WEDNESDAY, March 6, 2013 — First Lady Michelle Obama stepped into the small, packed gym at Northside/Eastside Elementary School in Clinton, Miss. last week and told the crowd of students, teachers and officials to take credit for turning the childhood obesity epidemic around in their community. The applause was long and loud.

“As we can see in Mississippi... we can actually solve this problem,” Obama said, pointing to a 13 percent drop in the rate of obesity among the state's elementary school-aged children from 2005 to 2011. “There’s no reason why this success can’t happen in cities and states across the country if we’re willing to work for it.”

Obama's energy and commitment to ending childhood obesity was on display last week in Clinton, Chicago and Springfield, Mo., as she celebrated the third anniversary of her signature "Let's Move" program and announced both an expansion of its mission and new partners. But experts cautioned that although the epidemic may have leveled off, it remains fueled by a powerful mix of cultural factors and economic incentives.

Nationwide, “we have not seen a 13 percent drop in childhood obesity,” said David Katz, MD, editor-in-chief of the journal Childhood Obesity and director of Yale University's Prevention Research Center. “We seem to witness a leveling off, which is encouraging, but it’s far too soon to celebrate anything like 'mission accomplished.' "

According to the CDC, one in three children and adolescents aged 2 to 19 were overweight or obese in 2011, the last year for which data is available -- and the extra weight puts them at risk for a host of illnesses later in life, from heart disease and diabetes to high blood pressure and stroke.

There's little question that Obama has focused public attention on the problem by founding "Let's Move" in 2010 and enlisting a host of celebrities -- including Beyonce, David Beckham and Gabby Douglas -- to support the group's efforts to promote healthier diets and more physical activity among kids.

"Let's Move" is widely credited with helping to pass the Healthy, Hunger-Free Kids Act of 2010, which mandated that whole grains be a key component of school lunches and limited the calorie counts of the lunches to a maximum of 850. But the act's major provisions only took effect last year and would have had little if any role in the 13 percent obesity decline cited by the First Lady in Clinton -- a number not matched by other school-aged groups in Mississippi. For example, the obesity rate among high schoolers didn't budge statistically during the time when elementary-age rate dropped, and a higher proportion of middle school students were actually obese in 2011 than in 2005.

Dwayne Proctor, director of childhood obesity programs for the Robert Wood Johnson Foundation, said that the 13 percent Mississippi obesity rate drop -- which was matched by similar, but smaller decreases in New York, Philadelphia and Massachusetts, reflects a number of political and policy changes supported by a number of agencies and communities, rather than "Let's Move's" actions exclusively.

“They’ve all focused on environmental changes in schools and in the community,” Proctor said. “When you put these policies in place, what you get is sustained changes.”

Dr. Sally Findley, PhD, professor of population and family health for the Mailman School of Public Health at Columbia University, underscored the likely impact of 2005 changes in WIC programs on childhood obesity. Those changes allowed more fruits and vegetables to be purchased with WIC funds, whose low income recipients have historically faced a high obesity risk. Dr. Findley, however, credited the First Lady with bringing the obesity issue to nation’s attention more recently.

“The initiative that she is spearheading is really about changing the hearts and minds of people,” she said. “The things she is doing aren’t anything no one had thought of before, but when she came long and said this is something she cares about, she ratcheted up the public awareness about it.”

Obama announced a new initiative called “Let’s Move Active Schools” on Wednesday at an event in Chicago. The new program will aim to provide schools with an assessment of their physical education programs and a customized plan to create sports teams and encourage physical activity by students both in and outside of school.

Only one in three children are active on a daily basis -- with most opting to spend an average of seven hours in front of either the TV or a computer every day, according to the First Lady's office. In addition, while recess and gym were once a crucial part of every school day,only 4 percent of elementary schools, 8 percent of middle schools and 2 percent of high schools offer daily physical education, which Obama said hurts not only children's waistlines but also their test scores.

"Let's Move Active Schools" will aim to change all that -- and expand the initiative's base in the business community, since it will be funded from part of the $70 million raised by NIKE, the GENYOUth Foundation, ChildObesity180, Kaiser Permanente, the General Mills Foundation and the White House.

“You’ve got to keep your body active, even if that means just turning on some music and dancing for an hour,” Obama said to 6,000 Chicago Public School students. “Do a little Dougie, a few jumping jacks, some push-ups. You just have to move. That’s how you’ll prepare your bodies and your minds for greatness.”

Is ‘Let’s Move’ Enough to Stop Childhood Obesity?

Encouraging kids to exercise and eat healthy foods through “Let’s Move” is all well and good, but it may not address a psychological cause of childhood obesity, said Edward Abramson, PhD, professor emeritus of psychology at California State University, Chico and author of the book “It’s Not Just Baby Fat: 10 Steps to Help Your Child to a Healthy Weight.”

“Kids are bombarded with messages encouraging them to consume foods that are bad for them,” he said. “There are no ads directed at kids for fruits and vegetables.”

A 2011 report by the Childhood Obesity Foundation, a Canada-based charity, found that children are easily persuaded by advertising, causing them to crave unhealthy products and pester their parents into buying them.

“The persuasive dimension of advertising and marketing is not easily identifiable for a child,” the report states. “They do not always know the difference between the program and an ad [and] may think that the ad is part of the program they are watching.”

The blurring of the line between television and advertisements means that children are a ripe for advertisers to target. Some companies, such as McDonalds, spend upward of $1 billion annually on marketing directed at children, according to the report, which encourages unhealthy eating habits and can lead children down the road to obesity.

“By the time they are 5 years old, children have seen an average of more than 4,000 television commercials for food annually,” the report says. “Food advertising focuses mainly on unhealthy and non-nutritious food.”

And while children don’t have much buying power, they have a strong voice when it comes to family purchase, the report says. Children spend $17 billion per year and influence up to 40 percent of all household purchases – estimated to be valued at $170 billion annually, according to the report.

“It has also been shown that young people have a very strong influence on the whole family’s food choices, parents often choosing to abdicate with regard to healthy eating issues to surrender to the children’s incessant demands,” the report states.

Some companies, such as Burger King, Kraft, Nestle and General Mills, have started promoting foods they say are “better for you” in commercials that air during children’s programming to reduce the amount of unhealthy foods advertisements that are aimed at children. But Abramson doesn’t believe that action will actually have an effect on the childhood obesity rate.

“That is a nice gesture, but it probably is inadequate because each of the major food companies gets to decide which foods qualify as ‘better for you,’ and some of their choices are debatable,” he said. Even if they were successful in limiting the marketing of foods to kids, there are other forms of advertising as well, such as product placement within the program. There are all sorts of loopholes.”

Abramson said the key is to encourage parents to only buy healthy foods and to not give in to their child’s demands for unhealthy foods.

“Parents have to be able to exercise some restraint,” he said.

The First Lady Partners With Walmart

Some of the challenges of following Abramson's advice were on display at the last stop of Obama's "anniversary" tour, a Walmart in Springfield, Mo. The store is one of the company's new “Neighborhood Market” stores, which bring fresh fruits and vegetables into low-income areas where they were not readily available.

“All of you at Walmart, you all really took a risk in doing this,” Obama said. “And you didn’t just make a few tweaks around the edges. I mean, one of the reasons why we've been so thrilled to partner with you is because you didn’t just dip your toe into the water. Instead, you went all in. You transformed the way that you did business to bring your customers healthy products at prices they can afford.”

The Walmart store in fact had a large fresh produce section -- but the store didn't appear to skimp on the standard product lineup available in American grocery stores, with aisle after aisle of condiments, snacks, both sugared and diet soft drinks, and more.

But Jeannette Ickovics PhD, professor of epidemiology at the Yale School of Public Health, said that enlisting business partners such as Walmart in the obesity fight is valuable, even if the businesses in some ways contribute to the problem..

“The causes of childhood obesity are multi-determined; therefore, our solutions must be too,” she said. “We need to mobilize families, schools, neighborhoods, the faith community and business community, along with health and public health to change the environment, behavior and ultimately improve health.”

Katz was more critical of Walmart's overall role. Although the company claims to be looking out for the well-being of American families, it has not stopped selling the same sodium-packed, unhealthy food as before, he maintained.

“These are big companies, so they do the least little thing and they get a photo op with the First Lady,” he said. “The administration is not going to be very critical of big companies, and Walmart doesn’t need to do much to get credit because they’re so big. My hope is that the partnership encourages Walmart to be more responsible.“

However, Andrea Thomas, Walmart Senior Vice President of Sustainability, said that Walmart customers appreciate having a choice between healthy and not-so-healthy foods.

"Ultimately it’s about offering our customers a choice," she said. "When your child is celebrating a birthday, you’re going to be serving birthday cake and ice cream, but you don’t want the times when you are for looking something healthy for everything to have extra added sugars and sodium."

As for Obama's role, Katz said her championing of the childhood obesity problem has put the country on the right path to finally beat it.

“The First Lady is an example and a cheerleader,” he said. “If there ever was a case where it takes a village, this is it, and every one of us lives in that village.”

Photo Credit: Orlin Wagner/AP Photo