August 2011





Mississippi Most Obese State, Colorado Least

July 7, 2011, Reuters

By Lisa Baertlein

The number of obese U.S. adults rose in 16 states in the last year, helping to push obesity rates in a dozen states above 30 percent, according to a report released on July 7.

By that measure, Mississippi is the fattest state in the union with an adult obesity rate of 34.4 percent. Colorado is the least obese — with a rate of 19.8 percent — and the only state with an adult obesity rate below 20 percent, according to “F as in Fat,” an annual report from the Trust for America’s Health and the Robert Wood Johnson Foundation.

While the number of states showing significant year-over-year increases in obesity has been slowing, no state chalked up an actual decline. Even Colorado does not win high marks — its score means one in five state residents is at higher risk for conditions like heart disease and diabetes

“Today, the state with the lowest adult obesity rate would have had the highest rate in 1995,” said Jeff Levi, executive director of the Trust for America’s Health.

Four years ago, only one U.S. state had an adult obesity rate above 30 percent, according to the report, which defines adult obesity as a having a body mass index — a weight-to-height ratio — of 30 or more.

Over the last two decades, people in the United States have been eating less nutritious food and more of it. At the same time, activity levels have fallen, Levi said.

“If we’re going to reverse the obesity trends, willpower alone won’t do it. We’re going to have to make healthier choices easier for Americans,” Levi said.

Public health experts around the world have raised the alarm about exploding rates of obesity — particularly among children — and many are promoting efforts to encourage exercise and easier access to affordable, healthy food.

In the United States — where two-thirds of adults and nearly one-third of children are obese or overweight — the obesity epidemic is sending healthcare costs higher and threatening everything from worker productivity to military recruitment.

Some groups say such behavioral initiatives are not enough, arguing that food manufacturers and restaurant chains need limits on how they market to children.

The Center for Science in the Public Interest, a U.S. consumer group, last year sued McDonald’s Corp to stop the world’s largest hamburger chain from using Happy Meal toys to lure children into its restaurants. Last month, the American Academy of Pediatrics — a group of U.S. pediatricians — called for a ban on junk food ads aimed at children.

The food industry — which has significantly increased portion sizes in restaurants and packaged foods like sugar-sweetened beverages over the last 20 years — is fighting regulation efforts and has adopted the mantra of “personal responsibility.”

To that end, food and beverage companies say consumers have the right to choose what they eat and should balance their caloric intake with activity.

The report released on July 7th showed that over the past 15 years, seven states have doubled their rate of obesity and 10 states have doubled their rate of diabetes.

Since 1995, obesity rates have risen fastest in Oklahoma, Alabama and Tennessee, while Colorado, Connecticut and Washington, D.C., had the slowest increases.

Adults from racial and ethnic minority groups, as well as those with less education and lower incomes, continue to have the highest overall obesity rates.



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Publications & Tools

Understanding U.S. Heath Care Spending

This data brief from the National Institute for Healthcare Management (NIHCM) Foundation summarizes heath care spending in the United States and cites rising obesity rates as one of the reasons for increased healthcare costs. A summary of the key points is below:

  • U.S. spending for health care has been on a relentless upward path – reaching $2.5 trillion in the aggregate, $8,100 per person, and 17.6 percent of GDP in 2009.
  • Spending is highly concentrated among a relatively small portion of high-cost users, with just 5 percent of the population responsible for almost 50 percent of all spending. At the other end, half of the population accounts for just 3 percent of spending.
  • As more people are being diagnosed with and treated for chronic conditions, including many linked to rising obesity rates, high health spending has spread to a larger segment of the population. The spending distribution remains highly concentrated, however.
  • Higher spending for hospital care and physician and clinical services accounted for half of the increase in total national health spending between 2005 and 2009 and more than 80 percent of the increase in private insurance premiums over the period.
  • Rising prices per unit of service have played a larger role than rising utilization rates as a determinant of recent expenditure growth.
  • Key drivers of rising unit prices and higher utilization include advances in medical technology, rising treated prevalence rates for chronic diseases, and increased provider consolidation and market power.


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Food Companies Announce Industry Food Marketing Standards

Some of the nation’s largest food companies announced that they will cut back on marketing unhealthy foods to children proposing their own set of advertising standards after rejecting similar voluntary guidelines proposed by the federal government. The announcement was made July 14, the same day that public comments were due to the Interagency Working Group on Food Marketed to Children (IWG) regarding the federal government’s proposed nutrition principles. The new industry standards, which will allow companies to advertise food and beverage products to children if they meet certain nutritional criteria, could force some brands to change recipes to include less sodium, fat, sugars, and calories. While many companies have developed their own efforts to market healthier foods to kids, the agreement would apply the same standards to all of the participating companies. Unlike the proposed guidelines of the IWG, the industry’s nutrition criteria set calorie and nutrient requirements for 10 food and beverage categories.


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USDA Publishes Farm to School Report

The U.S. Department of Agriculture (USDA) announced the findings of the first “Farm to School” report. The report summarizes observations from the USDA Farm to School Team, which visited 15 school districts from across the country that were involved in farm to school related activities. The report found that communities are passionate about providing locally grown products to schools and work hard to overcome challenges such as the limited availability of local agricultural products and difficulties with processing and storage. In addition, the report provides suggestions for further action by the USDA to support schools in obtaining locally and regionally grown and produced fresh, healthy food.


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Childhood Obesity Research & News

Industries Lobby against Voluntary Nutrition Guidelines for Food Marketed to Kids

July 9, 2011, Washington Post

By Lyndsey Layton and Dan Eggen

The food and advertising industries have launched a multi-pronged campaign to squash government efforts to create voluntary nutritional guidelines for foods marketed to children.

Calling themselves the Sensible Food Policy Coalition, the nation’s biggest foodmakers, fast-food chains and media companies, including Viacom and Time Warner, are trying to derail standards proposed by four federal agencies. The U.S. Chamber of Commerce has also lent its lobbying muscle to the effort.

The guidelines are designed to encourage foodmakers to reduce salt, added sugars and fats in foods and drinks targeted to children. If their products did not meet the standards, foodmakers following the guidelines would refrain from advertising them to children.

The standards would be voluntary and not regulations; companies would not be required to meet them, and the government would have no way to enforce them.

Public-health experts say children, many of whom may lack the critical-thinking skills to understand advertising, are bombarded daily by television ads, Web sites, toy giveaways and cartoon characters promoting junk food. The food and beverage industry spends about $2 billion a year marketing directly to children.

The business community has portrayed the government’s guidelines as job-killing government overreach. Foodmakers said the voluntary guidelines are too severe and would prevent them from marketing even relatively healthy foods to children.

Congressional directive

Concerned about rising obesity rates among children, Congress in 2009 directed four agencies — the Federal Trade Commission, the Centers for Disease Control and Prevention, the Food and Drug Administration and the Agriculture Department — to propose nutritional standards that food and beverages should meet in order to be marketed to children. The initiative was a bipartisan effort led by then-Sen. Sam Brownback (R-Kan.) and Sen. Tom Harkin (D-Iowa).

“We allow companies into our homes to manipulate children to want food that will make them sick,” said Margo Wootan of the Center for Science in the Public Interest, which is leading a coalition of public-health groups, including the American Heart Association and the American Cancer Society, in support of the guidelines.

The four federal agencies unveiled proposed standards in May and accepted public comment through July 14. A finalized version of the report will be send to Congress.

The business community has dispatched lobbyists to Capitol Hill, held conference calls for media and produced a print ad extolling its past successes in lowering sugar, sodium and fat in many foods marketed to children.

The food industry developed its own standards in 2006 for products marketed to children, but critics say that those efforts at self-regulation lack uniformity and that results have been modest. Foodmakers are updating those industry standards and released a new version of them July 14.

Advertising executives touted one economic analysis that suggested the government’s guidelines would kill 75,000 jobs annually, and the U.S. Chamber of Commerce highlighted a legal scholar’s assessment that the voluntary standards would impede commercial speech.

Rep. Jo Ann Emerson (R-Mo.) plans to insert a provision in the Federal Trade Commission budget to require the agency to weigh the costs before finalizing the guidelines. “I’m always worried when voluntary guidelines get pushed, because I fear that it will become prescribed,” she said. “All we want is to do a cost-benefit analysis of the economic impact.”

Foodmakers said the voluntary guidelines could even prevent them from marketing foods such as yogurt and whole-wheat bread.

Wootan countered that the whole-wheat breads currently marketed to children would meet the proposed guidelines, as would most of the yogurt now aimed at children.

David Vladeck, director of the Bureau of Consumer Protection at the FTC, said he was surprised by the intensity of the reaction from industry and worried about “misinformation.” He posted a July 1 blog item that dissected 12 “myths” regarding the proposed guidelines.

“Congress directed the [agencies] to prepare these guidelines because much of the foods marketed directly to kids are not healthful,” Vladeck said in an interview. “If you look at rising rates of obesity, one in three kids is either overweight or obese. That percentage is growing. I don’t think anyone thinks the status quo is okay. We are trying to be useful in this debate. This is not stealth regulation in any way, shape or form.

The industry coalition

Core members of the coalition — includingGeneral Mills, Kellogg, PepsiCo and Time Warner — spent $6.6 million on lobbying in the first quarter of this year, disclosure records show. Overall, records show, the coalition’s main members have spent nearly $60 million on lobbying since the start of the Obama administration.

One of the main players is media giant Viacom. It owns the Nickelodeon television network, whose animated characters — including Dora the Explorer and SpongeBob SquarePants — are featured prominently on food products marketed to children. Viacom’s corporate parent spent nearly $1 million a month on lobbying in the first three months of this year, mostly on media and technology issues.

The coalition declined to release its budget for the campaign, which is being managed by Anita Dunn of the firm SKD Knickerbocker. Dunn served as White House communications director under President Obama in 2009 and is married to Robert F. Bauer, the former White House counsel.

Her work on behalf of foodmakers is surprising to some because first lady Michelle Obama has made childhood obesity her signature issue. In a speech last year to food manufacturers and retailers, the first lady urged them to curb the marketing of unhealthy foods.

“Our kids didn’t learn about the latest sweets and snack foods on their own,” she told the industry. “They hear about these products from advertisements on TV, the Internet, video games, schools, many other places.”

Consumer groups say the food lobby is aiming to capitalize on Dunn’s connections, particularly among Democrats more sympathetic to nutritional guidelines. The Center for Science in the Public Interest said Dunn and her firm “should be ashamed.”

Dunn dismissed the criticism.

“Without resorting to personal attacks, everybody should be able to work together towards a common goal here,” she said. “At the end of the day, combating childhood obesity is not a question of what gets advertised but a matter of more exercise, healthier eating habits and working together.”


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McDonald's Happy Meals Get Apples, Fewer Fries

July 26, 2011, Reuters

By Lisa Baertlein

McDonald’s Corp said on July 26 it will soon tweak its Happy Meals, reducing the french fry portion by more than half and automatically adding apples to the popular children’s meals, after coming under pressure from consumer groups to provide healthier fare.

McDonald’s — which has been taking heat from parents, consumer groups and local lawmakers over the nutritional content and marketing of Happy Meals — said it would start making the changes in September and the new Happy Meals would be available in all of its 14,000 U.S. restaurants by the end of the first quarter of 2012.

The world’s largest hamburger chain also plans a 15 percent reduction in sodium across its U.S. menu by 2015. Beyond that, it vowed to cut sodium, added sugars, saturated fats and calories in domestic meals by 2020.

“We are going to be casting our gaze more closely on portion management as well as how we can introduce more food groups such as fruits, vegetables and whole grains,” Cindy Goody, McDonald’s senior director of nutrition, said on a webcast.

The new child’s french fry portion will be 1.1 ounces, down from 2.4 ounces previously, and equal to about 100 calories.

McDonald’s currently offers apple slices with caramel dipping sauce as a Happy Meal side. The new apple portion size is 1.2 ounces, compared with 3.1 ounces previously, and has no added sugar or accompanying dipping sauces.

The new Happy Meals will have about 20 percent fewer calories than today’s most popular Happy Meal, executives said. As a result, the new Happy Meals will be under 600 calories.

Prices will not change as a result of the new composition, and toys will continue to be included in every Happy Meal, said Jan Field, McDonald’s U.S.A. president.

The move from McDonald’s came after San Francisco and nearby Santa Clara County, California, passed laws that would curb free toy giveaways with kids’ meals that did not meet nutritional requirements.

“Without the looming prospect of regulation in cities and states around the country, McDonald’s would not have taken as seriously the concerns that the public health community and parents have been sharing with them about this issue,” said Samantha Graff, director of legal research at Public Health Law & Policy, which drafted the models for the ordinances eventually adopted in Santa Clara County and San Francisco.

Field told Reuters that the changes announced on July 26 were in the works for more than two years and had nothing to do with the Santa Clara County and San Francisco laws.

Field added that the new Happy Meals still would not meet San Francisco’s nutritional rules, which also require a vegetable serving.

Still, she said it is “absolutely” possible that McDonald’s could add a vegetable to Happy Meals over the next five years.

The Center for Science in the Public Interest, a consumer group that advocates healthier restaurant food for children, last year sued McDonald’s to stop it from using Happy Meal toys to lure children into its restaurants.

Some 1,700 health professionals and institutions also have signed an open letter to McDonald’s Chief Executive Jim Skinner calling for it to stop marketing junk food to kids.

CSPI’s nutrition policy director Margo Wootan, called the latest McDonald’s changes a step in the right direction.

“McDonald’s is an industry leader and Happy Meals have been copied by so many restaurants,” she said. “Having them change the nutritional quality for the Happy Meal sets a standard for the industry.”

Burger King Corp, DineEquity Inc’s, IHOP and more than a dozen other restaurant chains earlier this month backed an industry effort to serve and promote healthier meals for children. McDonald’s said it supported that effort, from the National Restaurant Association.

As part of that, Burger King said it was removing french fries and soda as the default for its kids’ meals. Diners now have to choose between those options or sliced apples, fat-free milk or juice before an order can be completed.

While the restaurant industry is taking steps to appease its critics, it also has been backing laws designed to restrict local lawmakers’ ability to regulate restaurant marketing and other activities.

Shares in McDonald’s were up 4 cents to $88.16 in afternoon trading on the New York Stock Exchange.


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First Lady, Grocers Vow to Build Stores in 'Food Deserts'

July 20, 2011, Washington Post

By Ylan Q. Mui

Supermarkets joined with first lady Michelle Obama on July 20 in a pledge to build stores in poor neighborhoods that have historically lacked access to fresh groceries, part of her signature effort to combat childhood obesity.

Participating retailers include Wal-Mart, the country’s largest grocer, Walgreens and Supervalu and regional supermarkets such as Brown’s Super Stores in Philadelphia and Calhoun Foods in Alabama and Tennessee. Together, they promised to open more than 500 stores that will employ tens of thousands of people.

“The commitments that you all are making today have the potential to be a game changer for our kids and for our communities all across this country,” Obama said during a news conference at the White House.

Traditionally, grocers have been wary of opening stores in low-income areas, creating food deserts in many urban and rural markets. A report released this month by the Food Marketing Institute, a trade group, said the costs of security, transportation and employee training are often higher in these areas. In addition, customers may have difficulty getting to the stores or may be too dispersed to justify the investment.

“We knew the conventional wisdom on this issue,” Obama said. “If we truly wanted to end the epidemic of childhood obesity . . .then we didn’t have a choice. We needed to confront this problem head on.”

Retailers have started to take a second look at these markets as their traditional suburban strongholds have become saturated. Wal-Mart, for example, recently unveiled a new, smaller store model called Wal-Mart Express designed specifically for urban and rural neighborhoods.

As part of its pledge Wednesday, Wal-Mart said it would open or remodel 275 to 300 traditional supermarkets over the next five years, a move it expects will create 40,000 jobs. Although the stores are just part of the hundreds of locations the behemoth retailer will probably build during that time, executives said Obama’s initiative helped focus its selection of sites.

“Her leadership causes companies like ours to go back and ask questions that challenge ourselves,” said Leslie Dach, executive vice president of corporate affairs for Wal-Mart. Grocery chain Supervalu also committed to opening 250 stores within five years, which it expects will generate 6,000 jobs. Drugstore Walgreens said it planned to convert at least 1,000 stores into “food oases” that sell fresh produce. It estimated that 45 percent of its current locations operate in underserved neighborhoods.

A 2009 report by the Agriculture Department defined a food desert as a low-income neighborhood where the nearest grocery store is at least a mile away, or 10 miles away in rural communities. About 23.5 million people — or 8.4 percent of Americans — live in these areas.

“Today we move past talking about statistics…and focus on steps toward a solution,” said James R. Gavin III, chairman of the Partnership for a Healthy America, a nonprofit group founded last year to help implement Obama’s obesity prevention efforts.

Improving access to healthy foods is one of the key components of that campaign. Last month, the first lady helped the Agriculture Department revamp the food pyramid into a chart called MyPlate, which left out desserts. But on July 20, Obama said that advising families to eat healthy foods was just the first step.

“If parents can’t buy the food they need to prepare those meals…then all of that is just talk,” she said.


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To Fight Obesity, Even Babies Should Exercise

July 11, 2011, Boston Globe

By Maria Cheng

In a new campaign against obesity, the British government issued guidelines on July 11 saying that children under the age of 5 — including those who can’t even walk yet — should exercise every day.

In its first such guidelines for children that young, the health department said kids under 5 who can walk should be physically active for at least three hours a day. Officials also said parents should reduce the amount of time such kids spend being sedentary while watching television or being strapped in a stroller.

The three hours of activity should be spread throughout the day. Officials said the children’s daily dose of exercise is likely to be met simply through playing but could also include activities such as walking to school.

For babies who can’t walk yet, the government said physical activity should be encouraged from birth, including infants playing on their stomachs or having swimming sessions with their parents. The government said children’s individual physical and mental abilities should be considered when interpreting the advice.

“It’s vital that parents introduce children to fun and physically active pastimes to help prevent them becoming obese children, who are likely to become obese adults at risk of heart disease, diabetes and some cancers,” Maura Gillespie, head of policy and advocacy at the British Heart Foundation, said in a statement.

Nearly a quarter of British adults are obese, and experts estimate that by 2050 about 90 percent of adults will be heavy.

According to a 2008 health survey that used devices to measure how much people actually exercised, officials found only about five percent of Britons meet the government’s minimum physical activity advice — about 150 minutes of moderate to vigorous exercise every week, including some every day.

For children aged 5 to 18, Britain recommends at least one hour of exercise, but that should include intensive activities to strengthen muscles and bones.

In the U.S., the Centers for Disease Control and Prevention advises children and teenagers to get about one hour or more of physical activity every day.

According to the Institute of Medicine, an independent organization in Washington, D.C., toddlers should get at least 15 minutes of exercise for every hour they spend in child care.


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