Contemporary Culture

The Cost of Childhood Obesity (Article)

Tackling the obesity problem has been on the forefront of the minds of politicians, doctors, and parents. Childhood obesity, defined as a BMI greater than 99% of the population, affects 20% of the children between the ages of 6 to 19 years old. This rate has doubled during the last two decades. A US Task Force on Childhood Obesity has set an ambitious goal to reduce that number to 5% by 2030. With the help of everyone who cares for children, I believe this is both achievable and cost effective.

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Childhood Nutrition Improving in U.S. (Article)

Finally some good news about childhood nutrition in the United States; children are eating more fruit! Recently published statistics from the Center for Disease Control show the daily intake of fruit by U.S. children has increased by 67% in the past 10 years. Even better, a drastic shift has occurred between the amount of fruit juice consumed and actual whole fruits. Fruit juice has seen a 30% decline in consumption, and whole fruit consumption increased proportionally. This is an important trend since dieticians and nutritionists strongly recommend a child consume whole fruit instead of fruit juices to lower the child’s sugar intake and afford them the full benefit of other nutrients found in whole fruit.


Other news in the same report is not as encouraging–even though fruit juice consumption is down and whole fruit consumption has risen among US children, diets among children remain critically deficient in both whole fruits and especially vegetables. The Vital Signs study, conducted by the CDC, revealed that children still aren’t reaching the ideal level of fruit intake, and vegetable intake is looking even more dismal. Though fruit intake doubled during the study period, only 40% of children were getting the recommended fruit intake and a dismal 7% were getting the recommended vegetable intake. Vegetables and fruits supply vital nutrients to a developing child, ensuring that they grow healthy and strong.


So how do we continue to improve healthy eating habits in today’s children? Since 60 million kids spend much of every day in schools and daycares, the CDC recommends that these institutions begin implementing healthier eating options as a force for change. The CDC suggests that school districts and childcare centers begin training their food preparation workers on ways to make fruits and vegetables more tasty, and provide educational nutritional programs that make fruits and vegetables fun. Ultimately, a child’s parents play the most critical role in encouraging the consumption of vegetables. If parents committed themselves to eating a diet rich in fruits and vegetables themselves, involving their children in shopping for whole food, teaching their children how to cook, and involving them in growing their own produce, many of the problems we see with the terrible diet many American children eat would quickly become a bad memory. Let your kids get their hands in some dirt, learn to shop for fresh produce, and sauté some vegetables, so they can be healthy eaters!

Your comments are welcome at Until next time.


Smo Notes:



Written collaboratively by Keri Register and Paul Smolen M.D.


Infertility Rate among Women in the U.S. Drops (Article)

Starting a family remains one of the central tenets of the ‘American Dream.’ A common image that comes to mind is the pitter-patter of an toddler’s feet as they dart across the kitchen floor during an afternoon game of hide-and-seek. Unfortunately for some potential mommies, infertility can prevent this happy picture from coming to fruition. Fortunately, recent data from the National Center for Health Statistics shows there may exist light at the end of this dark tunnel; the odds are improving for expectant parents. These data come from a recent report showing a 17% drop in infertile married women, ages 35-44 years, from 1982 to 2010. While this may sound small, this percentage translates to a drop from 2.4 million infertile women in 1982 to 1.5 million women!

How is this information measured? The National Survey of Family Growth (NSFG) provides measures of fertility for both women and men. According to the NSFG, the two measures for infertility in women are “a lack of pregnancy despite having unprotected intercourse with the same husband or partner” and “difficulty in getting pregnant or carrying a pregnancy to live birth,” with the latter known as ‘impaired fecundity.’ Among mothers in the 35-44 year age bracket, a common age for first pregnancy in United States, the infertility rate has dropped from 44% to 27%. This is a vast improvement and has allowed many more women to pursue both their careers and family aspirations.

Overall, it appears infertility is on the decline across American married women. I am sure there are many reasons behind the drop in infertility rate which statisticians and healthcare researchers will determine. Isn’t it great to hear about one health statistic of Americans that is improving?  Let’s not stop making things better until everyone who wants to can enjoy the glorious sound of pitter-pattering of little feet running across their kitchens floors.

Your comments are welcome at my blog, Until next time.

Smo Notes:

Infertility and Impaired Fecundity in the United States,
1982–2010: Data From the National Survey of
Family Growth

by Anjani Chandra, Ph.D., and Casey E. Copen, Ph.D., National Center for Health Statistics; Number 67 n August 14, 2013and Elizabeth Hervey Stephen, Ph.D., Georgetown University

Written collaboratively by Norman Spencer and Paul Smolen M.D.

Sugar in Children’s Cereals (Article)

We all know that children love sugar. Children burn a lot of fuel because of their near-constant need to run around. Maybe sugar provides them with the necessary fuel to keep moving? Could this insatiable craving have biologic roots? Quite possibly, this the reason. Unfortunately in a culture like ours, where sugar is easy to get and plentiful, the rate of type 1 and 2 diabetes, obesity, and other metabolic disorders among children continues to rise. When a child’s craving for sugar coincides easy availability, trouble begins. Nowhere is that more evident than on the cereal aisle of any grocery store in the US.

Recently, the Environmental Working Group (EWG), a Washington DC health information non-profit, analysed 181 cereals marketed toward children and found them very high in sugar; on average, children’s cereals were more than 40% sweeter than adult cereals. The EWG estimates that if a child eats one serving of children’s cereal daily, they will eat 10 pounds of sugar annually. Ironically, they found that the cereal highest in sugar per serving was Kellogg’s Sugar Smacks. At least The Kellogg’s Company gave this cereal an accurate name.

As a society, we are finally beginning to realize just how destructive allowing children to consume large amounts of sugar is. Grandma instinctively new when sugar crept into the diet of Americans in the twentieth century that this would be harmful to children. Turns out she was right. Soda, candies, and sweetened cereals in large amounts lead to obesity and many other long-term health problems among children.

How do we promote healthier eating among today’s children? At a minimum, parents need to have access to non-deceptive food labels that give them accurate estimates of how much sugar their children will be getting from their children’s breakfast cereal. Telling parents that a box of cereal has 24 servings really doesn’t help them figure out how much sugar their child will be getting at breakfast, does it? Neither does not revealing how much extra added sugar has been put in a food during production. I think manufacturers of food marketed toward children should carefully study the history of tobacco marketing in the US. If they did, they would voluntarily stop the aggressive marketing of their product directly to children before society forces them to cease the practice.

As always, your comments are welcome on my blog,  Until next time.

Smo Notes:


The Power of Advertisers (Article)

I was perusing my CDC weekly mortality and morbidity report a few weeks ago, and I saw an interesting statistical graph: smoking by occupation in the U.S. As we have talked about many times in this blog, smoking rates have been–and continue to–decline in the United States, thank goodness. Currently 20% of the population smokes, down from 50% during my childhood years. As you can see in the graph, the CDC has further broken down smoking by occupation, and I am happy to report that healthcare and social assistance occupations were the lowest group of smokers by percentage, currently at 16%.

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Just a few decades ago, the picture of the healthcare industry’s relationship with smoking was a very different one. Just take a look at these ads featuring doctors, babies, mothers, and cigarettes. Engaging pictures of distinguished looking doctors, cute babies, and young vital, attractive mothers were used to endorse cigarettes. A careful examination of the message in these ads to me revealed two essential messages:

1.  Loving, kind, respected, attractive people around you want you to smoke.

2.  The advertisers of particular brand of cigarette claiming that their brand is less “irritating” than the other brands.

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In other words, the makers of cigarettes knew, long before the devastating effects of tobacco smoke were fully understood, that some cigarettes were less likely to make smokers sick than others.

Oh, what a difference a few decades can make in behavior and attitude. I think we can conclude from all this information that the anti-smoking campaign, waged in the past 50 years, has been extremely effective. These new statistics once again reveal how effectively advertising can change behavior. Remember the government tobacco settlement with cigarette makers just a few years ago? Tobacco companies were forced to turn over a staggering amount of money to be spent mostly on anti-smoking advertising. I think we have to admit that these ads seemed to have worked. Negative images and messages about tobacco have had a big impact on our behavior, especially the behavior of healthcare workers and children. Isn’t it wonderful that without banning the sale or use of tobacco, a little negative advertising could convince so many millions of Americans not to sicken themselves by using tobacco? America: for our children’s sake, let’s not stop until we are completely tobacco free.

I welcome your comments. Visit today. You’ll be glad you did. Until next time.

Smo Notes:

Children and Pools (Article)

​Summer is a season when parents need to be especially vigilant about their children’s safety. One of the biggest summer risks starts when the pools open for business. What summer vacation signifies for youth is cooling off from the summertime heat by jumping and playing in a pool. For children, the neighborhood pool means freedom, friends, and fun. For parents however, their immediate concern needs to be, “safety first!” As beautiful and harmless as backyard appears, parents must remember it can be dangerous and even lethal for their children. A 2013 report found that children younger than 15 represented 78% of deaths from pool-related injuries. These data certainly cast a dark shadow over the image of fun in the sun. ​Since when did swimming at the pool become dangerous? The report “Pool and Spa Submersions: Estimated Injuries and Reported Fatalities” discusses findings related to this class of injuries. This 2013 report found that the majority of these pool-related fatalities involved children “15 years or younger” at neighborhood pools. Interestingly enough, the report also found interesting demographic information related to these incidents. The Centers for Disease Control and Prevention found African American and Hispanic children at higher risk of drowning. Particularly, African American children, between ages 5 and 19, were “six times more likely to drown in pools [versus] white and Hispanic children.” They also found that 70% and 62% of African American and Hispanic children, respectively, could not swim adequately. The report did not identify the exact origins behind these figures but point out a serious health hazard threatening a large group of children. ​How do we solve the problem of childhood drownings? Should we outlaw community and backyard pools? No, we need to increase our efforts to make sure every child learns to swim and know how to safely be around water. Thanks to organizations like the American Red Cross, the YMCA, and most public swim facilities, families can teach their children how to swim and remain safe during this and all future summer seasons. Proper swimming is a vital life skill that all beachgoers, children and parents should know. It may seem obvious but the solution to childhood drownings is really simple, professionally taught swim lessons along with good adult supervision around water. Smo Notes: Written collaboratively by Norman Spencer an Paul Smolen M.D.

Feed, Read, Play and Thrive (Article)

Malnutrition can stunt child development, but what about improper and infrequent social interaction? Could isolation inhibit a child’s psychological growth? Dr. Paul Gertler of the University of California at Berkley thinks it can. Dr. Gertler and his colleagues set out to determine if providing appropriate socialization could help disadvantaged children succeed in the academic and employment worlds. Maybe programs such as “Feeding America” would be more effective if social welfare agencies were able to improve the parent-child interaction. Could proper socialization of young children really make that much of a difference? To answer this question, Dr. Gertler conducted a twenty-year longitudinal study of malnourished Jamaican babies. His results are amazing! On a weekly basis from the ages of one to four, researchers provided structured positive social interaction and nutritional support to the experimental group, solely nutritional supplements to one control group, and no support at all to the final control group. At age twenty, the nutrition-plus-social-interaction group were earning 25% more than the controls, less likely to commit a crime, more physically fit, and more successful in school. The success of the experimental group over the controls led Dr. Gertler to conclude that nutrition is not the only factor controlling a disadvantaged child’s well being—frequent and healthy social interaction can help prepare a child for a productive life. Although many programs provide adequate food to struggling families, offering healthy social interactions to toddlers and young preschoolers may be just as important. Is it surprising that giving young children attention and stimulating their language/cognitive development can have a positive impact on their adult lives? The Head Start Program was designed in the 1960’s to provide social and cognitive stimulation to low income children, ages 3-5 years. Today, a similar kind of assistance is available through The Early Head Start program, reflecting the changing tide in child development research. We now know that by helping a child learn language and social skills from a very young age, we improve their chance of achieving success. With what we have learned recently about the negative effects of stress and deprivation on infants and toddlers combined with this new information that social skills training in very young children can dramatically improve their lives, we can begin improve academic and societal performance and maybe even help win the war on poverty.  Let’s hope so. Your comments are welcome at Until next time.

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Smo Notes: 1. Written collaboratively by Sam Allen and Paul Smolen M.D.