October 2013





Schools should not let liability concerns keep them from promoting physical activity

Oct. 8, 2013, NCCOR

Kids spend many of their waking hours at school. This puts schools in a unique position to help promote physical activity and healthy habits among children. However, many schools are deterred by fears of increased risk of legal liability for personal injuries.

A new article in the American Journal of Public Health outlines three school-based strategies for promoting physical activity—Safe Routes to School (SRTS) programs, joint use agreements, and playground enhancement— and describes how schools can substantially minimize their liability risk by engaging in an number of different approaches that include creating and maintaining safe facilities, having adequate insurance, and partnering with other organizations to share liability risk. In some cases schools are also protected under governmental immunity, further lowering their liability risk.

Initiatives such as SRTS, which encourages walking and biking to school; joint use (or shared use) agreements, which make school playground and recreational facilities publicly available during non-school hours; and the use of design strategies and equipment to provide more engaging school playgrounds have all been shown to help increase levels of student physical activity. Many schools fail to permit or actively promote physical activity approaches like these because of concern over increased exposure to lawsuits for personal injuries.

“Schools have a lot of anxiety about liability risk because they worry about effects on their already constrained budgets — that’s a really significant area of concern,” said Sara Zimmerman, senior staff attorney at ChangeLab Solutions and lead author of the article. “They also genuinely are concerned about kids’ well-being — they don’t want kids to get injured. For them, that sense of ‘maybe this is dangerous’ when it comes to potentially hurting kids and affecting their overall budget creates a big barrier.”

There are a number of steps schools can take to minimize their liability. School administrators can make sure they have adequate insurance and can explore entering into agreements where a partnering group agrees to take on some of the liability risk. Additionally, though it varies by state, schools are afforded a certain amount of governmental immunity, which precludes a plaintiff from recovering even if negligence is shown.

Zimmerman and her colleagues suggest that the best way for schools to decrease their liability risks is to make sure they are being thoughtful and responsible in how they set up and run physical activity programs. Schools should anticipate potential problems and take reasonable steps to avoid them, not just as they run programs, but also as they set up playgrounds and other school recreational facilities in good, safe, responsible ways.

“The best approach for schools is to look at whether the benefits of what they’re doing outweigh the risk,” said Zimmerman. “This is how we all approach decisions in life, consciously or not, and healthy physical activity programs should be approached in the same way. Will this program help kids grow and thrive? Will that make enough of a difference that we should accept the risk while, of course, minimizing it as best we can?”

The development of this AJPH article was funded by the National Policy & Legal Analysis Network to Prevent Childhood Obesity (NPLAN), which is a Robert Wood Johnson Foundation (RWFJ) funded project at ChangeLab Solutions. RWJF is part of the National Collaborative on Childhood Obesity Research (NCCOR). NCCOR contributor Matthew Trowbridge of the University of Virginia School of Medicine is also an author of the article. To learn more about NCCOR and its efforts to reduce childhood obesity please visit,www.nccor.org.

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Teenagers are getting more exercise and vegetables

Sept. 16, 2013, The New York Times

By Anahad O’Connor

Teenagers are exercising more, consuming less sugar, and eating more fruits and vegetables, a trend that may be contributing to a leveling off of obesity rates, a new study shows.

The findings suggest that aggressive anti-obesity messages aimed at children may be starting to make a difference, albeit a small one. The study was published in the journalPediatrics on Sept. 16.

Still, most teenagers were falling short of federal recommendations, which call for children to get at least an hour of physical activity daily, a central message of Michelle Obama’s signature Let’s Move! campaign. The new data showed that most children engaged in an hour of exercise fewer than five days a week and spent more than two hours a day watching television, chatting online, and playing video games.

The numbers also revealed something of an age and racial divide. Younger children had the highest levels of physical activity and fruit and vegetable consumption. But as children got older, the frequency of eating junk foods and engaging in sedentary behaviors crept up, along with average body mass index, a crude measure of obesity. Black and Hispanic adolescents lagged behind whites on almost every measure of progress, even after the researchers tried to take into account the influence of socioeconomic factors.

“In some ways you can interpret what we found positively by saying we’re beginning to bend the curve, and hopefully we’ll start seeing a downward trend in obesity,” said Dr. Ronald J. Iannotti, a study author and chair of the department of exercise and health sciences at the University of Massachusetts Boston. “But there’s large room for improvement.”

The study analyzed data from a national survey of tens of thousands of schoolchildren in grades six through 10, which was carried out once every four years from roughly 2001-2010.

Childhood obesity rates, which have more than doubled since 1980, rose slightly between 2001-2006, then leveled off by 2010, at roughly 13 percent. The proportion of those who were overweight also plateaued at around 17 percent.

Obesity tends to follow children into adulthood, raising the risk of heart disease and cancer as well as type 2 diabetes, a disease that has also risen sharply among children.

In the past year, other studies have hinted at improvements in the obesity rate among younger children, with some even showing a decline in some cities. But little was known about the extent to which physical and dietary behaviors might have played a role.

The new study found that at the same time obesity and overweight appeared to level off, there were, on average, very slight increases in physical activity, fruit and vegetable consumption, and the eating of breakfast, another habit public health officials consider a marker of healthy behavior.

The opposite trend was seen for behaviors that are widely discouraged. The amount of time teenagers spent watching television fell from about three hours a day in 2001 to less than two-and-a-half hours by 2010. Teenagers also reported drinking slightly fewer soft drinks and eating less candy.

Boys overall reported more physical activity than girls, but they also watched more television and played more video games and ate fewer fruits and vegetables.

One expert who was not involved in the study, David B. Allison, the director of the Nutrition Obesity Research Center at the University of Alabama at Birmingham, said it was impossible from the data to deduce a cause and effect, since any number of factors that could influence obesity rates may have changed over time.

“We should be very cautious about drawing any attributions about causes based on time trend data,” Dr. Allison said.

But Dr. Iannotti said the findings seemed to suggest a pattern. “I think the public health message is beginning to be accepted,” he said.


Original source: http://well.blogs.nytimes.com/2013/09/16/teenagers-are-getting-more-exercise-and-vegetables/

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Publications & Tools

CDC releases new guide for collecting body mass index measurements

The Centers for Disease Control and Prevention’s Division of Nutrition, Physical Activity, and Obesity (DNPAO) recently released two new resources for health care providers called the “HL7 Height and Weight Report Implementation Guide” and the “IHE Quality, Research and Public Health Technical Framework Supplement for Healthy Weight.” The tools are designed to help practitioners transmit body mass index (BMI) data from electronic health record (EHR) systems to public health surveillance systems so it can be used to assess progress in the fight against the childhood obesity epidemic.

The Healthy Weight (HW) Integrating Healthcare Enterprise (IHE) can be viewed at the here.

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Fresh fruit and potato chips among most popular in-school snacks

A new infographic from The NPD Group, a leading global information company, shows students, ages 6-12, consume 4.1 snack-oriented convenience foods daily in and out of school, and teens, ages 13 to 17, consume 3.8 snacks daily. The most popular school snacks vary by age group. In the case of 6- to 12-year-olds, an age when parents often choose the foods and beverages their children eat, fresh fruit, fruit cups/applesauce, potato chips, meal kits, and yogurt are the top school snacks. Teens, who tend to make their own food choices, include gum, fresh fruit, potato chips, chocolate bars/candy bars, and granola bars among their most popular school snacks.


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People who get food assistance are eating more whole grain products

Efforts to encourage healthy consumption of whole grains by people receiving federal food assistance are paying off, according to a study by the Yale Rudd Center for Food Policy & Obesity.

Purchases of 100 percent whole grain bread and brown rice increased among participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) after the program changed in 2009 to offer foods that better reflect dietary recommendations for Americans. The study is published in the American Journal of Preventive Medicine.


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Childhood Obesity Research & News

Physical education: How innovative school programs can boost kids' fitness

Sept. 2, 2013, The Huffington Post

By Dorene Internicola

Physical education in the United States has come a long way since the one-size-fits-all regimen of jumping jacks and rope climbing that was the bane of the baby boomer generation.

Today, where children learn can determine the type of fitness lessons they receive.

“We have schools with rock climbing walls, Zumba classes, inline skating – amazing stuff that I would have loved to have when I was a kid,” said Carly Braxton, senior program manager for advocacy at the American Alliance for Health, Physical Education, Recreation and Dance (AAHPERD), a nonprofit group that promotes physical activity and education.

Even in schools constrained by local budgets or indifference, Braxton said, imaginative physical education teachers are finding innovative ways to get kids moving, from snow shoeing in cold climates to treasure hunting in warm ones.

“Where there’s a big Native American population, they’ll bring in tribal games, hunting and fishing,” said Braxton, whose organization is one of the managing partners of first lady Michelle Obama’s Let’s Move! Active Schools program.

“Physical education people are among the most flexible people in the world when it comes to using the community and the environment,” she added.

Federal guidelines recommend children and adolescents, aged 6-17 years old, get at least one hour of physical activity daily, but in the schools where they spend much of their day, mandates for movement vary greatly.

Thirty-eight U.S. states mandate physical education in elementary, middle/high, and high school, according to the “2012 Shape of the Nation Report: Status of Physical Education in the USA,” which is released by the National Association for Sport and Physical Education (NASPE) and the American Heart Association.

But most states do not require a specific amount of instructional time and more than half allow exemptions, waivers, and/or substitutions, the report showed.

“Education is such a local issue,” said Braxton. “You see this variation. Even in states with stricter mandates, these mandates don’t have a whole lot of teeth.”

Physical inactivity is associated with obesity, which affects 17 percent of children and adolescents in the United States – triple the rate from just one generation ago, according to the Centers for Disease Control and Prevention.

Braxton said physical activity translates to lower absenteeism and higher academic performance.

“Research shows if you’re sitting for more than 17 minutes, your brain activity starts to slow down,” said Braxton. “If you’re sitting in a math class, even just a one-minute brain break, where maybe the kids play rock/paper/scissors with their legs instead of their hands (can help).”

Dr. Jacalyn Lea Lund, professor at the Georgia State University and past president of NASPE, believes physical education is undervalued in classrooms increasingly driven by testing.

“Our kids get squirmy and stressed out. We know activity can relieve a lot of stress,” Lund said.

“There’s a really good program called Take 10, where children take little activity breaks to do anything from dance to music to throwing bean bags at targets,” she said. “People found it makes a huge difference.”

Jessica Matthews, a spokesperson for the American Council on Exercise, a nonprofit group that educates people about fitness, applauds teacher-initiated activity breaks, as well as the introduction of cutting edge programs such as yoga and martial arts, to local school districts.

She said physical activity and physical education are not interchangeable.

“Both are important,” said Matthews, an exercise physiologist and former teacher.

With physical education, she said, children refine their motor skills, acquire specific abilities, and set a foundation for lifelong fitness.

“The physical education teacher does more than just have kids run around the gym,” she said.


Original source: http://www.huffingtonpost.com/2013/09/02/physical-education-kids-fitness_n_3854776.html

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Serving a school diet kids can live on

Sept. 2, 2013, The Oregonian

By Elizabeth Flock

From kindergarten through high school, from fingerpainting through calculus, more than half a million Oregon students will start school this week, with a single appointment they’ll all have scheduled: lunch.

Increasingly, we’re understanding how important that moment is as an approach to deal with both child hunger and obesity, and as both the federal government and the state sharpen strategies for this school year. The federal government is raising their health requirement for school lunches (and breakfasts and snacks). Oregon, in some ways ahead of the national trends, is expanding efforts in areas such as school gardens and local farm-to-school supplying, seeking to teach its kids that food isn’t created in a vending machine.

The year marks another advance, with both nutritional and educational impact, against the idea of a student lunch consisting of a slice of pizza, a candy bar, and a soda.

“Last year was a transition year. It was a significant change,” says Kevin Concannon, U.S. undersecretary of agriculture for nutrition and former head of the Oregon Department of Human Services. The transition continues this year, as the National School Lunch Program — feeding 31 million students a day — continues to implement the Healthy, Hunger-Free Kids Act of 2010, raising the emphasis on fruits and vegetables, whole grains, low-fat or non-fat milk, and fruit juices. It also includes a change in what’s available in school vending machines.

An Associated Press story in The Oregonian on Aug. 28 cited student resistance to the changes, which some saw as offering too many vegetables and not enough calories. The feds say the new program may take some getting used to, and have moved to add some flexibility.

In Oregon, Heidi Dupuis, manager of the state school nutrition program, says the shifts haven’t encountered that kind of resistance here. “Kids are getting exposed to a wider variety of fruits and vegetables,” says Dupuis, “and they are eating more.”

Many Oregon schools offer what Dupuis calls “variety bars,” allowing students to go back for more vegetables or fruits. She sees a lasting impact to sampling the altered menu with other students, which she calls “a passive education of what a healthy diet looks like.”

This year’s legislature expanded Oregon’s Farm to School program, and grants have been awarded to 21 school districts. Hillsboro is building an alliance with Hillsboro Farmer’s Market; Future Farmers of America students at Mountain View High School in Bend-LaPine are teaming with a local farm to raise hogs for the school menu; and Rainier offers Food Tastings at lunch.

The program is a match to Oregon’s highly successful school gardens effort, with 394 gardens around the state, from 74 in Multnomah County to one in Harney. The Joseph School District, with a total of 248 students, grew about six tons of produce last year.

These patterns are a considerable advance from 20 years ago, when Oregon school districts dug for revenue by selling vending machine rights to soft drink companies. Some of those contracts are still around, but the machines are more likely to contain water or sports drinks.

To fuel students and maintain focus, school breakfasts are now widespread through Oregon. The state’s school districts could still increase their nutritional output by increasing participation in the federal afternoon snack program.

This year’s efforts reflect the deepening understanding of the connection between nutrition and education. We’re never entirely sure how much algebra or French a student will remember, but we know what part of their school day will unquestionably stay with them.


Original source:http://www.oregonlive.com/opinion/index.ssf/2013/09/serving_a_school_diet_kids_can.html

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Los Angeles County tries to enlist restaurants in obesity fight

Sept. 12, 2013, Southern California Public Radio

By Jed Kim

If a new L.A. County plan works as hoped, people who got out to eat may soon have fewer leftovers to put in the refrigerator — or eat on the way home.

A new program launched on Sept. 12 by the Los Angeles County Department of Public Health aims at fighting obesity by getting restaurants to offer smaller versions of entrees and healthier kids’ meal options.

“We, on average in Los Angeles, eat out four times a week, and we spend more than 40 percent of our food budget on meals away from home,” said Dr. Jonathan Fielding, director of the public health department. “This is a great way to expand choices when dining out to reduce caloric consumption and to have healthier choices available.”

The program, which is called Choose Health LA Restaurants, is part of a larger push by the county to educate the public on the benefits of healthier food choices and physical activity.

Restaurants that meet county guidelines for the program will receive a decal with the Choose Health LA Restaurants designation. They will also eventually be included in listings and maps at the Choose Health LA website.

To qualify, restaurants must have a minimum number of smaller-sized entrees that contain the same ingredients but weigh at least one-third less than their full-sized counterparts. The number of smaller offerings they must offer depends on the total number of items on their menus.

A handful of restaurants have already qualified to be part of the program. The largest is Subway, which offers half-sized versions of its sandwiches.

The county has provided a worksheet to determine whether restaurants are eligible to be part of the free program. It also offers consultation services for restaurant owners interested in qualifying for the program.

In addition to the smaller menu items, restaurants that want to make the list must have kids’ meals must offer fruit and vegetable options, as well as milk or soy-based drinks.

Some nutrition experts say that while the program is a step in the right direction, it may not be as successful at curbing obesity as efforts at educating the public on how to eat.

“Even when healthy choices are offered at a restaurant, often you’re stress eating, or your food urges take over, and you go for the higher calorie, tastier dishes anyway,” said Dr. David Heber, director of the Center for Human Nutrition at UCLA. “So you might be offered a salad at a fast food restaurant, but you’re probably going to go for the burger and fries.”

Fielding said that the new program is just part of a larger county effort to educate the public.

“There’s no single approach that’s going to solve that problem, but there are a lot of small things, and this is one that we think could be very important over the long term,” he said.


Original source: http://www.scpr.org/news/2013/09/12/39196/new-program-takes-obesity-fight-to-restaurants/

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Calling obesity a disease may make it easier to get help

Sept. 16, 2013, NPR

By Patti Neighmond

Under the Affordable Care Act, more insurance plans are expected to start covering the cost of obesity treatments, including counseling on diet and exercise as well as medications and surgery. These are treatments that most insurance companies don’t cover now.

The move is a response to the increasing number of health advocates and medical groups that say obesity should be classified as a disease.

Not everyone thinks this is a good idea, but this summer, the American Medical Association determined that obesity is a disease. The organization followed in the footsteps of The Obesity Society, a health advocacy group that called obesity a disease back in 2008.

Many overweight or obese individuals are victims of their own genetic history, according to Dr. Lee Kaplan, an obesity specialist and director of the Massachusetts General Hospital Weight Center. “We’re all wired in slightly different ways,” he says, adding that those subtle differences are reflected in how the body deals with energy stores and fat.

There are thousands of genes in the body, and Kaplan says about 100 of them are involved in making some people more susceptible to weight gain.

Classifying obesity as a disease is long overdue, according to Dr. Osama Hamdy, who directs the Obesity Clinical Program at the Joslin Diabetes Center in Boston. “The reality is, if you have that genetic susceptibility to gain weight, you will gain weight easily, no matter what.”

Genetic susceptibility has to do with hormones and chemical systems in the body that direct appetite, metabolism and the absorption of nutrients and fat.

One of those hormones is leptin. It’s produced by fat cells and tells the body when it’s eaten enough. Hamdy says the majority of people who are obese are resistant to leptin. “The brain is shielded from the information on how much fat you have in your body,” he says. “The brain is under the assumption all the time that you need more fat.”

Other hormones make some people get hungry more often than others. Then there’s another system of brain chemicals, the endocannabinoid system. If it’s not functioning properly, it fails to tell the body to stop eating what it really likes. For example, if you’ve always loved the sugary flavorful taste of ice cream, you may end up eating way too much of it simply because an enzyme in your brain fails to halt the chemical that signals your brain to eat as much of the beloved food as you can.

A 2009 study on the genetic susceptibility of weight gain found that when 12 pairs of identical twins were overfed 1,000 calories a day for about three months, each set of twins gained a different amount of weight. Some only gained about 8 pounds, while others gained nearly 30 pounds. But within the pair of twins themselves, the weight gain was exactly the same.

Defining obesity as a disease should encourage more doctors to offer treatments like surgery and medication, Hamdy says. Two new obesity drugs, Qsymia and Belviq, were recently approved by the FDA.

But not everybody thinks calling obesity a disease will help make people healthier.

Classifying obesity as a disease “sets people who are heavier up to believe there’s something wrong with them and they’re going to get sick unless they do something about it,” according to Linda Bacon, a professor of nutrition at City College of San Francisco and the author of the book, Health at Every Size: The Surprising Truth About Your Weight.

That then is “used as justification for surgery to ward off the potential of future disease,” she says, “but that future disease may never exist.”

Indeed, research has shown that some people can be overweight or even obese and still fit, whereas their more slender counterparts may be at greater risk for heart disease.

Even so, Kaplan says obese individuals are still at greater risk of high blood pressure, high cholesterol, arthritis, sleep apnea, infertility, depression and diabetes.


Original source: http://www.npr.org/blogs/health/2013/09/16/222064771/calling-obesity-a-disease-may-make-it-easier-to-get-help

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