Convinced a half-billion dollar effort to reduce childhood obesity started eight years ago is beginning to work, especially with school-age kids, the Robert Wood Johnson Foundation today announced it would commit another $500-million to help America’s children maintain a healthy weight.
Over the next 10 years, the nation’s third-largest private grant maker will place a greater priority on children under the age of 5. To reach preschoolers, the foundation will support parental and prenatal education on the advantages of a healthy diet and focus on fighting obesity among poor and minority kids, who tend to face more challenges keeping their weight down. The foundation will seek grantees and partners that promote daily exercise to ensure that children enter kindergarten at a healthy weight.
A key priority is to make sure kids don’t drink soda or other sugar-sweetened beverages.
"None," says John Lumpkin, who directs the foundation’s childhood obesity efforts. "Zero. There’s no reason children under the age of five should be exposed to that."
After its first $500-million commitment was announced, the foundation built a case for making obesity a national concern through its support of research on diet and exercise. The grant maker plans to continue to support research but will place more emphasis on advocacy, building on earlier success in pressing for healthier school lunches, better food labeling, and prodding food producers to lower calories in their offerings.
The anti-obesity effort will be part of the foundation’s Culture of Health approach, a program it announced in June to encourage healthy choices. Instead of just working with health professionals, the foundation will continue to collaborate with civic leaders, educators, public advocates, and corporate executives to attack health problems at home, in schools, in stores, and in public spaces.
The new investment comes amid signs that America’s obesity epidemic is improving.
According to U.S. Centers for Disease Control calculations provided by the foundation, the obesity rate of children ages 2 to 5 in the school year ending in 2004 was 13.9 percent. In 2012, it had dropped to 8.4 percent.
But in a number of states, the rates for kids in low-income families declined much less. Black and Latino high-school students suffered from obesity at a higher rate than their white counterparts. Some areas where obesity rates improved in 2012, like West Virginia, have slipped in the years since.
"We are seeing signs of progress, but this progress is very fragile," Dr. Lumpkin says.
Working with parents will be key to improving younger children’s health, Dr. Lumpkin says, because they can instill good eating habits at an early age.
Georges Benjamin, executive director of the American Public Health Association, credits the Robert Wood Johnson Foundation with making childhood obesity a national priority.
"In many ways, they brought it to a screeching halt," he says.
The foundation supported groups that promoted good nutrition and exercise in schools and towns nationwide, including the Healthy Schools Program of the Alliance for a Healthy Generation and Healthy Kids, Healthy Communities. Following the launch of those efforts, first lady Michelle Obama started her campaign against childhood obesity, Let’s Move.
Those efforts helped build support for legislation and regulatory guidelines that updated school-lunch nutrition requirements and set rules for the first time on the nutrition requirements for snacks sold at schools.
But getting families to change their habits will be more difficult than changing school meals, Dr. Benjamin says. "That’s a harder sell. We are health educators. We don’t want to threaten people. We don’t want to be the food police."
It is not clear whether obesity rates are on the decline or if they have plateaued at a relatively high level, says Nicholas Freudenberg, a public-health professor at the City College of New York. For rates to go down further, he says, the food industry will need to provide healthier food in low-income areas and stop marketing unhealthy food to children.
"What we’ve done so far has been important," he says, "but it’s been the easy steps. We can’t let these big food companies make a profit by marketing unhealthy food to children."
From 2007 to 2014, the foundation provided $7-million to its Salud America program. For the first several years, the program supported researchers in 11 states who studied obesity among Latino children. After it compiled a body of research, Salud America began working in communities to call attention to the benefits of eating fresh food and to create pressure on food merchants to adjust their inventories to include healthy offerings.
Salud America now offers tools, like its Growing Healthy Change website, which spotlights "Salud Heroes," who develop grass-roots programs that encourage exercise and healthy eating, and allows people to find local resources.
The program received another $1.3-million this month from the foundation to continue its work in areas where many Latinos live.
Amelie Ramirez, the program’s director, is confident her group can use the research it’s compiled to help young parents provide healthy meals for their children.
"They’re absorbing this," she says. "Everyone wants to do right by their kids."
From Research to Results
Over the next 10 years, the foundation will need to translate its academic findings into real-world success, says Marlene Schwartz, director of the University of Connecticut’s Rudd Center for Food Policy and Obesity.
"There’s been an explosion of research in this area," she says. "They’ve built the field. Now they’re trying to bring the research into policy making."
The effort has a good chance of paying off, Ms. Schwartz says, because the foundation has built relationships with community leaders nationwide and with food producers.
At first she was skeptical that food companies would respond to pressure that they reduce the total amount of calories of the products sold at fast-food restaurants and supermarkets. But she was "pleasantly surprised" when 16 major food and beverage makers reduced the calories in their products by 6.4 trillion in 2012.
The caloric reduction was largely possible because the food industry trusted the Robert Wood Johnson Foundation as a credible, independent evaluator of their products, she says.
Reversing years of poor eating and exercise habits will require efforts from parents, schools, community leaders, politicians, and business, says Robert Wood Johnson’s Dr. Lumpkin. The $500-million price tag reflects the size of the effort required.
"There is not a single intervention that works," he says. "This has to be all hands on deck."