November 2013





Childhood obesity rates drop in Massachusetts

Oct. 17, 2013, The Boston Globe

By Kay Lazar

The percentage of the state’s public school students who are overweight or obese has significantly dropped over the past five years, according to newly released data that suggest the childhood obesity epidemic may be receding.

The percentage of overweight or obese students dropped 3.7 percentage points, to 30.6 percent, the Massachusetts Department of Public Health said Oct. 16.

Declines — reported by roughly three-quarters of school districts — were greatest among elementary school students.

“This is now a trend, and we are working hard to see that it continue,” said Carlene Pavlos, director of the health department bureau that runs the school screening program. “This is not the time to let up on our strategies and interventions.”

Researchers are still analyzing the data — based on annual weight and height screenings — to determine which of many school- and community-based nutrition and physical activity programs may have had the greatest impact, she said.

The findings come as state regulators agreed to scrap controversial letters schools send parents about their children’s weight, after years of complaints that they lead to bullying and excess costs for schools. Massachusetts began requiring schools to measure students’ height and weight in 2009, and to notify parents of the results, as part of a larger campaign aimed at reversing the obesity epidemic. Nearly a third of all U.S. children are overweight or obese.

Researchers at the state health department, along with scientists from the University of Massachusetts Medical School, analyzed nearly 1 million student weight and height records from 290 districts. They found wide variations across the state, with 9.7 percent of students obese or overweight in one district at the low end, and 69 percent of students at the high end.

The data show that obesity levels over the five-year period were highest in poorer households. But a federal report in August suggested that even in this population the trend was promising: obesity rates declined among preschoolers from lower-income families in Massachusetts and 17 other states from 2008-2011.

The state data also show that boys were more likely to be heavy, with 33.9 percent overweight or obese compared with 30.8 percent of girls.

Independent nutrition researchers said the early results are encouraging.

“These data show that obesity doesn’t defy the laws of common sense,” said Dr. David Ludwig, director of the New Balance Foundation Obesity Prevention Center at Boston Children’s Hospital. “You get rid of sugary drinks from schools, improve the quality of school lunch, promote regular physical activity, and children’s body weight responds.”

But Ludwig said kids are still exposed to a “toxic” social environment, laden with advertising for everything from “sugary beverages to Lucky Charms.”

He said the Massachusetts data suggest that the state has reached a new stage in the childhood obesity epidemic in which the rapid year-after-year increases have plateaued. “But we will need much more substantial declines before we can put the champagne on ice, let alone pop the cork,” he said.

Dr. Caroline Apovian, a Boston University School of Medicine professor, said she treats many families who can’t afford healthy foods, and often resort to pizza and other fat-laden choices because they are cheaper. Her clinic writes “prescriptions” that allow low-income families to receive free vegetables, fruit, and other healthy foods at Boston Medical Center’s food pantry.

“We need to continue all of these efforts,” said Apovian, who was traveling in Armenia, where childhood obesity levels are rising rapidly. “They are where we were 20 years ago or more,” she said. “People around the world can now see that these [anti-obesity] efforts are finally seeing fruition in the United States.”

The decision to eliminate school letters to parents was made by the Public Health Council, an appointed body of academics and health advocates that sets regulations. Schools will still have to conduct student weight and height screenings in first, fourth, seventh, and 10th grades to help officials gather data about obesity trends and identify possible solutions.

Schools complained that it was too expensive to mail the letters as required, so they often sent them home in students’ backpacks. That sometimes led to inadvertent disclosure of the information to other students and teasing, officials have said.

In addition, such letters, intended to foster conversations between parents and their child’s physician, appear not to help stem childhood obesity rates, according to a 2011 study of a similar program in the California public schools.

The new rules eliminate the required parental notification and instead allow school districts to make the information available to parents or guardians upon written request.

To address parents’ concerns, regulators added a provision that will allow local school committees or boards of health to adopt extra requirements to “ensure confidentiality.”

Massachusetts is one of 21 states that routinely measure school aged children’s weight and height, according to the health department, but only nine, including Massachusetts until now, sent letters home.


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Publications & Tools

NCCOR Envision members help inform new recommendations on managing children’s weight

The National Institute for Health and Care Excellence (NICE), part of the Department of Health in the United Kingdom, recently issued new guidance on managing overweight and obesity in children through lifestyle weight management services.

The National Collaborative on Childhood Obesity Research (NCCOR) Envision members Tim Marsh and Martin Brown, in collaboration with additional researchers, helped inform this guidance by conducting economic modeling to determine the level at which these interventions would be cost effective and add to the quality of life and health of children.

The guidance provides recommendations for good practice based on the best available evidence of effectiveness and cost effectiveness.



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USDA’s Team Nutrition program means healthier lunches for elementary school students

In January 2012, the U.S. Department of Agriculture updated its nutritional standards to require more fruits, vegetables, and whole grains; limit milk to lower-fat options; and reduce fat, sodium, and calories in school meals.

The USDA’s Team Nutrition (TN) program provides training and technical assistance to help school nutrition professionals prepare and serve meals that are nutritious and appeal to students. The program seeks to build support for school environments conducive to healthful eating and physical activity. In 2010, some $5.4 million in funding was awarded to 19 states.

Researchers used survey data from elementary public schools (2006–2010) conducted as part of the RWJF-funded Bridging the Gap research program at the University of Illinois at Chicago.

They found participation in the TN program higher in schools in the South (49 percent), compared to the Northwest (38 percent), Midwest (34 percent), and West (30 percent). TN schools were more likely to offer fresh fruit, whole grains, and salads (30 percent to 70 percent higher odds); and less likely to offer unhealthful foods such as salty snacks (20 percent to 30 percent lower odds), compared to non-TN schools meals.


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New data from CDC shows obesity rate leveling off but it is still an epidemic

Obesity among U.S. adults is continuing to level off after several decades of skyrocketing growth, according to new data from the Centers for Disease Control and Prevention. In 2012, about 34.9 percent of the people in the United States were obese, which is roughly 35 pounds over a healthy weight. That is not significantly different from the 35.7 percent who were obese in 2010.

The report also shows that disparities in obesity prevalence continue to exist. The obesity rate is higher among black adults (47.8 percent) and Hispanic adults (42.5 percent) than white adults (32.6 percent). It’s lowest among Asian adults (10.8 percent). Obesity is also higher among black women (56.6 percent) than Hispanic women (44.4 percent) and white (32.8 percent) and Asian women (11.4 percent).


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California teens drinking more sugary drinks

The California Center for Public Health Advocacy and the University of California, Los Angeles Center for Health Policy Research recently released the report “Still Bubbling Over: California Adolescents Drinking More Soda and Other Sugar-Sweetened Beverages.”

The study found that sugar-sweetened beverage consumption decreased by 30 percent among children aged 2 to 5 years and 26 percent among children aged 6 to 11 years. On the other hand, consumption increased by 8 percent among adolescents ages 12-17.

Additionally, there are major racial disparities when it comes to sugary drink consumption. Seventy-four percent of African American adolescents drink at least one sugary drink each day, compared to 73 percent of Latinos, 63 percent of Asians and 56 percent of whites. Adolescents in all ethnic groups, except whites, consumed more sugary drinks in 2011-2012 than in 2005-2007.


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Childhood Obesity Research & News

First-ever census reveals growing popularity of Farm to School program

Oct. 22, 2013, The Washington Post

By Tim Carman

More than 40 percent of the U.S. public school districts that responded to a historic census said they were participating in a program that helps bring fresh, local produce to school cafeterias. The percentage of participating schools was even higher in Maryland, Virginia, and the District, where the program has taken deep root.

The U.S. Department of Agriculture’s (USDA) first-ever census of school districts across the country revealed how popular the national Farm to School program has become in recent years: About 43 percent of U.S. school districts — or about 38,600 schools — bought local produce for their students during the 2011-2012 school year, investing more than $354 million in farms near their communities. Another 13 percent said they would be participating in the program “in the near future.” Those statistics are based on a census sent to approximately 13,000 public school districts, according to the USDA, which officially released the results on Oct. 22. An estimated 8,800 returned the census, for a 67 percent response rate.

The participating schools, noted Deborah Kane, national director for the USDA’s Farm to School program, cover the full spectrum: red states and blue states, affluent communities and poor ones. “We’re talking about programs that have wide appeal,” Kane said during a conference call with reporters on Oct. 21.

The numbers were even more impressive in Maryland, Virginia, and the District, Kane later told The Washington Post.

Ninety-one percent of the school districts in Maryland that responded — 22 of the approximately 25 public school districts in the state filled out the census — said they were participating in such a program, and the other 9 percent said they would be in the near future. In the 2011-2012 academic year, Maryland schools spent an estimated $8.5 million to buy apples, peaches, tomatoes, corn, milk, and other products from area farmers.

In Virginia, where 90 percent of the 138 school districts responded to the census, 64 percent of the districts said they were participating in a farm-related food program. Another 12 percent said they planned to participate in the near future. All told, during the 2011-2012 academic year, Virginia schools spent nearly $11 million to buy local apples, lettuce, sweet potatoes, berries, tomatoes, beef, and other products to feed schoolchildren.

The numbers are harder to crunch in the District, Kane said, where most students are enrolled in a single district, D.C. Public Schools. Nonetheless, the census was sent to 67 charter and private schools as well as to D.C. Public Schools. In most other jurisdictions, she said, states tried to screen out private and charter schools from their census responses.

Of those 67 census surveys in the District, 26 were completed, Kane said. About 73 percent of those that responded said they were participating in a farm-to-school program, she said. Another 12 percent said they plan to start one in the near future. Kane estimated that more than 57,000 children in the District are involved in such programs and that District schools spent $2.6 million to buy locally sourced apples, pears, milk, tomatoes, chicken, and other products.

Reliable Farm to School statistics have been hard to obtain in previous years because the USDA had to rely on a patchwork of state agencies and advocacy groups for data that was often outdated. The National Farm to School Network, which supports these programs across the nation, noted there were 400 Farm to School programs in 22 states in 2004, a figure that rose to 2,000 programs in 40 states in 2009. Now the census shows that 38,629 schools in all 50 states buy local produce.

The farm to school movement — a term that encompasses not just healthy eating in lunchrooms but also educational activities such as farm visits and school gardens — began in the late 1990s with a few pilot projects. The USDA established the national Farm to School program in 2000 and now supports participating school districts with research, training, technical assistance, and grants.

The surge in Farm to School programs has been a boon to local farmers, said Agriculture Secretary Tom Vilsack. Farmers now have one more way to sell their products directly to consumers.

“This is just another direct-to-consumer sale opportunity with a much larger purchaser,” Vilsack said during the conference call on Oct. 21, “and we hope that this information will spur not just school districts across the country, but universities and colleges” to buy more local produce for their cafeterias.

As part of the census announcement, the USDA rolled out an interactive website to give school districts, state agencies, and agricultural producers a snapshot of what schools are buying and what they plan to buy in the future. The site, said Kane, could help farmers and ranchers “ready themselves to participate in this bustling school food marketplace.”

The USDA plans to launch another Farm to School census during the current school year.


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Improving school lunch by design

Oct. 16, 2013, The New York Times

By Courtney E. Martin

What if the secret to getting kids to eat healthier is to stop focusing on food?

In spring 2013, the San Francisco Unified School District (S.F.U.S.D.) began a five-month collaboration with the design firm IDEO to re-imagine the school food system. This effort might not sound unique. Childhood obesity has become a hot topic, in large part thanks to the first lady’s Let’s Move! campaign, and projects by high-profile chefs like Jamie Oliver and Alice Waters have aimed at getting fresh, healthy foods in schools.

In this case, however, the adults aren’t as concerned with what students are eating as they are with how they are eating.

“When adults dine, we don’t just think about the food,” explained Orla O’Keeffe, the executive director of policy and operations. “The food is important, but so is what’s going on around it: the ambience, the service, the company. Why would we assume kids are any different?”

And yet that’s just what most school districts do. The S.F.U.S.D., to its credit, has made great strides in the quality of food available to students in the last decade, most recently engaging Revolution Foods, a company dedicated to creating healthy meals for schools, as its primary food vendor; but, until now, they hadn’t put as much effort into considering what the 40 short minutes that students actually have for lunch are like. IDEO, known for putting people’s experiences, not objects, at the center of the design process (what they call “human-centered design”) insisted that this be the starting point.

On July 11, 2013, at Everett Middle School, a diverse crew of high school students sit around low round tables in a cafeteria and look at a picture of Maru, the Japanese cat that became a YouTube sensation for jumping in and out of boxes, illuminated on a screen. “Maru is the best prototyper ever. Fearless. Fun. Today we want you to channel your inner Maru,” instructs Coe Leta Stafford, the design director and project leader from IDEO. The teenagers have come to participate in a prototyping session, which will help determine what it is that high school kids really care about when it comes to lunchtime.

Joyce Gu, a senior at Thurgood Marshall High School, lets out a giggle. She’s wearing skinny jeans and Converse All-Stars, scrolling through her Instagram feed on her cellphone. She’s known for posting pictures of unusual foods that she’s tried (the most recent was Chinese abalone).

Joyce is one of the 56,000 students in the district, 61 percent of whom qualify for free or reduced lunch (a family of four that makes $40,000 or less a year qualifies). Despite the district’s location in San Francisco, which is 43 percent white, only 12 percent of the public school students are white (24 percent are Latino, 42 percent are Asian, and 10 percent are African-American.) Many white students end up at one of the many prestigious private schools in the city.

Joyce and 14 other students spend the next hour participating in simulations of their lunch hour. They are given an allowance ($5 for the whole week and various options for how they might pick up their food each day, including the traditional lunch line (not a big hit), a vending machine (though the food appears to be fresh, students are skeptical), and a mobile cart featuring meals from a local restaurant (everyone’s favorite). Afterward the students are asked to reflect: What did you choose and why? What works best for you? How did you choose?

The answers are wide-ranging and sometimes surprising. Some students delay gratification — choosing to bring a lunch from home until Friday, when they will reward themselves by spending all $5 at once. Some talk about prioritizing sharing food with their friends who don’t have any — a dent in their budget, but a boon for their social lives. Still others focus on figuring out which meal they can get the fastest (they have homework to do) that will also give them the most energy for sports practices later in the day. Almost universally, they say that lunchtime is about spending time with friends — first and foremost — not food. The IDEO team documents their answers painstakingly.

Then Stafford asks the students to check out an app on the cellphone stationed at each table. It’s a prototype of what IDEO calls “smart meal technology”— where kids can pre-order meals in the morning that they will eat later in the day. They can also provide feedback on the meals and set dietary preferences; student nutrition services, for their part, can collect data on kids’ preferences and eliminate food waste. The kids intuitively start tapping away.

Joyce looks at O’Keefe, who is seated at her table observing, and says, “This is too good to be true. Who cares what students want?”

O’Keefe looks crestfallen. When I talk to her about the exchange later, she says: “It was a profound moment. You spend so much of your existence serving kids and then they are genuinely shocked that adults would be invested in doing something for them.”

The collaboration, aimed to change that perception, was paid for by the Sara and Evan Williams Foundation, which essentially bought the S.F.U.S.D. time (multiple staff members, like O’Keefe, were pulled off their day-to-day grind to participate), and of course, IDEO’s expertise.

But it also bought them something more intangible — the space to be truly innovative. Superintendent Richard Carranza explains, “If you look at the private sector, they have R&D [research and development] departments where people get to dream and create things that don’t already exist. That’s a luxury that doesn’t exist within the school system where we are often barely able to keep the trains running on time.”

The S.F.U.S.D. is the largest meal provider in the city of San Francisco, serving 33,000 school lunches and snacks a day. Even so, it’s greatly underutilized. Currently, only 57 percent of students who qualify for free and reduced lunch eat it, and only 13 percent of those who don’t qualify do. Not only is this a lost opportunity for improving student health (research consistently shows that those who go off campus eat poorly, if at all, and that children consume 40 percent of their daily calories at school), but also for the district’s budget (Student Nutrition Services has consistently operated with budget shortfalls the last few years.)

The S.F.U.S.D. — like most school districts — would have traditionally approached a challenge like this by doing an assessment of its current labor, vendors, equipment, budget etc., and then writing a lengthy report of recommendations for improvement. Places like Oakland High School, right across the bay, have recently taken to closing school campuses during lunch in order to force kids to eat the healthy meals provided.

“Sure, we could close all the campuses and get the same results,” says Sandy Speicher, an associate partner at IDEO, “but designing with the kids’ desires in mind makes them feel valued. Kids learn about what they’re eating through their choices. The district learns about consumption patterns and reduces waste. Everyone gets smarter.”

Over 1,300 students, parents, nutrition staff members, principals, teachers, administrators and community partners were involved in the process, which included workshops, prototypes, and experiential exhibits — all trademark IDEO tools. The IDEO and S.F.U.S.D. teams, consisting of almost a dozen people, then worked together to consolidate the learning and come up with 10 design recommendations and a comprehensive plan for how they might be prioritized, paid for and realized in schools.

The whole team presented its proposal at the Board of Education meeting on Sept. 17 to an unusually full house, starting — not surprisingly — with student voices and also including testimony from nutrition staff workers, the other population for whom the design of the food experience in schools is most urgent.

They proposed three very distinct eating experiences aligning with the developmental stages in a student’s life, but most fundamentally based on what the students themselves expressed wanting. For elementary school, they imagine lunchrooms where kids sit together at round tables and eat family style — learning to serve one another in stages (healthiest foods are brought out first by nutrition staff workers who oversee their own carts).

Principal Dennis Chew of Lau Elementary, who had initially expressed skepticism about the communal dining idea during an early workshop, was inspired by the final design and the idea of bringing back the ritual and lost art of communal dining: “The elementary school children are the best teachers for the parents.”

He requested that the pilot program take place at his school, where a large majority of the 700 students are Asian immigrants. “Their exposure to American culture is coming through the food that the dining services provides,” Principal Chew explained. The cart concept would work well, he believed, because it would be reminiscent of familiar styles of eating, like dim sum, but feature new foods.

For middle school, the focus shifts toward more independence; students can choose “grab-n-go lunches” from mobile carts and then sit in spaces designed by them.

And in high school, it’s all about choice; students multitasking on their short lunch break leverage the convenience of new technology, like the app tested out in the simulation, and are rewarded with discounts for making healthy choices and eating at school more frequently. They spend less time waiting in lines and more time hanging with friends.

After hearing the presentation, Jill Wynns, the commissioner of the Board of Education expressed some apprehension: “I am, of course, along with the rest of the board, excited about all of these recommendations and appropriately skeptical and nervous about the ongoing costs… As a matter of principle, we need a go-slow plan.”

But the other commissioners, seven in all, seemed on a much faster track: “Put me to work. I’m really excited about this. I want to see us move forward,” said Hydra Mendoza.

“Sometimes when we involve students, it’s often just to say we did and it’s in a token way,” admitted Matt Haney. “I’ve had the opportunity to talk to many of the students involved in this project and they said it was the opposite of that. If we can do that, not just with school food, but with everything we do as a school district, we’re going to get better results.”

Only time will tell if the S.F.U.S.D. team is able to realize the recommendations, but they have continued support from the Sara and Evan Williams Foundation and are fiercely determined. “I’m long in the tooth,” says O’Keefe. “I’ve seen the ‘thud effect’ with consultants — they plop down a big report and move on before you’ve even finished the engagement. This never felt like that. We all have a genuine desire to see this come to fruition.”

Carranza, the schools superintendent, puts it a little more poetically: “We’ve had a chance to imagine where the rubber meets the sky. Now we’re getting back to the road with a totally new vision.”


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Small number of schools drop out of federal lunch program due to healthier requirements

Sept. 29, 2013, Fox News

By Mary Clare Jalonick

The U.S. Department of Agriculture (USDA) says 524 schools — out of about 100,000 — have dropped out of the federally subsidized national school lunch program since the government introduced new standards for healthier foods last year.

The new standards have been met with grumbling from school nutrition officials who say they are difficult and expensive to follow, conservatives who say the government shouldn’t be dictating what kids eat and — unsurprisingly — from some children who say the less-greasy food doesn’t taste as good. But USDA says the vast majority of schools are serving healthier food, with some success.

Data the department released Sept. 30 shows that 80 percent of schools say they have already met the requirements, which went into place at the beginning of the 2012 school year. About a half dropped out of the program.

In an effort to stem high childhood obesity levels, the new guidelines set limits on calories and salt, and phase in more whole grains in federally subsidized meals served in schools’ main lunch line. Schools must offer at least one vegetable or fruit per meal and comply with a variety of other specific nutrition requirements. The rules aim to introduce more nutrients to growing kids and also make old favorites healthier — pizza with low-fat cheese and whole-wheat crust, for example, or baked instead of fried potatoes.

If schools do not follow the rules, or if they drop out, they are not eligible for the federal dollars that reimburse them for free and low-cost meals served to low-income students. That means wealthier schools with fewer needy students are more likely to be able to operate outside of the program.

According to the USDA data, gathered from the states that administer the programs, 90 of the 524 schools that dropped out of the program said specifically that they did so because of the new meal-plan requirements. Most of the rest did not give a reason.

Some school nutrition officials have said buying the healthier foods put a strain on their budgets. A study by the Pew Charitable Trusts’ Kids’ Safe and Healthful Foods Project, also released Sept. 30, said that 91 percent of school food officials the group surveyed said they face challenges in putting the standards in place, including problems with food costs and availability, training employees to follow the new guidelines, and a lack of the proper equipment to cook healthier meals.

But that study says 94 percent of the more than 3,300 officials surveyed said they expect to be able to meet all of the requirements by the end of this school year.

“It shows that this is certainly doable,” said Jessica Donze Black, director of the Pew project, which has lobbied for the healthier foods.

Leah Schmidt, president of the School Nutrition Association and director of nutrition programs at a Kansas City, Mo., school district, said any schools that would consider forgoing the federal funds would have to have very few students eating the free and reduced-cost meals.

She agreed that many schools have met challenges in trying to meet the new standards, but she said that is to be expected.

“Any time you have something new you’re going to have some growing pains,” she said.

As some schools struggled to follow the new guidelines at the beginning of the last school year, USDA relaxed some of the original requirements. In December, the department did away with daily and weekly limits on meats and grains that school nutrition officials said were too hard to follow.

Congress has also had its say on the new guidelines. In 2011, after USDA first proposed them, Congress prohibited USDA from limiting potatoes and French fries and allowed school lunchrooms to continue counting tomato paste on pizza as a vegetable.

The school lunch rules apply to federally subsidized lunches served at reduced or no cost to low-income children. Those meals have always been subject to nutritional guidelines because they are partially paid for by the federal government, but the new rules put broader restrictions on what could be served as childhood obesity rates have skyrocketed.

Schoolchildren can still buy additional foods in other parts of the lunchroom and the school. Separate USDA rules to make those foods healthier could go into effect as soon as next year.


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