E-Newsletter
December 2013


SPOTLIGHT

PUBLICATIONS AND TOOLS

RESEARCH HIGHLIGHTS

CHILDHOOD OBESITY NEWS


SPOTLIGHT

NCCOR-sponsored mobile health boot camp helps generate innovative ways to combat childhood obesity

Dec. 4, 2013, NCCOR

Watches that track children’s physical activity and mobile applications that monitor a kid’s diet are just a few of the ideas for innovative, obesity-prevention technologies generated from a workshop co-sponsored by the National Collaborative on Childhood Obesity Research (NCCOR) on mobile health and pediatric obesity.

The pre-conference workshop, a collaboration between NCCOR and The Obesity Society (TOS), was held in November at ObesityWeek, a conference that combines both TOS and the American Society for Metabolic and Bariatric Surgery annual meetings. The workshop was designed to orient the research and practice communities to mobile health (mHealth) technology and research and discussed how to incorporate mHealth technology into their work to achieve greater reach and enhance the treatment and prevention of obesity. Nearly 100 early-career childhood obesity researchers, program evaluators, and medical professionals participated in the event.

Throughout the day participants heard from experts within the field who discussed mHealth methodologies, novel approaches on analyzing data, and how mHealth technologies can enhance the effectiveness and reach of obesity interventions.

Participants also split into small groups and designed an intervention to address obesity in schools through a social ecological perspective, allowing groups to choose their approach. For instance, some groups chose students as the primary change agent, creating programs directed at increasing their physical activity and improving diets. Others focused primarily on system and policy change, aiming interventions at the schools and school districts.

Following each presentation, groups were allotted 45 minutes to work on developing their interventions while incorporating the new information and scenarios presented. The final discussion, led by NCCOR member Dr. Heather Patrick, introduced NCCOR tools and resources, including the Measures Registry, Catalogue of Surveillance Systems and the HEI infographic series. Patrick challenged the groups to choose one of these resources to incorporate into their interventions by: presenting ways in which these resources could be improved to be more mHealth friendly; identifying new resources NCCOR should consider including on their website; or proposing new resources NCCOR should consider developing that could enhance their intervention or current work within the field.

At the conclusion of the workshop, each group presented their interventions, talking specifically about the innovative technology they developed and NCCOR resources. Many creative ideas were presented, including using mobile games and sensors to track children’s physical activity and diet. From participants’ reactions to the NCCOR resources, Patrick and other NCCOR members gathered useful feedback on usability and ideas for new resources to consider developing.

Overall, participants spoke enthusiastically about the workshop, expressing their eagerness to take these resources and new techniques back to their current work within the field. The innovative ways in which the groups incorporated mHealth technology into their interventions provoked great discussion. Specifically, participants spoke about interest in approaching potential funders with these ideas, and looking for new, unique, transdisciplinary collaborations to create effective, evidence based interventions utilizing mHealth technology to have greater reach.

Both NCCOR and TOS were extremely satisfied with the result of the workshop. The experience provided a great example of a unique partnership between NCCOR and an annual conference creating a tailored educational experience for conference attendees.

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PUBLICATIONS AND TOOLS

Fast food still has a long way to go to promote healthy options

In 2010, researchers at the Yale Rudd Center for Food Policy & Obesity issued “Fast Food FACTS.” The report examined the nutritional quality of fast food menus, advertising on TV and the internet, and marketing practices inside restaurants.

Since 2010, fast food restaurants have introduced healthier kids’ meal options and regular menu items. At the same time, they have introduced high-calorie, nutritionally poor menu items, often supported by sophisticated marketing campaigns.

Objective and transparent data are necessary to evaluate restaurants’ progress in addressing the harmful effects of fast food consumption on the diets of young people. Three years after the first report — using the same methods as the original “Fast Food FACTS” — this report quantifies changes in the nutritional quality of fast food and how it is marketed to children and teens.

READ THE REPORT

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For obese teen girls, aerobic exercise may trump resistance training in health benefits

Although diet and exercise have both been considered as first lines to treat childhood obesity, SoJung Lee of the Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, and her colleagues recently showed that when obese adolescent boys increased physical activity alone, they improved several markers of health. These include reducing total fat, fat packed around organs in the abdomen (known as visceral fat, a risk factor for diabetes), and liver fat, and improving fitness of their heart and lungs.

To see if physical activity might work in the same way for obese adolescent girls, Lee and her colleagues performed a new study that compared the health effects of two different types of exercise—aerobic exercise and weight lifting—over three months to remaining sedentary. Although their results show beneficial effects for both types of exercise, the researchers found that girls who performed aerobic exercise, but not weight lifting, had significant reductions in visceral fat and liver fat, as well as improvements in insulin sensitivity, another risk factor for diabetes that's linked with obesity.

READ THE FULL ARTICLE

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Public agrees on obesity’s impact, not government’s role

Most Americans (69 percent) see obesity as a very serious public health problem, substantially more than the percentages viewing alcohol abuse, cigarette smoking and AIDS in the same terms. In addition, a broad majority believes that obesity is not just a problem that affects individuals: 63 percent say obesity has consequences for society beyond the personal impact on individuals. Just 31 percent say it impacts the individuals who are obese but not society more broadly.

Yet, the public has mixed opinions about what, if anything, the government should do about the issue. A 54 percent majority does not want the government to play a significant role in reducing obesity, while 42 percent say the government should play a significant role. And while some proposals for reducing obesity draw broad support, others are decidedly unpopular.

The new national survey by the Pew Research Center, conducted Oct. 30, 2013-Nov. 6, 2013 among 2,003 adults, finds that two-thirds (67 percent) favor requiring chain restaurants to list calorie counts on menus. But just 31 percent support limits on the size of sugary soft drinks in restaurants and convenience stores – 67 percent oppose this idea. More than half (55 percent) favor banning TV ads of unhealthy foods during children’s programming, but barely a third (35 percent) supports raising taxes on sugary soft drinks and unhealthy foods. On each of these policies, Democrats and women are more supportive than Republicans, independents, and men.

READ THE REPORT

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RESEARCH HIGHLIGHTS

Schools help kids choose carrots over candy bars

Nov. 13, 2013, Medical Xpress

When schools adopt healthful nutrition policies and practices, kids' diets improve.

According to new research led by Michigan State University (MSU) and published in the current issue of Childhood Obesity, when schools offered snacks in lunchtime a la carte or vending that were mostly or entirely healthful, students responded with improvements in their diets, said Katherine Alaimo, MSU associate professor of food, science, and human nutrition.

"When healthful food options are offered, students will select them, eat them, and improve their diet," she said. "Our study shows that schools can make the kinds of changes required by the forthcoming U.S. Department of Agriculture (USDA) guidelines, and these changes can have a positive impact on children's nutrition."

The USDA will ask schools to implement its Smart Snacks nutrition standards on July 1, 2014. Those recommendations will set limits on calories, salt, sugar, and fat in foods and beverages, as well as promote snack foods with more whole grains, low-fat dairy, fruits, and vegetables.

Alaimo and her team of researchers tested standards similar to the USDA's new requirements and demonstrated that Smart Snacks has the potential to improve students' eating habits.

For example, schools that started healthful snacks in lunchtime a la carte or vending programs boosted their students' overall daily consumption of fruit by 26 percent, vegetables by 14 percent and whole grains by 30 percent. Students also increased their consumption of fiber, calcium, and vitamins A and C.

For the study, researchers also compared schools that adopted a variety of nutrition programs and policies. Some schools made only limited changes, while others implemented more comprehensive programs to assess and improve the school's nutrition environment. Changes schools made included raising nutrition standards for snacks and beverages, offering taste tests of healthful foods and beverages to students, marketing healthful foods in school, and removing advertisements of unhealthful foods. When schools implemented three or more new nutrition practices or policies, students' overall diets improved.

"Creating school environments where the healthy choice is the easy choice allows students to practice lessons learned in the classroom and form good habits at an early age, laying a foundation for a healthy future," said Shannon Carney Oleksyk, contributing author and healthy living adviser for Blue Cross Blue Shield of Michigan.

What made the study unique, in part, was that the researchers measured students' overall diets, not just what they ate in school.

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Original source: http://medicalxpress.com/news/2013-11-schools-kids-carrots-candy-bars.html

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New study paints grim health picture for obese teens

Nov. 18, 2013, U.S. News & World Report

Severely obese teens are at increased risk for a host of serious health problems as adults, including asthma, kidney disease, and sleep disorders, according to a new study.

"Most people understand that the longer you carry extra weight, the higher your chances of developing heart disease or diabetes," said study author Dr. Thomas Inge, professor of surgery and pediatrics at Cincinnati Children's Hospital Medical Center, in Ohio. "But now it seems that an even larger number of conditions should be added to the list of health problems that some obese teenagers will likely face down the road."

The study, published online Nov. 18 in the journal Pediatrics, included more than 1,500 severely obese American adults, aged 19 to 76. All were about to undergo weight-loss surgery. They were asked about their weight at age 18 and then assessed for medical problems related to obesity.

Forty-two percent of the participants were normal weight at age 18, the researchers found. But 29 percent were obese at age 18, including 13 percent who were severely obese. Ninety-six percent of the participants had at least one obesity-related health condition. Severe obesity was defined as a body mass index (BMI) of 35 or greater – 220 pounds or more for an average-height woman. BMI is a calculation of body fat based on height and weight.

The researchers found that participants who were severely obese as teens had a greatly increased risk of serious health problems compared to those who were normal weight as teens.

They were four times more likely to have swollen legs with skin ulcers; more than three times more likely to have severe walking limitations and abnormal kidney function; and much more likely to have asthma, diabetes, obstructive sleep apnea and polycystic ovary syndrome, a condition that can cause cysts on a woman's ovaries. "As the number of children with severe obesity continues to increase, it is important for pediatricians to inform families about the short- and long-term health issues linked to this weight gain," Inge said in a medical center news release.

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Original source: http://health.usnews.com/health-news/news/articles/2013/11/18/new-study-paints-grim-health-picture-for-obese-teens  

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Study: Target empty calories in kids' diets at the source

Nov. 20, 2013, Reuters

By Kathryn Doyle

About one-third of the calories kids eat at school, at fast food restaurants, and from grocery stores are "empty calories" that should be targeted for reduction, according to a new study.

"Although fast foods are generally recognized as less healthful, our study found that foods consumed by U.S. children from grocery stores and schools were similar in empty calorie content to fast foods," author Jennifer M. Poti said.

Poti is a doctoral candidate in nutritional epidemiology at the University of North Carolina at Chapel Hill.

The 2010 Dietary Guidelines for Americans recommend for kids and adults that between 8 and 19 percent of their daily calories, maximum, should be "empty," that is, coming from added sugar or solid fat. Solid fats include those solid at room temperature, including butter, meat fats, and hydrogenated oils. Added sugars are incorporated during food processing, preparation, or at the table but do not include the natural sugars in fruit or milk, Poti said.

These fats and sugars add lots of calories but few nutrients to food. Getting too many empty calories can lead to weight gain and obesity, she said.

The new study, which analyzed data from a 2010 nationwide survey covering more than 3,000 kids ages 2 to 18 years old, looked at the calories consumed from three primary food sources: grocery or convenience stores, schools and fast food restaurants.

At each location, about a third of the children's average calorie intake was "empty calories."

In food purchased from stores, 33 percent of calories were from fats and added sugars. In food from fast-food restaurants, it was 35 percent, and school-bought foods were 32 percent empty calories.

Kids tended to get most of their food from stores, so that location provided the highest total empty calories — an average of 436 calories daily — according to the results published in the Journal of the Academy of Nutrition and Dietetics.

Sugary drinks and grain-based desserts like cakes were big empty calorie sources at each of the locations. Whole or two percent milk was also a common source from stores and at school.

The study also pointed the finger at pizza from schools and pizza and French fries from restaurants as major contributors to daily totals for empty calories.

Store-bought foods tended to have more sugar and less fat, whereas the reverse was true for fast foods. School food fell in the middle on both counts.

"Our study found that 20 percent of pizza and 22 percent of high-fat milk consumed by kids are provided by schools, and 72 percent of sugar-sweetened beverages like sodas, fruit drinks, sports drinks, and energy drinks consumed by kids are obtained from grocery stores," Poti said.

Efforts to improve kids' diets should be aimed at all three locations, she said. Since the top empty-calorie food sources were different at the three locations, strategies to reduce empty calories may need to vary by location, she said.

"The data analyzed in our study was collected before implementation of the new nutrition standards for the National School Lunch and Breakfast Programs, established by the Healthy, Hunger-Free Kids Act of 2010," Poti said.

These results could be an important baseline for gauging how effective more recent changes have been, she said.

"The new U.S. Department of Agriculture lunch rules that went into effect last year require only lower-fat milks, and proposed standards for vending machines and other venues also require lower-fat milks, but those standards have not yet gone into effect," said Lindsey Turner, a health psychologist and research scientist at the Institute for Health Research and Policy at the University of Illinois at Chicago.

"In our Bridging the Gap research studies of K-12 schools nationwide, we found that even just two years ago, many schools offered higher-fat milks at lunch," said Turner, who was not involved in the new study, but has conducted similar research in schools. Pizza is available most days or every day in most high schools, she said.

"It will be essential to keep tracking whether schools are implementing the new nutrition standards and removing unnecessary sources of sugar and fat that contribute to empty calories for children and adolescents," she said.

Current guidelines don't require added sugar or solid fats to be indicated on nutrition facts panels for packaged foods. But parents can keep track of saturated and trans fats, which are the main types of solid fats, and total sugar levels which are included on labels, Poti said.

The recent Food and Drug Administration ruling that trans fats are no longer "generally recognized as safe" could help to reduce children's empty calorie intake if trans fats are removed and not replaced with other solid fats, she said.

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Original source: http://www.reuters.com/article/2013/11/20/us-calories-kids-idUSBRE9AJ1A420131120

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What preschoolers know about healthy eating

Nov. 12, 2013, Michigan News

By Chris Weller

When you hand a preschooler a donut, does she know it's junk food? The answer is yes, says University of Michigan researcher Kristen Harrison.

Harrison, professor of communication studies and faculty associate at the U-M Institute for Social Research, studies predictors of early-childhood obesity by investigating the impact of family TV exposure on what preschoolers eat and what these young kids think about healthy eating. She believes the information may help predict the kinds of decisions preschoolers make about food as they grow older.

She says that doing research on 3- and 4-year-olds can be challenging, since kids that age can't necessarily verbalize what they're thinking or what they know. Her solution? The Placemat Protocol.

Harrison created a giant plastic placemat with six pie-shaped sections, each labeled with a different food group, such as beverages or milk and dairy. Preschoolers are asked to assemble a meal they would most like to eat if they could eat anything by placing plastic toy foods—three healthy and three "junky"—in each of the different food sections on the placemat. The kids are then be asked to put together a healthy meal.

Harrison and colleague Mericarmen Peralta conducted the Placemat Protocol with 250 children at 18 preschools in Washtenaw, Wayne and Jackson counties over a two-year period. They asked them questions about food brand recognition and obtained body mass index measurements. They also interviewed parents about family characteristics, including how much commercial television the family watches and what their child eats.

They found that preschoolers who watched more TV were more likely to eat foods that could lead to obesity and more likely to assemble meals consisting of junk food.

The results are important, Harrison says, not only because they show that TV ads are giving kids the wrong idea about what foods are healthy, but also because kids who eat too much junk food at an early age and put on extra pounds are more likely to grow up obese.

"The next step, of course, would be to see if those perceptions in preschool actually predict their food choice behaviors over time," Harrison said. "Because when it comes to obesity, prevention is where it's at. Parents are struggling with their own situations—they're constrained by family circumstances. But if you can get the kids to make choices that in the long run are going to benefit them, that's the way to go."

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Original source: http://www.ns.umich.edu/new/releases/21822-what-preschoolers-know-about-healthy-eating

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CHILDHOOD OBESITY NEWS

Too much of too little

Nov. 9, 2013, The Washington Post

By Eli Saslow

They were already running late for a doctor’s appointment, but first the Salas family hurried into their kitchen for another breakfast paid for by the federal government. The 4-year-old grabbed a bag of cheddar-flavored potato chips and a granola bar. The 9-year-old filled a bowl with sugary cereal and then gulped down chocolate milk. Their mother, Blanca, arrived at the refrigerator and reached into the drawer where she stored the insulin needed to treat her diabetes. She filled a needle with fluid and injected it into her stomach with a practiced jab.

“Let’s go,” she told the children, rushing them out of the kitchen and into the car. “We can stop for snacks on our way home.” The family checkup had been scheduled at the insistence of a school nurse, who wanted the Salas family to address two concerns: They were suffering from both a shortage of nutritious food and a diet of excess — paradoxical problems that have become increasingly interconnected in the United States, and especially in South Texas.

For almost a decade, Blanca had supported her five children by stretching $430 in monthly food stamp benefits, adding lard to thicken her refried beans and buying instant soup by the case at a nearby dollar store. She shopped for “quantity over quality,” she said, aiming to fill a grocery cart for $100 or less.

But the cheap foods she could afford on the standard government allotment of about $1.50 per meal also tended to be among the least nutritious — heavy in preservatives, fats, salt, and refined sugar. Now Clarissa, her daughter aged 13 years, had a darkening ring around her neck that suggested early-onset diabetes from too much sugar. Now Antonio, age 9, was sharing dosages of his mother’s cholesterol medication. Now Blanca herself was too sick to work, receiving disability payments at age 40 and testing her blood-sugar level twice each day to guard against the stroke doctors warned was forthcoming as a result of her diet.

She drove toward the doctor’s office on the two-lane highways of South Texas, the flat horizon of brown dirt interrupted by palm trees and an occasional view of the steel fence that divides the United States from Mexico. Blanca’s parents emigrated from Mexico in the 1950s to pick strawberries and cherries, and they often repeated an aphorism about the border fence. “On one side you’re skinny. On the other you’re fat,” they said. Now millions more had crossed through the fence, both legally and illegally, making Hidalgo County one of the fastest-growing places in America.

“El Futuro” is what some residents had begun calling the area, and here the future was unfolding in a cycle of cascading extremes: Hidalgo County has one of the highest poverty rates in the nation . . . which has led almost 40 percent of residents to enroll in the food-stamp program . . . which means a widespread reliance on cheap, processed foods . . . which results in rates of diabetes and obesity that double the national average . . . which fuels the country’s highest per-capita spending on health care.

This is what El Futuro looks like in the Rio Grande Valley: The country’s hungriest region is also its most overweight, with 38.5 percent of the people obese. For one of the first times anywhere in the United States, children in South Texas have a projected life span that is a few years shorter than that of their parents.

It is a crisis at the heart of the Washington debate over food stamps, which now help support nearly one in seven Americans. Has the massive growth of a government feeding program solved a problem, or created one? Is it enough for the government to help people buy food, or should it go further by also telling them what to eat?

Blanca walked her children into the doctor’s office in the sprawling town of McAllen and they took turns stepping onto the scale: 110 pounds. Seventy-eight. Fifty-five. “Not perfect, but not so bad,” the doctor said. Then a nurse handed him the children’s blood work — a series of alarming numbers that lately read more like averages in this part of Texas. Clarissa needed to watch her sugar, he said. Antonio needed to increase the dosage of his cholesterol medication. “Can I still eat hot Cheetos?” Antonio asked. “Just one bag a day?” “Not anymore,” the doctor said.

“One a week?”

“No.”

The doctor set down his chart and turned to face Blanca. He had 17 more appointments on his schedule for the day — 17 more conversations like this one. The waiting room was filled with the children of Hidalgo County, 40 percent of them experiencing severe hunger at least once each month and 32 percent of them obese. His challenge was the same one that preoccupied so many in the Rio Grande Valley: How could families who had so little find ways to consume less?

“Either you address this now or it will be too late,” he told Blanca. “I can give you medicine, but that’s not the permanent solution.”

Off the menu

There was a time when Terry Canales thought he knew the solution, and that solution could be accomplished through politics.

Canales, a 33-year-old Texas state representative, grew up outside McAllen, surrounded by the poverty and obesity he called “the double deaths” of Hidalgo County. He had waited in line at the area’s ubiquitous drive-through convenience stores and watched people use their government Lone Star cards to purchase some of South Texas’s most popular snacks, paying $1 for hot Cheetos smothered with cheese or $2 for a Mexican snow cone covered with gummy bears and chili powder. He had seen children use food stamps to buy Red Bull energy drinks by the case, and he had seen some of those same children waiting in line at the medical clinic near his house where 28 people had diabetes diagnosed every day.

“We are slowly killing ourselves,” he concluded.

So, he took time off from his law practice in 2012 to run for office, spending $500,000 of his own money to win a job that pays $600 a month. He left his wife and three young children at home to spend each week at the Capitol in Austin, where he became one of several lawmakers across the country working to change what people can buy with food stamps.

Minnesota wanted to ban candy, New York City hoped to eliminate soft drinks, and South Carolina wanted to rule out cookies and cakes. As a model, they heralded the U.S. Department of Agriculture’s (USDA) own WIC program, which subsidizes the purchases of only a few hundred essential foods such as milk, cheese, and baby formula for young mothers and children under age 5. But no state had yet persuaded the USDA, which prohibits using food stamps only to buy tobacco and alcohol, so Canales decided to start smallest of all.

Instead of trying to regulate the estimated $2 billion in junk-food purchases enabled each year by food stamps, he wrote a bill to ban the food-stamp purchase of only one product. That was energy drinks — high in caffeine and higher in sugar, expensive, and marketed to children despite offering little nutritional value.

“A no-brainer,” he explained as he introduced the bill in a committee meeting last summer.

Then he yielded the microphone and waited for rebuttals. The first critic was one he had anticipated, a lobbyist for the Texas Beverage Association, which desperately wanted all of its drinks available for sale to the fastest-growing market in America: the food-stamp market, which has quadrupled from $20 billion to $80 billion in the past 12 years. Companies such as Coca-Cola, Kraft, and Mars have spent more than $10 million in the past several years lobbying Congress to keep their products available to those using food stamps. “No clear standards exist for defining foods as good or bad,” the lobbyist said. But next came a litany of speakers Canales hadn’t expected. They were Democrats who shared his ideals and equaled his devotion in the fight against poverty. At previous committee meetings on his other bills, many of them had lined up to speak on his behalf.

“Better not to micromanage other people’s diets,” said the director of an interfaith organization.

“Opposed,” said the representative of a Texas food bank.

“Against,” said the head of an anti-hunger group.

For more than half an hour, Canales listened to their concerns about his bill and another proposed by a lawmaker who wanted to eliminate candy and chips: Should government really be in the position of telling adults what to eat? And if so, who would be trusted to sort through the 40,000 items sold in a typical grocery store and divide healthy from unhealthy? If energy drinks were banned, why not also ban canned iced coffee that has twice the caffeine and triple the sugar? Or Sunny D fruit drink? Or Gatorade? Or fruit punch? And once every product had been rated and sorted, what if some grocery stores decided it was easier not to accept food stamps at all? Or what if food-stamp recipients felt too stigmatized to shop?

Wouldn’t lawmakers be better off working to solve the problems of poverty rather than regulating them? How about funding programs for nutrition education, or encouraging more fresh produce in inner-city grocery stores, or building playgrounds and making streets safer so people would exercise? Why not focus on alleviating the stresses of poverty, which so many studies had linked to overeating?

“It is unrealistic to expect someone stretching their dollars to be highly worried and focused on nutritional content,” one food policy analyst testified. “They just need to eat.”

The committee meeting ended without a vote on Canales’s proposal, and suddenly he, too, felt a little less sure. He did nothing to resurrect his bill over the next weeks, deciding instead to raise money for diabetes awareness and nutrition education.

“The more you learn in this job, the more complicated it gets to take a position,” he told his district director one evening a few months after the committee meeting.

“What do you want to do about it, boss?” the district director asked. “I don’t ever want to pass a bill and end up regretting it,” he said. “Let’s teach people to make good choices and go from there.”

A nutrition lesson

Later that same afternoon, Luisa Colin and Jessica Rueda grabbed their nutrition brochures and their plastic vegetables and headed toward the Mexican border to do that kind of teaching. They had been working together for three years as nutrition educators, paid in part by the USDA to instill better eating habits in low-income families. Theirs was the government-sponsored solution.

“If only people had the basic knowledge,” Colin said.

“If they just understand their choices,” Rueda said.

The two women drove out of McAllen and into the desert until the paved roads gave way to gravel, and the gravel gave way to a roller coaster of irrigation ditches and rocks. Two miles from the border, they stopped at a collection of a few hundred ramshackle houses called Little Mexico where residents had built their own homes using drywall and scrap metal. The community had no running water and only intermittent electricity. Chickens wandered through the streets and a donkey stood in an intersection eating trash. Two children ran outside to greet them, and Rueda asked them in Spanish, “Is your mom home? I’d like to talk to her about something.”

Her job was to walk through the neighborhood and enroll women in nutrition classes that would improve their diets: better portion sizes, more dark-green vegetables and whole grains, fresh fish instead of ground beef, at least 30 minutes of exercise each day. These were the tenets of their work. Research showed that every $1 spent on nutrition education saved the government $10 in future health-care costs. But lately, the USDA had cut funding for nutrition programs by 25 percent and Congress was threatening cuts again. A dozen nutrition workers in Hidalgo County had been steadily reduced to six devoted women who worked 60-hour weeks to keep pace with the rising need. Now, in some of her conversations, Rueda’s goals had become more basic: to keep people nourished and living, she said.

“How is your nutrition?” she asked one woman in Spanish as they stood together at a front doorway missing its door.

“We eat what we can get,” the woman said.

“Do you ever eat vegetables?”

“Not much. Maybe beans, some salsa.”

“Do you exercise?”

“No.”

“Do you have a fridge?”

“Not anymore.”

The woman explained that she stored what little food she had in an icebox, and that the closest grocery store offering fresh produce was seven miles away. Nobody in Little Mexico exercised outside after 4 p.m., she said, for fear of the dogs and drug cartels that roamed the streets.

Rueda started to move on to the next house, but the woman called after her with a question of her own — one not covered in the six nutrition lessons, and the one Rueda heard most often in Little Mexico and the hundreds of places like it.

“Do you have any extra food?” the woman asked. “Anything?”

“Yes,” Rueda said. “We can bring you some.”

The diet dilemma

If education had failed to break the cycle of poverty and obesity, and politics had failed to break the cycle, then the only solution left for one family at the center of the crisis was the most basic solution of all: to eat better, one meal at a time.

“It ends today,” Blanca Salas told her son, Antonio, after they came back from the doctor.

“I’m on a diet!” he said.

“Me, too,” she said.

She had attended a nutrition class earlier in the week, and now she held a sheet listing federally recommended foods in one hand while sorting through her fridge to take inventory with the other. “Fresh vegetables,” the sheet suggested, and Blanca found two rotting tomatoes, a package of frozen broccoli and two containers of instant vegetable soup. “Fruit,” the sheet read, and she saw grape-flavored popsicles and three apples in the crisper. “Dairy”: They had Cool Whip and Nesquik. “Whole grains”: three frozen pizzas and a package of corn dogs. “Healthy Snacks”: a 24-pack of hot Cheetos.

She had already exhausted her food-stamp account for the month, and she had nothing else to spend until the next deposit arrived in a few days. This time she would receive about $30 less, like everyone on food stamps, because of stimulus funding that expired in November. She looked again at the list of recommended foods: fat-free cottage cheese, quinoa, bok choy, chickpeas, and dozens of other items. Some she had never heard of; most she had never encountered in the dollar stores of South Texas.

She had been born in the United States in the last years when being poor also usually meant being thin. Her parents had lied about her age when she was 11-years-old so she could get a job picking with them in the fields. They ate what they picked, raised their own chickens and boiled rice by the pound. But the sprawl of McAllen edged into the farmland, and Blanca dropped out of school in 10th grade and took a job at a Kentucky Fried Chicken. She had her first baby at age 19 and her second a few years later, with a man who soon disappeared to Mexico. She applied for public housing in a community that offered little space to grow her own food, near a commercial road lined with 17 fast-food restaurants. Now, each morning on the way to school, her children rode past signs that advertised “Dollar Menu,” “Ultimate Dollar Menu,” “Dollar Tacos,” and “Hot Cheetos, two for a dollar.” These were the treats they loved and the treats they could afford.

For years, Blanca had tried to provide an antidote by forcing the children to sit nearby as she gave herself insulin shots. “You need to look at your future,” she told them. “Is this what you want?” She had tried planning a menu and cooking family dinners, but tailoring meals on a budget to the varied tastes of five children exhausted her. They would eat broccoli only if she slathered it with butter and cheese. They would eat Mexican mole sauce only if it came with a hulking side of tortilla chips. The prepackaged diet lunches she splurged on at $3.50 each sometimes came back from school with uneaten turkey and whole-wheat crackers.

As her health worsened, she had started shopping mostly for foods she knew they would eat and prepare themselves. She was a single mother with little money and less energy, she reasoned; it was more important to provide enough than it was to worry about what, exactly, she was providing.

Now Antonio came into the kitchen looking for something to eat. “Make a smart choice,” she told him. She watched him grab a bag of Super Mario Brothers Fruit Flavored Snacks and a Coke Zero. “Fruit and diet,” he said.

“Good,” she said.

They sat together in the living room, shoulder to shoulder on the couch while Antonio did math homework and ate his snack. Three o’clock came, and together they swallowed their cholesterol medication. Four o’clock came, and Salas pricked her thumb and tested her blood sugar. Five o’clock came, and she injected her next dosage of insulin.

“I’m hungry,” Antonio told her.

“Wait for dinner,” she said.

He sat next to her for a few more minutes on the couch, attempting to be patient, caught in the cycle that has confounded politicians and nutritionists and families in the Rio Grande Valley. Was it more hazardous to go hungry or to eat junk? The choice was left to a 9-year-old boy stuck in a culture that provided him both too much and far too little.

“I need to eat,” he said, and he walked back to the kitchen and opened the fridge.

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Original source: http://www.washingtonpost.com/sf/national/2013/11/09/too-much-of-too-little/

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Food fight: Marketing healthy snacks like junk food

Nov. 24, 2013, CBS

By Courtney E. Martin

Consider for a moment the carrot. And, if you can, ignore that it's healthy and comes out of the ground.

What's left is a food that's snackable, crunchable, somewhat addictive — and, yes, neon orange.

From a marketing standpoint, the carrot is really not all that different from a Cheeto. At least, that is what the head of Bolthouse Farms seems to think, going by its ad, "Baby Carrots. Now in extreme junk food packaging!"

"Our first campaign for baby carrots was, 'Eat 'em like junk food,'" laughed Jeffrey Dunn, Bolthouse's self-described "Chief Carrot Officer." "We went right at junk food and said, we don't wanna be against junk food, we wanna be like 'em."

A Bolthouse TV ad shows a sexy woman enjoying the delights of munching on a tiny vegetable. "Oh, baby . . . carrot!" Dunn knows all about junk food marketing. His prior job was as an executive at Coca-Cola.

"Coke has done an amazing job of creating that moment of refreshment that's –you know, you can picture it when I say it," he told Cowan. "That's marketing. We've got to do the same good job for fresh fruits and vegetables. And there's no reason we can't."

But he knows it's an uphill battle — and so does the White House. First lady Michelle Obama has said, "The deck is stacked against healthy foods like fruits and vegetables."

To help level the playing field, Obama recently announced that Sesame Workshop would license their Muppet characters — for FREE — to the Produce Marketing Association. Muppets Elmo and Rosita appeared with the first lady to promote broccoli.

Last year, advertising for fruits and vegetables amounted to $116 million. That may sound like a lot, but it's only one-twentieth of what was spent on advertising junk food to kids.

Few look at that disparity with such a critical an eye as New York Times investigative reporter Michael Moss. He won a Pulitzer Prize for reporting on the meat industry, including the widespread use of "pink slime" — that unappetizing material found in some processed beef, including burgers served in school lunches.

And yet, despite unpleasant revelations like that, Moss says fruits and vegetables still have trouble competing.

"As well-meaning as it is, the government message — that you should be eating more fruits and vegetables 'cause it's better for you, 'cause it's healthy — isn't working," Moss.

The Centers for Disease Control and Prevention says two-thirds of adults and one-third of children in America are either overweight or obese.

Processed food is not the only culprit, but Moss says it is the combination of salt, sugar, and fat – as reflected in the title of his latest book, "Salt Sugar Fat: How the Food Giants Hooked Us" (Random House) – that junk food companies are using to make their products irresistible.

"They use words like crave-ability, snack-ability," Moss said. "One I heard recently that is my favorite now is, More-ishness."

Few snacks are as "more-ish," he says, as that famed Cheeto.

"When you put it in your mouth, you hardly have to chew; it disappears," he said. "And when it disappears, it sends a message to the brain that the industry calls, 'vanishing caloric density.'"

You will not find "vanishing caloric density" on the label, because it is really more of a feeling than an ingredient. "You might as well be eating celery for all your brain cares about," said Moss. "So you eat a Cheeto and your brain is going, 'Wow, did that taste good. No problem, Michael. Keep eating!'"

"There's no doubt that processed foods are manipulated, [and that] we're manipulated as consumers," said Cowan.

"No. We're not manipulated," said Howard Moskowitz, a legendary food scientist, with a Ph.D. in experimental psychology from Harvard.

"Processed foods are tweaked and changed to increase consumer acceptance. Not manipulated."

If you've enjoyed a Cherry-Vanilla Dr. Pepper, or Prego's chunky tomato sauce, you're largely eating his recipe.

His signature is finding what's known in the industry as the "bliss point" – that sweet-spot that creates likability.

"You know, at a certain point, this is part of American society," Moskowitz said.

"But you've tapped into it," said Cowan.

"Yes. But it's all — you know, I didn't tap into it. Science tapped into it."

That same science, he says, could be used to engineer and market produce, too . . . and that's where Bolthouse Farms thinks it has an edge.

So, is there the equivalent of a "bliss point" in baby carrots? "Oh, absolutely," said Jeffrey Dunn. "We spend a lot of time cross-breeding carrots for sweetness, for mouth feel, all of the same things a processed food guy would do."

Taking a page from the junk food playbook, Bolthouse Farms now even has a taste lab, where food scientists figure out not only how to spice a baby carrot, but what kind of flavors to mix into their fruit juices, too, like a strawberry protein drink. "I like to say we're kind of nerdy juicers," said a scientist named Lance.

The lesson here isn't that processed food can be beat — it's that healthy food can at least play the same game.

For Dunn, marketing fruits and vegetables is not just a nutritional imperative; it is a moral obligation.

"Long-term healthcare costs are directly linked to this obesity crisis," Dunn said. "And the obesity crisis is directly linked to our diet. And that's something we can do something about, as a society."

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Original source: http://www.digtriad.com/news/watercooler/article/307206/176/Food-Fight-Marketing-Healthy-Snacks-Like-Junk-Food-

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This is what America's school lunches really look like

Nov. 22, 2013, NPR

By Maria Godoy

School lunch has never been the stuff of foodie dreams. I'm still haunted by the memory of my elementary school cafeteria's "brain pizza" – a lumpy oval thing topped with fleshy white strips of barely melted mozzarella that clumped together like neurons.

And it looks like America's school cafeterias are still turning out the culinary abominations, judging by the images on Fed Up, a fascinating online project showcasing school lunch photos submitted by students across the country.

The project is the brainchild of Farah Sheikh, who manages education campaigns for Do Something, a nonprofit group that helps organize young people to take action around social change. She got the idea, she said, while researching student dropout rates. Nutrition, she noticed, "has a pretty big impact on student concentration and student performance in school," she tells The Salt.

The project features more than 7,000 school lunch photos, accompanied by often witty captions — such as "objects may taste worse than they appear." Some of the meals shown are real doozies — "we've gotten a lot of mystery meat," Sheikh says...

The aim, she says, is not to horrify, but to equip "young people who are upset with what they're being served with ways to make change in their school." Participants not only get to vote on whether to eat or toss the meals pictured, they also can download a kit with advice on advocating for better school lunches in their local district.

Of course, the state of school lunch has been a focal point of the food movement for several years now. And one thing that comes through from the photos is that, in at least some school districts, change has arrived. Some of the meals submitted look not just healthful but — dare we say? — tasty.

The transformation to more healthful school lunches hasn't been entirely smooth for school districts. As we've previously reported, revamped meals have left some kids protesting smaller portions that leave them hungry — a complaint that also pops up in some of the Fed Up images. That's one reason why, as school district officials redo lunches, students need to be part of the conversation, says Sheikh.

"We want to give decision makers a sense of what it's like to be a student who isn't getting the energy they need from their school lunch," she says.

Indeed, while a photo may be worth a thousand words, the Fed Up project extends beyond the visual. Students who submitted images also filled out a survey with questions like: How often do you toss your lunch? How nutritious were the school lunches you've eaten over the past four weeks? And how do you feel after eating your lunch (energetic, hungry, full, sick, etc.)?

The answers, Sheikh says, will be compiled in a report summarizing the state of school lunch around the nation from students' perspective. She plans to share the findings with school districts and nutrition advocates, including Let's Move!, the National School Lunch Program and the National Farm to School Network, which advised her on the project.

The Fed Up site stopped taking new submissions at the end of last week. Sheikh and her team are now in the process of analyzing the data. But one finding that's already clear, she says, is that the stereotype that teens just want to eat junk food simply doesn't hold up.

"If a teen says their meal is healthy," she says, "they're less likely to throw it out over the course of a week. But if a teen says it's unhealthy, that teen is more likely to throw it out."

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Original source: http://www.npr.org/blogs/thesalt/2013/11/20/246400702/this-is-what-america-s-school-lunches-really-look-like

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