Childhood obesity is the pandemic of all pandemics. It will likely be the number one health crisis we will face as a society in our lifetime. As obesity continues to take a firm hold on society, governments, researchers and the food and pharmaceutical industries are under growing pressure to tackle the issue.
The Childhood Obesity Pandemic
Recent studies on human life expectancy have projected that because of the obesity pandemic today's generation of children will be the first group to die younger than their parents. In fact, the New England Journal of Medicine reported in its March 2005 issue that the rapid increases in childhood and adolescent obesity could shorten the future American lifespan by two to five years.
In addition, the economic impact of obesity has placed a heavy burden on the U.S. healthcare industry. The U.S. Centers for Disease Control and Prevention (CDC), Washington, D.C., estimated that obesity-related medical costs totaled $117 billion in 2000 nationwide. Other health experts put the figure closer to $135 billion. This is likely because people who are overweight use nearly 40% more healthcare resources and twice as many pharmaceuticals than individuals without weight problems. CDC data also say obese people experience 49% more inpatient hospital days, resulting in 36% higher costs to their healthcare plans. In California, for example, the state's overweight and obese adults-more than half the state's population-cost it over $21 billion in 2000. That number is expected to reach $28 billion this year, a 29% increase in just five years. This trend data is reflective of the entire nation.
While the U.S. is leading the way, the childhood obesity epidemic is not just an American problem; it is affecting the global population-some even refer to the problem as "globesity". At least 155 million school-age children worldwide are overweight or obese, according to the latest estimates from the International Obesity Task Force (IOTF), which is part of the International Association for the Study of Obesity (IASO), London, U.K. The IOTF's report, "Obesity in Children and Young People: A Crisis in Public Health," says approximately 30-45 million children are classified as obese, which translates to 3% of the world's children aged 5 to 17. A further 22 million children under the age of five are also affected.
Childhood obesity comes with various undesirable health effects, such as reduced lung and alveolar capacity, poor metabolism leading to growth and developmental disorders, reduced physical activity, which can lead to reduced bone mass and joint problems, type 2 diabetes, hypertension and cancer, according to Dr. Richard Visser, founder and CEO, SimplyH, Los Angeles, CA, "Children today are being diagnosed at an alarming rate with conditions that once only affected adults," he said. "These health issues will not only impact our children, but the state of public health as a whole."
There is no doubt that poor nutritional choices are contributing to trends in childhood obesity. Calorie intakes have increased across the board, as portion sizes grow larger and snacking, sugary drinks and eating out become more common. A study presented at the Experimental Biology conference in April found that no other single food provides more calories to a teenager's diet than sodas and fruit drinks. In all, these sweet drinks provide about 13% of a teenager's total calories-more than cakes, cookies and other sugary foods. Sodas and fruit drinks are also the single leading source of added sugars in a teen's diet, providing more than half of all added sugars they consume.
Changes in lifestyle over the last two decades are also contributing to rising childhood obesity rates. Kids on average today are less active, spend more time in front of the TV and computer and are less likely to play sports. Indeed, children have clearly adapted to a more "plugged-in" lifestyle with all the latest electronic media calling for their attention daily, including iPODS, video games and cell phones. A report released by the Kaiser Family Foundation, Washington, D.C., on the role media plays in childhood obesity claims the majority of scientific research indicates that children who spend the most time with media are most likely to be overweight.
Starting Off on the Right Foot: Infant & Toddler Nutrition
The most effective long-term approach to fighting the childhood obesity epidemic is prevention. This means delivering the right nutrition to children from the time they are infants and toddlers.
While breast-feeding is regarded as the best way to feed infants, if formula is used it should be supplemented with DHA (docosahexaenoic acid) and ARA (arachidonic acid) because they significantly benefit infant development, according to two new studies. Both studies used Enfamil Lipil infant formula from Mead Johnson Nutritionals, Evansville, IN, which contains DHA and ARA from Martek Biosciences Corporation, Columbia, MD, at levels similar to median worldwide amounts reported for breast milk (0.36% DHA and 0.72% ARA of total fatty acids).
The one study, published in the April 2005 issue of the American Journal of Clinical Nutrition, found that term infants fed infant formula supplemented with DHA and ARA during the first year of life demonstrated clear differences in visual function. The other study, published in the April 2005 issue of The Journal of Pediatrics, found that infant formula supplemented with DHA and ARA resulted in enhanced growth and higher mental and psychomotor development scores in preterm infants.
Henry Linsert, chairman and CEO of Martek, said these findings further support the importance of DHA and ARA in infant development. "Parents can make sure infants receive an adequate amount of these nutrients by selecting an infant formula with sufficient levels of DHA and ARA. In addition, women who are breast-feeding can take a DHA dietary supplement to ensure adequate levels of DHA in their breast milk," he offered. "This is particularly important because pregnant and nursing women in the U.S. do not typically receive enough DHA through their diets to pass on the necessary amount to their developing infants."
When children reach the toddler stage of development, and mothers have stopped breast-feeding, they are usually fed soy- or milk-based nutritional drinks. However, SimplyH's Dr. Visser says the issue of allergic reactions among kids to both of these ingredients has become an issue. Dr. Visser's work with University of Minnesota affiliates led to the development and recent launch of Toddler Health, the first rice- and oat-based nutritional drink mix for children 13 months to five years of age. The drink delivers essential vitamins, minerals, protein, immune boosters, antioxidants, prebiotics, probiotics, fiber, phytonutrients and DHA to a toddler's diet. "The reason we came up with this product was because we felt there was a hole in the market," said Dr. Visser. "After age one, when babies normally stop breast-feeding, there were no alternatives to soy- and milk-based products for kids."
Nutraceuticals for Children's Health
The USDA has taken steps to stave off the obesity epidemic through the release of the 2005 Dietary Guidelines and the newly revised Food Guide Pyramid, which is now referred to as MyPyramid. The new system was developed to motivate and educate consumers to make positive diet and lifestyle choices. In the 2005 Dietary Guidelines, USDA reported that many children do not obtain adequate amounts of calcium, potassium, fiber, magnesium and vitamins A, C and E. This offers an opportunity for nutraceutical manufacturers to step and fill that void.
Discussing the importance of supplementing with a multivitamin to compensate for children's nutritional deficiencies was Jim Studer, vice president of sales and marketing, Hero Nutritional Products, San Clemente, CA, makers of Yummi Bears and Yummi Blast children's multivitamin supplements. "Children are notoriously picky eaters and their diets are generally high in processed foods and low in fruits and vegetables," he said. "Therefore, they are likely not getting all the nutrients, vitamins and minerals they need to grow up strong and healthy. Supplements, such as Yummi Bears, offer a fun way for children to receive the nutrients they need daily and help them avoid health-related issues that can stem from vitamin deficiency."
Highlighting some of the most common chronic health conditions affecting children today was licensed naturopathic doctor Mark Stengler, vice president and medical director, Life Solutions Natural Products, Vista, CA, makers of Liquid Children's Super MultiVitamins and Minerals supplement. "Parents bring kids to my clinic mostly for chronic health problems such as eczema, asthma, attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD) and allergies," he said, adding, "We have been pretty successful in improving or alleviating these chronic health problems with natural treatments, which include diet modification and supplementation."
In the realm of herbals, U.S. and Austrian researchers recently produced data that indicate they are effective in children. In particular, researchers at the University of Illinois, Chicago, and Karl-Franzens-Universitaet in Graz, Austria, found the herbal supplement Andrographis paniculata reduced colds by 70%, but only if taken for at least two months. Other studies showed that it might reduce upper respiratory infections.
The researchers said data also support the belief that evening primrose oil supplements improve dermatitis in children and help hyperactive kids to focus on the task in front of them. Another study found that taking valerian nightly for two weeks improved sleep length and quality in hyperactive boys. Cough tablets made with dried ivy leaf also eased chronic bronchitis in children, so much so that one-third of kids taking the supplement stopped exhibiting bronchitis symptoms.
According to research published in the Journal of the American College of Nutrition last year, children who have ADHD may benefit from supplements containing magnesium and vitamin B6. Magnesium deficiency has previously been reported in children with ADHD and supplementing with the mineral has been shown to decrease hyperactivity. At conclusion of the study, significant improvements were seen among all participants with hyper-excitability symptoms.
In the area of asthma, a recent clinical study found children and teenagers with mild to moderate asthma, which supplemented with French maritime pine bark extract Pycnogenol, experienced improvement in pulmonary function and a significant decrease in asthma symptoms. The double-blind, placebo-controlled study included 60 children six to 18 years old and was published in the November/December issue of the Journal of Asthma. It found that those supplementing with Pycnogenol were able to significantly reduce or discontinue use of rescue inhalers more often than those taking a placebo.
Trends in the Children's Nutraceutical Market
The childhood obesity debate has raised the profile of kid's nutrition in general, causing major food companies like Kraft, General Mills, Pepsi and Coca-Cola to add a broader variety of nutritious products to their portfolios. This climate has also created a ripe environment for the children's nutraceutical market, which is predicted to experience myriad growth opportunities. In fact, Euromonitor International, Chicago, IL, says child-specific supplements are one of the few growth areas in mature supplement markets such as the U.K. The market research firm forecasts that vitamins and dietary supplements for children will grow 19% between 2003 and 2008 to reach €28 million in 2008. This compares to overall growth in vitamins and dietary supplements of just over 1%.
According to Hero's Mr. Studer, children's supplementation is more about delivery systems and not so much about what is being delivered. "There are some really unique concepts coming out. Initially the trend breaker was going from a chewable product to a gummy product," he said. "The major challenge we face is taste. When marketing to kids you have to appeal to both parents and children. The kids can push Mom to a point but Mom has to feel good about buying a product and our focus groups indicate that mothers will purchase a product based on what they think is best for the child, while the child will go strictly on what looks fun and tastes good. The challenge is to develop products that fit somewhere in between."
Life Solutions' Dr. Stengler believes one of the reasons the children's market is growing rapidly is because adults are more comfortable using supplements themselves. As a result, they are more comfortable giving them to their children. He said the challenges the children's nutraceutical market faces moving forward is continuing to develop delivery systems that are acceptable to kids. "With capsules and tablets there are always going to be swallowing issues for younger children, which is why liquid supplements are on the rise, but here taste is a very big issue," he explained, adding, "Kids will not take something if it doesn't taste good."
On the heels of the new dietary guidelines, which clearly communicate the need for increased fruit consumption, as well as the need for dietary supplements where daily intake is not sufficient in certain nutrients, Pharmachem, Kearny, NJ, has developed a technology to fill these gaps by launching its newest endeavor-FruitCare. This is a patent-pending nutritional technology that uses real fruit to deliver nutrients and other actives for human ingestion. Pharmachem's FruityVites product is the only daily multivitamin made with real fruit. It is also the first commercially available product utilizing FruitCare technology. "Fruit is incredibly underutilized in terms of its resources for nutrients," said Gregory Drew, who heads the Kids' Health & Nutrition group at Pharmachem. "From our FruitCare technology we're developing many different delivery vehicles in various sizes and shapes that are fruit-based." In the future, he says there will likely be several technologies that revolve around fruit.
In other delivery technology developments, Israel-based Biodar has developed CapsuDar SR-gel-free microencapsulated vitamins and minerals and herbs uniquely coated to achieve a slow release effect. Designed to resolve taste issues for companies making mineral supplements and fortified foods, and especially suitable for chewable products such as gums and sweets geared toward children, CapsuDar is a coating derived from palm oil that resists the grinding and chewing forces in the mouth so that consumers do not taste the minerals in a gum or tablet. The active ingredients then pass to the stomach or intestine where they can be absorbed by the body.
According to Paul Flowerman, president, P.L. Thomas, Morristown, NJ, Biodar's North American representative for CapsuDar products in foods and chewables, this technology helps products leap the taste hurdle, which is the toughest obstacle when marketing to children. "Children have a much more sensitive palate than adults," he said. "It is critically important to fully understand the consumer in the children's market because it is much easier for a product to flop."
Taking the Fight to the Schoolyard
Parents and industry associations are fighting an uphill battle against multimillion dollar advertising campaigns targeted toward kids that market candy, soda and fast food with the help of popular TV and movie characters like SpongeBob and Scooby-Doo. Consequently, efforts are underway throughout the country to regain control of school cafeterias and vending machines.
For example, The Perkins School for the Blind, Watertown, CT, is participating in a taste test sponsored by Stonyfield Farms, Londonderry, NH. The products are being tested for the school's new vending machine, which will come compliments of Stonyfield's Health Vending Machines program, initiated by the company in 2003 in response to the increase in obesity among school-age children. Stonyfield loans schools machines stocked with snacks that meet specific nutritional guidelines. Gary Hirshberg, president of Stonyfield Farm, believes this is an ideal avenue for getting healthier foods into schools.
In the U.K., according to Stephanie French, director of Harlequin Plus Ltd, a U.K-based consultancy specializing in food and nutrition marketing and related new product development, celebrity chef Jamie Oliver recently participated in a television series called School Dinners in which he highlighted the junk food being served to children in both elementary and high school. His solution was to show people how healthy food can be freshly prepared on a low budget. "As a result, the U.K. government has committed significantly more funds to support an improvement in meal quality. Additionally, parents have become much more aware of how the food children eat can affect their concentration and performance levels in school," Ms. French said. "This interest can only serve to increase general interest in functional food and nutritional supplements for kids, and will be a key driving force in the coming months."
Last year, ADM, Decatur, IL, collaborated with researchers from the Illinois Center for Soy Foods at the University of Illinois in a project called ISoy, the objective of which was to introduce soy-enhanced foods into school lunch programs in order to make school lunches healthier.
According to Mark Merryfield, business manager for Soyfoods at ADM, the nutritional quality of school lunches can improve by incorporating soy alternatives because they will help lower the fat, calorie and cholesterol content of foods. "The biggest hurdles to implementing this type of program are cost and taste," he said. "School systems need to have the funding to be able to support such a program and the products have to taste good in order for the kids to eat them. Our data indicate that kids are just as accepting of soy-based alternatives as their regular meals."
Going into further detail, Mr. Merryfield said, "Education is vital in successfully implementing healthier school lunch programs. Parents and students need to understand why these food products are healthier and more beneficial. Everybody from the national level down to the district level needs to look at the current commodity programs and school lunch menus offered in schools in order to become educated about the benefits of switching programs."
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