September 2010





Childhood Obesity Collaborative Recognized for Innovation

September 2010, NCCOR

The National Collaborative on Childhood Obesity Research (NCCOR) was one of six winners of the inaugural cycle of the HHSinnovates awards program. Awardees were chosen by HHS employees’ votes and recognized last month.

Launched as a public-private collaboration in February 2009 at the start of the Obama administration, NCCOR aims to accelerate progress in reversing the childhood obesity epidemic by aligning and coordinating the efforts of four of the nation’s leading research funders – the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), the Robert Wood Johnson Foundation (RWJF), and the United States Department of Agriculture (USDA).

Providing a powerful example of how federal agencies are working with each other and with private funders to align efforts and reduce duplication, NCCOR was further selected as one of the top three choices by HHS Secretary Kathleen Sebelius.

The “innovation” honor is particularly apt for NCCOR; building on each other’s strengths through complementary and joint projects is novel for federal agencies and exactly what the Collaborative does.

In just a year and a half, NCCOR members have committed almost $3 million to fund a coordinating center for an initial three years. The NCCOR Coordinating Center provides a range of support for the Collaborative, conducting strategic planning, coordination, internal and external communication, and evaluation activities.

NCCOR members have also jointly funded more than $45 million in projects. Some examples include funding a $27 million, five-year evaluation study of communities to find out what works in reducing obesity at the local level, and forming an NCCOR Evaluation Forum, which will bring together the evaluation leaders from CDC, NIH, RWJF, and USDA that are collectively implementing more than $80 million in evaluation projects. The goal of this forum is to align these efforts so the results they produce are more comparable in guiding best practices.

NCCOR members have also dedicated $15 million to a five-year effort to use statistical modeling and other computational techniques to determine the cost and effectiveness of various policies and interventions. This modeling work is based on approaches taken in cancer screening and tobacco control.

Going forward, NCCOR will support major national initiatives launched in 2010 that relate to childhood obesity.

To receive this HHSinnovation recognition is very meaningful for NCCOR. We thank you again for recognizing our work.

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Presidential Proclamation: September is National Childhood Obesity Awareness Month

Sept. 1, 2010, The White House Office of the Press Secretary

One of the greatest responsibilities we have as a Nation is to safeguard the health and well-being of our children. We now face a national childhood obesity crisis, with nearly one in every three of America’s children being overweight or obese. There are concrete steps we can take right away as concerned parents, caregivers, educators, loved ones, and a Nation to ensure that our children are able to live full and active lives. During National Childhood Obesity Awareness Month, I urge all Americans to take action to meet our national goal of solving the problem of childhood obesity within a generation.

Childhood obesity has been a growing problem for decades. While it has afflicted children across our country, certain Americans have been disproportionately affected. Particular racial and ethnic groups are more severely impacted, as are certain regions of the country. In addition, obesity can be influenced by a number of environmental and behavioral factors, including unhealthy eating patterns and too little physical activity at home and at school.

We must do more to halt and reverse this epidemic, as obesity can lead to severe and chronic health problems during childhood, adolescence and adulthood, including heart disease, diabetes, cancer, and asthma. Not only does excess weight adversely affect our children’s well-being, but its associated health risks also impose great costs on families, our health care system, and our economy. Each year, nearly $150 billion are spent to treat obesity-related medical conditions. This is not the future to which we want to consign our children, and it is a burden our health care system cannot bear.

Earlier this year, the first lady announced “Let’s Move!” — an initiative to combat childhood obesity at every stage of a child’s life. As President, I created a Task Force on Childhood Obesity to marshal the combined resources of the Federal Government to develop interagency solutions and make recommendations on how to respond to this crisis. The Task Force produced a report containing a comprehensive set of recommendations that will put our country on track for solving this pressing health issue and preventing it from threatening future generations.

The report outlines broad strategies to address childhood obesity, including providing healthier food in schools, ensuring access to healthy affordable food, increasing opportunities for physical activity, empowering parents and caregivers with better information about making healthy choices, and giving children a healthy start in life. I invite all Americans to visit to learn more about these recommendations and find additional information and resources on how to help children eat healthy and stay active.

The new landmark health care law, the Affordable Care Act (ACA), includes a number of important tools for fighting and reversing the rise of childhood obesity. All new health insurance plans will be required to cover both screenings for childhood obesity and counseling on nutrition and sustained weight loss, without charging any out of pocket costs. The ACA also requires large restaurant and vending machine operators to provide visible nutritional information about the products they sell, enabling all Americans to make more informed choices about the foods they eat. As part of my Administration’s comprehensive approach to combating this epidemic, the ACA includes millions in new funds to implement prevention activities nationwide that support recommendations of the Task Force on Childhood Obesity.

Our history shows that when we are united in our convictions, we can safeguard the health and safety of America’s children for generations to come. When waves of American children were stricken with polio and disabled for life, we developed a nationwide immunization program that eradicated this crippling disease from our shores within a matter of decades. When we discovered that children were going to school hungry because their families could not afford nutritious meals, we created the National School Lunch Program. Today, this program feeds more than 30 million American children, often at little or no charge. When we work together, we can overcome any obstacle and protect our Nation’s most precious resource — our children. As we take steps to turn around the epidemic of childhood obesity, I am confident that we will solve this problem together, and that we will solve it in a generation.

NOW, THEREFORE, I, BARACK OBAMA, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim September 2010 as National Childhood Obesity Awareness Month. I encourage all Americans to take action by learning about and engaging in activities that promote healthy eating and greater physical activity by all of our Nation’s children.

IN WITNESS WHEREOF, I have hereunto set my hand this first day of September, in the year of our Lord two thousand ten, and of the Independence of the United States of America the two hundred and thirty-fifth.



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Publications & Tools

School District Wellness Policies Fail to Provide Strong Guidelines

Bridging the Gap, August 2010

A new study from Bridging the Gap, a research program funded by the Robert Wood Johnson Foundation, finds that school district wellness policies remain weak and often are not aligned with national recommendations for nutrition or physical activity.

Districts have improved their policies since the Child Nutrition and WIC Reauthorization Act of 2004 took effect and many have even exceeded its requirements. Yet many guidelines for competitive foods and beverages — those offered outside of school meal programs — do not comply with the mandate. Nutritional standards are lax, and district policies allow students of all age groups regular access to these items through school stores, vending machines and à la carte cafeteria lines.

Competitive food and drink products, which are linked to excess calorie consumption and obesity among school-age children, are an important part of the debate on the Child Nutrition Reauthorization.

The report, School District Wellness Policies: Evaluating Progress and Potential for Improving Children’s Health Three Years after the Federal Mandate, examines the latest data on district wellness policies and identifies opportunities for Congress, state policymakers and school districts to improve these policies.


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Brief: À La Carte Foods and Beverages in Kansas Public Schools

June 2010, University of Kansas Medical Center

Schools lose money on reimbursable meals and they often try to cover those losses by selling à la carte foods and beverages to students. These à la carte options are not always healthy. Reducing access to unhealthy à la carte items may be one factor in helping to address childhood obesity. This research brief prepared by the University of Kansas Medical Center with funding from Healthy Eating Research, provides research-based recommendations for improving the financial stability of school food service programs.


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Healthfulness of the U.S. Food Supply: Little Improvement Despite Decades of Dietary Guidance

Am J Prev Med 2010 NCCOR members Susan M. Krebs-Smith, PhD, and Jill Reedy, PhD; Claire Bosire, MSPH

Background: Every five years for the past several decades, the U.S. Department of Health and Human Services and the U.S. Department of Agriculture have issued and updated the Dietary Guidelines for Americans, which form the basis of federal nutrition policy and have shown remarkable consistency across various editions among the major themes.

Purpose: This paper examines whether the U.S. food supply is suffıciently balanced to provide the recommended proportions of various foods and nutrients per the amount of energy, whether this balance has shifted over time, and which areas of the food supply may have changed more than others.

Methods: The Healthy Eating Index-2005 (HEI-2005) was used to measure the dietary quality of the U.S. food supply, from 1970 to 2007. Sources of data were the USDA’s food availability data, loss-adjusted food availability data, and nutrient availability data, and the U.S. Salt Institute’s data on salt sold for human consumption.

Results: Total HEI-2005 scores improved by about 10 points between 1970 and 2007, but they never achieved even 60 points on a scale from 0 to 100. Although meats and total grains were supplied generally in recommended proportions, total vegetables, total fruit, whole fruit, and milk were supplied in suboptimal proportions that changed very little over time. Saturated fat, sodium, and calories from solid fat, alcoholic beverages, and added sugars were supplied in varying degrees of unhealthy abundance over the years. Supplies of dark-green/orange vegetables and legumes and whole grains were entirely insufficient relative to recommendations, with virtually no change over time.

Conclusions: Deliberate efforts on the part of policymakers, the agriculture sector, and the food industry are necessary to provide a supply of foods consistent with nutrition recommendations and to make healthy choices available to all.


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Analysis of Federal Policies and their Impact on Fruit and Vegetable Production

February 2010, Farmers’ Legal Action Group, Inc.

The Farmers’ Legal Action Group, Inc. released the report, Planting the Seeds for Public Health: How the Farm Bill Can Help Farmers to Produce and Distribute Healthy Foods, offering a legal analysis of the 2008 Farm Bill and explaining key agriculture and nutrition programs that were enacted into law.

In addition to providing policy recommendations to help farmers grow and distribute fruits and vegetables, the report emphasizes that many of the recommended changes could be made by the U.S Department of Agriculture without additional direction from Congress. However, the report recommends that if such policy changes do not occur, Congress will need to make changes in the reauthorization of the Farm Bill.


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Childhood Obesity Research & News

Food Stamp Discount for Buying Produce

Aug. 19, 2010, The Boston Globe

By Patrick G. Lee

More than two dozen cities and towns in Western Massachusetts will be the focus of a major federal initiative to increase low-income families’ consumption of fruits and vegetables, as part of the nation’s efforts to combat obesity.

The U.S. Department of Agriculture awarded $20 million to Massachusetts and a Cambridge-based research firm to test whether providing subsidies for buying produce will encourage food stamp recipients in Hampden County communities — including Springfield, Chicopee, and Holyoke — to eat more nutritious meals.

Of the 50,000 households in Hampden County that rely on food stamps, several thousand will be offered a 30-cent discount for every dollar spent on fresh fruits and vegetables, while other families will continue to pay full price. Households will be tracked for 15 months to see whether their eating habits change and health outcomes, including obesity rates, improve. State officials hope to begin the program in fall 2011.

The experiment, authorized by the 2008 Farm Bill, will guide policymakers in Washington as they consider how to revamp food stamps, now known as the Supplemental Nutrition Assistance Program, to promote better dietary habits among Americans.

“It’s one of the largest in the history of the Food and Nutrition Service, not only in terms of the size of the pilot, but the rigor associated with the evaluation,” Kevin Concannon, USDA’s undersecretary for food, nutrition, and consumer services, said in an interview yesterday. “We have a lot of information on nutrition, we have a lot of information on health, but we have a lot less information on what influences behavior.”

The grant announcement follows a flurry of more limited local and state programs to ramp up fruit and vegetable purchases among low-income residents. These include Boston Bounty Bucks, which offers discounts for residents who buy produce at farmers’ markets with food stamps, and doctor-provided ‘ “prescriptions,” which are actually coupons that can be redeemed at farmers’ markets for fruits and vegetables.

The new initiative is more sweeping, involving far more people and a rigorous methodology for measuring the impact of financial incentives on food consumption.

By drawing on a large, randomly selected sample in Hampden County, researchers will be able to control for variations in income, race, and age so as to isolate the influence of the 30-cent subsidy on families’ food choices, said Steve Carlson, a USDA program specialist and NCCOR member.

Financial incentives are important for bringing about lasting changes in behavior, but the key to their success will be whether the discount is large enough to make healthy food as affordable as junk food, said Dr. David Ludwig, director of the Optimal Weight for Life program at Children’s Hospital Boston.

The pilot program will help “remove the paradox that low-income people who suffer most from obesity and related illnesses are least able to afford the cure, which is nutritious food,” he said. “If low-income populations simply can’t afford nutritious foods, then behavior modification will not solve the problem.”

The state and federal governments have focused on making the purchase of subsidized produce through the program as seamless as possible: The regular prices will show up on the cash register receipt, but the discount will be immediately credited back to the customer’s food stamp debit card.

This might not be ideal, said Dr. Kevin Volpp, director of the Center for Health Incentives at the University of Pennsylvania. Incentives work best when they are immediate and “as visible as possible,” he said. “That’s probably the part I worry about most. Instead of taking $20 off my card, now I’m taking $14 — is that going to be noticeable?”

Volpp suggests that the distribution of a discount coupon for future fruit and vegetable purchases might be a more effective way to influence behavior and increase consumption of healthy foods.

And even if the 30-cent discount does succeed in increasing produce consumption relative to those who pay normal prices, the government will need to fund future studies to see whether other types of financial incentives change behavior more efficiently, Volpp said.

Even so, state officials said they are astounded and honored to have received the multimillion dollar grant authorized by Congress two years ago.

“Even when low-income people receive assistance for food, processed foods are less expensive,” said Julia Kehoe, state commissioner of the Department of Transitional Assistance, which administers the SNAP program. “What this is doing is leveling the playing field for low-income folks, so that a healthier diet is within their reach.”

About half the grant will go to Abt Associates Inc., a consulting company that will conduct three surveys during the research period to determine whether the produce consumption of those receiving the subsidy is markedly different from that of other families.

Up to $4 million could go toward the subsidies and about $6 million will go toward equipment and administrative costs.


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Restaurant Chains, Vending Machines Will Have to Post Calories

Aug. 25, 2010, Los Angeles Times

By Andrew Zajac

Many chain restaurants and vending machines would have to display the number of calories in their food for consumers under draft guidelines released by the Food and Drug Administration.

The guidelines require that calorie information be posted in the same size type as the menu item or price, whichever is larger. Vending machines would have to display the information in a “clear and conspicuous” manner so consumers could review it before making a purchase, according to the guidelines, which were authorized by the healthcare legislation passed this year.

Michael Hanlon, senior scientist for Consumers Union, praised the labeling requirement as a useful tool in guiding food choices but warned that it would not be a magic bullet in curbing the nation’s appetite. According to the Centers for Disease Control and Prevention, about two-thirds of American adults are overweight or obese.

Americans consume about a third of their calories from food prepared outside the home and tend to guess wrong about the number of calories in such foods.

The calorie disclosure requirement applies only to restaurants and other food chains with 20 or more locations and vending machine operators with 20 or more machines.

Menus must include the statement that “Additional nutrition information is available on request” and restaurants must make available more detailed data about the source of calories, calories from fat and the amount of saturated fat, sodium, sugars and other key food components in each menu item.

Daily specials, custom orders and items appearing on a menu for less than 60 days would be exempt from calorie disclosure.

New York City already requires similar calorie information on menus.

The proposed guidelines are preliminary and could change as a result of information received during a 45-day public comment period. The FDA won’t begin enforcing the labeling requirement until the rules are completed some time after the comment period.


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Sen. Klobuchar Announces Senate Passage of Child Nutrition Bill

Aug. 18, 2010, The Journal

U.S. Senator Amy Klobuchar, member of the Senate Agriculture Committee, announced recently that the Healthy, Hunger-Free Kids Act of 2010 has passed the full Senate with bipartisan support. The bill overhauls the major domestic food assistance programs that serve the nutritional needs of 29 million American children.

In the face of alarming statistics and a national decline in children’s health … the bill includes many of her provisions to strengthen nutritional standards and promote healthy lifestyles for children. Currently, one in four children is either obese or overweight before entering kindergarten.

“As school recess time gets shorter and shorter, our kids’ waistlines are getting wider and wider. In fact, the most common ‘vegetable’ many of our kids eat are French fries, and that needs to change,” Klobuchar said. “By promoting healthy lifestyles early, we can combat childhood obesity and improve children’s health across the country.”

The legislation reauthorizes the nutrition programs that are administered by the U.S. Department of Agriculture. The programs work to provide a nutritional safety net for children and include the National School Lunch Program, School Breakfast Program, Child and Adult Care Food Program, Summer Food Service Program, and the Special Supplemental Nutrition Program for Women, Infants, and Children. Childhood health has become a national health issue and, according to the Centers for Disease Control and Prevention, one out of every three children in the United States between the ages of 2 and 19 is overweight or at risk of becoming overweight.

… The legislation includes a Klobuchar bill that calls for changes to the Child and Adult Care Food Program to improve nutrition standards for meals served in the program and provide health education and guidance for child care providers. The bill will promote children’s health by requiring that the U.S. Department of Agriculture develop nutrition standards consistent with the dietary guidelines for all food served in the CACFP. Additionally, the bill will simplify the administration of the program to ensure greater access for families and reduced administrative cost.

The bill also includes provisions authored by Klobuchar that increase transparency and accountability for Local Wellness Policies. The provisions will require local educational agencies to develop implementation plans for nutrition education and promotion and physical activity in schools within one year of enactment of the bill and ensures that these policies are made readily available to parents.

Klobuchar also fought to include an amendment that grants the Secretary of Agriculture the authority to oversee the sale of all foods and beverages on school grounds and requires national nutrition standards for these foods.

The bill is now being considered by the House of Representatives.


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Chicago Partners with Walgreens to Bring Groceries to Food Deserts

Aug. 11, 2010, Chicago Tribune

By John Byrne

Mayor Richard Daley and Walgreen Co. officials touted progress last month in the city’s push to wipe out “food deserts” in Chicago.

The Deerfield-based drugstore chain is adding fresh fruit and vegetables at four stores by next week, bringing to 10 the number of such outposts on the city’s South and West sides. Those impoverished areas of Chicago have been plagued by the lack of grocery stores after major chains closed some locations over the years.

The mayor and company officials toured a Walgreens in the Grand Crossing neighborhood. Daley patted bags of onions and poked tomatoes that will be sold alongside greeting cards and aspirin.


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Nashville Parks and Vanderbilt Pediatrics Awarded $12 Million to Fight Childhood Obesity

Aug. 17, 2010, Newswise – Vanderbilt University Medical Center

Vanderbilt’s Department of Pediatrics, in partnership with Metro Nashville Parks and Recreation, has been awarded a $12 million, seven-year grant from the National Heart Lung and Blood Institute (NHLBI) for an ambitious project aimed at stopping obesity in preschoolers before it can take hold.

The project, titled “Growing Right Onto Wellness (GROW): Changing Early Body Mass Index (BMI) Trajectories,” will bring 600 families to their neighborhood Metro Parks’ facilities and provide a curriculum specially designed to fit a variety of ethnic groups.

Shari Barkin, M.D., director of the Division of General Pediatrics and principal investigator of GROW, said selecting the toddler/preschooler age group and partnering with families is crucial.

“As a pediatrician, I can see it happening right in front of me. An overweight preschooler is four to five times more likely to stay overweight as an adolescent. And if you stay overweight as an adolescent, there is a 70 percent likelihood you will stay overweight as an adult,” Barkin said.

GROW builds on the success of another project entitled “Salud con la Familia” (Health with the Family). In that project, Barkin and colleagues formed a group, the Nashville Collaborative, with Metro Parks and Recreation that worked with 100 Latino families with toddlers to do what has been difficult to accomplish in the past: spur lasting lifestyle changes in families.

“This partnership, overall with Vanderbilt and with Dr. Barkin, has been the most successful effort to really get a handle on health issues that I have experienced in my 20 years serving in Metro Parks and Recreation,” said Paul Widman, assistant director of Metro Parks and Recreation.

Salud con la Familia generated evidence for six research publications now in the works. Barkin said the science indicates that a family-based intervention that takes place within community centers can successfully impact the growth trajectories in early childhood. Other research indicates that achieving healthy growth patterns at this age can last into adulthood.

While the Salud project focused on Latino families, GROW will recruit a much wider spectrum of families within Davidson County. It is hoped that several racial and ethnic backgrounds will be represented among the 600 families ultimately recruited.

“To create sustainable change in the community we have to have the perspectives of the communities with which we work,” Barkin explained.

Widman said he never anticipated this larger grant opportunity, but he is pleased to have the opportunity to learn from his academic neighbors while offering the invaluable resource of two dozen community centers and hundreds of programs.

“The whole thing has been really exciting. It has enhanced what we do,” Widman said.

As part of the Salud program, Metro gained bilingual materials and popular cooking programs originally designed for Latino families at the Coleman Recreation Center, the flagship site of the Nashville Collaborative. Now the GROW project will also provide funds, allowing participating recreation centers to extend their hours to all users.

“That means we will be able to offer more hours for employees or even hire new people,” Widman said.

Barkin said the success of this format: bringing academic institutions and community resources together, could create a model to be used all over the nation to make lasting health changes in the community.

Six Vanderbilt co-investigators will work on a variety of aspects of the GROW project.

  • Russell Rothman, M.D., associate professor of Medicine and Pediatrics, will tailor the curriculum to fit a broad range of literacy and numeracy skills.
  • Sabina Gesell, Ph.D., research assistant professor of Pediatrics, will build and measure new social networks of families enrolled in the study and examine the impact.
  • Tom Morgan, M.D., assistant professor of Pediatrics, will examine whether weight loss success is tied with participants’ genes.
  • Matt Buchowski, Ph.D., director of the Energy Balance Laboratory, will find ways to measure energy expenditures in study participants.
  • Heidi Silver, R.D. will focus on nutritional elements of the research.
  • Warren Lambert, Ph.D., senior associate in Biostatistics, will handle data design and analysis for the project.


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