We would like to applaud you for your efforts to eliminate food deserts and create healthy environments in which children will thrive. We recognize the importance of access to the tools and means for healthy living – including affordable produce, information, and recreational space. Like you, we value improvements to the built environment, education, and food supply chains to address the problems associated with inadequate access to healthy living.
But we disagree that "the overall goal [is] solving childhood obesity in this generation."1
The medical problems associated with low-produce diets and insufficient physical activity cover a wide spectrum. While some of the more severe conditions, like diabetes and heart disease, can occur alongside above-average weights, weight is not the underlying cause of these public health problems.2 As you have noted, access to fresh foods and physical activity in our neighborhoods is essential for achieving childhood health. Access to these fixtures of a healthy living environment is particularly missing in many low-income communities and communities of color. To address this, we recommend a simple reframing of our shared long-term goals: to create healthy food and exercise options for all young people.3
We believe that targeting weight as the desired public health outcome diverts our efforts from the important changes to the natural and built environments that are necessary for fostering healthy lives.
Moreover, we recognize that this kind of undue attention on weight is extremely harmful.4 We know too well the relationship between body image, mental health, and eating disorders, particularly among women and girls. We know, also, that the examples set by adults can fuel harmful bullying among young people. There is a significant risk that emphasizing the dangers of a given body type is having a far-reaching, negative effect on public health.
We share with “Let's Move” a recognition that the problems are best framed as related to access and addressed via changes to the environment, rather than personal attributes. Placing emphasis on personal attributes can result in finger pointing and stigmatization,5 and those most often stigmatized for their body size tend to be low-income people and people of color. We choose to focus our efforts, instead, on positive changes that we can make to our community’s environments in order to improve the availability of affordable, healthy eating and exercise options.
Research shows that it is not possible for everyone to achieve and maintain weight loss.6 Many children may be deterred by this fixed goal. Furthermore, a focus on weight control may actually backfire; not only is dieting to control weight among youth ineffective, it may actually promote weight gain.7
A healthy lifestyle, on the other hand, is a goal that can empower everyone and that everyone can achieve. Evidence supports that people are much more effective at improving health and maintaining those changes when the emphasis is placed directly on health behaviors – as opposed to weight.8
The real task before us is to expand the availability of food options and activity options and to create environments that promote healthy living. We all agree on the central problems of diet- and exercise-related illnesses and the primary tactics for addressing them. Let's develop a common, positive platform that is inclusive and works to promote public health for all of us. Let's work together to foster healthy communities in which our children will thrive.
Anna Kirkland, Ph.D.
Linda Bacon, Ph.D.
Sander Gilman, Ph.D.
Eric Oliver, Ph.D.
Carol Boyd, Ph.D., MSN, RN
Glenn Gaesser, Ph.D.
Deb Burgard, Ph.D.
Abigail Saguy, Ph.D.
Paul Campos, Ph.D.
1 Obama, Michelle. http://www.letsmove.gov/blog/youalltookastand_1.html
2 Farrell, S.W., Braun, L., Barlow, C.E, Cheng, Y.J., Blair, S.N. “The relation of body mass index, cardiorespiratory fitness, and all-cause mortality in women. ” Obesity Research 10.6 (2002): 417-423.
Gaesser, G.A. “Thinness and weight loss: beneficial or detrimental to longevity? ” Med. Sci. Sports Exercise 31.8 (1999): 1118-1128.
Hahn, R.A., Heath, G.W., Chang, M.H. “Cardiovascular disease risk factors and preventive practices among adults—United States, 1994: A behavioral risk factor atlas. ” Morbidity and Mortality Weekly Report 47. SS-5 (1998): 35-69.
3 Daníelsdóttir, S., Burgard, D., Oliver-Pyatt, W. “AED Guidelines for Childhood Obesity Prevention Programs. ” Academy for Eating Disorders. http://www.aedweb.org/media/Guidelines.cfm
4 Neumark-Sztainer, D., van den Berg, P., Hannan, P., Story, M. “Self-Weighing in Adolescents: Helpful or Harmful? Longitudinal Associations with Body Weight Changes and Disordered Eating. ” Journal of Adolescent Health 39.6 (2006): 811-818.
5 Latner, J.D., Stunkard, A.J. “Getting worse: The stigmatization of obese children. ” Obesity Research 11.3 (2003): 452-456.
6 Coakley, E.H., Rimm, E.B., Colditz, G., Kawachi, I., Willett, W. “Predictors of weight change in men: Results from The Health Professionals Follow-up Study. ” International Journal of Obesity 22.2 (1998): 89-96.
Kassirer, J.P., Angell, M. “Losing weight – an ill-fated New Year’s resolution. ” New England Journal of Medicine 338.1 (1998): 52-54.
7 Field, A.E., Austin, S.B., Taylor C. B., Malpeis, S., Rosner, B., Rockett, H.R., Gillman, M.W., Colditz, G.A. “Relation between dieting and weight change among preadolescents and adolescents. ” Pediatrics 112.4 (2003): 900-906.
8 Bacon, L., Stern, J.S., Van Loan, M.D., Keim, N.L. “Size acceptance and intuitive eating improve health for obese, female chronic dieters. ” J. Am. Diet. Assoc. 105.6 (2005): 929-936.