It is a cool overcast morning here in Boston. I set out on a walk this morning and after about 25 minutes, I was inside Whole Foods. Suddenly I was surrounded by a bouquet of fresh fruits and vegetables. I swirled through a constellation of healthy foods.  This 25 minute walk for me is a mere two day drive from Triana Alabama, Norwood Birmingham, Heiberger Perry County Alabama and the St. Thomas community in New Orleans. I have visited or been in contact with these communities over the last year.

While in Birmingham, I visited with an old friend, Sandral Hullett MD CEO Cooper Green Hospital, Joanice Thompson at the UAB Health Disparity Program and Sue Thompson with Bethesda Life Organization. We all share the same passion. We must work to end obesity in the Deep South. Joanice says if possible she would put fresh fruit and vegetable stands on as many Norwood or West End corners possible. Sandral told me that she has to drive 3.5 miles to get quality produce. Dr. Don Erwin and the Peoples Institute told me that people are dying in New Orleans due to the impact of the environment and the visciousness of institutionalized racism.

A high ranking Blue Cross of Alabama official told me that BCBS of Alabama attributes over 40% of their expenditures on medical problems that can be directly traced to obesity. Alabama is sick and people are dying as a result of poor nutritional habits, their environment and a failure of policy-makers to act. Yes, I believe in “personal responsibility” but there is no evidence that a willingness to be more personally responsible will change this epidemic that has its roots in culture and non-medical health determinants such as poor transportation, violence, chronic unemployment, safe neighborhoods and a general poor social safety net.  I suspect that the high calorie, high fat foods sold in lower income neighborhoods costs more that quality foods sold at Whole Foods.

Take a look at this snap shot of Health Status in Alabama according to Condition and Value/Rank (out of 50 states):

Prevalence of Obesity – 32.2%/49th

Cancer Deaths ( per 100,000)  – 211.4/44th

Cardiovascular Deaths (per 100,000) – 358.8/49th

Prevalence of Diabetes – 11.2/48th

Infant Mortality ( per 1000) – 9.2/48th

These data should be a battle cry to all concerned about the health and wellness of the people of Alabama. To a person, those I have talked with state emphatically that the time for study and publishing academic papers is over.

The NIH, CDC, OMHD, FDA , USDA and all the other alphabets need to know that it is time that the millions of dollars being sent to Alabama to improve lives, be put to accountable use. We have to get over regional politics, racial and cultural differences and turf issues and come together so that the common pool of resources can used to save lives. Our future demands that we act.

According to a recent HealthAffairs reports, “Despite a number of programs combating childhood obesity on federal, state, and local levels, the trends show obesity rates on the rise. Among children ages 10-17, the number
who were obese grew significantly — from 14.8 percent in 2003 to 16.4 percent in 2007. This translates into a stunning 10,580,000 obese
American children. And research findings suggest that the obesity epidemic among children may not yet have reached a plateau”.

The report goes on to state that experts  believe that there needs to be “collective responsibility for taking on the problem along the lines of the movement to fight smoking and tobacco. Studies using laboratory animals show that the animals gain weight when their environment promotes foods high in sugar and fat, and that even when healthy foods are freely available, the animals eat the unhealthy ones, gaining much weight and exhibiting deteriorating health”.

The time to act is now if inroads are to be made. Policy must be changed to include:

• The executive branch and Congress should make fighting childhood obesity a signature domestic initiative for the health and well-being of future generations, and to ensure high productivity for industry in the years ahead.
• Congress should enact new taxes designed to discourage consumption of high-calorie foods and beverages and should invest the resulting revenues in obesity prevention.
• Congress should pass federal legislation that requires restaurants to list calories of all items on the menu.
• Federal regulators should set federal nutrition standards in schools for foods not covered now, including snacks, sodas, and candy sold in school stores and canteens and at events.
• Federal officials should set new agriculture policy that encourages farmers to grow more fruit and vegetables, and relatively fewer crops that are key ingredients for high-calorie foods.
• Federal officials should work with states that are now trying to make healthful foods and beverages more widely available, especially in low-income areas; expand numbers of parks and playgrounds; and make more funding available to promote biking, walking, and use of public transit.

Provide increased opportunities for physical activity by using more federal funding to improve communities’ existing trail or path systems and sidewalks, and to create bike trails, playgrounds, and recreational facilities.
• Launch educational or media campaigns that encourage parents to limit children’s television viewing and other recreational screen time.
• Devote additional resources to state and local agencies so that they can do more surveillance, monitoring, and prevention of obesity, as well as conduct more research on intervention strategies.
• Increase access to healthy foods in socioeconomically disadvantaged neighborhoods by encouraging the development of grocery stores and farmers’ markets through grants, loans, and tax benefits.

Source: HealthAffairs Obesity Brief March 2. 2010 http://www.healthaffairs.org

“If I am not for myself, then who will be for me? And if I am only for myself, then what am I? And if not now, when?” –Hillel.


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