WASHINGTON Some Indian tribes in Michigan are about to urge a return to traditional menus like wild rice and fresh fish, in hopes of fighting soaring obesity-caused diabetes.
Boston-area schools will begin teaching students why 100-percent juice is better than soda, and urging parents to limit children's TV time to two hours a day.
And a California-based managed-care company will soon let patients compete for prizes like a mountain bike or, for some, a discount on premiums if they lose weight and exercise.
Years of dire warnings about obesity's dangers don't seem to be shrinking Americans' girth. Now federal health officials hope programs that target different communities' special needs plus financial incentives like Pacificare Health Systems is about to offer will work better.
''This is the most difficult thing anybody can ever try to do, to get people to change their habits,'' says Health and Human Services Secretary Tommy Thompson.
This week, the Michigan and Boston communities become the first of about a dozen recipients of $13.6 million in federal grants to target unhealthy habits locally. The other recipients haven't been announced. It's a program poised to become the government's centerpiece in the obesity fight, if Congress grants Thompson's request for $125 million more next year to fund dozens more so-called healthier communities.
He envisions cities eventually will compete to be called the healthiest.
At the same time, Thompson wants health insurance companies to offer discount programs similar to Pacificare's, reasoning that a price break from an industry patients love to hate might be the final push some need to shape up.
Critics call those programs too soft and want the Bush administration to back some tougher solutions.
Make it easier for consumers to learn how many calories are in restaurant meals, urges Margo Wootan of the Center for Science in the Public Interest. She says people might not super-size a cheeseburger meal if its 1,600 calories were posted right on the menu.
Or, she says, put more realistic calorie counts on snacks, such as deli-sold chips and 20-ounce soft drinks, which are labeled as containing two or more servings but that most people eat all at once.
''We are looking at what we can do to help get information to people who eat out,'' responds Food and Drug Administration Commission-er Mark McClellan. He just ordered an agency task force to hunt new anti-obesity measures, from better food labels to speeding development of diet drugs.
But federal officials argue that ultimately, city-by-city involvement may prove which programs really help residents improve health habits.
Consider the Michigan project, to encompass eight Indian tribal communities, almost 43,000 people, where deaths from diabetes are six times the national average. As part of its $250,000 healthier-communities grant, tribal elders will encourage a return to more traditional foods fresh fish, berries, wild rice instead of today's processed fare. The project will measure if the diet switch is feasible and trims weight.
Boston's project covers the city's seven fattest, most sedentary neighborhoods. Schools vying for the $1.2 million grant are proposing to develop nutrition and exercise instruction for students to bring home to their families.
Then there are the insurance fitness incentives Thompson wants. When some reluctant insurers argued that laws forbidding group policies from charging the sick more than the well are a roadblock, Thompson ordered HHS lawyers to see if legal hurdles are an excuse and to determine how companies can offer appropriate perks.
Pacificare says it can be done. Starting Oct. 1, any of Pacificare's 3.5 million enrollees in eight Western states can enroll in various wellness programs, from Weight Watchers to exercise plans to smoking cessation, that earn points. Enough points earn a prize.
To change behavior, ''we've got to be creative,'' says Pacificare's Dr. Sam Ho. ''If people are healthier ... it'll be less expensive to provide affordable benefits.''
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