E-Newsletter
December 2010


SPOTLIGHT

PUBLICATIONS

RESEARCH HIGHLIGHTS

CHILDHOOD OBESITY NEWS


SPOTLIGHT

House Sends Child Nutrition Bill to President Obama

Dec. 3, 2010, The Washington Post

By Nick Anderson

The Democrat-led House voted to send President Obama a bill that would enable more poor children to receive free meals at school, raise the nutritional quality of cafeteria fare and reduce the junk food and sugary beverages sold in school vending machines.

The bill, which cleared the Senate in the summer, won House approval on a 264 to 157 vote. Seventeen Republicans broke party ranks to join Democrats in favor of the bill. Four Democrats were opposed.

The bill, a priority for the president and first lady Michelle Obama, would boost spending on child nutrition $4.5 billion over 10 years and raise federal reimbursements for school lunches more than the inflation rate for the first time since 1973. It also would require for the first time that free drinking water be available where meals are served.

The bill accelerates the budding healthful-food movement in public education - think whole wheat pizza with lowfat cheese and low-sodium sauce - but leaves unanswered key questions about whether schools can afford to give tens of millions of students better meals.

Democrats took steps to offset the bill’s costs, including a $2.2 billion cut to food stamp benefits for needy families. Those maneuvers, reflecting political pressures to avoid adding to the budget deficit, caused many Democrats to wince even as they voted for the bill because it would effectively shift funds from one anti-hunger program to another.

House Republicans opposed the bill as a needless expansion of government by the lame-duck Congress weeks after voters punished Democrats at the polls. National groups representing school administrators and boards also were opposed, calling the bill an unfunded mandate that would strain strapped school budgets.

But the Senate approved the bill through unanimous consent in August. It had strong backing from an array of groups seeking to improve child nutrition and has become part of the first lady’s campaign against childhood obesity and hunger.

For House Democrats, approval of the bill marked a show of force a month before they cede the gavel to a new Republican majority.

“In a country as great as ours, no child should go hungry,” Rep. George Miller (D-Calif.), chairman of the Education and Labor Committee, said Wednesday. But he added that many do. “We cannot afford to let that continue.”

Rep. John Kline (R-Minn.), the incoming committee chairman, said Democrats were flouting the will of the voters. “ ‘Stop growing government,’ people are telling us,” Kline said. “ ‘Stop spending money we do not have.’ It’s a simple request and a sensible one. Yet it continues to be ignored.”

Republicans proposed Wednesday to amend the bill, including a requirement for background checks for certain child-care providers, and thereby force another vote in the Senate that would jeopardize the bill’s chances of becoming law.

To neutralize that threat, Democratic leaders staged a vote on - and passed - a separate measure that mirrored elements of the Republican proposal. Then they muscled the nutrition bill, unamended, through its final vote.

The nutrition bill, steered through the Senate by Sen. Blanche Lincoln (D-Ark.), seeks to expand access to subsidized meals for needy children and ensure that those meals have more whole grains, lean proteins and fruits and vegetables. The national school lunch program serves 31 million children, with more than 62 percent receiving free or reduced-price lunches.

Key provisions of the legislation would:

  • Use Medicaid data in some states to enroll children automatically for free meals. That would add about 115,000 new students each year to the program. Experts say needy families often fail to fill out paperwork required to show their eligibility. This provision would address that problem.
  • Expand an after-school supper program for the needy – now offered in the District, Maryland and 12 other states – to all states. Doing so would provide an additional 21 million meals annually.
  • Authorize the establishment of nutrition standards for all food and beverages sold on school grounds throughout the school day. Currently, the government’s regulatory scope is limited to cafeterias during hours when meals are served. This provision, advocates say, would force out sugary beverages and snacks and clear the way for more healthful food and drinks to be offered through a la carte sales at snack bars and vending machines.
  • Raise the federal reimbursement by 6 cents per lunch for school districts that comply with new meals standards to be issued by the Agriculture Department. The reimbursement rate is now $2.72 for each free lunch, which most school administrators say is insufficient to cover costs.

    The 6 cent increase, like the base rate, would be indexed to inflation.

The American Association of School Administrators, the National School Boards Association and the Council of the Great City Schools opposed the bill, saying it would impose a host of requirements without providing schools money to pay for them.

Jeff Simering of the Council of the Great City Schools said the bill’s advocates won’t suffer the fiscal headaches of implementing it. “They don’t have to balance a budget,” he said. “They can take positions on issues that a lot of us would like to support.”

Diane Pratt-Heavner of the School Nutrition Association described the bill as “our best chance” for getting more money for school meals. “Whether a child is in the cafeteria ordering a school meal or in front of a vending machine or in an a la carte line,” she said, “they’ll be receiving a consistent message about healthy food choices.”

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Original Source: http://www.washingtonpost.com/wp-dyn/content/article/2010/12/02/AR2010120202737.html

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2011 Built Environment Assessment Training (BEAT-Plus) Institute

June 26-July 1, 2011, Seattle, Wash.

The built environment, which is made up of the nutrition and physical activity environments, streetscapes, transportation environments, and everything in between, has been identified as a key determinant in the obesity epidemic. Therefore, understanding how environmental and policy changes can inform efforts to control obesity, improve diet and physical activity, is a priority.

A variety of measures now exist that allow researchers and practitioners to plan and evaluate changes to the built environment. The Built Environment Assessment Training (BEAT) Institute is designed to train participants to use these measures for research and practice.

The goals of the BEAT Institute are to: 1) Prepare investigators and practitioners to use both observational and self-report measures of nutrition and activity environments and related behavioral assessments through lectures, fieldwork, hands-on skills, group work and individual consultation and 2) Increase the number of professionals qualified to conduct built environment assessments for nutrition and physical activity.

For more information, see our website.

(Funding through the United States Department of Agriculture, with support from the Center for Health Behavior Research at the University of Pennsylvania.)

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PUBLICATIONS

Report Highlights Changes Needed to Support Healthy Eating and Physical Activity in U.S. Elementary Schools

Nov. 23, 2010, RWJF Childhood Obesity News

By L Turner, FJ Chaloupka, JF Chriqui and A Sandoval

A comprehensive new report from Bridging the Gap and the Robert Wood Johnson Foundation shows that elementary schools across the nation commonly offer their students junk food and soda, serve meals that don’t meet current dietary guidelines, and provide little time for physical activity.

The report, School Policies and Practices to Improve Health and Prevent Obesity: National Elementary School Survey Results, examined practices that affect nutrition, physical activity and obesity prevention for tens of millions of students. Its conclusions are critical for informing the Child Nutrition Reauthorization legislation, including policies related to competitive foods and school meals.

Among the key findings from the 2007–08 school year:

  • Nearly two-thirds of public elementary school students were able to purchase competitive foods or beverages on campus. These items, sold or served outside of school meal programs, often included soda, candy, cookies and french fries.
  • Meals served through the National School Lunch Program often included higher-fat items such as pizza, french fries, and 2% or whole milk.
  • Only 20 percent of public school third-graders were offered daily physical education, and only 18 percent were offered at least 150 minutes of weekly physical education, as recommended by the National Association for Sport and Physical Education.

The report shows that many schools have not implemented the wellness policy provisions required by the Child Nutrition and WIC Reauthorization Act of 2004. That legislation called for school districts participating in federal child nutrition programs, such as the National School Lunch Program and School Breakfast Program, to adopt and implement a wellness policy by the start of the 2006–07 school year.

Results were based on surveys of school administrators during the 2006–07 and 2007–08 school years, and findings represent about 21 million students in kindergarten through fifth grade each year.

The report highlights key findings, presents data in user-friendly figures and tables, and describes policy opportunities. An executive summary was released in June 2010.

VIEW THE REPORT

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Original Source: http://www.rwjf.org/childhoodobesity/product.jsp?id=64429&cid=XEM_205602

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Report Shows Americans Do Not Eat Enough Fruits and Vegetables

A new report card from the National Fruit & Vegetable Alliance, developed by the Produce for Better Health Foundation, shows that there has been little improvement in efforts to increase fruit and vegetable consumption since 2005. The report card evaluated progress made by schools, restaurants, retailers, and federal and state governments. It found that the average American fruit and vegetable consumption remains far below recommended levels. The report recommended increasing fruit and vegetable availability in communities, schools, the work place, and restaurants; strengthening nutrition education programs; and aligning federal funding to be consistent with the federal dietary guidelines.

DOWNLOAD THE EXECUTIVE SUMMARY AND FULL REPORT

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RESEARCH HIGHLIGHTS

Study: Sweet Drinks Widely Available in Schools

Nov. 1, 2010, Reuters

By Julie Steenhuysen

Despite efforts to limit their availability, public elementary school students in the United States have more outlets to buy unhealthy beverages at school, U.S. researchers said.

Over a three-year period ending in 2009, more students could buy sweetened beverages like sodas, higher-fat milk and sports beverages from vending machines and school stores, they said. Such drinks are a major source of calories, and removing them from schools could help curb the nation’s obesity epidemic.

“Elementary school students are still surrounded by a variety of unhealthy beverages while at school,” said Lindsey Turner of the University of Illinois at Chicago, whose study appears in the Archives of Pediatrics and Adolescent Medicine.

“Sugar-sweetened sodas have been linked to childhood obesity. Because kids spend so much time in school, getting those beverages out of school should be a public health priority in our opinion,” Turner said in a telephone interview.

Although U.S. Department of Agriculture guidelines say schools should not provide sweetened beverages in government supported cafeteria meals, students can buy these items in vending machines or school stores – known as competitive venues because they compete with the government meals.

Turner and colleague Frank Chaloupka mailed surveys to U.S. elementary school administrators about the availability of high-calorie beverages for sale in three successive school years through 2008-2009.

They looked beyond the cafeteria to other places that might be supplying children with sugared beverages and they looked at the different types of milk for sale: low-fat, whole and flavored.

Vending machines, school stores

During the three years of the study, they said the number of vending machines remained stable, but access to stores or snack bars or a la carte cafeteria lines rose significantly. By 2009, 61 percent of students could buy high-calorie drinks from vending machines or school stores compared with 49 percent just two years prior.

“What we found was over time there was not a substantial decrease in sugary beverages, which is what we would have hoped to see,” Turner said.

“We also found that school stores become more common, as did a la carte lines in lunch rooms.”

Overall, she said 45 percent of public elementary school students could purchase some sort of beverage outside of the government meals program that did not meet national recommendations. That figure rose to 58 percent of students in private elementary schools, Turner said.

Too much sugar not only makes people fatter, but is also a key culprit in diabetes, heart disease and stroke, according to the American Heart Association.

The association said last year that Americans need to cut back dramatically on sugar consumption.

“I think at this point there still is a discrepancy between what we are actually recommending for children and what they are consuming,” Dr. Alice Lichtenstein, a heart and nutrition specialist at Tufts University, said in a telephone interview.

Reducing childhood obesity has been a major effort supported by the White House. First Lady Michelle Obama this year issued 70-point plan to reduce childhood obesity. The Center for Science in the Public Interest, a nonprofit health advocacy group based in Washington, urged Congress to pass the U.S. lawmakers to pass the Healthy, Hunger Free Kids Act now that it’s returned for the lame duck session.

That bipartisan bill passed the Senate unanimously in August and includes a provision to get junk food and soda out of schools.

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Original Source:
http://www.reuters.com/article/idUSTRE6A04ZO20101101

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Obesity Programs Less Successful for African-American Girls

Nov. 2, 2010, Reuters

By Alison McCook

Two large initiatives designed to prevent African-American girls from becoming obese are not very successful at it, according to two new studies.

The two-year programs consisted of either practical advice and goals for staying fit and healthy, or regular dance classes along with an intervention to reduce the amount of time girls spent playing video games, watching TV, or on the computer.

However, over the course of two years, 8- to 10-year-old girls who were enrolled in either program were just as likely to gain weight as girls who did not participate in the interventions.

It’s not clear why the programs had so little impact, lead author of one of the studies, Dr. Robert Klesges at the University of Tennessee Health Science Center, told Reuters Health. However, “the environmental factors that promote sedentary behavior” – such as TV and video games – and preferences for high-calorie foods “probably overwhelmed” the effects of the program, he suggested.

Obesity has become an epidemic among American children, and African-American girls are particularly at risk - a recent nationwide health survey found that approximately one-quarter of black girls are obese.

To see whether targeted programs help prevent young girls from becoming obese teens, Klesges and his colleagues followed 303 girls in the Memphis area for two years. They randomly assigned half to a program designed to prevent them from becoming obese by giving them goals for healthy eating and exercise while teaching their parents about providing healthy foods, and the other half to an alternative program that did not focus on diet and exercise, but just self-esteem in general.

They found that girls who completed the obesity program tended to consume more water and vegetables, and fewer sweet drinks, than girls in the other program. But both groups were just as likely to gain weight, and both decreased their amount of physical activity over the two years.

“For those girls who changed these eating patterns and didn’t see weight gain prevention, they probably just replaced these calories with other foods,” Klesges noted. The next step, he suggested, could be to encourage girls to reduce their overall calories, not just shift the calories they’d get from soda and fatty foods into other food types.

And younger girls appeared to benefit more from the program, Klesges noted, suggesting it is worth continuing this program in that age group. “We didn’t do a cost analysis but the intervention is definitely portable and could be implemented for very low cost,” he said in an e-mail.

In the other study, also published in the November issue of the Archives of Pediatrics & Adolescent Medicine, researchers randomly assigned 261 black girls in Oakland, Calif., to either participate in an intervention to reduce their “screen” time along with regular dance classes that included African, hip-hop, and step dancing; or receive newsletters about health issues for young girls and attend occasional family health lectures.

Here, too, girls in both groups were equally likely to gain weight during the study period, but those in the dance program showed improvements in some other aspects of health, such as lower cholesterol and insulin levels and fewer symptoms of depression. “I felt really good about (those findings),” study author Dr. Thomas Robinson at Stanford University School of Medicine told Reuters Health.

He added that the program experienced a few unexpected challenges that may have affected the findings - for example, transportation for the girls fell through early in the program, which likely lowered attendance. Implementing a similar program at a school would cut down on costs considerably, Robinson added, so the only expense would be paying the dance teacher, who might be willing to volunteer. “We haven’t given up on the concept,” he noted.

Furthermore, girls who were at higher risk of weight gain – those who watched more TV overall and were being raised by unmarried adults – appeared to benefit more from the program than other girls, Robinson said. “They have more room to go, and are more likely to benefit,” he suggested. “Our intervention definitely helped a lot of girls.”

The next step, Klesges suggested, is to ensure children have regular access to physical activity that they enjoy, and find ways to encourage people not to opt for fast foods. “While we have a long way to go, promoting healthy diets from the time a child is very small is needed,” he said. “If more people wanted healthy alternatives, (fast-food restaurants) would sell them.”

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Original Source: http://www.reuters.com/article/idUSTRE6A14WO20101102

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Fast-Food Kids Meals High in Salt, Calories

Nov. 9, 2010, USA Today; Health Jackal

By Nanci Hellmich

There are only a dozen or so healthful kids meals out of thousands of possible combinations at the nation’s popular fast-food chains, a comprehensive new analysis shows.

Researchers at Yale’s Rudd Center for Food Policy and Obesity reviewed the nutritional information on more than 3,000 kids’ meal combinations at eight fast-food chains: McDonald’s, Burger King, Subway, Wendy’s, Sonic, KFC, Taco Bell and Dairy Queen. The assessment evaluated whether the meals had healthful foods and didn’t exceed the recommended limits in categories such as calories and sodium.

They also hired people to order kids meals at 250 restaurants nationally from five chains to determine what is being served as the default choice.

The findings, released at the American Public Health Association’s annual meeting in Denver, show:

  • Twelve meal combos met the nutrition criteria for preschoolers; 15 combos met the criteria for elementary kids.
  • Another 20 meal combinations met kids’ calorie goal but were too high in at least one area, such as sodium.
  • The calories in kids meals ranged from about 300 to 1,000.
  • Teens purchase 800 to 1,100 calories in a fast-food meal, about half a day’s worth of calories.
  • Kids aged 2 to 12 typically order foods with about half a day’s sodium.
  • Some chains do not offer 100 percent juice or milk.

Most fast-food chains offer at least one healthful side dish and beverage, but employees usually automatically give customers french fries and soda as the default option. The exception is Subway, which promotes its healthy choices 60 percent of the time.

The report finds the industry spent more than $4.2 billion in 2009 on marketing and advertising on television, the Internet, social media sites and mobile applications. Subway and Burger King had the 10 healthiest kids’ meal selections, with Subway’s Veggie Delite Sandwich on Wheat Bread with apple slices and apple juice coming in at a scant 285 calories. McDonald’s, Dairy Queen, Taco Bell, KFC, Sonic, and, yes, Burger King as well, all offered the worst kids meals, each having an option at over 750 calories. The worst kids meal offering, the study found, is a Dairy Queen Original Cheeseburger with french fries, Mountain Dew and a Chocolate Dilly Bar, all of which comes in at a whopping 973 calories.

Making the healthy choices the default option in kids meals would cut children’s intake by billions of calories a year, says Yale’s Marlene Schwartz.

That’s important because about 84 percent of parents report taking their child to a fast-food restaurant at least once a week, according to a survey of parents.

Kids today are bombarded with ads for fast food on TV and the Internet, says Yale’s Jennifer Harris. Teens see five fast-food TV ads a day; elementary students see three and a half; and preschoolers see three.

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Original Sources: http://www.usatoday.com/yourlife/food/diet-nutrition/2010-11-08-kidsandfastfood08_ST_N.htm

http://www.healthjackal.com/health/2010/11/09/fast-food-ads-to-blame-for-childhood-obesity-epidemic/

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CHILDHOOD OBESITY NEWS

FDA Seeks Nutrition Face Label Format Comments

The Food and Drug Administration (FDA) is seeking public comments on the paperwork and regulatory burden associated with the proposed modifications to the nutrition facts label format. Comments are due by Dec. 17. The FDA Federal Register notice can be read here.

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Highmark Inc. Collaborates with the Alliance for a Healthier Generation

Nov. 29, 2010, PRNewswire

Thirty-nine percent of the children living in Pennsylvania are overweight and are at greater risk of developing such chronic diseases as diabetes, high blood pressure and heart disease than the generation before them. To continue its efforts to address childhood obesity, Highmark Inc. has collaborated with the Alliance for a Healthier Generation to expand its obesity benefits for children in 2011.

“Highmark has signed on to collaborate with the Alliance for a Healthier Generation’s Health Care Initiative to support the goal to provide a holistic approach to the prevention, assessment and treatment of childhood obesity through multiple avenues, including health insurance offerings,” said Dr. Donald R. Fischer, Highmark’s chief medical officer.

“More than 500,000 children will have access to this important care through Highmark. By decreasing the health risks of children, we decrease the number of children who will most likely develop into unhealthy adults. Highmark’s commitment to this endeavor is an investment in the health of the entire community.”

The Alliance for a Healthier Generation, a nonprofit organization founded by the American Heart Association and the William J. Clinton Foundation, works to positively affect the places that can make a difference to a child’s health – homes, schools, doctors’ offices and communities.

“We know that our network physicians are equally concerned about childhood obesity and represent a valuable resource of expertise and caring,” added Dr. Fischer. “Highmark’s participation in this initiative is helping to remove some barriers so that our network physicians can provide the optimal health care and guidance needed to address obesity.”

Starting Jan. 1, 2011, children ages 3 to 18 with a BMI over the 85th percentile for their age are eligible to receive the benefits and will be automatically enrolled. Through a preventive health benefit plan, eligible children will receive a minimum of four follow-up visits with their primary care provider (or other health care professional), along with four visits with a registered dietitian.

“Without proper prevention and treatment of childhood obesity, our current generation could become the first in American history to live shorter lives than their parents,” said Ginny Ehrlich, Alliance for a Healthier Generation executive director. “We applaud Highmark for making this ongoing commitment to help reverse the childhood obesity epidemic.” Highmark has had a deep history in promoting children’s health. The collaboration with the

Alliance for a Healthier Generation will serve as a complement to the existing programs, services and funding that Highmark has been providing to address this national issue. The alliance’s goal of providing comprehensive health benefits for the prevention, assessment and treatment of childhood obesity aligns with Highmark’s mission and the Highmark Healthy High 5 initiative to promote lifelong healthy behaviors in children and adolescents.

Highmark values the Alliance for a Healthier Generation’s long-term goal that more than 6 million children, or 25 percent of all overweight and obese children in the United States, will have access to this benefit by 2012.

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Original Source: http://www.prnewswire.com/news-releases/highmark-inc-collaborates-with-the-alliance-for-a-healthier-generation-to-address-childhood-obesity-110961429.html

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USDA Announces Wellness Grants in the Child and Adult Care Food Program

Nov. 19, 2010, USDA Office of Communications

Agriculture Secretary Tom Vilsack announced Child Care Wellness Grants to 14 states for the improvement of health and wellness in child care settings. More than $7.7 million in funding will support state agencies in implementing initiatives through the Child and Adult Care Food Program (CACFP). Over half of the funds awarded will be distributed to local child care sponsoring organizations and institutions through state agencies.

“Local efforts have the greatest promise to develop, test, and implement successful programs to promote health and nutrition improvement in childcare settings” said Vilsack. “These grants will inspire innovative improvements to enhance nutrition and promote physical activity of the children in these states and communities.”

The Child and Adult Care Food Program (CACFP) plays a vital role in improving the quality of child care and in making care more affordable for low-income families. Through CACFP, more than 3.3 million infants and children and 112,000 adults receive nutritious meals and snacks each day.

During the grant period, ranging from two to three years, states will fund activities that promote nutrition and physical activity in child care that reflect the Dietary Guidelines for Americans and the most recent scientific knowledge; provide technical assistance and training to sponsors and providers of child care centers and family and group day care homes; perform outreach campaigns that increase access to the program in underserved areas and populations; and/or make innovative use of technology to provide training to sponsoring organizations and child care providers.

The 14 states receiving grants are: Alaska ($200,454), District of Columbia ($212,614); Kansas ($954,445); Maine ($564,040); Maryland ($406,401); Missouri ($448,158); Montana ($111,034); Nevada ($349,875); New York ($693,635); North Carolina ($926,708); Oregon ($500,000); Pennsylvania ($684,883); Texas ($1 million); and Wisconsin ($666,922).

Strengthening the Child Nutrition and National School Lunch Acts, which authorize USDA’s child nutrition programs including the National School Lunch and School Breakfast Programs, is the legislative centerpiece of First Lady Michelle Obama’s Let’s Move! campaign. This legislation will help battle hunger and food insecurity during the school day while providing critical resources to raise a generation of healthy children.

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Original Source: http://www.fns.usda.gov/cga/PressReleases/2010/0612.htm

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Shopping Vouchers for Walking to School

Nov. 28, 2010, The Telegraph

By Stephen Adams

Children will receive shopping vouchers and cinema tickets simply for walking to school under a scheme aimed at tackling childhood obesity that could be rolled out nationwide.

Andrew Lansley, the Health Secretary, will unveil the walk-for-rewards initiative as part of the Coalition’s white paper on public health.

It will contain a raft of measures aimed at “nudging” people to take better care of themselves, after Lansley concluded that “radical action” was needed to improve the nation’s health.

Under the scheme, pupils will be issued with electronic swipe cards that they use to touch receivers on lampposts between their home and school, in much the same way that Oystercards work on the capital’s transport network.

In a pilot scheme in Wimbledon, southwest London, teenage girls received a £5 Topshop voucher if they walked to school eight times within a certain period, and an Odeon cinema ticket for five days of walking.

As a result there was an 18 percent increase in walking to school. Police time to deal with what organizers termed “overcrowding” at bus stops and on buses also dropped by almost half.

This led to a £24 public saving for every £1 invested in the scheme, according to official figures.

Tam Fry, of the National Obesity Forum, gave the idea a “cautious welcome.” “In principle it’s a good idea, but it needs to be closely monitored,” he said, advising that schools should set their pupils a “time limit” depending on distance.

“It needs to be a brisk walk; they’ve got to huff and puff,” he said. “If they amble to school and stop at the corner shop to buy fizzy drinks, it’s a waste of time, because then they would probably take in more calories than they would expend.”

Almost one in four children starting secondary school in Britain is now either overweight or obese, population studies show.

While the last Labour had pledged to halt the rise in childhood obesity by 2010, it quietly deferred that target to 2020.

Studies consistently show that overweight children tend to grow up into adults who are more prone to heart disease and cancer. Nearly half of pupils (43%) are driven to school by their parents, according to a poll by the campaign group Living Streets, which represents pedestrians. Road accidents and childhood abduction are the biggest fears that stopped them letting their children make their own way to school.

Lansley’s willingness to use what critics might dismiss as bribery to change children’s exercise habits, has its roots in what economist call “nudge economics”.

This is the theory that people will change their behavior if they are given small incentives – either sticks or carrots – to do so.

David Cameron was so impressed with the 2008 bestseller Nudge by American economists Richard Thaler and Cass Sunstein, who formulated the idea, that he instructed all his shadow cabinet to read it in opposition.

However, right wing elements of the Conservative Party object to what they believe is a nanny state lurking in what advocates term “liberal paternalism”. Lansley said that public health policy would be guided by a “ladder of intervention”, with persuasion used for certain policy objectives – such as increasing walking to school – and regulation for others.

For example, another idea to be put forward in the white paper is that cigarettes should only be sold in plain cartons, with tobacco companies banned from using attractive colors and designs to sell their products.

Imperial Tobacco, which makes brands including Lambert & Butler and Gauloises, has already indicated it will fight such legislation in the courts.

Lansley said: “This ‘ladder of intervention’ will help policymakers in central and in local government to deliver a public health strategy that is geared towards promoting effective behavior change and interventions only where necessary.”

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Original Source: http://www.telegraph.co.uk/health/8166020/Shopping-vouchers-for-walking-to-school.html

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