First Lady Betty Ford championed for equal rights for women. By publicly sharing her battle with breast cancer she encouraged thousands of women to get mammograms and early screenings. First Lady Claudia Taylor Johnson, known as "Lady Bird" Johnson, was the only woman present when Lyndon B. Johnson signed the Civil Rights Act. She is best known for her "Beatification" projects and the millions of flowers in the nations capitol and in highway medians across the country. Her projects also included many environmental conservation efforts and the preservation of national parks. First Lady Hilary Rodham-Clinton lead the President's Task Force on Health Care Reform and was the third First Lady to testify before Congress. Although her well-researched plan was heavily criticized and was abandoned before being brought to a vote before the Senate, it had great foresight. During their husbands' terms in office, these activists were severely criticized for their influence and motivations. Still, their influence is laced through complex legislation and gracefully woven into the tapestry of contemporary society. First Lady Michelle Obama faces the same challenges and has the potential to impact the health of future generations of Americans as she crusades against childhood obesity.
The US consistently ranks as one of the fattest nations in the world. Body Mass Index (BMI) determines the ratio of body fat to other tissues (muscle, bone, organs, etc.). "Overweight" is defined as a BMI equal to, or greater than, 25. "Obese" is defined as a BMI equal to, or greater than, 30. The World Health Organization (2003) estimates that 2/3 of adult Americans over age 20 are "overweight" and more than 1/3 are "obese." The CDC estimates that the prevalence of childhood obesity has more than tripled since 1980. Current CDC estimates (2009) reveal that the prevalence of obesity in children and teens (age 2-19) is 17%. Further, obesity disproportionately affects children in lower income families.
Childhood obesity is an issue of human rights, healthcare and economics.
While it may be a controversial perspective, consider that childhood obesity is a form of child abuse and neglect. It can be argued that physical and psychological abuses are more detrimental to the well being of a child. However, childhood obesity can cause irreparable and mortal harm to vital organ systems. What chance do children have for a healthy life with such a disadvantaged beginning?
Preventing obesity is simple- expend more calories than you consume. Failing to prevent obesity, however, has very complicated ramifications. Obesity is linked to five of the 10 leading causes of death in the US. Diseases of the heart, cancer, stroke, diabetes and kidney diseases account for 59% of deaths. Obesity is also linked to sleep apnea, gallbladder disease, arthritis, binge-eating disorder and depression (Clinical Cornerstone, 1999).
In the matter of childhood obesity and life: more, is less. "Over the next few decades, life expectancy for the average American could decline by as much as 5 years unless aggressive efforts are made to slow rising rates of obesity, according to a team of scientists supported in part by the National Institute on Aging (NIA)'" If obesity is not addressed, we could face the first decline in life expectancy since the government began tracking this information in 1900. According to CIA World Factbook
(2012) estimates, the current life expectancy of 78.49 years is more than one and a half times that of the 1900 life expectancy age of 49.2 (CRS Report for Congress, Life expectancy in the US, 2006). It would be shameful, if we as a society tolerated the shortening of lives by such a preventable cause.
The Organization for Economic Co-operation and Development's (OECD) country comparison estimates raise concern as to whether the current system can meet the growing healthcare needs of the US population. In particular, the US does not have many physicians relative to its population (2.4 per 1,000) compared to the OECD average (3.1 per 1000). The number of doctor consultations at 3.9 per capita is only 60% that of the OECD average (6.5 per capita). There are only 3.1 hospital beds per 1000 compared to the OECD average of 6.5 per 1000. In addition to having fewer hospital stays, the duration of hospital stays is much lower than the average. The average length of a hospital stay in the US is 4.9 days; whereas, the OECD average is 7.2 days. Remember that the OECD average not only includes the most advanced healthcare systems, but also, and more prevalent, archaic healthcare systems.
Despite the current healthcare deficiencies, the US has the highest rate of healthcare expenditures in the world at 17.4% of GDP (OECD, 2009). "Following the United States were the Netherlands, France and Germany, which allocated respectively 12.0%, 11.8% and 11.6% of their GDP to health. The OECD average was 9.6% (OECD, 2009)." The US also ranks the highest in per capita healthcare expenditures at $7,960, two-and-a-half times greater than the OECD average of $3,233 (2009).
The US also breaks ranks with other nations on sources of funding. According to the OECD, "The public sector is the main source of health funding in all OECD countries, except Chile, Mexico and the United States." Further, "In the United States, 48% of health spending was funded by public sources in 2009, a much lower share than the average of 72% for OECD countries." According to 1998 regional comparison on healthcare spending (WHO), the Americas private insurance and out-of-pocket expenditures (18.5% and 29.7%, respectively) were most similar to those of the Africa region (20.3% and 26.2%, respectively). A number of other sources indicate that the US falls short in primary and preventative healthcare, later burdening the system with more costly procedures.
Through her "Let's Move!" initiative, Michelle Obama's is addressing a root cause of the plethora of health issues associated with obesity. It is a bold paradigm shift from treating disease to preventing disease. It is a paradigm shift the country does not seem quite ready for. Through her website
, she offers nutrition and health advice for parents, schools and kids. She encourages community gardens and physical activity, as well as, providing nutrition information.
Schools are incentivized to serve healthier lunches and install salad bars. She has contributed to initiatives that determine which snacks will be available in school vending machines, opting for a greater number of healthier snacks. Taking on big corporations, well represented in Washington by lobbyists, Michelle Obama has called for clearer food labels and a reduction in the amounts of salt, sugar and fat in popular products. "Walmart promised to reformulate thousands of its store-brand products to reduce sodium, sugar and fat, and push its suppliers to do the same. The company also pledged to cut fresh fruit and vegetable prices, build stores in areas without grocers and develop a logo for products that meet its health criteria (Huffington Post, 02/08/11)." Historically, large foods companies like Kraft, General Mills and McDonalds have pledged to improve the nutritional value of their foods many times. Despite such promises, we have seen little to no reduction in the amounts of superfluous sugar, salt and fats they add to their wide range of products.
The First Lady admits change happens very slowly. It is too soon to determine whether her campaign will alter the health of the nation for future generations or we will ultimately see the first decline in life expectancy in US recorded history. We can all agree that improving the country's health is in the best interest of a moral and forward-thinking society. The health of children is the responsibility of families, but the burden of poor health is shouldered by the nation.
What can I do?