Currently browsing posts about: Obesity-in-kids

Mrs. Obama’s Let’s Move campaign is one year old and people are asking me whether it has accomplished anything.  I think it has.

• It has brought childhood obesity to public attention, as never before.
• The choice of action areas—fixing school food and getting supermarkets into inner city food deserts—makes excellent sense.  Both are doable and both can make a real difference to kids and their families.
• Encouraging the makers of packaged foods to reduce salt and sugar and to stop blatant marketing to kids brings attention to their worst practices.
• And now, according to the New York Times, Mrs. Obama is talking to restaurant companies about serving healthier foods, especially to kids.

This last one warms my heart.  Six or seven years ago, I was invited to speak to a small group of owners of restaurant chains, Applebee’s, Darden’s, and the like.  I went with a three-point agenda:

• Make healthy kids’ meals the default.
• Give a price break to encourage people to order smaller portions (charge 70% for a 50% portion, for example).
• And stop funding the Center for Consumer Freedom (an aggressive PR firm that does the dirty work for restaurant and other industries).

The response?  Ballistic. “What are you trying to do, put us out of business?”

Well, times have changed.  Some of those chains are actually doing some of these things.  And now the First Lady is urging them to do the first two points on my agenda, at least.

Mrs. Obama has no legislated power.  She only has the power of leadership and persuasion.  I’m glad she’s using it to promote action on childhood obesity, challenging as that is.

Happy birthday!

Occasionally I write short pieces on request.  A couple have just been published.

The State Department’s Bureau of International Information Programs (who knew?) runs a website, America.gov, on which it provides answers to questions “YOU Asked!”   It invited me to respond to the question, “Why are so many Americans overweight.”

And the professional journal, Childhood Obesity, asked several people to contribute to its new “Industry Watch” column.  The question: “Will private sector companies “step up to the plate” to protect children’s health?

Enjoy!  I file links to these and other writings under Publications on this site.

The World Health Organization (WHO) has a new, tough report out: “Set of recommendations on the marketing of foods and non-alcoholic beverages to children.”

It’s policy aim: to reduce the impact on children of marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt.

Here are some of its recommendations (edited):

• Given that the effectiveness of marketing is a function of exposure and power, the overall policy objective should be to reduce both the exposure of children to, and power of, marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt.
• To achieve the policy aim and objective, Member States should consider different approaches, i.e. stepwise or comprehensive, to  reduce marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt, to children.
• Settings where children gather should be free from all forms of marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt.
• Governments should be the key stakeholders in the development of policy and provide leadership, through a multistakeholder platform, for implementation, monitoring and evaluation. In setting the national policy framework, governments may choose to allocate defined roles to other stakeholders, while protecting the public interest and avoiding conflict of interest.
• Considering resources, benefits and burdens of all stakeholders involved, Member States should consider the most effective approach to reduce marketing to children of foods high in saturated fats, trans-fatty acids, free sugars, or salt.
• Member States should cooperate to put in place the means necessary to reduce the impact of crossborder marketing (in-flowing and out-flowing) of foods high in saturated fats, trans-fatty acids, free sugars, or salt to children.

The Rudd Center at Yale has just released Fast Food F.A.C.T.S., a thoroughly comprehensive report on the marketing of fast food to children and adolescents.

The report lavishly illustrates and extensively documents the ways in which fast food companies market to kids, the strategies they use, and the effects of these efforts on kids’ diets.

Readers: add it to your library!  FDA and FTC: get busy!

Addition: Advertising Age reports on the fast food industry’s response to the Rudd Center report.  All the industry can come up with, says Advertising Age, is a “canned response.”  Looks like the Rudd Center got it right.

The Government Accountability Office has analyzed the current status of food assistance programs in a recent report, “Domestic Food Assistance: Complex System Benefits Millions, but Additional Efforts Could Address Potential Inefficiency and Overlap among Smaller Programs” (GAO-10-346, April 15, 2010).

The GAO says that the prevalence of food insecurity rose to nearly 15 percent (or about 17 million households) in 2008, and that the federal government spent more than $62.5 billion on 18 different food and nutrition assistance programs that year.

Although the programs are poorly coordinated and often overlap, streamlining them is not easy and involves trade offs.  The GAO recommends that USDA:

identify and develop methods for addressing potential inefficiencies among food assistance programs and reducing unnecessary overlap among the smaller programs while ensuring that those who are eligible receive the assistance they need. Approaches may include conducting a study; convening a group of experts…considering which of the lesser-studied programs need further research; or piloting proposed changes.

More research needed!

Fortunately, we have some.  The Robert Wood Johnson Foundation has studied the question of whether food insecurity is linked to obesity.  Past research suggested that it is.

Foundation researchers reviewed studies examining a possible relationship between food insecurity and obesity, and those examining links between federal nutrition assistance programs and an increased risk of obesity.

The report, “Food Insecurity and Risk for Obesity Among Children and Families: Is There a Relationship?, finds no evidence of a direct relationship between food insecurity and obesity.  It also does not find a direct relationship of use of food assistance to obesity.

Food insecurity is linked to a host of physical and mental health problems and it is difficult to distinguish the effects of lack of reliable food from those due to the lack of money, education, transportation, stable housing, and health care also common among low-income households.

Harvard pediatrician David Ludwig and Tufts professor Alice Lichtenstein team up in a JAMA commentary with a novel idea.  How about re-introducing home economics into the school curriculum!

Girls and boys should be taught the basic principles they will need to feed themselves and their families within the current food environment: a version of hunting and gathering for the 21st century. Through a combination of pragmatic instruction, field trips, and demonstrations, this curriculum would aim to transform meal preparation from an intimidating chore into a manageable and rewarding pursuit.

…Obesity presently costs society almost $150 billion annually in increased health care expenditures. The personal and economic toll of this epidemic will only increase as this generation of adolescents develops weight-related complications such as type 2 diabetes earlier in life than ever before. From this perspective, providing a mandatory food preparation curriculum to students throughout the country may be among the best investments society could make.

I’m in California but fortunately was up early enough to participate in an unexpected White House conference call.  This was a preview of the press conference held this afternoon to announce food company pledges to reduce the calories in their products by 1.5 trillion by 2015.  As the press release explains, the 16 food company members of the  Healthy Weight Commitment Foundation (HWCF)

are pledging to take actions aimed at reducing 1.5 trillion product calories by the end of 2015. As an interim step to this goal, HWCF will seek to reduce calories by 1 trillion in 2012.

The energy gap?  That’s the 1.5 trillion excess calories that Americans consume each year on average.  This number assumes that the American population consumes an excess of 100 calories a day (the kids’ gap is less).  This number comes from some unexplained manipulation of 100 calories x 365 days per year x 300 million Americans.

How will food companies do this?

Healthy Weight Commitment Foundation manufacturing companies will pursue their calorie reduction goals by growing and introducing lower-calorie options; changing product recipes where possible to lower the calorie content of current products; or reducing portion sizes of existing single-serve products. These changes will help Americans reduce their calorie intake, improve their overall nutrition and close the energy gap.

How will we know they will actually do this?

To assess the impact of the pledge, the Robert Wood Johnson Foundation (RWJF) will support a rigorous, independent evaluation of how the Healthy Weight Commitment Foundation’s efforts to reduce calories in the marketplace affect calories consumed by children and adolescents. RWJF will publicly report its findings.

What are we to make of all this?  Is this a great step forward or a crass food industry publicity stunt?*  History suggests the latter possibility.  Food companies have gotten great press from announcing changes to their products without doing anything, and every promise helps stave off regulation.

On the other hand, the RWJF evaluation sounds plenty serious, and top-notch people are involved in it.  If the companies fail to do as promised, this will be evident and evidence for the need for regulation.

As I explained to Jane Black of the Washington Post, the White House efforts to tackle childhood obesity have been consistent and relentless.  What the White House is doing is holding food companies to the fire for making kids fat. That’s awkward for the companies.  They don’t see it as good for business.  Hence the agreement to change.

What the White House has not been able to get are similar pledges about marketing to kids, but that – and front-of-package labeling – are clearly the next targets.

So let’s give Michelle Obama a big hand for taking this on.  I will be watching for the evaluation with great interest although I hate the idea that we have to wait until 2015 to see the results.

*Added comment: see Michele Simon’s considerably less optimistic post on this.  As she puts it, “who needs policy when you’ve got promises?”

Update May 18: FoodSafetyNews covered the event.  The Atlantic’s political editor is skeptical and notes the absence of a

Calorie Measuring Authority, and the science of counting calories is not as exact as one might think. The Grocery Manufacturers Association, which helped to put together today’s event, spent $1 million in the first quarter of 2010 on lobbying, much of it for the maintenance of corn subsidies.

This report, Solving the Problem of Childhood Obesity Within A Generation, is a terrific summary of where we stand today on childhood obesity (“the challenge we face”) and what to do about it. The report wants to reduce rates of child obesity to where they were before all this started:

That means returning to a childhood obesity rate of just 5% by 2030. Achieving this goal will require “bending the curve” fairly quickly, so that by 2015, there will be a 2.5% reduction in each of the current rates of overweight and obese children, and by 2020, a 5% reduction.

This seems so modest that it might actually be achievable.

Like most such plans, this one has way too many recommendations, in this case, 70 (the summary table starts on page 89).  These are divided up in categories.  For example:

Recommendations for early childhood

• Educate and help women conceive at a healthy weight and have a healthy weight gain during pregnancy
• Encourage and support breastfeeding
• Prioritize research into chemicals in the environment that may cause or worsen obesity
• Educate and support parents in efforts to reduce kids’ TV and media time
• Improve nutrition and physical activity practices in child nutrition programs.

For empowering parents and caregivers:

• Government should work with local communities to promote the 2010 Dietary Guidelines for Americans and the 2010 food pyramid.
• USDA and FDA should work with the food and beverage industry to develop standard nutrition labels for packages.
• Restaurants and vending machines should display calorie counts of all items offered.
• The food and beverage industry should extend its voluntary self-regulation to restrict all forms of marketing to children. If this does not happen, federal regulation should be considered
• Media and entertainment companies should limit licensing of popular characters to healthy food and beverage products
• Insurance plans should cover services needed to help prevent, assess, and care for child obesity.

For healthier food in schools

• Update federal standards for school meals and improve the nutritional quality of USDA foods provided to schools.
• Increase funding for school meals.
• Encourage schools to upgrade cafeteria equipment to support healthier foods. Example: Swap deep fryers for salad bars.
• Connect school meal programs to local growers and encourage farm-to-school programs.
• Improve nutritional education in schools and make it more available.
• Increase the use of school gardens to educate about healthy eating.
• Promote healthy behaviors in juvenile correction facilities.

For improving access to healthy foods

• Launch a multi-agency “Healthy Food Financing Initiative” to make healthy foods more available in underserved urban and rural communities.
• Encourage local governments to attract grocery stores to underserved neighborhoods
• Encourage facilities that serve children (e.g., hospitals, recreation centers, and parks) to promote healthy foods and beverages.
• Provide economic incentives to increase production of healthy foods such as fruits, vegetables, and whole grains.
• Evaluate the effect of targeted subsidies on purchases of healthy foods through nutrition assistance programs.
• Study the effects of state and local sales taxes on calorie-dense foods.

For increasing kids’ physical activity

• School programs should stress physical activity as much as healthy nutrition.
• State and local school programs should increase the quality and frequency of age-appropriate physical education taught by certified PE teachers.
• Promote recess for elementary school students and activity breaks for older students.
• Federal, state, and local agencies should partner with communities and businesses to extend the school day in order to offer physical activity programs.
• The EPA should assist communities building new schools to place them on sites that encourage walking or biking to school.
• Increase the number of safe playgrounds and parks, particularly in low-income communities.
• Encourage entertainment and technology companies to continue developing new ways to engage kids in physical activity.

Good ideas, but there are some things I’m not so crazy about here.  The plan seems awfully voluntary and let’s be pals and all work together. Voluntary, as evidence demonstrates, does not work for the food industry.  Much leadership will be needed to make this plan work.  But these recommendations should give advocates plenty of inspiration to continue working on these issues.

The Washington Post has a particularly good summary of the key recommendations, and singles out the ones aimed at marketing to kids.

Jane Black of the Washington Post is cautiously optimistic.  Me too.

Today is Easter Sunday and my monthly San Francisco Chronicle column appears today.  It deals with Michelle Obama’s campaign against childhood obesity.  Enjoy!

Kudos for first lady’s anti-obesity campaign

Nutrition and public policy expert Marion Nestle answers readers’ questions in this monthly column written exclusively for The Chronicle. E-mail your questions to food@sfchronicle.com, with “Marion Nestle” in the subject line.

Q: What do you think of Mrs. Obama’s “Let’s Move” campaign against childhood obesity? It doesn’t say much about junk food or food marketing. Isn’t this a cop-out?

A: Skeptic that I usually am, I have nothing but applause for Michelle Obama’s decision to adopt childhood obesity as the first lady’s official cause. Lady Bird Johnson’s legacy is the flowers that bloom throughout the nation’s capital. Obama must want hers to be the flowering of better health for our nation’s children.

Yes, Obama is sensitive to political realities. She calls her campaign “Let’s Move” rather than “Let’s Eat Less Junk Food.” But its goals are crystal clear. Her campaign aims to improve food in schools and eliminate “food desert” areas without access to healthier foods.

The White House organic garden is an integral part of this effort. It is no accident that Will Allen, the charismatic head of Growing Power, the group that runs urban farms in Milwaukee and Chicago, spoke at the campaign news conference. Good food, he said, is about social justice. Every child should have access to good food.

This campaign reveals real leadership on a desperately important issue. Obama brings diverse groups to this table. She presses government agencies to take action. She exacts promises from Congress to make it easier for kids to eat low-cost meals in schools. She got her husband to create a task force to tackle ways to prevent childhood obesity.

In addition, she is asking professional and business groups to do more to help kids eat better. I’m particularly impressed by her speech to the Grocery Manufacturers Association, which represents the makers of processed foods and beverages.

With masterful tact, Obama nonetheless insisted that the association “entirely rethink the products that you’re offering, the information that you provide about these products, and how you market those products to our children.” We parents, she said, want assurance that food companies will stop “teaching kids that it’s good to have salty, sugary food and snacks every day.”

Yes, she avoids saying anything about soda taxes or other measures that might make it easier for kids and parents to make better food choices, but she is bringing childhood obesity to public attention in a fresh, new way.

Consider what her campaign is up against. Preventing obesity means eating less, often a lot less, of processed fast-food, snacks and sodas. This puts the makers of such foods in an impossible bind. Eating less is not good for business.

Short of going out of business, what can such companies do to help? They can reformulate their products to make them a little healthier. They can stop marketing their products directly to children. But this, too, is bad for business – unless it can be used for public relations.

Indeed, food and beverage companies are falling all over themselves – with much fanfare – to reformulate and to promise to restrict marketing that targets kids.

PepsiCo, the maker of soft drinks and Frito-Lay snacks, says it will stop pushing sales of full-sugar soft drinks to primary and secondary schools worldwide by 2012. The new policy is voluntary, encourages rather than mandates, and assures school districts in the United States and abroad that the company will not tell them what to supply.

It keeps vending machines in schools and allows for continued sales of branded sugary drinks such as Gatorade, juice drinks, and sweetened milk.

Kraft Foods says it will reduce the sodium in its foods by 10 percent, also by 2012. This sounds good, but has a long way to go. Kraft’s Macaroni & Cheese (the SpongeBob package) contains 580 mg sodium per serving and two servings per package. A 10 percent reduction takes 1,160 mg sodium down to 1,050 mg. Salt is 40 percent sodium, so this brings salt down to 2.6 grams – about half a day’s upper limit for adults.

Still, these are steps in the right direction. Are they meaningful? You decide.

In the meantime, the Center for Responsive Politics, a nonprofit research group focused on the effect of money on public policy, says soda companies have increased by ten-fold the amount of money they spend on lobbying – no doubt to counter the threat of soda taxes.

What are we to make of these responses? They raise my favorite philosophical question: “Is a slightly better-for-you processed food necessarily a good choice?”

What would be better for preventing childhood obesity would be to make eating real foods the default. These, as defined by Oakland’s Prevention Institute, are relatively unprocessed foods that contain nothing artificial. And they are produced in ways that are good for farmworkers, farm animals and the environment, and are available and affordable to all.

Getting to that point requires policy as well as voluntary actions. Perhaps I’m reading too much into Obama’s campaign, but that’s how I interpret it. I’m supporting it. How about you?