Prevention of obesity and diabetes.

The changing shape of childhood Francine Kaufman gave the outgoing President’s Address, discussing our burgeoning societal recognition of obesity as a health problem for children. She traced the differing environments of the child of 40,000 years ago through that experienced today. For the neolithic child, levels of physical activity were high. Approximately one-third of energy intake came from animal protein, typically low in associated fat because animals hunted for meat (as opposed to the high fructose feeds currently used for livestock which greatly increase the saturated fat content of these foods). Half of energy intake was from high-fiber fruits and vegetables, gathered close to home, and the remainder of the diet was high in polyunsaturated fats. Dietary sodium was low. With the advent of agriculture 5,000 years ago, the availability of grain led to greater fat depots in feed animals and began to alter the dietary balance to which humans had evolved. This pattern continued during the development of the civilization of the middle ages and the Renaissance, with the wealthy often exhibiting marked obesity and gluttony being recognized as one of the “seven deadly sins.” Although the lower prevalence of diabetes among European ancestry Caucasians may reflect a diminished need for “thrifty genes,” Kaufman mentioned a current speculation that diabetes did emerge as a health problem during this period in Europe. According to this hypothesis, the European diabetes gene pool decreased as the food supply increased, while other ethnic groups, particularly with the devastation of the subsequent centuries of European colonial rule, faced periods of extreme hunger for which there was survival advantage to the retention of “thrifty genes” (1). By 1920, food processing was the largest industry in the U.S. and the legislation of a secure food supply was seen as an important advance. The prohibition of alcohol use at the end of the decade led to increasing popularity of carbonated sweetened beverages. With the development of suburbs and automobiles requiring complexes of highways, and of fast food and frozen foods during the 1950s, imbalance existed between energy intake and energy expenditure and was worsened by subsequent increases in saturated fat intake and decreases in physical activity among children. Total energy intake rose. A typical snack increased from 160 to 250 kcal and a soft drink from 130 to 200 kcal during the period from 1970 to the 1990s. Large sizes became available for the vast majority of food products. Energy expenditure decreased. Television watching, already substantial at 1 h per child per day, increased to 3 h. Physical education in high schools decreased from 2 days to 1 day per week. As a result, rates of obesity increased from 5 to 20% in children, and even more among African Americans and Latinos, with similar statistics available from other countries in the developed world. Considering the “assault” of food and sedentary behavior, Kaufman stated, “Progress has nearly eradicated starvation. . . but no longer makes us healthy and well.” Many parties must be “stakeholders” to reverse these trends. The child’s parents “must assume responsibility to offer appropriate foods in appropriate quantities.” Schools and communities “must allow safe activity. . . Neighborhood must assure access to nutritious food. . . There must be a healthcare system. . . [that] promotes prevention beyond its own doors.” We need appropriate medications, the food industry must promote nutritious foods, and “reasonable portion sizes must be restored.” Kaufman also noted that “the media must be used for health promotion. . . [and] must communicate to youth images that are responsible.” Furthermore, government “must help set the appropriate agenda.” “Everyone in this audience,” Kaufman concluded, “has a responsibility to help end this epidemic. . . It is our responsibility to our paleolithic DNA.”