December 2014





New video, infographics, and photos highlight deficiencies in the current U.S. food supply

Nov. 10, 2014, NCCOR

The dietary recommendations for eating healthy have not changed much in the past few decades — eat more fruits, vegetables, and whole grains and cut back on calories, sugar, and fat. However, it might not be possible for everyone to eat this way even if they tried.

A new study, published in the November issue of the Journal of the Academy of Nutrition and Dietetics, reveals that the food supply contains too much sodium, unhealthy fat, and added sugar and not enough fruits, vegetables, and whole grains for a balanced diet. The findings show that in order to achieve a healthy balance, the fruit supply would need to more than double and the supply of vegetables would need to increase by almost 50 percent. There would also have to be a 40 percent decrease in unhealthy fats and sugar, and more than a 50 percent decrease in sodium.

“Our research shows that the healthfulness of the food supply has changed very little in the past 40 years. While the food supply does meet dietary recommendations in some areas, overall it provides too many empty calories and too few fruits, vegetables, and whole grains,” said Susan M. Krebs-Smith, study co-author and chief of the Risk Factor Monitoring and Methods Branch at the National Cancer Institute (NCI) and member of the National Collaborative on Childhood Obesity Research (NCCOR).

Researchers measured the diet quality of the U.S. food supply with a tool called the Healthy Eating Index (HEI). The study, an update of the HEI-2005 research, used the HEI-2010 scoring metric to grade the U.S. food supply in 1970 through 2010.

To draw attention to the deficiencies in the current U.S. food supply and support a healthy diet, the findings have been widely disseminated through a suite of innovative materials including a video, infographics, and a photo series developed by the NCI and NCCOR. The materials have gained traction among a range of national outlets such as the U.S. Food Policy blog, Active Living Research, and Gretchen Swanson Center for Nutrition.

“As the federal government prepares to update the Dietary Guidelines for Americans in 2015, a process they undertake every five years, the HEI scorecard and this suite of materials can inform its work, particularly when considering the national food environment and sustainability,” added NCCOR member Jill Reedy, study co-author and nutritionist with the Risk Factor Monitoring and Methods Branch in ARP at NCI.

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Publications & Tools

Building healthy communities: Establishing health and wellness metrics for use within the real estate industry

It is increasingly well recognized that the design and operation of the communities in which people live, work, learn, and play significantly influence their health. However, within the real estate industry, the health impacts of transportation, community development, and other construction projects, both positive and negative, continue to operate largely as economic externalities: unmeasured, unregulated, and for the most part unconsidered. This lack of transparency limits communities’ ability to efficiently advocate for real estate investment that best promotes their health and well-being. It also limits market incentives for innovation within the real estate industry by making it more difficult for developers that successfully target health behaviors and outcomes in their projects to differentiate themselves competitively.

In a recent Health Affairs article, National Collaborative on Childhood Obesity Research contributor Dr. Matthew Trowbridge, the primary author of the study, and fellow researchers outline the need for actionable, community-relevant, practical, and valuable metrics jointly developed by the health care and real estate sectors to better evaluate and optimize the “performance” of real estate development projects from a population health perspective. Potential templates for implementation, including the successful introduction of sustainability metrics by the green building movement, and preliminary data from selected case-study projects are also discussed.


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SNAP households must balance multiple priorities to achieve a healthful diet

The Supplemental Nutrition Assistance Program (SNAP), which has the goal of assisting Americans to purchase an adequate diet, is the largest of the federal food and nutrition assistance programs and served more than 47 million Americans each month in fiscal year 2013. Evidence shows that SNAP benefits help alleviate poverty and food insecurity among participating households. However, like most Americans, the dietary patterns of participating households show room for improvement, with adult participants typically under-consuming fruits, whole grains, and other healthy foods while consuming too many empty calories. A recent article highlights key findings from behavioral economics pilot studies, which suggest that the manner in which food choices are presented can influence consumers’ decisions. These insights may help design more effective strategies to encourage SNAP shoppers to make more healthful food choices.


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Report finds increased marketing to children, teens, and black and Hispanic youth

There is considerable evidence of increased marketing directed at children and teens and black and Hispanic youth according to the recently released “Sugary Drink FACTS 2014” report. Issued by the Yale Rudd Center for Food Policy & Obesity, the report examines the current status of the nutritional content and marketing of sugary drinks to children and teens, documenting changes over the past three years.

The report also found no change in the overall nutritional content of products offered by sugary drink brands, that the majority of children’s drinks remained high in sugar, and that packaging featured nutrition-related messages that could mislead parents. Many brands also increased non-traditional forms of marketing that appeal to young consumers, including brand appearance in prime-time TV programming, marketing in social media, and mobile marketing. These types of marketing raise additional concerns as they are more difficult for young people to recognize as marketing and for parents to monitor.


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Childhood Obesity Research & News

United States introduces menu calorie labeling to fight obesity

Nov. 24, 2014, Reuters

By Toni Clarke and Anjali Athavaley

The U.S. government published sweeping new rules on Nov. 25 requiring chain restaurants and large vending machine operators to disclose calorie counts on menus to make people more aware of the risks of obesity posed by fatty, sugary foods.

“Obesity is a national epidemic that affects millions of Americans,” Food and Drug Administration (FDA) Commissioner Margaret Hamburg told reporters on a conference call on Nov. 24.

“Strikingly, Americans eat and drink about a third of their calories away from home.”

The FDA’s new rules, which are part of the 2010 Affordable Care Act, set a national standard for restaurant chains with 20 or more outlets and will pre-empt the patchwork of state laws.

Under the rules, calories must be displayed on all menus and menu boards. Other nutritional information — including calories from fat, cholesterol, sugars, and protein — must be made available in writing upon request.

The new calorie rule covers meals at sit-down restaurants, take-out food, bakery items, ice cream from an ice-cream store, and pizza, which will be labeled by the slice and whole pie. Seasonal menu items, such as a Thanksgiving dinner, daily specials, and standard condiments will be exempt.

The final rule, unlike a 2011 proposal, includes movie theaters, amusement parks, and alcoholic beverages served in restaurants, but not drinks mixed or served at a bar.

Restaurants have one year and vending machine operators have two years to comply with the new rules following publication in the Federal Register.

Panera Bread Co. in 2010 became the first company to voluntarily display calorie information at all its cafes nationwide. Others, including McDonald’s Corp. and Starbucks Corp., followed suit.

The agency said it amended its proposals after considering more than 1,100 comments from industry, public health advocates, and consumers.

It narrowed the scope to clearly focus on restaurant-type food. Still, there are nuances: Foods such as deli meat bought at a grocery store counter will be excluded. But the rules will apply to food eaten in grocery stores, such as meals purchased at in-house cafes.

Hamburg acknowledged that calorie counts for pizza slices and many other foods made on the premises will vary. Restaurants may draw on databases, cookbooks, and food package labels to calculate calories.

The restaurant industry has supported a national standard for years and welcomed the changes.

“We believe that the Food and Drug Administration has positively addressed the areas of greatest concern,” said Dawn Sweeney, chief executive of the National Restaurant Association, which represents 990,000 restaurant and food-service outlets.

Not all industry groups were satisfied.

“We are disappointed that the FDA’s final rules will capture grocery stores, and impose such a large and costly regulatory burden on our members,” said Peter Larkin, president and CEO of the National Grocers Association.

National Automatic Merchandising Association, representing the food and refreshment vending industry, said it will “reserve judgment” on the impact on the industry, but said that two years was insufficient “implementation time,” especially for small businesses.

The rules aim to close a gap in the 1990 Nutrition Labeling and Education Act, which established nutrition labeling on most foods, but not restaurant or other ready-to-eat foods.

Katie Bengston, Panera’s nutrition manager, said menu labeling has not affected its business: “We did not notice a jump in sales from higher calorie items to lower calorie items.”


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Rethinking the happy meal? Small prizes may get kids to pick up fruits and veggies at school

Nov. 15, 2014, The Washington Post

By Abby Phillip

Since the 1970s, when the Happy Meal was developed by a Midwestern advertising executive, McDonald’s has made incentivizing food choices something of an art form. The little box of fast-food calories with a little toy surprise has proven to be so appealing to children that in 2010 San Francisco passed a law prohibiting toys from being sold with meals that fail to meet certain nutritional standards.

Now, researchers are looking at ways of using a similar model to get kids to choose fruits and vegetables with their school lunches.

Childhood obesity is a growing problem that currently affects about one third of American kids, and for years, public health officials — first lady Michelle Obama among them — have been arguing in favor of making school lunches healthier.

In partnership with Cincinnati Public Schools, researchers at the Cincinnati Children’s Hospital Medical Center have piloted a program that made a relatively small adjustment to the lunch program at one low-income public elementary school.

“The components are the entree with whole grain, fruits, vegetables, a salad bar, and milk, which could either be flavored or plain, low-fat milk,” said Robert Siegel, a professor of pediatrics at Cincinnati Children’s Hospital Medical Center. “The problem is the students don’t necessarily select the best combination of those and they often select chocolate milk.”

Chocolate milk is often high in sugar and can be no better than soda in terms of healthfulness.

“We came up with the idea of the power plate: plain milk, main dish or entree, fresh fruit, fresh vegetables or salad,” said Siegel, who presented the program’s findings at the European Child Obesity Group Congress in Austria in November.

Students had the choice of between three and five options, and if they chose the options that constituted the “power plate,” they received a small prize. It could be a pencil or a water-based tattoo or a sticker — all very inexpensive items.

Of the 297 children at the school, almost everybody — about 99 percent — participated in the free and reduced lunch program; very few brought lunches from home.

At the onset of the program, fewer than 10 percent of kids voluntarily chose the components of the “power plate.”

But when they were offered prizes, about 42 percent picked up the healthier options. Even when the prizes were removed altogether, 36 percent continued to choose healthier options.

High-quality prizes were more effective at incentivizing kids to make the healthier choices. But “low quality,” less expensive prizes like tattoos and stickers still worked — even when they weren’t offered every day.

“From a cost-benefit perspective, our conclusion is that the best way to carry this on is to do tattoos and stickers twice a week if you’re on a budget,” said Siegel, who was the lead author on the program’s accompanying study.

It’s important to note that the study did not look at whether the children actually ate the food they picked up. And as most parents know, kids can be crafty in pursuit of rewards.

Students also were not asked to choose between unhealthy foods and healthy foods — they simply were asked to take additional healthy foods that they might have otherwise skipped.

The study’s limited duration — two months — does not tell us anything about whether the effect of the prizes lasts.

In subsequent programs, Siegel said, the researchers hope to look more closely at those issues. But the results of the pilot program suggest that children can receive a critical introduction to healthy foods at school at a very low cost to the system.

“We look at this as the first step,” Siegel said. “Getting the kids to select. Even at home, getting them to look at it or maybe even touch it is the first step. We are going to get consumption data in our follow up studies.”

“You can make the argument that by making the kids make a selection, you’re teaching them to select healthy foods,” he added.


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Winning the kid lunch crowd, one healthy bite at a time

Nov. 9, 2014, Chicago Sun Times

By Diana Novak Jones

Gone are the days of nachos with ground beef and cheese, fried french toast sticks, or a bagel with butter for lunch and juice from concentrate to wash it down.

In their place at St. Therese Chinese Catholic School in Chinatown [in Chicago]: honey mustard chicken with a salad of organic romaine and tomato; oven-roasted chili lime drumsticks from chickens raised on a nearby farm; homemade granola bars.

As the White House’s battle for healthy school lunches comes under fire from lobbyists, students, and lunch ladies, two Chicago-area Catholic schools have implemented a homemade, organic, and produce-heavy lunch program that has the support of kids, parents, and school administrators.

Cafeteria workers and representatives of processed food companies frustrated by the strict rules on food in schools dictated by the Healthy Hunger-Free Kids Act hope to roll back the law with the help of Congress next year. They say the kids are not eating the mandatory fruits and vegetables, and rules against processed food are hurting their bottom line.

St. Therese Principal Phyllis Cavallone made it a priority to improve the quality of the cafeteria food, with positive results. She worked with the food service provider for Archdiocese of Chicago schools to create Earth Smart Kitchens, a pilot lunch program that goes beyond federal regulations and is more popular with her students than previous lunch programs. The other school is St. Andrew in Lake View, Ill.

In the past, the archdiocese’s Food Service Professionals provided St. Therese with lunches that came in a hot pack and a cold pack, served in pre-measured trays like a Lunchable.

“I know it met the nutrition standards, [but] the kids weren’t eating it; they were fussy,” Cavallone said.

She approached the providers about a better lunch, and Food Service Professionals created Earth Smart, which uses organic and locally grown produce as much as possible, whole grains, and low-fat dairy with no hormones or antibiotics. The menu, which is developed by a chef and nutritionist, never includes fried foods, high-fructose corn syrup, trans fats, or processed foods.

The food is prepared by a chef at a central kitchen and distributed hot to the schools.

A typical monthly menu might have burrito bowls with beef and black beans, oven-roasted locally sourced chicken drumsticks in a chili lime marinade, creole chicken, and multigrain macaroni and cheese.

Key to getting the kids to eat healthy is serving them things that are familiar, so the menu does include such favorites as pizza, hotdogs, and burgers.

The pizza is homemade by the chef and has a whole-wheat crust, organic tomato sauce, and low-fat mozzarella. The hotdogs are 100 percent beef, as are the burgers — and no fries. Every meal is accompanied by at least one vegetable side dish. Cookies and baked treats come about once a week, and they’re whole grain, low sugar, and homemade.

For produce listed among the “Dirty Dozen,” the Environmental Working Group’s 12 most insecticide-contaminated fruits and vegetables, Earth Smart only buys organic. This includes apples, strawberries, spinach, potatoes, and more.

“It meets and exceeds the U.S. Department of Agriculture’s (USDA) guidelines; it’s just a step above,” said Joanie Lombardo, who runs Earth Smart for Food Service Professionals.

St. Therese serves free or reduced-cost lunches to about 40 percent of its students, Cavallone said, and Food Service Professionals fills out the paperwork to enable the school to be reimbursed.

Federal school lunch rules set calorie and sodium limits for food served in schools, and increase the use of fruit, vegetables, and whole grains on school menus in line with USDA dietary guidelines. Schools that abide by the rules and serve free or reduced-cost lunches to students in need are eligible for reimbursement from the USDA. The law, which went into effect in 2012, had kids around the country boycotting their healthier school lunches and many cafeteria managers frustrated by lost sales and waste.

But at St. Therese, kids seem enthusiastic about lunch. A recent meal of roasted turkey breast, mashed potatoes, peas, and apples had multiple kids lining up for seconds.

As part of a tiered calorie system dictated by the law, older kids get more calories than younger ones. With Earth Smart, the increase in calories comes in the form of a larger serving of vegetables and fruit.

Children have the option of skipping some things, but they still need to be served a half cup of vegetables for the meal.

“Overall, most kids take everything. They don’t turn much down,” said Jennifer Psyhogios, Earth Smart nutritionist and registered dietician.

Cavallone said she has noticed less waste, though the school works with Psyhogios and Earth Smart to test entrees on kid taste buds before serving them to the whole school. Hummus wraps and black bean cakes did not make the cut.

Something as simple as cutting up the fruit makes a difference in how much of it kids eat, Psyhogios has found.

The program is in just one other school beyond St. Therese, largely because it requires significant staffing to serve the food, and the lunches cost about 75 cents more than other programs, Lombardo said. Schools need four or five people to serve the lunch, whether they are parent volunteers or paid staff.

At St. Therese, Cavallone helps on the food line with her assistant principal and a phalanx of parent volunteers, without whom the school would not have enough people to make Earth Smart possible.

Alice Eng, mother of two kids at St. Therese, said she comes on her days off to see them and help in the lunch line.

“I’ll speak for my kids,” Eng said. “This is probably the only healthy meal they get!”


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How ‘double bucks’ for food stamps conquered Capitol Hill

Nov. 10, 2014, NPR [The Salt Blog]

By Dan Charles

The federal government is about to put $100 million behind a simple idea: doubling the value of the Supplemental Nutrition Assistance Program (SNAP) benefits — what used to be called food stamps — when people use them to buy local fruits and vegetables.

This idea did not start on Capitol Hill. It began as a local innovation at a few farmers markets. But it proved remarkably popular and spread across the country.

“It’s so simple, but it has such profound effects both for SNAP recipients and for local farmers,” says Mike Appell, a vegetable farmer who sells his produce at a market in Tulsa, Okla.

The idea first surfaced in 2005 among workers at the New York City Department of Health and Mental Hygiene. They were starting a campaign to get people to eat more fresh produce.

“I think we were trying to confront the idea that healthy foods, [like] fresh fruits and vegetables, are not affordable,” says Candace Young, who was director of the department’s nutrition programming at the time.

Young recalls that one of their workers pointed out that some SNAP recipients live near farmers markets “and we thought, how about we incentivize them to use their SNAP benefits at these farmers markets?”

The city made a few thousand dollars available for the program. So at a few markets in the South Bronx and Harlem, when someone spent $10 of SNAP benefits, he [or she] then received an additional $4 in the form of coupons called HealthBucks, which could be used to buy more local produce.

This desire to make farmers markets more food-stamp friendly seems to have been floating in the air at that time. A farmers market in Lynn, Mass., used a $500 donation to do something similar the very next year.

Then, in 2007, the idea mutated into a form that really caught on.

It happened with the birth of the Crossroads Farmers Market, on the boundary that divides the towns of Langley Park and Takoma Park, Md. The area, just outside Washington, D.C., is home to many immigrants.

“A lot of Latinos come to this market,” says Michelle Dudley, the market manager. “I would say that 70 percent of our customers are Spanish-speaking, but we also see people from the Caribbean. Folks from West Africa.”

Back in 2007, a man named John Hyde organized the Crossroads market with this immigrant community in mind “and then realized — these people did not have a lot of money,” says Gus Schumacher, Hyde’s friend and collaborator at the time.

Schumacher says he and Hyde got to talking about this money problem and had a brainstorm: If they could raise some money, they could use it to double the value of food stamps, as well as vouchers from the WIC (Women, Infants, and Children) program and food benefits for seniors.

Schumacher, a former top official at the U.S. Department of Agriculture, used his connections to raise the money. “I asked the National Watermelon Association if they would provide a small stipend, and they were very generous. They provided $5,000,” he says.

They set up a system that has remained almost unchanged ever since. On a recent visit, I see SNAP recipients lining up to speak with a market volunteer named Rosie Sanchez. They tell her how much money they want to spend from their SNAP benefits. Sanchez swipes their SNAP card and gives them wooden tokens that they can spend at the market. But she actually gives them tokens worth twice the amount that she took from their SNAP benefits; up to $15 more.

Sanchez is a SNAP recipient herself. This program “is very important,” she says. “You know why? Because I get up to $15 for free. So I have $30 every week. With my $30, I’m able to buy fresh, local — it’s not expensive. It’s the best!”

Gus Schumacher loved it, too. The same year this market started, he co-founded, together with chef Michel Nischan, an organization called Wholesome Wave, which has brought this idea of doubling SNAP benefits to farmers markets from Connecticut to California.

Private foundations were happy to contribute, because they realized that their dollars could do several things at once: ease poverty, promote better health, and boost the local farm economy.

In Michigan, food activist Oran Hesterman set up the Fair Food Network, which called this idea Double Up Food Bucks and got it working in more than 100 places across the state.

“We wanted to take it from the seed of an idea to a demonstration that this is something that you could do at scale,” Hesterman says.

Hesterman was thinking big. He wanted to sell this idea to the government.

He invited one of Michigan’s senators — Democrat Debbie Stabenow — to see Double Up Food Bucks for herself. And last year, Stabenow, who is chairwoman of the Senate’s Agriculture Committee, proposed including it in the so-called farm bill.

On the other side of Capitol Hill, the chairman of the House Agriculture Committee, Republican Frank Lucas, from Oklahoma, was hearing about this idea, too.

Farmer Appell had brought Double Up Food Bucks to the Cherry Street Farmers Market in Tulsa, [Okla.] and talked about it to a member of Lucas’ staff.

“It didn’t seem like it required much of a sell,” Appell recalls. “They seemed to be on board with it.” If the program was supporting farmers, the congressman wanted to support it.

Earlier this year, the farm bill passed, and it included $100 million, over the next five years, to boost SNAP dollars when they’re spent on fresh fruits and vegetables. Those taxpayer dollars have to be matched by private funding, so the program could add up to $200 million in total.

That’s a huge increase. According to some estimates, it may be 10 times what these programs spend right now.

As a result, small programs like the Cherry Street Farmers Market and the Crossroads market are now applying for funding to expand. And Michigan’s Fair Food Network, one of the biggest programs, is even moving beyond farmers markets. It’s now working with supermarket chains to see whether SNAP recipients shopping there can double their dollars for fresh produce every day and all year round.


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