The terrible costs of childhood obesity

By Mike Markrich
A Kailua-based writer and researcher

As a public health nutritionist for the State Department of Health, Mae Isonaga, tries to keep up with all of the trends impacting food and society.

Martha Hernandez • The Honolulu Advertiser

"Isn't it odd," she reflects " that our society seems more concerned about the health of its prisoners than its children." It is estimated that 25 percent of the young people in Hawai'i ages 6-17 are overweight and therefore at risk for heart disease, high blood pressure and diabetes.

There are presently approximately 50,000 young people in this category.

Isonaga and other state health officials worry that if current trends continue, Hawai'i will soon face the onslaught of an epidemic of diabetes.

"Looking in the old data from 1995 and 1996, I was particularly disturbed to discover the increase in type two diabetes. Type two used to be called Adult Onset Diabetes. But we are finding this now in increasing numbers of younger people and children, and it is linked directly to obesity. I saw data that showed at one school in Kalihi nearly 37 percent of the students were classified as overweight. I was shocked!"

The school data is key because overweight children usually become overweight adults. This is particularly disturbing for Native Hawaiians who as a group are already twice as susceptible to diabetes as the rest of the US. population. The best estimates based on medical Insurance data indicate approximately 80,000 people in Hawai'i knowingly or unknowingly are diabetic.

Michael Wen is the diabetes statistician for the Department of Health. He said: "We know that our rates for children having diabetes is less than the national average but higher for adults. For some reason between the ages of 18 and 19 the numbers in Hawaii explode!"

Currently, the cost of diabetes to Hawai'i is estimated by federal health statisticians to be $600 million per year. With the number of children suffering from obesity and type two diabetes increasing rapidly this number will likely double.

Why are children in Hawai'i becoming so fat? It's part of a national trend. Hawai'i children, like their counterparts on the Mainland, are part of a generation of a children who have grown up eating fast foods high in fat and sodium, particularly fast food french fries cooked in a commercial frying substance. It is estimated nationally that potato chips and french fries make up one-fourth of children's vegetable servings.

Fast-food diets

Where many children once grew up around the dinner table nourished with homemade food and conversation, in today's busy world, where moms work sometimes two jobs, there is little time for either. Kids get fast food to eat in the car and prepackaged lunches to take to school. Although people are aware of nutrition guidelines, few take them seriously.

The problem is exacerbated in our public schools. Fifty-six percent of the public schools in Hawai'i have vending machines selling sugar drinks (many with large amounts of caffeine) that add large numbers of calories to children's diets. It is estimated nationally that the average teenage boy (13-18) consumes 35 ounces of sugar and caffeine drinks per day. Girls drink 24 ounces. Schools are a major distribution point.

The sugar and fat intake is made worse due to the lack of play equipment and physical activity. The kids don't burn it off. Only one year of physical education is required in Hawai'i public schools between grades 9 to12.

"We are sending students a mixed message," said Hawai'i State Department of Health Director Bruce Anderson. "On the one hand we are promoting good nutrition and encouraging kids to avoid tobacco and eat healthy foods. On the other hand, we are supporting the sale of sodas, candy, chips and other things that are obviously bad for you."

Even if there were more requirements to restrict sugar intake in public and private schools, often the Game-boy generation is just not interested. The parent of one 8-year-old boy, after his son missed basketball practice three times in a row, told me that after a long talk he finally figured out what boys problem was. "He hates to run," said the father. "He's more comfortable staying at home, eating and playing video games."

To make matters worse, Hawai'i children grow up eating large amounts of extremely fatty processed foods, such as macaroni salad in mayonnaise, and the state's favorite high fat delicacy — Spam.

As for role models: obesity is portrayed on TV as an endearing personal trait.

Traditional diets

The traditional diets of native Hawaiians were never this fatty.

In ancient days, Hawaiians ate fish, shell fish, taro, breadfruit, salt, limu and very rarely meat. There was no alcohol. It is interesting to note that the first doctors visiting Hawai'i were struck by the fact that there were no pathogenic bacteria in Hawai'i. Nor were Native Hawaiians ever said to be plagued by organ failure.

Scientists attribute the good health of the Native Hawaiian people to the "thrifty gene theory". This theory postulates that populations that are exposed to food deprivation have a genetic pool that selects in favor of people who can use calories in a "thrifty manner" and retain fat as a way to store calories. In the event of a famine or a long journey only individuals with this capability survive.

"When I was at Harvard I studied the relationship between traditional diets and health from around the world," said Dr. Terry Shintani, the founder of the Shintani diet. "I saw what happens when people with traditional diets change over to more modernized food: heart disease, certain cancers and diabetes go up. I can roll out studies that show the same thing over and over."

Dr. Shintani believes that if Hawai'i were to take steps to encourage people to change their eating their habits, many of our problems could be eliminated. "One of the problems we have now is that people overeat because they are no longer conscious of having a hunger shut-off mechanism after consuming a certain amount of food," said Shintani. "Instead they keep eating even though they don't need the calories."

Other states have recognized their serious problems in nutrition and acted to change public policy.

In Appleton, Wisc., for example, a public school, the Appleton Central Alternative High School, took out all the vending machines and now mandates that all of its students eat only approved non-processed low fat foods on campus.

Greg Brettenhauer, the dean of students, said: "Basically, five years ago we told our clubs to bite the bullet and finance their activities themselves. Since then we don't have children floating around on a glucose high from drinking Mountain Dew and chocolate bars. Our kids are calmer. They are more fit and more interested in studying. We are a school that was created to handle problem students who had drug, alcohol or disruptive problems. Our drop-out rate five years ago used to be 5 percent. Now it's zero."

The school's experience will be part of a special study by Yale University.

There is a reason that the federal government is interested in changing the diet in its prisons. (Prisons and Schools are the two state institutions that feed large numbers of people) They are concerned about the health problems associated with aging prison populations eating high fat foods.

This is why California licenses a private prison (Maranatha Corrections) that has an entire wing offering only low fat vegetarian foods.

In Hawai'i, only one school, Haiku Elementary School, currently offers low fat alternative healthy menus for children. The cafeteria manager, John Cadman, is a former Four Seasons Chef. He has the support of Eugene Kaneshiro of the Department of Education food service.

What needs to be done:

Hawai'i is now beginning to pay the social costs of the budgetary problems incurred during the Waihee administration. There is little money to go around now, for social programs or any other spending. And when you fail to put money into social programs, the long-range costs simply soar.

If steps are not taken now to change the nutrition programs in our schools, the staggering costs ahead — $1.2 billion — will negate any small economic gain made in the next two years.

However, this number may be conservative. According to the state Health Department, school nurses stopped taking weight and height data four years ago because no one was doing anything with the data. Thus, as far as anyone knows, the situation may be even worse.

At a minimum, we should start collecting this data again, and then make use of it. This is particularly important for the Hawaiian youngsters who are most at risk.

Metaphorically, Hawaii stands calmly at the water's edge as a huge tidal wave of human misery and financial disaster takes shape. The dedication to children's health that was once a point of pride in Hawai'i has come undone.

The attitude has drifted to the fatalistic shrug: it can't be helped. This view on the part of government and citizens should not be accepted.