March 2013





Children in Unites States are eating fewer calories, study finds

Feb. 21, 2013, The New York Times

By Sabrina Tavernise

American children consumed fewer calories in 2010 than they did a decade before, a new federal analysis shows. Health experts said the findings offered an encouraging sign that the epidemic of obesity might be easing, but cautioned that the magnitude of the decline was too small to move the needle much.

And while energy intake has not changed considerably for adults in recent years, fewer of their calories are coming from fast food, researchers said. Obesity rates for adults have plateaued after years of increases. A third of adults are obese.

The results of the research on childhood consumption patterns, the only federal analysis of calorie trends among children in recent years, came as a surprise to researchers. For boys, calorie consumption declined by about 7 percent to 2,100 calories a day over the period of the analysis, from 1999 through 2010. For girls, it dropped by 4 percent to 1,755 calories a day.

“To reverse the current prevalence of obesity, these numbers have to be a lot bigger,” said Marion Nestle, professor of nutrition, food studies and public health at New York University. “But they are trending in the right direction, and that’s good news.”

National obesity rates for children have been flat in recent years, but some cities have reported modest declines. The new evidence of a lower calorie intake for children may also foreshadow a broader national shift, experts said. “A harbinger of change is a good phrase,” said R. Bethene Ervin, a researcher at the Centers for Disease Control and Prevention and one of the authors of the report. “But to see if it’s really a real trend we would obviously need more years of data.”

A drop in carbohydrate consumption drove the decline, a point of particular interest for those who study childhood obesity. Sugars are carbohydrates, and many argue that those added to food like cereal and soda during processing are at the heart of the childhood obesity epidemic. Dr. Ervin said it was not clear whether such added sugars alone were behind the carbohydrate decline.

Over all, calories from fat remained stable, while those from protein increased and those from carbohydrates fell. The calorie decline was most pronounced among boys ages 2 to 11, and among teenage girls.

Carbohydrate consumption declined among white and black boys, but not among Hispanic boys. Among girls, whites were the only group that consumed fewer calories from carbohydrates.

Another surprise, researchers said, was the decline in calories coming from fast food among American adults. Those calories fell to 11.3 percent of adults’ total daily intake in 2010, down from 12.8 percent in 2006. The decline was sharpest among 40- to 59-year-olds, said Cynthia L. Ogden, a researcher for the Centers for Disease Control and Prevention who oversaw the research, which comprised two studies, one on caloric intake for children and the other on fast-food consumption among adults. For the analysis, called the National Health and Nutrition Examination Survey, people were interviewed in their homes and at mobile examination centers around the country.

Americans eat about a third of their calories outside the home, according to federal data, and some demographic groups still get a lot of calories from fast food. Blacks between the ages of 20 and 39 consumed more than a fifth of their calories from fast food, the highest share for any group. The lowest rate was among older people, ages 60 and above, who got 6 percent of their daily caloric intake from fast food.

Obese people also consumed more fast food, researchers found.


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Publications & Tools

Food and beverage marketing to children and adolescents: Limited progress by 2012, recommendations for the future

The marketing of high-calorie and nutrient-poor foods and beverages is linked to overweight and obesity in the United States. American youths are still exposed to a disproportionate amount of marketing for unhealthy products across a variety of media and an examination of research and policy trends related to food and beverage marketing shows that industry self-regulation has not substantially improved children’s and adolescents’ exposure to marketing for unhealthy foods and beverages between 2006 and 2012. This research review examines recent trends in food marketing to children and adolescents, as well as policy initiatives undertaken to address the contribution of marketing practices to the childhood obesity epidemic. Policy implications and future research needs are highlighted.



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Outdoor advertising, obesity, and soda consumption: A cross-sectional study

Recent research has shown that neighborhood characteristics are associated with obesity prevalence. While food advertising in periodicals and television has been linked to overweight and obesity, researchers wanted to know whether outdoor advertising is related to obesity. To test the association between outdoor food advertising and obesity, researchers analyzed a telephone survey of adults, ages 18 to 98, from parts of California and Louisiana. They matched the self-reported data on body mass index and soft drink consumption to the number of food or non-alcoholic drink billboard advertisements in each area. After controlling for race, age, and socioeconomic status, researchers found that the higher the percentage of food advertisements in a community, the greater the odds of obesity among the residents. For every 10 percent increase in food advertising, there was a 5 percent greater chance of being overweight or obese. Given these predictions, compared to an individual living in an area with no food ads, those living in areas in which 30 percent of ads were for food would have a 2.6 percent increase in the probability of being obese.


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Health information technology improves pediatric obesity screening and treatment

The objective of this study was to review the effect of health information technology (IT) – such as electronic health records (EHRs), telemedicine, text message, or telephone support – on patient outcomes and care processes in pediatric obesity management. Researchers identified and reviewed 13 published studies that examined the use of IT to deliver obesity screening or treatment to children (aged 2 to 18). The researchers found that, of eight studies examining the use of electronic health records, five showed increased body mass index (BMI) screening rates. Two studies showed that telemedicine counseling was linked with alterations in BMI percentile similar to that found for in-person counseling, with improved treatment access. Of three studies examining the use of text messages or telephone support, one showed an association with maintenance of weight loss.


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Childhood Obesity Research & News

Michelle Obama highlights obesity progress in Mississippi

Feb. 27, 2013, U.S. News & World Report

By Darlene Superville, Associated Press

Michelle Obama on Feb. 27 congratulated this Southern state for a more than 13 percent drop in its child obesity rates, saying its example should inspire the rest of the country.

It’s the reason she made Mississippi the first stop on a two-day tour to promote her signature effort, the anti-childhood obesity campaign she launched three years ago called Let’s Move!. In remarks at an elementary school near Jackson, the first lady cited new research showing that childhood obesity rates among elementary school pupils in the state had declined by 13.3 percent between 2005 and 2011.

“What’s happening here in Mississippi is really what Let’s Move! is all about,” she told an audience of state officials, school nutrition professionals and parents. She urged them to keep on doing what they’ve been doing.

“It’s the story of what you all have achieved here that we want to tell. It’s the story we want to be telling in every state all across this country,” the first lady said.

When she visited Mississippi three years ago, it had just been declared the most obese state in the nation, she said. But things have begun to turn around in just a few short years.

Mrs. Obama attributed the decline in childhood obesity rates here to efforts by state lawmakers, the Board of Education and individual school districts, which she said took such steps as setting new standards for food and drinks in school vending machines, serving more fruits, vegetables, and whole grains, and replacing food fryers with steamers, to which she exclaimed, “Hallelujah.”

Some churches even declared “no-fry” zones for their congregations, where only healthy food and nothing fried was allowed.

“So there’s no reason why this success can’t happen in cities and states all across the country — if we’re willing to work for it,” Mrs. Obama said. “So now is the time for us to truly double down on these efforts. We know what works. We’re seeing it right here. We know how to get results. Now we just need to keep stepping up.”

The first lady said Mississippi, and other parts of the country that also have seen their childhood obesity rates come down — including California and New York City and Philadelphia — are showing others what works. After all, she said, “love for our children” is the motivating factor.

Mrs. Obama was joined by Food Network star and daytime talk-show host Rachael Ray, who arranged for two school chefs to compete to prepare lunches that meet newly adopted federal nutrition guidelines. “I’m here to say, Mississippi, thank you. Thank you so much. Congratulations on your work,” the first lady said. “Thank you for taking the lead on this issue. Thank you for serving as an inspiration for states and communities across the country.”

About one-third of U.S. children are overweight or obese, putting them at higher risk for heart disease, diabetes, and high blood pressure, among other ailments.

Mrs. Obama launched Let’s Move! with the goal of helping to reduce childhood obesity rates within a generation. In response, a range of industry groups and others, including food companies, restaurants, retailers and others, promised to make their food healthier and make it easier for kids to get needed exercise.

Among the changes: Wal-Mart is now putting special labels on some of its store-brand products to help shoppers quickly spot healthier items. Millions of schoolchildren are helping themselves to vegetables from salad bars that have been donated for their lunchrooms. Kids’ meals at Olive Garden and Red Lobster restaurants are automatically served with a side of fruit or vegetables and a glass of low-fat milk.

For the cafeteria cook-off, each school chef was paired with a professional chef and each team was given 30 minutes to prepare a lunch for 20 kids that met federal nutrition guidelines. One team fixed two types of fajitas and a fruit smoothie, while the other team whipped up a turkey Sloppy Joe sandwich on a patty made of quinoa, fruit salad with a sour cream and honey dressing, and broccoli trees.

A panel of 20 students from the school judged the finished products. Mrs. Obama and Ray also sampled the lunches and kept saying how delicious they were.

“If these kids are eating like this every day,” said Ray, “I’m coming to lunch here,” added Mrs. Obama.

The competition was held for Ray’s daytime talk-show, and the results are to be revealed during the March 11 broadcast.


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Gym class isn’t just fun and games anymore

Feb. 18, 2013, The New York Times

By Montoko Rich

On a recent afternoon, the third-graders in Sharon Patelsky’s class reviewed words like “acronym,” “clockwise,” and “descending,” as well as math concepts like greater than, less than, and place values.

During gym class.

Ms. Patelsky, the physical education teacher at Everglades Elementary School here, instructed the students to count by fours as they touched their elbows to their knees during a warm-up. They added up dots on pairs of dice before sprinting to round mats imprinted with mathematical symbols. And while in push-up position, they balanced on one arm and used the other (“Alternate!” Ms. Patelsky urged. “That’s one of your vocabulary words”) to stack oversize Lego blocks in columns labeled “ones,” “tens,” and “hundreds.”

“I don’t work for Parks and Recreation,” said Ms. Patelsky, explaining the unorthodox approach to what has traditionally been one of the few breaks from the academic routine during the school day. “I am a teacher first.”

Spurred by an intensifying focus on student test scores in math and English as well as a desire to incorporate more health and fitness information, more school districts are pushing physical education teachers to move beyond soccer, kickball, and tennis to include reading, writing, and arithmetic as well. New standards for English and math that have been adopted by 45 states and the District of Columbia recommend that teachers in all subjects incorporate literacy instruction and bring more “informational text” into the curriculum.

But some parents say they object to the way testing is creeping into every corner of school life. And some educators worry that pushing academics into physical education (P.E.) class could defeat its primary purpose.

While generations of bookish but clumsy children who feared being the last pick for the dodge ball team may welcome the injection of math and reading into gym class, the push is also motivated by a simple fight for survival by physical education departments.

As budget cuts force school officials to make choices between subjects, “it’s just a way to make P.E. teachers more of an asset to schools and seem as important” as teachers in core subjects like language arts, math and science, said Eric Stern, the administrator in charge of physical education for the Palm Beach County schools, the country’s 11th-largest school district. “We are taking away the typical stereotype of what P.E. used to be like.”

Across the country, P.E. teachers now post vocabulary lists on gym walls, ask students to test Newton’s Laws of Motion as they toss balls, and give quizzes on parts of the skeleton or food groups. At Deep Creek Elementary School in Chesapeake, Va., children count in different languages during warm-up exercises and hop on letter mats to spell out words during gym class.

Chellie LaFayette, the physical education teacher at Roxhill Elementary in Seattle, used an iPad purchased with a federal grant to show her students pictures of the Iditarod sled dog race and maps of mountain ranges for which she had named routes on a climbing wall.

In some cases, homework and testing have accompanied the new gym content. Last year, the District of Columbia added 50 questions about health and physical education to its end-of-year standardized tests.

Not all parents are pleased with the changes. “I think there is such a thing as taking something too far,” said Kathleen Oropeza, co-founder of Fund Education Now, a nonprofit public education advocacy group in Florida. “If you’ve got children who are learning the joy of being a good goalie or learning that they want to participate as part of the team, why does that have to be overshadowed by the hard, high-stakes test environment?”

And at a time of increasing childhood obesity and diminishing recess time, some educators want to keep the focus on physical activity. “I’m more concerned that we don’t have enough time to be in the gym,” said Anna Allanbrook, principal of the Brooklyn New School, an elementary school that does not incorporate academics into gym time.

With parents and students rebelling against what they see as an excess of homework, some say that gym class assignments add to the busywork. “I never really learned anything from doing those papers,” said Annie Beyer-Chafets, 16, a sophomore in Westchester County, N.Y., who recalls being asked to write an essay about a relative’s lifetime sport choices last year.

Physical education teachers say they are not simply transforming gym class into another period of test preparation.

Instead, they say, P.E. helps students learn about lifetime fitness habits and other subjects previously taught in health classes. Students study the muscular and respiratory systems, learn to use pedometers and calculate optimum heart rates.

“We want to get kids moving,” said Paige Metz, coordinator for health and physical education at the San Diego County Office of Education. “But we want to make sure there is meaning to the movement.” At times, the meaning seems to overtake the movement. In Kristina Rodgers’s gym class at Indian Pines Elementary School in Lake Worth, Fla., students spent as much time pondering pictures of broccoli and blocks of cheese to stick into pockets on a food chart as they did hopping or running.

Rodgers said that during a 30-minute class, it would be difficult for the children to keep moving constantly, so she interspersed cognitive tasks with fast-paced drills.

At another station she had set up, students jumped, kicked, and ran to a pile of small cones that they stacked as quickly as possible. “It’s fun,” said Keyli Castellon, 9, breathing hard after sprinting. “Because you get to do different moves, and it’s learning.”

A growing body of research shows that physical activity can help improve cognitive function.

“Some children just learn better through more movement than they do sitting at a desk,” said Janis Andrews, chief academic officer in Palm Beach. “Some kids are going to have that ‘aha’ moment not in the classroom, but the light bulb is going to finally go on outside.”

At an outdoor pavilion at Manatee Elementary School in Lake Worth, Shawn Roney, a gym teacher, showed fifth-graders how to make chip shots with child-size golf clubs. Then he turned a club upside down and moved his palm across the club head. “Math majors, what is this?” he asked. Several children piped up with the answer he sought: an angle.

Some parents say that given how much students need to learn in a limited time during the day, sprinkling a few academic lessons into gym class makes sense. “They get the opportunity to play during recess,” said Renee Kelleher, a mother of four whose twin boys are in fourth grade at Manatee. “This is still class.”


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How 'crunch time' between school and sleep shapes kids' health

Feb. 25, 2013, NPR [Shots Blog]

It’s an important question for American families and the nation as a whole: Why do so many kids weigh too much? There are recent hints the epidemic may be abating slightly. Still, one in every three American kids is overweight or obese.

To understand why, NPR conducted a poll with the Robert Wood Johnson Foundation and the Harvard School of Public Health. It focuses on what happens in American households during the hours between school and bedtime.

This is crunch time for most families — when crucial everyday decisions get made about food and exercise.

Our poll used a unique design to get at what is actually happening in the life of a “target child” in each household. We supplemented their responses with more than 800 that came in when we asked parents, through NPR’s Facebook page, to describe their own “crunch times.” The most striking finding is that U.S. parents “get it.”

When we asked a parent or other principal caregiver in our poll how important it is that their child eats and exercises in a way to maintain a healthy weight, more than nine in 10 said it was important — and most said it was “very important.”

But all too often, there’s a disconnect. Despite good intentions, it’s not happening.

More than half of children ate or drank something during the “crunch time” window that can lead to unhealthy weight gain, as perceived by their parents. And more than a quarter of children did not get enough exercise, their parents say.

“It’s hard enough to get dinner on the table while trying to help them with homework,” says Paige Pavlik of Raleigh, N.C. “Once we do everything, there is absolutely no time to go outside and take a walk or get any exercise. It’s simply come in, eat, sit down, do homework, go to bed.”

The relentlessness of it makes her emotional. Pavlik starts to cry as she talked about her family’s daily crunch time. “It’s really hard,” she says. “This isn’t how I thought family life was going to be.”

Nearly half the parents in our poll say it’s difficult to make sure their child eats healthy.

Lori Bishop of Lexington, Ky., says she tries to excel as a parent and as a full-time laboratory manager. But she ends up feeling mediocre at both.

Both she and her husband have stressful jobs, she says, and often feel exhausted at the end of the workday. “But you gotta go right to work in the kitchen,” Bishop says. “And while I would love to prepare a well-balanced meal each evening … it doesn’t happen.”

She says dinner at the Bishops’ house is often pre-packaged meals — “things that are frozen that you can heat up like frozen pizza, frozen chicken nuggets.”

In three-quarters of the households polled, most of the family ate dinner together the previous evening. And of those, most said the “target” child’s dinner was prepared at home with fresh ingredients. But about a third of children who eat at home with their families are like Lori Bishop’s kids — they end up relying on pre-packaged, frozen, or take-out food.

And nearly half of those in our poll say it’s difficult for families to eat together on a daily basis.

Adam Jacobs’ family in Mesa, Ariz., is a case in point. He and his wife have long commutes to work. “My wife and I don’t even get to talk about our days,” he says. “If I have something to tell her, I literally put it on my smart phone to remind me.”

Their two boys, aged 14 and 10, usually have after-school activities. On one recent evening, Jacobs tried to rustle up dinner for himself and his older son.

“I was at home at 7:30 and it was ready by 8:30,” he says. “And by that time, my wife and younger boy weren’t even home yet and my older son had already eaten … so it wound up just being another solo deal.”

It’s not just time that’s in short supply. Among the parents we talked to who say it’s difficult to prepare fresh foods, money was also a factor.

Araceli Flores and her two young children live in the farm belt of central California, surrounded by fields of broccoli, cauliflower, asparagus, and fruit orchards. But she says it’s too expensive to buy fresh foods.

“I can buy a box of macaroni and cheese for a dollar,” Flores says. “A bunch of bananas – like a good maybe week-and-a-half’s worth of bananas — will cost me over a dollar. Strawberries are four dollars. Apples, a bag of apples, is going to cost me five dollars — way more pricier to buy vegetables and fruits than it is to buy boxed food.”

And it’s not just time and money that get in the way of doing the right thing. Parents say there are other barriers — such as their physical surroundings, school lunch policies, and their family’s culture.

Vanessa Benavides is a single mom in Miami who’s Cuban-American. She comes from a family with nutrition-related health issues. “Most of my family is overweight,” she says. “Most of my family has high blood pressure. My father’s diabetic.”

On weekends, Benavides fills up her grocery cart with fresh fruits and vegetables. She intends to cook healthy meals, she says. But at the end of a long day when she picks up 7-year-old Emily at her mom’s house, it’s often easier to eat the dinner that her mother has made.

“It’s a lot of Cuban meals,” Benavides says. “You know, it’s just a lot of rice-meat combinations that are often fried or greasy.”

And then Benavides’ mom and dad keep urging Emily to eat more. “They want to fatten her up,” she says.

That bothers Benavides, because she was once a skinny kid like Emily. But now she struggles with her weight.

“They were always trying to tell me to eat more and eat more and eat more,” she says. “You know, a nice chunky kid is [considered] healthy in our culture.”

Parents often say schools are undermining the messages many parents are trying to give their children. In school cafeterias across the country, kids are still eating dense, high-fat, and over-processed food for lunch.

Assonta Wagner, one of our Facebook respondents, lives with her husband and four children in Alamogordo, N.M. Her kids typically take their lunch to school. But sometimes she allows them to eat school lunches. And when they do, she cringes.

“One of their favorite meals was this mashed potato bowl,” Wagner says. “It was mashed potatoes, little fried chicken pieces and corn. And then they covered it in gravy.”

She’s a stay-at-home mom who’s super-conscientious about making healthy food at home — lots of fruits, vegetables, and lean meats, no pre-packaged foods, no instant meals, no soda. So what’s offered at school is particularly upsetting to her.

And it’s not just the lunches. At Halloween, Thanksgiving, and other holidays, they get bags of candy — even her overweight son — as a reward for doing a good job.

And when all those calories add up over the years, parents say the very environment they live in makes it hard to reverse the problem. Some parents say it’s too hard — or too expensive — to get their children to a safe place to exercise.

That’s one reason one poll respondent, Vivian Carter-Smith, is so worried about her 17-year-old grandson.

“He’s a good boy,” she says. “He’s overweight. He’s short … and I know he weighs 350 pounds easy.”

She says her grandson doesn’t get any exercise. He stopped going to the “Y” when other boys teased him about his weight. And Carter-Smith says there isn’t a place near his Cincinnati home where her grandson and his younger brother can even get outside and walk. And in fact, they don’t want to.

“The way the streets are,” she says, “with these kids with no parents and no rules and regulations and upbringing skills — they are scared.” But she knows that a lack of exercise combined with an unhealthy diet can lead to disaster. After all, her grandson’s father died last year of a heart attack – at the age of 38.


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Pencils down, spatulas up — England to teach kids to cook in schools

Feb. 13, 2013, Take Part

By Paige Brettingen

Teaching kids healthy eating habits doesn’t begin in school cafeterias, as the United Kingdom has discovered. It starts in classroom kitchens.

The U.K.’s Department for Education announced on Feb. 10 that all students will be required to learn the principles of good nutrition and basic cooking techniques until age 14 as part of its Design and Technology curriculum. The unprecedented decision comes by recommendation of two restaurateurs, who spearheaded the School Food Plan to improve the diets of U.K. children.

According to the Department for Education, the curriculum’s goal is “to ensure that, instead of baking out cupcakes and designing pizza boxes, cookery lessons will include a wide, imaginative range of savory, healthy foods.”

Their efforts are right on track, says Melissa Halas-Liang, M.A., R.D., C.D.E, and founder of SuperKids Nutrition, Inc., which is based in California.

“Kids’ eating habits are pretty much established by age 6,” she says. “Getting kids in the kitchen and teaching them how to cook is the first step toward healthy eating, which leads to chronic disease prevention.”

British chef and TV personality Jamie Oliver was among those applauding the decision on Twitter. Since 2010, his movement, Jamie Oliver’s Food Revolution, has encouraged cooking and getting processed foods out of schools in both the United Kingdom and the United States.

In the U.K., about 30 percent of children between the ages of 2 and 15 were obese in 2010, the year the Department of Health conducted its latest study. That same year, 17 percent of American children between the ages of 2 and 19 were obese, according to the Centers for Disease Control and Prevention’s 2010 research.

But there’s more at stake than just weight, says Halas-Liang, since 60 percent of overweight children ages 5 to 10 already have one to two precursors to heart disease. Furthermore, she adds, one in three cancers could be preventable through diet and lifestyle.

While the United States has yet to broadly follow the U.K.’s culinary lead in the classroom, it’s not impossible, she says. In fact, it’s already being done with the “Healthy Kids Today, Prevent Cancer Tomorrow” campaign, which helps teach children the power of cancer-fighting foods. And there’s also California’s “Harvest of the Month” program, where nutrition educators demonstrate new recipes in classrooms, proving to kids that vegetables can be delicious if given a chance.

“Kids in my neighborhood will try smoothies that have cooked asparagus, and like it,” says Halas-Liang of the program.

Besides establishing healthy eating habits, she points out other ways cooking skills support kids’ development. Some examples include teaching them basic organizational habits via assembling ingredients, the mathematic skills needed to understand fractions for measuring, or teamwork, as experienced in the kitchen.

So what’s the key ingredient for getting a public culinary education program started in U.S. schools?

Contrary to the U.K.’s successful approach, Halas-Liang says it’s not the government — at least not yet.

“It could happen, but we’ve got to have the parents buy in first,” she said. “Once you get the parents interested, they’re the ones who will start demanding something like this.


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