Share this article

print logo

Personal Health: Seeking efficient paths to slimmer children

Pardon the cliché, but it happens to be particularly apt in this case: In trying to tame the nation’s obesity epidemic, an ounce of prevention is decidedly worth a pound of cure – considerably more than a pound, in fact, according to the findings of a five-year collaborative research project.

Not only can several popular strategies help children achieve and maintain a normal weight and, in the future, reduce adult obesity, they can also save the country many health care dollars and, in a few cases, generate revenue to support further weight control efforts.

The time is long overdue for legislators, schools, policy wonks and parents to deal more effectively with what is one of the nation’s most costly health care problems.

In the meantime, parents and other adults who influence young lives can adopt the techniques found most likely to keep children lean and healthy and extend those benefits well into their adult years. For families as well as institutions, the dollar and health savings can be significant.

The project, initial results of which were published in the American Journal of Preventive Medicine, is called the Childhood Obesity Cost-Effectiveness Study, or Choices. It examined the costs and benefits of four possible approaches to curbing childhood obesity: placing an excise tax on sugar-sweetened beverages; ending the tax write-off for advertising on children’s television; increasing moderate to vigorous physical activity in schools; and fostering healthier habits in preschool settings.

As you might expect, these approaches vary both in their implementation costs and effects on children’s weight, but before this analysis, there was no clear guidance as to which gave the biggest bang for the buck (another apt cliché). The research team of experts, from the Harvard School of Public Health, the University of Washington School of Medicine, Columbia University Mailman School of Public Health, Deakin University in Melbourne and the University of Queensland, modeled the preventive interventions as if applied nationwide to children in 2015.

Their resulting estimates of expected benefits to children’s weight – and subsequent health – and the cost of implementation were based on scores of controlled studies in a wide variety of settings.

While each approach can have a positive effect, two stood out as most likely to lower children’s body mass index, also called BMI, for the least cost and greatest returns on the investment: an excise tax on sugar-sweetened beverages and eliminating the tax subsidy on TV advertising to children.

For each unit of BMI lowered per person during the first two years, the TV ad change would cost $1.16 per person but would also generate about $80 million a year and save $343 million in health care costs for the United States over the course of a decade. Instituting a 1-cent-per-ounce tax on sugar-sweetened drinks would cost $3.16 cents per BMI unit lowered but save an estimated $23.2 billion over 10 years and bring in $12.5 billion a year nationally.

American children and adults consume “twice as many calories from sugar-sweetened beverages compared to 30 years ago,” Michael W. Long of Harvard and the project’s co-authors noted, adding that the drinks have been linked to weight gain, diabetes and cardiovascular disease.

To be sure, progress has already been made in limiting children’s access to sugary drinks. Many schools have banned such beverages, and a number of large restaurant chains have removed them from children’s menus, including McDonald’s, Burger King, Wendy’s, Dairy Queen, Panera, Subway and Chipotle, according to the Center for Science in the Public Interest, a nonprofit health advocacy group.

Last month, Davis, Calif., passed an ordinance making only milk and water the default choices for children’s meals offered in restaurants – although parents can request soda if desired. Slowly but surely, sugary drinks may go the way of cigarettes – banned in most public places.

It is also true that the rate of obesity among young children has recently stabilized. But Steven L. Gortmaker of Harvard and the project’s leader, said, “The rate has peaked at historically high levels and only for children aged 2 to 5. It’s still increasing for older children.”

The best time to intervene, he emphasized, is when children are young and small changes – “an energy gap of only about 30 calories a day” – can have a major effect. Lowering an adult’s BMI is far more challenging, requiring a sustained deficit of about 500 calories a day, “but preventing childhood obesity lays the groundwork for a future reduction in adult obesity,” Gortmaker said.

Less screen time can affect BMI in two ways: Children will be exposed to fewer ads for snacks and other foods high in calories and low in nutrients, which many studies have shown increases their consumption of such foods. Children who spend less time with electronics would also have more time for physical activity.

However, far more costly would be increasing time spent on moderate to vigorous physical activity in schools; “BMI could be reduced after two years at a cost of $401 per BMI unit per person,” the research indicated. Increasing physical activity in schools is expensive primarily because better-trained instructors and facilities are needed. But in addition to lowering BMI, it would also benefit children’s physical and mental health, their cognitive function and their ability to concentrate in class, wrote Jessica L. Barrett of Harvard and her co-authors.

Less expensive and perhaps more effective long-term would be changing rules nationwide for drinks, physical activity and screen time in child care facilities for preschoolers, which could reach 3.69 million U.S. children, Davene R. Wright of the University of Washington School of Medicine and the co-authors concluded. This would cost $57.80 per BMI unit avoided the first year, but in 10 years would save $51.6 million in health care costs.

In an interview, Gortmaker said that “snacking is a big issue.” “Marketers made it normal to be eating at every moment. Toddlers in strollers are constantly munching, and parents show up at kids’ baseball and soccer games with tons of snacks, mostly junk foods and sweet drinks.”