PUBLICATIONS & TOOLS
- Report offers recommendations for combating spread of U.S. obesity
- School budgets, student health to benefit from higher nutrition standards, HIA finds
CHILDHOOD OBESITY RESEARCH & NEWS
- American Medical Association supports requiring obesity education for all public school kids
- Obesity in America: Schools on the front line of the fight
- Will Philadelphia's experiment in eradicating 'food deserts' work?
Study: Kids' cereals are healthier; ads aren't
June 22, 2012, Reuters
By Lisa Baertlein
While U.S. food companies are making healthier breakfast cereals for children, they’re also aiming more ads for their unhealthiest products at kids, according to a report issued June 15.
The “Cereal Facts” study from Yale University’s Rudd Center for Food Policy & Obesity offers an outside assessment of the industry’s actions and comes amid rising alarm over diet-related health costs in the United States, where nearly a third of children are overweight or obese.
Kelly Brownell, director of the Rudd Center, lauded cereal makers for changing their recipes to boost fiber and whole grain content while reducing sugar and sodium, but said there was ample room for further improvement.
“It’s not enough and the companies are still using all their marketing muscle to push their worst cereals on children,” Brownell said.
Spending to promote child-targeted cereals was $264 million in 2011, an increase of more than 30 percent from 2008, according to the Yale study, which follows a similar report three years ago.
The study highlighted aggressive marketing of cereals like General Mills Inc’s Reese’s Puffs, Kellogg Co’s Froot Loops and Post Holdings Inc’s Pebbles to children—brands which rank among the lowest for nutrition and the highest for added sugar, according to researchers.
In the three years through 2011, childrens’ exposure to television ads for Froot Loops leapt 79 percent; their exposure to ads for Reese’s Puffs jumped 55 percent and that for Pebbles was up 25 percent.
While regular Cheerios and Frosted Mini-Wheats have some of the highest nutrition scores, ads for those products were more likely to be targeted at adults, the report said.
The cereal companies defended their marketing practices and their products, which, they said, continued to evolve.
“Kellogg has a long-standing commitment to responsibly market foods that meet strict nutrition criteria to children ages 6 to 12,” spokeswoman Kris Charles said in an email.
In a statement, Post said it “continually works to address the nutritional make-up of our brands.”
General Mills said it has cut sugar levels in its childrens’ cereals by more than 14 percent, on average, since 2007.
Over the past several years, the nation’s food and beverage companies have fended off government oversight of marketing to children by promising to police themselves. Cereal makers Kellogg, General Mills and Post are among companies that have signed on to the Council of Better Business Bureaus’ Children’s Food and Beverage Advertising Initiative (CFBAI), a voluntary self-regulation program for food marketed to children. Participants have agreed to adhere to industry-created nutrition criteria for products advertised to kids under the age of 12.
Critics say those guidelines are less stringent than many health experts would like to see.
“Rudd tends to look at the glass half empty. I look at it as half full and rising,” said Elaine Kolish, director of CFBAI, adding that changing kids’ tastes would take time.
“The notion that kids could stop eating Froot Loops and go and have Grape-Nuts, with all due respect to Grape-Nuts, to me is unrealistic and not practical,” Kolish said, referring to the whole-grain cereal Post cereal promoted by the late Euell Gibbons, who advocated natural diets in the 1960s.
Before CFBAI was founded, some cereals had 15 to 16 grams of sugar per serving. Now, Kolish said, most have no more than 10 grams of sugar—or about 2.5 teaspoons—per serving.
The American Heart Association recommends that no more than half of discretionary calories come from added sugars.
Based on that AHA guideline and data from the U.S. Department of Agriculture, inactive to moderately active young children, on average, should consume no more than 20 grams of added sugar a day, the report’s authors said.
But children, on average, consume two servings of breakfast cereal, the study said. “Before they leave the house in the morning, children eating these pre-sweetened cereals will have consumed as much sugar as they should eat in an entire day,” it said.
Publications & Tools
Report offers recommendations for combating spread of U.S. obesity
June 5, 2012, Education Week
By Bryan Toporek
With one-third of U.S. children now considered overweight or obese, the country is facing a brewing health crisis. To combat the further spread of obesity in the United States, the U.S. Department of Health & Human Services and the U.S. Department of Agriculture (USDA) should develop and implement new dietary guidelines for the first 1,000 days of a child’s life and national physical-activity guidelines for all children younger than 6, suggests the Bipartisan Policy Center (BPC) in a report released in June.
Furthermore, schools should actively work to improve nutrition and physical-activity opportunities for students, requiring 60 minutes of physical activity per day for each student, the report says.
The report, “Lots to Lose: How America’s Health and Obesity Crisis Threatens Our Economic Future,” offers a number of recommendations for how the United States can help citizens control their weight and live healthier lifestyles. It comes from the BPC’s Nutrition and Physical Activity Initiative, chaired by two former secretaries of Agriculture, Dan Glickman and Ann Veneman, and two former secretaries of Health and Human Services, Mike Leavitt and Donna Shalala.
The authors highlight four major areas of focus in the report: Families, schools, workplaces, and communities. For schools, they specifically suggest integrating physical activity into the whole school day (not just P.E. class), restoring recess, and including physical activity in out-of-school activities.
Beyond providing ample opportunities for physical activity, the report suggests that parents and schools should work together and strive to limit children to only one to two hours of quality screen time per day.
“Learning to be active early on, and staying active throughout our lifetimes, is critical to reducing obesity and chronic disease,” Leavitt said at an event for the report’s release.
“To improve our performance in school, at work, and in the global economy, local public- and private-sector partners need to use existing infrastructure and leverage existing resources to increase physical activity.”
In the report, the authors note the research linking physical activity to improved academic success as all the more reason to boost physical activity in school. They include a picture of a child’s brain after sitting quietly versus after taking a 20-minute walk — guess which one had the more active brain?
“There is no silver bullet,” said Glickman at the report’s release. “But we have identified numerous steps that show what is possible. We must all take action to beat this threat. America cannot afford for the obesity crisis to go unnoticed any longer.”
In case this report reeks of controversy, similar to N.Y.C. Mayor Bloomberg’s recent proposal to ban the sale of large, sugary drinks, the report authors quickly moved to quash that notion.
“Our recommendations, we must note, are not about creating a ‘nanny state’—just the opposite,” the four secretaries wrote in an op-ed published today in The Hill. “They are intended to empower our people to live healthier, wealthier, and longer lives in the face of a real and present danger to our security, economy, and well-being.”
School budgets, student health to benefit from higher nutrition standards, HIA finds
June 26, 2012, Health Impact Project News
Updating national nutrition standards for snack foods and beverages sold in schools could help students maintain a healthy weight and increase food service revenue, according to a health impact assessment (HIA) released June 26 by the Kids’ Safe & Healthful Foods Project and the Health Impact Project.
The findings come as the U.S. Department of Agriculture (USDA) prepares to issue policies requiring that food and beverages sold outside of federal school meal programs meet minimum nutrition standards. These items sold in vending machines, school stores, and cafeteria a la carte lines are often called “competitive foods” because they compete with school meals for students’ spending.
The projects, both collaborations of The Pew Charitable Trusts and the Robert Wood Johnson Foundation (RWJF), conducted this HIA to examine how the USDA’s updated nutrition standards would affect student health. It also looked at the potential impact such changes could have on school revenue.
This HIA marks the first time such an evaluation has been completed to inform a new federal rule and is one of the most comprehensive scientific reviews ever conducted on competitive foods. Vetted by a wide array of experts, the peer-reviewed research includes an assessment of more than 300 studies and original economic data analyses.
“The evidence is clear and compelling,” said Jessica Donze Black, director of the Kids’ Safe & Healthful Foods Project. “Implementing strong national nutrition standards to make the snacks and beverages our children consume healthier is something that schools and districts can afford. The USDA should do all it can to finalize and help implement strong standards.”
The HIA found that national nutritional standards for snack foods and beverages would reduce the consumption of these items during the school day. With many children eating roughly half of their daily calories at schools, new guidelines will likely have a meaningful impact on student weight. For example, the spike in childhood obesity that occurred between 1988 and 2002 could have been substantially decreased by a modest reduction of just 110-165 calories a day.
The report also showed that many schools may be losing money from their food services departments when students buy snack foods instead of healthier breakfasts or lunches. School districts in states with nutrition standards for snack and a la carte foods and beverages saw total food- service revenues generally increase after the guidelines were put in place. This is largely because more children will purchase school meals if there are fewer items competing for their lunch money.
“School districts on average experienced an increase in food-service revenues after the implementation of standards for snack foods and beverages—even when controlling for factors such as the economic downturn, population size, demographics and poverty levels,” said Portland State University Professor Neal Wallace, who conducted the HIA’s economic analysis. “The increases in food-service revenues were found to offset any losses in sales of competitive foods, leaving overall food-related revenues virtually unchanged.”
All children would benefit from new nutrition guidelines, particularly those in vulnerable populations. Students from low-income families who participate in free and reduced-priced meal programs would be more likely to buy healthier foods after implementation of the guidelines. Likewise, these new standards would help black and Hispanic children, who tend to have a higher incidence of obesity and related diseases.
Based upon the rigorous research conducted by the HIA, the projects recommend that the USDA:
- Establish nutrition standards for all foods sold regularly onsite during the school day and that are outside of the USDA meal programs
- Set nutrition guidelines for all beverages sold on school grounds
- Adopt policies and practices that ensure effective implementation of the standards.
“This HIA looked at the health impact of higher nutritional standards in the context of the significant financial challenges that schools face already,” said Aaron Wernham, M.D., director of the Health Impact Project. “We found that schools can afford to do the right thing. School districts with healthier snack food and beverage policies also tend to do better financially. It is a win-win.”
The Kids’ Safe & Healthful Foods Project and the Health Impact Project worked with Upstream Public Health, a non-profit research and policy organization with experience in completing detailed assessments of health impacts, to conduct this assessment.
HIAs are part of a fast-growing field in the United States. In 2007, there were only 27 such studies. Today, roughly 200 HIAs have been completed or are ongoing.
Childhood Obesity Research & News
American Medical Association supports requiring obesity education for all public school kids
June 20, 2012, The Associated Press
Last month, the American Medical Association put its weight behind requiring yearly instruction aimed at preventing obesity for public schoolchildren and teens.
The nation’s largest physicians group agreed to support legislation that would require classes in causes, consequences and prevention of obesity for first- through 12th-graders. Doctors will be encouraged to volunteer their time to help with that under the new policy adopted on the final day of the AMA’s annual policy making meeting.
Another new policy adopted June 20 says the AMA supports the idea of using revenue from taxes on sugar-sweetened sodas as one way to help pay for obesity-fighting programs. But the group stopped short of fully endorsing such taxes.
Some doctors think soda taxes would disproportionately hurt the poor and disadvantaged. Others said taxes shouldn’t be used to force people to make healthful decisions they should be making on their own.
Doctors at the meeting shared sobering statistics and personal stories in urging the AMA to sharpen its focus on obesity prevention.
“I can’t tell you the number of 40-pound 1-year-olds I see every day,” Dr. Melissa Garretson, a Stephensville, Texas pediatrician, told the delegates before Wednesday’s vote. She said requiring obesity education “is a great idea.”
The measure was drafted by the AMA’s Pennsylvania delegation. It cited data showing that more than 300 million people worldwide are obese and said requiring nutrition education to prevent obesity has never been proposed.
Obesity affects more than one-third of U.S. adults and almost one in five children, or more than 12 million kids. Recent evidence suggests those numbers may have stabilized, but doctors say that’s small consolation when so many people are still too fat.
Excess weight is strongly linked with diabetes, heart disease and some cancers, and weight loss of just 5 percent can help improve health, the Pennsylvania doctors’ measure said.
Dr. Bruce Wilder, a delegation member, said he will ask Pennsylvania legislators to introduce legislation to enact that requirement in schools.
Obesity in America: Schools on the front line of the fight
June 27, 2012, The Christian Science Monitor
By Stacy Teicher Khadaroo
Eat better. Move more. That’s what more schools are urging young people to do to avoid becoming seriously overweight.
As society tackles obesity, many efforts center on schools’ potential to create a generation of children who value staying active and eating balanced, less-processed meals.
“Schools have access to children in [grades] K-12 for almost 2,000 days of their lives, so schools have got to play a big role. … The whole goal of education is to change behavior to [make it] more positive,” says Rhonda Clements, program director of physical education and sport pedagogy at Manhattanville College in Purchase, N.Y.
A big motivator for school officials may be the statistics: About 20 percent of people ages 6 to 19 were obese in 2008, up from less than 10 percent in 1980, reports the Centers for Disease Control and Prevention (CDC).
On the “move more” side of the equation, studies link fitness with better academic performance. Yet a 2011 study of 47 states found that 39 had no daily recess requirement, and 24 had no physical education requirement, Education Week reports.
About half of schools require physical education in grades 1-5, a quarter in grade eight, and less than one-tenth in grade 12, Ms. Clements says. One-third of schools don’t offer recess on a regular basis, according to a report by the Nutrition and Physical Activity Initiative of the Bipartisan Policy Center (BPC) in Washington, which advocates 60 minutes of physical activity daily in school.
Meanwhile, teachers are getting creative. In Charlotte, N.C., one physical education teacher incorporated measurement, geometry, and spelling into sports, jump-roping, and dance. Over two years, the share of students at or above grade level in math rose from 68 percent to 82 percent, according to a BPC report.
On the “eat better” side of the equation, new federal rules mean radically different menus in many school cafeterias this fall.
School meals now must include more whole grains, legumes, fruits, and vegetables, as well as age-appropriate calorie limits. For the first time, students will have to choose at least one portion of fruits or vegetables. And they’ll have less access to sugary drinks and junk food in vending machines and school stores.
Cooking healthier meals will be a challenge for some schools. But others have already started down the path, offering salad bars and whole-wheat pasta salads. It takes time for students to warm up to the new meals. But many schools now enlist kids as taste-testers, host visits from chefs and local farmers, and reward young children with “I tried it” stickers.
If kids don’t find the food appealing, “we’ll make healthy trash cans versus healthy children,” says Helen Phillips, president of the national School Nutrition Association and nutrition director for Norfolk (Va.) Public Schools.
When children learn to enjoy healthy meals, which can influence their parents. “This year we got into roasting a lot of vegetables … and these were new for inner-city youth. … People tell me, ‘My child asked for asparagus because he had it at school,’ “she says.
In Andover, Mass., a popular recipe shared with parents and other districts is macaroni and cheese with butternut squash.
Andover public schools food-service director Gail Koutroubas started cooking for kids 25 years ago. Most school food was cooked from scratch back then; but it was gradually replaced by processed, packaged food that needed heating or frying. School cafeterias were tasked with making money, not serving healthy food, she says. She got rid of fryers about six years ago in Andover.
Now, with the new federal requirements, “things have come full circle,” and she’s glad. “I want to sell nutritious meals to kids. … In five years you want to say, look at how these [obesity] trends have reversed themselves.”
Will Philadelphia's experiment in eradicating 'food deserts' work?
June 8, 2012, The Washington Post
By Sarah Kliff
Philadelphia has the highest obesity rate and poorest population of America’s big cities. It also has an ambitious plan—launched out of 632 corner stores—to put healthy food on every table.
The $900,000 investment in better health depends on apples and oranges, chips and candy, $1,200 fridges and green plastic baskets. The results could steer the course of American food policy.
Philadelphia is trying to turn corner stores into greengrocers. For a small shop, it’s a risky business proposition. Vegetables have a limited shelf life, so a store owner must know how much will sell quickly—or watch profits rot away. He also lacks the buying power of large supermarkets and is often unable to meet the minimum orders required by the cheaper wholesalers that grocery stores use.
With shelf space at a premium, shop owners must pick and choose the products they think will sell best. Chips and candy and soda are a sure bet. Eggplant? It’s hard to know.
Access to healthy foods has been a cornerstone of the Obama administration’s food policy, dedicating hundreds of millions of dollars in federal funds to projects like this one. The goal is to eradicate food deserts—low-income areas that lack access to nutritious foods—by 2017.
“More parents will have a fresh food retailer right in their community—a place that sells healthy food, at reasonable prices, so they can feed their families the way they want,” first lady Michelle Obama said when she launched the White House’s $400 million Healthy Food Financing Initiative.
More than just a drain on families, obesity is a huge economic drag: The United States spends $147 billion each year treating the condition.
But even as the White House has scaled up such efforts, a growing body of research has questioned its basic assumption: that people will eat better if given better options. Multiple studies have scoured local, state and national data looking for a causal relationship between weight and access to healthy food. None has found it.
“It’s a theory that makes sense, and it’s intuitive,” says Helen Lee, a policy fellow at the Public Policy Institute of California, whose research focuses on racial disparities in health outcomes. “But my concern would be that we’re investing in a strategy that may not be very promising. If you’re investing government money, you should carefully be evaluating how much you’ve invested and how much you’re getting out of that.”
That’s where Philadelphia comes in. Along with building the country’s largest network of healthy corner stores, the city is conducting the largest study to date of what happens when nutritious options are introduced into neighborhoods that have traditionally gone without. It’s measuring what people bought before, what they’re eating now and whether that improves.
“Availability of these products is definitely changing,” says Giridhar Mallya, director of policy for the Philadelphia Department of Public Health. “Now we’re waiting to see what is actually happening with people’s purchases.”
The Obama administration is watching, too.
“Research hasn’t caught up with all the interventions, because collecting evidence and evaluating it takes time,” Deputy Secretary of Agriculture Kathleen A. Merrigan said. “That’s why we’re excited about efforts like the one that they’re undertaking in Philadelphia.”
The term “food desert” is a relatively new one in public health policy, tracing to a 1995 paper from a government work group in Scotland. Various definitions exist today, and all describe parts of the country, both urban and rural, where there is inadequate access to affordable nutritious foods.
Public health researchers have long known that lower socioeconomic status correlates with worse health, including higher levels of obesity. Numerous studies have also noted connections between access to healthy foods and lower weight. A 2011 article in the journalObesity Review found that “greater accessibility to supermarkets or less access to takeaway outlets were associated with a lower prevalence of obesity.”
If governments could improve proximity to healthy foods, the theory went, it could reduce a rapidly rising obesity rate.
“In the U.K., we’d started making policy about this before there was any empirical evidence,” says Neil Wrigley, a professor of geography at Southampton University in England, who works on urban planning research. “Time to time, this happens, where you get policies that outstrip the evidence. Then the evidence needs to catch up.”
Wrigley conducted one of the first studies of a food desert intervention, looking at what happened when a grocery store was brought into an underserved part of Leeds, an industrial city in northern England. Of shoppers surveyed, 45 percent switched to the new store. Their habits, however, barely changed: Consumption of fruits and vegetables increased by one-third of a cup per day—about six grapes or two broccoli florets.
“The results came out quite small, a very modest increase in consumption of nutritious foods,” Wrigley says. “It seemed an almost nonexistent improvement.”
Similar research in the United States shows much the same.
Ohio State University’s Janne Boone-Heineman published a 2011 longitudinal study of food access in Birmingham, Ala., Chicago, Minneapolis and Oakland, Calif. Over 15 years, she traced obesity levels alongside the introduction of healthy food options (grocery stores) and unhealthy venues (fast food restaurants). Her study found no connection between a new grocery store and better health outcomes.
In March, the California institute’s Lee published a paper looking, nationwide, for a connection between proximity to grocery stores, fast food and obesity. RAND Institute’s Roland Sturm published a separate paper this year, one that compared food sold in a neighborhood and children’s diet in California. Neither could find a relationship.
“While some studies find a correlation between food accessibility and BMI and obesity, the causal pathways are not well understood,” the U.S. Department of Agriculture (USDA) concluded in a 2009 review of food desert research, noting elsewhere that “interventions aimed at increasing access to healthy foods may not be successful in addressing obesity.”
To date, no study has found a causal relationship between improving access to healthy foods and improving health outcomes. “You have more people starting to poke holes into what’s a simple thesis, that poor people are overweight because they lack access to healthy food,” Lee says. “My concern is that we might be investing in something that might not be very promising, at the cost of not investing in something that works.”
One pervasive theory of why food access interventions have not worked has to do with what, exactly, corner stores sell. Even when they offer fresh fruit and produce, they also stock chips and candy. The latter are often less costly, more calorie-dense and require little to no preparation—just the sort of thing, in other words, that people will grab on the run.
Others question whether proximity is a good metric for defining access. Adam Drewnowski at the University of Washington recently surveyed Seattle residents on where they bought groceries. He found that most people don’t shop where they live—access is determined as much by price and public transit, for instance, as proximity.
“If you live next to a Mercedes dealership, that doesn’t mean you’ll buy a Mercedes,” he says. “And it’s the same with living next to a grocery store: That doesn’t necessarily mean you’ll start eating salads.”
Others point to a lack of rigorous study of planned interventions: Most have been small in scale, involving a handful of stores. A 2012 review article looked at efforts in 16 cities to improve food access. Only four measured impact on weight; none found any change. And often, after a city’s initial investment, there was no follow-up.
“One big gap in much of the work has been a lack of detailed evaluation,” says Joel Gittlesohn, a public health researcher at Johns Hopkins University who has published extensively on food access issues. “Programs are often implemented by local departments with very little evaluation of what’s going on.”
Philadelphia’s study, distinct in scope and scale, may deliver a breakthrough.
The city has, in many ways, been the epicenter of American efforts to improve food access. Of the country’s 10 largest cities, its population is the lowest-income, and it has higher obesity rates than New York City and Baltimore. It’s home to The Food Trust, a nonprofit that has risen to national prominence as an advocate for increasing food access for low-income Americans.
Working with Food Trust, in the late 2000s Philadelphia began piloting healthy corner stores. In 2010, it ramped up efforts significantly when it received $25.4 million in stimulus funds meant to combat obesity and tobacco use. That initial grant was bolstered with $1.5 million more in funding from the Affordable Care Act’s Prevention and Public Health Fund, a $15 billion commitment to projects that promote preventive health.
“It was a historic investment in public health,” says the public health department’s Mallya, who oversees the initiative for Philadelphia. “I don’t know if we’ll ever get that level of investment again. So for us, it’s very much been transformative.”
The city has recruited 632 corner stores—of 2,500 overall—to its Get Healthy Philly initiative. Of those, 122 have gotten more intensive support, been supplied with new fridges to store produce and connected with wholesalers from whom they can buy at lower prices. It is also working with schools to improve nutrition and helping neighborhoods launch farmers markets, a multifaceted approach officials hope will improve public health.
“Access to healthy food is just one piece of the puzzle, and we are committed to doing the work to help improve public health,” Merrigan, of the USDA, said.
Anecdotal reports from shop owners suggest that sales of fresh produce have indeed increased alongside the surge in supply.
“Almost every day, people grab lettuce or something,” says Catalina Morrell-Hunter, who has owned her corner store in North Philadelphia for 15 years. Apples and oranges go fastest, and cilantro has proved popular in the largely Hispanic neighborhood. “I don’t say I sell like an entire market does. But when people are short a carrot, they can come to the convenience store.”
But whether that will have a health impact remains to be seen. Temple University’s Center for Obesity Research is working with the city to study how shopping habits do, or don’t, change when healthy options are introduced. Last year, before stores added nutritious options, researchers stopped 7,000 shoppers on their way out of the store to look at their purchases. With the new foods now available, researchers are doing another 7,000 stops.
“I don’t think we know much about how well this works,” says Gary Foster, director of the center. “It’s a field in its infancy … nobody has really done at such a big scale.”
Foster expects the research on urban corner stores to publish in about a year and, when it does, it will be “the largest study by a long shot.”
When kids come into Guillermo and Denise Rodriguez’s store, they often buy the bananas at her urging. “It’s not a problem getting them to buy the fruit,” Denise says. “It’s a problem trying to get them to keep buying the fruit, and stay off the junk food. You have people who buy what they want to buy.”
Sometimes they’ll hand out fruit for free, to encourage kids to try it. The goal, says Denise, is to familiarize kids with healthier foods.
That’s a hard way to run a business.
“It’s all good but, you know, when the moment this money stops flowing, things go back to normal,” Drewnowski says. “There needs to be a longer-term business model.”
The Rodriguezes say they are committed to the business; aside from the equipment they received from the city, the sales of fruit and vegetables make the new venture sustainable, if not quite profitable right now.
“There’s not too much of a profit,” Denise says. “We’re not really worried too much about the profit right now, not until we see a profit later on. Right now, we’re just selling the fruit and making things healthier for other people. That’s good enough for us.”