May 2010





Current Anti-Soda Strategies Not Curbing Childhood Obesity, May Warrant Higher Tax

April 6, 2010, Yale University Office of Public Affairs

Efforts to curb childhood obesity through school vending machine restrictions and making soft drinks more expensive with low levels of additional taxation have had a negligible effect, to date, on the waistline of America’s youth, a new study led by the Yale School of Public Health has found. The paper appears online in Health Affairs.

Researchers studied whether the two policy approaches have slowed what many regard as a childhood obesity epidemic that has been fueled, in part, by growing consumption of soda and other sugar-based beverages. Lead researcher Jason M. Fletcher, Ph.D., an assistant professor in the Yale School of Public Health, said evidence shows that as currently practiced, neither public health policy is working.

“Our strongest finding is that current policies of low soda taxes and incremental soft drink restrictions do not lead to any noteworthy weight reductions in children,” Fletcher said. “However, it remains possible, and perhaps likely, that more comprehensive policies such as higher taxes and a complete ban on sodas at school could work.”

Fletcher and co-authors David Frisvold of Emory University and Nathan Tefft of Bates College said that children are not deterred by vending machine bans. They simply find high-calorie substitutes or get soft drinks elsewhere. In schools that allow access to soft drinks, 86 percent of the students reported consumption within the past week, the study found. In schools without access, 84 percent of the students still consumed the beverages.

The prevalence of obesity in children ages 6-19 has approximately tripled since the late 1970s. Many health professionals believe that soda consumption is one of the factors driving this change. Soda intake has increased 500 percent in the past 50 years and is now the single largest category of calories for children, even surpassing milk.

How high is high enough?

Frisvold and Tefft say that any increase in soda taxes would have to be substantial to make a difference. They believe that increasing the tax to 6 percent (more than double the current rate) would result only in a small reduction in weight.

The nonprofit research organization RAND, likewise, has determined it would take a higher tax on soda to curb childhood obesity. The small tax on soda of 3.5 percent to 7 percent might help control childhood obesity in some subgroups, but to make an impact, higher tax on soda is needed.

Roland Sturm, the study’s lead author and a senior economist at RAND says imposing a small tax on sodas does not seem to have any noticeable effect on consumption of soft drinks, nor does it help curb obesity. Sturm says, “If the goal is to noticeably reduce soda consumption among children, then it would have to be a very substantial tax.”

The researchers looked at 7,300 children enrolled in the Early Childhood Longitudinal Study, an ongoing study of children that has been underway for years, examining variances in sales tax and rates of soda consumption and obesity.

The research group found wide variances among children’s patterns of consuming soft drinks. The average number of sodas consumed was six per week. The study showed that neither tax on sodas, or the amount consumed had any link to weight gain in children except among those at higher risk for obesity. Higher tax on the drinks in some states seemed to curb weight gain for those who were heavier, low-income families, those who watched television frequently, and among African American children.

The study suggests that a higher tax is needed on soda to curb childhood obesity, and that the current low tax on soft drinks has little effect for reducing soft drink consumption among children at high risk. An eighteen percent tax on soda would do more to curb childhood obesity.

Imposing higher taxes on soda could reduce obesity by 20 percent among third- to fifth-grade children. The researchers also suggest rather than raising soft drink taxes, an excise tax on sugar could increase the price of soft drinks and be more effective, versus a sales tax collected at checkout. How soda tax is implemented “[is] key to whether [it] create[s] measurable impact,” Sturm said.


Original Sources: higher-tax-needed-soda-curb-childhood-obesity.html

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Publications & Tools

Energy Balance Fact Sheet from RWJF Center

The energy balance is the relationship between how many calories we consume through foods and beverages (energy in), and how many calories we burn through physical activity and daily living (energy out). How well we manage the balance between eating and physical activity strongly influences our overall health and our chances of developing obesity.


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2010 Active Healthy Kids Canada Report Card Released

The focus of this year’s Report Card is the early years, as data show that less than half of Canadian kids younger than age 5 are getting regular physical activity as part of daily routines, and obesity and overweight are on the rise in this age group in Canada.

Research shows that children who are obese before age 6 are likely to be obese later in childhood, and overweight 2- to 5-year-olds are four times more likely to be overweight as adults.


Read more about Active Healthy Kids Canada Report Card below.

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Report Details Obesity Prevention Framework to Inform Decision Making

In April, the Institute of Medicine (IoM) released a consensus report titled “Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making.” The report is sponsored by the Robert Wood Johnson Foundation, Kaiser Permanente, and the Centers for Disease Control and Prevention.

In 2008, IoM was tasked to develop a practical, action-oriented framework to guide the use of evidence in decision making about obesity prevention policies and programs and to guide the generation of new and relevant evidence. The resulting L.E.A.D. framework, short forLocate evidence, Evaluate it, Assemble it, and Inform Decisions,” is an innovative process for generating, identifying, evaluating, and assembling evidence to inform the decisions that must be made about obesity prevention.

This report is primarily aimed at decision-makers and their intermediaries in the private and government sectors, practitioners in public health and other sectors, and program evaluators and public health researchers, with secondary audiences including research funders, journal editors, and the media. If decision-makers are able to collect and use the best available evidence and work with researchers to generate additional useful evidence, they will be armed with the most appropriate and relevant knowledge to help turn around the obesity epidemic.


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Childhood Obesity Research & News

Early Years Must Be Active Years

April 27, 2010, Active Healthy Kids Canada

We think of very young children as being in perpetual motion, constantly exploring their environments. But according to recent findings in the 2010 Active Healthy Kids Canada Report Card, they’re not on the move enough.

“We assume that young children are full of energy and will just naturally be active, but that’s not always the case,” says Dr. Art Quinney, Chair of the Active Healthy Kids Canada Board of Directors. “The Report Card tells us that less than half of Canadian kids younger than age 5 are getting regular physical activity as part of their daily routines.”

Canadian data indicate that less than half of kids aged 4-5 — and just one third of 2- to 3-year-olds—participate in regular, unorganized sports and other physical activities each week. And in childcare facilities, where more and more kids are spending their days, physical activity levels are low, with as much as 89 percent of kids’ time spent sitting still.

The Report Card offers the most comprehensive assessment of child and youth physical activity opportunities in Canada. Active Healthy Kids Canada produces and delivers the Report Card in partnership with the Healthy Active Living and Obesity Research Group at the Children’s Hospital of Eastern Ontario (CHEO-HALO) and ParticipACTION, as well as a national Research Work Group and network partner organizations that represent each province and territory in Canada.

“This year, we’re shining a spotlight on the early years. Because unfortunately, we know that many young kids are on the path to inactivity and obesity before they even begin school,” says Dr. Mark Tremblay, Chief Scientific Officer, Active Healthy Kids Canada and Director of HALO.

“Growing evidence shows that physical activity must be a fundamental part of the early-life experience, but Canada does not currently have physical activity guidelines for children five and under.”

According to the Report Card, physical inactivity in the early years should be high on the public agenda given that lifestyle patterns set before age 6 can actually predict overall health and obesity outcomes later in life. Children who are obese before the age 6 are likely to be obese later in childhood, and those who are overweight by the ages 2-5 are already four times as likely to be overweight as adults.

“Active play may be lots of fun for youngsters, but it’s certainly not frivolous,” says Tremblay. “Children younger than age 5 actually require plenty of active play for healthy physical, social, emotional and cognitive development.”

While international guidelines vary, the global consensus is that all children aged 1-5 should get at least two hours of physical activity spread out throughout each day, over recreational activities, active transportation and playtime.

It takes a village to raise an active child

According to the Report Card, the overall physical activity levels of a child are impacted by a variety of influencers, including family and peers, schools, community and the built environment, and policy.

At the societal level, our country must make a stronger commitment to its youngest citizens. In a 2008 UNICEF study, which assessed 25 economically advanced countries on 10 indicators ranging from the training provided to childcare staff, to national investments made to help children develop in their early years, Canada ranked in last place overall. The study’s key criticism of Canada’s efforts? A lack of “substantial public investment in education until children reach [age 5].”

“Our youngest generation deserves a strong start in life,” says Michelle Brownrigg, CEO of Active Healthy Kids Canada. “We have the opportunity to secure a healthier future for our young children by ensuring that policies mandate daily physical activities in schools and childcare facilities, investing in safe parks and play structures, and providing caregivers and educators with training and support to provide adequate physical activity opportunities to kids.”

In homes across Canada, parents and caregivers can also make a commitment to the youngest generation by dialing down the screen time.

“We’re still seeing time spent in front of television, computer and video game screens at unhealthy levels—even for kids as young as age 2,” says Tremblay.

The Report Card tells us that 90 percent of kids start watching TV before they’ve reached their 2nd birthday—even though experts recommend that children of this age group should get zero screen time.

It all adds up to a healthier, more active lifestyle

Parents, educators, health professionals and community programmers might feel overwhelmed at the thought of trying to keep little ones active for two or more hours each day. What they need to remember is that the activity can be built into a child’s regular routine, and should be spread out in blocks of time throughout the day.

“Parents must know that smaller, incremental routine changes can have major benefits in the health and wellbeing of their children,” says Kelly Murumets, President and CEO of ParticipACTION. “Families can make the local playground a regular destination, and encourage their toddler to climb, swing and simply explore the park with them. Or, they can rake the lawn, bike to the store or go for regular walks after dinner.”

Healthy household habits, including reduced screen time, regular physical activity and lots of healthy role modeling, can set young kids on the path to physical activity for life.

View the short form 2010 Active Healthy Kids Canada Report Card.

For more information on Active Healthy Kids Canada, visit

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Citing Child Obesity, County Bans Fast-Food Toys

April 27, 2010, New York Times

By Jesse McKinley

It was not a happy day for the Happy Meal. In what it described as a blow against the fattening temptations of fast food, the board of supervisors in Santa Clara County, south of San Francisco, voted April 27 to ban the promotional toys that often accompany child-size portions of cheeseburgers and chicken nuggets if those meals don’t meet certain nutritional standards.

The criteria, which are based on federal standards and recommendations from the nonprofit Institute of Medicine, would apply to all fast-food restaurants giving away toys in meals in-tended for children. Ken Yeager, the board president, said the new law would level “the playing field by taking away the incentive to choose fatty, sugary foods over healthier options.”

“What we’re trying to do is de-link the connection between unhealthy food and toys,” said Mr. Yeager, who added that he believed children chose their meals based on the giveaway that came with it. “Why would a kid say ‘I want a burger with fries’? It’s the toys that they want.”

The law, the first of its kind, will allow restaurants to give away toys as long as the meals don’t contain excessive calories, sodium, sugar or fat. “This ordinance does not attack toys,” Mr. Yeager said just before the board passed the law by a 3-2 vote. “Toys, in and of themselves, do not make children obese.”

One of four children in Santa Clara is obese, with even higher rates among low-income residents, a target audience for the various cheap meals that fast-food restaurants offer. Obesity is also a big problem nationwide. Two-thirds of adults 20 years and over are overweight or obese, according to the National Center for Health Statistics. Numbers for children and adolescents are much lower, however, ranging from 11 percent to 18 percent.

Mr. Yeager, who does not have children, said the law would take effect this summer after a final vote this month. Walt Riker, a spokesman for McDonald’s, said it was disappointed by the board’s action, adding that “our Happy Meals provide many of the important nutrients that children need,” including zinc, iron and calcium.


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United States, Mexico First Ladies Strive for Healthy Obesity Dialog

April 12, 2010, The Dallas Morning News

By Lauren Villagran

MEXICO CITY – With a basket of bread and a plate of milanesa, or fried steak, in front of him, Erik Flores was poised to repeat a daily – if unhealthy – ritual: eating fast food on his lunch break.

The 32-year-old commutes nearly two hours to his job at a bank in this frantic city, leaving him no chance for breakfast at home or time to return during the lunch hour.

“Sometimes we miss eating at home,” he said, as a colleague nodded in agreement. “It’s more relaxed. It’s cleaner. But we have no choice but to eat out.”

Life here, as in other industrialized regions of Mexico, is lived largely in the street. That means fewer home-cooked meals and more problems with weight.

It’s this transition that is at the heart of a ballooning problem in Mexico, one that Texas and the entire United States shares: the surge of obesity and diabetes in children and teenagers. It was also likely the top issue on the table when first lady Michelle Obama met with her counterpart, Margarita Zavala de Calderón, for a two-day meeting in Mexico City.

The statistics are “surprising and alarming,” said Mexico Health Secretary José Ángel Córdoba Villalobos. Some 4.5 million children and 6 million teenagers in Mexico are overweight or obese. In just seven years, the incidence of obesity in children ages 5 to 11 has swelled 77 percent and has prompted the health department to set a goal of reversing the obesity trend in Mexico’s youngest children by 2012.

Mexico’s widening waistline mirrors that of its northern neighbor. In the U.S., childhood obesity has more than tripled in the past 30 years. Nearly 20 percent of children between the ages of 6 and 11 were obese in 2008, up from 6.5 percent in 1980, according to the Centers for Disease Control and Protection. In Texas, nearly a third of high-schoolers and 42 percent of fourth-graders are overweight or obese, according to the latest data from the Texas Department of State Health Services.

Social changes

Experts say that what’s at work in Mexico is a social transition in which more people work in offices, both parents work outside the home, and more children and their families eat meals out.

But “meals” eaten at popular food stands on the street or snacks bought at school cooperatives are often unbalanced and too full of fat and sugar, said María Estela Fuentes, a nutritionist and diabetes educator in Mexico City.

“Parents aren’t paying attention to what their children are eating,” she said. “Both parents work, and they give them money to buy food at school. There aren’t healthy options.”

That’s not to say that traditional Mexican food is unhealthy. A diet based on corn, legumes and vegetables, Mexican food can be highly nutritious. In fact, Mexico recently applied to have the traditional cuisine of Michoacán state recognized by UNESCO as part of the world’s “intangible heritage.”

“Everything depends on how we combine foods,” said Fuentes.

A typical Mexican comida corrida, or lunch, could include a noodle soup, then rice, then an entrée accompanied by tortillas – far too many carbohydrates for one sitting, she said.

And then there’s the temptation of the tienditas, or little snack stores often found two to a block here, packed with snacks in brightly colored wrappers like chocolates, sugar-coated peanuts, sweet tamarinds with chili powder, apple and “sangria” soda and other sugary drinks.

Too often, these sweets are consumed like staples rather than occasional treats.

Mexico ranks as one of the world’s top consumers of soft drinks, downing an average of 42 gallons per person per year, but people in parts of Texas and the American South consume nearly double that amount at home, between 70 and 89 gallons per capita, according to the U.S. Department of Agriculture’s Economic Research Service.

Junk food ban

Some regions of Mexico have taken some steps to curb children’s access to junk food. The southern state of Guerrero recently instituted a ban on selling junk food in schools, which takes effect in the coming school year. The effort will be coupled with education on healthy eating and a plea by the government to beverage and snack producers to curb sales of low-nutrient foods around schools.

Still, if the change doesn’t start at home, efforts in the schools have little chance of gaining traction, said Dr. Sigfrido Miracle, an endocrinologist who works with diabetic children and adults.

“We are a seeing a black market by children in which they are exchanging sweets ‘underground’ on the playground,” he said. “If we don’t educate the children at home, it is very difficult to take care (of) everything at school.”

Michelle Obama has confessed that her family faced similar challenges at home before arriving at the White House. With both parents working and busy, the children were eating more fast food and fewer home-cooked meals, and the habit began to take a toll.

“It got to the point where our pediatrician basically said, ‘You may want to make some changes,’ “ she said in a video interview on “I wanted to bring the lessons I learned to the White House.”

Let’s Move is a four-point program, started by Obama, that aims to provide parents with information on making changes at home, improve the quality of food in schools, improve access to and the affordability of healthy foods, and encourage more physical education.

Both Obama and Zavala “have been highly successful at balancing their family life and work life,” said Dr. Judith Palfrey, president of the American Academy of Pediatrics, who has met separately with Obama and Zavala on the issue, “and that’s a balance we all need to move to.”

Lauren Villagran is a freelance journalist based in Mexico City.


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Michelle Obama Delves into the Details on Kids’ Obesity at Task Force Meeting

April 10, 2010, The Washington Post

By Robin Givhan

The fresh-faced elementary-school children were nowhere to be seen. There were no bright spring vegetables being harvested, no celebrated athletes or actors for added sizzle. First lady Michelle Obama’s campaign against childhood obesity got down, dirty and wonkish with a gathering of administration officials reeling off statistics and academics quoting from research papers.

Obama’s opening remarks, low-key and without exclamation points, set the tone for the afternoon. She sounded more like an executive preparing to dive into the minutiae of an immense project than a first lady speaking in sweeping statements that are designed to inspire.

“We’ve started an important national conversation. But we need your help to propel that conversation into a national response,” she said. “The information that we collect here today will be essential to construct the final report that’s going to come from the task force – a report that will serve as a very important road map, with goals, benchmarks, measurable outcomes that will help us collectively tackle this challenge.”

Obama gathered about 100 suits, professors, politicos and activists in the South Court Auditorium in the Old Executive Office Building where the air was artificially chilled, the lights were flickering and four American flags adorned the stage. Peter Orszag – Office of Management and Budget – was in the house detailing the financial costs of obesity-related health care: about $150 billion a year. Arne Duncan – Department of Education – was on stage talking about the importance of eradicating “recreation deserts,” those neighborhoods where kids simply have no place to play. And Ken Salazar – Department of the Interior – was making a pitch for building more parks in the vicinity of schools.

Back in February, when the first lady launched “Let’s Move,” her childhood obesity initiative, the president signed a memorandum creating a task force charged with developing workable ideas to help end childhood obesity within a generation. This summit brought together members of the task force, as well as folks who have, for years, been in the trenches doing research and trying to come up with ways to change the unhealthy eating habits of a nation.

The opening session did not get fizzy, but during the question-and-answer portion, with hands flying up left and right, many of the task force members in attendance proved themselves to be eager and well-read students on obesity. Deputy Secretary of Agriculture Kathleen Merrigan highlighted the connection between hunger and obesity, a paradox stemming from the lack of access to healthy food. Duncan reminded everyone about his department’s $1 billion budget. Then he talked about the importance of taking a holistic approach to education: “If we want students to be much more successful academically, they have to be active.” “I’m a big fan of recess,” he said.

Surgeon General Regina Benjamin noted that large corporations should provide female employees with a clean and private place to breast-feed because, she said, research has shown that children who are breast-fed for the first six months of their lives are less likely to become obese.

And Orszag proclaimed himself a star pupil, noting that he hadn’t met all the researchers sitting in the front row but he’d read all their work. Then he showed off his knowledge of behavioral economics while discussing how proximity to running trails, bike lanes and gyms makes people more likely to exercise; even four blocks can make a difference. He went on to note that the relationship between obesity and chronic disease is more profound than the connection between smoking and illness. Obese employees are less productive at work, he said.

And then for extra credit: Obesity causes premature aging, he posited. “Forty may be the new 30; but if you’re obese, 40 is the new 60.”

After about an hour, the audience divided into smaller groups to brainstorm. Melody Barnes, the director of the Domestic Policy Council and chair of the task force, gave them their assignment. “Come up with three to five of the best ideas, the important actions, the task force should recommend to the president,” she said. Don’t come back with 10 to 15, she warned. Focus. Edit. “Think critically.”

Class dismissed.


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