(Kim Tyo-Dickerson: Flickr)

Obese children face risks to their emotional and social well-being that can harm their academic performance, new research suggests.

The study, published today in the journal Child Development, found obese elementary school children performed worse on math tests than their peers without weight problems.

A lack of social acceptance could account for the lower test scores, researchers said. Obese children who do not feel accepted by their peers often exhibit feelings of loneliness, sadness and anxiety that can hinder their academic performance.

Those feelings became even more apparent as the children progressed through school, according to the study.

“Children who have weight problems are not as well-received by their peers. That creates a condition or situation where developing social skills isn’t as easy,” said Sara Gable, the study’s lead author and an associate professor in the department of nutrition and exercise physiology at the University of Missouri, Columbia.

For girls, but not for boys, difficulty developing social skills was related to obesity.

“The stigma of obesity and lack of conformity to standards of physical appearance – girls are perhaps … no pun intended, feeling the weight of that more,” Gable said.

The prevalence of childhood obesity in the United States has increased dramatically in recent decades. In the early 1970s, 5 percent of children ages 2 to 19 were obese. In 2007-08, 17 percent of kids in that age group were obese.

In California, physical fitness tests of public school students found 38 percent of children were overweight or obese in 2010. That rate varied dramatically across the state, from 11.3 percent among children in Manhattan Beach to 53 percent in Huntington Park.

For their study, the researchers analyzed data tracking 6,250 children nationwide from kindergarten through fifth grade. They compared the academic performance of students who were obese in kindergarten or first grade and remained so through fifth grade with children who were never obese. The data also included teacher reports of children’s interpersonal skills and feelings such as sadness or loneliness.

When children were tested one-on-one in math, those who were obese began scoring lower than their peers in first grade, the study found. The timing suggests that the relationship between obesity and poor academic performance takes root as children progress in school, Gable said.

“Kids who start school with weight problems come to kind of understand that, you know what? Maybe other people don’t like me because of this,” she said. “I don’t believe these children are ‘less smart,’ but I do believe if they’re put into a situation where they’re being expected to perform … they don’t perform as well.”

The study’s findings persisted across demographic differences, including race, household income, maternal educational attainment and employment status, and parental expectations for their child’s educational achievement.

Teachers of boys and girls who were persistently obese reported that the children expressed more anxiety and sadness – feelings that, while not clinical diagnoses, may reflect students’ struggles, Gable said.

In school, those feelings and poor social skills could mean that students are less engaged in learning or find classroom situations such as writing on the board in front of their peers “very anxiety producing,” she said.

Even though the study could not account for potential bias among teachers, their observations of obese boys and girls were consistent across grades and schools, Gable said.

Other factors related to obesity – such as health conditions that interfere with learning or school attendance – could affect academic performance as well and merit further study, she added.

People polled cited unhealthy eating habits and sedentary lifestyle as greatest threat to children's health. (Ian Britton: Flickr)

Nearly half of people surveyed in a poll released today say an unhealthy diet combined with lack of physical activity are the greatest health risks facing California children today.

In addition, almost three in four respondents to the Field Poll — 73 percent — said prevention efforts, while starting with the family, must extend to the broader community, including health care providers, schools, community organizations and beyond — to food and beverage companies and fast food restaurants.

“Voters acknowledge they have a role to play,” Mark DeCamillo, Director of The Field Poll told me. “They should be involving the larger community and lots of different entities, companies included should be taking some responsibility in reducing obesity in kids.

The poll surveyed 1,000 registered California voters and was funded by The California Endowment. (The California Endowment is a supporter of KQED). Respondents across political parties, ethnic backgrounds and household incomes all agreed a poor diet and sedentary lifestyle are the major health risks to children. Illegal drug use was a distant second at 22 percent.

More than half of respondents (60 percent) said that the neighborhood where a child is raised makes a difference in their health. A strong majority (68 percent) said a comprehensive program to prevent childhood obesity — including building parks and promoting neighborhood safety — would be worth it, even if it cost billions of dollars.

“Californians understand that health happens in schools, in neighborhoods, and with prevention,” said Dr. Robert Ross, CEO of The California Endowment, said in a statement. “Regardless of age, ethnicity, income or political ideology, they recognize that investments in prevention save money over the long run.”

Support for “soda tax”

More than three out of five Californians (62 percent) would support a special fee on soda and other soft drinks, presuming the money was spent to fight childhood obesity. Richmond City Council Member Jeff Ritterman is working to put a so-called “soda tax” before Richmond voters in November. “This is encouraging for us,” he said in an interview, “I think it will get people who are working on it feeling like they are going to win.”

Voter opinions about the state imposing a special fee on soda and soft drinks, using money to fight childhood obesity. (The Field Poll)

DeCamillo told me that if you break the polling data down, 45 percent “strongly support” the idea of a special fee on sodas, up from 33 percent in last year’s poll. “That’s a statistically significant change,” he explained. “Usually on tax measures — and we do so many tax polls … we really put the emphasis on the ‘support strongly’ proportion. Those people usually don’t back down in the face of opposition campaigns. They are base core supporters.”

Dr. Wendy Slusser is the medical director of UCLA’s Fit for Healthy Weight Program. In the past, she says, our major health issues were clean water and clear air. “In a way, we’ve addressed that with legislation,” she told me. “Now it’s really about health, healthy food and good health. These are the emerging issues of the next decade that we’re going to have to be working on in a big way.”

Learn More:

Listen to Contra Costa County Public Health Director Dr. Wendel Brunner’s podcast in response to today’s poll. He discusses the health effects of childhood obesity and his opinion of a soda tax.

(John Henry Mostyn: Flickr)

Proponents of public health have long worried about “food deserts”– but it took First Lady Michelle Obama to put the expression on the map when she launched her “Let’s Move” campaign. A food desert brings to mind an impoverished neighborhood where the main streets are lined with fast-food outlets or convenience stores with nary a full-scale supermarket to be found. ”Lack of access contributes to poor diet and can lead to higher levels of obesity and other diet-related diseases, such as diabetes and heart disease. But, this is a solvable problem,” it says on the Let’s Move website.

And to solve the problem the Administration has pledged to end food deserts within seven years by helping communities invest in healthier food outlets.

By looking at national records of businesses across the country, she could compare more disadvantaged neighborhoods to their wealthier counterparts. Yes, poorer neighborhoods had more fast-food outlets, but she also found they had more grocery stores. “So the picture I came away with … is they don’t have worse access to healthier food stores, it’s more a picture of food diversity,” she said in an interview. “That was a surprise to me. I did not expect to find that.” She says she crunched the data in different ways. “It came out consistently.”

In her study, “The Role of Local Food Availability in Explaining Obesity Risk among Young School-Aged Children,” Lee then turned to obesity rates among children. “That was the second question,” she said. “Does what families have access to, does it even matter for explaining who becomes obese over time and who doesn’t? … It has no relation to obesity outcomes.”

As a researcher, Lee believes it’s time to reflect on policies that focus on grocery stores. “We all like a silver bullet,” she told me, “but this is not it.”

A second study from the Rand Corporation reinforces Lee’s findings. The study could not find a “robust relationship between food environment and consumption.” Co-author Roland Sturm cautioned there were limitations of the study, but nonetheless added, “I never bought into the ‘supermarkets make you thinner’ story.”

Part of the problem is what happens when an individual enters a supermarket. “I challenge you to go to a grocery store and walk around and for every healthy food you can find, you can find an unhealthy counterpart,” Lee says. “For everything you can think of. There’s whole milk and fat free milk. You can buy fresh broccoli or broccoli with cheese sauce in the frozen food aisle.”

But as a sociologist, Lee did not want her research to be taken as fodder to “blame the individual.” People’s social situation drives health. “These things we know,” she says, “Education, economic mobility, they are so predictive of your health. … At the end of the day what drives obesity is choices we make, shaped by our environment.”

That environment still has to do with what’s actually in a grocery store, insist some advocates. Hannah Burton Laurison is with Public Health Law and Policy. While she says she agrees that access to grocery stores with fresh foods may not help to alleviate childhood obesity, she says the issue of food outlet availability is much more nuanced than ‘is there a supermarket in the neighborhood?’ “We’re trying to understand a complicated food retail environment where there are good options available and unhealthy options available, but pricing and quality and marketing are huge factors in how we make decisions,” she said. “You have to have access. It is not a single solution and I would agree with that finding in each of these studies, but you do have to have access, … access to healthy foods matters quite a lot.”

Laurison points to a specific example in San Francisco’s Bayview Hunters Point, a largely poor and minority neighborhood in San Francisco, with few grocery stores. In 1998, when the current owner purchased the store, alcohol sales accounted for 55 percent of revenue and and produce was less than two percent. In other words, more of a liquor store than a grocery store. Over the next 12 years, a community group worked with the store to improve the variety and quality of its produce. The store more than doubled its gross revenue. By 2010 produce sales were 17 percent of revenue and alcohol sales were down to 14 percent of revenue.

It would be hard for anyone to disagree that the improvement of this store’s produce offerings is not worthwhile. But a healthier diet does not necessarily affect obesity. “How can we improve diet to become healthier AND lose weight?” Sturm muses. “It’s not necessarily the same thing. You can have a really good diet in many ways, but still be heavy.”

A key component of the Let’s Move! campaign was the establishment of the White House Childhood Obesity Task Force. The Task Force explicitly promotes supermarkets and based its recommendation on a single study that found an association between supermarkets in a ZIP code and lower body weight among adolescents. But, as Sturm details in his study, the Task Force did not cite two other studies (here and here) that found no connection.

(Malingering: Flickr)

For the first time since the numbers were crunched in 1980, the U.S. obesity epidemic seems to have reached a plateau. Americans got heavier and heavier through the 1980s and 1990s, but starting in the early 2000s, the steep increases seemed to slow.

Two studies, one in adults and one in children, were published online today by the Journal of the American Medical Association. Researchers looked at data from the National Health and Nutrition Examination Survey from 2009-2010. They found no change from the prior survey, the second period of no change in the last 10 years.

Pat Crawford, Director of the Center for Weight and Health at U.C. Berkeley called the studies “cautious good news. … I am thrilled with the plateauing and I am encouraged. I think the biggest risk is that people relax and think we don’t have an obesity issue any more.” Today about one-third of American men and women, and about one in six children and teens are obese.

While the researchers would not say why they thought the rate of obesity was leveling off, Crawford attributed the change to many factors, from public education, worksite wellness campaigns, social marketing campaigns and even the move to ban soda machines from schools. In 2005, California became the first state to ban soda and certain kinds of less nutritious foods from being sold in all K-12 schools, a change which many states have followed in the years since.

“We’re beginning to inch toward some substantive societal changes,” Crawford said, “the same kind of changes we saw with the early tobacco movement. It’s not that we don’t know what causes obesity. It was the same thing with tobacco. We had lots of information that tobacco caused cancer, but we had to move forward on multiple fronts, the education alone was not enough.”

What’s critical, she said, is that the increase seems to have stopped. “If we build on the momentum and we keep linking all these activities together, we’ll continue to gain ground and that will have widespread implications.”

More from the Journal-Constitution:

Some public health experts, however, say the approach could be counterproductive when it comes to childhood obesity. The commercials and billboards do not give families the tools they need to attack the problem, some critics say. Others say the images will simply further stigmatize obesity and make it even less likely for parents and children to acknowledge that their weight is unhealthy and should be addressed.

Children’s Healthcare decided on the approach after finding in research that 50 percent of people surveyed did not recognize childhood obesity as a problem and 75 percent of parents with overweight or obese kids did not see their children as having a weight issue. Across Georgia, which ranks second nationally for childhood obesity, about 1 million children are overweight or obese, according to data compiled by the campaign.

“We felt like we needed a very arresting, abrupt campaign that said: ‘Hey, Georgia! Wake up. This is a problem,’ ” said Linda Matzigkeit, a senior vice president at Children’s Healthcare, who leads the system’s wellness projects.

The campaign — called Strong4Life — is planned as a $50 million project to be rolled out over five years. Children’s Healthcare has committed to paying half the costs while seeking donations to cover the rest. The Blue Cross and Blue Shield of Georgia Foundation recently kicked in $95,000 to support the campaign.

You can see the rest of the videos here.

Price going up? (Karen Blumberg: Flickr)

Last night the Richmond City Council voted to let the people decide. The Council instructed staff to prepare a ballot measure for next November to tax sugar-sweetened beverages, what most people call a “soda tax.”

Richmond voters may have the chance to make their city the first in California, and one of the first in the country, to slap a special tax not just on sodas, but also sports drinks, energy drinks, fruit-flavored drinks and the like. 100 percent fruit juice and diet drinks would not be affected.

The goals are twofold. If the drinks cost more, people will drink fewer of them. Plus, taxes generate revenue, which the City Council says it would devote to new sports fields and other health programs. The motivation for the tax is childhood obesity. Wendel Brunner, Public Health Director of the Contra Costa Health Department walked people through the makings of what has become an epidemic.

• 32 percent of school children in Richmond are obese
• 24 percent of adults in Richmond are obese
• 11 percent of all deaths in Richmond are linked to obesity–obesity is shortening people’s lives by years

(Justin Sullivan/Getty Images)

Health advocates heaved a sign of relief this month over a new report showing that the obesity epidemic may be leveling off. In the past five years, the percentage of overweight and obese kids in California dropped by one percent. Not a screaming success, but a lot better than the gains seen since the 80s … or even in the past decade. The rate of overweight kids in California increased by six percent between 2001 to 2004 alone.

Some individual counties saw drops in obesity levels while others, like Del Norte County, saw massive increases. The report, aptly named “A Patchwork of Progress,” reflects on these discrepancies. The Bay Area itself is somewhat of a patchwork, too. In nearly all Bay counties, childhood obesity rates are on the rise. The single exception was San Mateo county, which saw 5.6 percent decrease.

So why are San Mateo County kids getting thinner while the rest of the Bay is getting fatter?

It may have to do with a program the county started started seven years ago, when it aggressively started tackling the issues of childhood obesity and health disparities. The result was the “Get Healthy San Mateo County” Task Force, which has moved forward on a number of fronts.

For starters, the county launched the “Walking School Bus” program where one or more volunteers organize a group of kids to walk to school together.

“The idea is that you get the same level of camaraderie and peer support,” says San Mateo County Health Systems Chief Jean Fraser. “It raises the awareness that walking is a viable option for kids to get school.”

Fraser notes that San Mateo County is lucky in that most of the children in the county attend a neighborhood school. “Neighborhood schools are really key for making it even possible for kids to walk or bike to school.”

Fraser says the county also started a youth development program called “Healthy Corner Store Makeovers.” Kids approach neighborhood corner stores and work with the shop owners  to bring in more fruits and vegetables and to redesign stores so they’re more prominently and attractively displayed.

“The food marketing people are very smart. The first things you see up by the cash registers are the things we tend to buy. Though we didn’t get rid of the junk food, we’ve moved it moved back.”

She says the county focuses on neighborhoods with the highest health disparities levels, such as East Palo Alto and North Fair Oaks, an unincorporated part of Redwood City. In North Fair Oaks, kids organized a “healthy makeover” of La Carniceria Guadalupana (Guadalupe Meat Market), which they documented in this video.

As for East Palo Alto, the task force determined that the area was a food desert. The community was filled with fast food chains and corner stores, but not a single grocery store.

“Even if you wanted to get fresh fruits and vegetables in East Palo Alto, it was just physically very hard. And the community has lower car ownership than the rest of the county, so it was sort of a double whammy.”

She says the study raised awareness, and now East Palo Alto has at least one grocery store. Still, the county has a four to one ratio of fast-food outlets compared to grocery stores.

But by no means is Fraser declaring victory. She says while they’re pleased with the progress, San Mateo County still has a lot more work to do to significantly reduce childhood obesity rates.

“Nobody needs to celebrate where we are. We still have 34 percent of our children that are overweight or obese. We have so much work to do.”