January 2 2011

Children, Parents, and Obesity

Julie Gunlock

In December 1960, President-elect John Kennedy penned an article for Sports Illustrated titled "The Soft American." In the essay, he expressed grave concern about Americans' declining health and expanding waistlines; using the results of fitness tests to compare achievement, he explained that nearly 58% of American children had failed at least one of the tests, compared with fewer than 9% of European children. Dramatic in his tone, Kennedy even tied Americans' health to the nation's ability to topple communism, declaring that "our growing softness, our increasing lack of physical fitness, is a menace to our security." The president-elect went on to call for several government initiatives to "improv[e] the health and vigor of our citizens" - including policies that would make "the physical fitness of our youth...the direct responsibility of the Department of Health, Education and Welfare."

Five decades later, the White House is again interested in Americans' weight issues. This time, however, it is the first lady leading the charge - highlighting healthy eating through projects like her White House organic vegetable garden and by hosting celebrity chefs at nutrition-themed events. As with President Kennedy's alarm over flabby Americans, however, it seems that the true goal of Mrs. Obama's efforts is to expand government's influence over the care and feeding of America's children. She has, for instance, linked the "epidemic" of childhood obesity tothe related hot-button political topics of government health-care and welfare programs. And the real motivation behind her signature initiative - the "Let's Move" campaign, ostensibly designed to promote health and fitness among American school children - seems to be to boost federal funding for the national school lunch and breakfast programs, and to increase the number of children eating government-provided and -subsidized meals.

There are several reasons to be concerned about the White House campaign to enlarge these initiatives. To begin with, the federal government's existing programs to provide breakfast, lunch, snacks, and after-school meals are badly run, wasteful, and immune to reform. By providing food that is often high in calories and low in nutritional value, these programs also share a portion of the blame for our children's growing waistlines. And they are more likely to undermine than to help efforts to improve Americans' health: By re-allocating to government ever more responsibility for what goes into our children's bodies, these programs sabotage the parent-child relationship - turning the federal government into the primary food source for school-aged children.

A far better approach to our nation's childhood-obesity problem would be to scale back these programs significantly and to reduce the number of children eating these largely unhealthy meals. Schools should be given more freedom to choose what to feed students, instead of given more instructions by an overly prescriptive federal government regarding what constitutes a "healthy meal." And parents need to be encouraged to take a greater role in their children's food decisions and eating habits - particularly teaching them about proper food portioning, the importance of activity and exercise, and self-control.

AMERICA THE BULGING?

Listening to Mrs. Obama, officials in her husband's administration, and other would-be nutrition gurus, one might be justified in thinking childhood obesity to be a disaster of gargantuan proportions. The rhetoric out of Washington has labeled childhood obesity both an "epidemic" and a "national security concern." The former head of the Centers for Disease Control and Prevention, Julie Gerberding, even compared obesity to a worldwide pandemic, saying: "If you looked at any epidemic - whether it's influenza or plague from the Middle Ages - they are not as serious as the epidemic of obesity in terms of the health impact on our country and our society."

There is of course some cause for concern: Over the past few decades, Americans - including children - have certainly gotten bigger. From 1976 to 1980, the CDC determined that the obesity rate among pre-school children was just 5%. By 2008, the rate had more than doubled, reaching 10.4%. For older children, the increase has been even more significant: In the late 1970s, the CDC found that the obesity rate among children aged 6-11 was 6.5%; by 2008, however, it had climbed to 19.6%. The rate for children between 12 and 19 years of age, too, more than tripled - from 5% to 18.1% over the same period. It is worth noting that in each of these categories, corporeal abundance seems related to material want: Children living in low-income households suffered from obesity in greater numbers than children living in high-income households.

Moreover, researchers point to the increased prevalence of health complications that they associate with the rise in childhood obesity. The CDC, for instance, notes that the increase in rates of diagnosis of diabetes in children over the past two decades is "among the most concerning aspects of the evolving diabetes epidemic." In 2002, in the American Heart Association's journal Hypertension, doctors Jonathan Sorof (of the University of Texas Medical School at Houston) and Stephen Daniels (of the University of Cincinnati College of Medicine) described "obesity hypertension in children" as "a problem of epidemic proportions."

But it is important to keep this problem in perspective. A study released in 2010 by the CDC and published in the Journal of the American Medical Association illustrates that obesity rates overall are no longer increasing, and that the rates of overweight and obesity among children have remained stable at around 32% and 17%, respectively, for ten years. Nor does the evidence bear out claims - like those made by Mrs. Obama - that children who are overweight today are more likely to develop health conditions as adults that will shorten their lives. A 2005 Scientific American article examined these claims and found it difficult to make the connection between obesity and mortality:

[J. Eric] Oliver [University of Chicago political scientist and author of Obesity: The Making of an American Epidemic] points to a new and unusually thorough analysis of three large, nationally representative surveys...that found only a very slight - and statistically insignificant - increase in mortality among mildly obese people, as compared with those in the "healthy weight" category, after subtracting the effects of age, race, sex, smoking and alcohol consumption. The three surveys - medical measurements collected in the early 1970s, late 1970s and early 1990s, with subjects matched against death registries nine to 19 years later - indicate that it is much more likely that U.S. adults who fall in the overweight category have a lower risk of premature death than do those of so-called healthy weight. The overweight segment of the "epidemic of overweight and obesity" is more likely reducing death rates than boosting them. "The majority of Americans who weigh too much are in this category," [Paul F.] Campos [professor of law at the University of Colorado at Boulder and author of The Obesity Myth] notes.

The CDC itself has had to do some much-publicized backtracking in recent years. In an embarrassing episode in 2004, the agency retracted a report stating obesity would lead to 400,000 deaths annually (the CDC blamed the number on a mathematical error). One year later, the CDC revised the number down to only 25,814 annual deaths - meaning their original estimate was off by a factor of 14. Despite the correction, the larger number is still often repeated by politicians, journalists, and activists as proof that obesity has reached epidemic levels in this country.

At times the CDC's own rhetoric on obesity still flatly contradicts its research findings. The agency's web site has a page dedicated to childhood obesity that states that, "...during their youth, obese children and adolescents are more likely to have risk factors associated with cardiovascular disease (such as high blood pressure, high cholesterol, and Type 2 diabetes) than are other children and adolescents." Yet the agency's own studies come to a very different conclusion. Each year, the CDC compiles general health data on American children; given that the obesity rate among children is about 17%, one might expect the statistics to show that a similar portion are unhealthy. But the CDC's latest report, titled Summary Health Statistics for U.S. Children: National Health Interview Survey, 2009, found that 84% of American children are in "excellent" or "very good" health, and only 2% of children are in fair or poor health.

Obesity is certainly one of a number of health concerns that affect our (generally very healthy) population of children. It deserves to be studied and addressed, but it must be understood in its proper context. Talk of an "epidemic" requiring dramatic government action to protect America's children is grossly overstated. So why are the first lady and other activists continuing to engage in exaggeration and fear-mongering?

UNCLE SAM'S KITCHEN

One answer is that such claims make it easier to lobby for more money for federal feeding programs. And these programs need all the extra justification they can get - because neither their history nor their current performance paints a picture of great success.

Today, the federal government provides multiple supplemental food programs administered by the U.S. Department of Agriculture. Originally designed in 1946 as a way to use up surplus agricultural output - the byproduct of bloated farm subsidies - these food programs are now massive government entitlement programs. They continue to expand each year, despite the consensus that obesity has replaced hunger as the major health problem facing both adults and children. Currently, the three main programs providing food to needy families are the Supplemental Nutrition Assistance Program (SNAP, more commonly known as food stamps); the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); and the school breakfast and lunch program.

While the majority of Americans have never used food stamps or WIC, nearly all Americans living today have some experience with government school lunches. Authorized by Congress in 1946, the National School Lunch Act created a nationwide feeding program that replaced the patchwork, Depression-era distribution system that had provided schools with surplus agricultural crops and meat, eggs, and dairy products.

The program began modestly, serving just over 7 million of the nation's 28 million K-12 students in its first year, at a cost of $70 million in 1947. Today - at a cost of $9.8 billion in fiscal year 2009 - the program feeds 31.3 million of the nation's 55 million K-12 students, in 80,000 of America's roughly 99,000 public schools (an additional 20,000 private schools and day-care facilities also participate in the federal program). According to the Congressional Research Service, of the 30.5 million students receiving school lunches in 2007, 49% got the lunches free, while 10% received reduced-price lunches. The remaining 40% purchased their lunches at full price, though the cost of the meals was still reduced by government subsidies.

The amount of the lunch subsidies is determined by family income. Children whose families earn below 130% of the federal poverty level (or below $28,665 a year for a four-member household) receive free meals. Children whose families earn between 130 and 185% of the federal poverty level (between $28,665 and $40,793 for a family of four) receive reduced-price meals. The remaining children - those who do not fall within the federal poverty guidelines - must pay the full price of their (still-subsidized) lunches.

Responsibility for administering the program is shared by the USDA's Food and Nutrition Service, state education agencies, and local school food authorities. Districts and schools that decide to take part in the program receive cash subsidies and food commodities donated by the USDA. The available quantities and market prices of surplus crops determine the food supplies that the USDA provides directly to schools; the agency also works with the Department of Defense and local farmers to provide fresh produce. Most of the program's support to schools, however, is provided through the cash reimbursements. According to the USDA, during this school year, school food authorities that serve less than 60% of their lunches at the free and reduced-price rates receive reimbursements of $2.72 per free lunch; $2.32 per reduced-price lunch, and 26 cents per fully paid lunch. Schools with higher poverty rates receive more per meal.

But school districts can receive subsidies for these meals only if the lunches adhere to a byzantine set of USDA-created national nutrition guidelines - rules that many people argue are confusing and overly prescriptive, and that ultimately lead to unhealthy food being put on kids' lunch trays.

An excellent example of this confusing set of regulations played out in real time on the ABC series Jamie Oliver's Food Revolution - a reality show documenting British celebrity chef Jamie Oliver's exasperating attempts to improve the meals that kids were being served in one Huntington, West Virginia, public school. Just before serving the healthy meal he had prepared - consisting of a vegetable pasta dish, baked chicken, and a fruit cup - the school administrator admonished Oliver for not having the required 1ΒΌ cups of fruits and vegetables the federal government required. She then told the camera ominously, "It's not a reimbursable meal." In other words, the school wouldn't receive the coveted per-meal subsidy unless the lunch followed federal guidelines. As a result, french fries were added to the tray to bring it back into compliance. A dumbfounded Oliver was then told that the USDA considers french fries a vegetable.

This episode - and the countless others that surely play out across the country away from reality-TV cameras - suggest that less government meddling, and fewer government minders, would probably yield healthier meals for schoolchildren. Yet it is precisely more government involvement, and an increase in the number of children eating government-provided school lunches, that the people who claim to be most concerned about school lunches want.

Their campaign builds on several past (and evidently not successful) efforts to use school lunches and other government programs to control kids' weight. Indeed, Mrs. Obama is hardly breaking new ground with the Let's Move campaign and her push to make school meals more nutritious: Congress has focused on this issue for more than a decade. In 1994, Congress passed the Healthy Meals For Healthy Americans Act, which required schools to meet the recommended daily allowance for calories and nutrients and required meals to be limited in fat. And in 1995, the USDA's Food and Nutrition Service established the Team Nutrition Initiative. This program involved, according to a GAO report, "grants to states and technical assistance materials for school food service personnel and classroom nutrition education materials as well as guidance and materials on how to build school and community support for healthy eating, physical activity, and a healthy school nutrition environment." Two other USDA programs - "Changing the Scene" and "Eat Smart. Play Hard." - also provide resources to schools on how to promote healthy eating and physical activity.

The Centers for Disease Control, too, funds healthy-eating and physical-activity programs in schools. According to the GAO, "in 2000, CDC initiated a grant program to support state health departments in developing and implementing nutrition and physical activity interventions"; three years later, CDC began providing support for "coordinated school health programs in 22 states that focused on promoting healthy eating behaviors, physical activity, and tobacco use prevention among students."

There has been, in other words, no shortage of federal programs aiming to improve nutrition through schools. And yet, despite millions of dollars and years of effort, kids stubbornly persist in eating bad food. The idea that more federal control - or more rules to govern the school-lunch program - would transform the habits and choices of American kids seems implausible, to say the least.

THE HUNGER HOAX

Another common justification for today's school-feeding regime is the claim that, without government school lunches, many kids would simply go hungry. For instance, last summer, AOL News ran a startling headline - "Record Number of US Kids Facing Summer of Hunger" - and painted a Steinbeckian scene of children spending the summer months "cadging leftovers from neighbors, chowing down on cheap junk, lining up with their families at food banks that are already overmatched or simply learning to live with a constant headache, growling stomach and chronic fatigue." The reason for the imminent starvation? According to the article, it was simply the end of the school year - and, with it, the gravy train of government lunches. The article quoted the USDA's undersecretary for food and nutrition, Kevin Concannon, describing the problem as a "catastrophe" and a "serious challenge."

But the real number of poor children facing serious hunger is extremely small. According to the latest census data, about 14 million children, roughly 19% of kids in America, currently live in poverty. Most of those children, through their parents, receive hundreds of billions of dollars ($30,000 per household) from federal and state anti-poverty programs, channeled through benefits like housing aid, food stamps, Medicaid, and school lunches. These benefits are not counted by the Census as income; accordingly, one 2006 study in the Journal of Economic Perspectives found that, if such government benefits were included in the amount of cash income per household, the poverty rate in America would drop below 10%.

A report issued last year by the USDA further supports the notion that very few Americans are actually going hungry. The study examined what the USDA calls "food security" in the United States - which the agency defines as "access by all people at all times to enough food for an active, healthy life." The report found that, in 2009, 85% of U.S. households were "food secure" throughout the entire year; 14.7% of households were "food insecure," but only "at least some time during that year."

Occasional food insecurity in even 14.7% of households might seem high; indeed, the USDA noted that the figure was the "the highest recorded prevalence rate of food insecurity since 1995 when the first national food security survey was conducted." And yet, as is generally the case in the emotionally fraught field of school feeding and child nutrition, there is more to the story than the conventional sad tale. In congressional testimony, Heritage Foundation fellow Robert Rector examined the numbers more closely. He explained:

[I]t is important to understand what "food insecurity" means....In 2008, around two-thirds of food insecure households experienced "low food security," meaning that these households managed to avoid any disruption or reduction in food intake throughout the year but were forced by financial pressures to reduce "variety in their diets" or rely on a "few basic foods" at various times in the year. According to the USDA, the remaining one-third of food insecure households (around 6 percent of all households) experienced "very low food security," meaning that at least once in the year their actual intake of food was temporarily reduced due to a lack of funds for food purchase....Poor children are generally shielded from food insecurity. Around one million children, or 1.5 percent of all children, experienced "very low food security" and reduced food intake at least one time during 2008. Around one child in 150 missed at least one meal in the preceding month due to food shortages in the household. One child in a thousand went a whole day without eating at least once during the year because the family lacked funds for food.

Of course, one of the greatest indicators that poverty does not necessarily mean hunger - and thus the need for government-subsidized meals - is the fact that the poor children who do receive school lunches are extremely unlikely to starve, and are actually more likely to be obese. Indeed, Kevin Concannon - the same USDA undersecretary fretting about the prospect of widespread hunger among poor children - is simultaneously concerned about low-income schoolchildren's high obesity rates, as he explained at an April 2010 hearing of the House Agriculture Committee (in which he testified about the need to boost funding for the school-lunch program).

Rather than having too little food, then, it seems poor children are receiving too much of the wrong food. And research confirms that much of that "wrong food" is being served to them in schools. A recent study conducted by the University of Michigan's Cardiovascular Center found that middle-school children who regularly eat school lunches are more likely to be overweight or obese, to develop poor eating habits, and to have high levels of "bad" cholesterol compared to those who bring lunches from home. Another study, published last summer in the Journal of Human Resources, confirms that school lunches are contributing to childhood obesity: The authors studied data from more than 13,500 students, and found that children who participate in the school-lunch program are more likely to become obese than those who don't.

What federal feeding programs need to focus on, then, is better targeting their distribution in order to reach truly poor and hungry children. As matters stand today, schools are feeding far more students than there are children who really need government-subsidized meals. Even if one uses the more inclusive U.S. Census data to measure need, one would expect about 15.5 million children - the number living in poverty - to rely on school lunches. But in fact, the number receiving lunches is about double that amount: More than 30 million children eat a subsidized school-provided lunch each day.

Activists are seeking to make the mismatch worse. Rather than ensuring that subsidized meals reach the kids who truly need them, proponents of school feeding want simply to bloat the program. The Healthy, Hunger-Free Kids Act - signed into law by President Obama in December - will create "enhanced universal meal access" by enrolling students automatically, using data from Medicaid and the State Children's Health Insurance Program, instead of requiring individual applications. The bill will also allow the USDA secretary to have "access to income and program participation information from public agencies administering the Medicaid program," and will require states to demonstrate that they are working to increase the rate of lunch-program enrollment.

So while the conversation about school lunches usually centers on the need to expand the program, what is rarely discussed - and what clearly needs to be addressed - is that these school-feeding programs are grossly mismanaged. They even face charges of fraud, due mainly to the lax oversight from the USDA - the agency charged with overseeing government child-nutrition programs.

In 2004, Congress gave the USDA $5 million to improve oversight of Child Nutrition Programs, but the problems have persisted. In 2005, for instance, USDA inspector general Phyllis Fong testified before Congress that major fraud and mismanagement had been identified in Philadelphia schools, resulting in excess federal reimbursements of more than $800,000 to the district. Fong also found problems in the New York City school-lunch program, noting that 69% of families applying for free meals under-reported their income so as to meet eligibility requirements. Similar problems were identified in Chicago, where nearly 27% of schools submitted inflated meal claims, over-claiming by a total of 642,102 breakfasts and lunches.

A 2007 USDA inspector-general report found that $860 million in improper payments resulted from meal counting and claiming errors in the school-lunch and breakfast programs during the 2005-2006 school year. In 2009, the General Accounting Office affirmed that accounting problems persisted - finding that neither states nor the USDA had taken adequate steps to address the fraud identified by earlier investigations.

Taken together, all of these issues - from the exaggeration of the "hunger epidemic," to existing fraud and mismanagement, to the fact that poor children eating school lunches are in fact more likely to be obese - suggest that some reconsideration of government feeding projects is in order.

EMPTY EXCUSES

The poor performance of school-feeding programs thus reveals a strange disconnect in the childhood-nutrition debate. The people who most aggressively promote a healthy diet - one rich in whole foods that are locally and organically produced (grown, if possible, in one's own back yard) - are generally the biggest cheerleaders for expanding government's influence over kids' nutrition. They are especially enthusiastic about school-provided meals - the same meals that are mass produced and overly processed, made with ingredients these activists would never dream of feeding their own children. Indeed, one would expect these foodies to be the people most vocally encouraging parents to provide home-packed lunches, rather than ceding the responsibility to strangers wearing hair nets. After all, if one is concerned about controlling food quality, it is impossible to improve on the quality control of one's own kitchen.

But while these two views on food - insisting that everyone consume only the most conscientiously produced food products, and promoting school-provided lunches - may seem inconsistent, they actually dovetail perfectly. Both emerge from the same ideology - which endorses controlling what other Americans eat, and the belief that government can do the job better than parents.

Generally, those promoting the healthy school-lunch agenda have little faith in other people's ability to feed themselves healthy food. Sympathetically, they offer a litany of reasons for why average people can't manage to supply their families with healthy meals. Among their favorites: People don't understand how to cook; people don't have time to cook; people can't read (or are confused by) food labels; people live in "food deserts" where healthy food isn't available; healthy food is simply too expensive.

Ubiquitous as these excuses for government intervention are, most of them don't stand up to scrutiny. Consider, for instance, the common claim that Americans are simply too busy to cook. Most parents work; kids are in day care; there are errands to run and bills to pay. How can American adults possibly be expected to pack lunches for their kids?

The truth, of course, is that making a lunch is perhaps the easiest and quickest job a parent has to do. Multiple healthy food items can now be found in single-serving packages: From protein items like cans of tuna (with attached crackers, mayo, and relish) and reduced-fat cheese sticks to applesauce, crackers, yogurt, celery sticks, and fruit, food manufacturers and marketers have certainly tapped into the busy-parent demographic. Even if a parent is forced to make a sandwich, it takes less than five minutes to put a piece of turkey between two slices of bread or to assemble a simple PB&J.

Then there's the claim that many families can't afford to send their children to school with prepared lunches. For them, the argument goes, feeding-by-government is absolutely essential. But the reality is that most poor parents are more than able to provide their children with home-packed lunches, thanks to the support these families receive from food stamps and other forms of government assistance.

To prove this point, the Associated Press recently challenged two chefs and a food editor to plan meals for a family of four for seven days. For their budget, they used the national average for a food-stamp allotment for such a family: about $69 a week. While the meals weren't fancy or complex, each of the participants was able to cook healthy meals within the guidelines (one chef did go over budget, but the food-stamp program is designed to supplement one's food budget, not account for it entirely).

On the popular blog Momlogic.com, writer Michele Ashamalla offered readers the results of a similar experiment to see how much she was spending on her son's packed lunch. She broke down the cost for what many would consider a generous meal:

First, the sandwich: two slices of bread (10 cents, if twenty slices in a $1.00 loaf); 2 oz. of deli turkey (38 cents, if on sale for $3.00 a pound); 1 slice of cheese (17 cents). Next, the fruit: a banana (15 cents for an average-size one, if bananas are 50 cents a pound) and a tangerine (26 cents for an average-size one, if selling at $1 a pound). Now the extras: a fiber bar (39 cents each for Target brand; box of six for $2.34) and a cookie (a splurge, I realize now - a Girl Scout Do-Si-Do, $4.00 for a box of 18, so a whopping 24 cents a cookie). Total price: $1.69.

Providing a lunch for $1.69 should be affordable for most families. And even if, for some impoverished families, it is not, that is an argument for making sure school lunches reach the children who really need them - not for indiscriminately expanding federal school-feeding programs.

Another common rationale for unhealthy eating is the preponderance of "food deserts": areas dominated by a plethora of fast-food restaurants, convenience stores, and gas stations, with little or no access to healthy foods like fresh produce. These food deserts are a particular hobbyhorse of Michelle Obama's - and yet the first lady rarely addresses why they exist in the first place.

The reason for her silence is simple. Food deserts exist because of the regulatory barriers put in place - largely by the sorts of liberal community groups beloved of the Obamas - to keep large corporations like Walmart and other grocery chains and big-box stores out of the inner city. These same activists (often those who insist that everyone should consume more local, organic, and high-quality food) will use a variety of initiatives - city referenda, zoning and land-use challenges, the issuance of development moratoria, and the use of store-size caps - to keep big-name stores out of the city, so that mom-and-pop stores aren't run out of business. For these activists - most of whom have the means to find fresh, healthy food beyond their neighborhoods, or to purchase it at a premium at a nearby organic-food supplier - the burden of keeping the chain stores at bay is worthwhile. But for poorer families without the resources to get to and shop at Whole Foods, the anti-big-box crusades simply leave them without any options for healthier eating.

Michelle Obama's answer to the problem, however, has been to recommend more government intervention. In 2010, the Obama administration announced a new government-grocery store partnership, the Healthy Food Financing Initiative, which, according to the Department of Health and Human Services, will spend $400 million a year to "bring grocery stores and other healthy food retailers to underserved urban and rural communities across America." Of course, the easier - and less expensive - way to resolve the problem of food deserts would be to eliminate bureaucratic red tape and allow market forces to operate freely. Large grocery chains would likely open franchises in urban areas, thereby offering low-cost fresh produce and other healthy food options to residents of the inner city.

Still another popular canard is the claim that people simply don't understand nutrition labels. The truth, however, is that informing oneself about nutrition is made easy in today's weight-conscious times. The federal government now requires that nutrition information be listed on most pre-packaged food items sold in stores. Those labels include suggested serving sizes, calories per serving, lists of ingredients, and the nutrients provided in each serving. Moreover, the internet, public libraries, and doctors' offices are filled to the brim with anti-obesity information; even popular TV programming features a constant stream of shows - from NBC's The Biggest Loser to MTV's I Used to Be Fat - intended to highlight the perils of being overweight.

The real issue, then, isn't information - it's choice. What people seem to forget is that unhealthy eating tastes good; potato chips are far more appealing than carrot sticks. As celebrity chef and author Anthony Bourdain once said while debating the safety of ground beef, "Let's not forget the pleasure aspect of this argument. People eat meat because they like it. It tastes good. It smells good when it's cooking."

It is this component of the obesity debate that the activists most frequently overlook. For all of the excuses they offer, they lose sight of the fact that eating unhealthy food is simply more gratifying - a truth that no amount of legislation or education will change. The situation facing America is not that many millions of citizens are incapable of feeding themselves well; rather, it is that people do not choose to make healthy eating a priority. And it is this exercise of personal freedom that is a sticking point with many food activists. Their failure to grasp and respect individual agency is perfectly in keeping with an agenda that would take away from citizens ever more authority over the sphere of private life - everything up to and including how one feeds one's own children - and place it instead in the hands of government.

A RETURN TO PARENTING

The best response to this harmful worldview is for parents to step up and reclaim responsibility for the health of their own children. The good news is that studies show there are some easy ways to achieve this objective.

Last year, Ohio State University researchers released a major study on childhood obesity that found that children are likely to have a lower risk of obesity if they do three simple things at home: eat dinner with their families more than five times a week, get at least 10.5 hours of sleep per night, and watch two or fewer hours of television on weekdays. Published in the March 2010 issue of the journal Pediatrics, this was the first study to review the impact of all three activities on children in a national sample of pre-schoolers. Of the 4-year-old children whose households did not practice all three routines, 24.5% were considered obese. In households where all three habits were practiced, only 14.3% of children were obese. These routines were found to reduce the likelihood of obesity even among children at high risk of the condition (for reasons like having a family history of obesity, being raised in a low-income household, or growing up in a single-parent home).

A 2007 study from Northwestern University yielded similar results, finding that inadequate sleep put children between the ages of 3 and 18 at greater risk of being overweight. The researchers discovered that just one extra hour of sleep helped to reduce the risk of being overweight from 36% to 30% for young children.

These studies suggest that the key to controlling childhood obesity really has little to do with schools or feeding programs. Rather, the most important part of the solution is hands-on parenting. And in an ironic twist, it is Michelle Obama - the biggest cheerleader for giving government more control over kids' eating - who has offered some of the most poignant explanations of the importance of parental responsibility in keeping children healthy.

In July 2010, for instance, Mrs. Obama delivered a speech before the National Association for the Advancement of Colored People, in which she equated the fight against fat to the civil-rights movement of the 1960s. She spoke affectionately of the community in which she spent her childhood, where the kids "had to walk to and from school every day, rain or shine." She explained that when she was growing up, "there was no way we'd be allowed to lie around the house watching TV"; parents, she noted, "made us get up and play outside...riding bikes, playing softball, freeze tag, jumping double-dutch." The first lady explained that her family rarely ate out, adding that, "even when both parents worked outside of the home, most families in my neighborhood sat down at the table together as a family for a meal." And she cited her own mother as an example of why parents are so important in helping children form good eating habits:

[I]n my house, Marian Robinson's house, we ate what we were served. My mother never cared whether me or my brother liked what was on our plates. We either ate what was there or we didn't eat. It was as simple as that. We never ate anything fancy, but the portion sizes were reasonable and there were rarely seconds - maybe for your father, but not for you. And there was always a vegetable on the plate...[T]here was no expectation of dessert after our meals. And we didn't dream of asking for soda or pop. That was for special occasions.

In caring for her own girls, Michelle Obama seems to be no less attentive. Prior to kicking off the Let's Move campaign, Obama made several speeches and media appearances in which she cited her daughters' brief weight struggles as an example of how parents might deal with the issue in their own homes. After being told by Sasha and Malia's pediatrician that "something was getting off balance," Mrs. Obama decided that she needed to get more involved - by making small but significant changes to the girls' diets, and requiring her daughters to watch less television and get more exercise. After her intervention, Mrs. Obama reported, the girls' weight got back under control. Yet strangely, the first lady doesn't seem to believe that other American parents are capable of achieving the same turnarounds with their own children - at least not without the federal government assuming a major supporting role.

Here, Mrs. Obama is missing an enormous opportunity. There is perhaps no bigger megaphone than the one held by the president and first lady; the issues they care about are granted immediate cachet - a cachet that can move their fellow citizens to make better decisions. Plus, Michelle Obama isn't just the first lady. She's a mother, too, and the example of her involvement in her daughters' eating and wellness - what most would simply call "good parenting" - is probably the greatest contribution she can make to the issue of child health in America. Far more than soda taxes, sugar and salt bans, and highly regulated school lunches, the reform that could make the biggest difference in kids' diets is fostering a renewed sense of responsibility among American mothers and fathers. While Mrs. Obama does promote parental involvement, her message is often diluted by her repeated calls for expanding the school-lunch program. Indeed, her insistence on more bureaucracy is actually counterproductive, because it encourages parents to cede this unique and crucial responsibility - feeding their own children breakfast and lunch - to the federal government.

Of course, the first lady hardly deserves all the blame. Public-nutrition activists should consider the contradictions inherent in their positions, as well as the effects that their preferred policies would have on American children. Instead of pushing for more of the sorts of federal programs that have actually made kids less healthy over the years, they should encourage parents to declare their independence from government feeding programs, and help educate families about how they can provide children with meals that are simple, economical, and nutritious.

Additionally, Washington should pull back its control of school lunches and allow for a more federalist approach. There is no reason for states and individual school districts - many with school boards accountable to voting parents - not to have more freedom to choose how they will feed students. These local officials are certainly capable of determining what will work in their own communities: A 2003 GAO report on the national lunch program, which examined marketing efforts and menu alterations undertaken at the individual school level, demonstrated that school principals, administrators, teachers, and cafeteria workers - not distant USDA bureaucrats - are the best arbiters of what foods will sell, what kids like to eat, and how best to serve them "healthy" food. The GAO investigators reported:

In most of the SFAs [school food authorities] that we visited, officials had taken a number of steps to improve the nutritional quality of the food. For example, some food service officials had modified the recipes of several foods that are popular with students, such as enchiladas and macaroni and cheese, to make them more nutritious yet still appealing to student palates. Their techniques included baking rather than frying, reducing salt usage, and substituting low-fat ingredients wherever possible, such as in gravies, cheese sauces, and salad dressings....Researchers reported that when the number of healthy entrees was increased, the percent of students purchasing them increased and has stayed higher than pre-intervention levels.

Federal policymakers should also consider restoring the National School Lunch Program to its original purpose, so that only those students who absolutely need school lunches receive them. Recently, the Government Accountability Office praised the Department of Agriculture for focusing on errors related to the certification of children for free and reduced-price meals. But the federal government has not seriously considered scaling back the program so that only those children living below the poverty line receive school meals. The USDA might consider a gradual phasing-out plan, in which parents would be notified that students from families above a certain income bracket will henceforth be required to bring their lunches, and will no longer be provided with meals by their schools. Students who now qualify for free and reduced-priced meals would continue to receive the school lunches.

It is also essential that better accounting controls be included in all government child-nutrition programs, in order to reduce the fraud, waste, and abuse that cause millions of taxpayer dollars to be misspent each year. The Government Accountability Office reported last year that improper payments due to lunch counting and claiming errors (when the cashier erroneously categorizes a meal for reimbursement) totaled approximately $860 million during the 2005-2006 school year. Solving this problem does not require additional congressional action: The USDA's office of Food and Nutrition Service already evaluates each state's oversight of school meal programs. According to the GAO, however, "these evaluations do not directly focus on identifying and addressing meal counting and claiming errors." In addition, the GAO reports that the USDA has not updated its guidance to states on counting and claiming procedures in nearly 20 years. The secretary of agriculture should make the proper administration of the National School Lunch Program a priority by requiring the Food and Nutrition Service to review processes and include oversight of state accounting errors. In addition, the USDA should update its guidance to states.

THE RESPONSIBLE AMERICAN

Reforms like these would make a difference, but ultimately the most important intervention would be the one that President-elect Kennedy identified in "The Soft American." He wrote:

But no matter how vigorous the leadership of government, we can fully restore the physical soundness of our nation only if every American is willing to assume responsibility for his own fitness and the fitness of his children. We do not live in a regimented society where men are forced to live their lives in the interest of the state. We are, all of us, as free to direct the activities of our bodies as we are to pursue the objects of our thought. But if we are to retain this freedom, for ourselves and for generations yet to come, then we must also be willing to work for the physical toughness on which the courage and intelligence and skill of man so largely depend.

The challenge of childhood obesity, then - like so many challenges facing the nation today - demands the same remedy that has helped America overcome obstacles throughout our history: fostering, calling upon, and trusting in the character and sense of responsibility of individual citizens.

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