An Alternative to Outlawing Sodas - Opinion Piece

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Our national health status is in imminent danger from the effects of a

condition that most population health experts acknowledge is out of control.

I am speaking of obesity -- and, in particular, its increasing prevalence in

American adolescents and children.

Almost every study that has been done concerning obesity shows a correlation

with soda consumption. As a result, some states and municipalities have

tried to implement initiatives that make it more difficult (or expensive)

for people to purchase sugary soft drinks.

Even President Obama has " weighed in " on the topic. He was quoted as saying

that such initiatives were worth putting on the table as Congress debated

healthcare reform.

I have asked guest columnist, Diane Abatemarco, PhD, MSW, associate

professor and director of doctoral programs here at the Jefferson School of

Population Health, to react to the initiatives that have appeared in the

national media and to share her experience with an innovative program aimed

at reducing childhood obesity -- a program that engages physicians and

features " carrots " as well as " sticks. "

Dr. Abatemarco worked with the innovators of the program to implement and

evaluate it at three family medicine centers in western Pennsylvania.

Those in positions to fashion health policy should take note.

Dr. Abatemarco writes:

*In March of this year, the mayor of Philadelphia proposed a tax on

sweetened beverages such as soda, energy drinks, and bottled teas. Months

later, the mayor of New York sought federal permission to bar the city's 1.7

million food stamp recipients from using food stamps to buy soda or other

sugared drinks.*

*Whether you agree with these controversial legislative actions or not,

public health professionals and researchers agree that obesity among the

nation's youth is an epidemic.*

*More and more children, ages 9 to 12, have health issues related to

overweight and, while most children see their pediatrician or family

physician yearly, there has been no decrease in the rate of weight gain

among children.*

*The real question before intervening with children and their families is

" Whose job is it to tell parents that their child is overweight, obese, or

morbidly obese? " *

*R**esearchers have found that some physicians are uncomfortable bringing up

the subject of children's weight because, quite often, the parents are

overweight as well.*

*Other physicians may be reluctant to discuss the topic because they do not

want to make their patients feel uncomfortable.*

*Adding to the problem, we have yet to figure out how to deliver educational

messages about nutritional alternatives to typical inexpensive fast foods.*

*But interventions such as *Fitwits MD* have shown promise in the pilot

phase of testing.*

*Developed by researchers , at Carnegie Mellon University, and

Ann McGaffey, MD, of the University of Pittsburgh, and directed at

physicians, *Fitwits MD* is a brief educational intervention that includes

physician tools, children's games, food recipes to share with parents, and

tips to help change family behavior.*

*Pilot data showed that the 50% of physicians and residents who adopted the

intervention used it for the majority of well-child visits.*

*Qualitative data from the participating physicians showed that the tool

facilitated discussions with the child and the family regarding weight, BMI,

nutrition, and exercise.*

*Participating physicians reported that spending a few extra minutes on the

subject seemed to make a meaningful contribution to the child's and family's

welfare.*

*The physicians also reported personal feelings of confidence and

competence.*

*The intervention also changed physician beliefs about why patients are

overweight and about patients' resistance to making needed behavior changes.

*

*In post-intervention interviews, participants reported that the real

barriers are the lack of convenient places to buy inexpensive healthy foods

and the lack of safe environments for children to play and enjoy physical

activity.*

*If we are to turn the tide on childhood obesity and chronic illnesses that

result from overweight, we need more brief medical interventions that

include appropriate health literacy and easy-to-adopt behavioral changes.*

*Clinical transitional research can be used to inform practice change as the

science of nutrition and excessive weight gain is translated to " real life "

experiences.*

*The bottom line is that, if we want to move healthcare toward holistic

prevention, we must assist primary care physicians in taking on these

important issues without overburdening or overextending the office visit.*

Fitwits MD is part of a larger project designed to change the way we think

about nutrition, exercise, and portion size. Featuring characters that

embody healthy foods (Fitwits) and nonhealthy food choices (Nitwits), the

project has school and community components as well.

To read more about the intervention and its ideas on improving the health of

American children, visit

http://www.cmu.edu/homepage/health/2009/spring/fitwits.shtml.

--

Ortiz, MS, RD

*The FRUGAL Dietitian* <http://www.thefrugaldietitian.com>

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