Posts Tagged: nutrition
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.
Robert Wood Johnson report to help children grow up at a healthy weight.
- 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.
The decision, reflecting the latest science, will be felt well beyond the label. University of California food experts praised the labeling changes and offered six key takeaways.
1. Listing added sugar is the most important label change.
The new label will list the amount of added sugar in a product, both in grams and as a percentage of the daily recommended allowance.
“That's key,” said Laura Schmidt, a UC San Francisco professor of health policy and UC Global Food Initiative subcommittee member. “That will be really helpful for consumers.”
Added sugar – any sugar added in the preparation of foods such as table sugar, high fructose corn syrup and others – can be found in hundreds of products such as cereal, yogurt, pasta sauce and salad dressing. But the biggest source is sugar-sweetened beverages, which account for nearly half of Americans' intake of added sugar.
One 20-ounce soda will take you over the recommended amount of sugar for an entire day,” said Pat Crawford, senior director of research for the Nutrition Policy Institute of UC's Division of Agriculture and Natural Resources. “The new label will allow people to reasonably see what they're doing when they're consuming high-sugar products.”
The current label lumps added sugar with naturally occurring sugars in the foods themselves, which is a deceptive practice, said Dr. John Swartzberg, a UC Berkeley clinical professor emeritus and editorial board chair of the UC Berkeley Wellness Letter. Listing added sugar “will hopefully guide people away from consuming products with a lot of added sugar,” he said.
More than one out of three adults in the U.S. is obese. Nearly half of U.S. adults have prediabetes or diabetes, raising their risk of heart attacks, kidney failure, blindness and amputations. Among U.S. children, more than 1 in 6 is obese, and diabetes and prediabetes rates are rising. Amid these alarming statistics, there's a growing concern about too much added sugar in diets.
“It's important to give the public the information they need in order to modify their diets,” Crawford said. “We are now finding significant effects on diabetes and heart disease rates for those who regularly consume sugary beverages. A large study of women over an eight-year period found that the risk of diabetes among women who consumed one or more servings of sugar-sweetened beverages per day was nearly double the risk among women who consumed less than one serving per month. Further, drinking one 12-ounce soda a day increases the risk of cardiovascular mortality by almost one-third.”
Crawford noted that the new federal dietary guidelines for the first time recommend limiting added sugars in the diet to no more than 10 percent of one's daily calories.
“The average amount of added sugar in the American diet is more than 20 teaspoons per day, nearly all of which is added to our foods during processing,” Crawford said. “Since about half of this sugar comes in the form of beverages, we have to rethink our beverage choices. Water should be the beverage of choice.”
Consumers will be very surprised to see the percentage of daily value of added sugar in one soda drink, said Michael Roberts, executive director of the UCLA Resnick Program for Food Law and Policy and UC Global Food Initiative subcommittee member. “Time will tell whether this information changes human behavior, i.e., consuming less soda. To be fair, sugar pops up everywhere, not just soda, so the impact that these changes will have on consumers and manufacturers will be interesting to watch.”
3. Expect manufacturers to make product changes.
When the federal government required that manufacturers add trans fat information on the label a decade ago, the food industry responded by marketing more products with lower trans fats, Crawford said.
“Trans fats are now not allowed to be added to foods during processing, but it all began with labeling,” Crawford said. “We're going to see some big shifts in the marketplace with products lower in sugars such as cereals, yogurts, spaghetti sauces and beverages, of course. We can look forward to recipe reformulation, which will make products more competitive. It's a great first step for reducing sugar consumption. In preparation for the new labels, manufacturers are working on creating products with lower levels of added sugars.”
For manufacturers, the trick will be to keep food tasting good to consumers while reducing sugar, Roberts said. “Other large manufacturers will pursue new products that are not heavy on added sugars,” Roberts said. “For example, Coke and Pepsi sell bottled water.”
“There is a push to at least re-size products,” Schmidt added. “There certainly will be an effort for front-of-package labeling that says ‘low sugar.'”
4. The new label could lead to regulations limiting sugar.
“Including added sugar on the label will be a game-changer for those debates about what is a healthy diet for people in the federal food-assistance programs,” said Schmidt, lead investigator on the UCSF-led SugarScience research and education initiative. “Once you've got added sugar on the label along with a daily reference value, policymakers will be in the position to set standards for the quantity of added sugar allowed in school lunches and other federal food programs.”
Changes like this have happened before, Schmidt noted. “In the U.K., the government said salt consumption is way too high and mandated that packaged food manufacturers reduce the amount of sodium in their products. It worked like a charm – they just gradually reduced the excess salt in foods to everyone's benefit.”
5. The new label makes changes beyond sugar.
The new label also will list more realistic serving sizes and will list calories in a larger and bolder font. “This will help people assess how many calories they are actually consuming,” Swartzberg said. (View a complete list of label changes here.)
6. Further steps could help consumers.
While praising the label changes, UC experts say further steps could help consumers make more informed choices:
- Adding front-of-package labeling that states whether the product is high in sugar, salt or fat: “This banner on the front of packages would make it simple for a consumer to see whether a food is healthy or whether it has ingredients that contribute to risk of heart disease, stroke, obesity or cancer,” Crawford said.
- Having food vendors add “stoplight” stickers: “There is the stoplight idea of labeling products with green, yellow and red stickers – green for the low-sugar products and red for the high-sugar ones,” offered Schmidt.
- Promoting environmentally sustainable food practices: “(We should) consume more plant-based foods and less meat,” Swartzberg suggested.
- Increasing research: “The label change is not enough: Further research, education and sound policies will need to be developed to motivate more healthy eating,” Roberts said.
What are sixth-graders interested in these days? “Cooking!” “Growing food!” “Learning how to be healthier.” “Exercising.” “Meeting new friends!” These enthusiastic answers came from sixth-grade student leaders in Santa Maria, Calif., when asked by educators from the UC Cooperative Extension Youth, Families and Communities program in San Luis Obispo and Santa Barbara counties.
Through an integrated youth-focused healthy living project, called Food Smart Families, funded by National 4-H, the UC ANR 4-H Youth Development Program, and the UC CalFresh Nutrition Education program, 32 fourth- through sixth-grade student leaders were brought together from three schools in Santa Maria, Calif., for a full-day educational retreat that focused on engaging youth to explore their healthy lifestyle interests and see themselves as leaders.
Throughout the day, student leaders experienced physical activity games, learned cooking skills, participated in garden-based learning, and developed their presentation skills. They focused on skill development, as well as transference so that the student leaders could take these activities into their own schools to encourage and teach their peers. For example, the fun physical activity breaks that were incorporated throughout the day modeled games where no one is “out” or excluded, while moving enough to get heart rates up.
In the garden, student leaders learned the basics of growing food and how to lead a garden lesson. Students discussed garden tools and how to use them safely, then planted their own seeds to take home. The garden session ended with a gleaning of the school citrus orchard where students laughed and enjoyed the fresh air and fresh fruits growing around them. In their own school gardens, the student leaders have offered lessons and tastings to their peers.
By the end of the retreat, the student leaders were excited to take the information and skills back to their schools and start leading. Students shared their plans to help other students be more active during recess, be healthy, and help other kids be healthier too.
“This was the best day I have ever had,” said one of the students.
Through the efforts of the Food Smart Families program, the Youth, Families, & Communities program in San Luis Obispo & Santa Barbara counties merged the strengths of the UC CalFresh Nutrition Education program and the UC ANR 4-H Youth Development program to provide new opportunities and experiences for students in this community. With interested and caring adults, these student leaders learned to share their passions for cooking, gardening, and healthy lifestyle with their peers at school and others in their community. The rewards for the school, community and adult allies continue to expand as these inspired student leaders, with strong mentorship and support, take on some of the biggest challenges facing our society and world.
Grocery shopping can be the most anticipated or the most dreaded necessity of daily life. A trip to the market can end with a smile over the thrill of victory from finding great bargains or end with a frown from the agony of defeat over budget anxieties. For most of us, budget is the primary factor in our food experiences. Low budget or no budget is often the culprit that leads to unhealthy food choices.
University of California 4-H Food Smart Families program with the UC Kearney Agricultural Research and Extension Center, teens from Parlier High School in Fresno County are teaching Parlier youth ages 8-12 how to get around budget roadblocks on the path to healthy eating. The program uses a “Teens as Teachers” approach, with teens educating younger youth through a series of hands-on, interactive nutrition lessons after school.
Food connections to local agriculture are highlighted through the partnership with the UC Kearney Agricultural Research and Extension Center. The center will host agriculture tours and family nutrition education activities at a Wellness Fair later this month to wrap up the program.
According to recent United States Department of Agriculture studies, nearly 16 million children live in households where they do not have consistent access to food throughout the year.
UC 4-H Food Smart Families empowers families through food knowledge and education to build sustainable solutions that confront food insecurity and improve health. Youth are engaged at a critical age for growing skills and establishing behaviors today that become sustainable, healthy habits for their families and communities tomorrow. Youth learn they can prepare food themselves and parents learn about working together as a family to plan healthy meals.
Thoughtful discussions, and sometimes passionate debates, ranging from whole grain pasta versus whole wheat pasta to the tasty virtues of hummus, mixed with youthful laughter. The teens were pleasantly surprised to discover they had additional budget to spare. Return trips were made to the produce department for more fruit, vegetables and even hummus.
Comments from the teens told the story of their success. “Now I know what my mom has to go through when she's shopping for food,” and “Look at my cart. Food Smart Families is really influencing me!” Who knew grocery shopping could be so much fun?
The USDA Center for Nutrition Policy and Promotion offers these 10 tips for affordable vegetables and fruits:
• Use fresh vegetables and fruits that are in season.
• Check your local newspaper, online and at the store for sales, coupons and specials.
• Plan out your meals ahead of time and make a grocery list.
• Compare the price and number of servings from fresh, canned and frozen forms of the same vegetable or fruit.
• Buy small amounts more often to ensure you can eat the foods without throwing any away.
• For fresh vegetables or fruits you use often, a large size bag is the better buy.
• Opt for store brands when possible.
• Buy vegetables and fruits in their simplest form.
• Start a garden for fresh, inexpensive, flavorful additions to meals.
• Prepare and freeze vegetable soups, stews or other dishes in advance.
MyPlate icon clearly shows many Americans how to formulate healthy meals for their families with the proper proportions of fruits and vegetables, protein foods, grains and dairy products. However, UC Cooperative Extension nutrition educators in Central California discovered that the infographic was too abstract for local low-literate families. They embarked on a years-long effort to translate the shapes and colors into a series pictures showing plates filled with healthful, real food.
The concept clicked, so county and campus-based researchers joined together to document the effectiveness of a new curriculum shaped around pictures of properly portioned plates of food to share with nutrition educators around the nation and world. They wrote an article, A Picture is worth a thousand words: Customizing MyPlate for low-literate, low-income families in 4 steps, which was published in the July-August 2015 issue of the Journal of Nutrition Education and Behavior. In 2016, the article was named the “paper of the year” in a category of articles and research programs called “great educational material” (GEM).
In the paper, the researchers shared a four-step process for creating a set of meal photographs that will resonate with families in different communities.
The four steps are:
- Review food patterns and determine meal combinations – This is done by asking clientele what foods they recently fed their families. Once the foods are identified, they can be modified to meet MyPlate recommendations.
- Test meals and take final photographs – Prepare the meals, take photos and test the photos with the target audience.
- Develop and test education messages to accompany photos – Messages should have few words, use family vocabulary and be written for a low-literacy audience.
- Create and test education materials – After the suggested materials are created, they should be tested with the target audience.
The UC Cooperative Extension Expanded Food and Nutrition Education Program (EFNEP) is using the “My Healthy Plate” materials in reaching out to low-literacy and low-income families in California.
The authors of the Journal of Nutrition Education and Behavior paper of the year are Mical Shilts researcher at UC Davis; Margaret Johns, nutrition, family and consumer science advisor in Kern County; Cathi Lamp, emeritus nutrition, family and consumer sciences advisor in Tulare County; Connie Schneider, emeritus Youth, Families and Communities director for UC Agriculture and Natural Resources; and Marilyn Townsend, UC Cooperative Extension nutrition education specialist in the Department of Nutrition at UC Davis.
My Healthy Plate education materials are available at http://townsendlab.ucdavis.edu.