Malnutrition and McDonald's

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					Case Study
Fizz, Fat, and Fast Food
Kristi Martinez, Eastlake High School
July 2009

Unit Context/Prior Knowledge
This case is a fictional story based on current statistics and public policy based on obesity rates and
public health. This case is aimed at engaging students in an introductory unit about biological
macromolecules and their implications for human nutrition and health. Some essential questions that
can be investigated through this case include:
     How does the human body benefit from a healthy diet?
     What are some consequences of eating an unhealthy diet?
     Is it possible to have reliable access to large quantities of food and still be malnourished?

Case Study
          It was September 1, 2009 and Annie was so excited! It was her first day as a sophomore at
Eastlake High School. She started the day like every other sophomore at the school, first meeting in
homeroom and attending her first class of the day. Then came lunch where Annie met up with several
friends from junior high, some of whom she hadn’t seen since June. Since they were only sophomores
and couldn’t go off campus to eat at McDonald’s, Taco Time, or Starbucks, they decided on the coolest
option possible for lunch – the EHS Student Store.
          Annie’s friend Jen noticed her favorite snacks right away and bought some Gummi bears, a bag
of Gardetto’s and a Snapple for lunch. Billy, another student in the group was excited to see that the
student store had fresh Pizza Bagels and cream cheese. With his lunch he had an Odwalla Chocolate
Protein Monster to drink. Annie, on the other hand, was disappointed.
          “I’d like a can of Coke, please” asked Annie.
          “Sorry,” said the senior working at the student store, “we only have diet Coke.” When Annie
tried to order a different kind of regular soda, she was told that the schools were only allowed to carry
diet sodas, juices and sports drinks. When she asked why, the senior only replied “I don’t know.”
          Frustrated and curious, Annie wanted to get to the bottom of the issue. Puzzling over who to
ask, she noticed that her next class of the day was Biology. “I bet my Biology teacher, Ms. Istirk will
know.” thought Annie. At the end of class Annie asked her teacher “Why doesn’t the student store sell
regular Coke?” Thankfully, Ms. Istirk had an explanation.
          Since 1985, doctors have been concerned about the rising rates of obesity in both adult and kids
in the United States. In 1980, the adult obesity rate was only 15%, but by 2009 the rate had increased to
over 34%1. That means that about every one in every three Americans is considered obese. Doctors
estimate that in 2009, 1 in every 3 American children is obese. According to the U.S. Centers for Disease
Control and Prevention, obesity is measured in adults by something called the Body Mass Index, or BMI.
It’s a ratio that compares the weight of an individual to their height which for most people relates
directly with their amount of body fat. To be considered obese by doctors, adults must have a BMI of
over 30. For comparison, people with a BMI between 25 and 29.9 are considered overweight.2
          “I agree that people in other states are getting fatter, Ms. Istirk, but we’re not like that in
Washington!” cried Annie.
          “Unfortunately, Annie, the data contradicts with this idea.” said Ms. Istirk. Her teacher went on
to explain that in Washington, approximately 22% of adults in were obese, while about 36% of the
population was considered overweight by medical and public health professionals in 20043. Annie also
learned that in an early effort to increase the health of its citizens, King County Board of Health decided
to ban the use of artificial trans fats from cooking processes in all businesses that hold a food permit in
July 20074. This ban included restaurants, schools, and hospitals. However, King County was the only one
in the state to take action.
         Based on everything that Annie had learned about trans fats in her science classes, she thought
for sure that this ban would have produced a positive effect. She decided to do some research on her
own at home that night, but she found that obesity rates were still on the rise in Washington State. By
2009, the rate in adults had increased for the third year in a row! The rate was now at 25% for adults,
which was the 29th highest rate in the country. The numbers for 10 to 17 year olds were much the same.
In 2009, Washington had the 33rd highest obesity rate among children, with almost 30% of this
population being considered obese by medical and public health officials.
         “That’s 1 in every 3 kids!” Annie thought to herself. 1 Even still, Annie wondered why she
couldn’t buy regular soda at school. She decided to talk with Ms. Istirk some more about the issue.
         The next day before school, Annie stopped by Ms. Istirk’s room and found that Ms. Istirk had
done some research as well. Excited to learn more, Annie read through the newspaper article that Ms.
Istirk had found. Apparently,
Annie couldn’t buy a Coke from the student store because in 2006, the American Beverage Association
agreed to stop selling most types of sodas to all public schools in the United States. “This is really the
beginning of a major effort to modify childhood obesity at the level of school systems,” said the
president of the American Heart Association.5 Annie also read that the president and CEO of the
American Beverage Association thought the general public would support the agreement “because it
just makes sense”.4
         “But Ms. Istirk, didn’t you explain in class yesterday that a strong argument needs to be justified
with facts and data?” asked Annie.
         “Yes, Annie, that’s great thinking. While the president of the American Beverage Association
doesn’t do a good job of supporting their argument, there are others that have some thoughtful reasons
to support banning the sale of sodas in schools.” said Ms. Istirk.
         When Annie asked what those reasons were, Ms. Istirk went on to explain that today Americans
are eating fewer fresh fruits and vegetables and are instead are eating more sugars and fats and getting
less exercise.1, 6 Ms Istirk also said that some researchers think Americans have a “Health Halo” when it
comes to food.7 In other words, Americans are convinced that eating certain foods are healthy, but
really they’re not because Americans often eat more than one serving at a time and then misjudge the
number of calories in their food. Another article Ms. Istirk found said that “people who eat at
McDonald’s know their sins, but people at Subway think that a 1,000 calorie sandwich has only 500
calories.”5 Finally, Ms. Istirk went on to explain that Washington State officials have been concerned
about the economic depression and how families with less income will be able to pay for food if food
prices rise by the predicted 5% in 2009 alone8.Typically when income is reduced, families turn to lower-
cost food items. Unfortunately these items often have lower nutritional value than fresh fruits and
vegetables, lean proteins and whole grains. Annie thought long and hard about all Ms. Istirk had to say.
         After a long time deliberating, Annie said “While your research brought up some very good
points, Ms. Istirk isn’t it the responsibility of the people themselves to learn eat healthy and then take
action? It just doesn’t seem fair that I can’t decide what I’d like to drink for myself.”
         “You make a very good point, Annie. If you’re worried about not being able to buy soda at
school, there is another issue that you may want to consider. I’ve heard that some in Washington think
that all children under the age of 18 should be banned from eating at fast food restaurants as a way to
reduce obesity. What do you think?” asked Ms. Istirk.

Ethical Question to Consider: Should the Washington State Department of Health ban individuals under
the age of 18 from eating at fast food restaurants as a strategy for reducing the number of children who
are obese and overweight?
    Levi, Jeffery, et al. (2009) “F as in Fat: How Obesity Policies are Failing America.” Trust for America’s Health.
              15 July 2009 <>.
    “Defining Overweight and Obesity” U.S. Centers for Disease Control and Prevention. 28 May 2009. Retrieved 16 July 2009
    “King County Profile of Behavioral Risks” (2004) Washington State Department
            of Health. 15 July 2009 <>.
    “Trans Fat and Nutrition Labeling in King County.” Public Health – Seattle and King County. 10 July 2009. Retrieved 15 July 2009

    “Soda Sellers Agree to Stop Most Sales to Schools.” The Seattle Times. 3 May
           2006. Retrieved 15 July 2009 <>.

 Dixon, Jane, et al. “ The Health Equity Dimensions of Urban Food Systems.” (2007). Journal of Urban Health: Bulletin of the New
York Academy of Medicine. 84, 1: i118-i128.
 Tierney, John. “Health Halo Can Hide the Calories.” The New York Times. 2 Dec 2008. Retrieved 15 July 2009.
Ethical Analysis

Arguments for banning children from eating at fast food restaurants:
The number of overweight and obese children in America today is reaching an epidemic status. Since
1985, obesity rates have been increasing and show no indication of stopping. Parents and guardians
directly responsible for the care of children have not been able to instill healthy food habits into young
people. If the government values the health of their citizens, the government has the duty to protect
this vulnerable population within our society. Additionally, this argument upholds the value of justice in
that all children are experiencing the same regulations instead of discriminating against overweight and
obese children by subjecting them to special restrictions. This argument upholds the principles of
beneficence and justice.

From a consequentialist or outcomes based perspective, the benefits of banning children from fast food
restaurants outweigh the potential harms. The health of almost 2/3 of children would improve as the
number of obese and overweight children decrease, which would in turn lessen incidences of diseases
like Type II Diabetes in children. Eventually this would decrease the burden on the public health care
system which would benefit other unwell citizens in particular and the rest of the population in general.
There would also likely be a positive secondary effect on many members of the adult population. If
children are no longer able to eat at fast food restaurants, parents will necessarily seek out other
sources of nutrition for themselves as well as their children. This could in turn result in a decrease in
adult obesity and overweigh rates as well.

Arguments against banning children from eating at fast food restaurants:
Individuals in society need to consider the implications of banning children from eating at fast food
restaurants if the values of independence, self-control, and personal happiness are important.
Mandating where people can eat impinges on the principle of autonomy by not respecting an
individual’s right to exert self-control over their food choices. Although the children are between the
ages of 10 and 17, it is important for them to have the opportunity to learn how to make choices from
themselves. These choices should be guided by parents, guardians, and medical professionals instead of
being mandated by the state.

     Provide students with an opportunity to analyze graphical data by providing them with graphs of
        the obesity rates in the United States between 1985 and 2008. This may be a good way of
        helping students brainstorm possible solutions to the ethical dilemma.

Additional Resources
Stone Lombardi, Kate. “Does that Trans-Fat Ban Grease a Slippery Slope?” NY Times. 27 Jan 2008.
Retrieved 15 July 2009.

“The Science of Energy Balance” NIH Curriculum Supplement aimed at Grades 7 and 8.

“U.S. Obesity Trends 1985-2008.” Center for Disease Control and Prevention.

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