A generation at risk. An epidemic in full swing. A parent’s call to action.
It’s not hard to size up the scope of the childhood-obesity problem. Just look around – your neighborhood, the mall, a school, maybe even your own dining room! – and you’ll quickly spot a child who’s overweight or obese. In fact, chances are good you’ll see several overweight kids. Over the past several years, their numbers have ballooned to an astounding one in four. You can be certain that, especially in these thin-obsessive times, these kids have already heard plenty of cruel teasing. But that’s not nearly the worst part of this sad epidemic: Obesity greatly increases a child’s risk of diabetes, heart and liver disease, arthritis, asthma and bone problems. According to a report published in the Journal of the American Medical Association, it also makes them five times more likely to have a poorer health-related quality of life than healthy kids. In fact, the report asserts, obesity reduces their quality of life to that of a cancer patient undergoing chemotherapy.
Tragically, an obese child who doesn’t get the chance to change will likely join the 280,000 Americans who die prematurely each year from obesity complications. Dr. David Ludwig, who has seen a growing number of obese children in his pediatric obesity clinic at Boston Children’s Hospital, puts it this way: “Obesity is by far the single most serious medical problem facing children today.”
On the other hand, it’s not hard to find the heartening side of the story, either. When families calmly face up to the reality of a child whose weight is simply not healthy, there’s plenty they can begin doing to undo the damage. It could be as easy as skipping one soft drink daily (drinking one 20-ounce soda each day can add 26 pounds year) or taking a 10-minute after-dinner stroll (just 2,000 steps a day can shed a pound a year). There’s a wealth of other sensible tactics that families can adopt, ranging from step-by-step books packed with kid-friendly recipes and exercise motivators to reshaped eating philosophies that help kids reclaim the pleasure of eating, while also knowing when to stop. The bottom line is this: Families must begin by doing something – anything – to not only forestall serious health problems but to instill crucial health practices that last long after the child leaves home.
However you look at the problem, one fact is indisputable: Moms and dads need to fight this fight for their children. Government agencies and health advocacy groups are creating some inspiring anti-obesity programs for schools and communities, but unfortunately, they’re not widespread enough to reach most kids.
Of course, those resources could expand if the collective will existed to force change. When our nation poured millions into smoking-reduction efforts, we saw smoking rates take a dive, notes Kelly Brownell, head of the Center for Eating and Weight Disorders at Yale University. If we banned Joe Camel because of his effects on impressionable kids, he asks, why not ban the dean of fast food, the ubiquitous Ronald McDonald?
Unfortunately, even Brownell acknowledges that such a possibility is years away. In the meantime, families must begin to work on their own. Besides, that’s the most effective tactic. “A child’s success rate is highest when the family is the most supportive and involved,” reports research psychologist T. Kristian von Almen. Von Almen has studied and counseled hundreds of obese children and co-authored Trim Kids (HarperCollins, 2001), a book that outlines the successful anti-obesity approach he and other experts helped develop for one of the first pediatric weight-management clinics in the nation.
As parents, he says, we need to educate ourselves and our children about the formidable forces that have conspired to produce the fattest children in our nation’s history. Top of the list: food- and drink-makers who spend millions plotting how to convince impressionable kids to beg for (or sneak) ever-more fatty, sugary, fried and processed junk food. Ditto for makers of computer and video games, TV shows and movies who profit bigtime by luring kids away from running outdoors to stare at screens for countless hours a day. Parents need to talk tough to schools that serve our kids grossly unhealthy cafeteria foods pushed by agribusiness interests and that surround them with junk food ads and soda machines that earn schools big bucks from big corporations.
We need to fend off pharmaceutical firms licking their chops over runaway child obesity – they’re already pushing weight-loss pills with serious side effects to young kids and teens. We also need more information and accountability about “endocrine disrupter” chemicals that have been linked to obesity in lab animals.
Finally, we all need to demand changes that will revive safe, inviting spaces for kids to play in their own neighborhoods, as well as city planning that makes streets, paths and services for walking and biking more accessible.
On the other hand, we also need to take a good hard look at ourselves. There’s no question that the rat race we’ve set up for both ourselves and our children is a significant cause of obesity.
Modeling Maximum Density
When kids run from school to enrichment class to sports practice (and, oh yeah, there’s homework), there’s no time for relaxed, healthy family dinners – only a rushed drive-through or microwaved processed food.
When we let them zone out in front of the TV or computer instead of taking a family walk together, we’re the ones responsible for atrophied muscles and sloggy heart and lung capacities. When we give in to their nagging for nutritionally horrendous food just because we don’t want to argue with them (after all, food’s not really bad stuff like alcohol or drugs or cigarettes, right?), we’re not-so-subtly telling them that this aspect of health just isn’t that important.
When you think how often many of us model bad food behaviors without realizing it – using food as a reward or substitute for unfulfilled needs, viewing certain foods as escape routes or sworn enemies – it’s no wonder our kids pick up on our tricks. As parents, we hold the keys to family life, and we are by far the most powerful examples our kids consider when making decisions about how they want to run their lives. If we want them to view food and exercise in healthy, positive ways, we must make the changes that illuminate that attitude in ourselves.
It’s not just parents who need to gird for battle. As a society, we’re all paying for obesity-related health problems that ring up an estimated $17 billion yearly in increased insurance premiums and taxes. Yes, your insurance rates are higher because of someone else’s weight problem, and as the young generation of obese kids ages, you can expect those costs to rise.
We’re also hindering our future by letting obesity han-dicap this generation, which will soon take over the social and political reins. Think about the many ways that preventing kids from realizing their full potential could affect future generations, too. And whereas all health problems are sad, isn’t it particularly regrettable that so many otherwise healthy children are being burdened – and from such an early age – by a totally preventable health condition?
Take a Lesson
We can allow recent history to teach us a few things. Think back a dozen years and remember that junk food was a relative rarity, kids played outdoors for hours, and the obesity rate was a fraction of what it is now. We can’t turn back time, but we can invite the best parts of that reality back into our lives simply by following this six-step short course that you can start implementing today with a child you love.
1. Reality check. It may sound odd, but sometimes families with clearly obese kids are surprisingly slow to acknowledge the problem, say experts. This is a particularly common scenario among parents who are overweight or obese themselves – after all, how can they ask their kid to change if they’re not willing or ready to? Other parents fear that calling attention to an obese or overweight child’s size will hurt their feelings. That response may have its roots in an otherwise beneficial trend toward “body acceptance,” the notion that since few of us meet the unrealistic, stick-thin-supermodel build glorified in our culture, we should accept and love our bodies that aren’t magazine perfect. But denial of an obvious problem only confuses overweight kids who can clearly see and feel that their size is problematic.
If you are having trouble understanding a weight problem in your own family, look beyond food, experts suggest: Parents with overweight kids often use food too much as an easy, convenient way of expressing emotions – to give comfort, to assuage parental guilt, or to reward behavior. Pressed for family time, they don’t want to spend it arguing with kids about weight and food.
Other parents pooh-pooh obesity by blaming genetics, as in “our family has always run big.” While it’s true that genetics does play a role – few kids will turn out to be tall and thin if the folks in the family tree tend toward stocky and short – a thorough check of the extended family is unlikely to show uniform obesity that began in childhood.
Some parents also believe that large kids will “grow out of it,” even though most experts agree that if they haven’t by age eight or so, they probably won’t.
Worst of all, as obesity begins, there are no obvious side effects. “The price tag isn’t high enough for parents to take action,” says von Almen. “People in hospitals see the effects – in kids who die in their sleep because their weight presses down on their lungs or when limbs are amputated or blindness sets in because of diabetes. But most parents don’t want to think about that.”
The bottom line, he notes, is that it just shouldn’t be hard for parents (who know a child better than anyone) to honestly assess whether their child has grown larger than he or she should be. (For an approximate gauge, you can check your child’s BMI at http://public.bcm.tmc.edu/cnrc/consumer/nyc/vol1_03/bmi_calculator.htm, but defer to your pediatrician or healthcare professional if you still feel unsure.)
Ultimately, the challenge is for parents to face the facts without getting bogged down – either in guilt that they’ve “allowed” their child to get fat, or in frustration and resentment toward the child himself for becoming overweight. After all, what child would feel motivated to get on board for a health-improvement plan when his parents see the problem as “all his fault”?
Instead of getting hung up in assigning blame or interpreting the significance of excess weight, parents need to acknowledge the basic reality that their child is currently experiencing an unhealthy and dangerous condition. Furthermore, this condition is likely dependent on a variety of physical, environmental and emotional factors. When the entire issue is framed in a whole-person context, and as a matter of basic good health and life experience, it’s much easier to abandon the notion that a large child and/or his parents have had some kind of moral failure. It’s also much easier to make an accurate assessment of the situation – and the solutions.
In developing their strategies, moms and dads will need to think far wider than tweaking a few food and exercise practices. As anyone who has given any serious attention to health issues knows, health is greatly influenced by the physical and emotional structure and patterns of our lives. Parents must spend some time exploring the likely reasons that their child has gained too much weight. What are this child’s weak spots and challenges? Are they OD’ing on junk food? Addicted to Gameboy? Stressed out and using food for comfort? Modeling inappropriate or inconsistent parental eating habits?
If we want to start cooking more healthy family meals, for example, we’ll need to carve out time for shopping and cooking, not to mention time for a satisfying leisurely dining experience.
For an overscheduled child and chauffeur parent, that may mean giving up an extracurricular activity or two. If drive-through dining is the result of parents too overworked and stressed to do anything else, brainstorm about ways to address that problem. Maybe it’s time to push for a more equitable workload at work, or simply resolve to leave work stresses behind at the workplace.
Freeing up time to get everyone moving his or her body means changing family habits, too. If parents want Junior to ride his bike after supper, there’s nothing more motivating than to have the rest of the family abandon the TV and join in!
Sure, this will mean rearranging and reprioritizing some segments of your life. But remember, obesity IS a legitimate health problem, just like the diabetes or heart and bone problems that may well result from it. If your child needed extra time and attention for any other physical or mental ailment, you’d respond. If your kid was suffering from alcohol or drug problems, you’d get on the stick, pronto. Do the same for excess weight and impending (or existing) obesity.
Whatever the parental plan is, it’s very important that parents come to an agreement about the best overall course of action. Unless a clear, unified and consistent plan is reinforced by both parents, the message is apt to disintegrate into disagreements between parent and parent, and parent and kid.
When you’re pitching the game plan to your overweight child, be sure to stress the positives. Encourage him to actively visualize and describe that brighter future and help him get invested in the outcomes. Perhaps for your child, it looks like an end to teasing, being able to participate in active games, or having more clothing choices at the store.
Don’t forget important intangibles. “Children as well as adults are really exhilarated when they are able to feel competent and in control,” says von Almen. When he counseled at the Louisiana State University Health Sciences Center Pediatric Weight Management Program, graduates often told him that “what you really taught me was how to deal with a difficult situation and be able to manage life.” That confidence, he says, typically inspired kids to tackle other challenges as well.
2. Family plan. The more the family supports and partakes in a healthy weight-management campaign, the higher the chances the effort will be successful. In contrast, if the large kid is singled out for broccoli and jogging while the others munch Mars bars, the program is likely doomed. For complaining normal-weight siblings or spouses, von Almen has this response: “Just because a kid or a grownup is skinny doesn’t mean they’re healthy. Thin people have heart attacks, too.”
Stats tell us that only 3 percent of us meet the Food Guide Pyramid recommendations, and less than a third of us exercise the weekly minimums suggested. It’s pretty rare to find a family who couldn’t use some improvement in healthy eating and exercising, as well as stress reduction and a saner pace. Sure, the larger kid will likely have much higher motivation to do some extra work to get to a better weight faster, but everybody will ultimately benefit from eating better, moving more and collaborating toward a healthy-family solution.
Besides, emphasize the message that many favorite foods will continue to be part of an evolving diet, and that increased activity doesn’t mean hundreds of boring jumping jacks.
“Every family starts by making small changes,” notes von Almen, whose book, Trim Kids, outlines a 12-week gradual anti-obesity program. “If a family goes to fast-food places four times a week, we ask them to cut back to once or twice a week.” Similarly, enticing foods such as ice cream and potato chips don’t necessarily need to be all-out banned. As the family eases its reliance on such familiar treats, other delectable alternatives – say, fresh fruit and yogurt parfaits and a handful of nuts high in omega-3 fats – simply begin to replace the old standbys more often.
By the same token, it’s great to get kids to a pool, says von Almen, but don’t make them do laps – water play is just fine. Don’t outlaw TV, but at the commercials, everybody stands up to do a wacky dance. “The bottom line is to make it fun,” emphasizes von Almen.
There’s also a profound upside to an all-family effort that by far trumps any weight loss for the large child. “Over and over, children tell us that what they want the most is more time with their parents,” reports Betsy Taylor, author of What Kids Really Want That Money Can’t Buy (Warner Books, 2003) and founder of the Center for a New American Dream. Exactly what families do together doesn’t matter, she says: 15 minutes in the back yard throwing a ball, a nightly neighborhood stroll, anything that allows parent and child to slow down and connect.
And there’s another advantage to beefing up family bonding: It makes a child feel more emotionally “full” and satisfied, a quality that experts such as Taylor suspect is lacking in many obese children’s lives. “As children or adults, we often eat to try to fulfill unmet nonmaterial needs such as companionship, love, a sense of purpose in life,” she notes. Surely that point is familiar. When we’re absorbed in interesting pursuits and fulfilled emotionally, food reverts from its purpose of filling up holes of unhappiness and stress and instead plays the role it should: a pleasure that fuels us. As a result, we’re content to stop when we’re physically satisfied.
A final, important component of the “family plan” is investing all team members with their rights and responsibilities. First, the responsibilities. If Mom and Dad are doing all the cooking, shopping, and cleanup for healthy family meals, that’s simply not fair, and it’s not a good precedent for later life.
Even small children can be very useful assistants in food prep and preparing their own simple foods, such as sandwiches and soups. When parents invest time to tutor children from early on in basic culinary skills, by the time kids are 9, they’re able to prepare whole meals. Children take great pride in providing a family meal; plus you’ve already done your prep work in lifeskills for post-high school, along with earning the gratitude of future spouses!
In return for the team contribution, parents should brainstorm with kids about ways to make the work fun. Stock your kitchen with some good kids’ cookbooks. How about a competition, complete with prize, to see who can create the most delicious, nutritious menu for the week? A small cash award for kids who make their own school lunch and save some dough that would have gone to greasy cafeteria fare? A weekend getaway to celebrate meeting goals? Get creative.
3. Employ the ethical edge. Any parent alive has likely heard this steady refrain over the years: “It’s not faaaairr.” Kids, to their credit, are very moved by injustices, perhaps because, by dint of daily experience, they’re sensitive to attempts by bigger, more powerful creatures to intimidate smaller fry.
Parents can capitalize on this ingrained sense of ethics by steering kids’ outrage toward the food and media-industry Goliaths who repeatedly go after pint-sized Davids with endless offers and advertising. But first, we grownups have to take the time to enlighten and inform children about how the whole advertising/consumption system works.
Remember, kids see thousands of slick, clever, appealing ads each week, and generally the only commentary they hear is our monotonous, simplistic message: “Don’t eat/watch/want that crap – it’s no good for you.” Our kids need to hear much more specific and convincing arguments than that, and since they probably won’t hear it through schools or the media, it’s up to us to educate them (see Insight on page 76 of the printed version).
Any child psychologist will tell you that kids know when they’re being manipulated or patronized; they’ll also tell you that when kids are invested in a viewpoint or a project, there’s no holding them back. Observant parents also know that even preschoolers and elementary-aged children are very capable of receiving and processing seemingly complex issues when parents take the time to do the explaining. Once they know the score, it’s a good bet they’ll not only be incensed enough to resist manipulative and exploitive marketing, they may even want to take up a little activism of their own!
Here’s some ammunition on a few key issues. Modern kids like to brag that they aren’t persuaded by the ads bombarding them – notably, an annual $30 billion spent on food ads for primarily fast food, candy, snacks, and convenience foods – but study after study contradicts them.
As Eric Schlosser outlines in Fast Food Nation (Harper-Collins, 2002), ad-makers spend millions to employ legions of psychologists, anthropologists and market researchers who interview children, eavesdrop on groups of them and analyze everything from artwork to favorite books, plotting what most appeals to kids and what most incites them to convince Mom and Dad to plop down the cash. For example, many ads are carefully crafted to elicit one of seven major whines – from “persistent nags” to “pity nags.”
Another top priority for many marketers is “branding” kids from birth, brainwashing them to believe that one brand of candy, soda, burger, shoe (or whatever) is more preferable to another. The earlier the branding, the more years of sales that follow. Several European countries consider food ads aimed at kids so persuasive that they’re banned fully or partially in children’s programming.
Outline just a few details of this sell-job to your kids, and then ask them: Do you really want to be duped like this? Show them what you see, then listen to what they have to say. You can even make it a game to fight back, and to get kids to recognize when they’ve been sold.
Oregon eighth-graders did just that with classmates who tasted unmarked colas and were unable to identify their “favorite” brand. Instead of repeatedly harping about how bad soda is because of its 10 teaspoons of sugar, its diabetes-linked insulin surge, its completely artificial flavors, jitter-inducing caffeine and teeth-rotting acids, try asking your kid this: “Knowing what you know about this stuff, do you still want to pay outrageous prices (soda ingredients cost makers only pennies) to companies that use your allowance primarily to plot ways of selling you more of it (like 56 gallons a year more)?” Um, water fountain, anyone?
You might also consider filling kids in on the whole story about food and food sources – a story they’ll likely never hear unless you tell them (see Coming Home to Your Foodshed in the Sept./Oct. 2002 issue of Experience Life, or in our online archive at http://www.lifetimefitness.com/magazine/index.cfm?strWebAction=article_detail&intArticleId=75&intNewMagEditionId=7).
Kids will also be intrigued and incensed by the story behind the supersized food trend. Invite them to imagine they’ve zipped back in time to a 1950s burger joint to be served a 1.6-ounce burger, 2.6-ounce fries, and 7-ounce soda. These days, those supersized portions have morphed to 8, 7.1, and 64 ounces, respectively! Have them ponder how kids – and adults! – were perfectly satisfied with the meal 50 years ago, and explain how supersizing is a ploy for makers to spend a few more cents on larger sizes to rope in millions more bargain-crazed customers. Studies verify (duh) that portion-size growth dovetails with rising rates of obesity.
Chances are, you’re kids are already surprisingly well versed in the disturbing trends all around them, including junk-food ads showing up everywhere, from school-bus sides to math books to free computers and mandated TV news programs; soda and snack machines siphoning students from the cafeteria; lunch fare that rarely features fresh produce or nutritious, inviting entrées; PE classes abandoned for standardized test prep; and shrunken lunchtime and recess periods. Remind kids that, just like supersizing, things weren’t always so destructive, and point them (see Web Extra! link at the top of this page and No. 6 below) to folks all over the country who are fighting such unhealthy trends. When you let kids know they have options, many of them are more than willing to explore them.
4. Get a move on. Need proof that the rising rates of childhood screen-watching – now up to 21 hours a week – are linked to rising obesity rates? Just remember the last time you settled down in front of the TV with a bag of potato chips or pint of ice cream. Disappeared pretty fast, didn’t it?
When our attention isn’t focused on what we’re putting in our mouths, the ingestion rate gets out of control. That’s what motivated researchers from Stanford University’s Departments of Pediatrics and Medicine to see what happened when third- and fourth-graders were taught about being more selective TV viewers and were outfitted with home TV devices that restricted watching to seven hours per week. The researchers were pleasantly shocked when the test kids showed significant weight losses, without diet changes even mentioned – all because kids didn’t eat as often with the TV on, saw far fewer snack ads and consumed fewer snacks, and because they found more interesting and active things to do.
This heartening experiment speaks volumes about how we as parents have let down our kids. We’re the ones who’ve allowed one-fourth of 2- to 5-year-olds to have TVs in their rooms (and over two-thirds of all kids); we’re the ones outfitting their rooms with videoplayers, computers and electronic games. We’re apparently not shocked that our children spend a solid one and a half months each year staring at screens, and that snack/screen correlation has been proven over and over.
Worse, we can’t seem to control the same snack ‘n’ stare behavior in ourselves. Adult studies show the same troubling links with health-debilitating weight gains and decreased activity.
The point here is this: Just say no – to yourselves and your kids. Tell them that you understand the urge to de-stress in front of a screen, and that you aren’t proposing a ban, just a cutback. Have a screen-time shrinking contest with your kids, and you’ll all win when you use other activities to relax.
Children are sure to complain bitterly when asked to change long-held habits, but any parent knows that eventually children will find something else to do with their time – particularly if we help them. It’s wise to begin by enacting small restrictions. When they see that giving up a half-hour a day isn’t bad – and that they did indeed find an alternative – they’ll have the assurance that other small changes won’t be devastating.
A note on sports: Parents, carefully assess the big picture before signing up a chubby kid for a competitive sport for purposes of improving fitness. Most team and even individual sports for children have developed into a regimen that can require numerous hours per week in practices, games and travel to competitions. All too often, any gains gleaned from increased physical activity are counteracted by the overscheduling stress of before- and after-school practices, weekend events, and the inevitable increase in drive-through and convenience eating, as parents and kids rush around.
Besides, unless the child has above-average abilities, much of the time is spent doing nothing on the sidelines. “If a child genuinely wants to play a sport, a parent should look for something with a reasonable time commitment,” says Taylor of the Center for the New American Dream. Parents sick of the sports rat race could even organize a low-involvement sports co-op. Remember, up until recently kids typically got together to play games and sports in casual pick-up games and to enjoy flexible activities like bike riding or jump-rope. With adequate supervision, there’s no reason those modes couldn’t return.
Be creative in recognizing that ordinary life has many fitness opportunities. Leave the car parked and do errands with the kids on bike or foot. Maybe they’ll receive a “bonus” from the money you’ll save on gas? Get a cheap pedometer, and have a family competition over who racks up the most steps. And you know the usual drill – park far, not close, in parking lots; use stairs, not elevators.
Don’t second-guess kids’ preferences, either. While many kids prefer games like “hide and seek” or a hip-hoppy dance workout video inside the house to get their activity, some enjoy heading to the health club with their parents. When high schools in Illinois – one of just a few states that require daily PE – began retrofitting gyms to look like health clubs, kids unskilled or uninterested in the usual gym standards, such as basketball or track, rejoiced. They particularly embraced high-tech innovations, like heart-rate monitors, that gave them tangible ways to measure improved fitness.
5. Skip the quick fixes. Given the tendencies of many Americans to pick pill cures over preventive health practices, it’s not surprising that more children are on weight-loss drugs such as Meridia and Xenical and are undergoing stomach-stapling operations. With childhood-obesity rates projected to rise, the pharmaceutical trade publications already promoting drug use are noting gleefully that “the commercial attractiveness of the obesity market has never been greater.” But in both child and adult use, serious side effects are clear.
Meridia and other diet drugs such as stimulant-based remedies have caused heart problems resulting in many deaths. Xenical prompts embarrassing side effects such as “bowel urgency” and “oily flatus” and causes depletion of vital nutrients. Stomach stapling often loses its effectiveness as the body grows to counteract the lost stomach sections, and the eating restrictions required by the operation are severe.
6. Happy endings. Take heart. Despite some depressing stats on childhood obesity, an equally powerful truth is that families working on their own and an ever-growing proliferation of anti-obesity programs are showing great success. Perhaps the most inspirational is found in San Antonio, the city that this year won the dubious distinction of being the fattest city in America.
Health experts were alarmed a few years back that almost all the elementary school children had BMIs far in excess of the cutoff for clinical obesity and that as many as 3,000 children were at high risk of Type 2 diabetes, reports Greg Critser in his book Fat Land (Houghton Mifflin, 2003). The schools pulled out all the stops, with revamped cafeteria fare, community education, lessons integrating health-related facts, after-school programs packed with fun activities and older students guiding younger ones in better eating habits. The astonishing results: Fitness and healthy-eating scores soared, and best of all, the children involved in the program had vanquished their diabetes risk with near-normal glucose counts.
Also inspirational are moves in hundreds of cities by parents and students who’ve forced changes in unhealthy school policies, a critical step since children spend most of their waking hours in schools. Among the large and small changes are revamped unhealthy cafeteria menus, rejection of lucrative “pouring rights” contracts with soda companies that pump in money in exchange for soda machines and sales rights, and banned free or paid corporate advertising, which is mostly for junky food and drinks.
Clearly, the cultural and industrial forces that have driven childhood obesity ever higher in the last several years are powerful. There’s currently a lot of big, big money to be made selling unhealthy food, drink and entertainment to children, and this is a destructive trend that promises to be challenging for us, as parents and citizens, to turn around. But it is a challenge we must take head on, both because it is the right thing to do for our own kids, and because no child should ever die early – or even have to suffer – from a condition that’s completely preventable.
San Antonio has proven that when they’re committed and focused enough, normal everyday people can make significant, positive changes – and that those changes add up. Now that the model is there, the message is evident: When we gather together with our families and communities, anything is doable. Even undoing a nationwide epidemic.