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Clemente Botelho

Obesity Landscape (continued)

Ease the nutrition transition

This past July, a large barge set sail from the Brazilian town of Belem carrying a cargo of candy, ice cream, juices and other products bearing the Nestle brand. The barge—or "floating supermarket," as Nestle termed it—was scheduled to travel to 18 small cities to market Nestle products to 800,000 new customers who previously had no access to such items.

In a press release, Nestle Brazil CEO Ivan Zurita called the venture "a service to the population of the Amazon, who has streets and avenues in the form of rivers."

But as a nutritionist, Benjamin Caballero calls the plan a disservice. "It's predatory capitalism," says the professor of International Health. Since the people in the region have not been exposed to the packaged foods that characterize the Western diet, he notes, Nestles outreach could contribute to obesity and instigate the first stage of a pattern called the "nutrition transition."

The nutrition transition is a shift in a population's eating patterns and lifestyle that occurs as countries become more prosperous. Industrialization and economic growth generally usher in Westernized foods and habits—more fat, sugar and processed foods, and a more sedentary lifestyle.

All of these changes fuel obesity, says Caballero, who co-edited a book with Barry Popkin called The Nutrition Transition, Diet and Disease in the Developing World. Doctors and public health officials are concerned because as obesity climbs, so do its companion chronic diseases, such as high blood pressure, diabetes, stroke and heart disease.

In some countries experiencing rapid development, the impact is especially severe. Eight of the 10 countries with the fastest rising obesity rates are developing nations or newly industrialized, notes Caballero. For example, in China, Mexico, Thailand, Brazil and Morocco, obesity is increasing more rapidly than it is in the U.S. Paradoxically, several countries, such as Bangladesh, still struggling with high rates of malnutrition, are at the same time experiencing rising rates of obesity and chronic diseases associated with an unhealthy diet and inactive lifestyle. Worldwide, 60 percent of deaths are now attributed to chronic diseases (such as heart disease, diabetes and cancer) associated with obesity and lack of physical activity.

What can be done?

For one thing, Caballero would like to see companies such as Nestle take a step back and assess what people in remote regions truly need. Perhaps it's housing or education rather than candy. A scholarship with the Nestle imprimatur would benefit local people while still promoting the company's name, he notes.

Caballero would also like governments to get behind international efforts to promote a healthy diet and physical activity, such as a WHO endeavor called the Global Strategy on Diet, Physical Activity and Health. The strategy calls for nations and the private sector to support food and agriculture policies, marketing plans and education campaigns that encourage healthy eating and promote physical activity. It supports limiting sugar, fat and salt in the diet, and increasing the consumption of fruits, vegetables, whole grains and nuts.

There is a glimmer of good news: Some of the nations now struggling with a relatively new obesity epidemic are starting to address the problem, notes Caballero. Mexico, for example, has implemented a comprehensive program that combines efforts to attack poverty and curtail obesity.

Zone for health

In theory, it makes perfect sense: If people live in a place where it is safe to walk, jog or skateboard; if they have parks and playgrounds nearby, they'll be more active. Plus, if they live far from clusters of fast food restaurants and close to fully stocked grocery stores and farmers markets, they'll eat a healthier diet. Overall, their "built environment" will be more conducive to health.

Some communities have embraced that philosophy, and are starting to adjust zoning regulations with public health in mind. However, there's little data to show precisely what type of zoning would most effectively promote health, notes Brian Schwartz, MD, MS, professor of Environmental Health Sciences and co-director of the Program on Global Sustainability and Health.

To find some answers, Schwartz is conducting an exhaustive epidemiological study of the built environment and its impact on health. Working with the Geisinger Health System, he gathered a trove of data about the built and social environments in a large swath of central and northeastern Pennsylvania—data that include detailed information on food, physical activity, land use and social environments.

He then "geo-coded" about 50,000 children enrolled in the Geisinger Health System—that is, mapped each child to a specific latitude/longitude location, and then overlaid information about the children's health status (specifically, their body mass index, or BMI) on top of the environmental data. The study is ongoing, notes Schwartz. But his preliminary results suggest that the built environment does influence BMI, and that effect appears to vary depending on age.

For instance, living in densely populated neighborhoods is associated with a lower BMI in teenagers—but not in elementary and middle schoolers. Schwartz's interpretation? "Population density is a surrogate for compact development," he says. In such a community, schools, shops, recreation centers are more accessible and within walking distance for teens. But younger children are often not allowed the same freedom to traverse their neighborhoods. Other factors were associated with lower BMIs in this age group. For example, middle school children in neighborhoods that had a higher diversity of physical activity options had lower BMIs, Schwartz notes.

Meanwhile, in a separate project, researcher Keshia Pollack is focusing on one specific element of the built environment—the route to school. She has been documenting in detail the environment children encounter as they walk from their homes to six elementary schools in different parts of Baltimore. Walking to school affords a child a chance to exercise and burn calories. Research shows that young walkers are more physically active than those who travel to school by car. That route also reflects the safety of a child's neighborhood overall. If streets, parks and playgrounds aren't safe, then parents want to keep their kids indoors, and those children will be less physically active. Unfortunately, says Pollack, "some of these children are walking to school in the most hazardous neighborhoods."

Pollack is quantifying those risks. She is gathering data on various parameters that may affect children's safety as they walk to school,such as the number of abandoned homes along the route, and statistics on crimes committed in the vicinity, particularly near playgrounds.

Her findings, says Pollack, "are an opportunity to introduce some science into zoning decisions." Baltimore City, for example, is currently revising its zoning code. Some proposed changes, such as additional speed bumps, sidewalks and pedestrian signals—or even police patrols at strategic locations—could make the path to school safer and encourage kids to walk more.

If there is a common theme voiced by scientists seeking ways to curb obesity, it's that there is no single strategy for fixing our obesogenic environment. Change will require strategies on multiple fronts.

There is at least one sign that such efforts are starting to succeed: National survey data show that childhood obesity rates have started to level off in the U.S. and some other countries. It's not yet time to claim victory, however, says International Health associate professor Youfa Wang. He's taken a closer look at the U.S. data and has a more nuanced interpretation of what they reveal. "The decline is really mainly among young children, ages 2 to 5," says Wang.

If the decline is real, it's encouraging news. But the experts are unanimous that vigorous efforts are still urgently needed to inspire healthy eating and exercise habits.

Comments

This forum is closed
  • H Nicole Anderson

    San Lorenzo, CA 08/31/2011 04:56:22 PM

    Great article! I am writing on obesity this semester for my Intro to Public Health class and suggested that one of the ways the problem could be addressed is to stop subsidies for healthy food and instead create incentives to provide Americans with healthy food choices.

    I recently adopted a low fat vegan diet and after years of obesity/overweight, I was able to reverse obesity and am approaching my ideal weight.

    H nicole anderson San Lorenzo

  • Delores Rich

    Baltimore MD 10/18/2011 05:19:11 PM

    Excellent article. I am addressing obesity among African Americans in an essay I am writing. Health food choices along with regular exercises can do wonders for the body and spirit. I would love to see more funding put towards encouraging people to eat healthy as oppose to the multitude of commercials for unhealthy food choices. Yes, change will require strategies on multiple fronts. However, if enough of us commit to leading by example, perhaps we could change the obesogenic environment.

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