Solving the national obesity problem is not so simple

I have some burning questions, and I need your help finding solutions:

  • Why are so many of our community members struggling with their weight and obesity-related illnesses?
  • How can we help them get healthy and active?
  • Are we even asking the right questions to solve the growing nationwide obesity problem?
  • Do we need more grocery stores that sell fresh produce, or is the challenge really about better health and nutrition education?

The answers may be complex. Here are some of my favorite points from leading obesity experts:

Cost of Healthy Food

From 1985 to 2000, the prices of fresh fruits and vegetables rose 40 percent, while prices of fats and soft drinks decreased by about 15 percent and 25 percent, respectively, noted Arielle E. Traub, a senior systems analyst at the New York City Health and Hospitals Corporation in a report (PDF) she wrote for the Johns Hopkins Bloomberg School of Public Health. Researchers have found that energy-dense foods (those that contain the most calories per gram, which is to say sweets and starchy foods) — are far less expensive than low-energy and nutritious foods like fruits and vegetables. In fact, measured on a per-calorie basis, they are one tenth the price.

Food Deserts

U.S. Department of Agriculture (USDA) definition of a “food desert” is any census district where at least 20 percent of the inhabitants are below the poverty line and 33 percent live more than a mile from the nearest grocery store (or in rural areas, more than 10 miles). Approximately 23.5 million Americans live in a food desert, says the USDA, including large, rural areas of West Virginia, Indiana and Montana, as well as cities like Detroit, Chicago and New York. Research on access to supermarkets has focused on distance from home but does not account for routine daily travel. A University of Washington study (PDF) found that only 15 percent of people go to a grocery store in areas close to their homes, and most households (93 percent) in food deserts have access to a car, and can easily drive to grocery stores over a mile away. There is also a debate about whether supermarkets in poor neighborhoods are selling produce that is too costly and of poor quality. “Not all grocery stores are equal,” said John Weidman, deputy executive director of the Food Trust, an advocacy group in Philadelphia.

Food Swamps

Many Americans simply like fast food better. The Week reported on a recent University of North Carolina study of the eating habits of 5,000 people over 15 years that found living near a supermarket had little impact on whether people had healthy diets. But living close to fast-food outlets did make a difference. The real problem, the study found, is the existence of “food swamps,” filled with convenience stores selling calorie-dense processed foods, gallon containers of soda and other sugar-loaded beverages, and fast-food chains selling burgers, fries and fried chicken on almost every street corner. In fact, there are now five fast-food restaurants for every supermarket in the U.S.

It Tastes Weird

There is also evidence that people who are accustomed to fast-food diets find fresh food “bland, strange, and off-putting.” Unfortunately, “it’s simplistic thinking that if you put fruits and vegetables there, they’ll buy it,” said Barry Popkin, author of the UNC study. “You have to encourage it, you need advertising, you need support.” Changing Americans’ diets, in other words, won’t be as simple as telling them to eat their peas.

The Solution Is Complex

“It is always easy to advocate for more grocery stores,” said Kelly D. Brownell, director of Yale University’s Rudd Center for Food Policy and Obesity. “But if you are looking for what you hope will change obesity, healthy food access is probably just wishful thinking.”

While access to fresh food remains a significant barrier for many low-income people around the country, how the USDA defines “food deserts” may focus only on access and ignores the other important factors that influence what people buy and eat, like food prices, preparation time and knowledge, marketing, cultural practices and taste, and general levels of education. Education is key. Just as the problem of obesity is connected to poverty, it is connected to education. One of the most consistent predictors of health, including reduced obesity, is higher maternal education. This has been found across cultures.

Through programs like our Cardiovascular Outreach Prevention Program and Camp FRESH, Christiana Care Health System is working to teach community members how to make healthier selections in the grocery store and at fast food restaurants. We are educating people about how to easily prepare affordable, healthy food, and why it is so important to do so.

Will these programs ultimately reverse the trend of the ever-increasing obesity epidemic? We hope so. What do you think?