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JEFFREY BROWN: "We begin the 21st century with a startling setback: An epidemic of childhood obesity." That’s from the opening line of a report issued today by the Institute of Medicine, an independent group that advises the federal government. Dubbed a national action plan, it calls for major changes throughout American society, including new nutritional standards and exercise regimes in school, new advertising guidelines for the food industry, revised product labeling, and closer government oversight of marketing. The chair of the panel that produced the report is Dr. Jeffrey Koplan, former director of the Centers for Disease control, now at Emory University.
Welcome, Dr. Koplan. Put it simply for us. What’s the goal here of the report?
DR. JEFFREY KOPLAN: The goal is to reverse an ongoing epidemic of obesity amongst our children.
JEFFREY BROWN: You’re talking in your report about changes in our family structure, family life, the food we eat, the way foods are marketing. You’re talking about dramatic shifts over several decades.
DR. JEFFREY KOPLAN: It’s probably not an overstatement to say we really require a revolution in the environment in which we’re raising our children. We’ve done a great job in many aspects of health and disease with our children. But somehow we have drifted into an environment which is unhealthy towards their weight, toward their physical activity, and we need to change it.
JEFFREY BROWN: So let’s go to some specifics for schools, you’re talking about exercise regimes, and the food that children eat at school.
DR. JEFFREY KOPLAN: We’re not asking for a lot. In schools we’re hoping to get 30 minutes a day of physical activity for children during the course of the day, maybe at recess, maybe in part of physical education. We’re looking for some nutrition education and education about the value of physical activity for children, who are receptive to this, and part of the educational process. And we’re asking for healthy food stuffs to be supplied at school in all parts of the school day.
JEFFREY BROWN: On the exercise it’s kind of stunning to realize, and I have children in school too, it’s kind of stunning to realize, though, how little exercise many of them are getting.
DR. JEFFREY KOPLAN: Well, if you think of kids as being naturally active and then think of the process of having to sit in chairs all day long while learning, exercise both benefits their health and can be an adjunct to the learning experience overall by providing a break in book learning throughout the day.
JEFFREY BROWN: One of the issues in schools of course has been vending machines. Should there be a ban on vending machines, should there be some sort of enforcement that takes the junk food and the advertising out of the schools?
DR. JEFFREY KOPLAN: Those are several issues there. Some people have advocated removing vending machines. Our view is that it’s possible to have healthy substances in those machines for sale. Certainly children if they’re thirsty during the day and want bottled water ought to be able to get it, it’s possible fruit juice or milk or other things might be provided. So there are plenty of products that can be offered in schools that are consistent with the healthy diet. Advertising is something that has become more common in our schools. And our goal would be to have that circumscribed and have whatever marketing takes place be for promoting health rather than individual products.
JEFFREY BROWN: Now for industry, the food industry, you’re calling on them to have voluntarily developed advertising and marketing guidelines. Why voluntary?
DR. JEFFREY KOPLAN: Well, for one, as with most public health programs and campaigns, there has to be approval and agreement amongst the general populous and policymakers before you can make progress. In this instance, we think as well that it’s better to have a partnership amongst industry, amongst schools, communities, health care providers, and public health officials. And that would work well if we can get it to happen. It’s in the best interest of industry to have products that are both healthy and palatable and that sell. So we want to work together with them if that’s possible under oversight by the Federal Trade Commission as to appropriate guidelines.
JEFFREY BROWN: Well, that’s where I wanted to go next, because you’re calling for some more oversight by some government agencies, the FTC, the FDA, but not for specific new legislation or regulation, if I read it right.
DR. JEFFREY KOPLAN: Well, there is some request for a congressional approval for FTC to provide monitoring for what goes on with these guidelines lines over the next couple of years. The idea is that industry would work with others to create some guidelines, then it would be observed for a couple of years and if changes can be made and kids diets improvement in weight, then we’re on the right track. If that doesn’t work and the guidelines art successful, it might have to be revisited and other steps taken.
JEFFREY BROWN: So you plan to stay with it and try to seek some way of enforcement?
DR. JEFFREY KOPLAN: The only way this guideline, the whole blueprint we’ve proposed works is if we stay witness. If this is a one shot, put it on the shelf, that’s not what we’re interested in. We’re interested in public health action and follow up. The things that work need to be pursued and the things that don’t need to be changed.
JEFFREY BROWN: There’s a long list that we can’t go through, but there’s some community things, for example, that would require changes to infrastructure. Some of the things you’re calling for would cost quite a bit of money, I assume. Where would that money come from?
DR. JEFFREY KOPLAN: An amazing amount of these things doesn’t cost a lot of money. And it ought to be viewed in the context of the rates of obesity that occurring, twice what they were for some groups of children, twice what they were just 20 years ago for some groups of children, three times what they were, are going to enact a huge health care cost for us in the very near future. So with that in the background, some investment is appropriate to make a difference in averting those costs. Many of the changes in schools, maybe of the changes a home, many of the choices people make are not big cost items. For communities, we’re looking at increasing opportunities for kids to be active, playgrounds, sidewalks on the streets. Some of these will require some investment; some are just designed towards the future, how we’re going to build our community.
JEFFREY BROWN: And briefly you’re talking about a battle here that is some parallel to the fight against smoking, I assume, that goes over many, many years.
DR. JEFFREY KOPLAN: It’s addressing a complex issue that many factors have led us to where we are today, just like tobacco, and it’s going to take many actors in many locations to make these low changes to effect an improvement.
JEFFREY BROWN: Okay, Dr. Jeffrey Koplan, thanks for joining us.
DR. JEFFREY KOPLAN: Thank you.