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Protecting Our Future by Reducing Childhood Obesity

  • Kids spend an average of 7.5 hours a day watching TV, playing video games, or on the Internet.
  • Access to affordable, healthy and nutritional food can be challenging for parents.
  • UnitedHealthcare has joined forces with the President and First Lady to help all kids become healthier, helping to reverse the trend of childhood obesity.

Changes for the worse

It's no coincidence that the rise in childhood obesity has occurred during the same time period that American lifestyle habits have changed dramatically. Thirty years ago, most kids got plenty of exercise as a natural part of their daily routine. That included walking to school, running around at recess, going to gym class, and playing outside when they got home. Today, most kids get a ride to school. Many gym classes and sports programs have been cut. And after-school activities typically involve watching TV, playing video games or going on the Internet. Now, children 8 to 18 spend an average of 7.5 hours a day using entertainment media, and only one-third of high school students get the recommended level of physical activity.

Children's diets have changed, too. These days, enjoying dinner together as a family tends to be a rare occasion. Home-cooked meals, served with vegetables and a glass of milk or water, have been replaced with fast food meals served with a side of french fries and a soft drink—usually large. That's because portion sizes have increased dramatically. So has the intake of high-calorie snack foods. In fact, on average, Americans now consume 31 percent more calories than we did in the 1970s, including 56 percent more fats and oils and 14 percent more sugars and sweeteners.

A matter of balance
It comes down to calories in versus calories out. When people take in more food calories than they expend in their daily activities, they gain weight. Conversely, if they eat less, or exercise more, so that they burn more calories than they consume in a typical day, they'll lose weight. With the right dietary balance, most people can maintain a healthy weight.

Eat healthy and exercise. That sounds simple enough. But, in practice, the realities of daily life make it much easier said than done. And as hard as it is for most people, it's even harder for those who live in areas with limited access to fresh, good-quality meats, produce and dairy products.

It's hard to grow in a food desert
It was researcher Mari Gallagher who coined the term "food desert" to describe large, contiguous areas with little or no access to mainstream grocery stores. In real deserts, water is scarce. In food deserts, it's healthy food that's scarce. What fresh fruits and vegetables are available tend to be in limited supply, of lesser quality and higher priced.

It is estimated that 10 percent of the population, or 31 million people, across the nation live in a food desert. Although food deserts exist in rural and suburban areas, the problem is most often associated with densely populated areas in our inner cities. Typically, these neighborhoods have a higher concentration of ethnic minorities and low-income households headed by single women with children. Often lacking transportation, these residents are forced to shop for food in their immediate vicinity. Unfortunately, in a food desert, the choices are limited to fast food restaurants and "fringe" stores that tend to sell less healthy foods that are highly processed, high in sugar and low in nutritional value. In an analysis of food deserts in Detroit, Mari Gallagher determined that, even among stores that were approved by the USDA to accept food stamps as part of the Supplementary Nutrition Assistance Program, only 8 percent were truly mainstream grocery stores. The other 92 percent were, more accurately put, fringe providers like liquor stores, gas stations and convenience stores.

On a more positive note
In the original study of neighborhoods in Chicago, Mari Gallagher concluded that the city's food deserts could be completely eliminated with just 10 mainstream grocers located in key strategic sites. And some progress has been made in the years since. In a follow-up report published in 2009, she estimated that the Chicago food desert had shrunk by 1.4 square miles, or roughly 220 city blocks, and the affected population dropped from 632,974 to 609,034. Now, in the latest figures, she quotes the number to be 550,382. However, even small changes can make a big difference.

"Years of Potential Life Gain" is another key measurement Mari Gallagher developed to calculate the years of life that could potentially be gained by a community collectively if a new grocery store were established in an underserved area. Applying this metric to the Roseland community, on Chicago's far south side, showed that more than 24,000 residents would benefit and the community as a whole would gain 15 years of life back from diabetes, 58 years of life back from diet-related cancers, 112 years of life back from cardiovascular disease, and 13 years of life back from liver disease.

All the way up to the White House
So critical is the problem that First Lady Michelle Obama has made fighting childhood obesity her personal mission. In 2010, she launched Let's Move!, a comprehensive initiative with the ambitious goal to solve the problem within one generation. President Obama brought the full weight of the federal government to support the cause, by creating the first-ever Task Force on Childhood Obesity to review all governmental programs and policies relating to child nutrition and physical activity, and to develop a national action plan to work toward achieving the First Lady's goal.

The Task Force recommendations help support the five pillars of the First Lady's Let's Move! campaign, which are: 1 creating a healthy start on life from pregnancy through early childhood; 2 empowering parents and caregivers; 3 serving healthier food in schools; 4 improving access to healthy, affordable foods; and 5 increasing physical activity.

These five pillars are directly aligned with a number of new and innovative programs UnitedHealth Group is already implementing to help reverse the trend of childhood obesity in the communities we serve. 

First Lady Michelle Obama has officially declared the goal to solve childhood obesity within a generation. To succeed in that challenge will mean reducing current obesity rates to the equivalent levels of the late '70s—and doing it by 2030. Although no single program will by itself solve the problem, it is clear that concentrating efforts on improving eating habits and increasing physical activity is the key to achieving the greatest gains in the shortest time.

In a bold move that symbolizes the dramatic changes required, Ms. Obama recently introduced a new graphic icon to replace the long-standing, often misunderstood food pyramid. The new visual concept, called MyPlate, shows a stylized plate divided into four quadrants of varying sizes to demonstrate not only the ratio of meat and dairy to fruits and vegetables, but also to accurately depict the size of responsible portions.

A growing problem
Studies show that approximately one in five children are overweight or obese by the time they reach their sixth birthday, and over half of obese children become overweight at or before age two. It's a problem that starts young and continues to grow, because overweight and obese children are more likely to become obese adults. In fact, one study found that obese 6- to 8-year-olds were approximately ten times more likely to become obese adults.11 That's not a future to look forward to, because obesity significantly increases the risks of suffering many chronic and debilitating diseases, including type 2 diabetes, heart disease, some forms of arthritis and several cancers.

There is a critical need for more effective education and new programs to train people to adopt healthier eating habits. UnitedHealth Group is already exploring ways to reach large populations of children throughout all the years of childhood and to help them establish healthy habits that will set them on the right path to enjoy a longer life and better health.

Childhood obesity and childhood hunger go hand in hand
According to the most recent U.S. Department of Agriculture data, nearly 50 million Americans do not regularly get enough to eat.13 The term "food insecurity" describes households where there is a lack of access to enough food to fully meet basic needs at all times, due to lack of financial resources. Today, 17 million American children (nearly 1 in 4) are affected by food insecurity, and more than half are younger than 6 years old.

It may seem contradictory that a lack of food is linked to higher incidences of obesity. However, food insecurity tends to be cyclical, and it could be that families substitute cheaper, less nutritious foods when resources are low and then overindulge when food is more plentiful. According to the U.S. Census Bureau, there were 43.6 million people living in poverty in 2009, which was the highest number in all the 51 years that estimates have been published. A record number of people currently need help from food assistance programs, too.

How to eat on Sesame Street®
In 2010, UnitedHealth Group established a partnership with Sesame Workshop, the nonprofit educational organization behind Sesame Street, and The Merck Company Foundation to launch Sesame Street Food for Thought: Eating Well on a Budget™. This bilingual educational outreach program targets low-income families with children ages 2 to 8, to help them make food choices that are affordable and nutritional and to set the foundation for lifelong healthy habits.

The centerpiece of this initiative is an information kit that includes an original DVD starring the Sesame Street Muppets in a short documentary that demonstrates a variety of strategies for maintaining healthy eating habits with limited financial resources. The kit also includes child-friendly recipes, activity cards and a parent/caregiver guide with information about healthful eating and ways to make nutritional and economical food choices for the entire family.

To date, Sesame Street Healthy Habits for Life information has been mailed to over 2 million members in the 25 states and Washington, D.C., where UnitedHealthcare Community Plan operates. Bilingual, Healthy Tips flyers, posters and activity sheets were provided at the more than a thousand Sesame Street Reading Corners donated to Federally Qualified Health Centers. The information is also distributed to other low-income and vulnerable populations via the Web, through physician mailings and at numerous community health events.

This innovative program gained widespread acclaim and was featured in over 800 news stories in publications ranging from Newsweek to Parents magazine and in national television coverage on ABC's Good Morning America, CBS's Morning Show and CNN. Our partnership is further reinforced by UnitedHealthcare's current sponsorship of the 41st season of Sesame Street, which runs through September 2011 and reaches 6 million Sesame Street viewers each week in the 98 percent of American household that have access to PBS.

Finding common ground
Food unites us all. But as a culture, it seems we have collectively lost the skills to prepare good, nutritious food. Common Threads is an organization that teaches low-income children to cook wholesome and affordable meals through hands-on cooking classes. At the same time as it works to prevent childhood obesity and reverse the trend of generations of non-cookers, Common Threads also teaches children to celebrate cultural differences and commonality by enjoying different ethic foods.

Common Threads currently operates after-school learning programs, summer camps and special events at 18 sites in Chicago, two each in Miami and Los Angeles, and four in Washington, D.C. The organization reaches a diverse population of African American, Hispanic, Asian, Caucasian and other children ages 8 to 12, 98 percent of whom come from low-income households. The organization's immediate goal is to scale up the program and achieve critical mass in all the markets it serves. To help build awareness and gain greater support, UnitedHealth Group provided the funding for a recently completed documentary film to promote Common Threads.

Continuing education for older children
Curbing childhood obesity will take an ongoing effort, working with children at every grade level. Picking right up where our Sesame Street Food for Thought program leaves off, UnitedHealth Group recently established a partnership with 4-H to reach out to schoolchildren ages 5 to 18.

As the nation's largest youth development organization, 4-H reaches 6 million kids, which makes them the ideal partner to deploy a widespread education program to help school students improve their health through diet, exercise and personal safety. 4-H fosters strong and sustained relationships with its members through regularly scheduled activities, including after-school programs, health fairs, camps, clubs, workshops and educational forums. This also provides the necessary continuity, reinforcement and practice to instill healthy eating habits. Equally valuable is the fact that 4-H members tend to be leaders and role models among their peers. In addition to taking action themselves, participants are encouraged to influence their families and promote healthy living in their communities.

UnitedHealth Group is currently testing the program in Texas, Florida and Mississippi, which were selected because of the high incidence of diabetes and obesity among children in these states' underserved communities. All told, the program will reach almost one million 4-H members in these three states combined. Each state will establish a strategic action plan with defined goals and specific outcomes to be achieved. During the course of the program we will continue to measure results and share them with community leaders. Our objective is to help other 4-H chapters and community-based organizations learn from each other and to build the blueprint to implement increasingly effective programs in other at-risk communities in the future.

Small steps make a big difference
In Philadelphia, UnitedHealth Group is launching a pilot program to instill healthy eating habits among beneficiaries of Medicare and Medicaid, through a partnership with Greater Philadelphia Health Action (GPHA), a regional Federally Qualified Health Center. The program was born out of the desire to provide more opportunities for meaningful discussion with obese patients and to instigate positive change during their frequent visits to GPHA facilities.

The overarching theme is "Small steps make a big difference," and three successive stages—Capture, Connect, Commit—define the engagement portion of the program. The first stage, Capture, uses posters with powerful messages that resonate on a highly personal level. For example, one poster shows a pair of shoes as seen from the obese person's perspective, with the headline "This is the first time Paul has seen his shoes in 15 years."

Once their interest has been piqued, stage two, Connect, instigates conversations in which physicians, clinicians and pharmacists can engage their patients in a dialogue about healthy food choices. A second series of educational posters feature glorious, mouth-watering photographs of natural foods like tomatoes and whole-grain bread, to encourage making healthier, unprocessed foods part of their diet.

In the third stage of the communications campaign, Commit, participants are encouraged to celebrate their personal triumphs over temptation or in making positive changes, by writing them on sticky notes. These will be put on the walls throughout the facility to serve as a powerful visual reminder of the support and encouragement from all the other participants who are united in the effort and also succeeding in making small steps to reduce their obesity.

Bringing the food to the people
Knowing that education alone is not enough, UnitedHealth Group is also making easier access to healthy foods a key part of our program in Philadelphia. With help of The Food Trust, we are creating "mini" farmers markets on site at each GPHA test facility. Instead of multiple tents and vendors, a single stall will sell a wide variety of locally grown fresh fruits and vegetables. These markets will operate once a week coinciding with the highest-volume traffic days at the health centers. Nutritional consultants from The Food Trust will also be on hand to counsel participants on how to pick foods for freshness and to hand out recipe cards to help transform their freshly bought groceries into delicious and nutritious meals. As with other parts of the program, promotional giveaways like tote bags and coupons will provide an additional incentive for members to buy at the market or have a one-on-one meeting with a nutritionist.

Initially, the program will be tested in two GPHA facilities, starting in July 2011. Once the effectiveness has been determined, we plan to expand the program throughout Philadelphia and into other cities across the country as soon as possible.

We are committed to the challenge
Eradicating childhood obesity will not be easy. It will take the concerted and combined efforts of all of us, including parents and teachers, leaders in government and industry, and communities large and small. UnitedHealth Group is committed to doing our part to reduce obesity among the more than 75 million Americans we serve. It's never too late to make a difference. But the time to act is now. Lowering obesity will have a dramatic impact on improving health and quality of life for everyone, and most importantly for all our children, who are the future of the country.


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  13. Nord, Mark, Alisha Coleman-Jensen, Margaret Andrews, and Steven Carlson. Household Food Security in the United States, 2009. ERR - 108, U.S. Dept of Agriculture, Econ. Res. Serv. November 2010.
  14. Ibid