Posts Tagged: obesity
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.”
So today seems the perfect time to revisit a 2015 conversation with Rose Hayden-Smith, UC's Food Observer, and Crawford, now the Senior Director of Research at UC ANR's Nutrition Policy Institute. As Pat stated in her interview—
“Not changing is risky. The United States – along with Mexico – has the highest obesity rates in the industrialized world. With these extraordinarily high obesity rates, we are on a path toward ever-rising chronic disease rates including not just diabetes, but also heart disease and some cancers, increasing health care costs and reducing productivity.
Even more alarming, is a little known fact that 23 percent of the adolescents in this country currently have pre-diabetes or diabetes as measured by actual blood tests in our largest national study of health (NHANES). Something is seriously wrong in a society such as ours where so many children are growing up with such a high risk of preventable disease.”
You can read the complete interview at the UC Food Observer. You'll also find a recent story about the 45 youth advocates from organizations around California joining this year's conference to bring the voices of youth to this vital conversation.
On paper, the charge was clear: launch a statewide effort to integrate the nutrition education programs of USDA SNAP-Ed funded partners. Address childhood obesity and food insecurity holistically, yet specifically. Do this through policy, systems and environmental approaches that will leverage community participation and resources in order to create sustainability at the local level, and do it as funding is declining in SNAP-Ed programs.
But what would this integrated effort actually look like in practice? How could a single effort weave together the many agencies, actors, and systems that influence a child's earliest years, a family's food selection, and school and community activities? How could the people around a table, some meeting for the first time, coalesce around a shared vision, let alone mutually agreed strategies?
A problem as multifaceted as childhood obesity requires a similarly complex public health approach to meet the challenge. It is with this charge that over the past four years UC CalFresh has been working across California on nutrition education and obesity prevention with the California Department of Social Services, the California Department of Public Health, the California Department of Aging, and Catholic Charities to redefine Supplemental Nutrition Assistance Program-Education (SNAP-Ed, which is funded by the USDA Food and Nutrition Service).
The SNAP-Ed mission in California is to inspire and empower underserved Californians to improve their health and the health of their communities by promoting awareness, education, and community change through diverse partnerships, resulting in healthy eating and active living.
SNAP-Ed work is executed through county-led integrated workplans which now embody policy, systems and environmental (PSE) change in the body of work previously seen as a direct education program in schools and communities. Adding PSE activities to SNAP-Ed work acknowledges that a systems change approach that comprehensively addresses nutritional health where people live, learn, work, shop and play most effectively assures that children and their families will benefit from SNAP-Ed educational efforts.
- Tackling obstacles such as access to affordable fresh fruit and vegetables, safe areas to recreate, safe routes to school, and programs/curricula that encourage physical activity are important aspects of initiating long lasting community health and lifestyle changes.
- Teaming with the Department of Transportation or environmental programs such as Resilient Schools can fuse nutritional work with those working in other areas that contribute to and foster a safe, healthy community.
- Wellness policies in schools that encourage good nutrition and physical activity institutionalize healthy lifestyle choices.
- Programs like the Smarter Lunchroom Movement help schools and students make the healthy choice in food and beverages the easy choice.
- Environmental supports such as murals in the lunchroom or on school/community grounds visually reinforce key messages. On the playground, stencils depicting fruits and vegetables with key messages help motivate student's movement and play while reinforcing lessons learned in the classroom.
- Garden-based learning facilitates student and community members' exploration of low-cost methods to add fresh fruits and vegetables to their daily meal plan. Research shows that nutrition and gardening experiences, linked to academic standards for a specific age group, can increase vegetable and fruit consumption and physical activity.
Now, let's explore how these changes in the type of work executed through SNAP-Ed is poising California communities to tackle childhood obesity.
There is general agreement through research that the first years of children's lives can determine the rest of their development. Across ideological divides, there is consensus that investing early makes sense — it helps children develop healthy habits that can last a lifetime — creating a high return on the investment of public dollars.
As described, SNAP-Ed funded and non-funded partners in communities are tackling childhood obesity and food insecurity on multiple fronts. It has been initiated with five broad-based levers for change:
- Offering evidence-based direct nutrition education curricula and technical assistance
- Developing state and local partnerships
- Using data to inform strategies
- Building commitment among stakeholders
- Tackling policy and practice change
However, in the end, support in counties from SNAP-Ed funded partners requires community leadership and long term ownership to succeed. Each community is armed with essential knowledge about local context to make sense of these levers and to pursue emergent opportunities.
At the state and local level, the development and implementation of integrated workplans with community members input is a blueprint charting each counties course.
At the state level, the past four years of developing SNAP-Ed integrated workplans created several lessons in systems change evolution:
Listen and learn
The more we listen and support community members, bringing their ideas to the forefront of our work, the more sustainable our efforts will be.
Connect the dots and engage
Fragmentation and silos create a diverse but disconnected sector. Communicate and connect as much as possible.
Create mission and values statements that unify - then operate transparently
As you get to know the community members and organizations that you are working with— together create your mission and values statement and make that your solidifying “call to arms” — then work transparently to fulfill your mutual objectives.
Different settings, standards, and social norms create tension — successful systems change efforts face, rather than circumvent, these tensions…be respectful and “lean in”.
Foster a long term approach/celebrate short term “wins”
As we review the many factors that lead to childhood obesity and food insecurity, use long term systems change strategies, foster sustained commitment, and celebrate successes, no matter how small.
Be adaptable but purposeful
Reflect on how different organizations work and understand that your perspective may be a result of your vantage point. Try to be in another organization's or person's shoes, recognize their impediments, then work together with this in mind. Good strategies are shaped by reflection and steered with an understanding that there may be a need for course correction.
Keep a unified resolve
A recent Robert Wood Johnson Foundation report concluded that between 2005 and 2010 California saw “a modest but significant decline” in childhood obesity of 1.1 percent in grades 5, 7 and 9. In addition, a 2013 Centers for Disease Control and Prevention report indicated progress in the health of California preschoolers enrolled in federal health and nutrition programs. The report cited that “obesity rates among 2-4 yr olds from low income families dropped 2.9 percent from 17.7 percent in 2008 to 16.8 percent in 2011.” This data speaks to the significance of a comprehensive approach in preventing childhood obesity. Further, it emphasizes the importance of the teamwork provided by a network of state and local agencies, acting with community members, to make a difference in the lives of children.
- Since 2004, schools have removed soda and other sugar sweetened beverages from premises.
- Since 2007, schools have limited the calories, fat saturated, fat and sugar in snacks sold on their premises.
- Since 2012, school districts have been required to make free, fresh drinking water available in school food service areas.
- Since 2006, $40 million has been committed in annual dedicated state funding for elementary school physical education.
It was the first time a UC president has taken part in the long-running and nationally recognized gathering, noted the director of UC Agriculture and Natural Resources' Nutrition Policy Institute (NPI), Lorrene Ritchie.
“I think it demonstrates her commitment to the Global Food Initiative and the work we do at UC ANR,” Ritchie said.
During her remarks, Napolitano said it was fitting for her to speak at the conference as it coincided with the one-year anniversary of the Global Food Initiative, a sweeping effort involving all UC campuses and UC ANR that was inspired by many of the same concerns addressed by conference participants.
“As we meet here in San Diego today, a billion people — most but not all of them in the developing world — suffer from chronic hunger or serious micronutrient deficiencies,” Napolitano said. “Another half billion — primarily in the industrialized nations of the world, like the United States — suffer from obesity.”
Since the biennial conference's inception, Patricia Crawford, UC ANR Cooperative Extension nutrition specialist, and other members of NPI have been involved in its planning. Crawford announced she is “passing the baton” to Ritchie to guide the conference moving forward.
More than 1,700 nutritionists and other experts on children's health attended the San Diego gathering June 29 – July 2. In addition to the NPI, the conference was hosted by the California Department of Public Health, California Department of Education, the California Endowment and Kaiser Permanente.
NPI hosted a preconference workshop on June 29 to bridge the gap between research and policy regarding the federal nutrition assistance programs and the Dietary Guidelines, which reach more Americans than any other nutrition policy.
“The preconference session provided a rare opportunity for policymakers and administrators, nutrition researchers, advocates, and funders to sit together to identify today's key policy issues and propose research to inform future policy debates and developments,” said Kenneth Hecht, NPI director of policy. “Participants also focused on another extremely important question: How to improve communications in both directions between researchers and policymakers.”
“Childhood obesity is a national security challenge. The Joint Chiefs of Staff said that very clearly in 2013,” Clinton said. “In New York City, where I live, the New York City Fire Department and Police Department have said they are worried they won't be able recruit enough people to fill their ranks if obesity rates continue.”
To help address the problem, the Clinton Foundation along with the American Heart Association established the Alliance for a Healthier Generation 10 years ago. Because of the program, nearly 300 California schools have made changes significantly reducing overweight among children.
During a workshop session, NPI's Ritchie and other panelists discussed the importance of policies and standards for healthy alternatives to sugar-sweetened beverages for children in childcare settings. Crawford and other panelists presented data on childhood obesity trends and racial/ethnic disparities in California and discussed the health and financial consequences. They also addressed the cost-effectiveness of national and state excise taxes on sugar-sweetened beverages and labels to inform consumers of the health risks of consuming sugary drinks.
Hecht also moderated a panel on local and national initiatives that are linking farm fresh produce to food bank recipients. NPI researcher Elizabeth Campbell, who participated in the discussion with a local farmer, a food bank employee and a public health anti-hunger advocate, said food banks should have policies to guide the nutritional quality of their inventory.
During the closing plenary, First Lady Michelle Obama sent video greetings to the Childhood Obesity Conference attendees to praise them for their work and encourage them to continue to fight to protect children's health.
Ritchie has joined with dozens of nutrition and health professionals around the country to ask that the USDA put water onto MyPlate.
“We don't have all the answers to overcoming obesity, but the research on sugar-sweetened beverages is very clear,” Ritchie said. “When you drink beverages like soda, sports drinks or punch, the sugar gets absorbed very rapidly and the body doesn't recognize the calories. The result is excess calories and weight gain.”
The USDA introduced MyPlate in 2011 to reflect the message of its Dietary Guidelines for Americans, 2010. Federal law requires that the guidelines be reviewed, updated and published every five years.
“USDA officials say that, in order to change MyPlate, there must be more information in the dietary guidelines about water,” Ritchie said. “We are working through the public comment process to ask the advisory board to promote water as the beverage of choice.”
The ultimate goal – a new water icon on MyPlate – is important because of its high visibility. MyPlate is found on elementary school classroom walls and cereal boxes; at community gardens and the grocery store produce aisle.
“They see MyPlate as the face of the dietary guidelines and are very supportive of using the image as a teaching tool,” Hecht said. “They also supported the idea of adding a symbol for water.”
She shared the California educators' thoughts on MyPlate with her USDA contacts. “When they get a story from the field, it really matters to them,” Hecht said.
Ritchie and her colleagues around the country submitted a “Best of Science” letter to the Dietary Guidelines Advisory Committee imploring them to strengthen the language for drinking water.
“Current research indicates that children, in particular, are subject to ‘voluntary dehydration' from low intake of plain water,” the letter says. “Between 2005 and 2010, more than a quarter of children aged 4 to 13 years old in the U.S. did not have a drink of plain water on two consecutive days.”
Instead, they are drinking sugary beverages. National surveys in the early 2000s found that, on any given day, 84 percent of 2- to 5-year-old children drank sugar-sweetened beverages like sodas, sports drinks and fruit punch. The calories amounted to 11 percent of the children's total energy intake.
- Sugar-sweetened beverages – including sodas, juice drinks, pre-sweetened tea and coffee drinks, and fortified or energy drinks – are among the top sources of calories for children and adolescents.
- Between the late 1960s and early 2000s the consumption of sugar-sweetened beverages doubled.
- While the American Heart Association recommends no more than 6 teaspoons of added sugars per day for women and 9 teaspoons per day for men, the average U.S. consumption is 17 teaspoons per day.
- Low-income populations have higher intakes of sugar-sweetened beveragesand Latino children drink more of them than white children.
- Cardiovascular disease, present in more than one-third of American adults, is now understood to be exacerbated by the inflammatory effects of excess sugar consumption.
- Excess sugar consumption is a risk factor for non-alcoholic fatty liver disease, a precursor to diabetes.