Heredity and environment play key roles in determining a child's risk of becoming overweight or obese. If one parent is obese, then there is a 50 percent chance that a child will be obese, and when both parents are obese, a child has an 80 percent chance of being obese. While there is mounting evidence of genetic predisposition and susceptibility to overweight and obesity, childhood obesity is still considered largely an environmental problem—the result of behaviors, attitudes, and preferences learned early in life. Children's relationships with food develop in response to family and cultural values and practices as well as the influences of school, peers, and the media.
The question remains—which environmental factors have given rise to the increasing prevalence of overweight
FIGURE 4.7
Prevalence of overweight and risk of overweight* among children aged 2 to 5 years, by race and ethnicity, 1992–2001
children and teens during the past three decades? Many observers point to reliance on fat-laden convenience and fast foods along with time spent watching television, playing video games, and surfing the Internet instead of outdoor, physical activities. In 2001 38 percent of female high school students and 24 percent of male high school students did not engage in the recommended amount of moderate or vigorous physical activity. Figure 4.8 shows that the percentages of adolescents who failed to obtain recommended levels of physical activity increased by grade throughout high school with nearly half (47.9 percent) of twelfth-grade girls reporting less than advisable physical activity. Television viewing, media advertising, dwindling school physical education programs, neighborhoods where it is unsafe for children to play outdoors, and even working mothers have been implicated.
Working parents have been accused of a variety of nutritional and parenting infractions that have contributed to children's overindulgence in unhealthy foods. First, they leave children unsupervised and unable to satisfy their hunger with anything except cookies, chips, and soda. Some observers speculate that these children are starved emotionally—for time and attention—as well as nutritionally. They also may be hungry for information, because while many adolescents are responsible for
FIGURE 4.8
High school students not engaging in recommended amounts of physical activity (neither moderate nor vigorous), by grade and sex, 2001
choosing and preparing their own food, they are often unprepared to make healthy choices.
Eating alone, in front of a television or computer, kids are more likely to overeat because they are lonely, bored, or susceptible to advertising cues. Overcome with guilt because they are not home to prepare meals, some working parents may intensify the problem by indulging their children with too many food treats. Stay-at-home mothers do not necessarily convey healthier attitudes about food, eating, and nutrition than mothers who work outside the home. Both groups may use food, especially sweets, to reward good behavior or may pressure children to clean their plates. Though none of these suppositions have been proven, it is known that parents with eating disorders, obsessive dieters, and those with unhealthy eating habits are powerful, negative role models for children.
Children's Diets Receive Failing Grades
Most studies of children's nutrition reveal diets that are too high in fat, saturated fat, and sodium and too low in fiber. According to the U.S. Department of Agriculture (USDA), in 2001 just 16 percent of children met the recommended intake—10 percent—of saturated fat. From 1989 to 1997, children's diets increased by about 80 to 230 calories per day and most of these additional calories were derived from sugar-laden foods and beverages. Soft drink consumption rose by 40 percent between 1989 and 1996, from 1 to 1.4 servings per day. Depending on age and gender, from 56 percent to 85 percent of children drink soft drinks each day. Several studies have confirmed that children who drink soft drinks consume from 55 to 245 more calories per day than those who do not drink soft drinks. Worse still, soft drinks often replace healthy beverages such as low-fat milk or juice in children's diets. In 2001 just 30 percent of children had the recommended number of servings of milk per day—a 10 percent drop since 1989. Only 15 percent ate the recommended five or more servings of fruits and vegetables each day.
Between-meal snacking by teenagers also has increased from 1.6 per day in 1977 to two per day in 1996. Snacking accounts for about 610 calories per day, up from 460 in 1977. Eating out at restaurants has also served to increase children's caloric consumption. In 1970 Americans spent about one-quarter of their food dollars on dining out. By 2001 the percent of food dollars devoted to dining out had nearly doubled, and children derived about one-third of their daily caloric intake from foods prepared outside the home—restaurant or take-out foods. One study, "Children's Patterns of Macronutrient Intake and Associations with Restaurant and Home Eating" (Journal of the American Dietetic Association, August 2001), found that when children ate meals at restaurants, they consumed nearly twice the calories they would consume at home. The study's authors, including Christine Zoumas-Morse, also reported that when children ate at restaurants they consumed more saturated fat than when they ate meals and snacks at home.
Is Fast Food to Blame?
A staggering one-third of U.S. kids eat fast food on any given day, consuming extra calories, sugar, and fat in the process. Cara B. Ebbeling and her colleagues looked at the diets of a representative sample of 6,212 children and teens. They found that boys, adolescents, and children who were black, of higher-income families, or from the South were most likely to eat fast food. However, children of all races, incomes, and U.S. regions commonly consumed fast-food meals. The researchers found that on a typical day, more than 30 percent of U.S. kids ages four to nineteen ate burgers, fries, and other fast-food fare. In "Effects of Fast-Food Consumption on Energy Intake and Diet Quality among Children in a National Household Survey" (Pediatrics, vol. 113, January 2004), the researchers found that children who ate fast food consumed an average of 187 more calories than did those who did not eat fast food, and, on average, children ate 126 extra calories on the days they ate fast food, compared with fast food–free days. In addition to consuming additional calories, children who ate fast food ingested more sugars, fats, and carbohydrates, while ingesting less fiber, fruits, vegetables, and milk than other children. The researchers calculated that the extra fast-food calories could result in an additional 6 pounds of weight gain in a year.
The Role of the Media
Despite recent television and print media anti-obesity campaigns, many industry observers condemn corporate marketing efforts and media for continuing to assault children with unhealthy messages that encourage them to eat junk foods. The CDC defines junk foods as those that provide calories primarily through fats or added sugars and have minimal amounts of vitamins and minerals. Michael F. Jacobson, executive director of the Center for Science in the Public Interest (CSPI), a nonprofit nutrition advocacy group based in Washington, D.C., believes that the United States has permitted junk-food marketers—not only fast-food companies, but also makers of sugary cereals and high-fat, high-calorie chips—to target children. He charged that the marketing of fatty, sugary, and low-nutrient foods had reached an all-time high and was fueling childhood obesity, and he called for restricting promotions targeted at the young.
Jacobson observed that even if parents lead by example in terms of healthy eating habits, it is still unfair to allow companies with slick, aggressive, sophisticated advertising campaigns to bypass parents, undermine parental authority, and directly influence children's food choices. Jacobson believes that parents must assume responsibility for ensuring that their children eat healthy meals and snacks; however, he says the marketers and media have an unfair advantage, "Companies are going directly to kids and saying, 'Eat this, eat this, drink this, drink this, it's yummy—you'll love it.' Parents have to say 'No, no, no,' and how many parents say no a thousand times?"
In an interview on a CBS news program ("Beware of Junk Food Marketers," The Early Show, CBSnews.com, November 11, 2003), Jacobson decried advertising of unhealthy foods on Saturday morning television and asserted, "Twenty-five years ago, the government tried to get junk food advertising off of children's television, but they were stopped by the toy industry, the food industry, the broadcasting industry and the advertising industry." CSPI has called upon the U.S. Department of Health and Human Services to work with Congress and the Federal Trade Commission to limit junk-food advertising aimed at children. Currently, federal rules do not restrict advertising content to children, only how much time ads can interrupt children's programming—10.5 minutes per hour on weekends and twelve minutes per hour during the week. Jacobson proposed that in view of the overwhelming evidence of the harmful effects of junk foods on American children's health, "It's time to take another crack at that." CSPI also advocates government-sponsored media campaigns that encourage healthy eating and physical activity.
In an interview in the December 10, 2003, issue of the Washington Post, Margo Wootan, a scientist at CSPI, contended that "This wouldn't be a problem if the marketing was promoting healthy foods. Children are exposed to an endless barrage of marketing everywhere they go throughout the day." Research conducted by CSPI found that marketing aimed at children, including marketing of food products, increased from $6.9 billion in 1992 to $15 billion in 2002. The CSPI report Pestering Parents: How Food Companies Market Obesity to Children (Washington, DC: Center for Science in the Public Interest, 2003) found that the spending power of children doubled each decade in the 1960s, 1970s, and 1980s and tripled during the 1990s. By the year 2000, children were spending a full one-third of their money to purchase foods and drinks. Wooten asserted that "Congress should give the Federal Trade Commission the authority and adequate funding to develop and implement (in consultation with the Department of Health and Human Services) nutrition standards for foods that can be advertised and marketed to children." She also criticized the use of fictional characters and real celebrities including classic children's favorites to promote unhealthy eating. Wooten lamented on the CSPI Web site, "SpongeBob Squarepants, Winnie the Pooh, Elmo, and even sports stars like Jason Giambi are enlisted to push low-nutrition foods on kids."
The CSPI report observed that the variety of ways that food companies market to children and teens extends beyond print and electronic media advertising to promotions in schools, in conjunction with manufacturers of books and toys, throughout the entertainment industry, and on the Internet. Examples of such promotions included:
- The "Krispy Kreme Good Grades" program, which offers elementary school students up to six free doughnuts per grading period for each "A" on their report cards. Pizza Hut operates a similar program that rewards students who read a specified number of books with a coupon that entitles them to free Personal Pan Pizzas. CSPI observed that nutritionists advise parents not to use food to reward or punish children and that some states have prohibited the use of food to reward academic achievement.
- Cap'n Crunch Smashed Berries cereal encourages overeating in print advertisements with its boast, "Kids smashed 'em in the factory so you can fit more in your mouth." CSPI also declared the cereal name to be misleading since the product does not contain berries.
- The Pepsi Web site links its product with fitness and athletic prowess in an interview with New York Yankees baseball star Jason Giambi, in which he endorses the soft drink, asserting "I usually have several Pepsis each day—it really lifts me up." The "Pepsi Notes" contest provides musical instruments to schools in exchange for symbols collected from Pepsi and Frito-Lay packages.
- Food brand children's books, such as those published by the makers of M&Ms, Fruit Loops, Skittles, Hershey Kisses, and Necco Sweetheart candies, often combine reading and eating. For example, the Oreo Cookie Counting Book involves eating ten cookies, which provide 535 calories.
- Web sites aimed at children and teens offer "advergames" that blend product advertising into arcade game formats. For example, the Nabisco Web site boasts more than fifty games, puzzles, and contests sponsored by specific cookies and other snack foods. Preschoolers can search for Teddy Graham cookies, while older children play an adventure game in which finding Oreo cookie jars restores them to 100 percent good "health."
- Product placement, in which food manufacturers pay a fee or donate products for inclusion in movies and television programs, is another potent form of subliminal or stealth advertising—promotions that aim below the conscious perception of advertising. The CSPI report cited the appearance of the soft drink Dr. Pepper in the wildly successful 2002 release of the motion picture Spiderman, and McDonald's Big Mac, fries, and soda, along with the trademark golden arches in Spy Kids 2, another popular children's film released in 2002.
Some critics, including Velma LaPoint, professor of childhood development at Howard University in Washington, assert that advertisers exploit normal adolescent susceptibility to peer pressure with subliminal messages telling kids that they are "part of the in-crowd if you're consuming certain foods," and an outcast if you choose to forgo a particular soft drink or snack food.
Many Schools Offer Unhealthy Choices
Food manufacturers and marketers have discovered that schools are ideal sites to promote their products to children and teens. Nearly all young people attend school and spend many of their waking hours at school. Further, the presence of these foods in schools allows them to benefit from the implied endorsement of the schools and teachers. According to the CDC, in 2000 just 12 percent of schools prohibited the sale of junk food from vending machines, snack bars, and cafeterias on the school campuses, and 20 percent of public schools offered brand-name fast foods for lunch. Nearly all high schools (98 percent), three-quarters of middle schools (74 percent), and 43 percent of elementary schools had vending machines, stores, or snack bars on campus.
In addition to selling food in schools, food manufacturers advertise on vending machines, posters, book covers, scoreboards, and banners and offer schools educational materials, contests in which children receive prizes or food rewards for achievement, and fundraising opportunities. Some critics, including CSPI, assert that the manufacturers are taking unfair advantage of cash-strapped school districts. The National Association of State Boards of Education takes direct aim at these relationships between businesses and schools, decrying "cola wars" in which school districts bargained with franchises to obtain the highest-paying, exclusive marketing-rights contracts possible. In exchange for "pouring rights"—the exclusive right to sell and promote their products in the schools—the companies may pay the districts in excess of several million dollars. The National Association of State Boards of Education characterizes these relationships as "exploitation and a violation of the public trust."
A 2001 review prepared by Jim Bogden of the National Association of State Boards of Education, State Policies on the Sale of Food and Beverages at School, revealed that thirty-three states and territories simply administer USDA regulations governing school food programs that prohibit "foods of minimal nutritional value" from being sold in food service areas during meal times. The USDA definition of "foods of minimal nutritional value" does not include many popular high-fat snacks such as potato chips, tortilla chips, cheese puffs, and cookies. As a result, food sales are restricted only during meal times and nonnutritious food can, and often is, sold on school campuses in locations other than where meals are served. Twenty-two states have policies that go further than the USDA regulations, which many nutritionists have derisively termed "policies of minimal nutritional value." Eight states extend the sales prohibition beyond meal times, and five states forbid sales from the beginning of the school day until the end of the last lunch period. Maine has the most restrictive policy—prohibiting all food sales that are not part of the school meals program and use of vending machines on school campuses during school hours.
School physical education programs have been found as lacking as school nutrition programs. The CDC School Health Policies and Program Study (SHPPS), first conducted in 1994, is a national survey periodically conducted to assess school policies and programs. Figure 4.9 shows that the percentage of schools that require physical education steadily decreases from grades five through twelve, with a scant 5.4 percent of high school seniors required to have physical education. The 2000 SHPPS also found that just 8 percent of elementary schools, 6.4 percent of middle schools, and 5.8 percent of high schools provided daily physical education or its equivalent (150 minutes per week for elementary school, 225 minutes per week for middle and high schools) for the entire school year for students in all grades. Table 4.5 reveals SHPPS findings that 70.6 percent of states require education about nutrition and dietary behavior and fewer—just 64.7 percent—require education about physical activity and fitness.
Legislation Aims to Help Consumers Make Healthier Food Choices
CSPI is not the only critic of media advertising for junk food that targets children. Senator Joseph Lieberman, Democrat of Connecticut, wants the Federal Trade Commission to determine conclusively the extent of the connection between junk food advertising and the rise in obesity in American children and teens. In December 2003 he called for the institution of three interim measures while the Commission assesses the relationship between advertising and children's food consumption:
- Require junk food advertisements to include nutritional information that serves to instruct and caution parents about its content, similar to the parental ratings included in movie advertisements.
- Require restaurant chains to include nutritional information on menus and display-boards. In November 2003, U.S. Representative Rosa DeLauro, Democrat of Connecticut, introduced the Menu Education and Labeling (MEAL) bill, which would require restaurants with at least twenty outlets to display the calorie count of their meals prominently on menus and possibly on food packaging. The U.S. Food and Drug Administration also is considering voluntary and mandatory programs requiring restaurants to disclose calorie counts on menu boards to help consumers make healthier diet choices.
- Empower the USDA to establish more stringent standards for food sold in schools, primarily through vending machines. Although the USDA currently regulates lunch menus, students are not limited in what they can purchase from vending machines on school campuses.
The $426 billion restaurant industry argues that the measure currently under consideration by Congress would be impractical for most restaurant owners because of the variation in menu items. The industry also is concerned that restaurants might be held liable for falsely or inaccurately reporting nutritional content on their menus. The industry also considers the proposed legislation unnecessary in view of the fact that several fast-food chains such as McDonald's and Burger King have voluntarily disclosed nutritional information about their meals on their Web sites and in store brochures.
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