December 2009





Milk Wars: Is Flavored Milk Necessary in Schools?

Nov. 9, 2009, RWJF Childhood Obesity News Digest

By Laura Berthold Monteros

The National Dairy Council and the Milk Processor Education Program have launched a new campaign aimed at preserving the offering of flavored milks in schools, the Associated Pressreports.

Introduced Nov. 9 with an advertisement in USA Today, the “Raise your hand for chocolate milk” campaign asserts that, without flavorings, many children will forgo drinking milk and as a result miss out on the nutrients it provides. Specifically, the campaign seeks to draw a distinction between chocolate milk, which provides nutrients, including calcium, and “soda and candy that have come under attack in schools.”

The campaign, which also includes a website where visitors are encouraged to sign a petition supporting chocolate milk in schools, is expected to cost between $500,000 and $1 million (Frederix, AP/Yahoo! News, 11/9/09).

However, while milk of any flavor contains nutrients necessary to healthy bone growth, such as vitamin D and calcium, with childhood obesity on the radar of school administrators and dieticians, some districts are banning or cutting back on that cafeteria staple, chocolate milk.

Some educators and obesity experts say children get enough calcium and will drink white milk if it is the only milk offered. Critics also contend that children consume too much sugar and that schools should ban the sale of chocolate milk.

Students in a Barrington, Illinois district, which banned chocolate and strawberry milk from its elementary- and middle-school lunch menus, persuaded administrators to give it another chance. The district is serving chocolate milk on Fridays, only, and weighing whether the benefits of calcium and vitamin D are worth the extra three teaspoons of sugar in each serving.

“Kids weren’t drinking the white milk,” said one 10-year-old. “It’s better to have the chocolate milk than nothing.”

Marlene Schwartz, deputy director of Yale University’s Rudd Center for Food Policy and Obesity, studied milk consumption in federally funded preschools across Connecticut that served only plain milk. She found that those young children drank it happily.

“What I don’t understand is, when a child turns five and enters kindergarten, all of a sudden people think they will stop drinking plain milk,” she said.

There may be reasons other than taste and sweetness that draw students to flavored milk. A young man from Altadena who attended public schools says, “The regular milk at schools is often spoiled. The chocolate milk is more popular, so it’s fresher.”


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Publications & Tools

Journal Dedicates Issue to ALbD Program

The Active Living by Design national program is featured in the December 2009 American Journal of Preventive Medicine (Volume 37, Issue 6, Supplement 2 ). The entire issue is devoted to the Active Living by Design grant program and lessons learned from 15 of its 25 community partnerships.

This practice-based special issue focuses on the ALbD national program and community action model; features commentaries from experts in the field; and describes lessons learned from 15 ALbD community partnerships representing a range of lead agencies (e.g. planning departments, community development agencies, health centers, advocacy organizations) with emphasis on increasing physical activity in special populations (e.g. African-Americans, Latinos, Native Americans, older adults, children). Examples address the process of planning and implementing comprehensive approaches to increase community levels of physical activity, including how to engage partners, secure resources, increase community participation, design policy and environment interventions, increase political and community support, address challenges and sustain momentum.

Contents of the issue are posted at
Scroll down the page to view the list.



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RWJF Center Releases Factsheet on Southern Childhood Obesity

The Robert Wood Johnson Foundation Center to Prevent Childhood Obesity has released a factsheet on childhood obesity rates in the South.

Compared with the rest of the United States, the South has a disproportionately high percentage of children who are overweight or obese. The eight states with the highest percentages of overweight or obese children are all in the South. In every Southern state except Oklahoma, at least 30 percent of children are overweight or obese.


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The Future Costs of Obesity

In a unique study that departed from looking at historical costs of obesity, Kenneth E. Thorpe, Ph.D., and colleagues from Emory University developed an econometric model to estimate the growth of health care costs over time that are attributable to changes in obesity rates. This report provides projections of future health care costs directly attributable to obesity for each state and for the nation.

Using nationally representative data on adults, the study estimates the effect of the increasing prevalence of obesity on total direct health care costs. Estimates are controlled for age, gender, race, ethnicity, marital status, education, income, health insurance status, geographic region and smoking status.


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Childhood Obesity Research & News

Food Ads on Nickelodeon Slammed in Report

Nov. 24, 2009, CBS

Nickelodeon may be a kid-friendly network, but when it comes to nutrition they are serving up the wrong ads.

According to an analysis conducted by the Center for Science in the Public Interest (CSPI), “nearly 80 percent of food ads on the popular children’s network Nickelodeon are for foods of poor nutritional quality.”

During an obesity epidemic in the United States, it’s hard enough for parents to control what their children are eating – and the group says airing a lot of junk food ads on Nickelodeon doesn’t help.

Although the findings show a modest drop from about 90 percent in 2005, it’s not significant enough to make a dent.

The CSPI points out that between the 2005 and 2009 studies, the food industry instituted a self-regulatory program through the Council of Better Business Bureaus, the Children’s Food and Beverage Advertising Initiative (CFBAI).

But for junk food lovers, self-regulation doesn’t always work.

CSPI took a closer look at the practices of the food companies that participate in that self-regulatory program.

They found that “of the 452 foods and beverages that companies say are acceptable to market to children, that 267, (or nearly 60 percent), do not meet CSPI’s recommended nutrition standards for food marketing to children.”

The list includes: General Mills’ Cookie Crisp and Reese’s Puffs cereals, Kellogg Apple Jacks and Cocoa Krispies cereals, Kellogg Rice Krispies Treats, Campbell’s Goldfish crackers and SpaghettiOs, Kraft Macaroni & Cheese, and many Unilever Popsicles.

“While industry self-regulation is providing some useful benchmarks, it’s clearly not shielding children from junk food advertising, on Nick and elsewhere,” said CSPI nutrition policy director Margo G. Wootan. “It’s a modest start, but not sufficient to address children’s poor eating habits and the sky-high rates of childhood obesity.”

Puddings, cookies, or fruit-flavored snacks don’t meet CSPI’s nutrition standards – but they are fans of yogurt. Seventy-three percent of yogurts were up to par.

Other foods that meet CSPI’s standards include: Nabisco Teddy Grahams; Kellogg Frosted Mini-Wheats; Kellogg Eggo Waffles; several Kid Cuisine frozen dinners; only three of 47 Kraft-approved products; one of eight McDonald’s-approved meals; and, 22 of 86 General Mills-approved products.

Other foods that don’t meet CSPI’s standards include: fruit drinks, often high in sugar with little fruit juice as well as high-fat milk; and, PepsiCo’s 10 products that they say are appropriate to market to children.

CSPI also has urged Chuck E. Cheese’s, IHOP restaurants, Topps Candy, Yum! Brands (which owns KFC, Taco Bell and Pizza Hut) and Perfetti van Melle (maker of Air Heads candy) to join the CFBAI. Four companies that belong to the CFBAI (Coca-Cola, Hershey’s, Mars, and Cadbury Adams) state that they do not advertise any products to children (according to the CBBB definition).

According to CSPI, a fourth of the food ads on Nickelodeon were from companies that don’t participate in the industry’s self-regulatory program. “Almost none of those ads were for foods that met CSPI’s nutrition standards, and only 28 percent of the ads from companies in the CBBB Initiative met them,” CSPI said. …


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Parents' Inaccurate Beliefs Fuel Childhood Obesity

Nov. 23, 2009, Guardian News and Media Limited

Seven out of 10 parents think their child takes plenty of exercise, despite only one in 10 doing enough, a poll found today.

Research for the British Heart Foundation (BHF) found there was a “reality gap” between what parents believe and what actually happens in day-to-day life.

The charity released a report called “Couch Kids” on how a lack of exercise is fueling childhood obesity. Children are taking no more exercise than a decade ago and obesity levels have risen dramatically over the same period.

In 1995, 11 percent of boys and 12 percent of girls were overweight or obese, rising to 17 percent of boys and 16 percent respectively in 2007.

NHS data shows about one in three young people are currently overweight or obese. The BHF survey of more than 900 parents found 71 percent believe their children are “active enough” but only 11 percent of youngsters are active for 60 minutes a day, as recommended by the Government.

Dr. Mike Knapton, associate medical director at the BHF said: “[Moms] and dads need to take off the blinkers about how active kids need to be in order to keep their hearts healthy.

“Kids need to get moving more, yet we’ve been standing still for the last decade. Children aren’t really any more active than they were 10 years ago.

“Parents have such an important role in helping and encouraging their kids to be more active by building exercise into their everyday lives — whether that’s taking part in team sports, playing outside with their friends or walking to school.”

The report calls for consistent guidelines for people of all ages on how much exercise they should take.

The BHF also wants schools to do more to encourage exercise, and for robust data to be collected on how much people are doing.

A spokesman for the Department of Heath said: “Tackling childhood obesity is a priority for the Government. Emerging evidence suggests childhood obesity rates may be leveling off but they are still too high. If we’re going to turn the tide on obesity for good, our children need to be active for 60 minutes a day — including what they already do at school. We are taking tough action and investing [millions] to address obesity and to prevent people becoming overweight in the first placee. Many of the recommendations in “Couch Kids” have already been addressed in the Government’s obesity strategy and the P.E. and School Sport for Young People strategy. Our Change4Life campaign, launched in January, has kick-started a lifestyle revolution to help every family eat better and be more active.”


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Congress Uses Legislation to Fight Obesity

Nov. 25, 2009, U.S. News & World Report

By Kent Garber

In 2018, more than half the adults in Oklahoma, Mississippi, Kentucky, Maryland, Ohio, and South Dakota could be obese. That’s just one of many alarming projections in a studyreleased last week by Kenneth Thorpe, chair of Emory University’s Department of Health Policy and Management, and it comes, appropriately, as Congress is grappling with how to best reform a healthcare system that is becoming wildly and unsustainably expensive.

By Thorpe’s calculations, within a decade, nearly $1 of every $5 spent on healthcare in the United States will be attributable to obesity-related conditions, including diabetes and high blood pressure. “It’s certainly a wake-up call,” Thorpe says. “To see you’ve got six states within 10 years of the majority of the adult population being considered obese—that’s a pretty remarkable statistic.”

He added, “I think there is a growing recognition that a key driver of rising healthcare costs is the explosion of chronic diseases linked to rising rates of obesity.” According to his study, if obesity rates were kept constant, the country could save $200 billion a year by 2018.

But how much attention is Congress paying to obesity’s cost in the health bills it is debating? “I think they are moving in the right direction,” Thorpe says. “The question is, Is it aggressive and fast enough?”

For the most part, the Democrats’ healthcare reform legislation focuses on insurance coverage and insurance reforms. But experts say there are proposals on the table that at least begin to address the obesity problem. In one of the more far-reaching approaches, both the House bill and Senate Majority Leader Harry Reid’s bill would require fast-food chains and many restaurants to put calorie labels on their menus and displays. It’s a concept that’s been tried out on a smaller scale with some success, most notably in New York City. According to a study released last month by the city’s health department, customers who saw the labels at places like McDonald’s and Starbucks consumed 106 fewer calories than people who didn’t see the signs.

The menu labels are “an important first step toward educating the public on calories,” says Joe Thompson, the surgeon general of Arkansas and director of the Robert Wood Johnson Foundation’s Center to Prevent Childhood Obesity. “Most people don’t know how many calories they are consuming when they order something off a menu.”

Reid’s bill also sets aside $25 million for projects aimed at curbing childhood obesity, while the House plan has a pilot program that would award grants to communities for public-health campaigns. And both would give incentives to doctors to spend more time helping patients make healthy lifestyle choices. But many of these programs are still small or poorly funded.

One place where Democrats clearly took a pass was a proposal to impose a federal tax on sodas and sugary drinks. About a dozen states have adopted such taxes, and in poll after poll this summer, voters ranked the soda tax as one of their favorite options for financing healthcare reform. But the tax was vigorously opposed by the powerful beverage lobby, which said that it would adversely affect poor people and would not change consumer behavior. And so it disappeared.


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Children's BMI Data May Be Added to Immunization Records

Nov. 17, 2009, Amed News

By Pamela Lewis Dolan

Congress is considering a new grant program to fund body mass index surveillance demonstration projects.

Rep. Christopher Carney (D-Pa.) introduced legislation Oct. 28 to establish grants that would fund expansion of 10 state’s immunization records to include de-identified BMI data submitted by physicians.

All states maintain a registry in which physicians report and track children’s immunizations. Adding a BMI field, supporters say, would allow researchers to efficiently track obesity trends. It also would help physicians keep the obesity problem front and center by using an objective measure to monitor their patients’ weight.

While all states have an immunization registry, some are more sophisticated in their technology. Carney said states that receive the grants would be required to meet specific data standards and have an interoperable program allowing de-identified data to be shared widely. The program’s effectiveness would be evaluated after three years, at which time, Carney said, he would look at expanding it further.

Once data are collected, they can be analyzed to track obesity rates across states, counties, school districts or specific ZIP codes. By looking at obesity trends over time, researchers can assess the effectiveness of obesity prevention programs in targeted areas, Carney said.

BMI surveillance programs have been established in other areas of the country, but Michigan was the first to adopt a statewide program facilitated by physicians. Arkansas started a statewide program in 2003, facilitated through its schools.

According to the Centers for Disease Control and Prevention, obesity rates have tripled since 1980, with 16 percent of children age 6 to 19 classified as overweight or obese.


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USDA Proposes Increasing Meal Reimbursement for Schools That Serve Healthy Food

Nov. 17, 2009, RWJF Childhood Obesity News Digest

The U.S. Department of Agriculture (USDA) has proposed offering higher reimbursement rates to schools that serve healthy foods, Reuters reports. Child nutrition programs, including the National School Lunch and Breakfast programs, are slated for reauthorization early next year, and lawmakers are expected to focus their reform efforts on improving the nutritional quality of school meals as a way to help prevent childhood obesity. The school meal programs serve almost 40 million meals per day and account for “more than half [of] students’ food intake during the school day.” Under the current system, schools receive $2.88 in cash and USDA-provided food for each lunch served for free to students. The USDA proposal would increase that rate, by an amount to be determined, for schools providing more fruits, vegetables and whole grains. Noting that “it is important for us to reward top performers,” Agriculture Secretary Tom Vilsack told the Senate Agriculture Committee that they, as well as Congress, should examine “reimbursement rates that would be linked directly to increased nutritional values.” Sen. Blanche Lincoln (D-Ark.), chairwoman of the Senate Agriculture Committee, said she was “sympathetic to the concept of higher reimbursement rates” (Doering, Reuters, 11/17/09).


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Lawmakers Propose Legislation to Limit Food and Beverage Advertising to Children

Nov. 13, 2009, RWJF Childhood Obesity News Digest

Democratic lawmakers have proposed legislation that would more strictly regulate the advertising of foods and beverages to children, the Wall Street Journal reports. Introduced by Democratic Reps. Jim Moran (Va.) and Bill Pascrell (N.J.), the Healthy Kids Act would grant authority to three federal agencies to implement more stringent guidelines for the advertising of beverages and foods that “do not contribute to a healthful diet for children and adolescents.” The measure would authorize the Federal Trade Commission (FTC) to establish rules for marketing products to youth and grant it the power to determine when advertisements could be deemed an unfair trade practice. The U.S. Department of Health and Human Services (HHS), in consultation with other agencies, would be charged with developing advertising guidelines that consider “the emotional vulnerability of children and adolescents and their cognitive ability to distinguish between commercial and non-commercial content…and society’s interest in protecting the health and well being of its children.” Finally, the Federal Communications Commission (FCC) would be permitted to ban or limit advertisements for unhealthy beverages and snack foods. The legislation also would establish an Office of Childhood Overweight and Obesity Prevention and Treatment within HHS. Industry lobbyists already have suggested that the bill could be seen as an infraction of companies’ first amendment rights. However, the Wall Street Journal notes that both the FTC and FCC have commissioners who are focused on the public health aspects of advertising, and HHS has long held an interest in curbing childhood obesity (Mundy, Wall Street Journal, 11/13/09 [subscription required]).


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Obesity Reducing Life Expectancy in Mexico

November 2009, Latin American Herald Tribune

Experts warned that the rise in health problems due to obesity among Mexican children, which is considered to be an epidemic, threatens “for the first time” to reduce life expectancy rates in the country.

Within the framework of the opening of the International Forum on Childhood Obesity Operations, held in the Mexican capital this fall, researchers from Mexico, the United States, Canada, France and the Czech Republic acknowledged the need to establish a clear definition of childhood obesity.

Diabetes, hypertension and high cholesterol “are appearing at earlier and earlier ages among Mexican children and if they are not controlled they are going to reduce the life expectancy of the new generations,” warned Mercedes Juan Lopez, president of the Mexican Health Foundation.

Lopez said that the problem in Mexico is due to profound changes in lifestyle, in the behavior and customs of students and in their eating and leisure habits as well as to a probable genetic predisposition among those who suffer from obesity.

The expert based her remarks on a recent foundation study which Mexican and foreign researchers conducted for two years.

This public health issue must be dealt with in a comprehensive, immediate and coordinated manner, and it must be participated in by all sectors of society, she said.

Currently, 40 percent of Mexico’s more than 107 million citizens suffer from obesity, while a quarter of Mexican children are above their desirable weight, according to the 2006 National Health Survey.

Meanwhile, Mexico’s IMSS health care agency predicts that in 2025, 25 percent of the country’s adult population will be diabetic due to bad diet and being overweight.

The forum will seek to encourage researchers to continue their work focusing on potential solutions to the problem of excess weight and childhood obesity worldwide.


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