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Clemente Botelho

Obesity Landscape (continued)

Look outside the U.S. for models of success

It’s lunchtime in a Barcelona school. Instead of pulling sandwiches and chips from paper lunch bags, these children are cooking lunch themselves (under a teacher’s supervision), using fresh vegetables they just selected during a trip to the market.

Once they’ve finished their preparations, the children will be able to savor their lunches. In Barcelona, as in much of Europe, children have 90 minutes to eat. Contrast that with many U.S. schools, where the first lunch wave may roll into the cafeteria at 10:30 a.m., and students have only 20 minutes to bolt their meal. 

“In 20 minutes, you can’t even find out what you ate. You need time to enjoy the flavors and to recognize what you’re eating,” says Benjamin Caballero, professor of International Health and founder of the School’s Center for Human Nutrition. When kids can eat at a more leisurely pace, and if they can also help select and prepare their food, he says, “they appreciate it more and they care more about it”—which might translate into healthier eating. 

Caballero, MD, PhD, has visited Barcelona schools during lunchtime and observed child chefs preparing their meals. While the government-sponsored program does not specifically target obesity, it is one example of an initiative abroad that might hold lessons for the U.S. in battling its own obesity epidemic, he says. 

Another program, Agita Sao Paulo, was introduced in that city in 1996 to encourage Sao Paulo’s then-10 million residents to engage in 30 minutes of physical activity every day. Promoting movement in all sorts of venues, from city squares to bus stops, the program espouses the idea that even moderate exercise benefits health. As studies demonstrated Agita’s dramatic success, cities throughout Brazil adopted the plan, and now the WHO has launched its own “Move for Health” program. 

And in China, Bloomberg School nutritional epidemiologist Youfa Wang, MD, PhD, MS, is developing an intervention that will use the Internet and cell phones to transmit messages about healthy eating. The project, still in the early planning stages, will involve about 200 middle school students and their parents 

Clearly, not every strategy tried elsewhere will work in the U.S., and for a program to succeed, its designers must understand the constraints, such as tight budgets. American schools, for example, are stretched for funds and time, but Caballero says they might consolidate various health-related curricula and make nutrition education an important component. “We need to prioritize health,” he says. “What is the long-term legacy of school? It’s not just passing tests.”

Work it out in the workplace

Boxes of doughnuts on the counter. Pastries and chips in the vending machines. Bacon, eggs and soda in the refrigerator. That’s the “food environment” Stephan Cox typically finds when he walks through the Bel Air, Maryland, firehouse where he’s volunteered since 1968.  

For Cox, whose day job is serving as regional fire chief for the Navy Mid-Atlantic Region, it was a recipe for obesity and poor health. As of last fall, he was significantly overweight, on medication for high blood pressure and elevated cholesterol, and was borderline diabetic. So when he heard about a Bloomberg School project aimed at reducing cardiac risk factors among volunteer firefighters, he was keenly interested. 

Heart attacks are the number one cause of on-duty deaths among firefighters, says Keshia Pollack, PhD ’06, MPH, an assistant professor of Health Policy and Management who is directing the study. The three-year project, conducted in collaboration with the National Volunteer Fire Council, is sponsored by an Assistance to Firefighters Grant through the Federal Emergency Management Agency.

Dozens of other interventions and studies aimed at reducing obesity have been tested in various workplaces, says Pollack, and some have shown promising results. “It is important for a person to learn how to be healthy while at work since we spend so many of our waking hours at work,” says Pollack. Her ideal workplace would have vending machines that sell water and healthy snacks, bike racks, on-site gyms and opportunities for employees to take breaks for short walks. 

Pollack is currently exploring several strategies for improving the food environment at the firehouses in her study. One is a Farms-to-Firehouses program, in which vegetable farms located near the firehouses would deliver fresh produce directly to the stations. As part of the plan, Pollack envisions nutrition and cooking classes to help participants learn how to prepare healthy dishes with the produce they receive. 

She and Lawrence Cheskin, MD, director of the Johns Hopkins Weight Management Center, and two other co-investigators have also recruited volunteers among the firefighter leadership to serve as role models. Cox was their first recruit. Under Cheskin’s guidance, he’s improved his diet and increased his daily exercise routine. The changes weren’t radical, notes Cox, but they were enough to make a difference. One year in, he’s 40 pounds lighter and no longer needs medication for his blood pressure or cholesterol. He hopes his story will inspire others. 

Already, says Cox, people seem to be listening. “It’s not all that uncommon that I’ll walk into a fire station, and someone will say, ‘Hey, chief, you’re slimming down really good.’ And that feels good.”  



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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