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The childhood obesity epidemic is rooted in poverty, neighborhood deprivation and the political economy of our industrial food system, says Peter Arno

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SHARMINI PERIES: Welcome to The Real News Network. I’m Sharmini Peries, coming to you from Baltimore. The U.S. leads the world in child obesity. The Center for Disease Control, CDC, considers obesity to be an epidemic and warns that children’s obesity has quadrupled in the last 30 years. A new report on child obesity found that although the rate of obesity seems to have stabilized, it has stabilized at a very high level. And urgent action is needed to improve the health of children in the United States. The report titled “Advancing Equitable Approaches to Childhood Obesity Prevention,” by Peter. S. Arno, is our discussion today. He’s joining us from New York. And Peter is a Health Economist and a distinguished Fellow at the City University of New York. His 1992 book “Against the Odds: The Story of AIDS Drugs Development, Politics and Profit” was nominated for a Pulitzer Prize. Dr. Arno’s recent work includes studies on the impact of social security and the earned income tax credits on the health of the population, as well as geographic determinants of obesity. Thanks for joining us today, Peter. PETER ARNO: Thank you. It’s a pleasure to be here. SHARMINI PERIES: So, Peter, the problem of childhood obesity, it’s not a secret, it’s plain to us when we walk around theme parks or the local public pool. It also became the key issue that Michelle Obama worked on at the White House. So where are we at now? What’s the status of it? PETER ARNO: Well, today, according to the most authoritative studies, there are approximately 13 million obese children and adolescents, which is about 17% of all children between the age of two and 19. But there is also troubling evidence that the socio-economic and racial and ethnic disparities exist in these obesity rates and, in fact, they may be widening. Obesity rates are higher among Hispanics and non-Hispanic blacks than they are among whites, for example. So the epidemic may have stabilized and, you know, it’s a little too early to tell, but as you said, it’s at a very, very high level. And one of the issues I think we need to always understand about childhood obesity is that these children, when they grow to be adults, bring that obesity with them and present a whole range of public health and personal health issues as people age. So this epidemic is what’s led to the epidemic of diabetes, for example. So it’s a serious problem that we are going to be facing for decades to come. SHARMINI PERIES: All right. And in your report you examine obesity in segregated neighborhoods. So what is the connection between race and obesity? PETER ARNO: Well, as I said, there are disparities that exist in the obesity rates by both racial and ethnic groups and by socio-economic characteristics. And this is not unique to obesity, this is true for a whole range, in fact, most of the health burdens that we face in this country and elsewhere do fall along these socio-economic and racial gradients. And so, when you take a community that has a neighborhood deprivation or residential segregation these are areas where people live, that their choices are constrained by their environments. They have poor access to fresh fruits and vegetables. They have poor access to places to safely engage in physical activities. So it’s part of the entire social gradient and health, in general, that we see here in the obesity epidemic. SHARMINI PERIES: And, Peter, what’s causing it? What are the indicators? PETER ARNO: Well, I think it’s a complex issue with many, many factors. But, I’d like to just point out that, you know, in our study where we reviewed hundreds and hundreds of studies over the last decade on the causes and the interventions available to reduce obesity, particularly in children, what we found is that the bulk of the studies focus on individuals or their families as a target, as the primary unit of intervention. And I think that we need to focus more on the policies that generate the conditions that constrain these people’s choices. So to be a little bit flip, the anti-obesity movement, if you will, has been very big and the private philanthropies have been very big on building bike paths and pedestrian walkways and improving access to parks and supermarkets and all amenities that any community might favor — but these alone are unlikely to curb the obesity epidemic unless we address some of the underlying social determinates of health, such as poverty, income, neighborhood deprivation and the political economy of our industrial food system. That’s where the heart of the epidemic is. SHARMINI PERIES: Is some of this to be regulated? For example, the new Trump administration that’s coming in in Washington has said one of the things that they’ll do is actually deregulate some of the strict regulations that are in place for school lunches, for example. Do you think regulation will play, or should play, a part and are we at risk of furthering or making the situation worse? PETER ARNO: Unquestionably. Because the regulations that we have to date — at least in terms of food production — and you mentioned the school lunch program, which is administered by the United States Department of Agriculture, this is a program that, although it’s beginning to change over the last few years, it’s still a program that was basically designed to, yes, provide school lunches, but it was also designed to help agricultural producers. And, as a result, the kinds of subsidies that agricultural policy has produced have played a pivotal role. So, for example, there are subsidies for crops like corn and soya beans and when these are transformed into corn syrup and oils, these are the key ingredients to process, refined in calorie-dense foods and beverages. And when they drive down the prices by subsidizing these crops, this is our agricultural policies, that creates a food environment in which energy-dense foods become more affordable and increasingly represent a large portion of the overall caloric intaking. That’s a big part of the story of why we’ve seen this epidemic over the last 20 years. So, yes, reducing regulations like this or giving them freer run and, over the past five years there’s been a lot of attention to improving school lunch programs, if that gets turned back, that would be disastrous for curbing the obesity epidemic among kids. SHARMINI PERIES: And give us some sense of what the research into this problem is like. What are the limitations in research that you came across in doing your own study? PETER ARNO: Well, it was really an eye-opener for me. I’ve done research for myself for the last 25 years, but when we did this very expansive, annotated literature review — and our focus was on what’s called “systematic data reviews” where they meet certain criteria and they review a number of studies to try to see, does a school-based intervention work or does a community-based intervention work and so on and so forth — the studies were pretty weak across the board. A lot of the attention on these community-based and school-based programs provided very, very weak and contradictory evidence on programs that can reduce obesity. It doesn’t mean that these interventions don’t necessarily work, but it means that the science that’s applied to these studies is weak. And that’s a problem that faces all kind of interventional research. But I think the most promising areas has to do with policy-related proposals, which were based, not so much on intervention studies but on modelling studies which were based on actual data. So, for example, we know that advertising that’s focused on kids where they advertise junk food for children, we know that if that is reduced that would reduce consumption of junk food by kids. So one proposal is to eliminate tax subsidies for television advertising of unhealthy food that’s directed at kids. Another area where they did how some– SHARMINI PERIES: What kind of advertising subsidies exist when it comes to– PETER ARNO: They’re allowed to take all the expenditures on advertising or a business expenditures which are deducted from corporate taxes. And because of First Amendment issues, we have a lot of difficulty in curbing advertisements directly. But one way around First Amendment constraints are to disallow the subsidies and the tax deductions for this junk food advertising. But another one where there is some solid evidence is that subsidies, when provided for fruits and vegetables, particularly in schools where in some programs and some experimental studies were done, where they provided fruits and vegetables for free, they found that obesity was reduced. Another policy is imposing sugar-sweetened beverage taxes. Now this is a hot political issue and it remains controversial because many people don’t like the “nanny state” to tell us what we can or cannot eat. But it’s useful to learn from the history of the tobacco epidemic and the smoking epidemic that that it is the taxes on cigarette products that was one of the major mechanisms that reduced cigarette smoking and prevented cigarette smoking among young people. So there are a few policies. SHARMINI PERIES: There’s that and what other promising policy approaches exist to reducing childhood obesity? PETER ARNO: Well, the last one I would mention, which relates to subsidizing fresh fruits and vegetables, is to promote in the schools increased physical education time and improved nutrition in the schools. The evidence is there, it’s strong, the effect size is not huge, but there’s clear evidence that if kids are given more time to exercise during the school day and are given better meals at school, that they could reduce their obesity. SHARMINI PERIES: Where do we see that? Are there some examples you could point to that where– PETER ARNO: There have been a couple of very sophisticated randomized case-controlled type studies done by the Department of Agriculture — the best ones that I recall off the top of my head are studies that were done in schools where they made fresh fruit and vegetables available, completely free, to all children. And they compared that to comparable schools with comparable child populations and they actually measured how much of the food was consumed and they measured their weight gains or losses and they found that this was an effective mechanism. So, these are the kind of areas that I think show promise for the future. But there’s been so much effort that’s gone into very elaborate, expensive and sophisticated community-based models that affect the adults, the children, the schools — there is some efficacy there, too, but they’re hugely expensive and it’s difficult for interventions like that to be maintained in the long run. The kind of policy intervention that I’m talking about, about the tax subsidies or getting rid of advertising junk food to kids, these are relatively low-cost items. And some of them even have evidence of cost savings that, I think, would have a bigger impact on, a) reducing obesity and b) reducing the disparity between the poor and the middle class and the wealthy, in terms of their weight profiles. Because they’re cheaper, they can be sustained for a longer period of time and the evidence base is strong. Some of these community-based interventions are very expensive and the evidence base is quite weak. SHARMINI PERIES: All right, Peter, a very interesting topic. Hope you go on the road with this one because our children can really benefit from some of the studies. PETER ARNO: Oh, our study is up on the PERI website. So if anybody wants to check it out, it’s freely available for anyone to view. SHARMINI PERIES: We’ll put a link to it right below this interview. Thank you so much, Peter. PETER ARNO: I thank you very much. Appreciate it. SHARMINI PERIES: And thank you for joining us on The Real News Network. ————————- END

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Dr. Peter Arno is an economist and Senior Fellow and Director of Health Policy Research at the Political Economy Research Institute at the University of Massachusetts-Amherst and a Senior Fellow at the National Academy of Social Insurance.