Moving the Needle on Obesity and Diabetes: Harder Than We Thought
Dr. Fran Kaufman, a prominent diabetes specialist, and Maureen O'Hagan, a journalist, may have very different professions, but they share a common experience of being confounded by the challenges of getting people to change the behaviors that lead to obesity.
In other words: you can lead the people to fresh produce and other healthy food, but you can't make them eat it. And the stakes for encouraging both behavior and environmental changes to prevent obesity couldn't be higher, with children's rates of Type 2 diabetes rising rapidly.
Kaufman described the surprising results of the HEALTHY Trial, a large study of 42 American middle schools to assess whether an intervention program could help reduce kids' obesity and diabetes. The "intervention" schools provided healthy food choices, longer physical education classes and education on healthy eating. But while students at the intervention schools had a lower rate of obesity at the end of the study, so did students at the non-intervention (control) schools, and the difference between then was not statistically significant.
Kaufman had "high hopes" for the study, she told National Health Journalism Fellows gathered in Los Angeles this week. She theorized that by the end of the three-year study, some of the control schools had made some of the changes that the intervention schools made at the beginning, such as removing sugary sodas from campus. And while students ate lower-calorie foods at the intervention schools, they might have eaten more at home to make up the difference.
"Food intake is just one side of the equation, she said."
Seattle Times reporter Maureen O'Hagan can relate. An avowed fan of eating, especially chocolate, she noticed that when she was researching her four-part series on combating obesity, "all I could think about was food."
She had been researching whether bringing farmers markets, healthy cooking classes and supermarkets to communities that lacked them would indeed prompt people to make healthier choices.
The challenges of changing behavior, even when the healthy choice was the easy choice, were brought home to her one day when she was offered a free sample of cake at a Starbucks. Then someone brought in brownies, her downfall, to the newsroom.
"I thought about public health and food access and I thought about these brownies," she recalled. I thought, would a farmers market help me avoid brownies? Would cooking classes help me avoid brownies? If there was a plate of kale next to the brownies, would that help me avoid them?
She wondered: "Where is the data for all this stuff – what is the science behind all this food access work? She found little hard evidence to support the contention underlying some healthy food initiatives that simply bringing the healthy food to a community will spur better eating habits and better health.
A comprehensive USDA/Economic Research Service study of food access and food deserts had similar findings, one of which O'Hagan singled out:
Even if supermarkes are accessible to all, it's not clear consumers will significantly improve their diets by shopping at them – supermarkets carry all the unhealthy foods that convenience stores do, and usually offer them at lower prices.
It's a pessimistic picture both Kaufman and O'Hagan have painted, but Kaufman, at least, felt some optimism, noting that childhood obesity rates (if not diabetes rates) have recently stabilized. Medical interventions are available for diabetes if the disease cannot always be prevented, she added.
"Ultimately, I think we need to do more on the energy expenditure side," Kaufman said. "Adding fruits and vegetables to communities is not the sole answer."
Reporting Resources:
Diabetes: Covering a Silent and Tragic Global Epidemic
Diabetes: Online Reporting Resources
Photo credit: Cristiano Betta via Flickr