Note to readers: Each week through November 2019, a selection of our 101 California Influencers answers a question that is critical to California’s future. Topics include education, healthcare, environment, housing and economic growth.
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California Influencers this week answered the following question: As growing numbers of Californians and Americans struggle with obesity, what type of legislation or other steps can help address this crisis?
Carmela Coyle, President and CEO, California Hospital Association
Here is a sobering fact: 25% of California adults are considered obese. And if you think that’s bad, a full one-third of our kids age 10 to 17 also are overweight.
Kids and teens in 2019 spend an average of seven hours a day sitting in front of video screens. And many adults spend their working days at computers. When it comes to behaviors that affect our health, sitting has become the new smoking.
We need to focus on upstream solutions before another generation’s health and well-being is compromised. It costs far less to keep someone healthy than to treat them for more severe medical issues later.
The state can help by funding the community and social supports needed to make a difference: more education on obesity and its effects, safe communities where families can walk, run or ride bikes, access to healthy and nutritious food close to home and in schools, access to the behavioral health care needed to address stress and anxiety that can lead to obesity and more.
Addressing the obesity crisis will take close collaboration among elected officials, health providers and community leaders. We are all in this together.
Dustin Corcoran, California Medical Association
Obesity is a public health crisis that has been at the top of California Medical Association’s legislative and political agenda.
The rise in obesity matches the rise in sugar consumption. And the top source of sugar in the American diet – nearly 50 percent – comes from sugar-sweetened beverages like soda, energy drinks and flavored fruit drinks. Companies like CocaCola Co. and PepsiCo target their products to kids and low-income communities and communities of color. Not surprisingly, these are the places where we see the highest rates of obesity, diabetes and other related conditions.
These companies even time their advertising efforts to coincide with food stamps distribution schedules. Just as we did with tobacco, we must stop corporations from using predatory marketing tactics to target kids and low-income communities. We should pass a tax on sugar-sweetened beverages that will reduce consumption, protect public health and raise money to increase customer awareness and offset the public health costs associated with these harmful products.
Big soda has held the Legislature hostage, spending millions of dollars on lobbying and political campaigns, and maneuvering to preempt cities from passing new local soda taxes. State leaders must take action to stand up to big soda and address this growing public health crisis.
Marie Waldron, Minority Leader of California State Assembly
There’s no denying that Californians are getting heavier and it’s having an impact on our state’s public health. Still, government intrusion into our lunchboxes is going overboard.
However, the state should address food deserts in rural and underserved communities by supporting community gardens through schools, after-school programs and churches. Supporting preventative health and wellness programs and funding them through Medi-Cal, including screenings and healthy lifestyle education will help.
Increasing enrollees in CalFresh is critical. So is furthering the CalFresh pilot program that encourages healthy eating by providing double credits when beneficiaries buy local, fresh fruits and vegetables. Not only does this encourage better health habits for low-income families, it also supports local agriculture.
It’s up to each of us to make healthy choices to get obesity under control – drinking a glass of water instead of Coke or ordering the side salad instead of fries. The state’s role should be to educate consumers and empower them to make those healthy choices.
In 2016, then-Governor Jerry Brown issued one of his most well-known veto messages, “Not every human problem deserves a law.” That time he hit the nail right on the head.
Richard Pan, California State Senator
Our nation’s experts, the National Academy of Science, examined the research on childhood obesity and its causes. This report sits prominently on my desk because obesity may lead to shortened life expectancy and demands that we address the social determinants of health.
As a pediatrician and legislator, I have worked to improve access to healthy meals and greater opportunities for physical activity, especially in underserved communities. The state can adopt health in all policies to decrease obesity including public education and warning labels on sugar sweetened beverages, funding evidence-based prevention efforts like the diabetes prevention program by Medi-Cal and health plans, creating a built environment to encourage physical activity in local planning, eliminating food deserts and expanding access to fresh produce through CalFresh and food banks, and supporting further research on obesity prevention to inform effective policy.
More than half of California adults have Type 2 diabetes or are pre-diabetic, conditions driven by obesity. This will result in billions in health care costs in the next five years and beyond, if we do not act to reduce obesity.
Robert Ross, President of California Endowment
So let’s first stipulate that there is no neat, clean, single-pronged answer to our nation’s ridiculously costly obesity crisis. We must recognize that this crisis is structural, systemic, and driven by conditions which provide for choices and options for families and their children. The ability to eat healthier is dependent upon making healthy eating the easier choice; the ability to exercise is dependent upon making exercise the available choice.
With this in mind, the five ways for California to advance or support the right package of policies:
1. Tax sodas and other sugar-sweetened beverages and invest in prevention with the revenues.
2. Maintain and strengthen school meal quality standards in the federal Healthy & Hunger Free legislation.
3. Bring back a commitment to physical education and fitness in schools.
4. Do not allow federal cuts in SNAP benefits.
5. Did I mention taxing sodas and sugar-sweetened beverages?
Will California policymakers have the guts to stand up to the big soda lobby in the manner that we did with big tobacco years ago? With recent big soda lobby victories, this question is very much in doubt at the moment…
Zach Friend, Second District Supervisor for Santa Cruz County
Improving nutrition is one of the most cost-effective ways toward improving health outcomes. Even though backed by significant amounts of scientific study, which shows that improvements in diet and exercise have positive benefits on common U.S. health issues (obesity, type 2 diabetes, and heart disease), focus on nutrition in medical education and even access (such as government food assistance) continues to lack.
Easy fixes, some of which fall out of the legislative realm, would be to increase the training for influencers in this arena. According to the National Institutes of Health, even though research has shown that a physician’s knowledge of nutrition directly affects the quality of preventative health counseling and patient outcomes, medical students average fewer than 20 hours over four years of medical education on learning about nutrition.
One solution would be to increase this requirement so nutrition is elevated in knowledge and interest among physicians. Improving the prevalence of unprocessed foods, fresh fruits and vegetables within subsidized or free nutrition programs has also been shown to improve outcomes. Overall, these are inexpensive and simple solutions that could have large impacts on overall health.
Mark Ghaly, Secretary, California Health and Human Services
Primary care is 5 percent diagnosis and 95 percent plan, a ratio I learned to be generally true early in my clinical career. And it is as true as ever when it comes to caring for patients who are overweight.
Take my recent 6-year-old overweight patient. After reviewing his ongoing weight gain with mom, she and I entered into our typical exchange about diet and exercise. Given I knew the family well and the conditions in their low income community – few safe places to walk or play; few options for healthy food – crafting a plan for him to easily eat better and exercise more was difficult.
Identifying what could make his plan for healthier living easier would likely create similar opportunities for many of the 30 percent of California’s children who are obese today.
For example, grocers should complement existing efforts to provide nutrition education to CalFresh and WIC recipients by opening stores with healthy food options in our lowest income communities. We should invest in new parks, and good upkeep of existing parks, enriching them with sports and other community activities. We should pursue policies that address excessive screen time by promoting active alternatives and begin this push in early childhood educational settings. These concepts will help neutralize the inequities low-income communities face in what is a truly a harder battle to become and stay healthy.
Chet Hewitt, President and CEO, Sierra Health Foundation
The obesity epidemic is a multi-factorial health challenge that requires a multi-sectorial public health response. This will require state and local government and private sector collaboration to be successful.
Focusing on public efforts, important steps include ensuring walkable community design is a centerpiece of the state’s evolving master housing plan, providing incentives for healthy food markets to open in under-resourced neighborhoods, and setting higher standards and providing more support for school lunch and physical activity programs.
Cities should also join in by making sure park and recreation facilities are open on weekends and evenings and that opportunities to participate in sports leagues and other community activities are affordable and available to all age groups.
And finally, we must all work together to ensure neighborhoods are safe places for families, seniors and children to engage in outdoor activity. Turning the corner on this costly epidemic is possible but will require all hands on deck.
Anthony Wright, Executive Director, Health Access California
California can and should lead to address the increasing prevalence of obesity, a moral, public health and financial imperative. As part of the Let’s Get Healthy California Task Force a few years ago, we established a goal to reduce the rate of obesity. If the adult body mass index fell by 5 percent, California could save $82.7 billion in obesity-related health costs by 2030.
We were disappointed that the soda industry stalled legislation this year to address the consumption of sugar sweetened beverages. We need more public policies to encourage healthy eating and behavior, starting at childhood: nutritious eating choices in school, safe spaces for walking and exercise, opportunities for sports and physical activity, and more. Too many Californians lack potable water. California’s taken some actions, but more are needed.
Beyond these prevention efforts, everyone should have access to primary and preventative care to manage obesity, as well as diabetes, heart disease and other chronic conditions obesity is linked with. California has worked — expanding Medi-Cal and increasing affordability assistance in Covered California — to cover more people, and we should do more to include everyone in the health system, to confront the obesity crisis head on.
Le Ondra Clark Harvey, Director of Policy and Legislative Affairs, California Council of Community Behavioral Health Agencies
The prevalence of obesity across the nation is alarming, and continues to grow. Research indicates that obesity and emotional disorders such as anxiety disorders, depressive disorders, and alcohol use disorders are correlated. Also concerning is that children and adolescents with major depressive disorder may be at increased risk of becoming overweight.
Addressing the obesity epidemic and its correlation to behavioral health disorders is imperative. Legislation or regulations that require medical and behavioral health practitioners to routinely screen for risk factors for obesity should be pursued.
Jeannine English, National President, AARP (retired)
Obesity rates have tripled in the United States in the past 30 years with a startling 39 percent of adults between the ages of 40 and 85 and 19 percent of children (ages 2-19) falling into that category. Obesity is the number one public health threat in our country accounting for 18 percent of deaths for Americans 40-85 years old.
To successfully address this epidemic, we need to attack this problem with the same focus and determination we used to reduce tobacco use including both taxation and smoke free laws primarily enacted at the state and local levels.
Taxing harmful food like sugar sweetened beverage is a key strategy. In Berkeley, California, this led to a 25 percent reduction in consumption. Additionally, we need nutrition standards for food and beverages in childcare coupled with physical activity standards for children. Successful obesity prevention solutions will require commitment and focus from all sectors.
Bruce Chernof, President and CEO, The SCAN Foundation
Obesity is a chronic health condition that emanates from a combination of many factors, including social determinants of health and genetics. As a problem that often develops over years, it can have devastating health and daily living consequences in middle age and old age —impacting individuals and their families. Policy opportunities should focus on equitable access to healthy and affordable food choices, public spaces and neighborhoods that encourage physical activity, and positive reinforcement for those making healthier choices (through health insurance premium reductions, for example).
Dr. Joseph Alvarnas, VP of Government Affairs, City of Hope
Obesity increases the risk of chronic health issues, including hypertension, diabetes, heart attacks, strokes, asthma, and sleep apnea. What many people don’t know is that obesity also markedly increases the risk for developing cancer, including breast, liver, kidney, ovarian, thyroid, and other cancer types.
In 2017, California reported an adult obesity rate of 25.1 percent with African-Americans and Latino Californians reporting rates that are 25 percent higher than the state average. This is actually the fourth lowest in the nation but still presents risk for our residents.
We should concentrate on evidence-based strategies, as recommended by a person’s physician, to overcome obesity in our communities; these include healthy eating, refraining from smoking, daily exercise and limited alcohol intake. At City of Hope, we believe that people can take meaningful, sustainable steps toward wellness through realistically achievable dietary and lifestyle changes.
The first step in this process is one of educating Californians to the enormous power that exists in their own hands to prevent cancer and obesity. Through community-facing education programs, such as City of Hope’s cancer prevention initiative funded by the Conrad N. Hilton Foundation, Healthy Living Grant Program and Eat, Move, Live!, cancer centers such as ours are making a difference in addressing this epidemic.
Kassy Perry, President and CEO, Perry Communications
The obesity epidemic now accounts for more than 3 million deaths a year globally at a cost of more than $2 trillion dollars annually. That dwarfs the opioid epidemic and other public health threats.
The obesity epidemic has been called a “global catastrophe in slow motion” by Dr. Larry Cheskin of the Global Obesity Prevention Center at Johns Hopkins University. Yet obesity is still viewed as a personal problem caused by an individual’s willpower or individual decision-making. There is simply no way that 2 billion people around the world all started making poor decisions at the same time. And continuing to blame the individual distracts from the real causes of the obesity epidemic.
There is not one thing that caused the obesity epidemic and there is not one new law or regulation that will slow the spread. The obesity epidemic represents a systems problem, not an individual problem. It’s about biology and metabolism and diet. It’s about your gut biome, as researchers have just learned. It’s about economics, culture, environment, and access to healthy foods.
Exercise is no longer required in school or on the job where most of us are sitting on computers 14 hours a day and then watching television while sitting on the couch for 4 more hours in the evening. Stress disrupts sleep patterns which cause bodies to store fat. The failure of the winners of The Biggest Loser to keep the weight off after the television series shows what we are up against. Science proves that it is not just “calories in and calories out.”
We need a whole host of systems changes to address the crisis, and the only way we can accomplish that is to stop blaming the patient and start fixing the systems, and that starts with health insurers covering treatment adequately.
Jodi Hicks, Director, Mercury Public Affairs
According to the World Health Organization, the two most important means of preventing childhood obesity are healthy eating and physical activity. Our schools and communities must have equitable access to safe places to play, opportunities for physical activities both in and out of school and we must decrease access to unhealthy foods and beverages while making healthful options affordable and accessible.
One of the more controversial efforts in California this year has been attempts to reduce consumption of soda and sugar-sweetened drinks. We know that for children, each extra sugary beverage consumed per day increases their chance of becoming obese by 60 percent. Despite these staggering statistics, three bills attempting to limit the sale of soda in California all stalled in the Legislature. According to the Legislative Analyst’s Office, a statewide tax of 2 cents per ounce could reduce consumption of sugary drinks by 15 to 35 percent and bring the state an estimated $4 billion a year that could be spent on initiatives to increase the public health of Californians.
California has the highest obesity-related costs in the country, estimated at $15.2 billion. Our Golden State has long been a leader on public health issues, from banning the sale of soda and unhealthy foods in our schools to requiring menu labeling large restaurant chains. We should continue to lead by supporting public education and community planning programs, but we also need to enact policies to drive change in behavior, even when they go against well-financed industries.
Our policies to address obesity should reflect our values in California. Bold public policies like requiring recess, ensuring access to sidewalks and parks and reducing access to high-calorie and sugar-sweetened foods and drinks will make a difference to create and change environments for our children to thrive where they go to school, live and play.