June 2014






Breakfast cereals loaded with too much sugar for U.S. kids

May 15, 2014, Reuters

By Carey Gillam

U.S. children are consuming more than 10 pounds (4.5 kgs) of sugar annually if they eat a typical morning bowl of cereal each day, contributing to obesity and other health problems, and cereal makers and regulators are doing little to address the issue, according to a study released on May 15.

The Environmental Working Group (EWG), a Washington, D.C. based health information nonprofit, said its report covers more than 1,500 cereals, including 181 marketed to children.

As part of the report, the group re-examined 84 cereals it studied in a similar report in 2011, and found that the sugar content of those cereals remained on average at 29 percent. Some cereals had increased sugar content now compared to 2011, and none of the 181 cereals marketed to children were free of added sugars, the group found. On average, children’s cereals have more than 40 percent more sugars than adult cereals, EWG said.

"Obviously we know cereals have a lot of sugar in them," said Dawn Undurraga, an EWG consultant and a co-author of the report. "But there is a lot that manufacturers can be doing and [the Food and Drug Administration] FDA can be doing, to protect kids."

The group said one of the worst offenders is Kellogg Co.'s Honey Smacks, with 56 percent sugar by weight.

A child eating an average serving of a typical children’s cereal eats more than 10 pounds of sugar a year from that source alone, and the average daily intake of added sugar for children is two to three times the recommended amount, the EWG said.

A Kellogg official said the company has cut sugar in its top-selling kids’ cereals by 20 percent to 30 percent over time. The company said the EWG report ignores the benefits provided by a cereal breakfast, including pre-sweetened cereals.

"When you consider what constitutes a good breakfast, cereal and fat-free milk pack a powerful nutritional punch, lower in fat and calories than many other breakfast choices, and including many nutrients that people might otherwise miss," said company spokeswoman Kris Charles.

The report is the latest in a push by consumer and health groups to convince food companies and regulators to cut unhealthy ingredients from packaged food products.

In March, the FDA proposed that added sugar content be listed in nutrition facts panels on packaged foods. But the serving sizes need to be more accurately labeled, the EWG said.

Cereal maker General Mills also has already cut the sugar content in its cereals advertised to children, on average by 16 percent since 2007, according to spokeswoman Kirstie Foster. The company's cereals advertised to children have 10 grams or less of sugar per serving, with some at 9 grams, Foster said.

The EWG said companies should not market cereals containing 6 grams of sugar or more per serving to children.


Original source: http://www.reuters.com/article/2014/05/15/us-food-sugar-report-idUSKBN0DV08J20140515


NCCOR Connect & Explore webinar on childhood obesity declines happening June 12

Recent data has shown that childhood obesity rates are falling in many communities across the nation. In the latest installment of its Connect & Explore Webinar Series, the National Collaborative on Childhood Obesity Research (NCCOR) is examining the implications of this research, discussing lessons learned from public health leaders in communities experiencing these declines, and considering how these findings can be applied.

For those registered, this is a reminder to join us at 2 pm, Eastern, on Thursday, June 12, for Connect & Explore: A Deeper Dive into Childhood Obesity Declines, the second of three webinars planned this year.

We have reached capacity for this event and registration has closed. However, there are still spots available for those who want to listen to the conversation (no video). You can access the call-in information for the audio portion of the webinar here. A recording will also be made available on www.nccor.org after the webinar.



New CDC report finds most American kids are physically unfit

According to a new report by the Centers for Disease Control and Prevention, more than half of adolescents aged 12 to 15 are considered physically unfit. The authors of the report tested more than 600 young teenagers on treadmills to measure cardiorespiratory fitness, a measure of how well the heart and lungs can move blood to supply muscles during exercise.

They found that just half of all boys and only a third of all girls in the study met the minimum threshold of being called “fit.” Taken as a whole, this meant that only 42 percent of kids were fit. In 2000, by comparison, this figure was 52 percent. Overweight and obese children were less fit than those who had a healthy weight; only 30 percent of overweight children and 20 percent of obese passed the minimum standards to be called fit. But even so, only 54 percent of children with normal weight — barely half — had adequate levels of cardiorespiratory fitness.



Majority of states have ‘head start’ on Smart Snacks nutrition standards

Twenty-six states have laws that fully or partially meet at least one provision of the U.S. Department of Agriculture’s (USDA) updated nutrition standards for school snacks and drinks, according to a new study published in Childhood Obesity. The study, which was funded by the Robert Wood Johnson Foundation through its national research program, Bridging the Gap, is the first to examine how existing state laws align with USDA’s "Smart Snacks in School" guidelines that go into effect on July 1.



Families on food assistance are purchasing more fruits and vegetables

Efforts are paying off to increase consumption of fruits and vegetables among women and young children receiving food assistance, according to a study recently published by the Rudd Center for Food Policy & Obesity in Public Health Nutrition. Purchases of fruits and vegetables have increased among families participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) after revisions were implemented in 2009 to offer foods that better reflect dietary recommendations for Americans.

Rudd Center researchers examined fruit and vegetable purchases made at a New England supermarket chain by households participating in WIC over a two-year period. Fruit and vegetable spending and volume purchased by these households were compared before and after the WIC revisions. Purchases of fresh vegetables increased by nearly 18 percent, and purchases of frozen vegetables increased by nearly 28 percent. The biggest improvements were for fresh fruit, with an increase of almost 29 percent, adding over 2 pounds of fresh fruit per household per month.




Another downside to obesity for teens: Fewer friends

May 15, 2014, HealthDay

By Mary Elizabeth Dallas

As if the physical woes tied to obesity are not enough, a new study finds that obese teens are also more likely to face rejection by their peers.

"This is especially troubling since friendships are important sources of support and companionship," study co-author Sandra Simpkins, an associate professor a Arizona State University's School of Social and Family Dynamics, said in a university news release.

"Not having or losing friends is associated with higher depression and lower self-worth for young people, which could exacerbate the health problems associated with being overweight," she added.

In the study, the researchers analyzed survey data on almost 59,000 students, averaging 15 years of age, from 88 middle and high schools. About a fifth of the students provided information on their body mass index (BMI) — a measurement used to determine if someone is a healthy weight for their height.

The students also listed their five closest female friends and their five closest male friends.

The researchers then examined how and when the teens made friends — for example, if they met through activities or mutual friends or if they had common interests.

The study found that although overweight teens are mostly unconcerned about the weight of their friends, they are more likely to be rejected as friends by their normal-weight peers. And when their offer of friendship is refused, overweight teens often turn to befriending other overweight young people.

Since they are socially marginalized, overweight teens have, on average, one fewer friend than normal-weight teens, the study found.

"We found consistent evidence that overweight youth choose non-overweight friends more often than they were selected in return," study co-author David Schaefer, associate professor in the university's School of Human Evolution and Social Change, said in the news release.

Being rejected due to extra weight may be especially tough during the teenage years, the researchers said. In those years, "intimacy and fitting into peer groups is critical," Schaefer said.

However, he added that "it's important to keep in mind that overweight youth still have lots of friends. Having just one friend makes a big difference. And, it's less important how many friends teens have; what is key is that those friends are supportive."

The findings were published May 15 in the American Journal of Public Health.


Original source: http://health.usnews.com/health-news/articles/2014/05/15/another-downside-to-obesity-for-teens-fewer-friends


Families with preschoolers buying fewer high calorie foods and beverages

May 28, 2014, Medical Xpress

By Stephanie Stephens

Families with young children are purchasing fewer high-calorie drinks and processed foods, which may be a factor in declining rates of childhood obesity, finds a new report in the American Journal of Preventive Medicine.

"Somewhere between 2003 and 2010, the upward trend in childhood obesity started to stall, leveling off around 2007," said lead study author Christopher Ford, MPH of the department of nutrition at the University of North Carolina at Chapel Hill. The latest Centers for Disease Control and Prevention data showed a significant decline in obesity among children aged 2 to 5 years, from 12.1 percent to 8.4 percent.

Ford and his co-authors examined food and beverage purchase data between 2000 and 2011 from nearly 43,000 U.S. households with a preschool-age child. They utilized the Nielsen Homescan Panel, which comprises a representative sample of U.S. households, while controlling for major price changes and household income, demographics, and composition.

Taking into account the recessions of 2003 and 2007, "during which there might have been less waste," notes Ford, the team identified the top 20 foods and beverages purchased per capita during that 11-year period. They assigned household purchases into nine groups for analysis: grain-based desserts, savory snacks, ready-to-eat cereals, sweet snacks and candy, processed meats, soft drinks, juice and juice drinks, plain milk, and sweetened milk.

The researchers found the total calories from food and beverage purchases declined significantly. Declines were especially noted in milk, soft drink, juice and juice drinks, and grain-based dessert purchases, all of which include higher calorie solid fats and added sugars. Per capita, calories purchased per day decreased by 182 during the period.

"We know from previous research that 70 to 80 percent of the preschooler diet comes from stores, with the rest coming from school cafeteria and child-care centers," Ford said. Hispanic households saw the smallest decrease in total calories purchased, possibly due to less access to stores with bar-coded products and greater proportional spending on fruits and vegetables.

"Discussions about childhood obesity often focus on the negative impacts of fast food," said Meghan Slining, Ph.D., assistant professor of health services at Furman University. "And while these are indeed valid concerns, foods and beverages purchased from supermarkets and grocery stores represent a much greater share of young children's diets. This report suggests important improvements over the past decade in the food shopping behaviors of American families with young children."


Original source: http://medicalxpress.com/news/2014-05-families-preschoolers-high-calorie-foods.html  


Kids' impulse control for sweets influenced by computer games, study says

May 7, 2014, Fox News

By Jessica Firger

Kids eat more calories when playing a computer game featuring advertisements for candy than when the game has ads for toys, according to a new study from the Netherlands.

Children with low self-control were especially vulnerable to cues from a candy-themed game and ate more sweets even when offered a reward not to eat, the researchers found.

“Impulsive children have insufficient inhibitory behavioral control, and food advertisers try to influence eating behavior, thereby making it more difficult for especially impulsive children to self-regulate their food intake,” Dr. Frans Folkvord told Reuters Health by email.

Since kids are not fully aware of the persuasive intent of food marketeers, it is very difficult for any child to be critical towards the advertisements, said Folkvord, of Radboud University Nijmegen, who led the study.

Past research has shown that food advertising influences how much children eat, but little is known about what makes an individual child susceptible, Folkvord and his colleagues write in the journal Pediatrics.

The researchers recruited kids between the ages of 7 and 10 to play online games that had either a candy theme or a toy theme.

“We used an online memory game that is comparable to the advergames that are used by major food companies,” Folkvord said.

Kids played the simple memory ‘advergames’ on a computer. Sixteen cards marked with a candy or toy brand name and logo appeared face down. Two could be flipped over at once. On the other side, they displayed individual candies or toys. The object was to match pairs as quickly as possible.

For the study, researchers divided the 260 children from primary schools in the Netherlands into four groups. Two groups played the candy advergame while the two other groups played an advergame promoting a toy brand instead.

The kids played the games for five minutes in a room with two bowls of jelly candy and milk chocolate candy.

Researchers told one group playing each game that they could eat as much candy as they liked, and told the other group that they could eat the candy, but if they made it to the end without eating they would be rewarded.

Before the game-playing sessions, the researchers also had all the kids answer questions to gauge their level of impulsivity. Based on scores on that test, 39 percent of the children qualified as impulsive, according to Folkvord.

Overall, kids ate more calories when playing a game with a candy theme. But rewarding the kids for avoiding eating the candy in the room during the game sessions resulted in most eating fewer calories.

Children who played the candy game without the inhibition reward ate an average of 156 calories, for example, compared to 87 calories for kids who played the same game with the inhibition reward.

During the toy-themed game, kids without the inhibition reward ate 101 calories, compared to 33 calories when they had been offered the inhibition reward.

For certain more impulsive kids, however, the food cues in the candy game were stronger than the incentive not to eat. The more impulsive kids playing the candy game tended to eat the same amount of calories whether or not they had been offered the inhibition reward.

“Impulsive behavior is extremely common and it is believed to be genetic,” said Dr. Deborah A. Cohen of the RAND Corporation in Santa Monica, California.

Cohen studies how the social and physical environments influence health.

Impulsiveness tends to go hand in hand with making poor decisions, said Cohen, who was not involved in the new study.

“Most of the food companies have advergames on their websites,” she told Reuters Health by email. “Exposure depends upon how much time children have free computer access and also based upon their awareness of these games.”

“Children as old as 15 do not recognize that advergames are adverts,” Folkvord said. But parents can help train kids to recognize advertising and reduce their undesired effects, like overeating, he said.

“Parents should explain to their children why food companies advertise their products and brands, helping them to become more critical, and subsequently become less susceptible,” Folkvord said.

Even then, there is only so much that parents can do, Cohen said.

“Everyone is susceptible to advertising, even those who believe they aren’t,” she said. “Parents have a limited ability to protect their children, because they do not control advertising nor is it easy for them to limit exposure to advertising.”

Counter-advertising campaigns, like the ‘truth’ campaign against tobacco use, may be one way to inoculate kids against the persuasive power of food ads, she added.


Original source: http://www.foxnews.com/health/2014/05/07/kids-impulse-control-for-sweets-influenced-by-computer-games-study-says/


Study examines efficacy of taxes on sugary drinks

June 2, 2014, The New York Times

By Stephanie Strom

A new study of how taxes might be used to curb consumption of sugary drinks suggests that applying a tax based on the amount of calories contained in a serving rather than its size would be more effective.

The study, financed by the Robert Wood Johnson Foundation, which has long advocated taxing sodas and other sugary drinks as part of its efforts to reduce childhood obesity, found that consumption of calories in drinks would drop 9.3 percent if a tax of four-hundredths of a penny for every calorie was added to the price, but fall by just 8.6 percent under a tax of half a cent for each ounce in a can or bottle.

A calorie-based taxing system would also be fairer to consumers, said Chen Zhen, a research economist at the food and nutrition policy research program at Research Triangle Institute and the lead author of the study.

“It provides a better incentive to the consumer to switch to lower-calorie drinks, which would be taxed at a lower rate than higher-calorie drinks,” Dr. Zhen said. “One of the concerns about taxing ounces of sugar-sweetened beverages is that consumers are paying the same tax whether they buy 12 ounces of a drink with 150 calories or 12 ounces of a drink with 50 calories.”

At a tax rate of four-hundredths of a penny per calorie, six cents would be added to a 12-ounce can of Coca-Cola, for example, Dr. Zhen said, while only four cents would be added to a 16-ounce bottle of Vitaminwater.

“From a public health point of view, it makes a lot of sense to tax the sugar, which is the most harmful part of these drinks,” said Harold Goldstein, executive director of the California Center for Public Health. “We want to shift consumers from drinking more sugar to drinking less, so taxing beverages with more sugar makes sense.”

The California Senate last week passed a bill for warning labels on sugary soft drinks. The State Assembly has not yet voted on the bill.

Sales of sugary drinks already are falling, and Christopher Gindlesperger, a spokesman for the American Beverage Association, the trade group that represents the soda companies, noted that a variety of soda tax proposals have been defeated in various states over the last several years. Just last week, the Illinois House voted down a bill that would have taxed sugary soda at a rate of one cent an ounce, specifically citing the cost to consumers.

Arkansas and West Virginia tax soda — and are among the top 10 states for obesity. “Over the course of last several years, taxes on soft drinks and other sugar-sweetened beverages have gone nowhere, and it’s in large part because people don’t want it,” Mr. Gindlesperger said.

He also noted that one of the authors of the study, Ryan R. Ruff, was the director of research and evaluation at the New York City Department of Health and Mental Hygiene in the Bloomberg administration, which waged a war on sugary drinks.

Dr. Zhen previously has done research finding that taxes on sugary drinks might not be as effective as a high tax on cigarettes in reducing consumption because consumers can substitute a high-calorie food that is not taxed for a high-calorie soda that is.

“We are not saying you should tax sugar-sweetened beverages,” Dr. Zhen said, speaking about the new study. “We’re saying that if you’re going to tax them, the best way of doing that is on the basis of calories. We are trying to stay away from the politics.”

The study was published online by the American Journal of Agricultural Economics.


Original source: http://www.nytimes.com/2014/06/02/business/study-examines-efficacy-of-taxes-on-sugary-drinks.html?_r=0



First lady rebuts effort to weaken school lunch rules

May 27, 2014, The New York Times

By David S. Joachim

Michelle Obama turned uncharacteristically political on May 27, pushing back against a measure pending in the Republican-controlled House that would let some schools opt out of federal dietary standards for school lunches.

The standards, approved by Congress and the president in 2010, set limits on sodium, fat and calories, and require that unhealthy menu items be replaced with fruits, vegetables, and whole grains.

Some big food companies and Republican lawmakers have criticized the rules, calling them inflexible, ineffective, and expensive. Representative Robert B. Aderholt, Republican of Alabama, has attached language to a spending bill that would waive the requirements for financially ailing school districts.

In response, Mrs. Obama met with a half-dozen school officials on May 27 from New York, California, Virginia, Maryland, Georgia, and Tennessee who attested to the success of the new standards in their school systems. The standards have been introduced gradually over the last two years.

“The last thing that we can afford to do right now is play politics with our kids’ health, especially when we’re finally starting to see some progress on this issue,” Mrs. Obama told the group, adding, “It’s unacceptable to me not just as first lady, but as a mother.”

Sam Kass, the director of Mrs. Obama’s Let’s Move! campaign to reduce childhood obesity, acknowledged “legitimate challenges” for some districts in carrying out the standards. Last week, Mr. Kass said, the U.S. Department of Agriculture (USDA) said that some districts could delay serving whole-grain pastas because “the product didn’t hold up well over time.”

Mr. Kass said the administration was working with food suppliers to help fix the problem. But he cited academic studies showing that, over all, children were eating healthier foods because of the standards.

“Let’s remember that before this, there were no standards,” he said. “Schools could serve candy bars and sugary drinks in vending machines and in lunch lines.”

The School Nutrition Association, which represents cafeteria administrators, issued a statement on Tuesday calling the rules “overly prescriptive” and citing USDA data showing a drop in school-lunch participation since the standards were adopted.

It said the organization was “disappointed that the first lady is only going to speak with a handful of preselected school nutrition directors today.”

Last week, the president of the National Parent Teacher Association, Otha Thornton, wrote a letter to members of Congress urging them to reject Mr. Aderholt’s effort to scale back the standards. “At a time when families are working hard to live healthy lives, school meals should be supporting families’ efforts, not working against them,” he wrote.

Brian Rell, a spokesman for Mr. Aderholt, who is chairman of a subcommittee with jurisdiction over nutrition programs for children, countered that the rules were unnecessarily costly.

“These new federal regulations should not drive local school lunch programs under water,” Mr. Rell said.

Mr. Kass, who is also a White House chef, said that schools should not be able to opt out of food standards any more than students should be allowed to opt out of math class.

“From the beginning, we’ve looked to set standards that put our kids’ health and well-being first, giving them the nourishment they need to perform in school,” he said. “For so many kids, the nutrition they get at school is the only nutrition they get.”


Original source: http://www.nytimes.com/2014/05/28/us/politics/first-lady-rebuts-effort-to-weaken-school-lunch-rules.html?hpw&rref=education&_r=0


Kids, parents are embracing the walking school bus

May 26, 2014, The Colorado Springs Gazette

By Jennifer McDermott, Associated Press

As a group of children walked home together from school in Providence, R.I., they held hands and played the "I Spy" guessing game. When they reached a busy intersection, an adult accompanying them prodded, "What's the rule?"

"Behind the line!" they said in unison, as they stepped back from the edge of the curb and waited for the walk signal.

Shortly after, the group stopped in front of 8-year-old Jaiden Guzman's house. He said goodbye to his friends and raced to his front door. His mother waved and the rest of the walking school bus continued on its way.

For a growing number of children in Rhode Island, Iowa, and other states, the school day starts and ends in the same way — they walk with their classmates and an adult volunteer to and from school. Walking school buses are catching on in school districts nationwide because they are seen as a way to fight childhood obesity, improve attendance rates, and ensure that kids get to school safely.

Ten-year-old Rosanyily Laurenz signed up for the Providence walking school bus this school year. Before, she said, she was sometimes late to school when her grandmother didn't feel well enough to walk with her.

But now, "I get to walk with my friends," Rosanyily said. "Plus, I get snacks."

Many programs across the country are funded by the federal Safe Routes to School program, which pays for infrastructure improvements and initiatives to enable children to walk and bike to school.

Robert Johnson, of the Missouri-based PedNet Coalition, a nonprofit that advocates for transit alternatives, said the success of the programs reflects a growing interest in getting kids more active.

"Every parent is looking for ways to make their child a little healthier, and walking to school is one," he said.

In 2012, about 30 percent of students living within a mile of school walked there in the morning and 35 percent walked home in the afternoon, according to the National Center for Safe Routes to School. Those numbers have increased by about 6 percentage points since 2007.

Organizers in Providence are also motivated by high rates of chronic absenteeism. Thirty-seven percent of Providence students missed 10 percent or more of the 2010-2011 school year.

The nonprofit agency Family Service of Rhode Island targeted Mary E. Fogarty Elementary School for its first walking school bus in 2012 because it is located in one of the city's poorest neighborhoods. Children who live within a mile of school do not qualify for the bus.

In Sioux City, Iowa, nearly 1,000 children in 10 elementary schools use walking school buses during the spring and fall, said Alison Benson, spokeswoman for the district. Benson said the program has helped the schools incorporate fitness into the morning routine and build a sense of community.

Elementary schools in Columbia, Missouri, were among the first in the nation to have walking school buses. Piloted in 2003, the program, at its height, involved 450 children, 13 schools and about 200 volunteers. It was canceled this year because of funding issues, according to the PedNet Coalition.

Johnson said he is working with 15 school districts in Kansas on what may become the largest walking school bus project in the United States.

Some districts have been able to cut school bus routes and save money because of the program, he said.

On the mile-long route in Providence, the program's manager, Allyson Trenteseaux, and another volunteer recently led Jaiden, Rosanyily and six other children through busy intersections and around broken glass littering the sidewalks.

On the walks, Trenteseaux said, she mends relationships among the kids, builds relationships, and intervenes when there are problems. During the winter, a walk leader noticed some of the children were wearing slippers and bought them all boots.

Last year, 11 of the 14 students who participated and completed a survey attended school more often. The program now has a waiting list, and Family Service plans to expand into more schools next year.


Original source: http://gazette.com/kids-parents-are-embracing-the-walking-school-bus/article/feed/122158


A new prescription: Eat your veggies

May 12, 2014, Minnesota Star Tribune

By Jeremy Olson

One of Minnesota’s largest health care providers is going to a new extreme in its struggle to combat the epidemic of childhood obesity.

It has started writing prescriptions for vegetables.

For now, it's just a pilot project at HealthPartners clinics in Hugo and White Bear Lake, Minn. But if the experiment succeeds, the Bloomington-based health organization could expand the project across the Twin Cities to address the high — and rising — rate of childhood obesity. Nearly a quarter of the state’s ninth-graders are overweight or obese, according to last year’s Minnesota Student Survey — a trend mirrored in skyrocketing youth obesity rates nationwide.

"What we’re doing hasn’t been working," said Dr. Thomas Kottke, HealthPartners’ medical director for population health. "Obesity in kids has taken off in the last 20-25 years. And so we need to do something differently."

Emily Miller was a skeptic. The Forest Lake mom tried cutting junk food and putting out healthier snacks with the only results being whining children and rotting fruit.

But after her 12- and 10-year-old daughters got their veggie prescriptions at checkups earlier this year, they demanded to go straight to the grocery store.

"I didn’t realize how much it would spark an interest in my girls," Miller said.

Participating doctors issue the prescriptions to children ages 5 to 12 who could use healthier diets and encourage them to make their own choices and try something new; area supermarkets accept the prescriptions and track the varieties of produce purchased. The prescriptions are actually just vouchers funded by HealthPartners, rather than formal scripts billed to health insurance companies. But the idea is to make them look official so they send the message to children that good eating is good health care.

While braced for critics, who might object to "medicalizing" diet and using health care dollars for family food budgets, health system officials think it’s a sound investment.

"It could save us a huge amount of money down the road in our cholesterol-lowering drugs, in our heart-saving procedures," assuming that healthy children grow into healthy adults, said Dr. Elsa Keeler, a pediatrician at the White Bear Lake clinic.

And those costs can be staggering. A study late last month estimated that an obese child will incur $19,000 in additional lifetime medical costs, given the elevated risks for diabetes and heart disease as adults.

"Obesity ... affects our communities. It’s raising our health care costs,” said Dr. Ed Ehlinger, Minnesota’s state health commissioner. "I think physicians should be very concerned about it."

Fruit pizza

Miller's daughters differ in their eating habits, though both craved treats like Nutty Bars and gummy snacks as much as the next kid.

Her oldest girl, Alena, is picky. She tolerates apples, though, so she used her prescription to buy multiple varieties and took a chance on spinach. Now the family uses her favorite apples in applesauce and to make a substitute for cooking oil. She even liked the spinach and soon progressed to zucchini in salads and bread.

"If I had even said that before,” Miller said, "it was like, 'Ewwww, egh!' "

Her younger daughter, Amelia, is more adventurous. She used her prescription on tropical fruits such as kiwi and papaya for a yogurt-based fruit "pizza."

"I think it was [successful] because it was their thing," Miller said. "It wasn’t me encouraging them to do it. It was their choice."

Whether a one-time opportunity to test new fruits or vegetables will be equally transformative for other families is unclear. HealthPartners will study that question after the two clinics use up their 100 trial prescriptions.

Research on the issue has been inconclusive. Last month, a British study of fruit and vegetable prescriptions for 1,184 people in a low-income neighborhood found that most were used, but that they didn’t change long-term habits because people still considered fresh produce too expensive.

Ehlinger said such strategies will work only in conjunction with broader efforts to make healthier choices easier. Some lower-income parents, for example, find it hard to choose fresh produce when it is more expensive than high-calorie packaged foods that fill their families up for less money.

Junk food marketing and fast-food availability — compared to the scarcity of produce markets in some communities — also present challenges, he said. "We have to change the policies and systems in an environment, in a community, if we are going to get people to move and eat properly. It's not just about an individual choice."

Kids' choice

The prescription trial is part of Bear Power, a collaboration of HealthPartners, Children’s Hospitals and Clinics of Minnesota, and schools and civic groups in White Bear Lake to improve community health.

School "move-a-thons" and Bear Power bracelets are among the tools to spread awareness. Local grocers have already been participating in a variety of ways, such as putting healthy options in the "impulse buy" shelves next to the registers.

This "is about being proactive about health," said Tom Clasen, a vice president for Knowlan’s Supermarkets, which has three Festival Foods stores that accept the prescriptions. “Our medical system is so built around a reactive stance to problems."

Clasen said children have used prescriptions to buy everything from cilantro to mangoes to jicama.

While cost is a barrier to healthier eating, Kottke said there are other barriers that the prescription program might address. Even doctors tiptoe around subjects such as personal diet and weight with patients, so the prescriptions give them an excuse to be more direct. The prescriptions also appeal to the American desire to sample foods first, and to children’s love of gifts and opportunities to pick things out for themselves "without having to put 10 bucks at risk," Kottke said.

"One $10 coupon every year or two isn’t going to change things," he added. "That ... is trivial to the annual grocery bill. So this is about sampling and it’s about signaling the parents that we are serious about this."

Miller is left with a chicken-and-egg question: Did she spur her children’s junk food cravings with her own purchases, or did their cravings push her to buy foods she never really wanted?

Snack times and dinners at the Miller home still aren’t perfect, but they have improved.

Miller's 13-year-old son grumbled about the changes — he had no say because he didn’t receive a prescription — and loathed the lack of pop in the fridge. But he was OK with the new foods on his plate.

"He eats whatever is put in front of him," Miller said. "He's kind of a human garbage disposal."


Original source: http://www.startribune.com/lifestyle/kids-health/258776831.html?page=1&c=y