The number one cause of death in South Carolina is not car accidents, cancer or heart attacks. The supreme source of fatality in the state is obesity, and it’s growing every year into a greater and greater problem that affects children.
According to the White House Task Force on Childhood Obesity’s 2010 report, obesity is a risk factor for the top four causes of death in America, and the childhood obesity epidemic in America is considered a national health crisis worse than that of polio in the 1940s and 1950s. Today’s youth are on course to being the first generation of Americans to live shorter, less healthy lives than their parents. Unlike polio, there is no single cure for obesity, as it is a multifaceted and complicated problem.
“Overweight” is defined as a Body Mass Index (BMI) score of above 25, or above the 85th percentile and lower than the 95th percentile for children of the same age and sex. “Obesity” is defined as a BMI score of above 30, or above the 95th percentile for children of the same age and sex.
South Carolina is the eighth most obese state in the country — 30.9 percent of adults are obese, and the combined obesity/overweight is a staggering 67 percent. A variety of studies show that close to 30 percent of youth in South Carolina are obese, with the percentage higher than 60 percent in some counties. The implications of these statistics are frightening considering that children who are overweight have a 70 percent chance of becoming overweight as adults, which makes them more likely to be diagnosed with the related health problems and diseases later in life.
The Institute of Medicine states that childhood obesity has more than doubled in children and tripled in adolescents in the past 30 years nationwide. In August 2011, Dr. Vincent Degenhart, an anesthesiologist and former member of the South Carolina Medical Association Board of Trustees, recognized that physicians need to lead the state’s fight against this health crisis. Through his leadership, the South Carolina Medical Association Childhood Obesity Taskforce (SCMACOT) was created, consisting of numerous community and health care leaders all committed to stopping childhood obesity in South Carolina by targeting four key areas: schools, childcare, advocacy and insurance/healthcare.
“The numerous health issues associated with obesity all predispose these children to premature death,” Dr. Degenhart says.
Trimease Carter, Youth Coordinator with the South Carolina Eat Smart, Move More Coalition, says that diseases that are normally present in adults are now being diagnosed in children. The number of children with type 2 diabetes, high blood pressure and high cholesterol is steadily increasing, along with what used to be known as adult-onset diabetes. One third of all children born in the year 2000 are expected to develop type 2 diabetes during their lifetime.
The S.C. Eat Smart, Move More Coalition coordinates obesity prevention efforts across the state and leads the implementation of South Carolina’s Obesity Prevention Plan. The ongoing collaboration among a broad range of stakeholders capitalizes upon and leverages differing areas of expertise, skill and resources to impact obesity in South Carolina.
While childhood obesity didn’t happen all at once, Dr. Degenhart explains that the accelerated rate of obesity and overweight children seems to have started in the 70s. “We have changed from an agrarian, manufacturing, manual labor culture to a more urban society,” he says. “We have gone from a country and indeed a world where malnutrition and starvation were major killers of children, to one where over-nutrition and poor nutrition now kill twice as many people worldwide.”
Sweetened drinks have been recognized as a chief culprit, in addition to fast foods, packaged foods and snacks, as well as the sheer volume of food Americans consume. Foods are now of a higher caloric content, but they are not necessarily nutritious. Daily consumption of at least five fruits and vegetables is recommended, but people rarely hit that target since processed, packaged, frozen or fast food is far more convenient.
Research indicates that proper nutrition and physical activity enhance children’s test scores. Children should get at least one hour of physical activity per day, but computers, iPads, smart phones, video games, television and the general electronic boom have put them in front of screens rather than outside playing games, sports and riding bikes.
Trimease notes that the number of fast food restaurants has increased as well as the serving sizes. And rather than eating meals prepared at home, people often dine out.
She also explains environmental and social determinants, such as income, education, race and geographic location, are strong obesity indicators. Unfortunately, lower income individuals and those who live in rural areas have higher rates of obesity and chronic disease. Fresh fruits and vegetables can be unaffordable, never mind gym memberships, and not every neighborhood has sidewalks, parks or playgrounds. In some areas, it is just not safe for children to go outside and play.
On an economic level, obesity in South Carolina costs the state $1.2 billion in 2009, and it is estimated that the state will spend $5.3 billion on obesity-related illnesses annually by the year 2018.
Catherine Templeton, director of the South Carolina Department of Health and Environmental Control, says, “Obesity kills the most South Carolinians, makes the most sick, and, if prevented, would save the state the most money in treatment.” She is focusing DHEC’s resources on the fight.
Dr. Degenhart also explains that there is also a tremendous social cost. “Obese Americans struggle more with their jobs, finding employment and missed time at work. That is not to mention the social stigma that is associated with obesity. Life is tough, and it’s tougher if you are obese.”
The obvious question then is what can individuals and society as a whole do to combat this problem? Awareness alone can only go so far if it is not followed by action-based initiatives.
“I hate to give you bad news,” says Dr. Degenhart, “but in the past 30 years in spite of increased awareness, an emphasis on exercise and better nutrition, the problem has continued to get worse.”
While well-designed individual level approaches and education are important, individuals are more likely to sustain healthy lifestyles when the environment in which they live supports those behaviors.
Through SCCOT, Dr. Degenhart hopes to promote better eating habits, wellness programs in schools, “Farm to School” fruits and vegetables and an increase in physical activity. By creating an environment in which the healthy choice is the easy choice, individuals, families, schools, places of faith and workplaces can contribute to reducing obesity.
Catherine says, “The government shouldn’t mandate behavior, but it is important to educate. When children and their parents don’t know about nutrition, it is important to educate them so they can make informed choices.”
Trimease says that the SC Farm to School Program is a strong example of an initiative being used throughout the state to address childhood obesity. It supports schools in implementing these four components:
• source at least two Certified SC Grown fruits and vegetables per month to be served as a part of the school meal
• promote Certified SC Grown in the school cafeteria
• integrate nutrition and agriculture education into classroom activities
• establish a school vegetable garden
“South Carolina received funding for the Farm to School pilot program and awarded 52 Farm to School grants to schools across South Carolina for the 2011/2012 school year,” says Trimease. “We were also awarded an additional Farm to School grants for 37 schools and nine child care centers for the 2012/2013 school year.”
In 2012, the Eat Smart, Move More Grow Healthy toolkit was launched, as well as the recently developed a youth-oriented leadership initiative. The Healthy Young People Empowerment (HYPE) Project, with the help of local mentors, works with youth on a local level and teaches them how to use policy, systems and environmental change to combat obesity in their communities and schools.
“A promising approach to combating childhood obesity is to bring youth to the table,” Trimease says. “All too often, youth are not included in the process of addressing issues that affect them directly.”
The 2013 Annual Report, Joint Citizens and Legislative Committee on Children states that the benefit of supporting anti-obesity initiatives at the state and local levels will be lower health care costs for both children and adults, better academic performance, a stronger work/military force and the opportunity for children to live healthier and more productive lives.
“There are so many opportunities to turn this around, but it will take attention from all sides,” says Catherine. “We are working with retailers, schools, non-profits, farmers, hospitals and other state agencies to change the rules.”
Dr. Degenhart equates it to a cultural change much like the campaign against smoking. “Doing nothing is an early death sentence for our children,” he says, “not to mention the terrible health consequences and expense of diabetes, hypertension and heart disease that will continue to plague both our children and society.”
The ABC Grow Healthy initiative is a collaborative effort between DHEC and the South Carolina Department of Social Services ABC Child Care Program, the state’s quality improvement system. Through this initiative, enhanced nutrition and physical activity standards have been established and are being implemented in South Carolina ABC childcare centers.
The Eat Smart, Move More, Grow Healthy (ESMMGH) toolkit is a resource for child care centers that focuses on healthy eating and active living. The ESMMGH toolkit uses a three-pronged approach to address nutrition and physical activity by targeting the policies and practices in place at the childcare center, as well as with children and their families. The core component of the toolkit is the ESMMGH Child Care Assessment. This state-specific assessment outlines best practice recommendations for nutrition and physical activity and is used to assess policies, practices and the environment of a child care center. By completing the assessment, childcare center directors will be able to determine how policies, practices and the environment at their center align with national and state best practice recommendations. The ESMMGH toolkit contains activities and resources that can assist in meeting some of the ABC Grow Healthy nutrition and physical activity standards.
The S.C. Farm to School Program is a joint effort between DHEC, the S.C. Department of Agriculture, the S.C. Department of Education and Clemson University.
The Healthy South Carolina Initiative supports community-level efforts to reduce obesity and obesity-related chronic diseases such as heart disease, cancer, stroke and diabetes. By promoting healthy lifestyles, especially among population groups experiencing the greatest burden of chronic disease, these community-level efforts are helping to improve health, reduce health disparities and control health care spending. This is a collaboration of DHEC, the S.C. Tobacco Free Collaborative, the S.C. Eat Smart Move More Coalition and the Medical University of South Carolina’s Outpatient Quality Improvement Network. This project is funded by a five-year Community Transformation Grant award from the Centers for Disease Control and Prevention.
Tips from Dr. Vincent Degenhart for battling childhood obesity:
- Volunteer time
- Help set up a wellness council at a local school.
- Get the kids active. Promote PE, physical activity, sports and wellness competitions.
- Volunteer at a church or synagogue, local community center, YMCA, Boy Scouts, Cub Scouts or Girl Scouts.
- Organize health fairs
- Identify children in need of attention and follow-up with them. Help get at risk children to the doctor or a resource that can counsel them.
- Push for use of public facilities for physical activity for the general public, like school gyms, tracks and weight rooms. Many churches have gyms that could be used to help get the congregation in better physical as well as spiritual shape.
- Promote good nutrition at home and at school
- Promote the 5/2/1/0 plan: 5 fruits and vegetables every day, no more than two hours of screen time per day, 1 hour of physical activity, and no (zero) sweet drinks. Get unhealthy snacks and sweet drinks out of the house and school.
- Educate children and parents that eating healthy and being active is cool. It will save their lives.
- If you or your child is overweight (BMI greater than 25) or obese (BMI greater than 30), see a physician, get counseling and plan a course of action.
Tips from Eat Smart Move More SC:
- Become a part of the SC Eat Smart, Move More Coalition membership (www.esmmsc.org).
- Schools across the state have adopted a healthy fundraising policy.
- Worksites can put healthy snacks and beverages in their vending machines.
- Families can start eating more home cooked meals and being active as a family.
Tips to Eat Smart and Move More at Home
- Rethink your drink. Before picking up that can of soda, think about choosing something your body needs, like water or low-fat (1 percent) or fat-free milk.
- Right size your portions. Bigger is not always better.
- Tame the tube. Turn off the TV to lower your family’s risk of becoming overweight. Instead, spend more quality time together.
- Move more every day. Even small amounts of daily physical activity can help you stay healthy.
- Eat more healthy meals at home. Eating at home rather than eating out will not only reduce the amount of fat and calories you eat, it can save you time and money.
- Eat more fruits and vegetables. Whether fresh, frozen, canned or dried, fruits and vegetables are quick, delicious and convenient. They will keep you healthy all year round.
- Provide the best start. With all the benefits for mom and baby, breastfeeding is the best start to eating smart.
Tips Eat Smart and Move More in the Community
- Get involved in efforts to establish bike and walking paths.
- Help establish community farmers’ markets.
- Get involved with schools to support the S.C. Farm to School Program.
- Work with schools to implement a comprehensive Safe Routes to School program.
- Support a ‘take the stairs’ campaign at your place of employment to promote more activity during the work day.
- Advocate for healthy food and beverage options in cafeterias, vending machines and at meetings and other catered events.
- Support breastfeeding-friendly environments.
Schools play a critical role by establishing a safe and supportive environment with policies and practices that support healthy behaviors. Schools also provide opportunities for students to learn about and practice healthy eating and physical activity behaviors. Schools can:
- Provide daily opportunities for structured and unstructured physical activity, to include physical education and active play.
- Provide developmentally appropriate toys and equipment for physical activity and active play.
- Devote the majority of physical education class time to moderate or vigorous physical activity.
- Provide various physical activity options that reflect the interests and diversity of students.
- Teachers and staff model healthy behavior by participating in physical activity and playtime with children.
- Implement a comprehensive Safe Routes to School Program.
- Develop Joint Use Agreements to allow for the use of school facilities for physical activity programs outside of school hours.
- Adopt policies to support healthy eating, such as providing healthy food and beverage options in vending, school stores and other competitive food outlets.
- Make drinking water easily visible and available for self-serve both indoors and outdoors.
- Use point of decision prompts to encourage healthy food purchases.
- Participate in the S.C. Farm to School Program.
- Establish a school vegetable and/or fruit garden.
- Develop and implement guidelines for all foods and beverages served for meals, snacks, parties and celebrations.
- Develop and implement guidelines to eliminate the use of food as a reward.
- Promote nonfood or healthy food fundraisers such as flowers, gift-wrap, fresh fruit and plants.