A number of the policies we worked on in New York City have been associated with decreased obesity. These involve primarily efforts to change the environment, although they were accompanied by education. These included 2007 regulation of food, physical activity and screentime in childcare settings which lead to decreased obesity and disparities. Prior to the regulations many centers served unhealthy food or sncaks or allowed parents to send them. Neighborhood disparities in prevalence of childhood obesity among low-income children before and after implementation of New York City child care regulations.Sekhobo JP, Edmunds LS, Dalenius K, Jernigan J, Davis CF, Giddings M, Lesesne C, Kettel Khan L. Prev Chronic Dis. 2014 Oct 16;11:E181. Changes in the school food environment which went to low fat dairy, more fruits and vegetables, more water, no sugary drinks were associated with slight decreases especially in younger children Obesity in K-8 students - New York City, 2006-07 to 2010-11 school years..MMWR Morb Mortal Wkly Rep. 2011 Dec 16;60(49):1673-8. Placing water dispensers on school lunch lines was associated with reduced obesity: Effect of a School-Based Water Intervention on Child Body Mass Index and Obesity, Schwartz AE, Leardo M, Aneja S, Elbel B.JAMA Pediatr. 2016 Mar 1;170(3):220-6, consistent with other studies on water access. Passage of taxes on sugar sweetened beverages has been associated with reduced consumption of these products in Mexico BMJ. 2016 Jan 6;352:h6704..Beverage purchases from stores in Mexico under the excise tax on sugar sweetened beverages: observational study.Colchero MA, Popkin BM, Rivera JA, Ng SW, and we are seeing very similar preliminary results now in Berkeley, CA, the first such tax in the US, soon to be published. This policy is spreading rapidly globally and can raise revenue for prevention, healthier food, or for other social needs such as Philadelphia's recent;y passed measure which will fund early childhood education. Modelling studied suggest very significant impacts of soda taxes on obesity, diabetes and health care costs. Excise taxes and school nutrition standards have been estimated by Gortmaker to be cost-saving. In NYC and in an increasing number of locations public procurement policies, using the economic clout of government purchasing for schools, hospitals, jails or the military are playing a role in changing both social norms and production. Policies which prohibit advertising to children, especially of unhealthy food and beverage products are urgently needed. But the most essential issues lie in creating the food supply and community environments we need. Traditional food supplies are being replaced by highly processed foods and beverages in mega supermarkets worldwide, a trend the US pioneered and is suffering from today. Many of these policies above are responding after the fact. This is also a major contributor to climate change. Promoting and protecting traditional diets and minimally processed plant based foods will require a suite of fiscal, agricultural, comercial and environmental policies to successfully revert the obesity epidemic, assure long term food security, and promote and protect health fro the long-term. Replacing sugary drinks with generous access to clean water is an important starting point. Assuring food security must bring together access to food and access to healthy food as its two essential precepts to both prevent hunger and and the growing burden of global noncommunicable disease. Accompanying these changes by the environmental and transportation changes to encourage safe physical activity will also be essential.
Dr. Lynn Silver