for overweight adolescents initiated in primary care. Obes Res. 2002;10:22-32.
3. Stice E, Shaw H, Marti CN. A meta-analytic review of obesity revention programs for children and adolescents. Psych Bull 2006; 132:667-691.
4. Spear BA, Barlow S, Ervin C, Ludwig D, Saelens B, Schetzina KE, Taveras Em. Recommendations for treatment of child and adolescent overweight and obesity. Pediatrics. 2007;120(suppl 4):253-287.
5. Kirschenbaum DS, DeUgarte D, Frankel F, Germann JN, McKnight TL, Nieman P, Sandler RH Slusser MD. Seven steps to success: a handout for parents of overweight children and adolescents. Obes Manage. 2009;5:29-31.
6. Kirschenbaum DS. The Healthy Obsession Program: Smart Weight Loss Instead of Low-Carb Lunacy. Dallas, TX: BenBella Books; 2006.
7. Bravata DM et al. Using pedometers to increase physical activity and improve health. JAMA 2007;298:2296-2304.

This entry was posted on Sunday, February 14th, 2010 at 6:53 pm and is filed under Exercise, Obesity, Weight Loss. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.