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June 2009

SPOTLIGHT

PUBLICATIONS & TOOLS

CHILDHOOD OBESITY RESEARCH & NEWS

Spotlight

Individual Stress Linked to Adolescent Obesity

May 16, 2009, ScienceDaily

Stress may indeed be a direct contributor to childhood obesity. That’s according to a new Iowa State University study finding that increased levels of stress in adolescents are associated with a greater likelihood of them being overweight or obese.

The study of 1,011 adolescents (aged 10-15) and their mothers from low-income families living in three cities – Boston, Chicago and San Antonio – is posted on the website of the Journal of Adolescent Health, and will be printed in its August issue. Forty-seven percent of the teens in the sample were overweight or obese, but that percentage increased to 56.2 percent among those who were impacted by four or more stressors.

“We found that an adolescent or youth who’s more stressed – caused by such things as having poor grades, mental health problems, more aggressive behavior, or doing more drugs and alcohol – is also more likely to be overweight or obese,” said lead author Brenda Lohman, an Iowa State assistant professor of human development and family studies (HDFS).

Susan Stewart, an ISU associate professor of sociology; and Steven Garasky, a professor of HDFS at Iowa State; joined Lohman on the research team. Former ISU faculty members Craig Gundersen, a member of the agricultural and consumer economics faculty at the University of Illinois; and Joey Eisenmann, a member of the kinesiology and pediatrics faculty at Michigan State University, also contributed to the study.

Data collected from noted three-city study

The study analyzes data obtained from the “Welfare, Children and Families: A Three-City Study” – a six-year longitudinal investigation. Researchers measured the height and weight of the adolescents to determine their body mass index, which was subsequently used to determine weight status based on two widely used classification systems. Adolescent food insecurity status and individual, maternal, and family stressors were also determined through interviews.

The five factors used to determine the individual stressor index for the adolescents were:

  • Academic problems
  • Consumption of drugs and alcohol
  • Depression or poor mental health levels
  • Acting out or aggressive behaviors
  • Lack of future orientation.

The researchers wrote that the adolescents’ relationship with stress and becoming overweight may be a result of biological (perturbed hypothalamic-pituitary-adrenal glands) as well as behavioral responses to stress, such as overeating and lack of exercise.

“It could possibly be that the obesity is leading to these stressors too,” Lohman said. “And so the work that we’re doing right now looks at which one of these is really coming first: the stressors or the obesity. We know that it is cyclical and that all of these factors just compound on each other.”

The study also found that a mother’s stress, coupled with food insecurity in the household – a situation in which an individual cannot access enough food to sustain active, healthy living – contributes to a child’s chances of becoming overweight or obese.

“In our past research, we did not find this association for older youth (ages 11-17), we only found it for young children (ages 3-10) who were in a house that had enough food or were food-secure,” Lohman said. “But it may be that the adolescents are more cognitively aware of what’s going on in the household and they take on their mothers’ stress as well. This may be exacerbated in houses where there’s not enough food.”

Mothers receive the initial focus

While this study singles out mothers, fathers aren’t immune to their child’s weight status either.

“My own research focuses on fathers and shows that fathers, too, have an effect on children’s eating habits and obesity,” said Stewart, author of the book “Brave New Stepfamilies,” who had another study posted by the Journal of Adolescent Health last month on nonresident father involvement and adolescent eating patterns.

“In our latest study, we found that kids who are involved with nonresident dads eat better – more vegetables, less fast food,” she said. “However, similar to the Lohman study, living with a single mom was associated with worse eating habits.”

Lohman says the new research should emphasize the need for health care professionals to take a more holistic approach in their treatment of obese teens. “We absolutely have to focus on their (teens) health, well-being, nutrition and exercise – and education of these things for them,” she said. “But we really need to also look holistically at their life and work toward reducing stress and rates of food insecurity for those adolescents as well.”

Gunderson, Garasky and Lohman also published a study on the relationship between food insecurity and adolescent obesity. Among 2,516 participants (1,239 girls, 1,277 boys) drawn from the 2001-2004 National Health and Nutrition Examination Survey, 37 percent of families were considered food insecure. Using five different measures of obesity – BMI, waist circumference, triceps skinfold thickness, trunk fat mass, and percent body fat – the researchers determined that 15 percent to 45 percent of children were classified as obese. Yet they found no statistically significant relationship between food insecurity and obesity, regardless of which indicator was used. The study is online and published in the June 2009 issue of the Journal of Nutrition.

Lohman is part of another team of ISU researchers that just submitted a new grant proposal to develop family intervention strategies to reduce childhood obesity.

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Original Source: http://www.sciencedaily.com/releases/2009/05/090514125200.htm

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Publications & Tools

Leadership for Healthy Communities' Toolkit Offers Concrete Resources for Policymakers Working to Prevent Childhood Obesity

May 8, 2009

Leadership for Healthy Communities, a national program of the Robert Wood Johnson Foundation, released the Action Strategies Toolkit to help provide guidance on the best approaches policymakers can use to make their states, communities and schools healthier places to live.

The toolkit offers practical examples of policy approaches and resources covering a wide range of issues, including increasing access to parks and recreation centers, improving safety for bicyclists and pedestrians, offering healthier foods in schools, and attracting grocery stores that provide healthy, affordable foods to lower-income communities.

Download the Executive Summary and Action Strategies Toolkit here.

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Preventing Childhood Obesity: A School Health Policy Guide

May 6, 2009, RWJF Childhood Obesity News Digest

Schools have many powerful tools at their disposal to serve as one of the primary agents to address the obesity crisis. This policy guide is based on the National Association of State Boards of Education’s Fit, Healthy, and Ready to Learn: A School Health Policy Guide, a comprehensive document developed in cooperation with the Division of Adolescent and School Health of the U.S. Centers for Disease and Control and Prevention (CDC) divided into several chapters addressing various student health needs and the school’s role in addressing those needs.

The goal of this guide is to offer the latest policy updates and recommendations about how to promote physical education and activity and healthy eating policies in schools. To accomplish this goal, the guide refocuses the research and policy recommendations in these chapters to provide specific models for schools to address the childhood obesity epidemic. It is important to note, however, schools cannot and should not be expected to conquer this crisis alone. Instead, schools have a responsibility to work with parents, state and local government, and communities to take the necessary steps to truly address the epidemic.

Download the guide here.

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Daniels SR, Jacobson MS, McCrindle BW, Eckel RH, Sanner BW. American Heart Association Childhood Obesity Research Summit Report, Circulation, 2009;119:e489-e517.

As part of its strategic focus on childhood obesity, and particularly the prevention of childhood obesity, the American Heart Association convened a Childhood Obesity Research Summit to examine research opportunities where the obesity epidemic intersects with the healthcare system. The outcomes of the conference help inform the American Heart Association and the Alliance for a Healthy Generation broadly in terms that help to focus ongoing research and public policy initiatives.

CLICK HERE TO DOWNLOAD A PDF OF THE FULL DOCUMENT

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Childhood Obesity Research & News

Experts Testify Before Lawmakers on Fighting Childhood Obesity

May 14, 2009, RTT News - Global Financial Newswires

The House Healthy Families and Communities Subcommittee held a hearing in May where lawmakers heard testimony from expert witnesses on dealing with the growing problem of childhood obesity.

During the testimonies, lawmakers heard recommendations for both an increase and a decrease in federal government involvement in developing programs to fight childhood obesity.

Healthy Families and Communities Chairwoman Carolyn McCarthy (D-N.Y.) gave an overview of her experience with childhood obesity, stating that she has found that low income communities tend to have the highest obesity rates and that minority children are at the greatest risk for obesity.

Representative Michael Castle (R-Del.) argued that it is “clear we must work with state and local school districts to further address the important and complex issue of childhood obesity by supporting programs under current law that promote nutrition education and physical activity at the state and local level; implementing programs with proven results in improving health outcomes; and targeting those children who are at the greatest risk.”

Representative Lynn Woolsey (D-Calif.) testified that Congress should pass the bill she introduced, H.R. 1324, the Child Nutrition Promotion and School Lunch Protection Act.

According to Woolsey, the act “will ensure that all foods sold in schools during the entire school day are based on current, scientific, and sound nutrition standards.”

She further noted that it would “require that nutrition standards for foods sold in vending machines and ala carte lines meet standards for caloric intake, saturated fats, trans fats, and refined sugars.”

Nancy Copperman, director of Public Health Initiatives for the North Shore-LIJ Health System, discussed the importance of the Activity Works Program.

“The Activity Works Program is a unique elementary school physical activity program that integrates subject matter with an exercise physiologist designed beat per minute exercise protocol,” Copperman said.

She said it was specifically created to be easily implemented by a classroom teacher who “simply loads the CD or DVD into a player and the audio and/or video directs the class exercise program.”

“The Activity Works Program has been incorporated into the physical education curriculum of three school districts,” Copperman added.

“The program has provided an additional 50 minutes of Physical Education/week increasing daily activity and meeting New York State Department of Education Physical Education requirements without increasing staffing and space needs.”

“By increasing physical activity through the integration of subject matter and prescribed exercise in the classroom in daily 10 minute sessions, schools can address their physical activity wellness policy goals with gradual expansion to after school and home activities,” she continued.

“Activity Works is an example of one such innovative program.”

Reginald Felton, director of Federal Legislation for the National School Boards Association, testified that local schools should be the ones to implement programs to fight obesity, not Federal regulators.

“Federal mandates on our public schools should not be the vehicle for changes in society,” Felton argued.

“In our view, federal mandates on what is sold in our schools and what cannot be sold in our schools beyond federally subsidized food programs should not be adopted.”

He said the National School Boards Association believes that as local school board actions increase, positive changes in behavior will take place reflecting the will of the local communities.

“We feel that community-based decisions are much more effective in the long run than mandates from the federal government,” Felton said.

“Significant improvements in child nutrition and health will not be achieved through the expanded authority of the Secretary of Agriculture. Rather, it will be through the active engagement of local communities that hold strongly to the belief that those at the local level should best make such determinations.”

Virginia Stallings, Chair of the Committee on Nutrition Standards for National School Lunch and Breakfast Programs, took the opposite approach, asking for more government involvement in establishing obesity-fighting programs.

“It is now time to develop recommendations for further revisions to the nutrition standards and meal requirements of the school meal programs so that the program can achieve greater benefits for our nation’s children,” Stallings said.

She said that new revisions to the National School Lunch Program are needed, since revisions will “enable the programs to incorporate current public health recommendations and newer knowledge about the nutritional needs of children and adolescents and the impact on health in childhood and throughout the lifetime.”

A specific reason for revisions, Stallings stated, is the “alarming increases in the prevalence of childhood obesity coupled with the short and long term health consequences that will likely follow childhood obesity.”

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Original Source: http://www.rttnews.com/Content/PoliticalNews.aspx?Node=B1&Id=949584

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New Mexico Lawmaker Reintroduces Federal Obesity Prevention and Treatment Bill

May 21, 2009, RWJF Childhood Obesity News Digest

Sen. Jeff Bingaman (D-N.M.) has reintroduced legislation aimed at reducing the nation’s obesity epidemic, the Associated Press reports. The multifaceted Obesity Prevention, Treatment and Research Act of 2009 seeks to foster collaborative efforts among federal agencies, private entities and communities to reduce adult and childhood obesity. Specifically, the measure seeks to establish the United States Council on Overweight and Obesity Prevention (USCO-OP), which would be tasked with developing a comprehensive national strategy aimed at reducing and preventing overweight and obesity. The USCO-OP would work to update federal guidelines, identify best practices, perform ongoing surveillance and monitoring of existing federal programs, and update daily physical activity requirements for schools.

The council would also team with the secretaries of the U.S. Department of Health and Human Services and the U.S. Department of Agriculture (USDA) to update and reform federal oversight of food and beverage labeling. The legislation also would allow for enhanced access to nutritional counseling, prevention services and physical education programs for beneficiaries of Medicare, Medicaid and other federal programs and would allot additional funding to the USDA’s Fresh Fruits and Vegetables program. Meanwhile, the bill would create grant programs to support initiatives launched in schools, community health centers, medical societies, state health departments and communities that are designed to prevent and treat overweight and obesity. Calling obesity a “costly program for the United States both in terms of health care expenditures and the loss of life,” Bingaman notes that the bill marks “a first step to helping address this epidemic.” (AP/KWES NewsWest 9, 5/19/09; Office of Sen. Jeff Bingaman, release, 5/18/09)

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Original Source: http://www.rwjf.org/publichealth/digest.jsp?id=10807

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Massachusetts Approves Nation's Toughest Menu-Labeling Rules

May 14, 2009, RWJF Childhood Obesity News Digest

The Massachusetts Public Health Council has approved a measure requiring restaurant chains to display the calorie counts of all items on menus, including drive-through menu boards, effectively creating the nation’s strictest statewide menu labeling rules, Reuters reports. Created to address rising obesity rates, the regulations mandate that chain restaurants with 20 or more in-state outlets post the calorie count next to each menu item. The mandate, slated to take effect November 1, 2010, applies to 50 restaurant chains, accounting for 5,800 locations, according to Reuters. Although California and New York City have passed similar regulations “the drive-through component makes the Massachusetts measure the most stringent in the country,” according to Judy Grant, the campaign director of the advocacy group ValueTheMeal.org. In addition, the state policy will not supersede regulations from other municipalities that enforce even tougher labeling rules, marking a distinct departure from California’s regulations, which nullified menu labeling regulations that had been passed in San Francisco, Santa Clara and San Mateo counties. Commenting on the measure, Massachusetts Department of Public Health Commissioner John Auerbach says it “is a major step in the right direction in fighting the obesity epidemic,” adding that, “with more than half our adult population and one-third of our middle and high school students either overweight or obese, we need to do more to make informed choices” (Szep, Reuters, 5/13/09; Kirk, Eagle-Tribune, 5/13/09).

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Original Source: http://www.rwjf.org/childhoodobesity/digest.jsp?id=10711

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Schools Face Hurdles in Adopting Healthier Meals

May 27, 2009, RWJF Childhood Obesity News Digest

Poor enforcement of nutritional standards and a proliferation of fast-food restaurants are making it increasingly difficult for school districts and state governments to improve the nutritional quality of school meals, Reuters reports. Currently, the U.S. government spends $11.7 billion annually on the National School Lunch Program and School Breakfast Program, which provide meals for 30 million and 10 million students, respectively, but nutritional standards for the programs were last updated in 1995.

In the absence of broader reform, 18 states and some individual schools have adopted their own stricter nutrition standards for school meals. The Los Angeles Unified School District has eliminated deep-fat fryolators, improved fresh fruit offerings and reduced the sodium content of school meals. The district also has banned sugary sodas and no longer stocks vending machines with junk food. Despite such individual efforts, states lack the authority to punish schools that fail to comply with the revised standards. Additionally, efforts by many schools to enhance the nutritional value of their meals have been thwarted by an influx of fast-food options in the immediate community.

According to a study from the Trust for America’s Health and the Robert Wood Johnson Foundation, the number of fast-food restaurant outlets in the United States increased from 30,000 in 1970 to 220,000 in 2001, and fast-food spending has increased from $6 billion to $110 billion over the last three decades. However, comprehensive reform of school meal programs may be on the horizon, as President Obama recently announced plans to increase funding for U.S. child nutrition programs by $1 billion per year in light of the current economic downturn (Baertlein, Reuters, 5/26/09).

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Original Source: http://www.rwjf.org/childhoodobesity/digest.jsp?id=10860

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Survey Finds Link Between Obesity and Flu Severity

May 20, 2009, The Washington Post

By David Brown and Robin Shulman

A survey of people hospitalized because of swine flu in California has raised the possibility that obesity is as much of a risk factor for serious complications from the flu as diabetes, heart disease and pregnancy, all known to raise a person’s risk.

In all, about two-thirds of the California patients had some underlying medical condition, according to a report yesterday in the weekly bulletin of the Centers for Disease Control and Prevention.

Nationwide, 47 states and the District have reported 5,469 cases and six deaths since the start of the outbreak in late April, according to the CDC’s count. Yesterday, officials in Missouri reported a seventh U.S. death – that of a 44-year-old man who had no underlying medical problems, wire services reported. “We were surprised by the frequency of obesity among the severe cases that we’ve been tracking,” said Anne Schuchat, one of the CDC epidemiologists managing the outbreak. She said scientists are “looking into” the possibility that obese people should be at the head of the line along with other high-risk groups if a swine flu vaccine becomes available.

Other studies have shown that pregnant women are also at higher risk for serious influenza infection, especially in the third trimester, when the fetus and womb compress the lower parts of the lungs. This makes it harder to breathe deeply and cough forcefully; it may also alter blood flow in the chest. A similar thing may be occurring in severely overweight people, some experts speculated.

The average age of the 30 Californians hospitalized for swine flu was 27.5 years. Nearly three-quarters were women, and 65 percent were Hispanic. Half lived in two counties bordering Mexico.

Of the 30 people, 11 had a lung ailment such as asthma or emphysema, six had an immune disorder, five had heart disease, five were pregnant, four had diabetes and four were obese.

In New York, Mayor Michael R. Bloomberg (I) said officials were investigating whether 16-month-old Jonathan Castillo, who died with a high fever Monday night at a Queens hospital, had contracted the H1N1 virus. The toddler’s 3-year-old sibling was treated for flulike symptoms and released.

The mayor said lack of health insurance or immigration status should not deter people who feel sick from seeking attention.

“Whether you have health insurance coverage or your immigration status is in question, it doesn’t matter,” Bloomberg said. “We will not ask about that.” The mayor also said four inmates at a Rikers Island jail had been confirmed to have the H1N1 virus and four more are likely to have it.

The union representing the city’s correctional officers criticized the response to the swine flu outbreak among inmates and filed a letter of protest with the state Labor Department.

“If I had to design a place where you could put people who were sick and get as many people sick as possible, it’s the New York City jail,” said Richard J. Koehler, a lawyer for the Correction Officers’ Benevolent Association.

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Menu Labeling Bill Introduced by U.S. Lawmakers

May 16, 2009, Los Angeles Times

By Jerry Hirsch
jerry.hirsch@latimes.com

Two federal lawmakers have introduced legislation to require fast-food and other chain restaurants to post calories on menu boards and food display tags. The chains also would have to put information about calories, fats, carbohydrates and salt on printed menus.

Sen. Tom Harkin (D-Iowa) and Rep. Rosa DeLauro (D-Conn.) on Thursday introduced the Menu Education and Labeling Act, called the MEAL Act for short. They said it would help consumers make more informed choices about the nutritional content of the food they are ordering. The bill has the support of many consumer and health groups and emulates legislation signed by Gov. Arnold Schwarzenegger in September that requires chain restaurants in California to display calorie counts with each menu item. That was the nation’s first state law of its kind; it won the support of the California Restaurant Assn. because it standardized requirements and preempted ordinances in Santa Clara and San Francisco.

Health advocates believe that when people see the amount of calories, fat and salt in meals before they order them, they will gravitate to more healthful selections.

“Consumers play an impossible guessing game trying to make healthier choices in restaurants,” said Margo Wootan, nutrition policy director for the Center for Science in the Public Interest. “Who would guess that a large chocolate shake at McDonald’s has more calories than two Big Macs or that a multigrain bagel at Dunkin’ Donuts has 140 more calories than a jelly doughnut?” The restaurant industry is pushing a competing bill. The Labeling Education and Nutrition Act, nicknamed the LEAN Act, would require chains with more than 20 units to post calorie counts. It also would nullify state and local measures now in effect and preempt future regional measures.

New York City already has a law, and more than a dozen states and numerous cities are pondering menu-labeling legislation. The cities and states with such regulations take different approaches. New York requires the posting of calories, whereas Seattle requires a listing of calories, sodium, saturated fat and carbohydrates.

Americans get a third of their calories from eating out, according to the Center for Science in the Public Interest. “At table-service chains like Ruby Tuesday, Macaroni Grill and Chili’s, it’s easy to find 1,000-calorie appetizers, 1,000-calorie entrees and 1,000-calorie desserts. Not surprisingly, about two-thirds of American adults and a third of children and adolescents are overweight or obese,” Wootan said.

Some chains aren’t waiting for legislation.

Yum Brands Inc., the parent of KFC, Taco Bell and Pizza Hut, plans to add product calorie information to menu boards in its company-owned restaurants nationwide and to encourage franchise owners to do the same. The company said the calorie information would be phased onto menu boards starting this year and be completed by Jan. 1, 2011.

It’s a big move by one of the largest purveyors of fast food. Louisville, Ky.-based Yum franchises or owns about 20,000 U.S. restaurants.

The California law applies to restaurants with 20 or more locations in California, about 17,000 eateries. Beginning July 1, they must provide brochures with the number of calories and grams of saturated fat for each item. Starting Jan. 1, 2011, all menus and menu boards will have to include the number of calories for each item.

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Original Source: http://www.latimes.com/business
/la-fi-menu16-2009may16,0,1209361.story

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