- Temple-led Study Finds Prolonged Bottle Use May Contribute to Childhood Obesity
- Nutrition Plate Unveiled, Replacing Food Pyramid
PUBLICATIONS & TOOLS
- NCCOR's Measures Registry is a Success
- Regional Price Variations Could Affect WIC Purchasing Power
- USDA Introduces Online Tool for Locating Food Deserts
CHILDHOOD OBESITY RESEARCH & NEWS
- Food Makers Resist Lawmakers' Proposal for Guidelines in Marketing to Children
- Still Battling Weight in Arkansas
- Texas School Cameras Will Watch Kids' Calorie Counts
- Snack Trucks Thwart Nutrition Goals
- Pressure Could Make Ronald Grimace
Temple-led Study Finds Prolonged Bottle Use May Contribute to Childhood Obesity
May 5, 2011, Temple University News
Experts recommend that by 2 years of age children should not be drinking from a bottle, but a national study led by Temple researchers has found that the practice is still common at that age and further, it could contribute to childhood obesity.
In an article published this month in The Journal of Pediatrics, researchers Rachel Gooze, a doctoral candidate in public health, and Robert Whitaker, professor of pediatrics and public health at the Center for Obesity Research and Education, found that children who were using a bottle at 24 months were approximately 30 percent more likely to be obese at 5.5 years, even after accounting for other factors such as the mother’s weight, the child’s birth weight, and feeding practices during infancy.
The researchers analyzed data from 6,750 children enrolled in the Early Childhood Longitudinal Study, Birth Cohort to determine a link between bottle use at 2 years of age and the risk of obesity at 5.5 years of age. Twenty-two percent of the children were classified as prolonged bottle users — that is, at 2 years of age, they used a bottle as their primary drink container and/or were put to bed with a calorie-containing bottle.
Gooze said practices such as putting a child to bed with a bottle of juice or milk can lead to over feeding. “It is possible that the calories coming from the bottle might be in excess of what the child needs during the day,” she said. “For young toddlers, an 8 ounce bottle of whole milk can contain close to 12 percent of their daily caloric intake.” Whitaker notes that over 20 percent of the children in the study were still using a bottle at 2 years old, and in addition to the risk of obesity, this can lead to other health issues such as tooth decay.
“Children may over consume due to the comfort and security that a bottle provides,” he said. “But at 2 years old, calories and nutrients can and should be coming from sources other than a bottle.”
The researchers suggest pediatricians and other health professionals work with parents to find acceptable solutions for stopping bottle use around a child’s first birthday.
Nutrition Plate Unveiled, Replacing Food Pyramid
June 2, 2011, The New York Times
By William Neuman
The first lady, Michelle Obama, on June 2, relegated the government’s well-known food pyramid to the sands of history, unveiling a new, simpler image of a plate divided into basic food groups.
The new design, called MyPlate, was conceived as a crucial part of Mrs. Obama’s campaign against obesity, designed to remind consumers about the basics of a healthful diet.
The plate is split into four sections, for fruit, vegetables, grains and protein. A smaller circle sits beside it for dairy products.
Mrs. Obama, Agriculture Secretary Tom Vilsack and Dr. Regina M. Benjamin, the surgeon general, unveiled the new healthful eating icon at a news conference in Washington.
“This is a quick, simple reminder for all of us to be more mindful of the foods that we’re eating,” Mrs. Obama said. “We’re all bombarded with so many dietary messages that it’s hard to find time to sort through all this information, but we do have time to take a look at our kids’ plates.”
If the filled plate looks like the symbol, with lots of fruits and vegetables, she said, “then we’re good, it’s as simple as that.”
The Agriculture Department has created a website, ChooseMyPlate.com, that elaborates on the guidance reflected in the plate’s design. It includes tip sheets with recommendations like eating fish twice a week and avoiding high-fat, salty foods like salami and bologna.
Officials said they planned to use the plate in a campaign to communicate essential dietary guidelines to consumers, emphasizing one message at a time for the best effect.
The first part of the campaign will encourage people to make half their plate fruit and vegetables. Later phases will urge consumers to avoid oversize portions, enjoy their food but eat less of it and drink water instead of sugary drinks.
Nutritionists often criticized the food pyramid, which was first advanced in 1992, for being misleading or hard to understand. Some gave the plate cautious praise. “It’s better than the pyramid, but that’s not saying a lot,” said Marion Nestle, a professor of nutrition at New York University.
Dr. Nestle praised the plate for being generally easy to understand, but she said that labeling a large section of the plate “protein” was confusing and unnecessary, because grains and dairy products also are important sources of protein and most Americans get far more protein than they need.
But she said the emphasis on fruits and vegetables was a significant step.
“Americans aren’t used to eating this way, so this is a big change,” Dr. Nestle said.
The plate was created by the Agriculture Department with advice from the first lady’s anti-obesity team and federal health officials. The Agriculture Department said that it had conducted focus groups with about 4,500 people, including children, as it developed the plate.
The project, with the website and related educational materials, cost about $2 million. That money will also help pay for an educational campaign about the plate over the next year, officials said.
Publications & Tools
NCCOR's Measures Registry is a Success
On April 29, The National Collaborative on Childhood Obesity Research (NCCOR) launched the Measures Registry (MR), a searchable database of diet and physical activity measures relevant to childhood obesity research. Childhood obesity and public health researchers have commended the Registry for encouraging the use of common measures and accelerating childhood obesity research. The tool has also garnered a great deal of interest among users.
The launch included a new Registry homepage on the NCCOR site. As of the end of May, the homepage had over 1,907 visitors. Additionally, nearly 22 percent of all of the traffic to the NCCOR site was driven by visits to the tool.
A webinar describing the features and functions of the Registry was held on May 19th. More than 260 people joined the webinar. An achieved version of the webinar is available athttp://nccororgms.wpengine.com/upcoming_events_webinars.html#mr
The Measures Registry includes almost 750 measures in four domains: individual dietary behavior, food environment, individual physical activity, and physical activity environment. Types of measures in the Registry include questionnaires, instruments, diaries, logs, electronic devices, direct observation of people or environments, protocols, and analytic techniques. Users can search for measures and details about how to use them, find measures in development, link to other measures registries and related resources, and submit new measures for inclusion.
NCCOR recently launched another resource for childhood obesity researchers, the Catalogue of Surveillance Systems: www.nccor.org/css. This interactive Web tool provides one-stop access to a wide array of obesity-related data sources at multiple levels. Using the Catalogue, researchers can identify data resources, compare attributes across systems, and link to other resources of interest. The Catalogue and the Registry are complementary tools intended to increase obesity researchers’ productivity.
Please visit www.nccor.org for more information about the Registry, a full list of NCCOR-led projects, upcoming events, and childhood obesity research highlights.
Regional Price Variations Could Affect WIC Purchasing Power
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides supplemental foods to low-income women, infants, and children at nutritional risk. Since October 2009, WIC food packages have included a fixed-value voucher for purchasing fruits and vegetables. A new study by the Economic Research Service at the U.S. Department of Agriculture disproves the theory that the fixed-value voucher would help increase fruit and vegetable consumption for all WIC participants. It indicates that regional price variation can lead to different buying power, and subsequently different nutrition, to participants across the country.
USDA Introduces Online Tool for Locating Food Deserts
The U.S. Department of Agriculture (USDA) announced the launch of an online mapping tool that locates food deserts. The Food Desert Locator also provides data on population characteristics where residents have limited access to affordable and nutritious foods, including low-income communities. The tool can be used to help advocates expand the availability of nutritious foods in these areas.
Childhood Obesity Research & News
Food Makers Resist Lawmakers' Proposal for Guidelines in Marketing to Children
May 24, 2011, Washington Post
By Lyndsey Layton
The food and advertising industries are pushing back against an Obama administration proposal that calls for food makers to voluntarily limit the way they market sugary cereals, salty snacks and other foods to children and teens.
From yogurt makers to candy manufacturers, they lined up in May to tell regulators that the first-ever proposed guidelines for marketing to children would not stop the childhood obesity problem but would certainly hurt their businesses and abridge their right to free speech.
The guidelines, ordered by Congress and written by a team from the Federal Trade Commission, the Food and Drug Administration, the Centers for Disease Control and Prevention, and the Agriculture Department, ignited a debate about the role of marketing in soaring obesity rates among children.
“I can’t imagine any mom in America who thinks stripping tigers and toucans off cereal boxes will do anything to reduce obesity,” said Scott Faber, a vice president at the Grocery Manufacturers Association, which represents food makers and retailers.
But public interest groups and health experts say tighter controls on advertising will make a difference. “It’s clear that food marketing to children is a big factor,” said Daniel Levy of the American Academy of Pediatrics.
“Children and teens are being hit by food ads wherever they turn,” said Levy, adding that teenagers can now receive promotional messages about marketing deals on their cell phones as they pass fast-food restaurants.
The regulators held the meeting to gather input from the public. They are accepting written comments until July 14 before finalizing the recommendations and submitting them in a report to Congress.
The far-reaching guidelines would cover a wide array of marketing, from traditional media such as television, print and radio to pop-up ads on Internet sites. They would apply to social media, toys in fast-food meals, ads shown in movie theaters, sponsorship of athletic teams and philanthropic activities, as well as product placement in movies and video games.
“Marketing campaigns are highly integrated, very sophisticated with the result that marketing messages are ubiquitous,” said Michelle Rusk, an attorney at the Federal Trade Commission. “TV and traditional media are only about half of the marketing to children, maybe even less.”
The guidelines would be voluntary and implemented over a decade. But food companies and advertising firms say they would feel great pressure to follow guidelines, making them de facto regulations.
“This is a classic case of backdoor regulation,” said Dan Jaffe of the Association of National Advertisers. Advertising aimed at children is a big business; food companies spend about $2 billion a year to advertise to children.
Regulators say they hope the guidelines will nudge manufacturers to improve the nutritional content of processed foods aimed at children and teens.
“We don’t want them to just quit marketing to children but to lower the sugar content or include more whole grains and then market these better options to children,” Rusk said.
At the meeting food makers repeatedly said that they were already policing themselves and no additional measures were necessary. Since 2006, 17 food and beverage companies have participated in an industry program to restrict some marketing aimed at children. But that program lacks uniform standards, allowing each participating company to set its own criteria.
“Self-regulation shows hints of progress, but it’s not working well enough to protect our children,” said Margo Wootan of the Center for Science in the Public Interest, which supports the proposed federal guidelines along with several major public health organizations.
The guidelines say foods that are advertised to children cannot exceed limited amounts of added sugars, saturated fat, sodium or trans fat. And they must include healthy ingredients, such as fruit and vegetables, low-fat dairy products or whole grains.
The sugar limits would pose a problem for many foods currently marketed to children. Under the guidelines, one serving of a food aimed at children could not exceed 8 grams of sugar. A single serving of Count Chocula cereal currently contains 12 grams of sugar; a serving of Frosted Flakes contains 11 grams.
The guidelines would apply to both young children and teenagers. Food makers and advertisers argue the guidelines be more narrowly tailored when applied to teenagers because much of the programming and media consumed by teenagers are also seen by adults. Federal regulators say they will take that notion into consideration in the final recommendations.
Still Battling Weight in Arkansas
May 8, 2011, Los Angeles Times
By Jessica Pauline Ogilvie
For at least two decades, Arkansas has been among the heaviest states in the nation: By 2000, the state’s obesity rate was 20 percent to 24 percent and rising. Appalled, in 2003 then-Arkansas Gov. Mike Huckabee — who had been diagnosed with Type 2 diabetes and famously went on to shed more than 100 pounds — became a champion for healthy lifestyles in his home state.
He signed into law a sweeping piece of legislation targeting childhood obesity. Over the next few years, he launched the Healthy Arkansas Initiative, aimed at helping overweight and obese adults improve their physical well-being.
With broad efforts and the support of an impassioned governor, the state seemed poised to make serious progress. Eyes of obesity experts around the U.S. trained on Arkansas, waiting to see the results — and what lessons it held for tackling obesity nationwide.
Since then, Huckabee appears to have regained much of the weight he had lost, a stark reminder of how difficult it is to slim down and stay that way. And although Arkansas officials remain committed to fighting the state’s weight problem, they’ve found that it is, and will be, an uphill battle.
When Arkansas Act 1220 was signed into law in 2003, it was one of the most expansive pieces of legislation targeting childhood obesity in the nation, said Dr. Martha Phillips, an assistant professor in the department of psychiatry at the University of Arkansas for Medical Sciences, who has helped lead efforts to study the law’s effects.
It restricted access to vending machines in elementary schools, created an advisory committee to make recommendations about nutrition and physical activity to the state Legislature, asked school districts to set up committees overseeing the health needs of children and families, and — most controversially — implemented body mass index screenings of students, sending the results home to families as part of their report cards, and later as a separate letter.
It was the right approach, said Roberta Friedman, director of public policy at the Yale Rudd Center for Food Policy and Obesity — adjusting what children are exposed to at school rather than attempting to transform their behavior.
According to a recent evaluation of the law conducted by the University of Arkansas for Medical Sciences and funded by the Robert Wood Johnson Foundation, an organization devoted to public health, schools in Arkansas look much different now. Between 2004 and 2009, the number of students who reported that they had access to vending machines dropped from 64 percent to 23 percent, and the percentage of school districts with policies prohibiting the sale of junk food increased from 37 percent to 67 percent.
But those involved in evaluating the bill say that while schools have changed, behaviors of students and their families largely have not.
“Have we seen an increase in physical activity, healthy eating, healthy diets? No,” Phillips said.
According to the recent evaluation, which Phillips co-wrote, in 2009 parents reported modifying recipes to make them more healthful about 2.1 times a month, down a little from 2.3 in 2004. The average number of times that families said they ate fast food each month increased from 5.9 to 6.6 during that same period.
Results of the BMI screenings, which are published annually by the nonpartisan Arkansas Center for Health Improvement, show that the percentage of overweight and obese children has remained stubbornly and exactly at 38 percent from 2005 to 2009.
Students’ BMI screenings and reports were implemented, policymakers say, to help parents understand the severity of their children’s weight problems. They also would enable the law’s effects to be studied. But many parents resisted; some were worried that students would be tested using calipers or that they would be teased or go on unnecessary diets.
“There were quite a few parents that opposed it,” said Valerie Beshears, lead nurse for Arkansas’ Fort Smith public school district. “We would get notes back saying, ‘I don’t want this done.”
Beshears says objections have largely waned, and evaluations showed that weight-based bullying and dieting among students hasn’t increased. But the practice remains a subject of debate in the medical community.
In 2005, the U.S. Preventive Services Task Force, an independent panel of medical experts, reported that there wasn’t enough evidence against or in favor of BMI screenings in children to render them necessary. And specialists in the field of eating disorders still worry that the screenings could be a trigger pushing those with predispositions to anorexia, bulimia or binge eating over the edge.
“In every school district, there is going to be somebody with that predisposition who they are nudging towards an eating disorder,” said Lynn Grefe, president and chief executive of the National Eating Disorders Association.
Children aren’t the only people targeted by Arkansas’ efforts. As part of a focus on adults, the Arkansas Coalition for Obesity Prevention was formed, bringing together groups committed to improving public health by such measures as increasing access to healthy foods and helping residents become more physically active.
Arkansas designated much of the revenue from a recent tobacco tax increase for health improvement efforts, such as joint use agreements that allow communities have access to school fitness facilities. And for several years, more than 11,000 state employees have participated in a program in which they track their intake of fruits and vegetables, physical activity and tobacco use and get three extra vacation days a year in return.
But just as with children, the state’s obesity stats haven’t improved. According to the Centers for Disease Control and Prevention, in 2009, 30.5 percent of Arkansans were obese, a number that has gone up steadily: from 15 percent-19 percent in 1993, to 20 percent to 24 percent in 2000, to the current rate.
Friedman said that expecting behavior and obesity rates to change quickly through legislative efforts isn’t realistic.
“There is this assumption that a bill like [Arkansas Act 1220] is a sort of magic bullet … you focus on the school environment and you change it and it’s going to mean automatic weight loss,” she said. “What I see it as, is one piece of what needs to be going on.”
Parents and children must become informed about healthy living, she said; environments near schools must change, offering healthier options in stores and corner markets that students may pass walking to and from school; marketing of junk food to children must be scaled back.
“You can educate kids in school about the problems with drinking too many sugary, sweet beverages and eating too many snacks,” she said, “but if they then walk into the hallway to see vending machines with ads all over them selling soda and selling candy, it’s such a mixed message that it’s hard to say how well the education can then work.”
Though the future of obesity in Arkansas — and the entire U.S. — seems uncertain, those who have invested their energy there said they aren’t giving up hope.
“I want to be the first state that has clearly showed we have reversed the epidemic,” Arkansas Surgeon General Joe Thompson said. “And I think we have the pieces in place to do that.”
Texas School Cameras Will Watch Kids' Calorie Counts
May 11, 2011, Reuters
By Jim Forsyth
The next time kids in five San Antonio elementary schools try to sneak those extra french fries onto their tray in the cafeteria line, the eye in the sky will be watching them.
Using a $2 million grant from the U.S. Department of Agriculture, the schools are installing sophisticated cameras in the cafeteria line and trash area that read food bar codes embedded in the food trays.
“We’re going to snap a picture of the food tray at the cashier and we will know what has been served,” said Dr. Roberto Trevino of the San Antonio-based Social and Health Research Center, which is implementing the pilot program at five schools with high rates of childhood obesity and children living in poverty. “When the child goes back to the disposal window, we’re going to measure the leftover.”
The goal of the program is to cut down on childhood obesity by providing parents and school nutrition specialists with specific information on what types of food elementary students are eating.
They will then be able to design healthy meals based on students’ real-life habits, the center’s spokeswoman Denise Jones said. Parents will also be able to use the information to help them design healthier meals at home, she said.
“We will be able to determine whether current programs that are aimed at preventing obesity work, and whether they are really changing students’ behavior,” Trevino said.
Officials will receive information on the nutrient and calorie counts of the food children have actually consumed.
The technology will identify the food, capture the nutrient levels and measure the food that children eat, said Dr. Roger Echon of the center, who designed the program.
Echon showed reporters a printout of the reading from one student’s tray at W.W. White Elementary School. It listed the size of the serving, and its calorie, fiber, sugar and protein count. He said the program can break down the data into total monounsaturated fatty acids, soluble dietary fiber, and more than 100 other specific measures.
Trevino said the children will not be photographed, and only children who have the permission of their parents or guardians will be allowed to participate.
He said that if the effort is successful in San Antonio, the plan is to implement similar programs in elementary schools nationwide.
Snack Trucks Thwart Nutrition Goals
May 26, Wall Street Journal
By Bobby White
After the Novato school district banned junk food in its K-12 schools in 2007, Rana Sanghi saw an opportunity. He altered his ice cream truck route to include Novato High School, parking the vehicle just outside the entrance.
Initially, school officials in the Marin County district say they were reluctant to object, but their sentiments changed earlier this year when more trucks began to arrive. These days, as many as five can be found parked near the school’s entrance, attracting more than 300 kids during lunch hours.
“I’m just trying to make a buck here,” said the 47-year-old Mr. Sanghi, who has three children of his own though none at Novato High. But, he added, “I’d be lying if I said there wasn’t a problem” in how the trucks help students skirt the junk food crackdown.
The school’s principal, Rey Mayoral, said fights have broken out between drivers over choice parking locations, forcing him to call the police on more than one occasion. And the scores of students flocking to the trucks sometimes snarl traffic, he said.
“These trucks are contradicting everything we are trying to teach the kids” about nutrition, said Mr. Mayoral. “And what makes matters worse is it’s getting dangerous.”
Vending trucks have been a nuisance at some other Bay Area school districts trying to instill better eating habits. In 2007, San Francisco issued an ordinance that limits how close a vending truck can park near schools. The Oakland and Santa Cruz districts followed with similar ordinances in 2009.
In Novato, school leaders, many parents and even some students are in favor of the restrictions. But some students say the trucks are a convenient alternative to the crowded school cafeteria.
Lucas Ternell, 17, a senior at Novato High School, says some of his friends buy snacks from the trucks, though he says he doesn’t. “They’re kids so they aren’t thinking about the consequence of their actions,” he says. “They want quick, cheap and what tastes good.”
City officials have been hesitant to enact limits on the trucks, saying they would be costly to enforce at a time of deep financial strain. At a city council meeting earlier this month, after an hourlong presentation from school leaders, the council decided against passing an ordinance.
Mike Frank, Novato city manager, says the city will explore ways to rid the trucks from around the schools, but cautioned that he is reluctant to dedicate police officers to the issue.
“We’ll find a creative solution to deal with the problem, but we cannot afford to have police officers sitting around schools,” says Mr. Frank.
Novato does have in place an ordinance that places a 10-minute limit on parking and vending, but it is enforced only through complaints. To operate in the city, vendors must have a business license, a police permit and a health permit, which can total about $1,000.
Nutrition advocates say the disconnect in Novato highlights how the growing effort to improve nutrition in schools must extend to the community to have a lasting effect.
“Without a buy-in from the neighborhood and home it’s difficult for the healthy eating policies to take effect,” said Gail Woodward-Lopez, associate director of the Center for Weight and Health at the University of California, Berkeley.
Ms. Woodward-Lopez said nutrition efforts in schools in San Francisco’s Bayview neighborhood and South Los Angeles included local corner stores and convenience shops altering their choice of items to coincide with menu changes in neighboring schools. Some school districts in Orange County have been able to persuade some vending trucks to sell healthy items, in addition to making changes in the school menu.
California has been at the forefront of overhauling school cafeteria menus and vending options. In 2003, the state was the first to ban soda sales in elementary and middle schools. By 2009, state law required vending-machine snacks and cafeteria meals sold during school hours to have fewer calories and less fat. In the Bay Area, schools in Oakland and Berkeley have far-reaching policies governing nutrition, including partnerships with local farms to provide fresh produce and other items for meals.
The policy at Novato Unified School District, which includes 15 schools, restricts the sale of food with high fat content such as potato chips and pizza, as well as certain meats and chocolate milk.
Pam Conklin, Novato’s schools superintendent, said the district began to first encounter the vending trucks in 2009. Last year, she said, their numbers began to increase and parents began to complain about the unhealthy items.
The school district attempted to institute a closed campus policy for its three high schools, prohibiting students from leaving during breaks and lunch hour, but parents and some administrators were against the measure and voted it down. As a compromise, freshman students at Novato high schools remain on campus during breaks.
“We’re in an awkward situation,” said Ms. Conklin. “We’ve put a lot of effort into improving kids’ health,” she added, “but the trucks allow kids to ignore all of it.”
Pressure Could Make Ronald Grimace
May 18, 2011, Boston Globe
By Christina Rexrode
Ronald McDonald is having a midlife crisis.
His floppy shoes, painted-on smile, and flaming-red hair may be a harder sell to today’s kids who are trading in their dolls and trucks for manicures and mobile games at ever-younger ages. He also seems out of step with McDonald’s Corp.’s efforts to appeal to adults. The 48-year-old spokesclown has fallen flat in new ads this year, according to Ace Metrix, a group that tracks TV advertising.
And the government is getting strict on how food is marketed to children. That has both marginalized Ronald as more of a mascot than a product pitchman and landed him in the middle of the bigger debate about food makers’ responsibilities in stemming the rise in childhood obesity.
McDonald’s says it is proud of the food it offers and that Ronald teaches children to be active, but critics say it’s time to hang up the yellow jumper.
A group called Corporate Accountability International asked Ronald to retire at the company’s annual meeting in May. They say Ronald encourages kids to eat junk food, contributing to a rise in childhood obesity and related diseases such as diabetes.
The group, which campaigned against the Joe Camel cigarette mascot in the ’90s and complained about Ronald at McDonald’s annual meeting last year, has stepped up its campaign. The group has taken out full-page ads in the Chicago Sun-Times, New York Metro, and four other papers to call for his departure. The ads, signed by more than 550 health groups and professionals, carry the headline, “Doctors’ Orders: Stop Marketing Junk Food To Kids.”
McDonald’s defended Ronald against the group’s attack at last year’s annual meeting and is adamant that it has never considered retiring or even downplaying their smiling mascot.
“It’s totally unfounded,” said Marlena Peleo-Lazar, the company’s chief creative officer, who describes Ronald as “a force for good.”
While other clowns have faded, Ronald has endured. He has been immortalized as a Beanie Baby, a bobblehead, and a balloon in the Macy’s Thanksgiving Day Parade. Even now, Zagat says he’s the most popular fast-food mascot, beating out Jared the Subway Guy.
But Jack McKee, vice president of sales and marketing at Ace Metrix, said new Ronald McDonald commercials have failed to entice test audiences. His company surveyed 500 people about each commercial, he said.
“It’s really remarkable how often I saw the word ‘creepy'” in the survey comments, McKee said.
Replies Peleo-Lazar: “For everyone who may feel that way, there are more who feel the opposite.”