Let's Move! ...to Prevent Childhood Obesity

It's no surprise that childhood obesity is drawing more public attention than ever before. Evidence is growing on the ill-effects and complicated origins of childhood obesity, making inaction impossible both for public health programs and politicians.

We can prevent childhood obesity. And that's precisely what the White House initiative, Let's Move!, intends to do.

Is "Healthier" Healthy Enough for School Vending?

Early on a Tuesday morning, while walking the halls of Winter Hill Elementary School in Somerville, Massachusetts, I was struck by the absence of an item that has become nearly ubiquitous in schools across Massachusetts: vending machines. Vending machines are the most convenient source of exactly what you tell your kids not to eat.

Debunking American Nutrition Myths

Darya Pino of Summer Tomato (an amazing blog with lots of health and nutrition information) promoted this video. It's amazing -- Dr. Lustig of UC San Francisco debunks popular nutrition myths, particularly related to sugar consumption by tying together the science of public health, nutrition, and biochemistry.



Hope you enjoy!

Sugar-Sweetened Beverages the Next Tobacco?

Image from the NY City Department of Health Anti-Obesity Campaign

In class this week, we discussed strategies for reducing the consumption of sugar-sweetened beverages at home. Sugar-sweetened beverages are exactly what they sound like: any drink sweetened with sugar (sodas, fruit juices, "vitamin" or flavored waters, sports drinks, energy drinks....etc.).

The larger question at hand was: Can we utilize the same strategies that brought down the tobacco industry for reducing the consumption and availability of sugary drinks?

The idea of a "soda tax" has come under scrutiny by conservatives who don't like the idea of taxing anything, as well as groups that are strongly supported (i.e. funded) by the food and beverage industry, like the Center for Consumer "Freedom." And, yes, the quotes are my doing...

However, many in public health believe that taxation will curb consumption of sugar-sweetened beverages, particularly among those who consume the most and are most likely to suffer poor health and overweight because of it. Nonetheless, soda is just the tip of the iceberg when it comes to liquid, non-nutritive calorie consumption, especially among kids. There are many other beverages that provide just as many calories and can contribute to weight gain. What will happen when the beverage industry just switches production (and all its marketing!) to these other sugary beverages? Another tax?

Taxation of tobacco has been a primary strategy in reducing its consumption and preventing people from starting to use it. Yet, taxation of tobacco has gone extremely high! Right now the federal tax on tobacco is $1.00 per 20-cigarette pack, and states can tax tobacco even higher ($3.46). Would a soda tax ever get that high? Not likely. Harvard researchers suggest that just a $0.01 per ounce of soda would be enough to change consumption patterns of consumers; a typical 20 oz. soda would be marked with a 20 cent tax.

However, the strategy that I am most excited about is social marketing -- advertising that promotes healthy behaviors and discourages unhealthy ones. If you haven't seen the sugar-sweetened beverage ads out of New York City, check out my other post on this topic. Marketing can't just tell you that something is bad, it must suggest alternatives.

If you are looking for alternatives to sugary drinks here are a couple promoted on the Harvard Nutrition Source website:

• Plain (or Infused) Water -- I think this means throwing some lemons or cucumbers in with the plain water to add flavor without the calories.
• Tea -- Go light on the sugar and honey, of course.
• Coffee -- Choose milk over cream, go sugar-free.
• Sparkling water -- add a splash of 100% fruit juice for flavor, without packing in the calories.

The website even has a recipe for a healthy "fresh fruit cooler," which is a great alternative to store-bought smoothies. Notice, drinks that are "sugar-free" because they utilize artificial sweeteners are NOT included in this list.

Right now there is a national movement to get junk foods and soft drinks out of schools. While I believe this needs to happen soon, most kids get unhealthy foods outside of schools. A 2006 study by Harvard researchers found that 60-80% of sugar-sweetened beverages were consumed by kids at home.

This suggests that we need a national movement, not just to change school environments to provide healthier beverages, like water and low-fat milk, but also change social norms around providing sugary drinks to kids in homes.

What would sway parents to pass up purchases in the beverage aisle and stick to **free** tap water and nutrient-rich milk for kids?

That's a tough question. The strategy needs to incorporate environmental change, excellent social marketing of the health dangers of daily consumption of sugary drinks, and grassroots/community efforts. If we can get sugar-sweetened beverages out of schools (where they have no right to be!), perhaps we can raise awareness about the issues so that we can get them out of homes, too!

Could the tobacco model work? Perhaps. It may be important to look to other public health campaigns; however, to get the most insight into what public health strategies will be most effective. How about alcohol control campaigns?

Smart Choices Labeling System Divided, Fails?

The "Smart Choices" label, which was meant to be a guide for consumers to make healthier food choices when shopping the supermarket, may be lying on its deathbed, according to a recent article in the New York Times. A few of the major food industry supporters, including PepsiCo and Kellogg's have cut its ties with the program and will phase out production of products (like Froot Loops cereal) with the Smart Choices logo prominent on the box front. Although, Kraft indicates it has no intentions to remove the logo from its foods.

Battleground School Food

It may be a fluke or it may be fortune that the New York Times has taken up the "cause" of school food and nutrition in the last week or so. First there was the article profiling the cafeteria at a popular New York City public school in Queens. Then, Saturday, they ran an article on the ban of sugary foods from public schools in New York City even for celebrations (think kids' birthdays) and bake sales or fundraising activities. Actually, the 'bake sale ban' is not something new, it was issued in June but is just beginning to be implemented.

After my Public Health in the Media class last year (take it if you get the chance...I'll be the TA!) I am sure that it is not a mere coincidence that school nutrition has landed in the newspaper several times in the past month. I think the reason that the New York Times is talking about school nutrition policy is because people are starting to care about it! People want someone to do something about childhood obesity and schools are a natural starting place.

But it is important to ask: Does the ban on sugary snacks and treats in schools go too far?

School Nutrition Policies, MA on my mind

As I mentioned on Twitter this morning, french fries appear to be the lunch food of choice for students in a popular school in Queens, New York, according to the New York Times. That probably doesn't surprise anyone who works in a school or has visited one during lunch. Unfortunately, I have not.

Nonetheless, my memories of school lunch are not much different. I remember tater tots and pepperoni hot pockets being standard fare. By the time I graduated, there was a salad bar in place; it was not very popular. Occasionally, I opted for the food served as part of the National School Lunch Program (spaghetti comes to mind) and on days of cross-country meets I habitually ate a peanut butter and jelly sandwich, which was a pretty good choice thinking back on it.

Soda Tax To Combat Obesity, Will it Work?

Cigarettes are taxed, alcohol is taxed, why aren't soft drinks taxed?

One huge reason for the dirth of legislation levied against unhealthy foods including sodas is the enormous lobby of the food industry in DC and across the country. Whenever there is serious consideration of restricting access to unhealthy foods (such as in public schools) there is enormous resistance. Big Food has lots of money to manipulate (I mean influence) public opinion so that there is not enough momentum and public support for anti-junk food policies. The sad story is that public health professionals can have nearly the same trouble improving access to healthy, nutritious foods in these same places!!

The lead story of the Business section of today's New York Times was "Tempest in a Soda Bottle: Proposed Tax on Sugary Beverages Debated." It discusses the increased political open-mindedness to the idea of a tax on soft drinks and sugar-sweetened beverages in the US and the likely resistance to such a proposal.

Here's why I think this could be a good idea.

Missing the Health in Health Care Reform

Michael Pollan was preaching to the choir today in his New York Times op-ed piece on "Big Food Vs. Big Insurance." His words were music to my ears:

"...the fact that the United States spends twice as much per person as most European countries on health care can be substantially explained...by our being fatter. ...

That's why our success in bringing health care costs under control ultimately depends on whether Washington can summon the political will to take on and reform a second, even more powerful industry: the food industry."

As excited as I was to hear Obama's rallying cry on health care reform last night, I was disappointed to hear prevention offered as a critical element of reform only one, maybe two, times.  Prevention isn't a sexy or politically inspiring topic, I know. Yet, public health is all about prevention. Public health is about "creating the conditions in which people can be healthy."

The food industry has significantly changed the way Americans (and populations globally) eat. Few countries have been spared. Those that refuse to let huge US-based multinational food manufacturers in, or that limit their reach, have often met much resistance and criticism. Yet, as Barbara Kingsolver would say, these resistant countries are protecting their food culture. They are also consequently protecting their health.

In an effort to get the cheapest, most convenient food we have sacrified quality, nutrition, and health. We have kids in America who are both obese AND malnourished. How have we let that happen?

While I am all in support of health care reform moving forward, it will in no way be a panacea for America's poor health. There are enough players out there who want to profit from sickness, not just the insurance companies. Pollan has brought this to our attention, once again.

Buying "Organic" Or Are You?

A few weeks ago the Washington Post ran an article titled "Purity of Federal 'Organic' Label is Questioned." It discusses the major battle that is being waged by organic food advocates over the federal loopholes that allow companies to achieve a 'USDA Organic' seal of approval without assurances that 100% of the ingredients are non-synthetic or cultivated organically (in actuality the real proportion is only 95% organic ingredients - click here for an explanation of the tiers of 'organic' labels). A few examples:

• Pre-grated organic cheeses -- wood starch
• Organic beer - non-organic hops (how is it organic then? the water?)
• Baby formula - synthetic fatty acids

So why did the federal government introduce these loopholes? Industry lobbying. The organic market is growing -- everyone wants to be 'in on it' even if they do not technically produce or sell organic products. So because Kraft and Dole (among others...) want to be able to put organic products in stores without the requisite time, energy, and skill they appeal to the Organic Standards Board to expand the list of allowable non-organic substances (...that 5%...). In 2002 that list had 77 items, now it has 245!

This is the reason why consumer education is so challenging and important. Industry is constantly trying to manipulate consumers by calling their products "100% whole grain," "fresh," and "natural". They play on consumer desire to eat healthier, but what results is little actual change and movement toward healthy because consumers are often being duped.

This is a major reason why small farms that sell to your local grocer -- not the big chains -- may not market their products as "organic" even though they are! Why go through the hassle of getting the organic label when the food giants are corrupting the name?

In my opinion, the addition of synthetic ingredients should disqualify products to be labelled as 'organic.' This is clearly not how the USDA defines it. And as for the quote by Barbara Robinson, the deputy USDA administrator for the organics program,

"We don't attempt to say how synthetic products can be produced... Manufacturers say the fatty acids [added to infant formula] are safe and provide health benefits to infants."

I would like to know how rigorous and effective are the health and safety checks conducted by manufacturers (??!!) -- I would say that is not a part of their training or expertise. These politicians can not rely on them for information! They need to look to an independent, expertly conducted evidence base of research. They must fund this and prioritize it for progress to be made and for this nonsense to end. 

We need people in Washington to stand up for small farmers and to not cave in to industry lobbyists. There needs to be a 'food constitution' and a revival of food culture in the United States that expects transparency and clarity with regards to what we are putting in our bodies each day and how that will affect our health, energy, and vitality down the road. 

Will Obama's increased funding for the Department of Agriculture's National Organic Program put an end to these charades? Or will it just expand the consumer abuse? 

I mean, really! If I'm paying more to buy 'organic' it better be exactly what I think it is...

School Nutrition Programs: Tied to Obesity?

The USDA (US Dept of Agriculture) has stated that there is insufficient evidence to suggest that the public nutrition programs (e.g. food stamps, public school lunches) they oversee are a cause of the obesity epidemic. I commend the USDA for working to improve the nutritional components of its public food programs (which, I believe is in response to evidence that the vast majority of its current food offerings are not very healthy and may in fact lead to excessive weight gain). For instance, the USDA is offering schools more choices such as whole grains, fresh fruits, and lean meats. However, these items are still significantly more expensive than the white, nutrition-less alternatives (white pasta, white bread, muffins, bagels, etc). Additionally, schools can only order a limited quanitiy of the whole-grain items. So when they run out -- they are out for the rest of the month.

There are currently programs in Masschussetts that are working with schools to help them understand the food menu options and train their staff to prepare new items well. For example, anyone who has cooked brown rice knows that it takes a little while longer than white -- and fresh vegetables cook differently than frozen.

Anecdotally, reports are promising that making public lunches nutritious by cutting back the high-sugar, high-salt, high-fat alternatives actually are well received by students. Studies that examine how much of the new nutritious meals are eaten compared to thrown in the trash only to be replaced with sugary soft drinks and soft-baked cookies are currently underway (yes...soft baked cookies were my snack of choice back in high school).

I'm excited to hear how things develop and hope the USDA continues to consider the evidence for providing nutrient-rich foods to low-income children and their families.

Take Our Beef, Or Else!

The week before leaving office, former President Bush approved a 300% tariff hike on Roquefort cheese. The news caught my attention while riding the T. Dramatically, the Metro article suggested that in retaliation the EU may raise the tariff for US imports of Coca-Cola. While this seems a bit far-feteched, I had to wonder 'Why? Why did our government decide to place such an enormous tax on Roquefort, the infamous moldy, sheep's milk, inimitable creation?'  

Well, according to reports in Time, Huffington Post, and the UK's Guardian this political decision was made to punish the European Union (EU) for their refusal to import meat raised with artificial hormones and antibiotics, a restriction that dates back to 1989. Take that EU or more specifically, the French district of Lozeyron! No longer will Americans enjoy your delectable cheese because you refuse to import our potentially toxic meats! I mean really?! What may be the effect of such tariffs -- recipes left unfulfilled? Wisconsin (i.e., domestic) alternatives embraced? Roquefort-lover riots in protest?

This short announcement caught my eye because it sheds light on the huge influence that the meat industry has on US policy -- both domestic and international. The EU ban on beef imports was due to the untraditional methods used to raise the cattle (i.e., use of antibiotics and hormones to help the cows grow fatter, faster on a  corn, rather than grass-based,  diet). In fact, the International Trade Commission published a 2008 report on the current state of US beef exports, which details which countries and regions are not importing US beef and why.  

Anyway, it was an interesting story I had to share. For more on US Food Policy and developments in "BigAg" check out this US Food Policy blog out of Tufts University. It is a great blog!

U.S. Addictions: High-fructose corn syrup & other artificial sweeteners

Americans have a major sweet tooth. The US has a sugar addiction that is quite unlike most other countries in the world. Rather than using natural sources of sugar minimally, we have increased our consumption of sugar over 250% in the past two decades. An article published in US News & World Report stated "In 2003, each person consumed about 142 pounds of sugar per year. ...[compared to] a dismal 8.3 pounds of broccoli and just over 25 pounds of dark lettuces." Now, this is not in the form of honey, agave nectar, or raw sugar cane. No, most of this is often in the form of highly processed (refined), or artificial sweeteners. One of the most inexpensive and widespread commercially used sugars is high fructose corn syrup (HFCS). 

HFCS is particularly toxic because of its pervasiveness in commercially available foods (ketchup, soup, cookies, crackers, cereal, yogurt, etc.), many of which would be considered "healthy" choices. Please, check your ingredient labels!! Whenever possible, chose an alternative that is made without sugar, or uses natural or minimally processed sugar.

Well, what is so bad about HFCS? ...good question, one I was recently asked...

High-fructose corn syrup has been shown to deplete the amount of chromium in the body. This is dangerous because chromium aids the glucose (sugar) molecules in passing from the bloodstream into the cells. A drop in chromium (like that caused by eating foods containing HFCS) can raise bad (LDL) cholesterol and triglycerides, as well as interfere with immune system functioning. Therefore, not only does it heighten peoples' risk of chronic disease (i.e., heart disease and stroke), but also acute illness (i.e., cold or flu). There are also studies that suggest excess sugar consumption (with HFCS and just generally) may be linked with certain types of cancer.

My general thoughts: the less you consume HFCS in your diet, the better. 

For more information see Mark's blog on the subject.

UPDATE: A good friend reminded me that strong evidence of the impact of HFCS on human health (particularly its effects on overweight/obesity) is relatively scarce. The extent to which HFCS is harmful to one's health is highly controversial and well debated. Yet, I felt a need to address some of the recent advertising from the Corn Refiners Association.  In my opinion, any information equating (or even implying) consuming HFCS with eating actual corn is as silly as equating consuming vegetable oil with eating -actual- vegetables. The statement that there is NO evidence of the effects of consuming substantial quantities of HFCS on health and disease is misguided. Healthful living depends on limiting your intake of refined carbohydrates -- which really means sugar in any of its multiple forms, HFCS being just one of them. If I have a choice between a popsicle made of simple sugar versus HFCS I think I will continue to choose the one made with sugar, better yet, I may choose no popsicle at all!

BlogHer reviews several online sources that examine the role of HFCS on health and wellbeing. I urge those who are more interested in getting information from both sides of the HFCS debate to check it out and make your own -informed- decision!