by Dexter Louie, M.D.

Is there anything community physicians can do about the epidemic of childhood obesity? Of course we can treat the resulting diseases, after diagnosing problem. But simply treating obesity-related diseases will not stop the epidemic.

Over the past year we have had bans on junk food and sodas on school campuses, regulations on what kind of foods are served at schools, policies aimed at controlling food choices, and even attempts to sue fast food companies for being the cause of obesity. In my opinion, there is another approach, one that is not legislative or "top-down." It is a grassroots approach that involves community physicians and students. It is focused on engaging students, the next generation of potentially obese adults, getting student buy-in, and transitioning the next generation to healthier food choices and more physical activity.

We all know the numbers. Approximately 61 percent of adults and 15 to 20 percent of children are overweight or obese. In some predominantly black and Hispanic communities, 40 to 50 percent of children are overweight/obese. Unfortunately, the vast majority of these overweight children will remain so as adults. The health care cost of obesity is estimated at over $100 billion/year.

Yes, the numbers are huge. No longer are we a society of hunter-gatherers, burning up all the calories we consume. We now have the ability to produce and consume food far in excess of what we need to survive, leaving us with ever-increasing girths and body mass indices. This problem developed over time, mostly involving the past 2 to 3 generations. The solution, too, will take time and involve more than one generation.

This grassroots approach links volunteer community physicians with school “site champions” to develop programs specific to their schools and communities. The site champion can be a school nurse, administrator, teacher, or PTA member--anyone who is interested in student health and the problem of obesity. The site champion arranges for a volunteer physician to speak to classes or groups of students, explaining the health issues of obesity, diabetes, heart disease, and so on. When I do it, I try to bring the medical reality of obesity and life-long diseases from the medical office and hospital to the classroom. I don't just talk about the food pyramid. Students do not like to be lectured to or told what to do. But when they are challenged to take responsibility for their current and future health, they can become engaged, there can be buy-in, and there can be a change in behavior at a peer level.

Top-down is not the strategy here. A ban is simply a ban if there is no student buy-in. To achieve this buy-in, students need to be actively involved. This program is student-based, student-driven.The goal is for students to change behavior and to make better choices. I believe that if students understand the relationship between junk food, inactivity, and obesity, diabetes, and other diseases, they will be effective in:

1. managing/reducing junk food in their schools and in their lives and
2. improving their own health and the health of their peers, their family, and their community.

Students Take Charge
At one school, Joaquin Moraga Intermediate School, I presented the obesity problem, and the students did the rest. They brainstormed the health issues, researched junk food, fast food, healthy foods, and physical activity, and then developed a plan for their school and their community. They addressed the issues of revenue, freedom of choice, food services, vendors, pricing, and regulations. The students conducted taste testing, student body surveys, health awareness programs, and vendor interviews, and including free vendor samples of healthy foods. Only 5 to 10 percent of student athletes are at highly competitive levels, so the students developed noncompetitive physical activity programs.

	At Joaquin Moraga Intermediate School, students wait in line at the "Milk Chug" vending machine.

Within one year, the students made significant changes at their school and in their behavior. For example, the students initiated removal of one soda machine and had installed a “Milk Chug” machine that dispenses low-fat milk, water, and juices. I observed students lined up 10 to 20 deep at a time to buy milk, versus one student at the soft drink machine. I saw additional milk purchases during the snack periods between classes. The milk machine is restocked daily, while the soda machine is restocked twice a month. Students were happier with the lunch offerings, since they were involved in selecting what went on the menu. One parent told me that her 7th grader chastised her for drinking a soda because sodas were simply sugar and a bunch of empty calories.

“What I find exciting is that the kids are taking ownership, rather than having it forced on them by adults, which in my experience never works anyway,” said school principal Mr. Paul Simonin.

What does it take for a community physician to get involved in this type of grassroots program, and an otolaryngologist at that? After 2 years on this project, I found that it took commitment, patience, tenacity, and about 10 hours per year working with the students and the school site champion. Changes in schools take time, sometimes a very long time. Once the students take on the project, I communicated with the school site champion, who was my liaison to the students and school administration. My role was to bring the medical reality of obesity and junk food and diabetes to the classroom and to challenge the students to make the necessary changes at their school, in their lives, and in their community. I made a total of four visits to the school, first to present the obesity issue, then to hear the students' progress reports on a regular basis. The students developed a timeline and were responsible for presentations to me. Over the past year I worked by e-mail with the school site champion and we acted as consultants, but allowed the students to independently research, develop, and carry out their program

	Click here to view a video produced by the 2003 Leadership Class of Joaquin Moraga Intermediate School.

This grassroots, student-based, student-driven approach is but one means of trying to stop the epidemic of obesity and to control the increase in obesity-related diseases. This approach is adaptable to varying socioeconomic, cultural, and academic conditions. I believe it can be successful across different student populations and in different communities. It focuses on this generation of students and allows them to take ownership of their health and to be responsible for making better choices in nutrition and activity.

Dr. Louie is a past president of the San Francisco Medical Society, current SFMS delegate to the CMA House, and current president of the Moraga School Board.