- Urge to splurge at checkout counter may contribute to obesity
- NCCOR helped increase awareness at fall scientific conferences
PUBLICATIONS & TOOLS
- Technical assistance matters: Schools need support to become healthier
- Rudd report on sugar-sweetened beverage taxes: An updated policy brief
- The role of parks and recreation in promoting physical activity
CHILDHOOD OBESITY RESEARCH & NEWS
- Prescriptions for produce helping to cut obesity
- Childhood obesity declines in several states, cities
- Soda makers will post calorie counts on vending machines
Urge to splurge at checkout counter may contribute to obesity
Oct. 11, 2012, ABC News
By Liz Neporent
We all know impulse buys can lead to overspending. But when something isn’t on your shopping list, health policy experts worry it’s also likely to lead to weight gain.
Tempting treats placed right near the cash register are literally eye candy, deliberately displayed so they’ll catch your attention when you’re waiting on the checkout line. Tossing those high-calorie, low-nutrition vices into the cart is something consumers tend to do without thinking, even when they know deep down it’s against their best interests.
Dr. Deborah A. Cohen, a senior natural scientist at Rand Health, says people are susceptible to spontaneous bad-for-your-health buys because of a struggle within the brain. She has co-written a commentary about food marketing and the obesity epidemic in the Oct. 11 issue of the New England Journal of Medicine.
“Our brain has both automatic and deliberate thoughts, a fast and slow way of thinking,” Cohen said. “We are wired to act first and think later, so we grab a delicious food without stopping to consider the consequences.”
People have the ability to make only so many choices per day, Cohen also said. Marketers know this, which is why they place high-profit grab items like candy and soda at the end of the shopping experience when a shopper’s decision-making capacity is shot. “This is the most likely moment when consumers can’t avoid the junk food and can’t resist it either,” Cohen said.
The trick seems to work. Nine out of 10 shoppers make impulse purchases, buying items that weren’t on their shopping lists, according to a recent survey by The Checkout, an ongoing shopper behavior study conducted by The Integer Group, a retail branding firm. And, as another survey by the retail analyst group IHL found, there’s a good chance all this mindless, spur-of-the-moment buying translates into excess pounds.
According to the 2008 IHL analysis, the average American woman eats more than 14,300 calories a year in impulse purchases alone; women could lose 4.1 lbs a year — at least theoretically — by simply resisting checkout candy bars and chocolate candies, chips, and soda once they are in the checkout line. Men fare even worse: They buy fewer but higher calorie items for a whopping 28,350 total calories worth of impulse buys per year on average.
Checkout lines aren’t the only places retailers use to steer consumers toward high-profit food items they don’t really want, don’t really need, and never intended to buy, Cohen said. Goods placed in prominent end-of-aisle locations account for about 30 percent of all supermarket sales and can increase the sale of an individual item fivefold.
Vendors pay “slotting fees” to retailers to guarantee their products will be placed in prime locations. In many cases, Cohen said, these fees will net stores more profit than consumer spending.
Additionally, marketers pretest promotional displays to make them influential and hard to resist. They frequently use sophisticated eye-tracking systems to make sure that customers cannot ignore them. People lack the capacity to control their eye gaze fully, and what they look at the longest is the strongest predictor of what they will buy. Purchasing decisions are often made subconsciously in less than a second — and the choice to buy foods high in fat and sugar are made more quickly than the choice to buy healthful foods such as fruits and vegetables.
Emily Dhurandhar, an obesity researcher at the University of Alabama at Birmingham, said retailers carefully manipulate pricing as well. “It’s well-known that higher prices reduce consumption. Marketers know that even strategic, short-term sales promotions can lead to long-term increases in consumption of a particular food,” she said.
Cornell University studies also show that consumers who pay with plastic tend to throw caution to the wind. When they use credit and debit cards versus cash, they buy a larger proportion of food items rated as impulsive and unhealthy.
“Cash helps you feel the pain of spending and anticipate the regret from impulsive consumption,” said Manoj Thomas, the lead author on the Cornell studies and director of the University’s business simulation laboratory. “That alone seems to help hold back from consumption.”
And, although impulse marketing is something that’s used right under our noses, Cohen said she thinks we should consider treating it as a hidden risk factor for diet-related chronic diseases, like carcinogens in water, because it affects our food choices in ways that are automatic and out of our conscious control. They could well be contributing to the obesity epidemic that has left more than two-thirds of Americans overweight or obese.
“We often talk about personal responsibility but we need to stop putting all the onus on individuals who are naturally influenced by their environment and born to overeat when there is too much food available,” she said. “It becomes a barrier to good health when we undermine people by asking them to say no at every step.”
NCCOR helped increase awareness at fall scientific conferences
Nov. 11, 2012, NCCOR
The National Collaborative on Childhood Obesity Research (NCCOR) went on the road this fall. Its booth — providing a backdrop to discuss childhood obesity research and NCCOR goal areas, and displaying and offering materials about the Collaborative’s activities — attended two professional conferences.
First, the NCCOR booth attended The Obesity Society’s 30th Annual Scientific Meeting (TOS) in San Antonio, Texas, from Sept. 20-24. Then it went to the 140th Annual Meeting & Exposition of the American Public Health Association (APHA) in San Francisco, Calif., Oct. 27-31.
This was the first time NCCOR exhibited at these two conferences, having developed the booth earlier in 2012 and introduced it at the Weight of the Nation™ (WON) conference on May 7-9, in Washington, D.C.
The NCCOR Coordinating Center from FHI 360 staffed the booth and happily talked to conference attendees about work being done in NCCOR’s five goal areas. They also assisted guests in signing up for the NCCOR e-Newsletter, locating funding opportunities on the NCCOR website, and watching videos about the Collaborative’s tools on the NCCOR YouTube Channel. Attendees to TOS and APHA walked away with items like the NCCOR 2011 Annual Report or giveaways like NCCOR-branded jump ropes.
Since its inception and public launch in February 2009, NCCOR has worked to improve the efficiency, effectiveness, and application of childhood obesity research through enhanced coordination and collaboration. With tools such as the Catalogue of Surveillance Systems and the Measures Registry to highlight and various project activities such as its support of The Johns Hopkins Global Center on Childhood Obesity to discuss, this year was the right time to target several affiliated conferences and talk with attendees of various professional disciplines.
“We placed a focus in 2012 on building awareness of NCCOR among external audiences and doing outreach,” said NCCOR Project Director Todd Phillips of FHI 360. “This was great exposure for the Collaborative.”
Given the positive feedback NCCOR has received from attending WON, TOS, and APHA, NCCOR members and the Coordinating Center will research venues for booth outreach in 2013.
NCCOR is a collaboration between the Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), Robert Wood Johnson Foundation (RWJF), and the U.S. Department of Agriculture (USDA). For more information, check out www.nccor.org
Publications & Tools
Technical assistance matters: Schools need support to become healthier
In 2006, the Alliance for a Healthier Generation launched the Healthy Schools Program, the nation’s most extensive effort to prevent childhood obesity in schools. Today, the Healthy Schools Program, which receives major funding from the Robert Wood Johnson Foundation, works with more than 15,000 schools across the nation and reaches more than 9 million students, as well as teachers and other school staff. This brief highlights findings from two peer-reviewed research papers and an evaluation of the program that was conducted independently by RMC Research Corporation.
The evaluation found that schools that accessed and participated in more training and technical assistance made the most progress in implementing policies and programs that support healthy eating and regular physical activity among students. The findings have implications for school-based obesity prevention policies being considered and implemented nationwide.
Rudd report on sugar-sweetened beverage taxes: An updated policy brief
The Yale Rudd Center for Food Policy & Obesity has updated its Sugar-Sweetened Beverage Taxes Policy Brief. Since the 2009 publication of the first report on soft drink taxes, significant progress has been made in the effort to reduce consumption of sugar-sweetened beverages. The body of scientific literature that links consumption to overweight, obesity, and chronic illnesses has grown substantially. The report discusses this literature, the estimated effects of a tax, policy recommendations, and the arguments used by proponents and opponents of the tax.
The role of parks and recreation in promoting physical activity
Parks, trails, and recreational facilities provide a wide variety of opportunities for physical activity and can help many Americans lead a more active lifestyle. This infographic highlights evidence that parks and recreation areas can increase physical activity levels while also providing economic benefits to families and communities. The infographic also shows that racial disparities exist in access to parks and recreational facilities.
Childhood Obesity Research & News
Prescriptions for produce helping to cut obesity
Oct. 16, 2012, The Connecticut Mirror
By Jan Ellen Spiegel
Yesika Gonzalez and her boyfriend are loaded with nearly a dozen heavy bags of produce from the farmers market in this city’s Fair Haven section.
“Corn, peppers, tomatoes, potatoes, too many fruits, apples, pears,” she ticks off in an accent that is still heavy with traces of her native Puerto Rico. “I think that’s it. For today.” In fact there was more, including broccoli and eggplant.
These are the fruit and vegetables that will feed Gonzalez and her three children for a week. It’s just what the doctor ordered. Literally.
Gonzalez’s family is among more than 30 enrolled in the Fruit and Vegetable Prescription program (FVRX), an innovative strategy to combat obesity. Doctors actually write patients prescriptions for fruit and vegetables from their local farmers’ market. But the key – the patients also get money to pay for them.
“The thought that someone would give money and help people who have a diagnosis of obesity or overweight buy fruit and vegetables,” said Elizabeth Magenheimer, the family nurse practitioner who works with these families at the Fair Haven Community Health Center, “was one of the most brilliant ideas.”
It’s the creation of Bridgeport, Conn.-based Wholesome Wave, started in 2007 by Connecticut chef Michel Nischan, perhaps best-known for his restaurant collaboration at Dressing Room in Westport, Conn., with the late actor Paul Newman. Wholesome Wave, in general, provides programs to help underserved communities nationwide get access to affordable locally grown, healthful food.
FVRX is now in its second year of pilot programs in more than a half-dozen states, including its first year in Connecticut. The program links patients — obese or overweight children and/or pregnant women — with community health services like Fair Haven and farmers markets like the five run by CitySeed in New Haven.
Its premise is that combating obesity among the poor requires not only education on what to eat, how to eat it and other aspects of good health such as exercise, but also the money so they can afford the often pricier fruits and vegetables the doctors are prescribing.
A change for the entire family
The program is designed to treat the whole family, which means all family members attend monthly clinical sessions for the educational components. Those visits include a body mass index measurement and other health checks for the actual patient. The family focus also includes the calculation for how much money is allotted — $1 a day per family member — distributed every week.
“I have two children with diabetes,” Nischan said. “So I understand you can’t just change the diet of one person living in a family of seven or two people living in a family of seven if they have a condition that relies on a lifestyle change. It’s only going to be successful if the whole family participates.”
So for Gonzalez and her three children — her 11-year-old son Ian is the actual patient — that’s $28 a week for fruit and vegetables, which she can buy at any CitySeed-run market, though Fair Haven is considered the primary one. She trades in her prescription for turquoise-painted wooden tokens with FVRX in big letters.
While she said the whole family is on a diet now because of the program, and she’d been shown how to prepare food more healthfully, she recalled what she and her kids had been eating.
“Junk food,” she groaned. A lot of rice and beans and fried chicken and pork. Now it’s “Grilled chicken with some vegetables and some salad.”
Like other mothers in FVRX shopping on a recent Thursday at Fair Haven, Gonzalez said the results so far show Ian maintaining BMI, which measures body fat based on weight and height. Wholesome Wave has crunched data from first-year pilot programs in Maine, Massachusetts, Rhode Island, and California, and Nischan said what Gonzalez and the other mothers are similar to what they’ve found.
“Thirty-eight percent of all participants lost BMI in a population that 100 percent were expected to gain BMI,” he said. “In a four-month intervention, that’s near historic.”
Mixed revenue results
Among the other data from year one: 54 percent of families said they increased their knowledge of the importance of fruit and vegetables, and more than 66 percent increased their fruit and vegetable consumption.
The data also showed that other goals of FVRX — to bring more business to farmers and to help maintain the existence of farmers markets in underserved, low-income communities like Fair Haven — were also achieved. More than half of FVRX patients had been non-users, or extremely infrequent users, of the markets. Participating markets increased revenue by an average of more than $8,100 per season. Results for CitySeed markets have been a bit mixed. Some farmers said they haven’t really noticed a big revenue bump. Others, like Stacia Monahan of Stone Gardens in Shelton, said she had.
“It adds up,” Monahan said. “If these people aren’t here shopping that’s another $100 I wouldn’t be making that Saturday. $100 is $100.”
Market Manager Keren Kurti Alexander said some growers have grumbled a bit about the extra tokens — there are now six for various programs at the CitySeed markets. “Very minimal I would say for the most part [though].” she said. “It’s additional revenue for them so I would say that right there is big incentive.”
Result in Maine ‘phenomenal’
In Skowhegan, Maine, home to one of the earliest FVRX programs, farmers market manager Sarah Smith called the program “phenomenal.” Without having to worry about taking a financial risk, participants were trying new foods and business had improved, even among farmers selling products like meat, eggs, and cheese, which are not eligible for FVRX.
“I don’t think there’s a lot that isn’t working about it,” she said. “One woman, she had lost so much weight we thought she had a gastric bypass.”
Smith’s medical counterpart, Mike Lambke of Redington-Fairview General Hospital, said he’d tried for years to find ways to get anti-obesity efforts to work.
“It’s very obvious to folks who are working with this group,” he said. “It’s the best iteration of childhood obesity work we’ve seen. It’s the right combination of carrots and sticks.”
But he, like others — including Nischan himself — admitted that without the financial incentive, FVRX wouldn’t work. But Nischan is quick to point out that it’s a prescription, and like most prescriptions, is discontinued once the patient recovers. In the meantime, he said, it’s a justifiable expense.
“When you look at the cost of providing a family of four around $100 to $125 a month to prevent diabetes, that’s a lot cheaper than if one of them gets diabetes and needs medication for life,” he said. “Right now, we spend about a $1.20 per American on prevention and we spend $1,300 per American on treatment. Imagine what would happen if we could flip that.”
Among other persistent concerns about FVRX is that it only runs for four months to coincide with most farmers markets. Magenheimer of Fair Haven Community Health said they are looking for money to continue education and clinical visits after the program ends in a few weeks, but that will still leave patients without the actual prescription and the money.
“I get the point that it’s not a dole-out forever,” she said. “But if we think about it in relationship to those diseases which will be costing us a fortune with blindness, dialysis, heart attack, stroke, amputation and infections, then I think three months, thank you very much, it’s wonderful, but we’re going to beg for some more.”
Wholesome Wave’s research of its older program that doubles the value of federal nutrition coupons, such as food stamps, shows that once people see the benefit of eating more nutritionally they will keep buying healthful foods even if the financial assistance runs out. But no such data is being collected on FVRX to see how patients fare in the off-season.
Gonzalez and other FVRX mothers said they planned to keep trying to buy fruit and vegetables all winter. “I’m going to do my best to still do the same thing,” she said. “We need it.”
Childhood obesity declines in several states, cities
Oct. 24, 2012, USA TODAY
By Nanci Hellmich
Nutritional improvements made in the foods served at schools could help reverse the nation’s childhood obesity epidemic, and the first evidence of that is in places that have implemented changes early.
Childhood obesity rates have declined slightly in several cities and states that are tackling the issue including Mississippi, California, New York City, Philadelphia, El Paso, Texas, and Anchorage, Alaska, according to two groups that are tracking the trend.
“We’ve had 30 years of increasing rates of obesity, but we might be seeing the turning point for this epidemic,” says pediatrician James Marks, a senior vice president for the Robert Wood Johnson Foundation (RWJF), which issued a summary report on the topic. One of the Foundation’s goals is to reverse childhood obesity in this country. The gains are pretty small in some communities, but if nothing else they reverse long-building trends of higher obesity rates among kids. “There are enough communities that have had declines that it shows any community that makes these kinds of changes could see their children get healthier,” Marks says.
Margo Wootan, director of nutrition policy for the Center for Science in the Public Interest, a Washington D.C.-based consumer group, which did its own analysis of the changes, says, “We are seeing decreases in obesity in places where they are making a concerted effort to address the problem, mostly in schools. They’re not just crossing their fingers and hoping the problem goes away.”
A 2010 law directed the U.S. Department of Agriculture to update the national nutrition standards for all food served in schools. The standards are designed to improve the health of about 53 million children who attend primary and secondary schools. Kids consume about 30 percent to 50 percent of their daily calories while at school. The changes that went into effect this year mean students are being offered healthier options and slightly fewer calories at lunch, Wootan says.
Some cities and states also have increased the quantity and quality of physical activity for students, and many have instituted strong nutrition guidelines for the types of foods that can be sold in vending machines, à la carte lines, and school stores, she says.
The decline in childhood obesity could become more widespread with the improvements being made in school food nationwide, Wootan says. Greater declines in obesity are likely to come when the government implements rules for competitive foods, such as candy, chips, soda, cookies, and pastries, sold in vending machines, à la carte lines, and school stores, she says. Those should be released later this year and go into effect in two years or so, Wootan says. “That’s where we’ll see a bigger impact.”
Nationally about a third (31.8 percent) of kids and adolescents, ages 2 to 19, are obese or overweight, government statistics show. About 17 percent of them — about 12.5 million kids — are obese. Children are classified as overweight or obese based on where they fall on body mass index (BMI) growth charts.
Those extra pounds put kids at a greater risk of developing a host of debilitating and costly diseases, including type 2 diabetes, high blood pressure, and high cholesterol.
According to the two groups, these places have made improvements in childhood obesity:
- In Mississippi, the percentage of children in grades K-5 who were obese or overweight fell from about 43 percent in 2007 to 37.3 percent in 2011. (Mississippi has the highest adult obesity rate in the country.)
- In California, obesity and overweight rates for children in grades 5, 7, and 9 decreased from 38.44 percent in 2005 to 38 percent in 2010.
- In Anchorage, Alaska, it declined from 38 percent in 2002-03 to 36 percent in 2010-11 for those in kindergarten through grade 12.
- In New York City, obesity dropped among kindergartners through grade 8 from 21.9 percent in 2006-07 to 20.7 percent in 2010-11.
- In Philadelphia, obesity among K-12 kids decreased from 21.5 percent in 2006-07 to 20.5 percent in 2009-10.
- In El Paso, Texas, obesity among fourth-graders decreased from 25.5 percent in 2000-02 to 18.8 percent in 2004-05.
Some reasons for these improvements: In Mississippi, the state board of education set nutritional standards in 2006 for foods and beverages sold in school vending machines, and a 2007 state law required the state’s public schools to provide more physical activity time, offer healthier foods and beverages, and develop health education programs, the RWJF report says.
California set strong nutrition standards for school snacks in 2007, the report notes. The Foundation’s report also cites a study that found that students in California are consuming 158 fewer calories a day than students in states with weaker nutrition standards.
Counties in the state, such as Los Angeles County, that were on the cutting edge in making healthier changes had bigger decreases in obesity, Marks says.
“The places in the country that are really on the cutting edge are doing more than just addressing the problem in schools,” he says. “For instance, Philadelphia, Pa., has worked on opening grocery stores in the food-desert areas (places with little access to healthy foods), and New York City, N.Y., has been very comprehensive including offering street carts where people can buy fresh fruits and vegetables.”
Adds Wootan: “These are good initial results, but clearly we have a lot more work to do and need to help all schools adopt healthier food policies and address the rest of the places where children eat — home, restaurants, parks, zoos, recreational facilities.”
Gary Foster, director of the Center for Obesity Research and Education at Temple University in Philadelphia, Pa., says, “Environmental changes will make the tough work of healthy eating and active living a bit easier. But everyone (both parents and kids) still have to have some skin in the game.”
The verdict is still out on exactly how much changes in school food can reverse the childhood obesity epidemic, he says.
Kelly Brownell, director of Yale University’s Rudd Center for Food Policy & Obesity, says, “Small changes are worth celebrating, especially in light of how fast rates had been rising, but many more bold changes will be necessary for real change to occur.”
Soda makers will post calorie counts on vending machines
Oct. 9, 2012, TIME
By Olivia B. Waxman
Major soda makers, including Coca-Cola, PepsiCo, and Dr Pepper Snapple Group, will start displaying calorie counts on vending machines and encourage consumers to make lower-calorie choices, starting in 2013.
The beverage industry initiative, called the Calories Count Vending program, will launch first in municipal buildings in Chicago and San Antonio where government employees are participating in a “wellness challenge” to see who can make greater improvements in their health (as measured by factors like weight loss and lower blood pressure). The winning city gets a $5 million grant from the American Beverage Association.
Soda companies said they planned to roll out the program nationwide in 2013 in an effort to curb the nation’s obesity epidemic. The initiative is the industry’s latest move to counter growing criticism of sugary beverages as a major cause of obesity in the United States and to fend off cities’ efforts to reduce consumption.
Last month, New York City passed an historic ban on the sale of sugary drinks larger than 16 ounces, the first of its kind in the United States. Cambridge, Mass., is considering doing something similar, while several other cities and communities are either raising soda taxes or voting to institute them.
The new vending machine labels will encourage consumers to “Check Then Choose” or “Try a Low-Calorie Beverage.” Calorie counts will also be inserted on buttons. The plan falls in line with the Affordable Care Act’s requirement that vending machines and restaurant chains with more than 20 locations display calorie information. In September, McDonald’s also started printing calorie counts on its menus nationwide in advance of the new labeling requirements, which aren’t expected to take effect until the end of 2013.
So, will calorie information change Americans’ dietary habits? Maybe. Some early research has suggested that calorie counts didn’t do much to curb fast-food consumption. But later studies have found that calorie information, when presented clearly — and at the point of sale — does tend to sway people’s eating and drinking behaviors. In a December 2011 study published in the American Journal of Public Health, for example, researchers at Johns Hopkins University went to corner stores in predominantly black neighborhoods and posted signs with calorie information about sugary drinks (sodas, fruit drinks, energy drinks, and the like) on refrigerated beverage cases.
Overall, the study found, black teens — a population that is more likely to consume sugary drinks and is at higher risk of obesity than other groups — were 40 percent less likely to buy soft drinks when they saw the calorie signs. They were even less likely to buy them when the calorie labels put information in context: for instance, by noting that it would take 50 minutes of running to burn off the calories in one sugary drink. Those signs reduced soda consumption by 50 percent
A trio of studies published in the New England Journal of Medicine in September suggests that Americans, especially children, could benefit from any effort to reduce soda consumption. The studies showed that limiting kids’ access to sugary drinks — and giving them water or other zero-calorie drinks instead — can help kids lose weight or curb their weight gain. For people who are already genetically predisposed to obesity, the research showed, drinking soda can make their weight problem even worse.
The soda companies’ new initiative, which will also increase the availability of low-calorie and zero-calorie drink options in vending machines, seems to be a step in the right direction. “People tend to overconsume products with sugar and for these companies to be doing something that may decrease consumption of their sugared beverages surprises me,” Kelly D. Brownell, director of the Rudd Center for Food Policy & Obesity at Yale University, told The New York Times. “But it does seem to me to be a positive move.”