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Supersizing a Generation

How the remote-control, drive-through world we built has made our children more overweight than ever and why that should make the business community shudder

The numbers are downright shameful. Nearly 30 percent of kindergarten students entering Hawaii public schools are overweight, according to a recent state survey. That means more than one out of four 5-year-olds started their first day of kindergarten – a day meant for contemplating crayons, finger-painting and perhaps a nap – already on the road to a life of chronic health problems.

Photos by Rae Huo

Nearly 15 percent of those kindergarteners are in a weight category that in adults doctors call obese, says a state Department of Health survey done of the 2002-'03 class. By middle school, 35 percent of public school students are overweight.

Nationwide, since 1980, the percentage of overweight children from ages 6 to 19 has more than tripled, reaching 16 percent, reports the U.S. Centers for Disease Control and Prevention.

"They used to have juvenile onset diabetes and adult onset diabetes. Now they are calling it Type 1 and Type 2, because they are seeing adult onset in teenagers," says Ann Pobutsky, Hawaii Department of Health chronic disease epidemiologist. "They say this generation of kids might be the first generation that does not outlive its parents."

Saddled with our increasingly poor, on-the-go diets and more sedentary, plugged- in lifestyles, experts say our children today are more overweight then they have ever been. The numbers on childhood obesity have vast implications, most of all for families. But health experts are also warning that when this generation hits the workforce – with its increased likelihood of chronic health problems – there will be seismic ramifications for an already careening health care system.

"It is very frightening looking toward the future," says Laura Lott, Hawaii Medical Service Association manager for community and public relations.

The business community is already burdened with the cost of adult obesity in the work place, but the next generation of work-force entrants could make that cost look like child's play.

That's why people like Gary Allen, executive director of the Hawaii Business Health Council, are out pounding the drum trying to get business leaders to join the fight against obesity. His pitch is straightforward: It will save you money, a lot of money.

"The only way we will be successful is to have business leadership believe in it," Allen says.

That buy-in begins with a good look in the mirror.

THE APPLE DOESN'T FALL FAR …

Nationally, the CDC reports that more than 60 percent of adults in America are overweight, with 30 percent of them, some 60 million people, obese. In Hawaii, 50 percent of adults are overweight or obese, though some populations, such as Native Hawaiians and Pacific Islanders, statistically appear more vulnerable to obesity, as do people in lower-income segments.

The cause for alarm is that people who are overweight have an increased risk for cardiovascular disease, diabetes and some cancers. The costs for adult obesity are escalating, from loss of productivity in the work place to strains on the health care system.

According to the Office of the Surgeon General, the cost of obesity nationwide was more than $117 billion in 2000. Between 1987 and 2002, private spending on obesity grew from $3.6 billion to $36.5 billion, or from 2 percent of all health spending to 11.6 percent. A Hawaii study put the cost for the state at $290 million in 2003, which is 4.9 percent of total health expenditures.

PUBLIC KINDERGARTEN STUDENTS 2002-'03
% overweight * % obese ** Total
State 14.1 14.4 28.5
Oahu 13.8 13.9 27.7
Big Island 15.2 15.1 30.3
Kauai 16.4 12.5 28.9
Maui 13.8 17.9 31.7

The cost of childhood obesity is harder to estimate, particularly its eventual cost as the next generation enters the work place. But consider the current childhood trends and that overweight adolescents have a 70 percent chance of being overweight or obese adults, according to the Surgeon General. That number jumps to 80 percent if one or more parent is overweight or obese.

Says Lola Irvin, health department tobacco settlement project manager, "We are used to dealing with adults in their 60s, and making sure they are doing all these [preventative] things and screenings, in terms of diabetes and hypertension. But we have never had to deal with a population that was already coming in at risk from childhood.We don't know what this is going to mean for these kids. It has never happened before."

THE NEW TOBACCO

We tend to see weight problems as a personal failure. But when 60 percent of your adults are overweight, it is increasingly hard to ignore the existence of a larger trend.

"Only recently have we begun to say something must have changed in our society," says Betty Wood, an epidemiologist with the department of health. "It is beyond some personal moral failure."

Our downfall is our diet – increasing in portion sizes and processed foods because of our time-starved schedules – and our lack of exercise, due to lifestyles designed around work and cars and computers and televisions. Other developed countries are seeing the same trends. We've matched high-calorie diets with low-exertion, convenience-laden lifestyles for one possible outcome. That's the world we've built for our children.

The biggest step in recovery is awareness. Dennis Chai, a retired associate professor at the University of Hawaii, who studies obesity, says the issue needs to be attacked like tobacco, a health vice that took a decades-long campaign to substantially dent.

To that end, the Department of Health is running a statewide campaign called Start Living Healthy. The most prominent part so far has been the "1 percent or less is best" milk commercials. Some Hawaii health insurance companies have also launched campaigns to raise awareness, to get people taking the first baby steps to eating better and moving more.

"Obesity is beatable, just like tobacco was," says Chai.

REENGINEERING HEALTHY KIDS

A 2003 survey of Hawaii public schools reported that 43 percent of middle school students watch more than three hours of TV every school day.

That makes people like Claudio Nigg, associate professor in the UH department of social science and health program, want to get children running. Nigg works with HMSA and state Department of Education to offer an after-school program centered on physical activity.

But he doesn't want the kids doing just any activities. Take kick ball. In a revamped game, Nigg says 10 kids have to run around the bases after the ball is kicked and all the kids in the outfield have to pass the ball around to get someone out. That way everyone gets a workout. They are reengineering gym class during the school day, too.

"We are more about inclusive, lifelong activities, and less about team sports that only the athletic kids can participate in," says Cathy Tanaka, school health coordinator for the department of health.

Schools have also eliminated vending machine snacks, limited unhealthy drinks such as sodas, and offer federally approved, nutritional lunches. But Donna Ede, health and physical education specialist for the education department, says schools are facing tight budgets to improve physical education and nutrition as initiatives such as No Child Left Behind redirect school focus and spending to math and verbal skills.

Kamehameha Schools, for its part, decided to attack the problem years ago. After reviewing the higher rates of such illnesses as diabetes in Native Hawaiian children, the school system started offering obese high schools students special physical education classes 15 years ago, says Theone Chock, who developed the program. That includes nutrition lectures, discussions on dealing with the emotional aspects of obesity and a separate locker room and physical activities.

That program was expanded for grades K through 6 seven years ago and plans are underway for a middle school program. Chock adds the rest of the student body gets rigorous, aerobic-based P.E.

But such programs only chip away at the problem. The real key to solving childhood obesity is solving adult obesity, say health experts.

"The children are more victims of their environment," says Susan LaFountaine, manager of rehabilitation services for Kapiolani Medical Center for Women and Children. "It's very important for adults to have healthy lifestyles, because children don't really shop for their food, and parents that are physically active are good role models."

FOLLOW THE LEADER

A survey conducted by the health department found that 50 percent of Hawaii adults thought it was "not at all important" to eat five plus servings of fruits and vegetables a day, a basic tenet of a healthy life. That's a canyon-size gap to cross in public awareness.

Health experts say one of the most effective ways to reach adults is through the work place, where adults increasingly spend their days. Whether it is as simple as encouraging them to take the stairs or take a walk at lunch. Some companies have begun offering health classes and healthier offerings in their cafeterias.

Linda Chock, branch chief for the health department's Women, Infants and Children division, says even such measures as providing a private room for breastfeeding would help, too. Breastfeeding has been connected with lower rates of childhood overweight problems.

The key is making it easier to lead healthy lives.

Allen, of the Hawaii Business Health Council, argues that the business community will benefit directly from addressing obesity issues in lower health premiums and increased productivity.

This month, the council, a coalition of Hawaii businesses who want to improve health care, plans to start a diabetes counseling pilot program. Three companies are funding it, Punahou School, Outrigger Enterprises and Times Supermarket, and the counseling will be free to their employees. Allen is certain the council can demonstrate that the program can lower health costs for a company.

"We will do that pilot for one year to show other employers that this one-on-one life coaching will give a return on investment," Allen says. "That is the message we give to the CEOs. If someone can create a program that creates a 300 percent return on your investment, what businessperson could turn that down?"

To learn more about combating obesity, the state health department's Web site, healthyhawaii.com, is a good place to start. To learn more about worksite wellness, visit The Wellness Councils of America's site, www.welcoa.org.

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