Children’s Hospital of Wisconsin has a vision that the children of Wisconsin will be the healthiest in the nation. By some measures we do pretty well, though we continue to struggle with a higher level of disparities than other states. For example, according to the National Initiative for Children’s Healthcare Quality (NICHQ), Wisconsin has a lower rate of obesity/overweight among children (31%) than the national average; our ranking is 12th best, and has improved since 2003. However, when we look at the disparity in obesity, we fare poorly: 17 of 22 when measured by race, and 32 of 35 when based on income.
But let’s step back a second. Is it really OK to have almost one-third of our 10-17 olds overweight? Consider this: Oxfam reports the US ranks 121 out of 125 nations in its rate of diabetes and obesity. I’m not sure it’s enough to aim to be the best in the nation. That would still leave our kids in sad shape from a global perspective. Indeed, despite high ratings for food quantity, quality, and affordability, the US is ranked only 21st in the overall index, due to abysmal statistics on health impact of the food we (over)eat.
And let’s be clear – this is not solely, or even largely, an issue of poor choices or lack of willpower. It’s primarily a societal issue. First, while on a global scale obesity is largely associated with affluence, within the developed countries there is an inverse relationship between income and obesity. Much has been written about “food deserts” in inner cities – neighborhoods without access to healthy food options. But even when there is such access (and Milwaukee actually does not have food deserts as defined by the USDA), healthy foods may be out of reach. A study from University of Washington showed that the most energy-dense foods, high in saturated fats and low in other nutrients (think potato chips, Oreos, and Hot Pockets) are 10 times less expensive than the least energy-dense (salad, fresh fruit) on a per-calorie basis ($18.16/1,000 kcal as compared to only $1.76/1,000 kcal). Worse, the most nutritious foods rose in price by almost 20% over a 2-year period, while the least nutritious actually got even cheaper. No wonder people with limited income or food stamps pick “junk food” – it may be the only way to afford enough calories to feed the family.
In part, this reflects basic economics – junk food is simply cheaper to produce than the healthy stuff. But it’s made worse by national farming policy (as enshrined in the latest farm bill), which continues to subsidize industrial producers of products destined to be converted to, in Michael Pollan’s memorable phrase, “edible foodlike substances.”
What can we do? We already have made important steps, like providing healthier food choices for patients, families, and staff. Here are some additional suggestions:
- Let’s increase awareness of nutrition as an issue we ask about at patient encounters throughout the system. We can be intentional asking patients and families about food insecurity, or concerns about their child’s weight. And it needs to start early; this week’s New England Journal of Medicine has a study demonstrating that childhood obesity is largely present by age 5.
- We can leverage our considerable organizational expertise in feeding and nutrition by creating a pediatric nutritional program of excellence, which can be a resource for providers, patients, and families. Then we need to steer them toward educational resources to counter the massive advertising by the “edible foodlike substance” industry, and help them identify nutritious yet affordable alternatives.
We can support local efforts such as Fondy Food Market, Walnut Way, and Growing Power, all of which are working to provide affordable access to healthy foods in our poorest communities, in large part by promoting people to grow their own food.