Posts Tagged: obesity
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.
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.
Christina Hecht, UC Nutrition Policy Institute coordinator, asked UC Cooperative Extension specialists in California for input on MyPlate. Their enthusiasm was unanimous.
“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.
Research from UC San Francisco is showing that we also should pay attention to what's inside the gut.
Gut bacteria may affect both our cravings and moods to get us to eat what they want, and often are driving us toward obesity, according to an article published this month in the journal BioEssays.
Researchers concluded from a review of recent scientific literature that microbes influence human eating behavior and dietary choices to favor consumption of the particular nutrients they grow best on, rather than simply passively living off whatever nutrients we choose to send their way.
“Bacteria within the gut are manipulative,” said corresponding author on the paper Carlo Maley, director of the Center for Evolution and Cancer with the Helen Diller Family Comprehensive Cancer Center at UCSF. “There is a diversity of interests represented in the microbiome, some aligned with our own dietary goals, and others not.”
We also can influence this diverse community of microbes, collectively known as the gut microbiome, by altering what we ingest, Maley said, with measurable changes in the microbiome within 24 hours of diet change.
“Our diets have a huge impact on microbial populations in the gut,” Maley said. “It's a whole ecosystem, and it's evolving on the time scale of minutes.”
The gut is a growing field for research.
Michael Fischbach, a UCSF assistant professor of bioengineering and therapeutic sciences, studies gut bacteria and how they could help reveal the causes and new treatments for Crohn's disease and obesity.
“When I look at a person, I don't just see a warm, shiny human being,” Fischbach said. “I see bacteria crawling all over you and living on every surface that's exposed and not exposed in your entire body. And you're lucky that they're there because these bacteria do very important things for you. They make your immune system function properly. They help you digest foods. And they produce important chemicals that serve as vitamins for your body.”
With advancements in genetic sequencing technology, Fischbach and colleagues are mining gut bacteria for natural products – small molecules from microbes – that could hold the key for treating diseases.
“You used to have to travel to the coast of Palau to mine the ocean sediment for drugs,” Fischbach said. “Now we can just check our gut!”
Fischbach discussed his gut research with collaborator Justin Sonnenburg, a Stanford University microbiologist with degrees from UC Davis and UC San Diego, at the recent New York Times Health for Tomorrow conference at UCSF Mission Bay Conference Center.
“The beauty of being in basic research is you don't know where you're going to end up,” Fischbach said after their panel presentation. “It's nice to be on a journey where you don't know where the ship lands. I hope it's going to improve human health.”
-Do gut bacteria rule our minds?, UCSF
-Our microbiome may be looking out for itself, New York Times
-The next frontier of medicine, Slate
-Culturing for cures, UCSF
I spent last week at the Childhood Obesity Conference in Long Beach representing UC Agriculture and Natural Resources. I had heard that obesity was an epidemic. I had heard it's an issue that needs to be tackled. But I hadn't ever heard the extent of it before.
According to the Centers for Disease Control and Prevention (CDC), childhood obesity has more than doubled in the past 30 years. Adolescent obesity has tripled. In 2010, more than one-third of children and adolescents were obese. Last week, the American Medical Association went as far as to declare obesity a disease. The CDC has stated this is a direct result of caloric imbalance - children aren't expending enough calories, and they're eating too many.
In his keynote address, Michael Moss, investigative reporter with the New York Times and author of Salt Sugar Fat: How the Food Giants Hooked Us, mentioned that a half cup of tomato sauce has as much sugar as several Oreo cookies. I researched this, and sure enough according to MyFitnessPal, a leading food tracking software and app, a half cup of Ragu Roasted Garlic Pasta Sauce has 11g of sugar, while a serving of three Oreo cookies has 12g of sugar. As Moss mentioned, kids are taught to expect sweetness in everything they eat. According to him, the food industry is exploiting the biology of children. No wonder we can't get our kids to eat their vegetables.
This reminds me of a video clip I saw on YouTube of Jamie Oliver's television show Food Revolution. He goes into a classroom, hoping to have kids identify fresh vegetables, only to discover they don't know the difference between a tomato and a potato.
How did we get to this point? How have we become so disconnected from the food we eat and the things we put into our body? How did we get to a point where Oreos, Happy Meals and Cheez-Its were cool, but vegetables and fruits weren't? And most importantly, what do we do about it?
Is this next video a sign of where we are headed?