- Author: Liz Sizensky
- Author: Ann Brody Guy
The San Francisco Chronicle reported this exercise in a 2016 interview with Crawford about newly approved USDA nutrition labels that would include added sugar information and thereby eliminate the need for such complex computations by consumers. Sadly, these nutrition guidelines have yet to come out. Why not, if we know that added sugar is related to heart disease, diabetes, tooth decay and other negative health conditions? Why hasn't this regulation been adopted? Crawford works to provide the research needed by policymakers to reduce the barriers to implementation of helpful policies such as this one.
Pat Crawford's work on improved food labeling is but one example of the way that for decades her timely and rigorous research has demonstrated the role of sugary foods and beverages in the development of diabetes, and obesity and in helping to fuel America's childhood obesity epidemic. In countless ways Crawford, who is retiring this year after more than 40 years of service at the University of California, has supported the adoption of public policies that promote safer, healthier food and beverages for all people, across the state and the nation.
You can draw direct lines from her resume to countless major policy advances in nutrition education and public health. Since earning her master's degree in public health nutrition and her registered dietician credential at UC Berkeley in 1972, Crawford has been a force of unceasing productivity as a researcher, an evaluator, an educator and a leader. Early in her career she managed the nation's largest biracial study of girls' health, the National Growth and Health Study. During the course of this long-term study, she went back to school to obtain her doctorate in public health nutrition. She soon was hired as the first UC Cooperative Extension Nutrition and Obesity Prevention specialist and she co-founded and directed UC Berkeley's Atkins Center for Weight and Health. The work of the center focused largely on food and nutrition policy to improve the health of children, and it provided a structure whereby University research could be effectively shared with community health workers throughout the state. Local and state health professionals found in the center an extension partner eager to conduct research that would answer important questions and provide real-world solutions, productively linking research, policy and practice.
The Center for Weight and Health, which in 2015 merged with the UC ANR Nutrition Policy Institute (NPI), became known for rigorous research that is aligned with UC ANR's core values of addressing food security, obesity, socioeconomically based health disparities, and access to healthy foods. After the merger, Crawford became NPI's Senior Director of Research, working with her long time collaborator, Lorrene Ritchie, the NPI director.
Ritchie stated that in addition to Crawford's academic achievements, she is the consummate mentor — a “career godmother” for Ritchie and many others. She said, “Pat has an uncanny ability of knowing what you are good at — even before you yourself do — and mentoring you to build on that strength. Likewise, she has an uncanny ability to know your weaknesses, and help you to overcome those by developing new skills or pairing you with others who have those skills.”
That kind of nurturing is rare, Ritchie noted, particularly in the competitive environment of academia. Through mentoring, she added, Crawford has ensured new generations of researchers will continue this work.
“Pat has proven that you can be caring and compassionate yet still be highly effective.”
What does highly effective look like? A few examples illustrate the impact that Pat Crawford's work has had on nutrition policies and trends.
To improve the food environment at child care centers and schools, the Center/NPI provided the evidence for:
- California's 2010 Healthy Beverages in Childcare Law, requiring child care centers to make water and other healthy beverages available at all times.
- The 2013 Foundations for Healthy Nutrition in Childcare Act, requiring nutrition education for all child care providers.
- “Competitive food” policies — banning unhealthy sodas and snacks that competed with more nutritious school lunches — a policy that started in California and later was implemented at the federal level in the USDA's 2016 “Smart Snacks Standards.”
- The expansion of school garden and cooking programs in California and nationwide.
- An expansion of support for replacing packaged foods with healthier scratch cooking in school cafeterias.
To promote more nutritious food in programs serving low-income families the Center/NPI advocated:
- Improvements in the federal Women, Infants and Children (WIC) program including quadrupling the amount of vegetables and legumes WIC provides and adding information about physical activity needs for young children.
- Food bank policies that increase the amount of fruits and vegetables distributed and reduce the amount of snack foods and sugary beverages. Their free online course on how to make these policy shifts is a popular web resource for food banks across the country.
To advance education and communication:
- Crawford co-founded the first interdisciplinary conference on childhood obesity. Twenty years later, the biennial meeting is the premier obesity conference in the nation.
- The “My Healthy Plate” nutrition-education tool, which replaced the old Healthy Eating Pyramid, was developed, tested, presented and promoted by Crawford and her extension colleagues before the plate concept was officially adopted by USDA in 2011.
- California became the first state to put calories on chain-restaurant menus. Crawford's evaluation of Kaiser Permanente's pilot study of menu-board labeling provided the evidence needed by policymakers. Calorie labeling in chain restaurants has been expanded nationwide.
- Crawford's evaluation of California's SNAP-Ed program, the education arm of the Supplemental Nutrition Assistance Program, (or SNAP, previously known as food stamps), has informed programming focused on the prevention of chronic disease through efficacious nutrition changes in the environment.
Although Crawford would be quick to tell you that her work is collaborative, she has been a researcher or important influence on nearly every population-based nutrition policy success. She has served as president of the California Nutrition Council and on countless state and national committees and task forces focused on improving health and addressing obesity, including being an advisor to California's Let's Get Healthy Task Force. Most recently, she co-authored a seminal Healthy People 2020 report for the U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, on model policies to increase fruit and vegetable intake in the population.
Training the next generation
Given her commitment and her influence, it's no wonder that Pat Crawford won the 2013 David Kessler Award for Extraordinary Contributions to the Public's Health, as well as multiple honors from the American Public Health Association. In 2018, the UC Berkeley School of Public Health honored Crawford as one of its 75 most influential alumni in recognition of her significant contributions to reduce the epidemic of childhood obesity in California and across the country. And she's not done yet — as an emeritus Cooperative Extension specialist, her research will go on. That won't surprise anyone who knows her. As Crawford said in a 2015 interview, “What keeps me passionate is knowing that change is possible when high-quality, policy-relevant research is conducted and communicated to decision-makers and those who work with children.”
To honor the work that Crawford does and to continue this kind of work, the Nutrition Policy Institute has established a student fellowship fund to train the next generation of students on nutrition research and its policy impacts. Donors to the student fellowship fund help honor Crawford and help NPI continue its work to improve the nutrition and health of children.
- Author: Liz Sizensky
Lunches served in the National School Lunch Program have higher nutritional quality than lunches brought from home, according to the largest comparison study conducted to date.
Published in the November 2016 issue of the Journal of the Academy of Nutrition and Dietetics, the study, conducted by researchers at UC's Nutrition Policy Institute, involved nearly 4,000 elementary school students in Southern California.
“This rigorous study confirms what we have long known: The school lunch program, which has served the country's students since 1946, makes an invaluable contribution to their nutritional well-being, their health and their academic performance," said Lorrene Ritchie, Ph.D., director of the Nutrition Policy Institute and a senior author of this study. "And thanks to the recent, improved nutrition standards, it will only provide stronger, more essential support for our children's success.”
School lunch consumption was associated with higher overall diet quality. School lunch eaters also consumed diets that were higher in dairy-rich foods, lower in empty calories from solid fats and added sugars, and lower in refined grains than students who ate lunches from home.
Established in 1946, the National School Lunch Program is a federal nutrition assistance program that provides nutritionally balanced, low-cost or free lunches in over 100,000 K-12 schools throughout the United States. School lunches are required to meet certain nutrition standards based on the latest Dietary Guidelines for Americans. New requirements increase the availability of fruits, vegetables and whole grains and reduce sodium and fat in school lunches. Guidelines on calorie limits are set to ensure age-appropriate sized meals for grades K-5, 6-8 and 9-12.
During the 2014-15 school year, the program served lunches to about 30.5 million children each school day. More than 21.5 million of these students qualified for free or reduced-price service. Given the program's broad reach and its targeting of low-income children, the nutritional improvements shown in this study are of considerable benefit to needy students for whom school lunch may represent roughly one-third of their daily calories.
Since the study was conducted, new and more rigorous nutritional standards have been implemented, thus increasing the likelihood that school lunches are contributing to healthy overall diets – and reversing the extremely worrisome obesity epidemic. Currently as many as one-third of U.S. youth are obese or overweight.
In 2009, more fruits, vegetables, whole grains and low-fat milk were included in the food package provided by USDA's Special Supplemental Nutrition Program for Women, Infants and Children (WIC). As a result, the quality of diets improved for the roughly 4 million children who are served by WIC, according to a study by researchers at UCSF Benioff Children's Hospital in Oakland, UC San Francisco and UC Agriculture and Natural Resources' Nutrition Policy Institute.
“Although the findings only showed significant improvement for consumption of greens and beans, the other areas for which WIC has put in important efforts – increased consumption of whole fruits rather than fruit juice, increased whole grains – all show trends in the right direction,” said lead author June Tester, a physician at UCSF Benioff Children's Hospital Oakland, “and there is opportunity for further study in the future when more years have passed after this landmark change in the WIC package.”
Diets of children age 2 to 4 compared
For the UC study, which will be published in the May issue of Pediatrics journal, researchers analyzed the diets of 1,197 children, ages 2 to 4 years, from low-income households before and after the 2009 change in the food package.
The researchers used the National Health and Nutrition Examination Survey (NHANES) to compare a nationally representative sample from 2003 to 2008 with diets in 2011 to 2012. The researchers calculated the Healthy Eating Index (HEI-2010), which is a score with 100 possible points measuring adherence to dietary guidelines, from two 24-hour diet recalls. For children in households using WIC, this score increased from 52.4 to 58.3 after the policy change. After adjusting for characteristics in the sample and trends in the comparison group, the researchers showed that there was an increase of 3.7 points that was attributable to the WIC package change. This represents important evidence of an improvement in the diets for these children in WIC households.
Children don't eat enough green vegetables
“Vegetables are part of a healthful diet, but in general, children don't eat enough of them,” Tester said. Using the Healthy Eating Index, the researchers calculated the Greens and Beans score, which counts dark green vegetables and includes any legumes, such as beans and peas, that were not already counted as protein foods on a different score.
After the food package was changed, the Greens and Beans score increased for children in WIC but not for their counterparts. Roughly half of the children in WIC households had eaten some vegetables, whereas only one in five non-WIC children had consumed any green vegetables at all in the two days their parents were surveyed.
Important policy change
The change in the WIC food package is an important policy change in the effort to improve the quality of diets of young children, said Tester, a pediatrician.
Tester noted that the results of this study will be useful to the Institute of Medicine committee that is reviewing and assessing the nutritional status and food needs of the WIC-eligible population and the impact of the 2009 revision to WIC food packages. The committee will make recommendations for changing the food packages.
Establishing healthy eating patterns
“Increasing consumption of nutritious foods such as green leafy vegetables and whole grains in the low-income children served by WIC will help them establish healthier eating patterns for their future,” said co-author Patricia Crawford, UC Cooperative Extension nutrition specialist with UC ANR's Nutrition Policy Institute.
The switch from whole milk to low-fat milk was well received by the clientele and did not result in decreased milk consumption among the preschoolers, noted Tester, Crawford and co-author Cindy Leung, postdoctoral scholar at UCSF Center for Health and Community.
This study is the first to report on the significant improvements in diet quality in young children associated with the WIC package change using a nationally representative sample, and the first to do so with the updated Healthy Eating Index (HEI-2010). The National Institutes for Health funded this study.
Para leer la versión en español de este artículo, visite http://ucanr.edu/sites/Spanish/Noticias/?uid=6735&ds=199.
The “Technology and Design Innovation to Support 21st Century School Nutrition” project will assess the impact of using a “SmartMeal” technology platform, distributed points of sale and staff promotion of school meals at 12 SFUSD middle and high schools. Sixty percent of the district's students are eligible for free and reduced-price meals, as part of the National School Lunch Program, the country's largest child nutrition program. The researchers say that improving dietary intake among low-income youth is essential to reducing obesity, and schools are arguably the most important venue for change.
“Improving school meals is critical for addressing social inequities to healthful food access, said Lorrene Ritchie, Ph.D., RD, UCANR Nutrition Policy Institute director, Cooperative Extension specialist and co-primary investigator. “Poor nutrition is a primary cause of the obesity epidemic that threatens the health of American children, especially in low-income communities. We are targeting schools for interventions because most school-age children spend half of their waking hours and consume up to half of their daily calories in school.”
“This project will test whether we can change behavior by addressing the reality of today's adolescent lifestyles,” said Kristine Madsen, MD, associate professor in the School of Public Health and co-primary investigator.
“Mobile phones are ubiquitous among teens from diverse economic backgrounds, which makes this technology an ideal tool for promoting healthful food choices and nutrition education.”
The Nutrition Policy Institute was created in 2014 by UC Agriculture and Natural Resources, the division of the University of California charged with sharing research-based information with the public about healthy communities, nutrition, agricultural production and environmental stewardship. NPI seeks to improve nutrition and health in low-income communities in California and the nation by engaging in research and communications that inform, build and strengthen policy. Visit NPI online at http://npi.ucanr.edu. SFUSD's Future Dining Experience (http://www.sfusdfuturedining.org/) is funded by USDA and the Sara & Evan Williams Foundation.
The U.S. government should promote plain drinking water as the beverage of choice, according to comments submitted today by the University of California's Nutrition Policy Institute (NPI) at a public meeting for oral testimony on the Scientific Report of the 2015 Dietary Guidelines Advisory Committee. The institute also urged the U.S. Department
of Agriculture to add a symbol for water to its MyPlate graphic.
NPI experts said the government should employ strong language encouraging consumption of plain drinking water as a strategy in the fight against childhood obesity. Studies have established that Americans' single largest source of added sugars is sugar-sweetened beverages, that sugar-sweetened beverages are among the top sources of calories for U.S. children and teens, and that there are income and racial disparities in sugar-sweetened beverage consumption.
“It is clear from the evidence that a major contributor to obesity is sugary drinks,” said NPI Director Lorrene Ritchie. “And the healthiest alternative to sugary drinks is plain water.”
NPI noted that the Advisory Committee's 2015 scientific report said, “Strategies are needed to encourage the U.S. population to drink water when they are thirsty.” MyPlate – the infographic used by USDA to portray the recommendations in the Dietary Guidelines for Americans – is the “ideal platform” from which to encourage water consumption, according to NPI. In its comments, the institute said, “the addition of a water symbol will enable MyPlate to promote water consumption along with its other strong messages about a healthy diet.”
Ritchie said NPI is encouraging the public to join them in sending a message to the government. “Tell Washington to make water first for thirst and ask the USDA to reinforce it with an icon for water on MyPlate,” she said.
NPI developed a “Take Action!” page on its website with easy-to-follow guidelines for submitting comments on the Dietary Guidelines for Americans. The “Take Action!” web page is located at http://npi.ucanr.edu/water.
The Nutrition Policy Institute was created in 2014 by UC Agriculture and Natural Resources, the division of the University of California system charged with sharing research-based information with the public about healthy communities, nutrition, agricultural production and environmental stewardship. The institute seeks to improve eating habits and reduce obesity, hunger and chronic disease risk in California children and their families and beyond. Visit NPI online at http://npi.ucanr.edu.