Preventive Medicine Column

Dr. David L. Katz

Last week, the Senate passed the “Healthy, Hunger-free Kids Act,” a re-authorization of child nutrition legislation governing school food and related programs, such as WIC (Special Nutrition Program for Women, Infants, and Children).  Action by the House is pending, and is expected after the summer recess.

In general, reactions to the current bill- including my own- are positive in public health circles.  The bill allocates resources to raise nutrition standards in school cafeterias, in particular by extending existing standards to “competitive foods,” items sold in schools but not in the lunch line per se.  The dual standards formerly in play established a side door through which “junk” foods could undermine the standards for the lunch line (which in my view could be quite a bit higher themselves), and sabotage the average student’s prospects for a nutritious meal.

The bill also helps clamp down on junk foods in vending machines, and expands current restrictions on sugar-sweetened beverages.  The bill provides a bit more money per meal for schools meeting higher nutrition standards, and sets aside money to support both local sourcing of foods, and the establishment of school gardens.  Progress, to be sure, and commendable.  Kudos to the Senate, and here’s hoping the House follows the Senate’s lead.

But, alas, there are potentially noxious impurities in this effort to improve diet and health.  For what one hand purports to be giving, the other may be taking away.

Some of the costs in the school nutrition bill are covered by siphoning over $2 billion away from the food stamp program, now known as SNAP (supplemental nutrition assistance program).  This follows an even larger reduction in SNAP funding –over $10 billion- imposed to help cover other, unrelated expenses in the federal budget.  Research shows clearly that the SNAP population is particularly vulnerable to the adverse health effects of poor diet, and reducing their resources certainly won’t help.

It also suggests a peculiar blind spot in nutrition policy.  Does anyone think that young children will eat better if their families do not?  Schools certainly exert some influence on the quality of food choices, but the influence is modest; most eating is done outside of school, and the influence of family reliably exceeds that of the lunch room monitor.  Children and their parents- families- will likely get to better eating and better health together, or we won’t get there at all.

Nestled in that blind spot, alongside family as the basic functional unit of our society, is a whole load of conventional wisdom, and the view from altitude.

Conventional wisdom tells us that ounces of prevention are worth pounds of cure.  This may be uniquely true at a time when pounds- namely, those accumulated by a society prone to epidemic obesity- constitute one of the gravest health threats of modern times.  Poor diet is among the leading causes, and may actually be the leading cause, of premature death and chronic disease in the United States.  Combating this in school cafeterias is good, but ignoring it in SNAP- which supports nearly 1 in 8 American households (roughly 40 million people) certainly is not.

Conventional wisdom warns us against being penny wise, pound foolish.  There are those pounds again, and with good reason.  Obesity, already an enormous drain on the national economy, is projected to cost us nearly $200 billion more per year by 2018 should current trends persist.  Just these pounds account for ten times as much money as was taken out of the SNAP program this year, yet the money taken out of SNAP may actually exacerbate this problem.  The national economy may not withstand the weight of such shortsighted foolishness.

The view from altitude, to which we are equally, ostensibly blind, suggests better options.  What if instead of taking money out of SNAP, the use of that money was tethered to nutritional quality so that purchasing power and nutrition moved in tandem?  Colleagues and I have a federal grant application under review right now that would test this very option.  But USDA has already signaled its own interest in this sensible practice.  Unfortunately, it did not influence decision-making within the very short sight distance of federal legislation.  Shifting diet pattern to the better for 40 million SNAP beneficiaries could help reduce the burden of excess pounds, and related chronic diseases such as diabetes, just where they fall most heavily.  This, in turn, could save a whole lot more than pennies.  The costs of chronic disease care massively exceed the costs of food.  Moving the needle in this area, just a little bit, could readily pay the costs of SNAP, better school nutrition, and other policy priorities into the bargain.

But getting there from here requires us to think about pounds while counting pennies, a capacity we apparently lack.

So, I applaud the improvements in school food that will ensue with passage of the Healthy Hunger-free Kids Act.  But I wince at the prospect of the right hand breaking what the left just fixed.

We are amazingly, and indeed alarmingly, impervious to our own conventional wisdoms.  We teach our children about the tortoise and the hare, yet are a perennially, and gullibly quick-fix, silver-bullet society.  We recall our grandparents’ insights about sound mind, sound body; yet remove physical activity from the school day and wonder why ever more children need medication for both behavioral disorders and diabetes.  We recite the danger in failing to learn from the follies of history, yet routinely repeat them- most glaringly at present choosing to dial back the national deficit during a recession, and watching passively as the economy predictably tanks.  We intone the peril of being penny wise, pound foolish, yet choose to save pennies with policies that will reliably drive up pounds, and the enormous burden of dollars attached to them.

How we feed ourselves and our children provides a chewy morsel of food for thought: when we speak good common sense to ourselves, is anybody actually ever listening?




Dr. David L. Katz;