November 2010





School Cafeterias to Try Psychology in Lunch Line

Oct. 12, 2010, Associated Press

By Marilynn Marchione

Hide the chocolate milk behind the plain milk. Get those apples and oranges out of stainless steel bins and into pretty baskets. Cash only for desserts.

These subtle moves can entice kids to make healthier choices in school lunch lines, studies show. Food and restaurant marketers have long used similar tricks. Now the government wants in on the act.

The U.S. Department of Agriculture announced what it called a major new initiative, giving $2 million to food behavior scientists to find ways to use psychology to improve kids’ use of the federal school lunch program and fight childhood obesity.

A fresh approach is clearly needed, those behind the effort say.

About one-third of children and teens are obese or overweight. Bans on soda and junk food have backfired in some places. Some students have abandoned school meal programs that tried to force-feed healthy choices. When one school district put fruit on every lunch tray, most of it ended up in the garbage.

So instead of pursuing a carrot or a stick approach, schools want to entice kids to choose the carrot sticks, figuring children are more likely to eat something they select themselves.

“It’s not nutrition till it’s eaten,” said Joanne Guthrie, a USDA researcher who announced the new grants. The initiative will include creation of a child nutrition center at Cornell University, which has long led this type of research.

Some tricks already judged a success by Cornell researchers: Keep ice cream in freezers without glass display tops so the treats are out of sight. Move salad bars next to the checkout registers, where students linger to pay, giving them more time to ponder a salad. And start a quick line for make-your-own subs and wraps, as Corning East High School in upstate New York did.

“I eat that every day now,” instead of the chicken patty sandwiches that used to be a staple, said Shea Beecher, a 17-year-old senior.

“It’s like our own little Subway,” said Sterling Smith, a 15-year-old sophomore. (Hint to the school: Freshen up the fruit bowl; the choices are pretty narrow by the time Smith gets to his third-shift lunch period.)

Last year, the USDA asked the Institute of Medicine for advice on its school lunch and breakfast programs, which provide free or subsidized meals to more than 31 million schoolchildren each day. The institute recommended more fruit, vegetables and whole grains with limits on fat, salt and calories. But it was clear this wouldn’t help unless kids accepted healthier foods, Guthrie said.

“We can’t just say we’re going to change the menu and all of our problems will be solved,” she said.

The agency requested proposals from researchers on how to get kids to actually eat the good stuff. Cornell scientists Brian Wansink and David Just will get $1 million to establish the child nutrition center. Fourteen research sites around the country will share the other $1 million.

“Findings from this emerging field of research — behavioral economics — could lead to significant improvements in the diets of millions of children across America,” Agriculture Secretary Tom Vilsack said in a statement.

Cornell’s focus will be developing “smart lunchrooms” that guide kids to make good choices even when more tempting ones are around.

“We’re not taking things away from kids,” Wansink said. “It’s making the better choice the easier, more convenient choice.”

Wansink is a prominent food science researcher, known for studies on the depiction of food in paintings of the Last Supper and how the placement of a candy jar can affect how much people eat from it.

Christine Wallace, food service director for Corning City School District near Cornell University, met him a few years ago and invited him to use her 14 schools as a lab.

“We tend to look at what we’re offering and to make sure it’s well prepared and in the correct portion size, and not the psychology of it. We’re just not trained that way,” Wallace said.

For example, some Corning schools had express lines for a la carte items — mostly chips, cookies and ice cream. The idea was to reduce bottlenecks caused by full tray lunches that took longer to ring up. But the result was a public health nightmare.

“We were making it very convenient for them to quickly go through the line and get a bunch of less nutritious items,” Wallace said.

After studies by Wansink, they renamed some foods in the elementary schools — “X-ray vision carrots” and “lean, mean green beans” — and watched consumption rise. Cafeteria workers also got more involved, asking, “Would you rather have green beans or carrots today?” instead of waiting for a kid to request them.

And just asking, “Do you want a salad with that?” on pizza day at one high school raised salad consumption 30 percent, Wansink said.



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Publications & Tools

Dietary Data Brief: Snacking Patterns of U.S. Adolescents

October 2010, USDA ARS Food Surveys Research Group

Dietary patterns established during childhood and adolescence often persist into adulthood, and therefore have implications for the risk of developing chronic diseases, not only in the near term but also in the future. Rising rates of overweight and obesity among children and adults in recent years have led researchers to evaluate associations between various eating patterns and weight status. One pattern that has received considerable attention is eating more frequently, particularly in the form of snacking. Although some studies have shown that eating patterns which include snacking may help people meet their nutrient needs, other studies indicate that snacking can lower the nutrient density (i.e., the amount of nutrients per calorie) of the total diet. Data on the prevalence of snacking among adolescents and its association with body mass index and with food and nutrient intakes are presented in this report.


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Lunch Line Redesign

Oct. 19, New York Times

By Brian Wansink, David R. Just and Joe McKendry

School cafeterias are much criticized for offering the kind of snack foods and desserts that contribute to childhood obesity. But banning junk food from cafeterias, as some schools have tried, or serving only escarole or tofu, can backfire. Students then skip lunch, bring in their own snacks or head out for fast food. We’ve even seen some pizzas delivered to a side door.

Children and teenagers resist heavy-handed nutritional policies — and the food that is associated with the heavy hand. No food is nutritious, after all, until it is actually eaten.

A smarter lunchroom wouldn’t be draconian. Rather, it would nudge students toward making better choices on their own by changing the way their options are presented. One school we have observed in upstate New York, for instance, tripled the number of salads students bought simply by moving the salad bar away from the wall and placing it in front of the cash registers.

Experiments that we and other researchers have done in cafeterias at high schools, middle schools and summer camp programs, as well as in laboratories, have revealed many ways to use behavioral psychology to coax children to eat better. Here are a dozen such strategies that work without requiring drastic or expensive changes in school menus.



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Sugar-Sweetened Beverage Fact Sheets Available

The Yale Rudd Center for Food Policy and Obesity has developed and released new materials to inform the national discussion on sugar-sweetened beverage (SSB) taxes. They are designed to address the inclusion of beverages in addition to soda in the definition of SSBs. The resources focus on sports drinks, enhanced water, and energy drinks and include definitions, a synopsis of research, position statements from national organizations when applicable, and talking points for use in campaigns to reduce SSB consumption.


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Childhood Obesity Research & News

Chicago School Gardens' Produce Doesn't Wind Up in Lunchrooms

Oct. 19, 2010, Chicago Tribune

By Monica Eng

It’s harvest time in Chicago Public School gardens full of chubby tomatoes, heavy squash and fragrant basil. These urban oases, carefully tended by teachers, students and volunteers, range from several square feet to several acres of fruits, vegetables, herbs and flowers, and some schools even grow plants year-round in school greenhouses.

But one thing the more than 40 gardens have in common is that none of the produce ever finds its way into CPS lunchrooms. Instead, because of rules set by the district and its meal provider, the food is sold or given away. The policies are in place despite the high obesity rate among Illinois children and experts’ concerns that young people are eating few fresh vegetables. Meanwhile, studies suggest children eat and accept vegetables much more readily when they have helped grow them.

But in a district that touts its use of some local produce in the lunchroom, the most local of all remains forbidden fruit.

Kathleen Merrigan, deputy secretary of agriculture at the U.S. Department of Agriculture, recently toured a CPS school garden at the Academy for Global Citizenship on the Southwest Side. There, two second-grade girls showed her the eggplant, squash and tomatoes they grew, along with the chickens they kept for eggs.

“Ideally, all of those products would make it from the garden to the lunchroom,” Merrigan said. But rules created by CPS and its meals supplier, Chartwells-Thompson, prevent that from happening.

“In order to use food in the school food program, it would need to meet specific/certified growing practices,” CPS spokeswoman Monique Bond said.

These requirements would include eliminating all “pesticides and insecticide” applications and using only “commercially prepared organic compost and fertilizers,” said Bob Bloomer, regional vice president of Chartwells-Thompson.

Commercial vendors, though, don’t have to abide by these rules. They can sell the district produce treated with several pesticides and grown in nonorganic fertilizer.

But produce grown by the Chicago High School for Agricultural Sciences on its 25-acre farm wouldn’t make the grade because, for example, it treats its corn with a single pesticide.

Instead, the high school ends up selling most of the bounty — including pumpkins, tomatoes, squash, greenhouse basil, farm-raised tilapia, fresh eggs and blueberries. Other schools give away the produce or send it home with kids.

Chef Greg Christian requested permission to serve school garden produce at Alcott Elementary School when he was running its Organic School Project, which ceased this year. But district administrators refused, on the grounds it wasn’t safe. “It was good enough to use for cooking demonstrations and good enough to send home with the kids but not good enough to feed kids in their lunch,” Christian said.

Chartwells said its guidelines are designed to protect students.

“Farmers and suppliers of our produce are professionals, and therefore are at less risk of conducting poor agricultural practices,” Bloomer said. “Those that are working a school garden may not always be as cognizant of what constitutes good agricultural practices.”

Other districts in the region and across the country are planning or have already launched garden-to-school programs. The key, organizers said, is getting support for healthy food and nutrition education straight from the top.

This year, Denver Public Schools students have already harvested more than 1,000 pounds of garden produce for school lunches as part of a program cooked up by school food service director Leo Lesh.

Working with chef Andrew Nowak, who is also an officer for the activist group Slow Food Denver, Lesh put out a call for interested schools with gardens last year.

“We asked them to grow mainly cherry tomatoes, cucumbers, peppers and squash for the salad bar,” he said.

In this first pilot year, 11 schools supplied up to 20 percent of their produce needs at the peak of the harvest, Nowak estimates. They also harvested and froze hundreds of pounds of pumpkin destined for cranberry-pumpkin breads.

“I can’t tell you how proud the kids were to pick vegetables at the beginning of the week and then see them on the salad bar a couple of days later,” said Nowak, who helped develop safety guidelines for the growing and handling of the food.

With Denver’s limited growing season and the gardens’ limited acreage, the program was never designed to replace the district’s produce vendors, Nowak said, but to augment the produce and “connect the kids to their food in a meaningful way.”

This month, Lesh said, he will write a check to pay for produce the schools harvested.

“I have to buy this anyway,” he said. “So why not give the money back to the district schools rather than somebody else?”

The gardens, planted and tended by adult volunteers and students, even provide green summer jobs to students who are willing to water and weed, Lesh said.

Similar garden-to-school programs include Berkeley’s Edible Schoolyard Program and the Baltimore school district’s 33-acre Great Kids Farm, which provides learning opportunities for students and produce for an after-school meals program.

Closer to home, the Elgin-centered U-46 district, the second largest in the state, is developing a proposal to use up to 5 acres of city land for growing cafeteria produce and for teaching.

Though still in the planning and grant-writing stages, the program’s “ultimate goal is to let students experience the whole food cycle,” said Claudie Phillips, food service director for district U-46. “When kids are involved in the growing process and buy into the concept and see the end product, that’s when the whole thing works.”

Phillips said she is grateful for the support of district Superintendent Jose Torres. “It’s a dream to have the district head understand that healthier kids are better students and that food and nutrition can play a part,” she said.

Merrigan of the USDA said school gardens can help feed students’ minds, if not their bellies. She mentioned several recent studies on the topic, including one she co-authored with Michelle Ratcliffe, a doctoral student at Tufts University.

“She found that children who engaged in garden-based learning did better on their standardized test scores, were more environmentally aware and were willing to try and consume more fruits and vegetables, even beyond what they saw in the garden,” Merrigan said.

Chef David Blackmon, who oversees CPS career programs in hospitality, the culinary arts and agricultural science, said he believes he can bring the three disciplines together. Despite current regulations, he hopes to persuade the Chicago High School for Agricultural Sciences and Marshall High School to allow CPS culinary students to incorporate garden produce into special cafeteria offerings during the next school year.

“If a dish comes from the garden and it’s made by one of their friends,” Blackmon said, “I think the kids will be much more likely to try it over the same old pizza, nachos, burgers and chicken patties.”


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GMA Voices Views on Childhood Obesity Strategies

Oct. 22, 2010, Decision News Media

By Caroline Scott-Thomas

The food industry recognizes the need to change the way it makes and markets its products, the Grocery Manufacturers Association said in an Oct. 21 presentation to an IoM childhood obesity prevention committee.

The GMA’s vice president for federal affairs Scott Faber spoke at a meeting of the Institute of Medicine’s (IoM) Food and Nutrition Board Workshop on Legal Strategies in Childhood Obesity Prevention, reiterating the industry’s backing for Michelle Obama’s goal of ending childhood obesity within a generation. Faber also raised questions about the effect of television advertising on children, citing a new research review from professor of strategic management and public policy, J. Howard Beales, at the George Washington University School of Business.

His review assesses the literature published since an IoM report on food advertising to children in 2006, which found a strong association between exposure to television advertising and obesity – but could not find sufficient evidence that it was advertising itself that was the cause of increased obesity rates in children who watched the most television.

Beales concluded that the studies reviewed “do not significantly change the weight of the evidence, and they do not strengthen the case for concluding that the relationship between television viewing and adiposity is caused by advertising. The evidence remains inadequate to rule out plausible alternative hypotheses.”

Faber said in his presentation to the IoM panel that although the evidence may not be conclusive about whether television advertising of foods to children contributes to obesity, or whether it is the sedentary behavior of television-watching itself, the food industry recognizes that it needs to act.

“Though there remain many questions on how to effectively address the obesity crisis, industry recognizes the need to change the way we make and market our products, and we pledge to continue to do even more,” he said.

Faber also criticized proposals, currently under consideration in New York City, to prevent SNAP (Supplemental Nutrition Assistance Program) participants from buying sugary drinks with food stamps.

“Ultimately, solutions to childhood obesity … are solutions that trust Americans – not tell Americans – to make the healthy choice,” Faber said. “We should not be limiting choice, as some have proposed, but should instead be doing more to make the healthy choice the easy choice.”

He said that there have been several arguments put forward about why food stamps should continue to be valid for the purchase of sugary drinks.

“It’s discriminatory, it’s hard to implement, or it will discourage program participation,” he said. “I think the best argument is it simply won’t work. SNAP participants will simply use cash to purchase prohibited items.”

Faber added that the GMA supports the guiding principles of the IOM for overhauling front-of-pack nutrition information: They should include nutrients most strongly associated with diet-related health risks affecting the greatest number of Americans; consistency with the Nutrition Facts Panel; and they should apply to as many foods as possible.


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GMA Plans a Package-Front Label Showing Nutritional Data

Oct. 27, 2010, The New York Times

By William Neuman Responding to pressure from federal regulators, a major food manufacturers organization said that it would develop a labeling system for the front of food packages that would highlight the nutritional content of foods, including things like calories, unhealthy fats and sodium that many consumers want to limit. The group, the Grocery Manufacturers Association, said the labeling system would be introduced early next year.

The Grocery Manufacturers Association represents more than 300 large food, beverage and consumer product companies. It will work on the labeling system with the Food Marketing Institute, a trade group of major food retailers.

The Food and Drug Administration is moving to develop guidelines for the information on the front of packages.

Details on the labeling system were sketchy, and it was not clear that it would satisfy regulators’ preference for a system that would clearly alert consumers to the less-healthy aspects of many packaged foods.

A report this month by the Institute of Medicine called for package-front nutrition labels to show only calories, saturated fat, trans fat and sodium, the nutrients most closely associated with the major public health problems of obesity, diabetes and heart disease.

“We’ve committed today to put nutrients to limit on the front of our packages,” Scott Faber, a vice president of the manufacturers association, said in referring to nutrients that can be considered health concerns. Mr. Faber said it had not yet been determined which nutrients would be on the label. And he said the group would not commit to keep off the types of nutrients that food companies like to trumpet on their packaging, like vitamins and fiber.

Mary Sophos, an executive vice president for the group, said the label would not characterize a food’s overall nutritional qualities as good or bad — like the traffic signal label in Great Britain that displays a red circle for less healthy nutrient levels and a green circle for healthier levels.

“We’re not going to get into interpreting elements of the food,” Ms. Sophos said.

An FDA statement said, “Our hope is that the industry will develop a label that aids in consumer understanding and helps parents and other shoppers easily identify and select products that contribute to a healthy diet.”

The food industry was forced to halt a package-front labeling campaign called Smart Choices, which was criticized because it gave a nutritional seal of approval to foods like sugary cereals and highly salted frozen meals.

That led the FDA to say it would set guidelines for package-front nutrition labels.

“Is this an effort to try to head off what the FDA is doing?” said Marion Nestle, a nutrition professor at New York University. “That’s what it looks like to me.”


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E-Mails Reveal Dispute Over City's Ad Against Sodas

Oct. 28, 2010, The New York Times

By Anemona Hartocollis

In the midst of a legislative fight over taxing sodas last year, the New York City health department put together a media campaign about how drinking a can of soda a day “can make you 10 pounds fatter a year.”

But behind this simple claim was a protracted dispute in the department over the scientific validity of directly linking sugar consumption to weight gain — one in which the city’s health commissioner, Dr. Thomas A. Farley, overruled three subordinates, including his chief nutritionist.

“CAUTION,” the nutritionist, Cathy Nonas, wrote in a memorandum to her colleagues on Aug. 20, 2009. “As we get into this exacting science, the idea of a sugary drink becoming fat is absurd.” The scientists, she said, “will make mincemeat of us.”

But Dr. Farley argued that the advertisements had to have a message that would motivate people to change their behavior. “I think what people fear is getting fat,” he wrote.

The dispute, reflected in unusually candid internal e-mails, reveals a health commissioner with a high tolerance for dissent, yet committed to fighting obesity, a passion shared by Mayor Michael R. Bloomberg. The soda tax proposal was eventually dropped from the state budget, but the mayor escalated his antisoda campaign this month by requesting permission from the federal government to bar city residents from using food stamps to buy sodas and other sugar-sweetened beverages.

But the e-mails, which were obtained by The New York Times under the state’s Freedom of Information Law, also show what happens when officials try to balance science and public relations and toe the line between disseminating information and lobbying for a cause.

Few would argue that soda is nutritious, and there is a body of evidence showing a high correlation between rising obesity in the United States over the past 30 years and a parallel rise in the consumption of sugar-sweetened drinks. It is also possible to calculate the conversion of calories into fat, as the health department did in developing its advertisement.

But Ms. Nonas, along with at least two of her colleagues and a Columbia University professor they consulted, expressed strong doubts about the weight-gain message of the video and urged the department to rethink it. They pointed out that, on an individual basis, the conversion of calories into fat depends on factors like exercise, genes, gender, age and overall calorie consumption.

“Basic premise doesn’t work,” Dr. Michael Rosenbaum, a professor of pediatrics and clinical medicine at Columbia, said in an e-mail to Ms. Nonas on Aug. 18, 2009.

The advertising campaign, called Pouring on the Pounds, was developed by an advertising agency, Bandujo, in consultation with city health officials. City officials wanted the campaign to have, in the words of one of them, a “major gross-out factor” that would make the YouTube video, called “Man Drinking Fat,” “go viral” on the Web. The campaign produced a print advertisement for 1,500 subway cars showing fat tumbling from a soda bottle, but without the direct weight-gain claim. The video, which has been viewed more than 700,000 times, shows a young man sucking down fat from a can as it dribbles down his chin to a cheery calypso-flavored tune.

It was the video that sparked the dispute, with its claim: “Drinking 1 can of soda a day can make you 10 pounds fatter a year. Don’t drink yourself FAT.” The video’s release was delayed for months. Geoffrey Cowley, the communications director for the department, said that it had decided to release the video separately, and that the disagreement did not cause the delay.

Mr. Cowley, who had sided with Dr. Farley, said this week, “We took into account what they were saying and came up with a phrase that everybody could live with.”

Ms. Nonas said this week that she was satisfied with the video. “It’s totally supportable to say ‘can,’ ” she said.

Early on, the e-mails showed there was discussion about whether the fat looked too much like a “strawberry smoothie” and whether one of the drinks contemplated for the advertisements — orange juice — would provoke ridicule.

Then, on July 1, 2009, Sabira Taher, who holds a master’s degree in public health and is the campaign manager for health media and marketing for the department, wrote to Ms. Nonas raising doubts about the video’s message.

“I think Dr. Farley really wants to say something about ‘gaining 15 pounds of fat in a year,’ ” Ms. Taher wrote. But she had reservations. “We know gaining and losing weight isn’t that cut and dry — some people can drink and eat whatever they want and still maintain their weight without doing an incredible amount of exercise to burn off the extra calories. I think going this route would raise a lot of skepticism within the public about our message.”

Ms. Nonas agreed and was joined by Jeffrey Escoffier, the department’s director of health media and marketing.

Ms. Nonas sought advice from Dr. Rosenbaum. “The commissioner would like to say, ‘like making you gain up to 15 pounds a year,’ but that’s such a stretch and brings some idea of reality (but not pure science) into something that’s so exaggerated,” she wrote.

Dr. Rosenbaum replied that a more accurate number would be 10 pounds. But beyond that, he added, the underlying assumption was flawed because “you would need to make the case that you are talking about a can of soda more per day relative to energy expenditure.”

The argument was becoming too sophisticated to convey in a simple advertisement. “The science absolutely weakens our potential for mass distribution,” Ms. Taher wrote.

She advocated sticking with the gut-level appeal of the “goopy fat images.” “This is what viral marketing is all about,” she wrote in an Aug. 19, 2009, message to Ms. Nonas.

The dissidents marshaled medical journal articles, including a study of twins showing that a significant part of the variance in metabolizing calories was because of genetics.

As Dr. Farley and Mr. Cowley pushed back, Ms. Nonas tried to come up with a compromise. What was “defensible?” she asked in an e-mail to Harvard and Columbia professors. “What can we get away with?”

Steven L. Gortmaker, professor of the practice of health sociology at Harvard, suggested it might be safe to say that a year of daily sodas for a typical 10-year-old would lead to a five-pound gain, leveling off at nine pounds over time.

But Dr. Farley had the final word. “I understand that there is inter-individual variation and the experts’ caution,” he wrote on Aug. 20, 2009. “But I think what people fear is getting fat, so we need some statement about what is bad about consuming so many calories.”

Dr. Farley said he had reviewed other studies, a couple of them “quite old,” that “within the margin of error” would support the idea of a gain of 10 to 15 pounds. “So I favor the 10 pound sentence, but maybe keeping even a little more wiggle room,” he wrote.

He suggested less certain language, saying that soda “can make you gain” weight, and he proposed a disclaimer at the end, along the lines of “assuming no other changes in diet or physical activity.”

Just before the video went up, Ms. Nonas sent another message to Dr. Rosenbaum, explaining what the video would say. “I think this is broad enough to get away with,” she wrote. But she wanted to know “what the guru thought.”

Dr. Rosenbaum wrote that the advertisement was “misleading in that there is no reference to energy output changes.” The disclaimer Dr. Farley had proposed about diet and activity had been dropped.

If Ms. Nonas or Dr. Farley took Dr. Rosenbaum’s caveat to heart, it is not evident in the e-mail provided by the city. “It looks as if we got the go-ahead from City Hall to release our video on Pouring on the Pounds,” Ms. Nonas wrote to a Yale professor on Dec. 11. “It’s deliciously disgusting.”


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