Commentary - May 2009
Tex Med. 2009;105(5):45-46.
By Lawrence A. O'Brien, MD
I read with hope that turned to dismay the article " The Obesity Threat " (January 2009 Texas Medicine , pages 29-36). All the meetings, wheel-churning legislation, school-based initiatives, and money spent will not address the simple problem of access to junk food and poor choices by parents due to ignorance and a lack responsibility that I'm not sure how to fix.
Parents seem unable to enforce what they intuitively know is a healthy diet. The same parents to complain they cannot get little Johnny off the bottle at age 2 "... because he cries ..." or "... he won't give it up ..." cannot stop giving their kids soda pop, Hot Cheetos, and McDonald's food when they are older. Add to this all the grandmothers who complain that José is too thin.
Texas' own Women, Infants and Children (WIC) program gives out and recommends cereals that derive 93 percent of their calories from sugar and fat and are low on protein (e.g., General Mills Kix).
Senate Bill 530 appears to be one of those feel-good initiatives that at least we are doing something. However, the FitnessGram is a waste of time and money, with apologies to Dr. Cooper. Making the schools implement these tests would be analogous to requiring physicians to get pulmonary function tests (PFTs) to enable them to tell adults to stop smoking. No one needs PFTs to point out the detriments of smoking. You sure don't need the FitnessGram to know our kids are overweight, have a poor diet, and need more exercise.
More legislation and money recommended by the Texas Public Health Coalition for physical activity programming is amusing. Our schools can't keep up with the academic needs of our children; how are they going to fill in this physical activity programming?
I have a number of suggestions that are cheaper for the taxpayer, easier, and, I suspect, of greater impact:
- Require that foods recommended by WIC be healthy and nutritious. No cereal will be recommended or provided unless it has at least 3 grams of protein. After a year, this requirement can be increased to 4 grams in conjunction with Texas Department of Agriculture (TDA) mandates outlined below.
- Require from manufacturers that, in Texas, cereals have a minimum level of protein and a maximum level of sugar. Addition of a required minimum level of vitamins should be considered, also. I mentioned Kix, but Dora the Explorer cereal, Fruit Loops, Frosted Flakes, Cap'n Crunch, and too many others to list need to go or be made into something worth eating.
- Require schools in Texas simply to serve healthy food: fruits and veggies - never sodas - and only chips that are low in fat and sodium and have significant protein. Protein sources will be prepared in a healthy fashion and fat content brought to acceptable levels.
- Require manufacturers to market healthy snacks in Texas, and remove or bring into line the unhealthy foods available at the markets. For example, Hot Cheetos are worthless as a food and are high in fat and salt. Yet there seems to be a Hot Cheetos-eating epidemic in Del Rio. Double Stuf Oreos have no redeeming qualities and we can do without them. These are just examples; many others fit the pattern. It would seem 60 years ago these foods were not available, and obesity was not prevalent. Now these foods are ubiquitous.
- Eliminate marketing of McDonald's to children in Texas. McDonald's knows that the same parents who cannot get their kids to eat right at home cannot tell them "no" when they cry for McDonald's. I pick on McDonald's as it seems to be the worst, but all fast-food marketing to children needs to stop.
- Require fast food vendors in Texas to serve healthy food. Stop all marketing of the "supersize" mentality. Double- or triple-meat burgers with bacon have to go. Sorry. If you want to kill yourself, do it at home.
- Eliminate junk food and poor cereal marketing to children in Texas.
I guess nothing is free, but I don't understand the $141 million budget wish list from TDA, the Texas Education Agency, and the Department of State Health Services (listed on page 33 of the article) when the above suggestions would cost the taxpayers nothing. Further, these measures will produce results. I think there is support for the idea that the mere presence of the products on the shelves, the marketing of these products, their endorsement from WIC means "they/we" are saying these products are okay. These products are not okay, and it is time "they/we" sent this message to the public in a loud and clear fashion.
The prospect of universal health coverage is looming on the horizon at great cost to the state. If the public wants universal coverage, then the public needs to be shoved into eating a healthy diet.
Dr. O'Brien is a pediatrician in Del Rio.
Editor's Note: The WIC Supplemental Nutrition Program has implemented revisions to the food packages available for recipients. For the first time, participants will be able to purchase fresh fruits and vegetables, as well as whole wheat products. The new food package aligns with the 2005 National Dietary Guidelines for Americans and infant feeding practice guidelines of the American Academy of Pediatrics. The revisions must be implemented in Texas by August 2009 and will affect 900,000 women and children who participate in WIC throughout the state. More information is available on the WIC Web site.
The views contained in this commentary do not necessarily reflect the views of Texas Medicine or the Texas Medical Association.
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