George L. Blackburn, M.D.

In 1994, the Institute of Food Technologists issued a Scientific Status Summary that identified facts about human obesity necessary for its treatment. It said that while genetics clearly defined the distribution of body mass, genetic change since the Stone Age had been virtually nil. The growing epidemic had been fueled by more current factors, e.g., excess use of high-fat (feedlot) animal and processed dairy foods, added sugars, and sedentary lifestyles. Among the treatment recommendations were development of diets with specifically altered chemical compositions, i.e., foods for special dietary purposes and functional foods.

The past decade has seen further erosion in Americans’ healthy eating habits and behaviors. The invasion of super-sized, energy-dense, nutrient-poor junk food has continued unabated, as have the decline in physical activity and the rise in obesity-related disease.

A recent Harris Poll showed that 80% of people 25 years of age or older were overweight, up from 71% in 1995. Consider these figures in comparison to those of other high-profile public health issues: there has been zero increase in the proportion of adults who smoke cigarettes, and 81% of all adults say that they now wear seatbelts. These results indicate how powerfully legislation can contribute to changes in lifestyle behavior.

In 1999, 13% of children aged 6–11 years and 14% of adolescents aged 12–19 years in the United States were overweight, according to “The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity,” issued last December ( The prevalence of overweight has nearly tripled for adolescents in the past two decades. Type 2 diabetes, previously considered an adult disease, has increased dramatically in children and adolescents.

The most immediate consequence of overweight, as perceived by children themselves, is social discrimination. This is associated with poor self-esteem and depression. Overweight children need support, acceptance, and encouragement from their parents. Adults need to be good role models for their children, to let them see how they enjoy healthy foods and physical activity. Children who do so are more likely to follow in their parents’ footsteps now and for the rest of their lives.

Such action is needed from families as well as communities. While schools cut back on physical education, and video games and the Internet supplant outdoor play, snack and soda companies are spending hundreds of millions of dollars a year to promote empty calories.

The government has published new charts showing healthy weight ranges for kids 2–20 years of age. To be “at risk” of becoming too heavy, a child must fall above what was the 85th percentile during the 1960s (145 lb for a 5 foot 4 inch girl). Only after hitting what was the 95th percentile (170 lb for that same girl) would a child be considered “overweight.” Other factors include family history of diabetes, and measurements of glucose tolerance and insulin resistance.

According to the Surgeon General, overweight and obesity may soon cause as much preventable disease and death as cigarette smoking. Obesity and overweight, which cost the nation $117 billion in 2000 alone, are already responsible for as many as 300,000 premature deaths each year.

The only way to deliver the health dividend of a nutritious diet to Americans will be through a highly structured, intensely marketed, gradual adjustment of familiar foods to new micronutrient-dense, low-calorie, high-fiber foods. These efforts, in conjunction with city ordinances and state laws that promote consumption of healthy foods and physical activity, will eventually stop the epidemic of obesity.

The IFT report discussed the diet–health relationship and the challenge of reconciling recreational food and drink with the promotion of optimal health. Today, more than 90% of foods consumed are “prepared” foods, and those eating them have little knowledge of their health profiles or nutrient densities. Simple health messages regarding risk factors and how best to avoid and/or control them are effective ways to help people optimize health. So are environments with facilities that lead to fun physical activities essential for maintaining a healthy body weight.

Healthier foods will need to be clearly identified and widely distributed to fit into today’s eating patterns. “Healthier food” aisles in grocery stores and convenience stores, and “healthier food” vending machines, restaurants, and school and business cafeterias will promote acceptance. So will cash-back and other consumer credit programs funded by debits for high-calorie junk foods.

Food companies worldwide already see opportunities in healthier foods and are developing products to fill dedicated aisles with great-tasting, balanced, portion-sized, nutrient-dense foods. Unilever–Best Foods, for instance, is committed to the delivery of “nutrition and health benefits through its brands by marketing appealing foods that enhance the quality of life.” Its Slim-Fast Plan uses structured diet meal replacements to promote reduced-eating patterns for weight loss and long-term weight maintenance. ConAgra Foods is marketing its Healthy Choice line of foods. Dannon has its Light ’n Fit family of lowfat yogurts. As other companies enter the market and expand available choices, we can expect to see an ongoing trend toward healthier dietary patterns.

by George L. Blackburn is Associate Director, Div. of Nutrition, Harvard Medical School, Boston, Mass.