April 2011

Accelerating Evidence Reviews and Broadening Evidence Standards to Identify Effective, Promising, and Emerging Policy and Environmental Strategies for Childhood Obesity Prevention

March, 2011

By Laura Brennan [NCCOR Member], Sarah Castro, Ross C. Brownson, Julie Claus, and C. Tracy Orleans [NCCOR Member]

The childhood obesity epidemic has stimulated the emergence of many policy and environmental strategies to increase healthy eating and active living, with relatively few research recommendations identifying the most effective and generalizable strategies. Yet, local, state, and national decision makers have an urgent need to take action, particularly with respect to lower-income and racial and ethnic populations at greatest risk. With the surge of promising and emerging policy and environmental strategies, this review provides a framework, criteria, and process modeled from existing expert classification systems to assess the strength of evidence for these strategies. Likewise, this review highlights evidence gaps and ways to increase the types and amount of evidence available to inform policy and environmental strategies. These priorities include documenting independent and interdependent effects, determining applicability to different populations and settings, assessing implementation fidelity and feasibility, identifying cumulative benefits and costs, ascertaining impacts on health equity, and tracking sustainability.

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Let's Move! Cities and Towns Releases New Toolkit

Let’s Move! Cities and Towns is part of first lady Michelle Obama’s Let’s Move! initiative. It serves to engage mayors and other local leaders to join the effort to combat childhood obesity. A new toolkit was recently released to help these local policymakers adopt long-term, sustainable, and holistic approaches toward solving the childhood obesity epidemic crisis.

ACCESS THE TOOLKIT

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CDC Releases Food Environment Guide

The Centers for Disease Control and Prevention (CDC) has released a new guide to help states and localities develop, adopt, implement, and evaluate a food procurement policy with a focus on improving the food environment through nutrition standards.

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RWJF Center Legislative Update

Keep up with the various federal bills about childhood obesity and obesity prevention. This page will keep you up to date with what’s happening and how legislation is moving.

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Let's Move! Can it Make a Dent in the Childhood Obesity Problem?

March 20, 2011, Los Angeles Times

By Jessica Pauline Ogilvie

Can childhood obesity be eliminated in a generation? Will we ever get our children away from video games and into the park? Is there anything to be done about neighborhoods with a plethora of fast-food outlets and a dearth of options for eating healthfully?

A year ago, first lady Michelle Obama launched the Let’s Move! campaign from the front lawn of the White House. She outlined her plan to focus on four primary objectives: educating and empowering parents, providing more-healthful foods in schools, increasing access to healthful foods in underserved neighborhoods, and encouraging more physical activity.

Among the specifics, Obama set the goal of doubling participation in the Healthier US School Challenge, which recognizes schools in the National School Lunch Program that have worked to promote more-healthful school environments. She also announced her intention of working with food retailers to stock more-healthful fare, and challenged kids and adults to exercise five days a week.

Many childhood obesity and nutrition experts believe that the first lady’s initiative is an important step in raising national awareness about childhood obesity, which in 2008 reached an all-time high of 17% among kids age 2 through 19, according to the federal Centers for Disease Control and Prevention.

“Let’s Move! is first time food issues have had this kind of legitimacy at this high a government level,” said Marion Nestle, nutrition professor at New York University and the author of the book “Food Politics.” “Just doing that is an enormous, enormous contribution.”

But in a culture where junk food abounds and outdoor play continues to lose ground to controllers and computers, some experts are skeptical as to how successful the public awareness program — which also works to allocate funding for government agencies involved in nutrition and health, such as the Department of Health and Human Services — can be.

We spoke to five specialists in the fields of nutrition and childhood obesity to get their take on each aspect of the Let’s Move! campaign:

Empowering parents

In addition to purchasing food for the family, parents and caregivers serve as role models for healthy behavior. For that reason, said Dr. William Roberts, the president of the American College of Sports Medicine, reaching adults with information about good health practices, and encouraging them to examine their own habits, is a key part of battling childhood obesity.

“The apple doesn’t fall far from the tree,” said Roberts, who has a private practice in Minnesota. “I can often see who will have trouble with obesity and who won’t from looking at the parents; obese parents have obese kids, and active parents have active kids.”

According to a report by a task force implemented by President Obama to oversee Let’s Move!, the campaign has worked with a handful of government agencies to help parents make more informed decisions. The Food and Drug Administration has begun to explore the effects of putting nutrition labels on the front of food packaging, and how it can be effectively implemented. The Department of Agriculture will soon release a new food pyramid, condensing its dietary guidelines. And Michelle Obama herself has urged restaurants across the country to provide nutritional information about their dishes.

Obesity Research Center, getting parents to change their behavior is likely to be much more challenging than putting numbers on menus and packaging.

“We’re talking about changing what people eat, their physical activity levels,” he said. “This has been very, very difficult to do and quite frankly, we have more failure than success.”

A program like Let’s Move! can help, he said, but “at the end of the day, it’s a cultural shift, the way smoking is now unacceptable, not wearing seatbelts is now unacceptable. It’s an amazing challenge and it’s going to be a lot for any one program to do alone.”

Getting healthful foods in schools

In December, President Obama signed the Healthy, Hunger-Free Kids Act of 2010, which provides funding for federal school meals and child nutrition programs and is reauthorized every five years. Informed, in part, by the Let’s Move! objectives, the bill requires national standards to be set for food sold at schools, including meals and vending machine snacks.

Margo Wootan, director of nutrition policy at the Center for Science in the Public Interest, worked on the bill, and said that it’s passage was a victory for Let’s Move! program.

Getting junk food out of schools is “something we’ve wanted to do for decades,” she said.

To ensure compliance with the bill, one school per district nationwide will be audited every three years, said Wootan.

“The review that they do is so comprehensive and labor intensive [that] it’s hard for them to do many more schools,” she said, adding that she’d like to see the review process more streamlined.

Some experts, however, see the bill as falling short of what kids need.

“I think we need universal school meals,” said Nestle, referring to lunches provided to all children regardless of income, “and anything short of that is an enormous compromise.”

Areas that are dominated by fast-food restaurants and have a dearth of healthful options are another target of the Let’s Move! campaign.

The program made a significant stride in January, when Wal-Mart agreed to join Let’s Move! by stocking its shelves with more-healthful more-clearly labeled products. The collaboration, said Nestle, represents an important step towards getting buy-in from the food industry, which has often viewed junk food as more profitable than more nutritious fare.

“Anything Wal-Mart does is going to have an enormous effect on other food companies, because they are going to have to follow suit,” she said.

Still, said Hill, the effort within the food industry is “not as coordinated as we might like it to be.” And it remains to be seen whether more-healthful options will lead to more-healthful choices.

“The question is, are people just waiting for healthy food, and once you bring it in they will eat it?” he said. “I suspect that’s not the case. Getting people to make these healthy choices and sustain them over time is very much a challenge.”

Increasing physical activity

Without an increase in physical activity, overweight kids are likely to remain that way. To that end, Let’s Move! has teamed up with national sports organizations, including the National Football League and Major League Baseball, to develop public service announcements to motivate kids who may see professional athletes as role models.

But many believe that increasing physical activity represents the biggest challenge facing the program. “I think it’s going to be easier to solve the food problem then the physical activity problem,” said Hill.

Roberts suggests that schools need to support gym and recess and that city planners should keep in mind the development of play areas when “building towns and living spaces.” Ultimately, though, there’s no proven way to entice the unmotivated to get off the couch, he said.

“I don’t know how you can get people to exercise who aren’t willing to or don’t want to,” Roberts said. “In the end, it has to be an individual decision that you’re going to make the changes you need.”

Looking ahead

As the Let’s Move! campaign enters its second year, it’s not without political detractors. Some have criticized the first lady and the program for what they suggest is an overstepping of government bounds.

On his radio program earlier this year, talk show host Rush Limbaugh said that Obama was “urging, demanding, advocating, requiring what everybody can and can’t eat.”

But health experts continue to suggest that Let’s Move! is on the right track, if perhaps not far-reaching enough.

“The obesity epidemic is caused by a toxic environment,” said David Ludwig, who developed the Optimal Weight for Life program at Children’s Hospital Boston. To truly combat it, he says, government involvement needs to include providing subsidies for farms that grow nutritious foods, as well as better funding for schools so that food quality and physical education aren’t sacrificed.

Wootan adds that marketing that targets children, such as television commercials and kid-themed packaging, also needs to be curtailed.

Hill believes that until more research is done to find creative solutions to the childhood obesity epidemic, the problem may not be going anywhere.

“I think things may get worse,” he said, “before they get better.”

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Original Source: http://articles.latimes.com/2011/mar/20/health/la-he-lets-move-assess-20110320

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Type 2 Diabetes Surges in People Younger Than 20

March 21, 2011, The Washington Post

By Susan Brink

Annie Snyder figured she’d be out of the pediatrician’s office in 30 minutes, tops. Then she’d head home, tuck the medical permission for YMCA summer camp in her bag and finish packing.

But that exam last summer wasn’t like any other she’d had in her 16-year, basically healthy life. Within minutes of learning the results from a urine test, she got two corroborating blood tests and was hustled off to Inova Fairfax Hospital. Lying on a gurney in the emergency room, she heard the word “diabetes” several times and knew from the urgent medical reaction that it was bad. Frightened and crying, she thought: “What have I done to myself?”

Doctors had discovered that Annie had Type 2 diabetes, a disease that is often linked to being overweight. She never made it to summer camp. By the time she came home from the hospital a week later, she knew how to inject herself with insulin and she knew that she’d have diabetes for the rest of her life.

As recently as the mid-1990s, Type 2 diabetes was almost exclusively a disease of adults. But apparently fueled by the childhood obesity epidemic, cases in people younger than 20 have ramped up from virtually zero to tens of thousands in the United States in little more than a decade. The children who have it are breaking new scientific ground: No one has any idea how they will fare over the course of a lifetime.

Annie says she was “most definitely overweight” at the time of her diagnosis, and she has already made major lifestyle changes to control the disease. By exercising and cutting back on carbohydrates, she has lost 12 pounds so far. She has reduced her need for insulin from several injections a day to just one each night, and she’s hoping that soon she’ll be able to put the needle aside and just use an oral drug, metformin.

Although she is the only person in her household with diabetes, Annie’s diagnosis triggered a family response. Her parents got rid of the dining room table and turned that space into an exercise room, complete with a bowl of apples and artfully arranged bottles of water at the door. Everyone exercises, including her 15-year-old brother, Stephen; everyone has given up sodas and snacks, everyone eats smaller portions.

“When I see my dad exercise, I know that I’ve helped get him motivated,” Annie says. “Before, exercise was a chore. I would sit and watch TV and eat snacks. Now, as soon as I come home, I put on my workout clothes.”

A disturbing trend

Today, about 3,700 Americans under the age of 20 receive a diagnosis annually of what used to be called “adult-onset” diabetes, according to the Centers for Disease Control and Prevention. That relatively small number makes it a rare disease in children, but it represents a trend with larger ramifications.

“In a little more than 10 years, the numbers went from nothing to something,” says Larry Deeb, a pediatric endocrinologist and past president of the medicine and science division of the American Diabetes Association. “And that’s something to worry about.”

Diabetes can cause a litany of medical woes, including heart disease, kidney failure, limb amputations and blindness. It costs the U.S. health-care system $174 billion a year, according to the National Institutes of Health.

Those statistics are grim enough when patients are in their 60s. When the diagnosis is made decades earlier, new fears are raised: Will these children suffer heart attacks in their 20s, need kidney dialysis in their 30s or go blind before they see their own children graduate from high school?

Because about 80 percent of Type 2 diabetes patients are overweight or obese, it’s not surprising that patients such as Annie ask if they’ve done this to themselves. But there are other risk factors that no one can control: family history, ethnicity (blacks, Hispanics and American Indians have higher rates of diabetes), genetics or a mother who had diabetes during her pregnancy. Instead of wallowing in regret, doctors suggest that young patients and their parents seize the opportunity for a crash course on how to improve their health.

“I used to wear a button that said ‘Stamp Out Guilt,’ ” says Fran Cogen, director of the Child/Adolescent Diabetes Program at Children’s National Medical Center. “I try to tell people that no one caused their diabetes. I emphasize that they can make changes now.”

Alarm bells are going off among those who study diabetes in children because of what they know about the adult version of the illness. More than 25 million Americans have diabetes (more than 90 percent have Type 2), according to the National Institute of Diabetes and Digestive and Kidney Diseases — but an additional 79 million have a condition called pre-diabetes, in which blood sugar levels are higher than normal but not as high as in diabetes.

Pre-diabetes isn’t a disease requiring medical treatment — it’s a wake-up call. A large national study showed that adults with pre-diabetes who lost 7 percent of their body weight reduced their risk of diabetes by 58 percent.

Officials are concerned that the number of children already identified as having Type 2 diabetes is just the tip of the iceberg. In a national study of 2,000 eighth-grade students from communities at high risk for diabetes, more than half of the kids were overweight or obese. Only 1 percent had diabetes — but almost a third of them had pre-diabetes, according to Lori Laffel, chief of the Pediatric, Adolescent and Young Adult Section of the Joslin Diabetes Center in Boston and a principal investigator on the study.

It’s crucial, she says, to find those children before their condition progresses to diabetes so that it can be reversed by lifestyle changes, without medication.

Making progress

If there is any good news in childhood diabetes, it is that pediatricians are starting to look for it. “It’s in the news, and all over the medical literature,” says Susan Conrad, a pediatric endocrinologist at Inova Fairfax Hospital. “Pediatricians are on top of it.”

For example, sometimes children whose bodies are beginning to have problems regulating insulin develop a telltale dark, velvety rash around their necks. A decade ago, such a child might have been referred to a dermatologist. In addition, CDC guidelines suggest that a child with a family history of diabetes, or one whose weight is above the 85th percentile for age and sex should be screened, with blood and urine tests, for diabetes.

Family experiences made John Perrone of Winchester, Va., aware of diabetes and its consequences. John’s mother, who developed gestational diabetes during all three of her pregnancies, now has Type 2 diabetes. His mother’s aunt had diabetes, and by the time she died in her 70s, she was on dialysis, in a wheelchair, legally blind and had suffered two strokes.

John got a diagnosis of Type 2 diabetes four years ago, and he has worked hard ever since to keep the disease under control. He says he’s gone from an overweight 11-year-old to a husky but fit 15-year-old. He has progressed from needing insulin injections to keeping his glucose under control with oral medication, combined with healthful eating and a lot of exercise.

He has learned enough to want to teach other kids with the disease. As an Eagle Scout project, he has developed a PowerPoint presentation aimed at youngsters. He has translated medical terms, such as glucose and glucometer, into words they understand, such as sugar and meter. He has also wanted to simplify for kids the basics of weight loss, which is so crucial for diabetes control. “It’s all about in and out, what you eat, how much you exercise,” he says. “Maybe if kids understand it better, they can do it.”

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Original Source: http://www.washingtonpost.com/national/type-2-diabetes-surges-in-people-younger-than-20/2011/03/09/ABGpyE8_story_1.html

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Vilsack: Schools to Receive More Fresh Produce

March 24, 2011, Food Safety News

By Gretchen Goetz

About four million elementary students should receive a free vegetable or fruit snack at school next year, thanks to the expansion of a U.S. Department of Agriculture program, Agriculture Secretary Tom Vilsack announced in March.

Vilsack said USDA plans to put $158 million into its Fresh Fruit and Vegetable Program for the 2011-12 school year; the expanded assistance could help to benefit an estimated 600,000 to 950,000 more students than were served this year.

The Fresh Fruit and Vegetable Program was authorized and funded under the National School Lunch Act and expanded in recent years as a result of the 2008 Farm Bill. It operates in selected low-income elementary schools. Each student receives between $50 and $75 worth of fresh produce over the school year.

The program has been a success, both with kids and the U.S. produce industry.

“This program is very popular. It’s a hit with kids, with the parents and with the schools, and it’s having an undeniably positive effect not only on the way kids eat at school but also on their eating habits at home,” said Dr. Lorelei DiSogra, vice president of Nutrition and Health for the United Fresh Produce Association in a statement.

Kevin Concannon, USDA Under Secretary for Food, Nutrition and Consumer Services, said in a news release, “I am pleasantly surprised when children tell me it was their first time trying a particular fruit or vegetable. Fortunately children are learning fruits and vegetables are healthy choices and tasty alternatives to snacks high in fat, sugar, or salt.”

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Original Source: http://www.foodsafetynews.com/2011/03/vilsack—schools-to-receive-more-fresh-produce/

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Deconstructing 'The Very Hungry Caterpillar': Excellent Food Choices, Portion Control Needs Work

March 8. 2011, Los Angeles Times

By Melissa Healy

Eric Carle’s famous book “The Very Hungry Caterpillar” has become a foot soldier (well, a many-footed soldier) in the war against child obesity.

The storybook character, beloved by parents and children since he emerged from an egg — pop! — on a Sunday morning in 1969 is not exactly the exemplar of good eating habits himself. But the American Academy of Pediatrics and a consortium of philanthropic groups has decided that parents can point to the omnivorous larva to convey a few important messages about healthy eating (while their wee ones poke their tiny fingers into the various fruits and food items devoured by the very hungry caterpillar).

Starting in March, more than 17,500 pediatricians’ offices are to receive free copies of “The Very Hungry Caterpillar,” packaged with growth charts and a reading guide designed to help parents use the story to talk to their young children about healthy eating. The packages are an initiative of the Alliance for a Healthier Generation (the anti-obesity campaign established by the American Heart Association and former President Bill Clinton) and two literacy groups: the Pearson Foundation and We Give Books, a digital initiative of “The Very Hungry Caterpillar’s” publisher, Penguin Books.

For those whose children have long since built a cocoon around themselves — or become beautiful butterflies — here’s a recap of the very hungry caterpillar’s story: From the moment he pops out of his egg in the warm sun, he is propelled by his hunger to look for food. Between Monday and Friday, he eats his way through a great deal of fruit. But on Saturday, his hunger really gets the better of him, and he eats through a piece of chocolate cake, an ice cream cone, a pickle, a slice of Swiss cheese, some salami, a lollipop, a piece of cherry pie, one sausage, a cupcake, and a slice of watermelon. (Being a caterpillar and all, he burrows a tunnel through all these foods just big enough for a small finger to poke into.)

Following this excessive intake of saturated fat, sodium and high-fructose corn syrup, he is diagnosed with gastroesophogeal reflux disease (GERD) and begins a regimen of proton pump inhibitors. (Just kidding — that night, Eric Carle reports, “He had a stomachache!”)

This cautionary tale, it turns out, provides some important teaching moments. Children can be induced to notice all the terrific fruits the caterpillar consumes, and to suggest more (which they might come to think of as snacks). Parents can pointedly note the unhappy results of his weekend binge — the stomachache — and remind their child that a sensation of fullness is a good signal that it’s time to stop eating. Readers might observe that the consumption of “one nice green leaf” on Sunday made the very hungry caterpillar feel “much better.” And for the scientifically minded child, there’s even a lesson in cumulative effects: despite his Sunday of calorie restriction, the caterpillar enters the next stage of his life bearing the cumulative effects of his excessive consumption: “He was a big, fat caterpillar”–with a significant case of abdominal adipose deposition to show for it.

Author and illustrator Eric Carle says he’s thrilled that his creation has metamorphosed into a “spokescharacter” for an anti-obesity campaign. Quoted in an announcement for the campaign, he says, “I hope ‘The Very Hungry Caterpillar’ will be a happy reminder for children to grow healthy and spread their strong wings, like the butterfly in my book.”

Original Source: http://www.latimes.com/health/boostershots/lat-hungry-caterpillar-obesity-030811,0,4662468.story?

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