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System-wide Approach Needed To Combat Obesity Epidemic

System-wide Approach Needed To Combat Obesity Epidemic
What can our state government do to help improve community health, and fight against childhood obesity? We speak to Dr. Loel Solomon about his work with state and national lawmakers to address the childhood obesity epidemic.
System-wide Approach Needed To Combat Obesity Epidemic
What can our state government do to help improve community health, and fight against childhood obesity? We speak to Dr. Loel Solomon about his work with state and national lawmakers to address the childhood obesity epidemic.

MAUREEN CAVANAUGH (Host): I'm Maureen Cavanaugh, and you're listening to These Days on KPBS. Too much junk food and not enough activity are two of the factors that have led to what some call a childhood obesity epidemic in America. Health leaders from around California gathered in San Diego this week to talk about ways to fight that epidemic. The health experts are advising a multi-pronged approach that targets not just what kids eat and their activity levels, but things like how much produce is available at local supermarkets and how safe our neighborhoods are. Joining us with more about these initiatives is my guest, Dr. Loel Solomon, vice president for Community Health at Kaiser Permanente and a keynote speaker at this week’s California Action Institute’s conference. Dr. Solomon, good morning, welcome.

DR. LOEL SOLOMON (Vice President, Kaiser Permanente Community Health): Good morning.

CAVANAUGH: Is there a growing sense of urgency about addressing the issue of childhood obesity?


DR. SOLOMON: There really is for so many reasons. I think there’s a real strong appreciation that if we don’t get on top of this epidemic, we’re going to have a continued cost explosion in healthcare, which, of course, depresses wages and causes a lot of misery and pain for a lot of people. And if we don’t address obesity, we’re really going to have a problem with downstream healthcare costs. It’s a critical part of our health reform agenda.

CAVANAUGH: And that’s because kids who are overweight tend to turn into overweight adults, is that right?

DR. SOLOMON: They do. They do. They – For the first time in as long as anybody can remember, we’re seeing children that actually come into the doctor’s office with diabetes and hypertension and all these chronic diseases that are typically diseases that you get later in life. So there’s a very strong sense of urgency here.

CAVANAUGH: There have always been fat kids. What’s happened in our society over time that’s contributed to the increase in childhood obesity?

DR. SOLOMON: So, you were so right in your introduction, Maureen. You know, we need a multi-pronged strategy because the factors that have led to this epidemic are so many and we’ve always had overweight kids, that’s true, but there really has been an explosion of obesity over the last 20 years or so, 15 years even. What has driven that has been a number of things. Firstly, we have really designed activity out of our everyday lives. As little as 20, 25 years ago, about half of the kids walked to school or rode their bikes to school. Today, there’s less than 13% of kids that walk and bike to school, is one example. School lunches have become quite unhealthy. Where kids used to be out playing after school, running around in their neighborhoods and their parks, kids are now sitting in front of the screen. There’s been an explosion of marketing for unhealthy food. Fast food has taken hold. The Big Gulp has taken hold. All these things conspire to lead to this obesity epidemic. You know, Mrs. Obama has this “Let’s Move” campaign. She has a great thing that, you know, these kids didn’t do this to themselves. The environment around them, their physical activity environment and their food environment has really conspired to create this problem.


CAVANAUGH: So it seems that the way that people are starting to think about this is that it’s not just an issue that the health community needs to think about but it’s something that needs to be embedded in all levels of the government, the public sector, and in the way we design the – the way we live our lives, is that the way you’re thinking about it?

DR. SOLOMON: Absolutely. This is – requires a – everybody needs to step up to this. There’s, you know, families that need to step up and take responsibility for what’s in the refrigerator and what’s on the dining room table and how much screen time their children get. Businesses need to step up and make sure that they’re selling healthy products, and school administrators need to look at their cafeterias. And government needs to step up, too, and make sure that we’re designing communities where walkability and bikeability is a priority and people are able to get around. And it’s a full court press, as we like to say here. We really have to all be doing so much more to get on top of this.

CAVANAUGH: I’m speaking with Dr. Loel Solomon. He’s vice president for Community Health at Kaiser Permanente. He was a keynote speaker at this week’s California Action Institute Conference, which focused on childhood obesity. Dr. Solomon, I wonder if you could tell us a little bit about this conference. What is new? What kind of initiative did it launch?

DR. SOLOMON: So the Centers for Disease Control and Prevention is launching this cohort of communities, this group of communities. It’s really going to take this comprehensive approach to obesity prevention. And so this was the first of a number of what they’re calling Action Institutes to bring these communities together and do some training, get them all on the same page and really launch them into this area of comprehensive change. So this was a group of communities that are in the western part of the United States. San Diego is actually one of the communities that won one of these Communities Putting Prevention to Work Awards. And so they also got to host the meeting.

CAVANAUGH: I know that you’re – you’ve written an awful lot and spoken a lot about the interaction of creating healthy communities and how that can help our environment, how it can even help our economy. This sort of synergy between making sure that kids grow up in a healthy way and improving the larger society, can you give us a kind of an idea of what those connections are?

DR. SOLOMON: Yeah, I mean, it’s kind of an interesting situation in which the problems that we confront are so great. There’s this, you know, obesity problem. I think we’re also focusing on how to green our cities and address climate change and things like that, and also how to bring more jobs to our communities. And a lot of the conversation at the conference is how good solution solves many problems. If we are able to get people out of cars and walking more and biking more, that’s a thing that obviously creates more physical activity. People are more active so they’re burning more calories. They’re also burning less carbon, and that’s good for the air and good for the environment. So I think people are really desperate for looking for multiple solutions to some of the big problems here.

CAVANAUGH: Talk about multiple solutions, there’s apparently some sort of a link between childhood obesity and tobacco use. Are there deep connections that exist between these two issues?

DR. SOLOMON: There’s – there are definitely connections and that was a subject of conversation. I think the – there’s a lot more work to do to figure out what the strategies are that can address both…


DR. SOLOMON: …tobacco use and obesity prevention. I think the thing that they have in common is that both the folks that know a lot about tobacco control and the folks that are really working on obesity prevention are seeing that we need to not just focus on individual behaviors, as important as that is, but we’ve got to create positive environments for helping address both of those problems, you know, indoor air quality. And a lot of local jurisdictions are trying to make sure that people aren’t in environments where they’re subject to secondhand smoke kind of similar to people thinking about creating healthy environments for healthy eating and, say, physical activity, there’s definitely some connections there.

CAVANAUGH: You know, on this program we have spoken on several occasions about communities that are trying to put together farmers markets so that they can get fresh produce to people, people who are talking about putting in areas, activity areas in neighborhoods that don’t have many places for kids to play. Are those the kinds of initiatives that are being looked at on the grassroots level to really tackle this problem of childhood obesity?

DR. SOLOMON: Indeed. Actually, one of the things that we’re doing at Kaiser Permanente is putting in farmers markets in a lot of our facilities and it’s a really great way for physicians and other providers to talk about the kinds of things that are available and, you know, when you’re done with your exam, you know, check out our farmers market. It’s a easy way to get fresh fruits and vegetables. And there’s really this groundswell of interest in bringing healthier food closer to people, making it more convenient, making the healthy choice the easy choice, and that’s something that we’re starting to talk about more and more in our exam rooms. And when you compare that with a farmers market that’s close by, it’s a real winning strategy.

CAVANAUGH: How is it that you actually get kids involved in all of this, though? I saw you talk about the launch of a computer detective game.


CAVANAUGH: Is it strategies like that that really sort of involve kids and try to get them to recognize, you know, a good activity, a good healthy activity as opposed to, you know, just snacking and sitting around?

DR. SOLOMON: Yeah, I think there’s many different strategies we need to try. I think the game that you’re talking about is The Amazing Food Detective…


DR. SOLOMON: …which is the – an online game that we created based out of an educational theater program that Kaiser Permanente offers to school kids in – throughout our – the state of California and other places where we are. The cool thing about that game is that you could play it for, I believe, 20 minutes at a clip and then it automatically turned off and tells you to get outside and get some exercise.

CAVANAUGH: That’s a good innovation.

DR. SOLOMON: Yeah, I think – I think the kids liked it. So – and that was a kind of a novel approach. I’m not sure how they liked it when it got turned off.

CAVANAUGH: What are some of the other innovative programs that you might know about here in San Diego that sort of geared towards all of the issues of childhood obesity that we’ve been talking about. Any – I think there’s a Walk San Diego program, something going on in Chula Vista.

DR. SOLOMON: There is. There – I mean, San Diego’s kind of the epicenter of so many good things around childhood obesity prevention. There’s some really great stuff that Kaiser Permanente and others have supported in La Mesa and Chula Vista. The county itself, as a whole, has a Childhood Obesity Initiative that brings together as a private-public partnership, it brings together public agencies, businesses, the health community, the public health community, and it’s a very comprehensive strategy that’s really seen as a national model for pulling all of these different things together to surround people with good health. And so there’s a large number of things which is why, I think, the CDC recognized San Diego as a trailblazer with this Communities Putting Prevention to Work grant, and I believe that San Diego has the largest grant of any community for obesity prevention because of the significance of the model there.

CAVANAUGH: That’s – On the one hand, that is wonderful news to hear but in researching this, Dr. Solomon, I came across a couple of articles that said, you know, we got to worry about not becoming a nanny state and, you know, regulating everything that goes into kids’ mouths or every moment of their time. Where do you think that balance is, you know, to give kids enough information and enough encouragement to make the right choices and yet at the same time not sort of policing them.

DR. SOLOMON: Yeah, you know, I think that’s – I think we have to get beyond language like that as…


DR. SOLOMON: …you know kind of the ideological debates that’s tied us in knots and think seriously about the solutions that we need to, you know, help our kids be healthier. And what we need to do is create the right defaults, and Kaiser Permanente has been investing a lot of time and energy. Our pediatricians are onboard on this, too, and leading the way. We have to create the right defaults to make the healthy choice the easy choice. If you look at the big successes that we’ve had in public health around tobacco control, around lead paints, around seatbelts and whatnot, there has been an element of public policy that’s been important. There’s also been a lot of individual responsibility that’s part of it. I think we need both people to step up and be more responsible and we need to create the conditions that support those healthy choices. It’s kind of unfair to put all of the onus on the family and the individual when people are kind of besieged with – surrounded by all this marketing and advertising and all the, you know, unhealthy food is really cheap and easy, and the healthy food is often expensive and more difficult to get, particularly in our low income neighborhoods. So we need private sector solutions, public sector solutions and families at the middle of all that to do what’s best for our kids.

CAVANAUGH: I know state legislators here in California are once again trying to do something about soft drinks, putting a tax on sugary soft drinks in an effort to address childhood obesity. How important would an effort like that be, Dr. Solomon?

DR. SOLOMON: Well, I mean, certainly sugar-sweetened beverages are a large part of the problem. There is a study that UC Berkeley did that showed that 43% of the increased calories that have been entering the American diet over the last 10 years or so have been because of the increase in sugar-sweetened beverages. So that is a kind of a serious part of the problem and I think the California and local jurisdictions and community-based organizations are really thinking seriously about what we could do to reduce the consumption of sugar-sweetened beverages which is, you know, really liquid candy.

CAVANAUGH: Right, right. Dr. Solomon, you know, hearing you speak about this, it – you’re making the case that you have – we’ve made choices in our society that have made healthy things less attractive and more expensive and unhealthy things more attractive and less expensive.

DR. SOLOMON: Yeah, kind of crazy.

CAVANAUGH: Is that right?

DR. SOLOMON: That, I mean, that is the situation we find ourselves in. And, you know, as a healthcare organization that is very prevention focused, our pediatricians are seeing that, you know, it’s really challenging to talk to their patients about the right thing and have them leave the doctor’s office and walk into an environment that makes the healthy choice really, really difficult. And we need to turn that around, and Kaiser Permanente is stepping into this. We see lots of people in San Diego stepping into it, the CDC’s getting involved in a big way. So it’s encouraging. People are appreciating the gravity of the problem and the solutions that are within our grasp and there is definitely a tipping point that’s happening in the country with the First Lady getting involved in bringing attention to this. And my hope is that by reaching for those solutions, we’re going to be able to really come to common ground and actually be able to make some progress here in a way that we haven’t been to – been able to do for a lot of other problems that our nation faces.

CAVANAUGH: Dr. Solomon, we have a caller on the line. Karina is calling from Encinitas. Good morning, Karina. Welcome to These Days.

KARINA (Caller, Encinitas): Good morning. Thanks for taking my call.

CAVANAUGH: You’re welcome.

KARINA: I really like the project and the ideas of Dr. Solomon but I think it’s so important to say. I must say that nutrition starts at home. My daughter’s only four years old and we teach her that we need to eat vegetables or salads in each meal. There’s no sodas, only maybe juice with a glass of water. And I see kids of her age eating junk and eating fast food and it’s so sad. Where are the parents? You know?

CAVANAUGH: Thank you.

KARINA: We can’t just count on teachers and doctors. We need to teach our kids at home from a early age so that’s the norm for them.

CAVANAUGH: Good point, Karina. Thank you.

DR. SOLOMON: And I totally agree. I mean, we – I have a nine-year-old and a twelve-year-old and I, you know, appreciate that I’m the first line of defense and my parents – my kids’ first teacher. The challenge, of course, is when your daughter, Karina, goes off to school and she is, you know, getting school lunch and has access to, you know, to the food environment in school. It’s hard to control that environment so we need to make sure that those health – those options are healthy as well. And I’m sure that if you’ve done a good job in engaging your daughter and letting her know the difference between healthy choices and unhealthy choices, she’ll be in a much better position to weather that environment.

CAVANAUGH: So, Dr. Solomon, this big conference happened this week here in San Diego, launching the CDC’s Initiative. What is the next step in this process?

DR. SOLOMON: Well, this is a two-year program. They have very ambitious goals. Every community, including San Diego, wants to create some major change in the food and physical activity environment and there’s some counties that are doing tobacco work as well. And the idea is that this is really creating the – kind of paving the way for how the nation is going to think about big prevention investments moving forward as part of the Health Reform Bill that President Obama signed a few months ago. There is a couple billion dollars of prevention spending that’s going to be ramping up over the next several years and so the work in San Diego and the work in the other communities that are launching this initiative is really going to teach us what – how we can use that money most effectively to improve health for our communities.

CAVANAUGH: Well, Dr. Loel Solomon, thanks so much for talking to us about this today.

DR. SOLOMON: It’s a pleasure. Thank you for the time.

CAVANAUGH: Dr. Solomon is vice president for Community Health at Kaiser Permanente. He was a keynote speaker at this week’s California Action Institute’s Conference here in San Diego. If you’d like to comment on this segment, please go online, Coming up, the changing face of Facebook. That’s as These Days continues here on KPBS.