Recent studies published in the journals of Social Science and Medicine and the American Journal of Preventive Medicine found that building more supermarkets in “food desert” areas (poor urban communities) is an ineffective response to the epidemic of childhood obesity. While I agree that access to food is important, I disagree that focusing solely on any one issue will solve our obesity problem.
I give First Lady Michelle Obama credit for targeting the issue of childhood obesity, but it was clear from the get-go that she has a limited scope of the problem, and seems to be moving forward with it in a vacuum. I think it’s great that she plants a vegetable garden at the White House, and that she’s involved with her daughters, helping them, and their generation, live healthy, active lives. I’m sure she’s a good mom, and in my mind, feeding a child well is part of responsible parenting.
So while I agree that the Let’s Move initiative is a nice offer of support from our government to reduce the childhood obesity epidemic (as in “we’re concerned and we’re with you”), there is no way eradicating all U.S. food deserts “within seven years” will “solve” childhood obesity within a generation. There are too many pieces to this cultural puzzle.
The notion that folks in America “can’t” eat well because the food is unavailable or too expensive, however, doesn’t sit well with me. My grandparents were immigrants and my parents lived through the Great Depression. Opportunity was limited, but they still managed to nourish their children and make ends meet. Of course that was a simpler time, where there were very few “convenience foods”, and working people like my family simply couldn’t afford them anyhow.
Did my grandparents live in a ‘food desert’? No, but they valued the importance of feeding their children well. It was a matter of the “right” thing to do; and they had skills – survival skills (maybe we somehow need to return to the old notion of teaching a man or woman to fish, and not just giving them the fish to cook and eat)…
Access to Food or Valuing Proper Nutrition?
The White House chef, Sam Kass, clears up some misconceptions, pointing out that access to food is only one piece of the obesity puzzle.
“At the heart of Let’s Move! is providing families with the information they need to make the best choices that they can for their kids,” says Kass.
Access is not the issue here, convincing families that proper nutrition is important, and helping them understand what that means, is the issue. What Kass doesn’t mention is how and when children and their families could get the proper nutrition counseling that they need. Nutrition counseling and education (or lack thereof) is an important component of the solution to the problem. Families need to understand the important role diet has in health, and changing current behaviors takes proper one-on-one or group education, and time.
The Disconnect Between Food Deserts and Nutrition Education
The same administration that initiated Let’s Move, also approved coverage for Intensive Behavioral Therapy for Obesity (CAG-00423N) for CMS (Center for Medicare and Medicaid Services) that excluded the registered dietitian from the bill (in other words, CMS has eliminated the most qualified provider, the RD, to deliver comprehensive nutrition counseling! According to CMS, any potentially lifesaving preventive services for obesity can only be furnished by primary care providers in the primary care setting – physicians, physician assistants, and nurse practitioners – most of which have limited if any training in nutrition and intensive counseling, and most don’t have the time or desire to do it).
Passing this bill to provide nutrition counseling, and not designating the registered dietitian as the provider, is like an insurance benefit that would cover a mammogram only provided by an optician. It makes no sense. There was obvious disappointment and disagreement among those in my profession when this bill passed.
Appropriate Nutrition Counseling is Only One Puzzle Piece, but Essential
We need appropriate support on the health care side of the issue for addressing the nutrition problems that children have, or will have, as a consequence of obesity. Effective health care bills that include the use of Registered Dietitians (RDs, along with clinical psychologists and other mental health specialists have been able to produce the best results for patients) for provision of nutrition counseling services, for both adults and children, is essential to addressing the childhood obesity crisis. It’s certainly part of the puzzle as we attempt to make changes in the statistics for the next generation.
Even if a child’s family suddenly gains access to healthy foods, this does not automatically mean they will pursue it and develop healthy habits. In lieu of proper nutrition counseling benefits, or school nutrition education programs, we have programs being developed like the Healthy Food Financing Commission, which may play a role in childhood obesity, but frankly, not much of one in my opinion. These initiatives won’t help without the underlying nutrition education about why it’s important to nourish children properly.
The importance of both providing families with access to healthy food, and providing them with the best education and the skills to incorporate that food into their diet, seems so obvious to me. If the government wants to create an effective program, Chefs should be working alongside Registered Dietitians to educate families about how to properly feed their children (another idea – reforming the food stamp program – SNAP – by making nutrition counseling with an RD mandatory in order to receive food stamps). The RD is the most obvious, and most qualified to tailor these food and nutrition messages to the public and to consumers who may have a variety of medical and economic needs.
I hope Mrs. Obama is listening: You need more registered dietitians on your team!