Currently browsing posts about: Children

Yesterday, USDA and HHS released the official version of the leaked draft:  Make Our Children Healthy AgainStrategy 

It’s pretty much the same as the one I saw previously and posted about.

A bunch of reporters sent me copies of the draft for comment.  I wrote up some general comments:

Comments on MAHA Strategy Report

First impression:  Wait!  I’ve seen this before.  Make Our Children Healthy Again?  Isn’t that exactly what Michelle Obama was trying to do in 2010 with a Task Force Report, greeted by outrage and disdain for nanny-statism.  So here’s the RFK Jr version of the nanny state.

The report has a lot of ideas for actions that really could improve health, but is short on specifics and weak on regulatory action.  It has not changed much from the leaked version.  Its overriding message is still “more research needed.”   It does not say nearly enough about what needs to be done to improve the diets of America’s children.

On reducing intake of ultra-processed foods, it says it will try to develop a definition as a basis for future research and policy—a distant goal.

On school food, it says it will improve farm-to-school grants without noting the contradiction: this was one of the first programs eliminated by the Trump administration.

It gives a big win to the dairy industry: allows whole milk, eliminates low-fat requirements.

It does promote increased awareness of physical activity in schools but nothing about how schools are to pay for healthier meals or get more time.

It dropped any mention of reducing sugar and salt in processed foods.

What’s still missing is regulation.  So much of this is voluntary, work with, promote, partner.

The big issue for me is what are they going to do about food marketing to children?  They will “explore” “potential” guidelines for industry.  Really?  That’s all?

This is such an opportunity.  I sure wish they had taken it.

MAHA has so much bipartisan support.   This was the time to regulate food marketing to kids—not “explore,” get ultra-processed foods out of schools, and promote farm-to-school programs and school gardens—all shown to improve kids’ dietary intake.  Where’s the policy?

The bottom line: Where’s the action?

Press coverage

• Press release:  MAHA Commission Unveils Sweeping Strategy to Make Our Children Healthy Again
• Video of the press conference
• The Hagstrom Report interviewed lots of groups on reactions. Farm Action reprinted them.  The Ag industry is enthusiastic; others not so much.
• Food Fix: also has lots of comments from various groups
• Scientific American (I’m quoted)
• The New Lede (I’m quoted)
• Reuters (I’m quoted)
• Ag Funder News (I’m quoted)
• ABC News (I’m quoted)
• PBS News interview transcript  The video on X
• Time Magazine (I’m quoted)
• CSPI

We need good news.  This announcement comes from the Norwegian government.

It will still be legal to sell these products to children and youth, but marketing unhealthy products to this group will be illegal.

When it comes to products covered by the ban, the most unhealthy products, such as candy, soft drinks, ice cream and energy drinks, cannot be marketed particularly towards children. For other products, such as cereals, yogurt and fast food, limits for different nutrients are used to cover the most unhealthy products in these categories. For example, for breakfast cereals, the content of sugar and dietary fibre determines whether the product can be marketed particularly towards children or not.

The foods that are covered by the ban are listed in a product list attached to the regulation (in Norwegian, PDF).

I looked for an English translation and found this from Obesity Action Scotland:

The ban on unhealthy food advertising will cover all forms of marketing, including television, print, online, and in schools. Products affected by the ban include sugary drinks, salty snacks, and fast food…The regulation will ban the advertising of unhealthy foods that are high in fat, salt, or sugar. It will also ban the advertising of foods that are marketed as being “healthy” or “natural,” if they are high in unhealthy ingredients.

Impressive!  I wish RFK Jr’s MAHA campaign would do this as well as removing color additives.

Thanks to Marit Kolby for sending this.

The White House has announced the formation of a President’s Commission on Making America Healthy Again

It will be chaired by newly confirmed HHS Secretary Robert F. Kennedy Jr, and according to the The MAHA Commission Fact Sheet “is tasked with investigating and addressing the root causes of America’s escalating health crisis, with an initial focus on childhood chronic diseases.”

The Commission will include representatives of relevant agencies.  It is to:

• Produce a Make our Children Healthy Again Assessment within 100 days.
• Submit a Make our Children Healthy Again Strategy within 180 days.

Comment

Whew.  I can’t wait to see what this Commission comes up with.  But it sounds like nothing will be done, actually, for at least six months.

Oh.  Wait!  I’m having a deja vu.   Didn’t we already do this?

Isn’t this just what Michelle Obama’s Let’s Move initiative did in 2010?

• Recall: White House Task Force on Childhood Obesity Report to the President: Solving the Problem of Childhood Obesity Within a Generation.
• Also recall: Republicans pushed back so hard on this that hardly any of it could be accomplished.
• And: President Trump opposed her initiatives as late as 2017.

Don’t get me wrong.  I am totally for doing this and hope the Commission takes its mandate seriously.

Let’s Move got pushback for trying to take on the food industry.  If RFK, Jr’s Commission can do this, it will deserve much applause.

As always, stay tuned.

The headline in The Guardian: UK children shorter, fatter and sicker amid poor diet and poverty, report finds.

Here’s the report.

It’s principal findings:

• The height of 5 year olds has been falling since 2013.
• Obesity among 10-11 year olds has increased by 30% since 2006.
• Type 2 diabetes among under 25s has increased by 22% in the past 5 years.
• Babies born today will enjoy a year less good health than babies born a decade ago.

As it says in the introduction,

Crucially, the report not only highlights a deeply worrying increase in conditions driven by calorie dense diets such as obesity and type 2 diabetes, but also highlights the equally concerning and substantially less talked about results of poor-quality diets and undernutrition….All children should be able to eat in way that fuels their bodies and minds, giving them sufficient calories and nutrients to be free from hunger and diseases of nutritional deficiency, while being protected from the bombardment of ultra-processed, highly sugary and salty foods that most often contribute to excess calorie intake but lack vitamins, minerals, fibre, healthy fats and quality protein.

Comment

I’m guessing if a similar study were to be done in the United States, its results would be similar.  Children are the future of our nation and society; they deserve good health and protection against junk food.

Shannon Saia sent me copies of three books in the series, Gertie in the Garden, aimed at kids ages 6-9.  Here’s one:

The other two are Going Offbeet and Making Peas (puns intentional).

She asked if I would blurb the series.  Once I read them, I was happy to:

The Gertie in the Garden series is so engaging that kids will catch on right away to why growing vegetables and even playing with them will encourage kids to view healthy foods as helping them negotiate their way in the world.  Kids will love these books (and parents will too).

I have to admit to not liking most books aimed at getting kids to like vegetables.  But I liked these a lot.  For one thing, they are focused on Gertie’s struggles to figure out how to get along with others (not easy, in her case), and her social awkwardness feels real—and fixable.

For another, learning how to garden with her grandmother is a relief from those struggles and integrated into her life in a way that again seems authentic.

I think it would be fun to read these to young kids not yet ready to read them on their own.  And the stories raise plenty of issues to talk about as well as offering practical advice about how to grow these vegetables.

Shannon tells me these are available in the usual way through bookstores and online.

So many readers have asked me to comment on the American Academy of Pediatrics’ Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity that I thought I ought to say something about it.

The guideline report is so long and detailed that I cannot imagine anyone actually reading it.  I started with the introduction, which summarizes basic facts.

• 14.4 million children and adolescents are affected by obesity.
• Obesity is a chronic disease with potentially serious health consequences
• Childhood obesity is strongly affected by social determinants of health (poor education, poverty, racism, exposure to toxins, etc)
• Childhood obesity is stigmatized in ways that fail to acknowledge social determinants.

What got press attention—and the attention of readers of this blog—is the AAP’s endorsement of drug and bariatric surgical treatment of obese children.

I cut right to the chase and looked at Appendix I, which gives the AAP’s algorithm for deciding on treatment options.  

The report’s major conclusions expand on this chart (the report does not define KAS, but I think it means Knowledge, Attitudes, and Skills):

KAS 9.  Pediatricians and other PHCPs should treat overweight (BMI ≥ 85th percentile to <95th percentile) and obesity (BMI ≥ 95th percentile) in children and adolescents, following the principles of the medical home and the chronic care model, using a family-centered and nonstigmatizing approach that acknowledges obesity’s biologic, social, and structural drivers.

KAS 10.  Pediatricians and other PHCPs should use motivational interviewing (MI) to engage patients and families in treating overweight (BMI ≥ 85th percentile to <95th percentile) and obesity (BMI ≥ 95th percentile).

KAS 11.  Pediatricians and other PHCPs should provide or refer children 6 y and older (Grade B) and may provide or refer children 2 through 5 y of age (Grade C) with overweight (BMI ≥ 85th percentile to <95th percentile) and obesity (BMI ≥ 95th percentile) to intensive health behavior and lifestyle treatment. Health behavior and lifestyle treatment is more effective with greater contact hours; the most effective treatment includes 26 or more hours of face-to-face, family-based, multicomponent treatment over a 3- to 12-mo period.

KAS 12.  Pediatricians and other PHCPs should offer adolescents 12 y and older with obesity (BMI ≥ 95th percentile) weight loss pharmacotherapy, according to medication indications, risks, and benefits, as an adjunct to health behavior and lifestyle treatment.

KAS 13.  Pediatricians and other PHCPs should offer referral for adolescents 13 y and older with severe obesity (BMI ≥ 120% of the 95th percentile for age and sex) for evaluation for metabolic and bariatric surgery to local or regional comprehensive multidisciplinary pediatric metabolic and bariatric surgery centers.

What is not in this guideline is anything that addresses the social determinants of childhood obesity.  What we have here is a focus on treating the symptoms, but getting nowhere near the cause.

It is difficult for someone like me who is not affected by those determinants to even imagine how drugs and surgery could be thought even remotely acceptable for children, even those over the age of 12, but I am not treating these kids.

Providers who do treat obese children tell me they are relieved to be able to offer options that might help kids achieve healthier weights.

As I see it, these should be absolute last resorts if used at all. And this is without even getting into issues of cost or our dysfunctional health care system.

In public health terms, drugs and surgery are “downstream” solutions to a problem that began way upstream with all those societal determinants.

If ever we needed upstream approaches, chldhood obesity is a prime example.

Upstream means policy changes that make healthy eating more appealing, accessible, and affordable  That’s what pediatricians need to be calling for.

This AAP report deliberately separates treatment from prevention.  It promises a discussion of prevention in a subsequent report.  I hope it is as hard hitting as any AAP report has ever been.

If childhood obesity teaches us anything, it is that our society needs to change in ways that are healthier for our children.

Additional supporting documents

• Executive Summary: Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity
• Appraisal of Clinical Care Practices for Child Obesity Treatment. Part I: Interventions
• Appraisal of Clinical Care Practices for Child Obesity Treatment. Part II: Comorbidities

Thanks to all the people who wrote me about this.  Much appreciated.

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For 30% off, go to www.ucpress.edu/9780520384156.  Use code 21W2240 at checkout.

The White House Conference on Hunger, Nutrition & Health is convening today.  As a reminder of why it matters, here’s what’s happening with the much-needed reauthorization of the Child Nutrition Bill.

The reauthorization bill, required every five years, was introduced in the House in July as H.R.5919 – Early Childhood Nutrition Improvement Act of 2021.  If and when passed, it will:

• Increase kids’ access to free school meals
• Expand kids’ access to summer meals
• Expand kids’ access to day care meals
• Expand WIC (the Special Supplemental Nutrition Program for Women, Infants, and Children) benefits and access
• Enable Tribal sovereignty in program administration 

The Food Research & Action Center (FRAC) offers:

• A primer on the bill
• A full summary of the bill

I’m hoping the White House Strategy announced today will include these elements for reducing childhood hunger.

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Coming soon!  My memoir, October 4.

For 30% off, go to www.ucpress.edu/9780520384156.  Use code 21W2240 at checkout.

The World Health Organization has just published “Food marketing exposure and power and their associations with food-related attitudes, beliefs and behaviours: a narrative review”

This is an update of a review WHO published in 2009 on the extent, nature and effects of food marketing.

The update includes a review of studies from 2009 to 2020 of

• Where food marketing occurs
• How much there is,
• Which brands and products are marketed
• How they are marketed
• How consumers react to food marketing

The report, which covers digital and social media,  concludes

Food marketing remains prevalent

• It is especially prevalent where children are and what they watch on TV
• It predominantly promotes “fast food”, sugar-sweetened beverages, and chocolate and confectionery
• It uses a wide range of creative strategies  aimed at young audiences (celebrity/sports endorsements, promotional characters, games)
• Its exposure is positively associated with habitual consumption of marketed foods or less healthy foods

The report confirms what advocates have been saying for years

• Food marketing is pervasive
• Food marketing is persuasive
• Food marketing is bad for health

The bottom line: Food marketing, especially to children, must be stopped