Sugarplum Society

Rob Capriccioso
December 22, 2003


“Mom, can I have money for a gumball?”

“Not right now, honey.”

“But it’s only a quarter.”



“Not now.”

“But Mo-o-o-o-m, I want a gumball—please, please, puh-lease...

After the scene plays out for just a few more seconds, a shiny, purple gumball whirls down a winding plastic chute. The child, about five years old with SpongeBob SquarePants emblazoned on her coat, has a delighted grin on her face as she shoves her prize in her mouth. And the mother looks relieved to no longer be the center of attention in the checkout line.

But why did she ultimately give in? Experts on the growing childhood obesity epidemic say that understanding such decisions is of utmost importance for children’s health.

What’s BMI Got to Do with It?

Body mass index is the ratio of weight in kilograms to the square of height in meters. It’s useful because it correlates well with more accurate measures of body fat and because it can be derived from commonly available data—weight and height.

Pediatric growth charts for the U.S. population now include BMI for age and gender and are available online. Overall, a BMI between the 85th and 95th percentile for age and sex is considered at risk for overweight, and BMI at or above the 95th percentile is considered overweight or obese.

The Size of the Problem

The American Academy of Pediatrics reports that in the last two decades, the rates of obesity have doubled in children and tripled in adolescents. Currently, 15.3 percent of 6- to 11-year-olds and 15.5 percent of 12- to 19-year-olds fit the bill for being overweight or obese.

The Centers for Disease Control and Prevention defines obese and overweight kids in terms of BMI (body mass index), adjusted for age and gender.

Obese and overweight individuals have increased risk of heart disease, stroke, high blood pressure, and some types of cancer. Approximately 300,000 deaths are associated with the condition in the U.S. every year. Medical problems for overweight kids and adolescents range from high blood pressure to menstrual irregularity to insulin resistance. Mental health problems like depression and low self-esteem are common as well.

Being overweight also increases a child’s chance of becoming diabetic. Children as young as 10 are being diagnosed with Type II diabetes, once called “adult onset diabetes.” The condition can contribute to heart attacks, strokes and peripheral vascular disease later in life. Only a decade ago, it was virtually unheard of in children.

According to a study in the October 2003 Journal of the American Medical Association, a child born in 2000 and diagnosed with type II diabetes at age 10 could expect to lose 19 years off his or her lifespan. The study also estimated the lifetime risk of developing diabetes for individuals born in 2000 at 32.8 percent for males and 38.5 percent for females. Hispanics have even higher estimated lifetime risks with males at 45.4 percent and females at 52.5 percent.

Prevention Confusion

How to prevent childhood obesity and overweight is not clear. The Academy says that there have been few studies focusing on prevention. It urges pediatricians to use the best information available to combat the problem, but there is no consensus on effective strategies.

Richard H. Carmona, the U.S. Surgeon General, suggests health professionals address three key factors: physical activity, eating habits and health literacy. To achieve these goals, he promotes the CDC’s Youth Media Campaign, which enlists young people to design ads and other materials promoting healthy lifestyles.

Marlene Schwartz, a mom who also happens to be an obesity researcher at Yale, has done research into the role of society and environment in childhood obesity.

“I have been amazed by how powerful the desire is to give small children cookies or candies or soda—people are almost afraid not to give kids candy,” says Schwartz. “They think they are going to disappoint their children.”

The Role of Marketing

In the past year, the average child has seen approximately 10,000 ads, according to researchers at Yale University. A whopping 95 percent of those ads are for candy, soft drinks, fast food and sugared cereals. The CSPI (Center for Science in the Public Interest) says marketing and advertising aimed at children has doubled over the past decade.

Like the girl in the SpongeBob coat, kids are hardly immune to the power of marketing. And they’re pretty good persuaders themselves, when it comes to pushing parents for what they want.

“The pressure is definitely there,” says Karen Wilbur, a mother of three from Davis, California. “Friends of my children visit fast food restaurants frequently and acquire a collection of toys that my children desire. The ‘Wonderball chocolate-with-surprise-inside’ commercials completely mesmerized my daughter and I was inclined to purchase her a few to keep from breaking her heart.”

“Unfortunately, that’s the environment we live in,” says Schwartz. “We’re surrounded by these foods and we basically try to tell our kids and ourselves that we can’t eat that, but we can sit there and look at it in commercials.”

Healthy Resources is a healthy eating and active living Web site for parents and kids.

The USDA’s Healthy School Nutrition Environment contains more advice.

The Center for Science in the Public Interest provides the latest in nutrition research.

Happy Meal?

The way food is marketed to kids is raising the eyebrows of some public policy advocates.

Margo Wootan, CSPI’s director of nutrition policy, authored a November 2003 report called “Pestering Parents.” She cites examples such as the Krispy Kreme “Good Grades” program that offers elementary school kids one doughnut for each “A” on their report cards. Wootan says that food should not be used as a reward for good behavior or academic performance.

Others, like Kelly Brownell, professor of psychology at Yale, would like to see restrictions placed on characters used in advertising aimed at young people—much as they were for R.J. Reynolds’ smoking Joe Camel character.

“We take Joe Camel off the billboard because it is marketing bad products to our children, but Ronald McDonald is considered cute,” Brownell recently told the Psychology Monitor. “How different are they in their impact, in what they’re trying to get kids to do?”

Some advocates are asking Congress to give the Federal Trade Commission and the Department of Health and Human Services authority to set nutrition standards for foods that can be marketed to children. Limits on the sale of sweets and sodas in schools are being enacted in districts across the country.

“At my old high school we had vending machines full of candy and soda all over the place,” says JoAnna Crawford, responding to an question about sugar in school. “...I must admit I ate way too many sweets as a teenager because of it and am now worried my own children will make the same mistake.”

An Emerging Industry Response

Earlier this year, McDonald’s faced a lawsuit blaming its food for the negative effects of childhood obesity. While the case has been dismissed, food and beverage companies are worried about such developments.

General Mills, the maker of sweetened cereals like Lucky Charms, has launched a new national initiative focusing on youth nutrition and fitness. The Kraft Company says it’s already testing alternatives to the trans fats in its Oreo cookie brand, in response to research linking trans fat consumption to higher heart attack risk. And Coca-Cola Chairman Douglas Daft told Reuters in December 2003 that beverage companies must provide healthy choices for consumers.

But companies also say that parents, teachers and schools must help children make sensible choices. They’re hoping Congress will shield them from obesity-related lawsuits: Sen. Mitch McConnell, R-Ky., has introduced a bill to prevent people from suing restaurants and food manufacturers for making them fat.

“Do as I Do”

Researchers say that parents can have a big impact on their children’s eating habits—not by nagging, but by eating healthy foods themselves, especially during family mealtimes.

In one of the most recent studies that focuses on childhood obesity prevention, Jennifer Fisher, a Baylor College of Medicine behavioral nutrition scientist, found that kids were less likely to eat fruits and veggies when their parents ate few of these healthy foods themselves.
Fisher also found that parents who reported consuming the fewest fruits and vegetables were also those who exerted the most pressure in trying to get their kids to eat healthy foods. Despite these efforts, their children consumed 1.6 fewer servings of fruits and vegetables per day than the children of parents who themselves ate more fruit and vegetables.

Marlene Schwartz

"Parents need to start from the very beginning. I mean, my kids—I have a 7-year-old and I have 3 ½ -year-old twins—they already know that there are foods that are healthy for your body and then there are other types of food. If you start at the beginning, you just do not buy certain types of food. It's a lot easier than if you buy them and then suddenly say, ‘Okay, no more Cocoa Puffs.' Eventually they stop asking. It's basic behavioral conditioning. If you reinforce something variably—sometimes saying “yes” and sometimes “no,” then your child is going to ask for it a lot more than if you always say “yes” or always say “no.” Parents want to avoid giving variable reinforcement for certain foods—those are foods we just don't eat because they aren't healthy for our bodies."

Since adults eat most of their daily fruits and vegetables at dinnertime, the evening meal is a particularly good time for children to observe healthy eating habits in action.

In order for “do as I do” to work, nutrition advocates argue that healthy foods need to be accessible and affordable. But while highly processed mass-marketed foods are generally becoming far cheaper, particularly in urban areas, fresh foods are becoming more expensive.

Fresh Thinking on Treats

Putting on her researcher’s cap, Schwartz recently decided to look at one aspect of our society where candy, sweets and overeating seem to always go hand-in-hand: holidays like Christmas and Halloween.

In a study released in October 2003 called “Trick, Treat or Toy,” she and her team investigated whether children would choose toys over candy when offered both.

“The study really came from my experiences as a parent and noticing how frequently we use candy and sweets to celebrate with our kids,” she says. “I was thinking that, perhaps, there are other non-food treats that we could use as alternatives that kids would be just as excited by and happy about and would have fewer health consequences.”

In the study, seven households gave 284 trick-or-treaters between the ages of 3 and 14 a choice between comparably sized toys and candies. The results: Kids were just as likely to choose toys as candy.

Schwartz believes that now is an important time to be creative with gift certificates, books, hugs, and other items of value to kids that will reinforce healthy attitudes. “I think parents can decide not to put candy canes in stockings and to put other types of things in there,” says Schwartz.

Wilbur has found that it helps to educate kids about how and why marketers try to influence their behavior: “I have introduced my children to the concepts of marketing, so they can better cope with the mass amounts being thrown at them,” she says. “Along with educating them on the values of nutrition, they tend to make better choices on the selections at meal times and in stores.”

“There are brilliant marketing minds working constantly to come up with more powerful, more exciting ways to entice our children,” says Schwartz. “I think parents really need to fight back and try to limit the industry’s access to our children.”

Rob Capriccioso is a staff writer for Connect for Kids.