Resistance to, if not outright rebellion against, implementation of the Healthy Hunger-Free Kids Act in the nation's schools is fast becoming notorious. The video elements of the uprising are, predictably, going viral. Kids, apparently, don't love it.
And yet the government in general, and the USDA in particular, are to be commended for trying to do something to address the ever-worsening problem of childhood obesity and the calamitous health effects attached to it. The government has long been told it should take such action.
Public health professionals, the likes of my colleagues and I have long emphasized that we were putting our children's futures in peril, potentially taking both years from their lives and life from their years with an evermore sedentary, evermore soda- and junk food-laden status quo. We have emphasized that schools were never the whole problem and could never be the whole solution -- but were either part of the one, or part of the other.
Economists have warned the government that the dollar costs of business as usual were unsustainable. The future health care needs of the kids who get evermore soda and French fries but ever-less physical education could hobble our economy permanently. A nation in which one in three has diabetes might not even be viable. America can't really run on Dunkin' without running itself into the ground.
And of late, the military has weighed in, with accomplished brass advising the government that epidemic obesity among the young was putting the nation's military preparedness in jeopardy. We were -- and are -- becoming too fat to fight.
Most recently, the government received independent reports from both the Institute of Medicine and the Trust for America's Health advising an array of corrective actions, including improvements in school food, such as those at the heart of the current turmoil.
And then there was the simple fact that we did not take matters into our own hands. Despite an all but daily barrage of information about the urgency of this crisis, we did not rise up as a nation of loving parents and grandparents who would not take "no" for an answer. We did not demand that the growing bodies of children we love be built from wholesome food and not junk; we did not insist that "sound mind, sound body" was right all along and find a way to fit physical activity back into our children's days, no matter what.
Far too many of us, for far too long to far too great an extent, abdicated. And as a culture, we abdicate still, failing to make health something our children come to value and love.
These, then, were among the insistent calls for government action. In this context, the right question is not why the government did what it did, but if anything: "What took so long?"
So the USDA stepped in where too many of us, apparently, feared to tread. And for that, they are to be commended.
But the job does not appear to be going all that well so far, to put it mildly. So, what has gone wrong? Here's my initial breakdown of what appears to have broken down:
1) Never "assume"...
My contemporaries may remember getting this advice from Felix Unger of The Odd Couple, and it has stuck with us ever since. Felix's advice in this case pertains to the kids we left out of the conversation. Somewhere along the line, someone assumed kids would eat whatever we gave them. Not!
There was -- and is -- a need to involve the kids directly in initiatives that affect them. This notion is now so fundamental in public health that a whole area of research has grown around it: community-based participatory research (CBPR). In CBPR, interventions are developed WITH rather than FOR groups of people. In this case, that meant kids at the table when food for thought was being served... and before a lunch they wouldn't eat was served without that appetizer.
2) What we have here is a failure to communicate...
The kids themselves could, and should, have been involved in deciding how to improve school food. But once that ship sailed, it was still possible to inform them about what was coming. The more people know about what's going on and why, the more willing they may be to tolerate some temporary inconveniences -- and kids are people, too (allegedly). This initiative may have simply landed on the kids from out of the blue, who did the predictable thing under such circumstances: some combination of flight and fight.
3) One fell swoop...
Other than those who go on a diet to lose 20 pounds in three days, adults rarely do a good job with a total diet overhaul. It's generally much easier and more palatable to make incremental changes. Kids, if anything, tend to be more that way. There is, I suspect, far greater potential to improve diets, and health -- among adults and children alike -- with incremental improvements within food categories than most people realize. Such changes can take enormous amounts of sugar, salt, trans fat, saturated fat, and calories out of diets, and do so almost imperceptibly. The health effects can be quite stunning.
4) Not so "hunger-free"...
High school athletes in particular have protested the new calorie caps, protesting that they are left, in a word, hungry by the Healthy Hunger-Free Kids act. Oops.
The problem here is that restricting the quantity of food people eat inevitably means forcing them to eat less than they want, which in turn means they will be hungry or something like it. There is an alternative. Among the many virtues of wholesome foods is that they help fill us up on fewer calories. If highly-processed foods come with a "betcha' can't eat just one!" tag line, wholesome, minimally-processed foods -- and especially those direct from nature, such as vegetables, fruits, nuts, seeds, beans, whole grains, etc. -- come with a "bet I can!" rebuttal. I recall what being 17 felt like. I was hungry all the time (and quite lean). I think we can and should let adolescents eat until full, while ensuring they fill up on good stuff that helps do the job with the most possible nutrients and fewest possible calories.
5) Demand trumps supply...
Whether in schools, supermarkets or restaurants, the food supply is subordinate to the food demand. People are a bit like those notorious horses and their water; for the most part, you can't make them eat anything in particular. People choose what to eat.
If, as a nation, we chose to embrace more healthful eating, that infamously-suspect "food supply" of ours would keep pace with us. The business of business is business, and companies would either keep the customer satisfied or make way for companies that could.
Minimally, if we are going to overhaul the school food supply, we should do so in conjunction with efforts to modify demand. We should be sure kids know the stakes. We should tell them in ways suited to age and inclination. We should be sure they know that food affects health, and that healthy people have more fun. We would need families to get involved and help convey the message that health is something that really matters.
We are, as a culture, neglecting the value of health, and maybe even denigrating it. The quote of the day in yesterday's (10/6) New York Times from a high school senior in Brooklyn was: "Before, there was no taste and no flavor. Now there's no taste, no flavor and it's healthy, which makes it taste even worse."
Why would "healthy" make it worse, independent of taste and flavor? Something here is very fundamentally wrong at the level of our culture.
We should inform kids that we and they tend to love the foods we know -- but we can get to know and love new foods. Taste buds are malleable little fellas; when they aren't with the foods they once loved, they learn to love the new foods they are with in as little as a couple of weeks. I suspect nobody told the kids the "new and improved" foods would taste weird at first just because they were new, but that they'd forget all about it in a couple of weeks.
The evidence for this is strong overall, but I'll just offer an anecdote. I asked my 17-year-old daughter, Valerie, a high school senior, how this whole business was playing out in her school. She tells me she heard a lot of griping at first, but it's already dying down. She mentioned in particular friends who didn't like the new baked French fries at first but have gotten used to them already. One told her "these are fine, and I really can't even remember now what the old ones tasted like."
The USDA takes its place in rather august ranks by dishing out some unintended consequences along with efforts to improve diet and health. The effort is commendable even so. But it could be better with a focus on changing demand as well as supply, on controlling quantity by improving quality, on making the healthier choices fun and appealing, on tweaks and incremental improvements, and on the time it takes for taste buds to adapt.
Updating the school food supply is a reasonable charge for the USDA and the federal government. But updating the food demand extends well beyond their mandate. It is a task for our culture at large. We may tend to forget that we devised our culture, and that we can update it. We can, and should, update love -- so that helping one another be healthy is an honored and prevailing means of expressing it.
Health is for living. We want our kids to eat well because we want them to be healthy, and we want them to be healthy because we love them. They need to know that -- and that job resides with families, not government. They need to know that they can wind up loving foods that love them back. Love has long figured in the marketing of the very foods that foster obesity and chronic disease. It can and should be the centerpiece of our comprehensive efforts to fix this mess.
Here's hoping we can all stay calm and carry on long enough to get there from here.
-fin
Dr. David L. Katz; www.davidkatzmd.com
www.turnthetidefoundation.org
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