Posts Tagged: Lorrene Ritchie
At fast food and sit-down restaurants across California, kids' meals come with water or milk automatically. At least, that should be the case since state law requires restaurants to offer the healthy beverages by default to reduce the amount of sugary beverages served to children.
California Senate Bill 1192, authored by Sen. Bill Monning (D-San Luis Obispo), went into effect Jan. 6, 2019, but research by the UC Nutrition Policy Institute (NPI) has found that implementation has not been universal and more can be done. The results, along with results from a similar study in Wilmington, Del., were published Aug. 20 on HealthyEatingResearch.org.
Before the law, 10% of menu boards observed by the researchers in California listed only the healthy beverages. Data collected after the law went into effect showed 66% of menu boards list the healthy default beverages. The researchers also collected data on the proportion of cashiers who verbally offered only healthy beverages with kids' meals when orders were placed. This happened only 5% of the time before the law was enacted, and dropped to 1% after.
“Parents look at menu boards and kids look at menu boards, but it is likely that what the cashier says also influences which drink they choose,” said Lorrene Ritchie, NPI director and UC Cooperative Extension nutrition specialist. Ritchie was the lead researcher on the California portion of the study. “In our data collection, we would order a kids' meal and wait for them to offer a drink. But mostly they said, ‘What drink do you want?' instead of ‘Do you want water or milk with that?'”
The law doesn't specify whether the cashier must offer the default beverages, but the spirit of the law suggests they should, as it would likely have a greater impact on the selections that children and parents make, Ritchie said.
According to Gail Woodward-Lopez, an NPI researcher and co-investigator on the study, most restaurant managers expressed support for the legislation, but didn't know much about it.
“NPI in partnership with the California Department of Public Health is working with some local health departments to provide training and materials to help restaurants comply with the letter and spirit of the law,” Woodward-Lopez said. “Our next step is to measure whether this health department support is effective.”
The dire need to direct children away from sugary sodas is clear. Empty calories from soda and other sugar-sweetened beverages is the No. 1 cause of obesity in children, Ritchie said. Obese children are at least twice as likely as non-obese children to become obese adults. Obese children and adults are at greater risk for Type 2 diabetes, heart disease, stroke, high blood pressure, high cholesterol, certain cancers, asthma, low self-esteem, depression and other diseases. The Centers for Disease Control and Prevention names obesity as one of the conditions that increase risk of severe illness from COVID-19.
Many open questions remain, such as how drinks are portrayed on drive-thru signs and offered by drive-thru order takers. The COVID-19 pandemic has also altered the way Americans purchase food, with increased online ordering, delivery and drive-thru usage. In-store kiosk ordering is also growing in popularity.
“The role of default beverage policies in this context is important and not well understood,” Woodward-Lopez said.
Woodward-Lopez and Ritchie are working with colleagues around California and across the country to design follow-up studies of newer food technologies and beverage policies being passed elsewhere, to determine how government policies can protect children's health by steering them toward healthy beverage consumption.
The newly published research was funded by the Robert Wood Johnson Foundation and by the California Department of Public Health with funding from the United States Department of Agriculture.
A study of the first University of California campus (UC San Francisco) to ban the sale of soda on campus has shown that employees reduced their consumption by nearly 50 percent. UCSF staff who took part in the study also reduced their waist measurements and weight.
“This was not a ban on the consumption of sugared beverages,” emphasized co-lead author Laura Schmidt, PhD, MSW, MPH, UCSF professor in the Philip R. Lee Institute for Health Policy Studies. “This was a ban on sales on sugary beverages in vending machines, break rooms and cafeterias...People could still bring them from home or buy them off campus.”
The study was published Oct. 28, 2019, in the Journal of the American Medical Association, Internal Medicine.
California Assembly Member Richard Bloom (D–Santa Monica) noted the importance of workplace and governmental restrictions on soda sales while communities are prohibited from establishing local soda taxes for the next 12 years. In June 2018, the beverage industry strong-armed the California Legislature and Governor into enacting a “preemption” law that prohibits communities from passing local soda taxes.
“Workplace restrictions enable communities to take charge of their own health as we build momentum to pass AB 138, my bill that establishes a statewide soda tax that will fund prevention efforts. The bill will reduce soda consumption and generate positive health outcomes in impacted communities, where most needed, just like the UCSF effort,” Bloom said.
Lorrene Ritchie, UC Cooperative Extension specialist and director of the UC Nutrition Policy Institute, which conducts nutrition research to strengthen public policy, commented: “I am so impressed with both UCSF's sales ban and this very well-done study. Sodas are such a huge contributor to our obesity crisis that it is heartening to recognize a solution that any employer can adopt to help people improve their lives.”
Speaking of the UCSF study, lead author Elissa Epel, PhD, UCSF professor of psychiatry and director of the UCSF Aging, Metabolism, and Emotions Center, said: “This shows us that simply ending sales of sugary drinks in the workplace can have a meaningful effect on improving health in less than one year. There is a well-known pathway from soda to disease. High sugar intake leads to abdominal fat and insulin resistance, which are known risk factors for diabetes, heart disease, cancer and even dementia. Recent studies have also linked sugar intake to early mortality.”
Real progress has been made in tackling the epidemic of childhood obesity since the first California Childhood Obesity Conference was held 20 years ago, but there is more work to be done.
“Collectively, we have come so far,” UC Nutrition Policy Institute Director Lorrene Ritchie told an audience of 1,025 public health, nutrition education, research, and other professionals at the event in Anaheim in July 2019. NPI was one of six conference hosts.
In the last 20 years:
- Federal school meal standards have been revised so that the food children eat at school is healthier than the lunches they bring from home.
- Sugar-sweetened beverages are no longer available to students during the school day.
- Foods provided by the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) are healthier and give mothers incentive to breast feed their babies.
- The Supplemental Nutrition Assistance Program (SNAP) education component is now linked to policy, systems and environmental changes.
- The Child and Adult Care Food Program now provides healthier meals and snacks to children in childcare centers and homes across the country.
The average quality of the diet of American children has improved, but the rate of childhood obesity in the United States is still too high.
According to the Centers for Disease Control and Prevention, 18.5% of U.S. children and adolescents 2 to 19 years old are obese – about 13.7 million youth in all. The rates trend higher in minority communities, with 25.8% of Latinx youth and 22% of African American youth obese. Obesity is also more prevalent among children in families with low incomes.
Obesity, which is defined in children as a body mass index at or above the 95th percentile of CDC growth charts, is associated with poorer mental health status, reduced quality of life, and increased prevalence of diabetes, heart disease, stroke and some types of cancer.
The vice president of UC Agriculture and Natural Resources, Glenda Humiston, pledged the organization's commitment to community health and wellbeing at the Childhood Obesity Conference. UC ANR is the umbrella organization of the Nutrition Policy Institute, UC CalFresh Healthy Living, UC Cooperative Extension, 4-H Youth Development, the UC Master Gardener Program and the California Naturalist Program, among others.
“Going forward, solutions to the obesity epidemic are multidisciplinary,” Humiston said. “NPI does world class work in conducting research to influence nutrition policy. We need to harness 4-H. Master Gardeners are increasingly focusing on edible gardens. CalNat is getting people out into nature. We are finding synergies in community wellness.”
Humiston has dedicated UC ANR resources to finding and implementing solutions to the obesity crisis.
“I'm looking forward to working with all of you – public and private organizations – to design a way to move forward,” she said.
The opening keynote presentation at the conference featured Patricia Crawford, NPI's Senior Director of Research emeritus, a pioneer in addressing the growing problem of childhood obesity during her long career. Beginning in the 1970s, she recognized that childhood obesity was on the rise and launched several studies to search for the causes and potential solutions.
In one study, Crawford followed a group of 9-year-old African American girls over a period of 10 years to determine why these youth were growing up heavier than other adolescents.
“Finally, we began to get some answers,” Crawford said. “We learned obesity wasn't the children's fault. They were living in environments that made the unhealthy choice cheaper and easier to find. It's so unfair for people who have fewer resources. Health disparities has to be the No. 1 thing we are working on to address chronic disease rates in this country.”
“The solution to obesity is prevention. It's cheaper and more effective than treatment,” Crawford continued. “Healthy food is a taste that is easy to acquire if it is not preempted by junk food.”
Crawford said she honed in on the best strategies for prevention by actively listening to people struggling to make healthy choices
“There is a chasm between research and community,” Crawford said. “We have to get people together from the research level and the policy level with folks on the ground. We need to learn from people.”
Farmers grow lettuce, spinach, broccoli and other vegetables in California's Imperial Valley, Central Valley, Salinas Valley and far northern counties. However, these nutritious foods are not readily available to local low income communities.
“Children often don't have access to healthy food options,” said Christopher Gomez Wong, UC Cooperative Extension nutrition educator in Imperial County. “I'm from the Imperial Valley and often the fruits and vegetables grown here are not sold in local markets.”
According to the non-profit organization Feeding America, almost 2.5 million young people in the United States do not have access to nutritious food.
“In California, one of every six children lives in a home where it's difficult to get the amount of nutritious food needed for their families,” said Lorrene Ritchie, director of the UC Nutrition Policy Institute. “We call this ‘food insecurity.'”
A study by UC Agriculture and Natural Resources (UC ANR) found that food insecurity increases school absences and behavioral problems, and reduces children's concentration and academic achievement.
Ritchie, who leads a group of experts fighting obesity and food insecurity, said when family income is not sufficient, there is a tendency to buy cheaper foods, generally, junk food.
“If I'm hungry and I don't have much money, I'm going to a fast food restaurant where I can get more calories at a lower price,” Ritchie said. “Fast foods have more calories and cost less, but they typically also contain more sugar, salt and fat.”
For example, research presented at the UC ANR Statewide Conference on food insecurity included a graphic showing that for one dollar, consumers can purchase a bag of potato chips with 1,200 calories or a soda with 875 calories. In contrast, one dollar can buy just 250 calories of fresh vegetables or 170 calories of fresh fruit.
In everyday life, there are many examples of nutritious foods being displaced by junk foods
“We are studying children's eating habits,” Gomez Wong said. “Children aren't eating in the cafeteria and are eating lots of sweets. Five dollars more often buys them chips and a soda than a salad.”
UC ANR works to combat food insecurity in many ways. It implements various ongoing community programs, conducts research and promotes government nutrition programs.
Urban gardens and orchards have a positive impact in low income communities, particularly where families do not have space for their own gardens and are interested in growing their own food. One example is the Community Settlement Association in Riverside. Other cities with similar programs are Sacramento, San Jose, San Francisco, Los Angeles and San Diego.
UC Master Food Preserver Program teaches the public how to preserve food by canning, freezing and drying in order to take advantage lower prices for fruit and vegetables purchased in season.
Expanded Food and Nutrition Education Program (EFNEP) offers free nutrition workshops in most California counties where people can learn how to purchase nutritious foods for less money and how to prepare them.
In addition, there are successful government programs, such as the National School Lunch Program, that provides nutritious foods free or at a reduced cost for children in public schools. The food is aligned with the national food guidelines that promote the consumption of fruits and vegetables, whole grains, lean proteins and low-fat milk.
“Every study we have done shows that school food contributes in an important way to children's nutrition,” Ritchie said. “For example, many children can meet half of their daily nutrition needs from school foods available absolutely free. I encourage all families to review school food programs to assure that their children arrive at school in time for the school breakfast and take advantage of the school lunch.”
“What we are trying to figure out is how to create an environment in which healthy options are the easiest options,” Ritchie said.
She said it would be ideal if supermarkets were designed under in concert with the healthy eating guidelines set forth in MyPlate. That is to say, to have stores where half the space is devoted to fruit and vegetables, a third is grains and whole grains, and another third are proteins, dairy foods and water (although water is not currently on MyPlate.)
With an eye on reducing childhood obesity and improving overall health for children, the U.S. Department of Agriculture announced the final rule for snacks at schools. The rule made final on July 21 includes requiring snacks served at school to meet nutritional standards similar to those required of school meals.
Lorrene Ritchie, director of UC ANR's Nutrition Policy Institute applauds the USDA for their recently final Smart Snacks in School rule, which complements the nutritional improvements made to school lunches and breakfasts through the Healthy, Hunger-Free Kids Act.
Creating school environments that offer more healthful foods such as fresh fruits, vegetables and whole grains can also influence the way children eat at home and away from school.
“No single setting has the potential to influence the nutrition of more children than schools,” said Ritchie.
“Research – conducted by our Nutrition Policy Institute and others – has demonstrated that the healthy school foods and beverages consumed by children have a positive impact on their overall diet quality,” she said.
USDA also now requires any food or beverage that is marketed on school campuses during the school day to meet the Smart Snacks standards. Children are a target market for many foods and beverages that contain low nutritional quality and high calories that contribute to excess weight. To be advertised on a school campus, foods and beverages must meet the same Smart Snack standards for items sold or served by a school, according to the new Local School Wellness Policy rule.
“We are starting to see a leveling of child obesity rates in some places and changes to the school food environment are essential to furthering this progress,” said Ritchie.
Providing a consistent source of nutritious food at school will help the approximately 6.2 million California K-12 students develop healthy eating habits for life.
To read more about the federal changes to school food requirements, read the USDA news release at http://www.usda.gov/wps/portal/usda/usdahome?contentid=2016/07/0172.xml&contentidonly=true.