There have been numerous efforts by U.S. lawmakers and public health officials to curb the obesity epidemic in recent decades. Even so, the number of individuals who are overweight or obese has continued to increase. From 1999 to 2018, the prevalence of obesity increased nearly 12%, with severe obesity increasing more than 4%, according to the Centers for Disease Control and Prevention.

But Janani Thapa, an assistant professor of health policy and management at UGA’s College of Public Health, believes that lowering these numbers is within reach. With a background in applied economics, Thapa takes her knowledge of individual decision-making and researches potential programs and policies that could prevent obesity and address health disparities in affected communities.

Thapa, who serves as director for UGA’s Economic Evaluation Research Group, has studied school lunchroom environments, access to insurance plans by obese adults, and how income and school locations affect initiatives designed to curb childhood obesity. She and a multi-interdisciplinary team received funding from UGA’s Presidential Interdisciplinary Seed Grant to study the relationship between schools’ built environments and implementation of a statewide childhood obesity policy.

What are some of the health risks associated with obesity?

There are many health risks associated with obesity: cancer, diabetes, fatty liver, heart disease, hypertension, sleep apnea and stroke. It’s a critical issue because many chronic diseases associated with obesity are preventable, which is why I feel strongly about this research area. We’re losing lives from preventable chronic disease deaths. There is also an abundance of potential mental health issues, like anxiety, depression, low self-esteem and stigma surrounding obesity. These mental health issues are especially prevalent in children.

Why is it important for children to develop a healthy relationship with food early in their lives?

If someone is overweight or obese as a child, they’re more likely to be obese as an adult. The food we grow up with is so close to us in our adulthood. For example, my husband and I grew up around the same part of the country, but his family was more urban and relied on foods purchased from stores. My family was more rural. We have very different food choices that never came together, even though we’ve been together for almost 20 years now. Our tastes are so different. That is why it’s essential to establish healthy food habits early, because food habits are formed early and stay with you for life. Of course, new habits can be formed, but I think the relationship we have with food is more than just a habit, like trying to wake up early. Food is much more ingrained. There are so many environmental issues and problems with lack of access to healthy food that dictate food habits for some families. That’s where school lunches are even more critical, because they provide healthy fare that includes fruits and vegetables.

What are a few of the innovative methods that school systems have used to reduce childhood obesity?

School lunchrooms reach millions of kids every day. Some of these children might not have access to fruits and vegetables at home due to family resources and social and environmental conditions. But school lunchrooms do, and it’s so important that what’s provided in the school lunchroom is eaten. One of the issues we found is that although the 2010 Healthy and Hunger-Free Kids Act increased the availability of fresh fruits and vegetables in school lunchrooms, what was available was not always eaten. I saw it firsthand when I collected data in school lunchrooms. You see overweight and obese children throw away fruits and vegetables.

Something that has happened in the most recent decade is the smarter lunchroom movement. Part of my research identifies easy, low-cost methods to change the presentation of food in lunchrooms using behavioral economics, which encompasses both economics and psychology. Our goal is to find strategies that change lunchroom environments, making healthy food selection an easy decision. Thousands of schools now use smarter lunchroom design. But it’s not like kids start eating healthy today, and the impact on weight and health is observable the next day—it’s a process. Hopefully, the generation that is growing up in school lunchrooms today, compared to the previous generation, has a healthy relationship with fruits and vegetables.

What has led to an increase in obesity in recent decades?

It’s our lifestyle. If we want to be physically active, we have to take the time to be physically active. Otherwise, we could pass the day by hardly taking any steps. For example, we park in our garage, walk to the office and sit at our desk until we go home. That’s about it. Even for some jobs that might require physical activity, it’s a lot more mechanized than in the past. That’s a good thing, but if we want to be physically active, we have to separate out the time. Also, food that is high in calories and less nutritious is widely available. I love food, and it’s difficult to eat less. It’s the environment we live in. We call it an obesogenic environment, where we have a high availability of high-calorie, low-nutrient food. All of the advancement that we have made in today’s world is one of the main reasons for an increase in obesity.

Do you think people are becoming more health-conscious?

A lot of new markets are coming up for places you can go to work out and improve physical fitness. Considering how much we know about the risk factors associated with obesity, I am optimistic that more and more of us will become aware and start practicing healthy lifestyle choices. But the biggest challenge is that we will see this happen only where money, resources and time are available. There are areas where physical activity opportunities are not available, where it’s not safe to walk outside, where healthy food is still not available. There may be playgrounds, but one might not feel safe there. Overall, I think some people are becoming more aware, but I’m concerned about areas that might not have access and resources available to make that change. That is where policy should continue focusing.

How are policymakers trying to curb the obesity epidemic?

There are so many policies in place that hope to improve school lunchrooms and require schools to implement physical activity. The way the food industry gets by with promoting unhealthy food is by informing consumers and leaving them to make their own choices. How do we work around that? There are taxation policies in states and discussions around how to implement better nutrition with federally funded food safety nets, like the Supplemental Nutrition Assistance Program. Right now, 60% of the U.S. is overweight or obese. There’s still a lot of effort needed for changing lifestyles and improving access to healthy food, but changing behavior is not an easy task. I’m optimistic we will see changes, but a lot more work is needed.

-Tyler Wilkins

Originally published in UGA Research’s online magazine.

Posted on July 13, 2020