From The Field S E P T E M B E R 1 5 , 2 0 1 5 Help All Children Grow Up at a Healthy Weight JOHN LUMPKIN, M.D., M.P.H. Senior Vice President, Robert Wood Johnson Foundation N early a decade ago, the Robert Wood Johnson a relentless rise from the 1980s to early 2000s, the Centers Foundation (RWJF) announced that it would for Disease Control and Prevention’s “gold standard” commit $500 million toward the cause of preventing National Health and Nutrition Examination Survey now childhood obesity. The foundation also set an ambitious goal finds that childhood obesity rates have plateaued among for ourselves and for the nation: to reverse the childhood adolescents and are declining among two- to five-year-olds obesity epidemic by 2015. (Figure 1). It was never a solo effort. We were joined by parents, local • Cities and states that take a comprehensive approach officials, funders, nonprofits, industry leaders, and others report the biggest gains. Communities that were among the working for change. Together, we were determined to create first to take on this challenge are reporting significant declines in healthier communities throughout the United States and childhood obesity rates. Early successes are coming from all over prove that obesity is not our destiny as a nation. ↓11.6 percent), California (↓1.1 percent), New York City the country, including Mississippi (childhood obesity rates More than halfway through 2015, we are seeing real signs of progress, but not nearly enough. To torture an already (↓5.5 percent), Philadelphia (↓4.7 percent), and Lincoln, overused football analogy, we have brought the ball down the Nebraska (↓8.2 percent) (RWJF 2015). field with the end zone finally in sight. It would be foolish to punt; now is the time to recommit, make strategic adjust- • Industry leaders are joining the movement. Although ments, and dig deep for that final push to the goal line. industry practices remain far from ideal, many leaders are working to be part of the solution. For example, in 2010, 16 SIGNS OF PROGRESS ON CHILDHOOD leading food and beverage companies pledged to remove a OBESITY total of 1.5 trillion calories from the marketplace by 2015 (Ng et al. 2014). According to independent evaluations The evidence of progress is strong and unmistakable. conducted by highly respected public health researchers, • Childhood obesity rates have stopped rising and may be those companies shattered their own goal, cutting a total of declining among the youngest age groups. After reporting 6.4 trillion calories, three years ahead of schedule. FIGURE 1: PREVALENCE OF CHILDHOOD OBESITY (BMI > 95 TH ), 1963-PRESENT 20% 16% Ages 12 to 19 12% Ages 6 to 11 8% Ages 2 to 5 4% 0% 1963-70 1971-74 1976-80 1988-94 1999-2000 2003-06 2007-08 2009-10 2011-12 Source: Ogden et al. 2002, 2008, 2010, 2012, 2014 These signs of progress are exciting and reflect a broader • Make a healthy school environment the norm and not cultural shift that values being healthy and having access to the exception across the United States. When supported healthy choices. Slowly but surely, we are moving toward a by parents, teachers, and administrators alike, well-designed Culture of Health. RWJF’s overarching goal is ensuring that school-based initiatives have been proven to help children such a culture takes hold in every community in the United maintain a healthy weight. Over the next 10 years, we will States. work to bring these best practices to scale. But we are not there yet. • Make physical activity part of the everyday experience Progress to date has not been shared equitably among our for children and youth. Getting up and moving around children and communities. In too many places, gains have should be a fun and routine and part of life, whether chil- been concentrated in upper-income neighborhoods and dren want to join a competitive sports league or just take a among white families. In New York City, for example, walk in the park. We will work with public and private obesity prevalence among white middle schoolers is down 2.2 sector partners to create demand for opportunities to be percent, but it has declined only 0.4 percent among African physically active in schools and neighborhoods and to Americans (Berger et al. 2011). Results like these are discour- ensure that physical activity programs and infrastructure are agingly common, but there are inspiring exceptions. In available in all communities. Philadelphia, for example, obesity prevalence has declined 7.6 percent among African-American boys, compared to 6.8 per- • Eliminate consumption of sugar-sweetened beverages cent among whites (Robbins et al. 2012). Philadelphia has among zero- to five-year-olds. Toddlers should never proven that interventions to help children maintain a healthy consume sugar-sweetened drinks—whether full-calorie weight can also help to eliminate health disparities. sodas, energy drinks, or “juice” drinks with sugar added Even if obesity rates have stabilized, they remain far too (and frequently, very little juice). Together with parents and high. Approximately 25 million children in the United other partners, we will work with both for-profit and non- States—nearly one in three children—remain at risk for high profit child care providers to establish the norm that water, blood pressure and type 2 diabetes. If current trends con- unsweetened milk, and 100 percent juice in appropriate tinue, this generation of young people may be the first in U.S. serving sizes are the only acceptable beverages for young history to live sicker and die younger than their parents’ gen- children. We will also work to raise awareness among eration. That outcome is unacceptable to our foundation, and parents about the health risks of sugary drinks. it should be unacceptable to every parent, elected official, and • Make healthy foods the affordable, available, and desired health funder in the nation. choice in all neighborhoods. We are committed to Recognizing that the scope and pace of progress were insuf- eliminating food deserts once and for all, using Fresh Food ficient to meet our goals, RWJF announced a second $500 Financing Initiatives, farmers market “double bucks,” and million commitment to this cause earlier this year, with a new other incentives to increase fruit and vegetable consumption 10-year goal of helping all children grow up at a healthy among low-income families. Fundamentally, we believe that weight, no matter who they are or where they live. This com- every parent should be able to find healthy, delicious, and mitment is part of our broader vision for building a Culture affordable foods in their communities, every day. of Health in every community—a culture that puts health first and surrounds children and families with opportunities We believe that if our nation can achieve these five goals, it to make healthy choices every day. will help all children grow up at a healthy weight, no matter Over the next 10 years, our work to help all children grow who they are or where they live. And, it will bring our nation up at a healthy weight will focus on five core strategies: significantly closer toward the goal of building a Culture of • Ensure that all children enter kindergarten at a healthy Health that will benefit generations to come. weight. The evidence tells us clearly that when children We are excited by the possibilities but are also aware of the enter school at a healthy weight, they are more likely to limits of what any single organization can achieve. Everyone maintain that healthy weight into adolescence and adult- has a role to play in helping our children achieve a healthy hood. To help children get the healthiest start possible, weight: parents, youth, community leaders, industry leaders, RWJF plans to intensify our work with pre-school and faith leaders, and more. Philanthropies can also play an early child care providers, and engage health care practi- important role in catalyzing change at the local and national tioners in a broad campaign to communicate with parents level, and I hope grantmakers will embrace that role. about how to introduce healthy habits in the home—even before their babies are born. 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