October 2015





U.S. Surgeon General launches campaign with national call to action on walking

Sept. 9, 2015, U.S. Department of Health and Human Services

The U.S. Surgeon General issued a call to action to address major public health challenges such as heart disease and diabetes. Step It Up! The Surgeon General’s Call to Action to Promote Walking and Walkable Communities articulates the health benefits of walking while addressing the fact that many communities unacceptably lack safe and convenient places for individuals to walk or wheelchair roll.

“Everyone deserves to have a safe place to walk or wheelchair roll. But in too many of our communities, that is not the reality,” said Dr. Vivek H. Murthy, the 19th U.S. Surgeon General. “We know that an active lifestyle is critical to achieving good overall health. And walking is a simple, effective, and affordable way to build physical activity into our lives. That is why we need to step it up as a country ensuring that everyone can choose to walk in their own communities.”

Data consistently show there are safety and accessibility issues that make communities less walkable. A 2013 study by the U.S. Department of Transportation, for example, found that three out of every 10 Americans reported that no sidewalks existed along any streets in their neighborhood. In many communities violence—and the perception of violence—may prove a barrier to walking.

The Surgeon General calls on community planners and local leaders to create more areas for walking and wheelchair rolling and to prioritize the development of safe routes for children to get to and from schools. The call to action suggests that these designs should include sidewalks, curb cuts, crosswalks, safe crossings for the visually impaired, and more green spaces. The Surgeon General further calls on city managers, law enforcement, and community and public health leaders to address safety concerns by better maintaining public spaces, working with residents to promote a shared sense of community ownership, ensuring proper street lighting, and fostering neighborhood watch programs.

The Surgeon General’s report discusses the health benefits of walking and calls on individuals to make walking a priority in their lives. Fewer than half of all U.S. adults get enough physical activity to reduce their risk of chronic disease, and only a quarter of high school students get the recommended amount. Physical inactivity contributes to heart and lung disease, diabetes, and cancer, which account for 86 percent of our nation’s health care costs. Building walking into daily life can reduce disease and save money.

“We know that an average of 22 minutes a day of physical activity—such as brisk walking—can significantly reduce the risk of heart disease and diabetes,” added Dr. Murthy. “The key is to get started because even a small first effort can make a big difference in improving the personal health of an individual and the public health of the nation.”

To read the Surgeon General’s Call to Action and learn how to promote walking and walkable communities, please visit www.surgeongeneral.gov.


Original source: http://www.hhs.gov/news/press/2015pres/09/20150909a.html

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Designing the Healthy Communities Study

Oct. 1, 2015, NCCOR

The Healthy Communities Study (HCS), funded by the National Institutes of Health (NIH) and supported by the National Collaborative on Childhood Obesity Research (NCCOR), aims to answer important research questions about how diet, physical activity, and body mass index (BMI) are related to aspects of community programs and policies.

The five-year observational study is assessing community efforts designed to address local childhood obesity rates in areas where those rates are the highest. The study employs a complex design that includes a diverse sample of communities across the country and combines current/cross-sectional and retrospective data over a two-year period.

Study authors, which include NCCOR members, will release a special supplement in the American Journal of Preventive Medicine to describe the study overview and different aspects of the study design.


Original source: https://www.nccor.org/blog/designing-the-healthy-communities-study/

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Publications & Tools

NCCOR webinar on integrating clinical-community systems now available

NCCOR’s Connect & Explore Webinar on Sept. 8 examined recently published research advocating a shift in the framework to prevent and treat obesity and related chronic diseases. The webinar featured William H. Dietz, director of the Sumner M. Redstone Global Center for Prevention and Wellness at The George Washington University. The webinar recording and slides are now available online.


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Special collection of Preventing Chronic Disease spotlights policies to improve the U.S. population’s diet

From New York City to Cleveland-Cuyahoga County, a recent special collection published in Preventing Chronic Disease examines nutrition policies across the United States from a variety of policy levels, types, and settings. Studies in the series, many of which were authored by National Collaborative on Childhood Obesity Research (NCCOR) members and contributors, use diverse methodologies to explore policy development, adoption, implementation, and transferability while tackling best practices in policy translation, communication, and dissemination.


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Behavioral Risk Factor Surveillance System 2014 data now available

The Centers for Disease Control and Prevention’s Division of Nutrition, Physical Activity, and Obesity released its 2014 state- and territory-specific data on adult obesity prevalence using self-reported information from the Behavioral Risk Factor Surveillance System (BRFSS). This new data shows that the prevalence of adults with obesity in the United States in 2014 continued to remain high with estimates across states/territories ranging from 21.3 percent in Colorado to 35.9 percent in Arkansas.


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CDC launches Built Environment Assessment Tool

The built environment can influence overall community health and individual behaviors such as physical activity and healthy eating. The Centers for Disease Control and Prevention (CDC), launched the Built Environment Assessment Tool (BE Tool) to measure core features and qualities of the built environment that affect health, especially walking, biking, and other types of physical activity. Core features assessed by the BE Tool include built environment infrastructure, walkability, bikeability, recreational sites and structures, and food environment.


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Childhood Obesity Research & News

The United States doesn't have enough of the vegetables we're supposed to eat

Sept. 19, 2015, NPR

By Tracie McMillan

If you are looking for proof that Americans’ vegetable habits lean toward french fries and ketchup, the U.S. Department of Agriculture (USDA) has it: Nearly 50 percent of vegetables and legumes available in the United States in 2013 were either tomatoes or potatoes. Lettuce came in third as the most available vegetable, according to new data out this week.

And while the USDA’s own dietary guidelines recommend that adults consume 2.5 to 3 cups of vegetables a day, the agency’s researchers found that only 1.7 cups per person are available.

“The dietary guidelines promote variety,” Jeanine Bentley, a social science analyst at the USDA’s Economic Research Service, tells The Salt. “But when you look at it, there isn’t much variety. Mostly people consume potatoes, tomatoes, and lettuce.” (The data technically tally domestic production and imports, then subtract exports, but researchers commonly use them as a proxy for consumption.)

The federal dietary guidelines do not recommend relying primarily on potatoes, tomatoes and lettuce for most of our vegetable needs. They prescribe a varied mix that includes dark leafy greens, orange and yellow vegetables, and beans—along with those potatoes and tomatoes. And they want us to eat them because they help reduce the risk for heart disease, stroke, and some cancers as well as help keep us at a healthy weight.

So the vegetables that are available don’t really match what we’re supposed to be eating. What about what we are actually eating?

Some 87 percent of adults failed to meet the vegetable intake recommendations during 2007-2010, according to recent survey data from the Centers for Disease Control and Prevention (CDC). The survey found a lot of variation state to state—with 5.5 percent of people in Mississippi getting enough vegetables to 13 percent in California meeting the recommendations.

Most people are likely to be eating tomatoes and potatoes, but as the USDA has noted, we often get them in the not-so-nutritious forms of french fries and pizza. About one-third of potatoes, and two-thirds of tomatoes, were bound for processing—think chips, sweetened pizza sauce, and ketchup.

All these numbers beg some questions: Do our lopsided habits mean that Americans are merely eating what’s on offer, a kind of supply-side theory of diet? Or are all those potatoes and tomatoes crowding out spinach and Brussels sprouts because they’re what consumers demand?

“We have a serious disconnect between agriculture and health policy in our country,” said Marion Nestle, a leading nutrition researcher and author at New York University. “The USDA does not support ‘specialty crops’ [like vegetables] to any appreciable extent and the Department of Commerce figures show that the relative price of fruits and vegetables has gone up much faster than that of fast food or sodas.” So while Americans are told to eat fruits and vegetables for their health, the government has meanwhile mostly just subsidized other crops that end up in cheaper, less healthy processed food. “Price has a lot to do with this,” she adds.

Although the USDA report focuses on the limited variety of vegetables available to American shoppers, other agency data suggest that the country simply doesn’t offer enough vegetables, period. A 2010 study in the American Journal of Preventive Medicine [authored by several NCCOR members] estimated that the U.S. vegetable supply would need to increase by 70 percent—almost entirely in dark leafy greens, orange vegetables, and legumes—in order for Americans to meet recommended daily allowances at the time.

[Learn more about the related National Collaborative on Childhood Obesity Research Healthy Eating Index project and resources at http://nccororgms.wpengine.com/projects/hei/.

With a dietary landscape like that, it’s entirely possible that Americans are choosing potatoes and tomatoes, at least for now, says Lindsey Haynes-Maslow, a food systems and health analyst at the Union of Concerned Scientists.

“What I see here with lots of potatoes, tomatoes, and lettuce … [is] that people are used to these items, and habits are hard to break,” says Maslow, adding that relying mostly on the potatoes, tomatoes, and lettuce “doesn’t cut it,” nutrition-wise.

Still, she says, “If more Americans got used to eating more fruits and vegetables they might be demanding more of it,” she says. “But it’s really hard to demand something you’ve not grown up with.”

That’s why behavioral economists are so keen to figure out how to nudge kids to try and develop a taste for more vegetables—they’re researching everything from financial incentives to arranging food differently on the lunch line. And there’s some hopeful news in that department: The CDC recently reported that, since the passage of the Healthy, Hunger-Free Kids Act of 2010, there’s been a big increase in the number of schools serving two or more vegetables and whole grain-rich foods every day.

Most interesting of all, that food isn’t just on kids’ plates: It’s getting eaten, too. A Rudd Center for Food Policy & Obesity study of kids’ lunch habits following the passage of the bill found that kids ate more fruit, threw away fewer vegetables and ate more of their now-healthier entrees, too.


Original source: http://www.npr.org/sections/thesalt/2015/09/19/441494432/the-u-s-doesnt-have-enough-of-the-vegetables-were-supposed-to-eat

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About a third of U.S. kids and teens ate fast food today

Sept. 17, 2015, NPR

By Allison Aubrey

Fast food is an undeniable part of American culture. We’ve probably all encountered the McDonald’s “I’m Lovin’ It” jingle and the white-goateed Colonel Sanders of KFC at least once, if not hundreds, of times.

The big fast-food chains market their foods to us constantly. And our children see, on average, 3-5 fast-food ads per day.

So perhaps the Centers for Disease Control and Prevention’s (CDC) new findings shouldn’t come as a surprise.

“About 34 percent of all children and adolescents, aged 2 to 19, consume fast food on a given day,” says Cheryl Fryar of CDC’s National Center for Health Statistics.

In other words, every day about 1 in 3 kids in the United States is chowing down on fries, burgers, pizza, or other fast-food favorites.

And despite all the promptings to eat more healthfully, this rate of fast-food consumption hasn’t budged in the past 15 years.

So even if McDonald’s bottom line is hurting right now, it seems Americans’ overall appetite for fast food is as strong as ever. The CDC has found that adult consumption of fast food mirrors what it is seeing in kids.

Part of the appeal is price. For example, a burger or ice cream off the dollar or value menu is cheap. And c’mon, admit it: French fries can be hard to resist. Fast-food menus are geared to our most basic desires.

“We’re programmed to seek sweet and salty foods, and fast food knows how to pander to those cravings,” says pediatrician Stephen Pont of Dell Children’s Medical Center of Central Texas and chairman of the American Academy of Pediatrics section on obesity.

And once kids have a habit of eating these foods, it’s hard to break it.

“A particular challenge with teenagers is that they all feel invincible, and they’re not as sensitive to the long-term impacts of [diet] on their health,” Pont says.

So it seems fast food’s trifecta of marketing, affordability, and taste has a hold on America’s youth. And even as fast-food giant McDonald’s is increasingly competing with fast-casual chains such as Five Guys and Chipotle, the basic formula remains the same.

“I think it speaks to how big a role fast food plays in how we eat in America,” says Julia Wolfson, a doctoral student and researcher at the Johns Hopkins Bloomberg School of Public Health.

Shifting our preferences away from salt, sugar, and fat is no small task.

But, Wolfson says, there seems to be some progress. She points to evidence that the major fast-food chains are trying to make their menus more healthful.

McDonald’s, for instance, downsized its Happy Meal portions. And it has introduced new kinds of salads and added kale to its breakfast bowls in some locations.

As we’ve reported, Wolfson’s research points to changes across the board. “We have found that fast-food restaurants have been introducing new menu items that are on average 60 calories lower than old menu items,” Wolfson says.

Wolfson says if this trend continues, it could make a difference.

Kids are eating about 190 calories per day in fast-food calories. So if you think about shaving 60 calories off, “that’s a good chunk out of the total.”

Of course, there’s lots of room for improvement.

There are still lots of sugary drinks, double burgers, and dollar desserts to tempt us—and our offspring.


Original source: http://www.npr.org/sections/thesalt/2015/09/17/440951329/about-a-third-of-u-s-kids-and-teens-ate-fast-food-today

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Obesity in blacks and Latinos: Amid national epidemic, vast disparities by race, state

Sept. 21, 2015, International Business Times

By Elizabeth Whitman

America’s obesity epidemic is a highly uneven one, the latest report in an annual series on being overweight showed. In the South and Midwest, rates of obesity are notably higher than in other parts of the country, and they’re also far higher among blacks and Latinos than among whites. Even with these disparities, at least one-fifth of every state’s population is obese, a rate that has stabilized in recent years.

“Efforts to prevent and reduce obesity over the past decade have made a difference,” Jeffrey Levi, executive director of the Trust for America’s Health, a health advocacy organization in Washington, D.C., that co-authored the report with the Robert Wood Johnson Foundation, said. “But we still haven’t invested enough to really tip the scales,” he said.

In addition, the report compiled data on diabetes and hypertension in the United States, two diseases or conditions frequently tied to obesity. It also looked at physical inactivity, access to healthy food, and obesity-related healthcare costs.

Obesity rates appeared to have leveled off in the past decade or so, yet Americans have still been growing bigger, the U.S. Centers for Disease Control and Prevention (CDC) found in September 2014. Obesity rates did not significantly change from 2003-2004 through 2011-2012, but the average waist circumference of an American adult has nevertheless grown from 37.6 inches in 1999 and 2000 to 38.8 inches in 2011 and 2012.

But the picture of obesity, and all its health implications, varied significantly by state and racial or ethnic group, the report showed.

Of the 25 states with the highest rates of obesity, 23 are in the South and Midwest. Of the 10 states with the highest rates of diabetes, nine were in the South. Arkansas had the highest rate of obesity at 35.9 percent, followed by West Virginia at 35.7 percent, and Oklahoma at 35.5 percent. The states with the lowest obesity rates were Massachusetts at 23.3 percent, Hawaii at 22.1 percent, and Colorado at 21.3 percent.

On a national level, obesity rates were at 47.8 percent among blacks and 42.5 percent among Latinos, but among whites it was 32.6 percent. Still, the rate was highest among American Indian and Alaska Natives, at 54 percent.

The report noted that preventing children from become obese or overweight is much easier and more efficient than helping people lose the weight as adults. But it also found, alarmingly, that by the time they’re 6 to 11 years old, 5 percent of children are already obese.

“In order to build a national Culture of Health, we must help all children, no matter who they are or where they live, grow up at a healthy weight,” Risa Lavizzo-Mourey, the president and CEO of the Robert Wood Johnson Foundation, said in a press release.

The report called for improvements in school nutrition and physical education programs as well as community programs that encouraged physical activity and health-related initiatives, particular in low-income areas.


Original source: http://www.ibtimes.com/obesity-blacks-latinos-amid-national-epidemic-vast-disparities-race-state-report-2106322

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Researchers have discovered a surprisingly simple way to get kids to eat more veggies

Sept. 29, 2015, The Washington Post

By Roberto A. Ferdman

It seems like an age-old problem—kids not eating their vegetables—and it is. Little ones, more interested in macaroni and cheese than sautéed spinach, are still leaving the latter largely untouched. The proof is both anecdotal—what parent hasn’t tussled with this?—and borne out in data. Nine out of 10 children, after all, still don’t eat enough vegetables, according to the Centers for Disease Control and Prevention (CDC).

The problem has been blamed, at least in part, for the deteriorating diets of American youth. It has also been on clear display ever since the government updated, in 2013, its nutrition standards for the National School Lunch Program. Children, suddenly confronted with vegetables on every plate (as required as part of the change), have responded not by eating them but by leaving them on their plates—untouched.

It’s a poignant example of how kids are really good at making really bad decisions about food. And it has proved pretty frustrating for health and nutrition advocates, who can’t seem to find a reasonable way to get children to eat more healthfully at school.

But it turns out there might be an ingenious solution hiding beneath everyone’s nose.

Researchers at Texas A&M University, looking for patterns in food consumption among elementary school children, found an interesting quirk about when and why kids choose to eat their vegetables. After analyzing plate waste data from nearly 8,500 students, it seems there’s at least one variable that tends to affect whether kids eat their broccoli, spinach or green beans more than anything: what else is on the plate.

Kids, in short, are much more likely to eat their vegetable portion when it’s paired with a food that isn’t so delicious it gets all the attention. When chicken nuggets and burgers, the most popular items among schoolchildren, are on the menu, for instance, vegetable waste tends to rise significantly. When other less-beloved foods, like deli sliders or baked potatoes, are served, the opposite seems to happen.

“Pairings of entrées and vegetables are an important consideration when assessing plate waste among elementary school children,” the researchers note.

Indeed, the effect can work the other way around. The study found that children tend to eat less of their entree when popular vegetables (mostly starchy fried vegetables, like tater tots and french fries, which many wouldn’t classify as vegetables) are offered. When the entree is paired with steamed broccoli—the vegetable children eat the least of on average—kids instead eat more of the main dish.

And that interrelationship can be useful in reducing the amount of food wasted at schools, which has been a persistent problem.

But these observations are probably more useful as a gauge for how appetizing vegetable are in different contexts than as a subscription for what pairings will lead to the least amount of food waste. Kids’ favorite meals, after all, aren’t particularly healthy. What’s more, they, too, lead to considerable waste. The most popular pairing—hamburger and tater tots—still results in about 26 percent waste on average, according to the study.

The notion that food pairings can significantly affect the attractiveness of certain foods isn’t new. Traci Mann, who teaches psychology at the University of Minnesota and has been studying eating habits, self-control, and dieting for more than 20 years, believes that it can, in fact, be crucial. One of the simplest ways to eat better is to make it easier to eat better. That involves a strategy Mann calls “get alone with a vegetable,” which is similar in that it shows how important context can be. She described the strategy earlier this year:

Normally, vegetables will lose the competition that they’re in—the competition with all the other delicious food on your plate. Vegetables might not lose that battle for everyone, but they do for most of us.

This strategy puts vegetables in a competition they can win, by pitting vegetables against no food at all. To do that, you just eat your vegetable first, before any of the other food is there. Eat them before other food is on your plate, or even at your table. And that way, you get them when you’re hungriest and unable to pick something else instead.

She also noted that it’s been effective with kids:

We’ve actually tested this in a lot of ways. And it works unbelievably well. We tested it with kids in school cafeterias, where it more than quadrupled the amount of vegetables eaten.

It’s just about making it a little harder to make the wrong choices, and a little easier to make the right ones.

Of course, persuading schools to serve vegetables by themselves could be too tall a task. Asking them never to serve foods kids adore might be, too. But understanding how something as simple as what a vegetable is served with can have a sizable impact on whether a child eats it is a pretty useful thing. At school, and at home.


Original source: http://www.washingtonpost.com/news/wonkblog/wp/2015/09/29/researchers-have-found-a-simple-way-to-get-kids-to-eat-more-veggies/

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