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CGordo Obeso Chunky Big boned Thick Fluffy Husky Humongous
Fatso Frankso Roly Poly Puffy Salad Dodger. These were some of the names
cute and cruel that folks called me when I tipped the scales at 321 pounds. This paper is
intended to partly describe my personal struggle as an example of the fight with obesity but
really to illustrate the complexity of obesity and some of the policy steps and grassroots
actions being taken including our nonprofit, the Latino Healthcare Forum to try to even the
scales.

Personal Case

This is a photo of me about 3 years ago.




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My health profile at this time was the following:

Body Mass Index 43.4 at a classification of Morbidly Obese
High blood Pressure
High levels of blood fats
Pre-diabetes
Secondary medical effects
o Sleep apnea and respiratory problems
Mental health disorders
o Mood instability
o Depression
o Low self-esteem

I fortunately was not obese as a young child. I say fortunate because the Centers for Disease
Control and Prevention (CDC) predicts that obese kids have a higher risk of developing type
2 diabetes and that one in three kids will develop the disease. In thinking about how I
arrived at this stage of poor health I identified the following causes:

1. Lack of energy balance Taking in more calories than I used
2. An inactive lifestyle Sitting in my office working nonstop and then sitting at the
computer at home and then sitting in my Lazy boy watching TV late at night
3. Environmental factors Lack of access to healthy foods, oversized portions, work
schedule, and being surrounded by food advertising for high-calorie, high-fat snacks,
and sugary drinks.
4. Fat genes and health habits Overweight and obesity tends to run in my family and
I also simply adopted the habits of my parents.
5. Emotional factors- Eating when I was stressed.
6. Lack of sleep Sleeping fewer hours and feeling hungrier.

I embarked on a solution. I tried pills, counseling, diets, exercise, and even hypnosis. I would
lose weight and then gain it back. I finally decided on bariatric (lap-band surgery) as the
solution for my needs. I found that lap-band surgery has been documented as being the only
treatment available that results in sustained weight loss.

My surgery was outpatient and the bariatric surgery involves having a silicone band placed
around the stomach to create a pouch the size of a golf ball, limiting the amount of food I
was able to ingest. Basically it forced me to follow a low-calorie diet. I started losing one to
two pounds a week, and shed 40% of my body weight over a year and a half.

So after paying $15,000 out of pocket I had the surgery that then led to significant
improvements in my obesity-related co-morbidities. In fact those health issues I identified
early disappeared. I lost 126 pounds have kept it off for three years now. Heres a recent
picture.


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So after the surgery Im was good to go. But I found that there is a health inequity in access
to bariatric surgery. Individuals who meet the eligibility criteria for bariatric surgery are
generally older, come from racial or ethnic minorities, are economically disadvantaged, and
have low levels of education. According to research from BioMed Central, however, the
population who actually receives bariatric surgery does not reflect the individuals who need it
most. There needs to be further research to explore and identify barriers to accessing
bariatric surgery.

Fortunately the Affordable Care Act (ACA), i.e., Obamacare mandates that all insurance
plans cover obesity screening and counseling for adults and children. Insurance companies
cannot collect copays, coinsurance or apply any amount to deductibles for patients that
access obesity screening through their primary care physician. If patients are considered to
be obese, they can access counseling at no additional cost as well. Insurance companies have
the flexibility to decide how the ACA mandate covers obesity through guidelines provided
by the ACA. Programs might include counseling, diet, and physical activities. However, the
ACA leaves it up to the states to consider whether bariatric surgery is a treatment. Currently
only 23 states cover bariatric surgery. Of the three largest states (California, Florida, and
Texas) with Latino populations only California covers bariatric surgery.

Shortly after this surgery I started a nonprofit, the Latino HealthCare Forum to focus on
health and healthcare disparities. Partly the motivation in starting this nonprofit was my
personal experience and thinking how community leaders can impact issues like obesity and
other chronic diseases. I was able to solve my obesity problem by having the money. What
about those that didnt have it? Or any insurance? It helped that I had a healthcare
background being a founding board member of our countys health care authority and
setting on the board for 8 years.


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Here is background information on obesity from government sources primarily Centers for
Disease Control and Prevention, U.S. Department of Health and Human Services and
medical journals.

OBESITY TRENDS

Adult Obesity Trends

Thirteen states currently have an obesity rate of above 30 percent, 41 states have rates of
at least 25 percent, and every state has a rate above 20 percent
Rates vary by age. Obesity rates for Baby Boomers have reached at high as 40 percent.
Obesity rates for young adults are below 28 percent.
Obesity rates vary by education. More than 35 percent of adults who did not graduate
from high school are obese, compared with 21. 3 percent who graduated from college or
technical college.
Gender gap closing. Ten years ago the obesity rate for women was significantly higher
that the rate for men 33.4 percent compared with 27.5 percent. Currently obesity rates
for men are 35.8 percent and for womens 35.5 percent obesity rates.

Childhood Obesity - Trends

Rates of obesity among children ages 2 to 19 are high more than triple what they were
in 1980. According to the National Health and Nutrition Examination Survey, 16.9
percent of children ages 2 to 19 are obese, and 31.7 percent are overweight or obese.
This translates to more than 12 million children and adolescents who are obese and
more than 23 million who are either obese or overweight.
Extreme obesity rates rising among adults and children. The number of extremely obese
adults and children also has grown significantly over time. The rate of extremely obese
adults grew from 1.4 percent between 1976 and 1980 to 6.3% percent during 2009-2010.
In individual is considered extremely obese if his or her body mass index (BMI) is
greater than or equal to 40, which is roughly the equivalent of being 100 pounds or more
above ideal body weight. The number of extremely obese women is nearly twice of that
of men (8.1 percent versus 4.4 percent). For children and teens ages 2 to 19, severe
obesity grew from 1.1 percent among boys and 1.3 percent among girls during 1976 to
1980 to 5.1 percent among boys and 4.7 percent among girls during 1999 to 2006. Rates
were particularly high among Hispanic boys (9 percent) and non-Hispanic Black girls
(12.6%).

OBESITY AND HEALTH - Estimated medical costs of obesity are as high as $147
billion a year for 2008, or almost 10% of all medical spending according to the National
Institute of Health.

Diabetes
More than 25 million adult Americans have diabetes
Another 79 million Americans are prediabetic

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CDC projects that as many as one in three U.S. adults could have diabetes by 2050
Approximately 215,000 individuals under the age of 20 have diabetes and two million
adolescents ages 12 to 19 have pre-diabetes.
Compared with non-Hispanic white adults, the risk of diagnosed diabetes in 18
percent higher among Asian Americans, 66 percent higher among
Hispanics/Latinos, and 77 percent higher among non-Hispanic blacks
Diabetes is the seventh leading cause of death in the U.S. and accounts for $245
billion in total U.S. healthcare costs annually. Diabetes accounts for more than one is
five U.S. healthcare dollars, and healthcare costs for individuals with diagnosed
diabetes are approximately 2.3 times higher than costs for those without diabetes.
More than 80 percent of people with diabetes are overweight.
The National Institute of Diabetes and Kidney Diseases found that a 7 percent
weight loss together with moderate levels of physical activity (walking 30 minutes a
day, five days a week) decreased the number of new diabetes cases by 58 percent
among people at risk for diabetes.

Heart Disease and Stroke

One in four Americans has some form of cardiovascular disease.
One in three adults have high blood pressure; high blood pressure being the leading
cause of stroke and more than 75 percent of cases with hypertension may be
attributable to obesity.
Heart disease is the leading cause of death in the United States, and stroke is the
fourth leading cause.
People who are overweight are more likely to have high blood pressure, high levels
of blood fats, and high LDL (bad cholesterol), which are all risk factors for heart
disease and stroke.

Cancer

Cancer is the leading cause of death is the United States.
Approximately 20 percent of cancer cases among women and 15 percent of cancer
cases among men are attributable to obesity.
Obesity increases risk for endometrial (uterine) cancer by 39 percent, esophageal
cancer by 37 percent, kidney cancer by 25 percent, colon cancer by 11 percent and
post-menopausal cancer by 9 percent.
Physical activity can reduce a persons risk for a number of cancers, including colon
cancer by 30 percent to 40 percent, breast cancer by 20 percent, lung cancer by 20
percent

Neurological and Psychiatric Diseases

Both overweight and obesity at midlife independently increase the risk of dementia,
Alzheimers disease and vascular dementia.

F
Data analysis from a health survey of more than 40,000 Americans found a
correlation between depression and obesity.

Kidney Disease

Obese individuals are 83 percent more likely to develop kidney disease than normal-
weight individuals, while overweight individuals are 40 percent more likely to
develop kidney disease.
In the U.S., an estimated 24.2 percent of kidney disease cases among men and 33.9
percent of cases among women are related to overweight and obesity.

Liver Disease
Obese individuals are at greater risk of nonalcoholic steatohepatitis (NASH), a liver
disease that can lead to cirrhosis, in which the liver is permanently damaged and no
longer able to work properly.

Arthritis

Obesity is a know factor for the development and progression of osteoarthritis of
the knee and possibly of other joints. Obese adults are up to four times more likely
to develop osteoarthritis of the knee than healthy-weight adults.
68.8 percent of individuals diagnosed with arthritis are overweight or obese.
For every pound of body weight lost, there is a 4 percent reduction in knee joint
stress among overweight and obese people with osteoarthritis of the knee.
Adults with arthritis are significantly less likely to participate in leisure time physical
activity compared to those without arthritis

HIV/AIDS

Antiretroviral treatments are less effective for obese patients.

Obesity and Childrens Health

More than one third of children and adolescents are overweight or obese.
The number of fat cells a person has is determined by late adolescence, although
overweight and obese children can lose weight, they do not lose the extra fat cells.
Obese adolescents are more likely to become obese adults.
At least one of out every five U.S. teenagers has abnormal cholesterol levels, a major
risk factor for heart disease. Among obese teenagers, the rate jumped to more than
two out of five. (43 percent).
Overweight and obesity are associated with a 52 percent increased risk of a new
diagnosis of asthma among children and adolescents.
Children and adolescents with a BMI greater than 28 are four to five time more likely
to experience sleep-disordered breathing than their peers with a lower BMI.

G

Maternal Health and Obesity

There is a growing body of evidence documenting the links between maternal health
conditions, including obesity and chronic diseases, and increased risks before, during,
and after childbirth.
Children born to obese mothers are twice as likely to be obese and to develop type 2
diabetes later in life.
Teenage mothers who are obese before pregnancy are four times more likely than
their healthy-weight counterparts to develop gestational diabetes, a form of diabetes
that arises during pregnancy and increases a womens risk of developing type 2
diabetes later on.
CDC and Kaiser Permanente Northwest Center for Health Research found that
obesity during pregnancy is associated with an increased use of healthcare services
and longer hospital days.

DISCUSSION

Latino HealthCare Forum (LHCF)

The Latino HealthCare Forum, a nonprofit, was established in 2012. See
www.latinohealthcareforum.org The primary purpose of the organization is to tackle health
and healthcare disparities. The vision for the Latino Health Care Forum (LHCF), as an
advocacy organization, is to provide leadership and support to state and local consumer
organizations, policymakers, and foundations to increase access to high-quality, affordable
health care for everyone.
LHCF goals include: (1) Supporting the transformation of healthcare and building a high-
value healthcare system which provides increased access for the uninsured; (2) Support the
strengthening of the healthcare infrastructure and workforce; (3) Advancing the health,
safety, and well being of racial and ethnic minorities who fare far worse than their non-
minority counterparts across a broad range of health indicators; (4) Advancing knowledge
and innovation by improving patient-centered research and tools like mobile applications to
provide access and information; and, (5) Increase the efficiency, transparency, and
accountability of public healthcare programs.
Obesity and the LHCF

The risks of obesity are well known; life threatening and chronic illnesses that strain an
already health care system, shortened life spans, and reduced quality of life especially in
low-income communities of color.

The LHCF has designed strategies and programming for obesity management and
prevention, particularly targeted to the Latino vulnerable and hard-to-reach population. The
LHCF has recognized that building healthy communities requires addressing the underlying

H
causes of poor health rooted in social, economic, and physical conditions that determine an
individuals health risks and opportunities.

The LHCF has been trained in a disparities health program conducted by the Harvard
Medical School and Massachusetts General Hospital. Using this training and working with
obesity experts from the University of Texas Public Health Program, the LHCF has aimed
its efforts at preventing obesity among school-aged children and parents by using
environmental and policy change strategies to increase physical activity and promote healthy
eating. One program, Manantial de Salud http://dovespringshealthnet.blogspot.com/
located in low-income communities is built around collaborative partnerships with the
LHCF, local government and other community-based organizations. Manantial de Salud
using health promotion strategies initiates campaigns for healthy activities including no-soda,
take back the parks, tobacco cessation, walkability, and other activities. Manantial de Salud
has been evaluated and recognized as best practices by the CDC for community based
health promotion campaigns.

The LHCFs health promotion campaigns are carried out by Community Health
Workers/Promotores. CHWs are frontline public health workers who are trusted members
of and/or have an unusually close understanding of the community served. This trusting
relationship enables CHWs to serve as a liaison, link, or intermediary between health/social
services and the community to facilitate access to services and improve the quality and
cultural competence of service delivery. CHWs also build individual and community capacity
by increasing health knowledge and self-sufficiency through a range of activities such as
outreach, community education, informal counseling, social support, and advocacy.
1


The LHCF started a 210-hour training program in 2012 to recruit community-based
individuals that we then certify as Community Health Workers through the Texas State
Department of Health Services. The training program is a highly effective intervention in
interrupting the poverty cycle and providing a future career pathway. The Latino Healthcare
Forum through its PromoSalud program provides the Community Health Worker (CHW)
Training Program at no cost to the trainee. The skills training course includes an intense
interactive application provided by skills-based activities trainers with backgrounds in
education methods, adult education, mental health counseling, and healthcare expertise.

Clearly, CHWs can help overcome barriers to controlling chronic disease. Twelve years ago,
the National Community Health Advisor Study, conducted by the University of Arizona and
funded by the Annie E. Casey Foundation, identified the core roles, competencies, and
qualities of CHWs after contacting almost 400 of these workers. Core roles were identified:

Providing outreach to individuals in the community setting;
Educating patients and their families on the importance of lifestyle changes and on
adherence to their medication regimens and recommended treatments, and finding
ways to increase compliance with medications;
Helping patients navigate health care systems (e.g., by providing assistance with
enrollment, appointments, referrals, and transportation to and from appointments;

I
promoting continuity of health services; arranging for child care or rides and
arranging for bilingual providers or translators);
Providing social support by listening to the concerns of patients and their family
members and helping them solve problems;
Assessing how well a self-management plan is helping patients to meet their goals;
Assisting patients in obtaining home health devices to support self-management and
supporting individualized goal setting.

Currently the LHCFs CHWS are implementing The Diabetes Empowerment Education
Program (DEEP). This is a multi-cultural, bilingual self-management education curriculum
developed for Latinos and African Americans with type 2 diabetes. The DEEP has been
developed to be delivered in various health centers and community settings.

Strategies To Address Community Issues Connected to Obesity Prevention

After some work in the field dealing with obesity issues, a number of questions can be
raised. What are the most promising strategies to address the emerging community issues
connected to obesity prevention? How can impact be measured? How can community
improvements be sustained and how can efforts be spread? What is the right amount of
outside technical assistance for community based efforts?

The LHCF sees some encouraging signs but much more is needed. Here are some key
issues.

Issue: The fight against fast food advertising and childhood obesity

Research by the Rudd Center for Food Policy and Obesity shows that thirty three percent of
kids and 41% of teenagers eat high-calorie, high-fat fast food every single day. They end up
consuming an extra 126 to 310 calories a day when they eat fast food, less than 1 percent of
all kids meal combinations actually meet recommended nutrition standards. While a majority
of schools are getting rid of junk food and snacks in the cafeteria, many secondary schools
have contracts with fast food vendors like Taco Bell, McDonalds, and Dominos Pizza that
sell unhealthy dishes.

What can educators and parents do to combat fast food marketing to children and teens?
Some communities have started taking more drastic measures against fast food
establishments, like proposing that restaurants be located a specific distance away from
schools. In Texas, 44% of children in Austin public schools are at risk of obesity. This high
rate has prompted the City of Austin Health Director to propose that the city create healthy
food zones to protect local students from new fast-food restaurants.

First Lady Michelle Obama is pushing also for new rules to limit marketing of unhealthy
foods in school by phasing out the advertising of sugary drinks and junk foods during the
school day.

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Issue: Create healthier environments for after-school providers

The Boy and Girls Clubs of America and the National Recreation and Parks Association
have committed to creating healthier environments for five million kids in their programs.
They will serve a fruit or vegetable at every meal or snack along with healthier drink options
and ensure that kids get 30 to 60 minutes of physical activity each day.

Issue: Marketing of unhealthy food and beverage products

The food and beverage industry spent $1.7 billion in 2009 to advertise their products to
American children and adolescents
Americas youth view 12 to 16 food and beverage ads every day
More than 2 billion ads for food and beverages appeared on childrens websites in 2009,
primarily for sugary cereals and fast-food restaurants
The vast majority of child-directed ads promote unhealthy foods and beverages, such as
candy, sugary cereals, fries and sodas. Ads for healthy foods, such as fruits and
vegetables, are extremely rare, accounting for 1 percent or less of all ads.
Between 2008 and 2010, Latino children saw 49 percent more television ads and teens
say 99 percent more ads on Spanish language television for sugary drinks and energy
drinks compared with White counterparts.
Food and beverage companies also use sponsorship to expand the places they reach into
communities of color. In addition to blanketing neighborhoods with billboards and signs
outside corner stores, food marketers, brand places like athletic fields and sporting
events, festivals, concerts, and award shows. These tactics integrate food companies and
their products into the cultural and social fabric of peoples lives.

Black and Latino children and adolescents who experience higher rates of overweight,
obesity, and diet-related chronic diseases, such as type 2 diabetes, are exposed to higher
levels of marketing for unhealthy food and beverage products according to Healthy Eating
Research. Despite some progress to improve the nutritional quality of foods marketed to
children at home, in schools, and in restaurants, Americas youth continue to grow up in
environments that promote unhealthy schools and beverages.

In 2005, the Institute of Medicine recommended that the food, beverage, and restaurant
industries improve the health of their products and shift their advertising and marketing
emphasis to healthier child- and youth-oriented foods and beverages. The IOM has since
reaffirmed the need for stronger standards to improve food-marketing practices that target
young people.

The food and beverage companies created the Childrens Food and Beverage Advertising
Initiative (CFBAI), a self-regulatory program to limit unhealthy marketing aimed at children
under 12. While the CFBAI has le to some reductions in unhealthy food marketing aimed at
children, several studies show that the vast majority of marketed products remain unhealthy.


""
Television advertising remains the dominant form of marketing to children and adolescents.
There are also other highly effective techniques to reach young people. These include new
digital and online media, such as online games, mobile apps, and ads that can be shared via
text messages, and social networks.

In 2009, Congress established the formation of an Interagency Working Group on Food
Marketed to Children (IWG). The group composed of experts in health, marketing, and
nutrition released a set of voluntary principles in 2011 to improve the nutritional profile of
foods marketed directly to children. There has been no further progress made to implement
the IWG proposal. The CFBAI did unveil a set of uniform standards to go into effect 2014
but these standards dont go as far as the IWG proposal.

Issue: Barriers and Challenges for Latinos

Latinos and their children have been particularly impacted by the growing prevalence of
obesity and overweight problems. Primarily of their economic constraints, Latinos settle in
areas saturated with fast food restaurants, mini-markets, smoke shops, and small grocery
stores. These areas are also food deserts or environments where access to healthy food is
more limited and contributes to poor diets and elevated prevalence obesity and other health
related conditions among Latinos. This makes it much more difficult for Latinos who live in
these neighborhoods given limited access to supermarkets, safe parks, and affordable fresh
foods, to be physically fit and healthy.

Latinos also have high levels of obesity-related health conditions due to the lack of
preventive care and treatment. Lowering obesity rates for uninsured Latinos is even more
challenging when they lack health access. The lack of access to physicians, community health
clinics, and specialized hospitals directly contribute to poor health for many Latinos. Because
they lack access to health care, many Latinos suffer from disproportionate rates of
preventable diseases and health. In addition, the lack of health care, access to cultural
competent and linguistic appropriate service and professionals pose barriers as well.

For this reason, the LHCF acted as a navigator recently for the rollout for the Affordable
Care Acts Insurance Marketplace. The LHCF deployed 38 employees over 6 months to
provide outreach, education, and enrollment services for the insurance marketplace. The
target was the zip codes with the most eligible but not enrolled comprising about 45,000
individuals.

Issue: Using New Tools To Examine Obesity

John Cawley, an economist from Cornell University has studied the issue of obesity and has
made several observations:

Obesity lowers wages, especially for white women. Obese workers miss work for health
reasons more often than non-obese workers; obesity-related job absenteeism costs $4.3
billion a year in the U.S.
Economic explanations for the rise in obesity include:

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o Lower food prices account for 41%-43% of the rise in young adults body mass
index. The price of fruit and vegetables, on the other hand, has risen 17 percent
and some studies have linked this to higher BMI in American children and teens.
o Farm polices have profound impacts on the food system that go beyond pricing.
Restricting sugar and subsidizing the production of corn and has led to
substituting high-fructose corn syrup for sugar.

Crawley evaluates the various interventions that help people lose weight.

In schools, does more physical education make a difference? He notes that increased
physical activity has a multitude of benefits, but his study found no evidence that the
physical education requirements lowered the rate of student overweight or obesity. A
possible explanation is that increased physical activity may not be sufficient to counteract
other factors that favor unhealthy weight gain.
Does paying people to lose weight work? Cawley used data from 2,407 employees who
participated in a voluntary, year long health promotion program at 17 worksites
nationwide. Participants were incentivized for losing weight. The results were modest
and the drop rates were high.
Will voters pay for anti-obesity programs? The answer is a qualified yes, according to
Cawleys analysis of polls and survey. Cawley found that the average amount taxpayers
were willing to spend for a 50 percent reduction in childhood obesity was $49.41
annually per household. On the average, those who were willing to pay more had higher
household incomes, identified childhood obesity as a major problem, and identified
themselves at liberal or Democrats.

Costs

Health Care

Obesity related medical treatment costs range between $147 and $120 billion a year, or
nearly 10 percent of all annual medical spending (based on 2006 data)
Childhood obesity alone is responsible for $14.1 billion in direct costs
Annually, the average total health expenses for a child treated for obesity under Medicaid
is $6,730, as compared to the average health cost for all children covered by Medicaid is
$2,446.
Hospitalizations of children and youths with a diagnosis of obesity nearly doubled
between 1999 and 2005, while total costs for children and youths with obesity-related
hospitalizations increased from $125.9 million in 2001 to $2376 million in 2005,
measured in 2005 dollars.

Decreased Worker Productivity and Increased Absenteeism

Obesity related job absenteeism costs $4.3 billion annually.
Obesity is associated with lower productivity while at work (presenteeism) which costs
employers $506 per obese worker per year

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As a persons BMI increases, so do the number of sick days, medical claims and
healthcare needs associated with that person.

Higher Workers Compensation Claims

A number of studies have shown obese workers have higher workers compensation
claims. One study showed obese employees medical costs per 100 full-time employees at
5 times more than non-obese employees.



CONCLUSION

In response to high levels of obesity and overweight rates particularly within the Latino
population, a series of actions and intervention strategies are highlighted.

1. Support the inclusion of bariatric surgery as a covered cost in the ACAs Insurance
Marketplace for Texas. Although not all overweight people are suitable for weight
loss surgery, it is an alternative that considerable results. It is ironic that the State of
Texas allows this surgery to be covered for State employees but not the citizenry.

2. The Community Transformation Grant (CTG) is the primary federal program that
focuses on priorities for healthier living. The CTG is works to create healthier
communities by making healthy living easier and more affordable where people
work, live, learn, and play. Awardees are improving health and wellness with
strategies that focus on areas such as

a. Tobacco-free living.
b. Active living and healthy eating.
c. Clinical and community preventive services to prevent and control high
blood pressure and high cholesterol.

Awardees may also focus on disease prevention and health promotion, including
social and emotional wellness (i.e., facilitating the early identification of mental health
needs and access to quality services) and healthy and safe physical environments.
Examples of community interventions include
Increasing access to physical activity through quality physical education instruction in
schools.
Increasing access to healthy foods by supporting local farmers and developing
neighborhood grocery stores.
Protecting people from secondhand smoke exposure.
Promoting improvements in sidewalks and street lighting to make it safe and easy for
people to walk and ride bikes.

The LHCF was an awardee of this program that the CTG primarily funded its work
on obesity prevention. Unfortunately the programs funding has been cut with funds

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re-allocated to other program. While many questions remain to be answered about
this shift in funding allocation, what is clear is that the CTG efforts are making a
difference right now in communities across the country. With their focus on equity,
multi-sector partnerships, community engagement, and linkages between healthcare
and community health, these grants embody a new paradigm and vision of health and
prevention, and play an important role in shifting the health system to promote health
and wellness, in the first place. Moving forward, its critical that we work together to
maintain this vision, and not overlook the valuable infrastructure that has already been
built. Transforming communities to achieve great health, safety and equity for
everyone will not happened by addressing one disease or condition at a time: The
right community solutions will solve many problems.
3. The Institute of Medicine and National Research Council recommends that state and
local government tax junk food and soft drinks, give tax breaks to grocery stores that
open in blighted neighborhoods and build bike trails. They also suggest that
government limit television and video games in after-school programs, require
restaurants to list calorie counts on their menus and open school playgrounds and
athletic fields in communities. Recently the government of Mexico has become the
standard bearer in the global fight against obesity after a law was passed imposing
significant new taxes on junk food and sugary drinks. Mexico has taken the long view
that potential economic harm form reduced junk food and soft drink sales now is
insignificant compared with damage in 10 years if obesity continues at the current
rate. Some 9.2% of children in Mexico now have diabetes.

Obesity campaigners worldwide have been looking to food and drink taxes as a way
to encourage people to change their diet and reduce the amount of fattening food
and drink they consume. Norway has had higher duties on sugar, chocolate, and
sweetened drinks since 1981. In 2011, the Danish government imposed a tax on all
foods containing more than 2.3% saturated fat. The food industry claims such taxes
are a burden on the poor and do not work. In the case of Denmark, preliminary
results after the introduction of the tax showed that it has a 4% effect on saturated
fat levels. What is needed is more of these steps around the world to come up with
clear evidence of their effectiveness.


Are we fighting a losing Battle Against Obesity?

Its clear as rain. We are a nation who is and has gotten fatter. Our children are getting fatter,
and global obesity has become a worldwide epidemic. The World Health Organization
(WHO) warns: Obesity has reached epidemic proportions globally with more than 1 billion
adults overweight at least 300 million of them clinically obese and is a major contributor
to the global burden of chronic disease and disability. The WHO blames poor eating for
the rising levels of obesity. The WHO recommends that countries adopt policies that
promote low-fat, high-fiber foods, daily physical exercise of at least 30 minutes, greater
consumption of fruit and vegetables and a move away from animal saturated fats to
unsaturated, vegetable oil-based fats.

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But isnt what weve all been trying to do with health promotion, government programs (that
are being cut), and public service announcements without any significant impact on the
problem. So are we fighting a losing battle against obesity and if that is the case, how can we
reverse the trend and win the war?

What about shifting the focus from consumers to the all-powerful, multi-billion food
industry? Scientists at the Scripps Research Institute in Florida published the results of a
study that reveals junk food high in calories and fat contains additive properties as strong
as cocaine that can lead to compulsive eating.

According to CNN Health, even Coca-Cola, the worlds largest beverage company, is now
calling obesity, the issue of this generation. It has launched an ad campaign aimed at
reinforcing its efforts to work together with American communities, business, and
government leaders to find meaningful solutions to the complex challenge of obesity.
Michael Jacobson, executive director of the Center for Science in the Public Interest (CSPI)
concedes that sugar and soda consumption are, in fact, on the decline, But, the scientific
community hasreached a consensus that soft drinks are one food or beverage thats been
demonstrated to cause weight gain and obesity. And if were going to deal with this obesity
epidemic, thats the place to start. Coca-Cola continues the sentiment that beating obesity
will take action by all of us, based on one simple, common-sense fact: all calories count, no
matter where they come fromAnd if you eat and drink more calories than you burn off,
youll gain weight.

The CSPI states that these comments are not a meaningful contribution toward addressing
obesity. While the industry is trying to do is forestall sensible policy approaches to reducing
sugary drink consumption, including taxes, further exclusion from public facilities, and caps
on serving sizes.

The Latino HealthCare Forum will continue to fight the good fight against obesity La
Lucha Contra La Grasa but it may be that we need to win the battle against the food and
drink industry first.