PUBLICATIONS and TOOLS
- New Website on School Food for Parent Advocates
- Report: U.S. Spending Billions of Dollars to Subsidize Junk Food
- CDC Releases Fact Sheet on Strong Nutrition Standards and Financial Implications
- Study Finds Payment for Pediatric Obesity Services Now Can Save Money Later
- Lifetime 'Dose' of Excess Weight Linked to Diabetes Risk
- "Hey Bobby Slow Down!" Helicopter Parents Can Impede Child's Ability to Play
- Obese Kids May Face Social, Emotional Woes
CHILDHOOD OBESITY NEWS
- New Steps to Fight Childhood Obesity Taken By CDC
- Attacking the Obesity Epidemic by First Figuring Out Its Cause
- Data Is Power: Michigan Fights Childhood Obesity by Tracking It
- Public Schools Face the Rising Costs of Serving Lunch
- Boston Launches Ad Campaign against Sugary Beverages
Sept. 15, 2001, Associated Press
By Darlene Superville
Calorie by calorie, first lady Michelle Obama is chipping away at big portions and unhealthy food in an effort to help America slim down.
In the year and a half since she announced her campaign to curb childhood obesity, Mrs. Obama has stood alongside Wal-Mart, Olive Garden and many other food companies as they have announced improvements to their recipes — fewer calories, less sodium, better children's menus.
The changes are small steps, in most cases. Fried foods and french fries will still be on the menu, though enticing pictures of those foods may be gone. High-sodium soups, which many consumers prefer, will still be on the grocery aisle. But the amount of sodium in each can will gradually decrease in some cases, and the taste of their low-sodium variety will be improved.
On September 15, the first lady joined Darden Restaurants Inc. executives at one of their Olive Garden restaurants in Hyattsville, Md., near Washington to announce that the company's chains are pledging to cut calories and sodium in their meals by 20 percent over a decade. Fruit or vegetable side dishes and low-fat milk will become standard with kids' meals unless a substitution is requested.
Mrs. Obama said Darden's announcement is a "breakthrough moment" for the industry. The company owns 1,900 restaurants in 49 states, including Olive Garden, Red Lobster, LongHorn Steakhouse, The Capital Grille, Bahama Breeze and Seasons 52.
"I believe the changes that Darden will make could impact the health and well-being of an entire generation of young people," the first lady said.
McDonald's, Burger King and more than a dozen other restaurants have also said this summer that they will revamp children's menus. Changing recipes and menu items is good business for the industry because consumers want wider choices — chefs and food manufacturers say consumers are demanding more healthy food than ever before.
Nutrition advocates and food industry representatives say that the first lady embraced the issue just as consumers began to demand healthier foods and advocates were making headway in getting industry to make foods healthier. They say she has been a key catalyst in getting lawmakers and companies to jump on board.
"There's been more progress on nutrition in the last several years than in the whole previous decade," says Margo Wootan, a leading nutrition advocate and lobbyist with the Center for Science in the Public Interest who has been working on the issue for almost 20 years. "There is a lot of momentum in addressing obesity right now and the first lady adds significant momentum to that movement."
Wootan says Mrs. Obama and her staff have done more than just public appearances, working behind the scenes with industry and Congress to affect change. "She does more than use the bully pulpit," says Wootan.
The landscape has certainly changed for the food industry since President Barack Obama took office and the first lady launched her campaign. In that time, Congress has passed laws to improve school lunches, improve food safety and require calorie labeling in restaurants, all with industry support. The administration has proposed new food marketing rules for children and the food industry has come at least part of the way with their own proposal to limit marketing to kids. Major companies have launched a joint effort to cut calories and put more nutrition information on food labels.
The first lady's effort has had "a dramatic impact on manufacturers, restaurants and retailers," says Scott Faber, a lobbyist for the Grocery Manufacturers Association, which represents all of the major food companies. "Until the first lady launched her initiative there was no one American who was inspiring this generation of kids and parents to do more to have a healthy lifestyle."
Mrs. Obama's participation with Darden Restaurants was her latest appearance with retailers and other private-sector players in support of her anti-obesity campaign. In January, she stood with Wal-Mart, the nation's largest grocer, as it pledged to reformulate thousands of products it sells to make them healthier and to push suppliers to do the same.
This summer, the first lady applauded as Wal-Mart, Walgreens drug stores and several regional grocers committed to help eliminate "food deserts" by opening or expanding in rural and urban areas without easy access to healthy foods, including fresh fruits and vegetables.
One in three U.S. children is overweight or obese, putting them at greater risk of developing diabetes, heart disease or other health conditions. Mrs. Obama has said her goal is to help today's youngsters become adults at a healthy weight by eating better and getting more exercise.
In a speech to the National Restaurant Association one year ago this month, the first lady asked members to "actively promote healthy foods and healthy habits to our kids."
Dawn Sweeney, CEO of the association, said that was an "acceleration point" for many restaurants that were already starting to change their menus.
"Certainly the focus she has put on food and healthy living has been a great boost to create even broader consumer interest," Sweeney said.
PUBLICATIONS and TOOLS
New Website on School Food for Parent Advocates
On September 13, the Rudd Center launched a website aimed at helping parent advocates navigate through the complex issues of school food. Rudd SPARK - Supporting Parent Advocates with Resources & Knowledge - connects parent advocates to Rudd Center research and resources and each other.
Rudd SPARK helps parent advocates understand school food regulation at the federal, state, and local levels and provides strategies on how to become a school food expert, advocate effectively, and use local and social media for change within their own district.
The site highlights areas that can have a positive impact on the school food environment, including wellness policies, national meal programs, foods sold outside national meal programs, school gardens, and school food legislation. Each area contains relevant research, local examples utilized by school districts, and tools to develop strategies and track progress.
Rudd SPARK also identifies key players in schools, school districts, and the community who are essential in building a healthy school food environment.
Report: U.S. Spending Billions of Dollars to Subsidize Junk Food
A new report released in September has found that, among the billions of dollars spent each year in federal subsidies for commodity crops, a steady flow of these taxpayer dollars are going to support high fructose corn syrup and three other common food additives used in junk food. The report, "Apples to Twinkies: Comparing Federal Subsidies of Fresh Produce and Junk Food" by CALPIRG and the U.S. PIRG Education Fund, studies the interesting question of whether the nation's problem with obesity is fueled by farm subsidies.
From 1995 to 2010, $16.9 billion in federal subsidies went to producers and others in the business of corn syrup, high fructose corn syrup, corn starch and soy oils, according to the report.
The findings come as the White House has been rallying to battle childhood obesity, and Congress is poised to potentially either quash or curtail direct farm subsidy payments in the future.
So how much is America spending? Enough for each U.S. taxpayer to buy 19 Twinkies a year, according to the report. In comparison, it said, federal subsidies for fresh produce would cover only a few bites of an apple per taxpayer a year.
One of the more interesting findings: Taxpayers in the San Francisco area spend $2,762,295 each year in junk food subsidies, but only $41,950 each year on apple subsidies. "If these agricultural subsidies went directly to consumers to allow them to purchase food, each of America's 144 million taxpayers would be given $7.36 to spend on junk food and 11 cents with which to buy apples each year –- enough to buy 19 Twinkies but less than a quarter of one Red Delicious apple apiece," CALPIRG officials said in a statement.
CDC Releases Fact Sheet on Strong Nutrition Standards and Financial Implications
The Division of Adolescent and School Health (DASH) at the Centers for Disease Control and Prevention recently released a new fact sheet, "Implementing Strong Nutrition Standards for Schools: Financial Implications," which summarizes the existing evidence of the financial impact on schools that have implemented strong nutrition standards. Implementing nutrition standards can be an effective strategy to improve the nutritional quality of foods offered and purchased in the school setting. One of the primary reasons that state and local education agencies are hesitant to implement strong nutrition standards for competitive foods is that they are concerned about losing the revenue that is generated from selling snacks and beverages to students. However, a key finding presented is that while some schools report an initial decrease in revenue after implementing nutrition standards, a growing body of evidence suggests that schools can have strong nutrition standards and still maintain financial stability.
Study Finds Payment for Pediatric Obesity Services Now Can Save Money Later
Sept. 6, 2011, Newswise
Pediatric obesity ends up costing $3 billion annually in the U.S., but a significant amount of that could be saved by streamlining medical coverage to address health issues affecting young obese patients now rather than waiting to treat conditions they develop as they get older, according UCLA researchers and colleagues.
For morbidly obese children, access to multidisciplinary services can lead to successful outcomes. But because clinicians lack a universal set of guidelines to follow, health insurers and hospitals often evaluate insurance coverage for obesity services on a case-by-case basis. This creates a critical barrier between patients and providers.
In an effort to guide medical providers, patients and payers in better serving obese children and enabling the best health outcomes possible, a UCLA-led work group from the FOCUS on a Fitter Future collaboration of the National Association of Children's Hospitals and Related Institutions, reviewed existing successful programs to evaluate what works best.
They found that stage three comprehensive, multidisciplinary intervention programs should include a health care team with a medical provider, a registered dietitian, a physical activity specialist, a mental health specialist and a coordinator. The team should provide a total of at least 26 to 75 hours of service to overweight and obese children.
While some may argue that up to 75 hours of service is a lot of time, the group determined that the investment of services would be recovered in 6.5 years for the privately insured patient and 3.5 years for the patient insured by Medicaid.
"With pediatric obesity, the focus has been on the related diseases that usually come later, such as diabetes, heart disease and hypertension," said lead author Dr. Wendy Slusser, medical director of the UCLA Fit for Healthy Weight program at Mattel Children's Hospital UCLA. "However, what we see now is that the obese child or adolescent may suffer from gastrointestinal disorders, mental health issues and musculoskeletal problems such as backaches or knee problems. By investing in the health issues of today, we can improve the health conditions of tomorrow and ultimately impact the future costs."
According to the Centers for Disease Control and Prevention, 17 percent of children between the ages of 2 and 19 are now considered overweight or obese — a number that has tripled since 1980. Adolescents who are overweight have a 70 percent chance of becoming overweight or obese adults.
"Why can an obese adolescent get coverage for bariatric surgery to lose weight but not all the services that could help that child avoid surgery in the first place?" asked co-author Dr. Daniel De Ugarte, surgical director of UCLA's Fit for Healthy Weight program. "Scientific evidence supports practice recommendations for the stage 3 level of care, and it is time to address the payment for the delivery of this care."
For the study, researchers interviewed 15 children's hospitals participating in the FOCUS on a Fitter Future collaborative and one non-participating hospital. They used the interview transcripts to identify five financially sustainable stage 3 programs, each funded differently. The programs examined in the study ranged from the newly launched to those operating for more than 20 years. All had multidisciplinary teams delivering services via one of three institutional structures: 60 percent freestanding, 7 percent specialty and 33 percent hospital-within-a-hospital. One-third had one to two funding sources, and 67 percent had three or more.
The authors concluded that the programs they reviewed shared some common strategies for achieving financial stability and followed key strategies of the chronic-care model.
The findings are included as one of eight articles published in a special supplement, "Pediatric Obesity: Practical Applications and Strategies From Primary to Tertiary Care," published in the September issue of Pediatrics, the journal of the American Academy of Pediatrics. The supplement is available online.
The next stage of research will be to collect data for obesity-related conditions and follow changes made after instituting an improved multidisciplinary health care model. Additional authors included Karan Staten of Arkansas Children's Hospital, Karen Stephens of Mercy Hospitals and Clinics, Dr. Lenna Liu of Seattle Children's Hospital, Dr. Christine Yeh of UCLA, Dr. Sarah Armstrong of Duke University, and Dr. Matthew Haemer of Children's Hospital in Aurora, Colo.
The authors have no financial ties to disclose.
Lifetime 'Dose' of Excess Weight Linked to Diabetes Risk
Sept. 12, 2011, HealthDay
It's long been known that obesity increases diabetes risk, but a new study finds that the amount of excess weight someone carries -- and how long it's carried -- can make that risk even higher.
That's especially worrisome given the growing number of obese children and teens who will spend more years of their lives obese than prior generations, researchers from the University of Michigan Health System warn in a university news release.
"Our study finds that the relationship between weight and type 2 diabetes is similar to the relationship between smoking and the risk of lung cancer," said the study's lead author Dr. Joyce Lee, a pediatric endocrinologist at the University of Michigan C.S. Mott Children's Hospital. "The amount of excess weight that you carry, and the number of years for which you carry it, dramatically increase your risk of diabetes."
This has the potential to continue to push up rates of diabetes in the United States, Lee added. "We know that, due to the childhood obesity epidemic, younger generations of Americans are becoming heavier much earlier in life, and are carrying the extra weight for longer periods over their lifetimes," said Lee. "When you add the findings from this study, rates of diabetes in the United States may rise even higher than previously predicted."
Researchers examined information on roughly 8,000 teens and young adults and calculated how far above a certain body mass index (or BMI, a calculation based on weight and height) they were and for how long. The study found those with a BMI of 25 or higher (overweight) or 35 and higher (30 and up is obese) for a greater length of time had a higher risk of diabetes.
For example, individuals with a body mass index of 35 for 10 years were considered to have the equivalent of 100 years of excess BMI -- a considerable cumulative "dose" of excess weight.
What's more, black and Hispanic participants had a higher risk for diabetes than whites with the same amount of excess weight over time, the researchers noted. Among those with a BMI of 35 or more, Hispanics were twice as likely to develop diabetes than whites. Blacks in this group also had a 1.5 times greater risk of developing diabetes than whites. The study's authors said the findings suggest obesity prevention programs should focus on teens and young adults, particularly minorities.
The study was published online ahead of the September print issue of the Archives of Pediatric Adolescent Medicine.
"Hey Bobby Slow Down!" Helicopter Parents Can Impede Child's Ability to Play
Sept. 9, 2011, North Carolina State University News
By Caroline Barnhill
Parental safety concerns may prevent children from getting good exercise, according to a new North Carolina State University study that examined how families use neighborhood parks.
Results from the study suggest that children who were monitored too closely by hovering "helicopter" parents were less likely to engage in higher levels of physical activity. "It's a catch-22 for today's parents, unfortunately. Many parents are worried about the safety of their children, so they tend to hover," says Dr. Jason Bocarro, associate professor of parks, recreation and tourism management at NC State. "The worry is – especially as we are seeing childhood obesity become an epidemic in this country – hovering is keeping kids from running around and playing with their friends and neighbors, and instead maybe sitting in front of the computer or television."
Based on these findings, researchers including Robin Moore, professor of landscape architecture and director of the Natural Learning Initiative at NC State, hope to provide guidance to parks and recreation departments and park designers about ways to better design public parks. "If children's play environments are designed for the whole family with comfortable, shady places to sit and observe kids playing from a distance, parents may be less inclined to 'helicopter' and impede spontaneous play – which can also be increased by providing lots of environmental choice and diversity," Moore says.
The research showed that formal programs and facilities – like soccer programs or basketball courts – increase the likelihood of children ages five and up engaging in a higher level of activity. Also, as any school teacher can tell you, the presence of even one or two children with higher physical activity levels will increase those levels in other kids. The study also found that girls were less likely to be observed in parks, and less likely to be observed in higher levels of physical activity.
A group of 16 trained observers – undergraduate and graduate students from NC State –systematically examined 20 neighborhood parks in Durham, N.C. from 10 a.m. and 7 p.m. for an 8-week period to learn how families use park facilities. While scanning different areas in the park, the researchers counted the children, recorded their gender and apparent age group (0-5, 6-12 and 13-18), and coded their activity level as sedentary, moderately active or vigorously active. Making note of the differences in age gave researchers more sensitive data, since they were able to assess how different areas of the park meet the needs of different age groups.
"We chose to study parks because they have been identified by studies as critical spaces within communities to help children stay active. They are free and accessible and provide an opportunity to engage underserved and lower-income populations, whom data have shown have a higher likelihood of being classified as 'inactive' and obese," Bocarro says. "So are public parks even attracting kids? If not, what things would draw kids in? This research will help us determine what activities and programs we can implement to make our public parks and recreational facilities places where people – especially children – want to spend their free time."
An article describing the research appears in the September issue of the American Journal for Preventive Medicine. Dr. Myron Floyd, professor of parks, recreation and tourism management, served as co-principal investigator of the study and lead author on the paper.
The Robert Wood Johnson Foundation funded the two-year study. Other NC State contributors were Dr. William Smith, associate professor of sociology and anthropology, Dr. Perver Baran, research associate professor of parks, recreation and tourism management, and Dr. Nilda Cosco, research associate professor and education specialist for the Natural Learning Initiative.
Original Source: http://news.ncsu.edu/releases/cb-bocarroplay/
Obese Kids May Face Social, Emotional Woes
Sept. 19, 2011, HealthDay
By Jenifer Goodwin
Obese 8- and 9-year-olds are more likely to suffer socially and emotionally than their normal-weight peers, a new study finds.
In the study, researchers in Australia checked children's BMI, a measure of height and weight, at ages 4 and 5 and then again a few years later. Parents and teachers filled out questionnaires that assessed children's mental health and health-related quality of life.
They found that kids with high BMIs -- meaning they were already either overweight or obese -- at ages 4 and 5 had 15 to 20 percent greater odds of having problems interacting with their peers, as reported by teachers, when they were 8 and 9.
While prior studies have made similar observations about the psychological difficulties faced by obese kids, one question that has vexed researchers is whether obesity leads to social problems, or if it's the other way around -- that emotional and other mental health issues such as depression help spur children to become overweight.
"There have been a number of studies over the past 5 to 10 years looking at whether or not obesity in young children and adolescents is related to emotional, behavioral and mental health problems," noted Dr. Julie Lumeng, an assistant professor in the department of pediatrics and communicable diseases at University of Michigan C.S. Mott Children's Hospital. "There's been a lot of discussion about which direction that relationship goes in -- does obesity cause children to be unhappy, or is it that unhappy children are more likely to become obese? Many people think it goes in both ways."
According to Lumeng, the new research suggests that children's obesity may have helped prompt their unhappiness, perhaps because kids are getting teased or socially ostracized.
The study, which was led by Michael Gifford Sawyer of Women's and Children's Hospital in Adelaide, is published in the October issue of Pediatrics.
In the United States, about 17 percent of children aged 2 to 19 are obese, according to the U.S. Centers for Disease Control and Prevention. That is much higher than the obesity rate in the sample of nearly 3,400 kids in Australia used in the new study. There, only about 4.5 percent of boys and 5.2 percent of girls were obese.
Those differences mean that the effect of obesity on a child's social functioning may be different in the United States than in Australia, Lumeng said.
And despite some difficulties with their peers, obese children were not worse off by other psychological measures, including conduct problems and other mental health issues.
Of course, mental health isn't the only factor to consider in obese kids. Dr. Jeffrey Schwimmer, a pediatric gastroenterologist and an associate professor of pediatrics at the University of California, San Diego, said the physical health risks of obesity in childhood can have lifelong consequences. Those include sleep apnea and fatty liver disease, which can, over time, cause irreversible damage to the liver, diabetes and high blood pressure.
"Obesity at age 5 is a critical time point in life. It's the age at which most children are entering or in kindergarten, and children who are obese entering kindergarten and who remain obese over those first several years of elementary school are the most likely to end up with the health consequences we see," Schwimmer said.
As for poor social treatment of obese kids, it's not just kids, but other adults and even family members, too, who can be cruel, he added.
"If one looks at what childhood is all about, it's about developing both within our families and our peer groups, and learning both in and out of the school environment," Schwimmer said. "Because obesity is associated with impairment in those things, it can have a long-lasting impact. What I believe this research team was capturing was the change in social standing and the interaction with one's peers and teachers in the school environment that has a greater tendency to be impaired for obese children than for healthy-weight children."
Original Source: http://consumer.healthday.com/Article.asp?AID=656965
CHILDHOOD OBESITY NEWS
New Steps to Fight Childhood Obesity Taken By CDC
Sept. 30, 2011, Medical News Today
A new effort to address childhood obesity using successful elements of both primary care and public health was launched September 29 by the Centers for Disease Control and Prevention (CDC). A four-year Childhood Obesity Demonstration Project, supported by $25 million in funding awards made available through the Affordable Care Act, will enable the project to build on existing community efforts and work to identify effective health care and community strategies to support children's healthy eating and active living and help combat childhood obesity.
The project aims to target children between the ages of 2 to 12 years covered by the Children's Health Insurance Program (CHIP).
CHIP provides low cost health insurance to more than 7 million children from working families. Although childhood obesity rates are high overall, those for minority and low-income communities in particular are even higher. Many diseases linked to childhood obesity can be prevented, such as type 2 diabetes, asthma and heart disease.
Childhood obesity can be overcome by using innovative approaches to reach low-income and minority families; these strategies include combining changes in preventive care at doctor visits with supportive changes in schools, child care centers, and community venues such as retail food stores and parks. Community health workers will provide the link between families and resources in their communities. Their task will be to inform and educate those that are hard-to-reach, those with limited English proficiency and minority communities about disease prevention, including obesity, health insurance enrollment opportunities, and disease management.
As a whole, the grantees' work will be based on improvement strategies for children's health behaviors by involving the children themselves, their parents and other family members as well as the communities in which they live.
CDC Director Thomas R. Frieden, MD, MPH stated: "Over the last three decades, obesity rates among children and adolescents have nearly tripled. Obese children are more likely to have asthma, depression, diabetes, and other serious and costly health problems. This project will help figure out ways our children can grow up to lead long, healthy and productive lives."
For identifying effective childhood obesity prevention strategies, the project grantees have included three research facilities at the University of Texas Health Science Center at Houston, the San Diego State University and the Massachusetts State Department of Public Health. Each facility will receive funding of approximately $6.2 million over a four-year period.
The University of Houston, appointed to be the evaluation center, will receive about $4.2 million over the four-year period to determine successful strategies and share lessons and successes.
The CDC will evaluate the findings and provide recommendations for successful strategies at the end of the project in September 2015 in order to prevent obesity among underserved children throughout the United States.
Original Source: http://www.medicalnewstoday.com/articles/235311.php
Attacking the Obesity Epidemic by First Figuring Out Its Cause
Sept. 12, 2011, New York Times
By Jane E. Brody
If you have gained a lot of unwanted pounds at any time during the last 30-odd years, you may be relieved to know that you are probably not to blame. At least not entirely. Many environmental forces, from economic interests of the food and beverage industries to the way our cities and towns are built, have conspired to subvert the body's natural ability to match calories in with calories out.
And the solution to the nation's most pressing health problem — the ever-rising epidemic of overweight and obesity at all ages — lies in the answer to this question: Why did this happen in the first place?
That is the conclusion of an impressive team of experts who spent the last two years examining obesity-promoting forces globally. They recently published their findings online in a series of reports in The Lancet. But as has happened with smoking, it will take many years, a slew of different tactics and the political will to overcome powerful lobbying by culpable industries to turn the problem around and begin to bring the prevalence of overweight and obesity back to the levels of the 1970s.
When I was growing up in the 1940s and '50s, I had to walk or bike many blocks to buy an ice cream cone. There were no vending machines dispensing candy and soda, and no fast-food emporiums or shopping malls with food courts. Nor were we constantly bombarded with televised commercials for prepared foods and drinks laden with calories of fats and sugars.
Yes, we kids had our milk and cookies after school, but then we went out to run around and play until dark. Television watching (through my father's business, my family acquired an early TV with a seven-inch screen) was mostly a weekend family affair, not a nightly ritual with constant noshing.
Most meals were prepared and eaten at home, even when both parents worked (as mine did). Eating out was a special event. "Convenience" foods were canned fruits and vegetables, not frozen lasagna or Tater Tots. A typical breakfast was hot or cold cereal sweetened with raisins or fresh fruit, not a Pop-Tart, jelly doughnut or 500-calorie bagel with 200 calories of cream cheese.
Before a mass exodus to the suburbs left hordes of Americans totally car-dependent, most people lived in cities and towns where feet served as a main means of transportation.
Since 1900, the energy requirements for daily life have decreased substantially with the advent of labor-saving devices and automobiles, yet American weights remained stable until the 1970s. Dr. Boyd A. Swinburn, an obesity researcher at Deakin University in Melbourne, Australia, and his co-authors in one Lancet paper call that decade the "tipping point."
As more women entered the work force, the food industry, noting a growing new market, mass-produced convenience foods with palate appeal. The foods were rich in sugar, salt and fat, substances that humans are evolutionarily programmed to crave.
"Women were spending a lot less time on food preparation, but the industry figured out ways to make food more readily available for everybody," Steven L. Gortmaker [NCCOR member], a sociologist at the Harvard School of Public Health, said in an interview. "The industry made it easier for people to consume more calories throughout the day."
As Dr. Swinburn and his co-authors wrote, "The 1970s saw a striking rise in the quantity of refined carbohydrates and fats in the U.S. food supply, which was paralleled by a sharp increase in the available calories and the onset of the obesity epidemic. Energy intake rose because of environmental push factors, i.e., increasingly available, cheap, tasty, highly promoted obesogenic foods."
During a morning run in Ohio some years ago, I passed five fast-food and family restaurants in one long block, including one that advertised a "Texas-size breakfast" of three scrambled eggs, two fried potato cakes, a buttered croissant and a choice of three sausage links, three ounces of ham or four strips of bacon — enough to produce a Texas-size heart attack, and for $1.99. Americans are not known for resisting such temptations, especially if money is tight.
The Lancet authors reported that to bring the weights of Americans back to 1978 levels, steep reductions in caloric intake are needed: about 240 calories a day less for the average person and double that amount for obese adults, whose body mass index is 35 or higher.
'Systems Approach' Needed
Several coordinated, complementary policies are needed to turn the epidemic around, Dr. Gortmaker and his co-authors wrote in one report. He pointed out that four interventions worked together to drive smoking rates down to 20 percent from 40 percent.
First, tobacco advertising was banned from television. Then tobacco taxes were increased, the nicotine patch became available and smoking was banned in more and more public places.
Just as the decline in smoking did not happen overnight, a reduction in the rates of overweight and obesity will take a while, Dr. Gortmaker said. He emphasized the importance of taking action immediately, before the increase in life expectancy that Americans have enjoyed is reversed by obesity-caused diseases.
He and his co-authors listed three of the most cost-saving and health-saving measures: a 10 percent tax on unhealthy foods and drinks (like sugar-sweetened beverages, a proposal defeated in New York State by industry pressure); more obvious nutrition labeling of packaged foods, like a red, yellow or green traffic light on package fronts; and reduced advertising of "junk foods and beverages to children."
"Marketing of food and beverages is associated with increasing obesity rates and is especially effective among children," they wrote. Dr. Gortmaker pointed out that "very few children are born obese," but most American children grow up in an obesogenic environment. For those who become obese by age 10 or 11, he and his co-authors said, family-based programs are needed to keep overweight from carrying over into adulthood. (In Scotland recently, authorities went so far as to remove two children from a family that had failed to control the youngsters' girth.)
"Children aged 2 to 19 consume seven trillion calories of sugar-sweetened beverages a year. It's a $24 billion industry just for kids alone," Dr. Gortmaker said.
He called a tax on sugared drinks a "no-brainer," noting that it could raise billions of dollars a year for cash-starved states. California, for example, could bring in $1.5 billion a year with a 1-cent-per-ounce excise tax on sugar-sweetened drinks, he said.
But Dr. Gortmaker and his co-authors noted, "Almost all food policies recommended as priority actions, including front-of-pack traffic light labeling, have been heavily contested by the food industry." Although there has been some reduction in unhealthy food advertisements on children's television, the decline has been minimal.
Also needed — and less controversial — are school-based programs to encourage healthier eating and exercise habits and to reduce television watching, the authors said. Schools that introduce healthful foods in the classroom have shown that they are more likely to be eaten in the lunchroom and at home.
Of course, the rising overweight and obesity rate is not just an American problem. The effect is being seen globally, even in low- and middle-income countries. This month the United Nations General Assembly will focus on noncommunicable diseases, with the "wicked problem" (as Brian Head, a social scientist at the University of Queensland in Australia, put it) of the global obesity epidemic.
Editor's Note: The principle investigators of the research appearing in The Lancet are members of NCCOR's COMNet (Collaborative Obesity Modeling Network) modeling teams.
Data Is Power: Michigan Fights Childhood Obesity by Tracking It
Sept. 14, 2011, ABC News
By Courtney Hutchison
In an attempt to combat Michigan's childhood obesity epidemic, Gov. Rick Snyder announced on September 14 that the state would begin tracking kids' body mass index through the Michigan Care Improvement Registry. Although the policy would be one of the most extensive government anti-childhood obesity efforts, pediatricians were divided over whether it would have the desired impact.
The tracking system would encourage pediatricians to calculate patients' BMI using height and weight measurements, and report these numbers to the state through the existing immunization tracking system, the Michigan Care Improvement Registry. The numbers would be reported anonymously, meaning that the child's identity would not be connected to his or her BMI in state records.
The hope is that having doctors track height and weight in this way would encourage more discussion among parents, kids and doctors about the dangers of being overweight, says Geralyn Lasher, director of communications at the Executive Office of the Governor.
The new policy does not require that doctors discuss obesity with kids and parents, nor does it provide physicians with the extra time or training needed to discuss weight problems -- a narrowness of focus that some doctors believes will limit the policy's effectiveness.
"Merely tracking and reporting BMI may encourage some doctors to do more to help their overweight patients, but it is far from enough," says Dr. Christina Scirica, director of the Pediatric Fitness Collaborative at Massachusetts General Hospital in Boston. "At the current time, many pediatricians feel ill-equipped to address obesity even after it has been identified," she says.
Others questioned the policy's use of BMI, an obesity metric some pediatricians call oversimplified and misleading, especially in children.
"BMI is a very poor tracking mechanism for a child, because it doesn't look at body fat. It looks at height and weight," says Dr. Dan Cooper, a chairman of the pediatrics department at the University of California at Irvine. "Take a high school football player who's 6 feet 1, and mostly muscle and someone who is 6 feet 1 and 30 percent fat, and they will have the same BMI," he says.
Cooper worries that discussing obesity in terms of BMI with parents and kids will be misleading, as tracking BMI does not reflect positive changes overweight kids can make in their activity level.
"If you have a kid in a fitness program who starts putting on muscle, his BMI may not change, but he is getting much healthier. I encourage discussion about weight and health, but you don't do it through mandating phony endpoints. This is just going to be a lot of money and bureaucracy. It won't' solve the problem," he says.
But Keith Ayoob, director of the Rose R. Kennedy Nutrition Clinic at Albert Einstein College of Medicine, defended the use of BMI, saying that while it's not a perfect measure, it's the "best we've got" for measuring obesity on a population.
The Michigan chapter of the American Academy of Pediatrics expressed it's support of the policy in a hearing earlier this week, according to executive director of the chapter, Denise Sloan.
Reporting Weight to the State
While Michigan's BMI tracking system will most likely become only an entry point for further discussion and intervention in cases of obesity, any pediatricians still believe it's worth the effort.
In Michigan, 12.4 percent of individuals under 18 are obese, and that rate rises to 31.7 percent among adult Michiganders. As many as two-thirds of adults in the state are overweight, if not obese, making Michigan the eighth fattest state in the nation.
Data Is Power?
"It is absolutely essential that pediatricians track BMI in their patients," Scirica says. "Obesity in childhood is highly predictive of obesity later in life, and the longer a child remains overweight and the more overweight they become, the harder it becomes to achieve a healthy weight."
Encouraging a regular conversation between pediatrician and parent about a child's weight is so important, Scirica says, because "some parents are simply not aware that their child is overweight or obese. Even among parents who do recognize that their child is overweight, there is a tendency to underestimate just how overweight their child is ... and underestimate the long-term health and other risks associated with their child's excess weight."
Childhood obesity is "arguably the No. 1 pediatric health problem," says Ayoob, "so if reporting on BMI -- something doctors should already be tracking on their own -- allows for documentation of a worsening or improvement, this could also help influence future policy."
Public Schools Face the Rising Costs of Serving Lunch
Sept. 19, 2011, New York Times
By Fernanda Santos
The federal government is making school meals more nutritious this year, but also more expensive.
Under a little-noticed provision of the child nutrition bill signed by President Obama in December, which brought more fresh produce and less whole milk to cafeterias nationwide, school districts are required to start bringing their prices in line with what it costs to prepare the meals, eventually charging an average of $2.46 for the lunches they serve.
Though the law suggests that prices go up by a maximum of 10 cents a year, the town of Seymour, Conn., raised its prices by 25 cents, after years without increases; the new prices, $2.25 a day for elementary school pupils, $2.50 for middle-school students and $2.75 for high school students — are listed on the district's Web site, just under the words, "Welcome Back to School!" In Suffolk County, on Long Island, the president of the Board of Education at the Riverhead Central School District — which also raised prices by a quarter a day, or 12.5 percent for most students — said that parents had cornered her and other officials at supermarkets, gas stations and before meetings, questioning the increase.
"All we could tell them was we really had no choice," said the president, Ann Cotten-DeGrasse. Officials are already bracing for a backlash as the increases pile up.
"Our parents haven't complained, but I don't know if they'll be as understanding if we do it again next year, and the year after, and then the year after that," said Louise D'Angelo, director of food services at the North Syracuse Central School District in upstate New York, where lunch prices just went up by 25 cents across all grades — to $1.75 in elementary school, $2 in middle school and $2.25 in high school.
The new pricing requirement, which comes amid school budget cuts and a lingering recession, is the first time the federal government has gotten into the business of cafeteria prices since its school lunch program was established in 1946. Under the roughly $10 billion program, families with incomes up to 130 percent of the poverty level— $28,665 a year for a family of four — are eligible for free meals. Those that earn 130 percent to 185 percent of poverty level, or $40,793 for a family of four, qualify for reduced-price meals.
The federal government reimburses districts $2.72 for free meals, $2.32 for reduced-price meals and 26 cents for the rest. Generally, this money is combined with proceeds from the sale of meals and snacks into a single pot. But there is a wide range of what districts charge paying customers: in Fairfax County, Va., lunch costs $2.65 in elementary school and $2.75 in middle and high schools, while in Austin, Tex., it is $2.15 and $2.50, respectively. Other districts have kept prices far lower than costs — in New York City, for example, there is a $1.10 gap — to make lunch affordable.
A study published last year by the Center on Budget and Policy Priorities, a research organization in Washington, argued that this arrangement "appears to be subsidizing meals for children whose families are much better off" than the children for whom the reimbursements are meant. It urged a gradual rise in lunch prices to prevent federal money from being "siphoned off to keep prices low for paid meals." Congress heeded the suggestion, tying an increase of 6 cents in the reimbursement rates, the first in 30 years, to the mandate for increased meal prices in the child nutrition bill.
Based on a convoluted formula that takes into account inflation and the average price of meals sold in schools, certain districts — like New York City, where lunch is sold for $1.50 — did not have to raise prices this year. But next year, it could be different, unless the districts decide to use their own money to subsidize lunches.
The mandatory increases in meal prices are "a recognition that over time, the money coming in to schools from the sale of paid meals has not kept pace with the cost of preparing those meals," said Kevin Concannon, under secretary for food, nutrition and consumer services at the Department of Agriculture, which oversees the school meal program. "The consideration here is the transition and giving school districts time to make the adjustments that they need to serve healthier meals to all our kids."
But Eric Goldstein, who oversees the New York City schools' food program, said the law "misses the point." Price increases threaten to upend the delicate balance of school food operations, Mr. Goldstein said, as they might compel more parents to pack their children's lunches or to skip on paying cafeteria lunch fees altogether — already a huge problem, with the city absorbing $42 million in unpaid fees since 2004.
Mr. Concannon, of the Agriculture Department, said the bill "seeks to ensure that the level of support for all school meals is equal." Mr. Goldstein said the goal was "unrealistic."
"We want to serve the same food for everyone, in the same cafeteria, to have everyone eating together," Mr. Goldstein said. "It shouldn't be that we have to say, this is for this child, and this is for that child, and here's money to pay for this and here's money for that."
Then, there is the financial burden that higher meal prices would carry for families whose income lies just above the cutoff line for reduced-price lunches, for which schools can charge no more than 40 cents. (They cost 25 cents in New York City.)
"We could be shooting ourselves in the foot here if we're not setting prices at a level that parents are able or willing to pay," said Diane Pratt-Heavner, a spokeswoman for the School Nutrition Association, which represents cafeteria administrators.
Cindy Brooks, the food service director in Seymour, a 2,500-student district northwest of New Haven, said she had been closely monitoring the sales of paid meals, which provide the bulk of her revenues, since the 25-cent price increase went into effect.
"I'm worried," Ms. Brooks said. "A lot of our families are struggling to make ends meet."
And in North Syracuse, Ms. D'Angelo said the entire pricing structure was out of balance. After labor costs, she said, she is left with 15 cents per lunch to buy ingredients, repair equipment and equip cafeterias.
"The federal government knows this is not enough to pay for the food we make," she said.
Original Source: http://www.nytimes.com/2011/09/20/education/20lunch.html?_r=1
Boston Launches Ad Campaign against Sugary Beverages
Sept. 07, 2011, Boston Globe
By Kay Lazar
The teen, perspiration dripping from his brow, longingly eyes a cool orange soda in the clutches of a young woman. He then strides into a store, buys himself one, eagerly twists off the cap and, just as he is about to gulp, a glowing yellow glob soars through the air and smacks him on the head.
"Don't get smacked by fat,'' intones a voice on a commercial. "Calories from sugary beverages like soda, sweet tea, and sports drinks can cause obesity and type 2 diabetes."
Hoping to blunt the pervasive reach of sugary drinks, Mayor Thomas M. Menino of Boston and public health authorities unveiled a public awareness campaign on September 6 that urges residents to reduce consumption of sweetened beverages, which public health specialists link to rising obesity rates and higher health care costs.
The campaign, which will include a media blitz, premieres a month before an executive order by Menino phases out the sale, advertising, and promotion of sugar-sweetened beverages in all city buildings.
"We are in the midst of a health crisis in the city of Boston," Menino said at a City Hall press conference yesterday. "Forty percent of the kids in Boston public schools are overweight or obese."
The $1 million federally funded campaign will blanket Boston with TV, radio, MBTA, Web, print, and billboard advertisements. The program will focus on black and Latino neighborhoods, including Dorchester, Roxbury, and Mattapan, where obesity rates are much higher, officials said. Some of the ads will be in Spanish, and the campaign will air on TV and urban hip-hop radio stations. The ads will run for about six weeks.
About 63 percent of black and 51 percent of Latino adults in Boston are considered overweight or obese, compared with 49 percent of white adults, according to the Boston Public Health Commission.
The media campaign is aimed at two age groups - parents who do the bulk of the household grocery shopping, and teens and young adults who consume more soda, energy drinks, and other sugary beverages than other age groups, according to a US government nutrition study.
The ads addressing parents show children rollerblading with helmets and protective pads, or strapped into a car seat. Near them is a stash of empty cola bottles.
"You do so much to protect them. But maybe you never realized how much these could hurt them,'' the ad states. "After all, your kids are sweet enough already."
The other ads, including the "Don't get smacked by fat" spot, were developed by teens who worked with the Public Health Commission.
Brandon DaGraca, a 16-year-old Boston Arts Academy junior and member of the youth council working on the antisugar campaign, said many young people do not understand how insidious sugar is.