I was finishing up some grocery shopping when I heard a small voice yell, “Yummy!” This was followed by the sound of running and a shriek of joy from a 7-year-old boy skidding to a stop in front of a display case. I turned around and saw a set of shelves with a well-organized array of chocolate-covered candied apples (marked down 50%) and, in the same display, a few trays of blueberries. Fully-expecting the youngster to gravitate to the sweet treats, I was amazed when he went straight to the blueberries, picked up a tray, lifted it to his nose, and took in a deep breath. The joy on his face was beyond description. 

Needless to say, I was impressed. A few seconds later, his father arrived with a shopping cart. I hesitated but couldn’t resist commenting to his dad about the youngster’s reaction to the blueberries. He smiled and told me that the kid loved fruit and rarely ate sweet treats. As if on cue, the little boy, who had run off after dropping the blueberries into the cart, came back with a large bag of apples. 

In October 2017, the CDC reported that the prevalence of obesity in 2015-2016 was 39.8% for adults and 18.5% among youth and that there are statistically significant variances based on education, race, and geography. The United States spends approximately $147 billion per year (based on 2008 US dollars) on medical costs associated with obesity – which translates to $1,429 per year higher than non-obese people. Beyond the direct financial costs are the human costs in terms of mortality and morbidity from obesity-related medical conditions – diabetes mellitus, cardiovascular disease, stroke, some cancers, and orthopedic issues.

What can we do about it? Clearly, this young person’s family – and I’m sure his own preferences – are leading to healthy choices which bode well for his risk of obesity. Individual (and family) responsibility is, of course, part of the solution. And, community-based initiatives can help educate, inform, and encourage (or nudge) better choices.

For several years, I was privileged to serve on the Board of The Horizon Foundation in Howard County, Maryland. One key initiative of the organization was called Howard County Unsweetened – an effort to help reduce childhood obesity through reducing consumption of sugar-sweetened beverages. The success of the program was documented in a peer-reviewed paper published in the Journal of the American Medical Association in 2017.

Regular soda sales decreased by 19.7%, fruit drink sales decreased by 15.3%, and juice sales decreased by 15.0%, changes significantly larger than those observed in the control stores.

The organization continues to monitor the effects of the program on equity and is evaluating the prospect of legislation to help further reduce the prevalence of obesity.

In the end, the risk of obesity starts at the beginning – in early childhood. The American Academy of Pediatrics published an excellent monograph about promoting healthy weight.  The first paragraph of the paper summarizes the overall approach:

Maintaining a healthy weight during childhood and adolescence is critically important for children’s and adolescents’ overall health and wellbeing, as well as for good health in adulthood. A child’s or adolescent’s weight status is the result of multiple factors working together—heredity, metabolism, height, behavior, and environment. Two of the most important behavioral determinants are nutrition and physical activity. How much and what a child or adolescent eats and the types and intensity of physical activity she participates in can affect weight and therefore overall health. A balanced, nutritious diet and regular physical activity are keys to preventing overweight and obesity.

As for the young man in the grocery store, he seemed somewhat confused when I complimented him on his choice of fruit because for him there wasn’t really a decision to be made! I hope he is able to maintain that approach to healthy eating and can influence others along the way.