Obesity is a societal as well as a personal sickness, and public funding for education is essential to its cure, health practitioners say. Yes, Hawaii’s adult obesity rate is second lowest in the U.S. at 21.8 percent, but let’s not pat ourselves on our fat backs. This rate has basically doubled since 1995, when 10.6 percent of us were obese.
Wordsworth, that famous hiker, wrote that the child is father of the man, meaning that traits and habits acquired in youth tend to stay with us. So do pounds. This is why public health professionals are desperately trying to instill leaner living habits early on. “[Obesity] starts very early,” says May Okihiro, M.D., a pediatrician at the Waianae Coast Comprehensive Medical Center and associate professor of pediatrics at the UH John A. Burns School of Medicine.
According to the National Cancer Institute, obesity is associated with increased risks of breast, colon, kidney, pancreas and other cancers, as well as coronary heart disease, stroke, high blood pressure and diabetes.
While Hawaii youth obesity rates decreased to 13.2 percent in 2007 from 15.2 percent in 2007, the number of overweight youth remained constant at an ominous 13.4 percent, according to the Healthy Hawaii Initiative of the state Department of Health.
As with adults, there are ethnic disparities in rates of obesity and overweight among Hawaii’s children. “The prevalence, or cross-section of kids that have that problem, is still extremely high at our health center,” says Okihiro, who works with patients who are predominantly Hawaiian and Pacific Islanders. But even among Asian-American children, who have historically been at low risk, rates for overweight and obesity may be rising nationally, according to a 2012 study by the U.S. Centers for Disease Control (CDC).
A soda tax of one cent per ounce, which Gov. Neil Abercrombie is proposing to the Legislature, would be a great help, says Okihiro, a member of the childhood obesity prevention task force that recommended a sweetened beverage surcharge in a December, 2012 report.
The proceeds, estimated at $37 million per year, would be applied mostly to childhood obesity prevention programs. “You can [still] have your soda, but [right now] they’re so cheap,” Okihiro says. “We need to change buying habits and the revenue can help us by supporting early childhood health programs.”
The task force also recommended that the state implement standardized early child care center wellness guidelines, and student fitness programs and criteria at public schools. The latter would help with learning, since “Behaviors associated with obesity (skipping breakfast, lack of physical activity) are also associated with academic underachievement,” Okihiro says. “A lot of studies show that obese kids have lower math scores, for example,” she adds.
Then there’s poverty, which gets in the way of eating regularly and healthily. “If you skip breakfast, you’re more likely to be obese. Your ability to focus and your behavior change after eating or not eating certain foods.” Eat a doughnut and take a test–you’ll run out of energy before it’s over, she warns. Yet many teachers still give out candy as classroom rewards, she observes, “when they could let them dance to a video instead. And for punishment, they’re still keeping kids indoors because they’re not doing their homework.”
In extracurricular sports, the emphasis on sweetened drinks such as Gatorade adds useless calories, she says.
Schools are doing a better job at identifying and counseling students at risk for obesity, but while health and wellness is a consideration, it could be more effective as part of the core curriculum in public schools, Okihiro observes.
While many families of her patients are getting motivated to eat healthily and be active, the problem is that regulations largely aren’t in place, she says–a situation that she hopes will change if the Legislature adopts the task force recommendations. “If you look at other cities (like New York and San Francisco, which have banned sweetened beverages and junk foods in public places) and states, we don’t have the physical education requirements and other standards in place; we aren’t anywhere near the national requirements. Honolulu city parks has got sodas out of the machines, which is a good step,” Okihiro adds.
One health educational model that might be shared statewide is that of Kamehameha Schools. In the cafeteria, says Health Director Nathan Wong, M.D., there are no sodas in the vending machines; whole fruits and vegetables are served, and whole grain breads and brown rice.
The physical education program is “vigorous. The freshmen train for a biathlon at the end of their sophomore year. Juniors and seniors have to do a community event, either swimming or running a 10K or Tin Man or both,” Wong says.
Sports such as paddling or football do not replace the P.E. requirement.
Yet KS still has obese students, many of whom enter the schools overweight. For heavy children, “who have difficulty staying with the standards of the regular program,” there’s a special P.E. program called Health Promotion Education. Wong visits and talks with the students about preventing diabetes and heart disease, and instructor Theone Chock designs individual programs for them. “They don’t all lose weight, but they all have some level of physical activity,” Wong says, noting that, “I would say that [obesity] has decreased here, compared to the general population and particularly the broader native Hawaiian population.”
In Hawaii, at “every single step of our lives, there’s such a push in our community to buy and eat more food,” Okihiro says, “and at McDonald’s big sizes are not much more money.” How does she not get discouraged? “I got into this 7-to-8 years ago because it didn’t seem like anything we said would change anybody’s behavior,” Okihiro says. But in the past few years, she says, she has seen kids doing better. “It usually starts with the parents making changes not just for one kid, but the whole family makes a commitment,” she says, pointing out that our communities and society need to do the same. About Waianae, she says, “it’s the most interesting place to work and the community is great. The people are wonderful. I like working with people who have greater needs. I would not work anywhere else.”