The child abuse we inflict through child obesity.

America is guilty of child abuse. That’s a central conclusion to be drawn from this issue of Health Affairs, devoted to combating child obesity. It is one thing to be a nation that’s allowed two-thirds of its arguably “personally responsible” adults to become overweight or obese. It’s quite another that nearly one in three children now fall into the same category, including kids entering Head Start programs at the ripe old age of four. We also know that the obese among them are predisposed to develop chronic health conditions including diabetes and colon cancer, and to face shorter life spans than their parents’. So what charge would one level against a nation that allowed this to happen, if not of a form of child abuse with horrific consequences? POLICY & PATHOLOGY: This issue describes root causes of this pathology and offers prescriptions for a healthier future for our kids. The causes start, as David Wallinga writes, with an agricultural policy that has spurred production of cheap sugars and refined grains while doing little to encourage production of fruit and vegetables. Overall, inflation-adjusted food prices have been falling—except for fruit and vegetables,whose real prices rose 17percent from 1997 to 2003, reports John Cawley. These forces have produced a glut of calorie-dense, nutrient-poor foods, many of which are cleverly marketed to kids. As Carmen Piernas and Barry M. Popkin write, children ages 2–6 are now consuming 182 more calories per day than three decades ago, with more than 27 percent of their daily calories coming from snacks. These faux foods have a lower “satiating” effect, so you caneatpiles andnot feel full. Throw ina TV in a kid’s bedroom and he or she is more than 1.5 times more likely to be overweight or obese, write Christina Bethell and colleagues. Perhaps obviously, Gopal K. Singh and colleagues report, children are more likely to be overweight or obese if they live in neighborhoods parents perceive as unsafe, or that lack a park or recreation center. The consequences to health, health care, and health costs—not to mention to society—are sobering. As we’ve previously published, the estimated annual cost of treating obesity-related illness in adults reached $147 billion in 2009.With child obesity growing three times faster than adult obesity, MartinJ. Sepulveda and colleagues cite data showing that the average claims cost of children with type II diabetes, at $10,789, exceeds the $8,844 average claims cost of adults with the same condition. Other research shows that overweight and obese children are more likely than others to repeat a grade in school or to miss more than two weeks of school in a year. Employers, write Sepulveda and colleagues, “are at risk of inheriting a future workforce” in which many are obese and have costly chronic illness. The solution, as Jonathan D. Klein and William Dietz write, is a broadbased set of interventions comparable in scope to the four-decade assault on smoking. Since “default” conditions in this country now predispose many to obesity, the goal should be defaults that predispose everyone to better health, urge Kelly D. Brownell and coauthors. This means taking action in agriculture, food labeling andmarketing, education, transportation, parks and recreation, and health care. A strong federal role is key, but much will also fall to the states, which face big differences in obesity rates relative to each other and within their borders. PRESCRIPTIONS: As this issue describes, there are modest reasons to be hopeful. First Lady Michelle Obama has made fighting child obesity one of her signature initiatives. The expected reauthorization in 2010 of the federal Child Nutrition Programs seems likely to promote healthier school meals and eliminate sales of less healthy foods that “compete” for schoolchildren’s taste buds. The Centers for Disease Control and Prevention is now headed byThomasR. Frieden,whobacks apenny-per-ounce tax on beverages with added sugar or caloric sweeteners to fund obesity prevention programs and subsidize healthy foods. We’re grateful to the Robert Wood Johnson Foundation, which has invested heavily in obesity prevention andwhose supportmade this issue possible.We also thank Doug Kamerow of RTI International, who served as our thematic issue adviser. ▪