PUBLICATIONS & TOOLS
- RWJF infographic explains positive impact of healthier school meals
- Report documents latest trends in TV food advertising to children
- A number of moms-to-be develop pregnancy-linked diabetes
CHILDHOOD OBESITY RESEARCH & NEWS
- Farmers markets reaching more consumers who get nutritional benefits
- U.S. schools develop a nicer version of gym class
- A school lunch menu where students have a say
Obesity is undercounted in children
June 23, 2014, The Wall Street Journal
Childhood obesity might be a bigger problem than we thought. A new study finds that the commonly used body mass index (BMI) measure may fail to identify as many as 25 percent of children, age 4 to 18 years, who have excess body fat. The meta-analysis, published online in the journal Pediatric Obesity on June 24, reviewed 37 separate studies involving a combined 53,521 participants.
“BMI is not capturing everybody who needs to be labeled as obese,” said Francisco Lopez-Jimenez, director of preventive cardiology at the Mayo Clinic in Rochester, Minn., who headed the study with Asma Javed, a pediatric endocrinology fellow.
Measuring BMI is a relatively easy and inexpensive way to screen for obesity among large groups of people, such as children in a school setting. A problem is that BMI, a calculation based on a person’s height and weight, is not well-suited to children because their height and weight do not proportionally increase as they grow, said Ruth Loos, a professor of preventive medicine at the Icahn School of Medicine at Mount Sinai in New York, who was not involved with the Mayo study.
“It doesn’t mean that we cannot use BMI in childhood but it requires extra caution,” she said.
Though BMI does not directly measure body fat, it is considered a good indicator when averaged over the whole population. The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) recommend using BMI to screen for obesity in children starting at 2 years old, and school nurses routinely use BMI as a screening measure.
The rate of childhood obesity has more than doubled in children over the past 30 years. About 18 percent of children age 6 to 19 are classified as obese based on their BMI, according to the most recent CDC statistics.
In February, the CDC reported that 8.4 percent of preschool-age children were obese in 2011-2012, the most recent survey. That was down from 13.9 percent in a similar survey conducted in 2003 and 2004. The decline encouraged some experts to suggest we were perhaps seeing a turnaround in the rising rate of obesity in young people. But other scientists noted that a one-time decline could be a blip, not a trend.
Dr. Lopez-Jimenez, of the Mayo Clinic, said BMI is helpful in showing broad trends of obesity in the overall population but is not a reliable gauge of health risks in individual children. Although a child with a high BMI reading will have too much body fat, another child with a BMI below the obesity threshold could still have too much fat, he said. Boys tended to be undercounted for obesity more often than girls, the study found.
Previous research found that adults with a normal BMI could still have other biological markers associated with obesity, such as hypertension, prediabetes, high triglyceride levels, and an increased risk for cardiovascular-related disease.
Dr. Lopez-Jimenez said more research needs to be done to analyze the different degrees of obesity that may be associated with health risks for children as they grow.
“We need to get more data and not to accept BMI as the gold standard to measure fatness because it’s not,” he said.
Although BMI is a convenient way to classify children for obesity and being overweight, it must be followed by a set of questions about eating and physical activity to determine if a child faces health risks, said Sandra Hassink, medical director of the AAP’s Institute for Healthy Childhood Weight.
“The take home is that BMI is an initial first step to assess risk,” said Dr. Hassink, president-elect of the AAP. “I think we need another measure that really may speak in a more refined way to the relative amount of adiposity versus muscle.”
Other methods measure body fat more accurately than BMI, but these are generally more difficult to implement on a wide scale. Bioelectric-impedance devices, including specialized weighing scales and small gadgets, send a small amount of electrical current across the body to estimate body fatness.
More expensive machines include the Bod Pod, a plastic capsule that measures body volume and then calculates density, and the DXA, or dual-energy X-ray absorptiometry scan, which is used for bone-density tests but can also measure body fatness.
The Mayo study stops short of recommending alternatives to BMI pending additional data.
Bob Siegel, medical director of the Center for Better Health and Nutrition at Cincinnati Children’s Hospital Medical Center, said his practice uses techniques other than BMI, including bioelectric-impedance devices.
“It takes more time and there’s a little bit of training involved and it varies somewhat on hydration status” but it is a more reliable indicator than BMI of body fatness, Dr. Siegel said.
Original source: http://on.wsj.com/1oxtDmE
Publications & Tools
RWJF infographic explains positive impact of healthier school meals
A new infographic from the Robert Wood Johnson Foundation (RWJF) draws on the best of RWJF-funded research to show how more than 30 million kids in the United States have healthier school meal options than children had 10 years ago.
Released June 9, “Healthier School Meals Matter” highlights the positive impact of healthy school meals on kids’ choices and obesity rates, particularly among children from low-income families.
Report documents latest trends in TV food advertising to children
The total number of food and beverage ads viewed by children has increased by 8 percent and advertising to adolescents increased 25 percent since 2007, the year the food and beverage industry’s voluntary Children Food and Beverage Advertising Initiative went into effect, according to an updated research brief from the Yale Rudd Center for Food Policy & Obesity. The brief also notes that youth saw more ads for candy, carbonated beverages, and fast food in 2013 versus 2007, while ads for healthy product categories represented less than 5 percent of food ads viewed.
A number of moms-to-be develop pregnancy-linked diabetes
As many as one in 10 pregnant women in the United States develop the pregnancy complication called gestational diabetes, a new study from the Centers for Disease Control and Prevention (CDC) estimates. Gestational diabetes can have short- and long-term effects for both mother and baby.
Women who are diagnosed with gestational diabetes are approximately seven times more likely to develop type 2 diabetes in the 5-10 years after delivery. Children born to mothers with gestational diabetes are also more likely to develop pre-diabetes.
The data from this study indicates that the prevalence of gestational diabetes is between 4.6 percent and 9.2 percent of all pregnancies. The incidence varies by geographical area. Wyoming and Utah have the lowest rates of gestational diabetes, and New York City and Rhode Island have the highest. The authors say most of the state-by-state difference appears to be related to obesity levels.
Childhood Obesity Research & News
Farmers markets reaching more consumers who get nutritional benefits
June 8, 2014, Los Angeles Times
By Lee Romney
Mercy Mena arrived at Heart of the City Farmers Market in the shadow of San Francisco’s City Hall on a crowded Wednesday.
Before she meandered the stalls for fresh herbs, broccoli, and nuts, she stopped at the main tent. After a swipe of her electronic benefits card on a wireless machine, she was handed bright yellow tokens in exchange for her federal Supplemental Nutrition Assistance Program (SNAP) benefits — formerly known as food stamps.
Mena, the mother of a 4-year-old, lives in the nearby Tenderloin, where poverty rates are high, there are no supermarkets, and life expectancy is 20 years lower than in surrounding neighborhoods largely because of preventable diet-related disease.
A grower-run nonprofit since 1981, Heart of the City knows those statistics well: It has made the most successful push of any farmers market statewide to let local residents know their federal benefits are welcome, processing more than $230,000 in electronic benefits last year.
“Where we live there are so many corner stores with bad food, just bad,” said Mena, 25, who recently lost her cafe job. “This is just amazing to have.”
Other California farmers markets have also begun to reach more consumers who receive nutritional benefits, thanks in part to a subsidy from private and public sources that stretches their buying power.
The Market Match program has been modest — and Heart of the City has simply been too successful to qualify. (It would burn through the available incentive in one market day.)
But now, thanks to $100 million set aside in the 2014 federal Farm Bill for precisely such incentives over the next five years, the program is poised to expand.
Heart of the City Executive Director Kate Creps estimates that access to the incentives could help her market triple its already hefty electronic benefit sales, reaching more at-risk customers while supporting small growers.
An outside evaluation of Market Match and three similar incentive programs in other states — which collectively serve 518 farmers markets — showed that consumers in “food deserts” were buying fresh fruits and vegetables with their benefits.
The research helped persuade federal lawmakers to act, said Martin Bourque, executive director of the Berkeley-based Ecology Center, which manages Market Match.
The catch: the Farm Bill dollars must be matched by state or private funding, and many market organizations lack the time and capacity to pool those resources.
A bill sponsored by Assemblyman Phil Ting (D-San Francisco) would have brought the Market Match program under the control of the California Department of Food and Agriculture. The agency ultimately would have provided the matching funds, applied for the federal dollars on behalf of California’s farmers markets, and ensured that even those operating on a shoestring had technical support.
The appropriations committee last month placed the bill in “suspense” because of cost concerns after unanimous passage in the agriculture committee. Ting plans to reintroduce it.
“The beauty of this thing is that it works,” said Michael Dimock, president of Oakland-based Roots of Change, which in 2009 created Market Match and recently handed the management reins to Bourque’s group. “We’re going to go back. We have support on the Democratic side and on the Republican side, and I think it’s just a matter of timing.”
California has already seen a huge uptick in the purchasing power of benefit recipients at farmers markets, with or without the match.
Mena, who receives $230 per month, greeted a nut farmer by name in Spanish before getting an informal lesson from a sprout grower on his offerings — along with some tastings. The bounty at Heart of the City, she said, is “a blessing, really.”
Farmers market vendors once liberally accepted federal nutritional benefits — when they were paper documents. But when the federal government in 2003 switched over to the electronic benefit, or EBT, swipe card, the markets were caught off guard.
“They don’t have hard-wired phones and power, which you needed for swipe devices,” Bourque said.
The Ecology Center helped devise a wireless, battery-powered point-of-sale swipe card device that satisfied the security concerns of federal officials, and launched a campaign to get them into markets.
According to the California Department of Social Services, which has provided free EBT machines to markets, the number accepting electronic benefits grew from 50 in 2008 to 428 as of last month.
Market Match, generally capped at $10 a week per shopper, served 38,000 families last year who, using just $237,000 in incentives, spent more than $1.5 million at 150 California markets, according to Roots of Change.
Last month, the early-childhood support organization First 5 LA funded the largest expansion of Market Match to date, with a $2.5-million grant to the Ecology Center that will help 37 Los Angeles-area farmers markets.
James Haydu, executive director of Sustainable Economic Enterprises of Los Angeles, which operates eight markets set to benefit from the grant, said Market Match has driven “overwhelming” customer growth at its Watts and Central Avenue locations. “We’re gleaning new customers weekly.”
U.S. schools develop a nicer version of gym class
June 14, 2014, The Washington Post
By Michael Alison Chandler
The cavernous gymnasium at Patriot High School can be intimidating for 15-year-old Kristin Ansah. When students break out the hockey sticks before gym class, she ducks for cover.
“I don’t work out,” she said. “I don’t play sports.”
But Kristin looks forward to her physical education classes, because her teachers let her choose what she wants to play. During the first unit, she bypassed football and tennis for jump-rope games with her friends. “It reminded me of my childhood,” she said.
The program at the Prince William County school is part of a national effort to mobilize a generation that has been labeled the most sedentary in the nation’s history. It represents a major shift in physical education to reverse the trend of inertia, with gym teachers working harder to make sure that their classes don’t appeal just to the most athletic students while the rest of the kids in school-issued shorts are left sitting on the sidelines.
“The country depends on us to do something different than what we have been doing,” said Dolly Lambdin, president of the Society of Health and Physical Educators (SHAPE). “We cared too much about who is the best, who can do the most push-ups, and not nearly enough about what it means to be healthy and physically active for a lifetime.”
“The New PE,” as it’s often called, is a nicer PE.
Out are dodgeball and other sports that use kids as targets, contests that reward students who are the strongest, and exercise doled out (or withheld) as a form of punishment: Still talking? Four more laps!
In are personal fitness plans, target heart-rate zones, and sports that play to different strengths and introduce students to activities that they can pursue across a lifetime. “Physically literate” and “lifelong movers” are buzzwords of the New PE.
Nearly one of every three U.S. children is overweight or obese, a rate that has tripled in the past three decades. Students are less likely to walk to school or play outside before dinner, and they are more likely to spend hours in front of a television or computer screen. Many advocates see physical education, with its potential to reach 56 million students, as a key way to influence behavior during and after the school day.
The D.C. public school system received a federal grant to introduce students to more “life-time physical activities,” said Heather Holaday, the health and physical education program manager for the District.
Archery is one of many sports, including rock climbing, fly fishing and yoga, that District schools are now offering as they try to up the activity level of a wider range of students. Archery — popularized in the “Hunger Games” movies — has egalitarian appeal, Holaday said.
“You could be standing next to the most athletic person in your class and have a chance to be successful,” she said.
Some of Miesha Thompson’s physical education students at Roosevelt Senior High School were skeptical as they went through an 11-step introduction to archery one day this spring.
“Bows and arrows?” asked freshman Karlos Kinney, eyebrows raised. Thirty minutes later, any grumbling was drowned out by the sound of whap! whap!, followed by cheers and “I got it in the red!”
The school district is also investing in technology, including heart monitors that teach students how their bodies respond to exercise and give them a picture of how hard they are working. The monitors also help teachers evaluate students based on effort rather than on how fast they are moving.
School districts across the country are adopting different approaches to introducing lasting exercise habits to more students.
In Prince George’s County, high school students take “Your Personal Fitness,” a required class during which they create individual plans with activities they can pursue outside of school, such as Zumba or walking around the neighborhood.
And a Fairfax County program is outfitting students with pedometers so they can analyze how much exercise they are getting during their daily lives.
Professional associations for physical educators have spent 20 years trying to make the curriculum more accessible through academic standards and teacher training.
First lady Michelle Obama gave the effort a big boost in recent years with her campaign to get kids moving. Last year, she launched a schools-based program to increase physical activity throughout the school day with a goal of 60 minutes of exercise per day, the amount recommended by the U.S. Department of Health and Human Services. An Institute of Medicine report estimates that at least half of students fall short of that amount. Walking or biking to school, recess, intramural sports, classroom breaks, and physical education are all part of the push.
Competing for attention
The efforts come as physical education programs struggle for time and resources, overshadowed by growing academic demands. In a 2007 survey of school administrators, 44 percent reported cutting time from physical education and recess, as well as other subjects, to increase reading and math instruction following the passage of the No Child Left Behind law.
Advocates point to growing evidence that shows a connection between exercise and academic performance. But most state and local regulations are weak when it comes to what federal law considers a nonessential subject.
Just six states require elementary schools to provide at least 150 minutes of physical education a week, as recommended by the physical educators’ association. Just two states require middle or high schools to offer the recommended 225 minutes weekly, according to a state survey by researchers at the Bridging the Gap Program at the University of Illinois at Chicago. The 2010 Healthy Schools Act in the District requires elementary and middle schools to meet these standards by next school year. Virginia and Maryland laws have no time limits.
Time spent in physical education tends to drop off in high school. Most states, including Virginia and the District, require only one or two years of physical education in high school to graduate. Maryland requires one semester.
At the same time, the era of testing and accountability is helping to shape physical education. The New PE has an official test that yields reams of data used to evaluate programs, mold instruction, and help students set fitness goals.
The Presidential Physical Fitness Test, a mainstay of gym classes for decades, was officially retired last school year, based on the recommendation of a childhood obesity task force convened by the president. The contest rewarded students and schools if they scored in the 85th percentile or higher in such categories as curl-ups, push-ups, and the mile-long endurance run.
The new president-sponsored test, the Fitnessgram, evaluates students according to their personal progress and research-based targets of optimal healthy fitness levels for each age and gender. Many school districts in the Washington area years ago switched to the new test, which was originally designed in 1982. The categories are similar, though there is a trend away from the mile run.
With the mile, the kids who are the least fit are the last to finish, said Cheryl Richardson, senior director of member engagement and programming for SHAPE. The more popular test now is a goal-based, back-and-forth shuttle run across the gym, and the kids who are the most fit tend to run more times — and be the last to finish. “It changes the tone from a hurry-up-and-finish to a how-long-can-you-go?”
Some people are wary of the changes in physical education, worrying that the cultural shift could soften the nation’s children.
“It’s becoming too politically correct,” said Dennis Senibaldi, a school board member in Windham, N.H., who advocated against a policy in his district to ban dodgeball last year.
“We want to teach kids you don’t always get first place, you don’t always get a trophy. . . . My son didn’t make the seventh-grade soccer team. Should we get rid of the soccer program because not everyone made it?”
As many as you can
Even though the new tests are geared to be less competitive, many students still dread them.
“Just exempt me now. I can’t do it,” Kristin Ansah told her teacher at Patriot High School in Bristow, Va., on the spring morning she had to take her push-up test. At the beginning of the year, she completed five push-ups before collapsing.
Kristin used to live in Staten Island, where she would walk to the store or the bus stop, but since moving to the Northern Virginia suburbs two years ago, gym class is often the only exercise she gets.
When her teacher, Charles Porterfield, showed no mercy, she reluctantly lined up with the other girls against the wall.
“Backs nice and flat. Down 90 degrees,” Porterfield prompted. “Think about the number you got last time and try a little harder this time.”
A recording turned on. “Ready? Begin,” the voice droned. “Down, up one. Down, up two. Down, up three.”
“Do as many as you can, literally till your arms are shaking and you can’t do any more,” Porterfield said.
Kristin made it past five, then six, then seven, before finally stopping at eight.
A regional soccer star in her class kept going long after everyone else had let out a last groan, surpassing 60 push-ups.
But Kristin was happy with her number.
“I improved,” she said.
A school lunch menu where students have a say
June 17, 2014, WTOP-FM
By Rachel Nania
At noon on a recent Friday, students at D.C.’s Aiton Elementary School eagerly line up in front of a table in the cafeteria. On the table are small cups filled with something most of the students have never tasted: zucchini.
“We have Parmesan-crusted zucchini crisps, roasted zucchini, and stewed zucchini and tomatoes,” Stacey Snelling tells the crowd of kids, who are there to sample the options.
It is Fresh Feature Friday at Aiton — a day when students get to try a vegetable that is prepared three different ways and tell the adults which one they want to see on their lunch menu.
“We have improved fruits and vegetables, whole grains, lower-sodium items [in schools], but what we noticed was kids weren’t familiar with these foods,” says Snelling, associate dean at the School of Education Teaching and Health at American University.
For the past two years, Snelling has been working with D.C. Central Kitchen to feature seasonal vegetables at eight local schools: four in Arlington and four in the District.
Gone are the days of mushy and tasteless steamed vegetables. The recipes served on Fresh Feature Fridays are prepared with a twist — all while adhering to the Healthy Schools Act standards.
Another Friday revealed students at the eight schools prefer their broccoli cooked Asian-style.
“We saw a great increase in the consumption of broccoli,” when it was served Asian-style, Snelling says. “We do need to find the right preparation method that alters it a little bit in order to get them to try it again. … They don’t get exposed to it if it’s sitting on their tray. They actually have to try that vegetable.”
Snelling says that in the past, 90 percent of the zucchini on lunch trays would end up in the trash, because students weren’t familiar with the vegetable and it did not look appetizing to them. Her goal this week is to change that pattern.
The 30-plus students who went through Friday’s Fresh Feature line were very vocal about which zucchini recipe they liked best.
“The first one. It was crunchy and tasted good,” said one student after eating the Parmesan-crusted zucchini crisp.
“I want this one for lunch,” said another, pointing to the baked crisps.
Greg Hollins, a teacher at Aiton, says his students routinely look forward to Fresh Feature Fridays.
“It gives them the opportunity to shake things up because they can look at foods in a different light,” Hollins says. “I think that when you have the opportunity to try something [prepared] a different way, you might develop an appreciation for it.”
So far, Snelling and D.C. Central Kitchen have featured six different types of produce for Fresh Feature Fridays — from sweet potatoes to spinach and strawberries.
Katie Nash, program manager and registered dietitian for D.C. Central Kitchen, says she tries to develop the Feature Friday recipes around foods with which the kids are most familiar.
“The sweet potato fries were really popular. We also did chickpea fries, which is a little bit different, but had that ‘fry appeal,’ even though it wasn’t fried; it was actually baked. Really, it’s about that familiarity,” says Nash, who says the Asian-style broccoli was a hit because a lot of the kids said it tasted “like takeout.”
“Hopefully now that they’ve seen it in this new way, it will be something that they try all the time.”
The new recipes strike a chord with the kids’ taste buds, and so does the initiative’s approach: to let the students have a say when it comes to what’s served for lunch.
“They’re usually just told to do something, and now they get the option to tell us what to do and what to put on the menu. So I think that’s really cool for a child to be able to do,” Nash says.
Ed Kwitowski, director of school food services at D.C. Central Kitchen, agrees. “Really, the thing that they get the most excited about is just having that buy-in and having a choice,” he says.
Despite introducing unfamiliar vegetables to young students, Nash says, so far she’s seen little hesitation about trying new foods.
“I’ve never had a student say, ‘Absolutely not; I’m not trying it.’ They always try. They might not like it, and that’s fine — we let them know that they don’t have to like it. But usually they end up liking one of the three methods,” she says.
Friday’s recipes brought in 25 votes for the Parmesan-crusted zucchini crisps, two votes for the roasted zucchini, and five votes for the stewed zucchini and tomatoes. Over the next few weeks, Nash and Kwitowski will fine-tune the winning recipe, and in one month, it will be on the school’s menu.
When the students go through the lunch line, a sign next to the new vegetable recipe will let the kids know that’s the one that won their votes.
But not every school votes for the same preparation method, Snelling says.
“Every school has its own culture, and sometimes we have two methods that have to be prepared because one method won at one school and another method won at another school,” she says.
In the fall, Fresh Feature Fridays will return with a handful of new, seasonal vegetables to introduce to the students.
“We created cafeterias that serve healthier foods. But in order to increase the adoption of those foods, children need to be involved. And that’s the gap right now,” Snelling says.
“The provisions are not going to go away. People believe that healthier foods are better for children, so now we have the challenge, as educators, to help students accept these foods.”