- Author: Michael Hsu
NPI researchers provide influential evidence that shapes federal, state nutrition programs
Of the many challenges facing humanity, nothing is more fundamental than securing healthy food and water for all. Life itself would not be possible without nutrients, energy and water – but for many people across the United States, that essential fuel is compromised.
“Right now, the average American diet quality has a failing grade,” said Lorrene Ritchie, University of California Cooperative Extension nutrition specialist. “If you scored it from 0 to 100, it would be about 55 to 60. And we're trying to move that number closer to 80.”
To help society reach that goal, the Nutrition Policy Institute was established 10 years ago, under the UC Agriculture and Natural Resources umbrella.
“NPI was created in recognition of the fact that more people in the United States are now ill with a nutrition-related chronic disease than are well,” said Ritchie, who has been director of the institute since its founding. “Six in 10 adults in the U.S. have one or more chronic diseases – 4 in 10 have two chronic diseases – that are preventable. When you have that big of a public health nutrition problem, the scope requires big policies, big program changes and big environmental changes.”
Since 2014, NPI – building upon the work of the Center for Weight and Health at UC Berkeley – provides scientific data to inform and guide a host of nutrition improvements across wide swaths of the population, with a focus on low-income and racially and ethnically diverse communities.
The work of NPI's 40 academics, staff and students have furnished policymakers, program managers and school administrators with the pivotal research that, among other things, has enhanced access to federal nutrition programs, reduced food insecurity for children of all ages, and removed unhealthy snack foods and beverages from schools while boosting access to drinking water.
And with about 1 in 3 people in the U.S. touched by federal nutrition programs, NPI experts have become instrumental in evaluating programs such as SNAP (Supplemental Nutrition Assistance Program, popularly known as food stamps or CalFresh in California) and SNAP-Education, WIC (Special Supplemental Nutrition Program for Women, Infants and Children), school meal programs, and the Child and Adult Care Food Program.
“This institute is the only one of its kind on the West Coast, with a very substantial number of graduate-level nutritionists and policy experts who are ready and able to take on policy questions that are being considered at the federal, state and local levels,” said Pat Crawford, a pioneer in the field of nutrition policy and the founding director of the UC Berkeley Center for Weight and Health, which merged with NPI in 2015.
In assessing NPI's overall contributions to the nutrition and public health space, Ritchie is astonished by the work of its academics and staff.
“Our findings have really informed policy and moved the field in a way that I could have hardly conceived of 20 or 30 years ago, when I first started working in this area,” she said. “I could not imagine that we would have achieved all the policy impacts that we have.”
Trusted partners in researching school meal programs
An illustrative example of NPI's prominence in nutrition policy research is its leading role in studying California's effort to provide school meals for all students.
The Nutrition Services Division of California's Department of Education oversees virtually all meal programs in public schools across the state, serving 870 million meals and snacks each year to about 5.8 million students.
According to its director, Kim Frinzell, the division relies on NPI to help evaluate and understand the emerging trends at schools by gathering and analyzing feedback from students, teachers, food service directors, parents, community organizations and other partners. With a better pulse on these trends, Frinzell's team uses the data to inform its policies, practices, training and overall strategy.
“NPI brings the expertise of knowing what kind of research questions to ask; as a state agency, we don't have research resources, nor the specific expertise,” Frinzell said. “So being able to partner with NPI is an incredibly valuable service.”
In addition to working with Christina Hecht on drinking water access and Wendi Gosliner on food waste issues, the California Department of Education has partnered with NPI researchers in recent months to conduct surveys and organize focus groups on California's universal school meals program, School Meals for All.
Coming out of the COVID-19 pandemic, California was one of the first states in the U.S. to adopt a universal school meals program, offering breakfast and lunch at no cost to all K-12 students, regardless of household income. NPI was funded to evaluate the implementation and impact of the program.
“The great value of what NPI brings to School Meals for All is that their work is not just quantitative but qualitative, value-added information that tells a story about real individuals and real situations that is backed by the data about a particular program, and you're able to anchor back to a very well-respected institute and the research they've done and say: ‘This is what the survey says, this is what the evaluations and the data provide,'” Frinzell explained.
“What's been really wonderful about NPI over the past 10 years is they're such leaders in studying and helping to create strategies for greater access to healthy meals for all – while also promoting healthy habits for all – across the entire child-nutrition spectrum,” Frinzell added.
Pioneers in researching universal school meals
May Lynn Tan was one of the first students working at NPI. She was interested in learning about universal school meals and accessed data on meal programs from across the U.S. using Lorrene Ritchie's work on a nationwide collaborative school nutrition project.
“At the time, there was not a lot of evidence on the impact of universal meals on participation, because there just weren't that many places where that was happening,” Tan said. “So that data set really helped illustrate some of these patterns that I wouldn't have been able to get at, otherwise.”
Tan chose this topic for her doctoral dissertation. She concluded that students who previously had been ineligible for free or reduced-price meals experienced the greatest impact through universal school meal programs. “It really just went to show that when you offered universal meals in schools, the kids who weren't qualified to get them for free before, but who still needed them, could start participating at a higher rate,” said Tan, noting that her research continues to be used in modeling to predict the effects of such programs in other states.
Presently, as director of research and strategic initiatives for California Association of Food Banks, Tan is thankful for her relationships with NPI team members – and regularly accesses NPI resources and briefs (compiled by NPI communications director Danielle Lee, in collaboration with other NPI researchers) to stay abreast of the latest research.
“NPI does a really good job packaging their findings for practitioners who are managing and providing services for communities,” Tan said. “That's really important in this field, because policymakers and program staff don't necessarily want to wade through a giant study. NPI often puts out one-pagers and things that are more graphically designed that make it easy to understand the findings – and what they mean for the real world.”
Experts in examining WIC program policies, impact
In the early 2010s, Lauren Au was working in Washington, D.C. as a U.S. Senate nutrition advisor, providing lawmakers with the latest research on nutrition programs. But she sought a more active role in the field.
“Instead of being the legislative assistant who's meeting with constituent groups that are giving me their one-pagers about why their legislation should be supported, I wanted to be driving the research that's behind that one-pager,” Au explained.
Having studied with Pat Crawford as an undergraduate student at UC Berkeley, Au returned to the West Coast in 2014 as a postdoctoral researcher with NPI. One of her projects was a long-term study of children, from birth to age 9, participating in the WIC program.
Au's experience in studying WIC – including its pandemic-era changes that increased fruits and vegetables and offered online options for participant enrollment, recertification and education – allowed her to carve out her own niche in the academic space. She cited that research focus, along with the collaborative relationships she cultivated at NPI, as major reasons for her success as a recently tenured professor in the Department of Nutrition at UC Davis.
“I love this work because you're constantly learning and keeping up with where the field is going,” Au said. “I've seen, over time, how it's changed from focusing on obesity to now focusing more on the social determinants of health. And that's where my research has shifted as well, becoming broader and seeing how all these environmental influences play a role in impacting nutrition and public health.”
Trailblazers in studying policy, systems and environmental approaches
NPI's work has been a driver of the field expanding its focus to research and interventions beyond the individual (such as direct education efforts) to the social, cultural and environmental context.
“We know now that nutrition is absolutely one of the determinants of all of the chronic diseases that we're suffering from in this country, whether it be cancer, heart disease, stroke, diabetes or obesity,” said Crawford, emeritus CE nutrition specialist and adjunct professor of public health. “And we've learned that it takes more than just educating people – it really takes policymakers to help make those good, nutritious choices easier for the public.”
Sugar-sweetened beverages, for example, have a significant negative impact on children's diet quality and health, according to Ritchie. And because such beverages are heavily marketed and ubiquitous, parents and caregivers are challenged to make the right choice – even if they know about their harms.
“Regardless of the quality of the education, the onus is on the parents to remember to make the healthy choices, which can be hard when kids naturally love sweets, and given the influence of kids' ‘pester power,'” Ritchie explained.
To help those dietary decision-makers, a bill was passed in California to make the healthy choice (i.e., milk or water) the “default” beverage offered with kids' meals served in restaurants. Since that law went into effect in 2019, its efficacy – and shortcomings in practice – and have been extensively studied by NPI's CalFresh evaluation team.
Innovators in SNAP, SNAP-Ed evaluation
Federally funded by the United States Department of Agriculture, the California Department of Public Health oversees SNAP-Ed (known as CalFresh Healthy Living at the state level) as the largest of four CFHL state implementing agencies to fund work in California's 61 local health departments. CDPH contracted with NPI (and before that the Center for Weight and Health) to conduct ongoing comprehensive evaluation of CalFresh Healthy Living interventions, including individual education and behavior change as well as broader systems approaches.
“NPI has been a wonderful partner and contributed a tremendous amount in how CalFresh Healthy Living evaluates its work, especially as policy, systems and environmental change approaches have evolved and been encouraged over the years,” said Erica Eilenberg, chief of CDPH's Nutrition and Physical Activity Branch.
While developing more efficient systems and processes for tracking, evaluating and reporting results of CalFresh Healthy Living initiatives across California, NPI also provides technical assistance to local health departments in collecting crucial data and measuring outcomes. In particular, NPI researchers helped develop an innovative “dose score” method to quantify the cumulative and combined impact of multiple interventions at school sites – as opposed to measuring each type of intervention independently.
As a result, more robust evaluation data and reporting have provided local health departments with key information to improve their program planning and delivery.
“NPI's evaluation work has resulted in more effective initiatives that have contributed to improving food and nutrition access for many CalFresh Healthy Living-eligible participants across California,” said Eilenberg, who added that NPI academics are valued contributors to state-level workgroups and national committees advising SNAP-Ed.
Respected voices on food insecurity, nutrition in higher education
One of the many NPI-affiliated researchers who have become prominent voices at the national level, Suzanna Martinez was among the 500 invited attendees at the 2022 White House Conference on Hunger, Nutrition and Health – the first convening of its kind since 1969. Many of the conference's recommendations, outlined in the Biden-Harris administration's national strategy, are supported by research underpinnings from NPI and its partners.
Martinez was invited to the conference because she's part of a UC effort to halve, by 2030, the number of students in the UC system who are facing food insecurity – meaning they are regularly unable to access enough food for a healthy lifestyle.
Now an associate professor in the Department of Epidemiology and Biostatistics at University of California San Francisco, Martinez said her research on student food security in higher education was a direct result of her time at NPI. One of the first researchers to join NPI in 2014, she began working with Ritchie on a groundbreaking, systemwide survey about food security across the UC system.
“Up until that point, there had only been some smaller studies, convenience sample surveys of community college students, and so this was one of the bigger studies to look at this issue in a large public university system,” said Martinez, who noted that she had to be resourceful to avoid being food insecure as a graduate student.
Their initial study found that 4 in 10 UC students were facing food insecurity – a startling statistic that provided hard evidence to policymakers on the need for additional funding and resources, such as campus food pantries. In subsequent years, Martinez and NPI colleagues partnered with staff at UC campus basic-needs centers to pinpoint the barriers preventing greater student access to food assistance – and offered potential ways to streamline processes.
Follow-up surveys indicated improvement in food security at UC locations, until the pandemic halted that progress. Nonetheless, Martinez – who continues to intensively study the subject – said that NPI's broad platform was crucial in spotlighting food needs at colleges and universities.
“It was important, at that time, that this work came out of NPI,” she said. “I don't think it would have had as much impact as it has had because of where the work was coming from.”
Growing as a key source of research in food systems
The depth and breadth of NPI's influence is even more striking given the “youth” of nutrition policy as a field in public health nutrition, which dates back only about 50 years.
“For the applied nutrition policy research that we do at Nutrition Policy Institute, it's only in the last couple of decades that we've really been doing research to see how policy, systems and environmental change can support behavior changes of everyday people like you and me,” Ritchie said.
She pointed out that NPI's partnerships are key to expanding its reach. Partners assist in bringing NPI's rigorous research to legislators, policy staff and the people who manage and deliver nutrition programs. By working with state entities like the Departments of Education, Public Health, Social Services, and Food and Agriculture – as well as organizations such as the California and National WIC Associations, CACFP (Child and Adult Care Food Program) Roundtable and the Center for Science in the Public Interest – NPI researchers provide key data to decision makers and advocates, and receive critical guidance on their research projects in return.
“We are researchers, but we are not on the ground implementing these programs and policies and we absolutely cannot do the work that we do without our partners,” Ritchie explained. “Asking the right questions of the right people is really hard to figure out if we don't have the community partners at the table.”
By virtue of its place alongside UC ANR experts on agriculture, natural resources and the environment, the NPI team is also connected to an even larger community of farmers, producers and other people along the food supply chain. Ritchie envisions, in the next decade, NPI taking a larger role in examining and improving the greater food system. As Wendi Gosliner and Ron Strochlic did through NPI's involvement in a recent project linking local growers with state correctional facilities, UC ANR can help connect the many scattered dots from farm to fork – from the food production side to the consumer nutrition side.
“Looking toward the future, that's the kind of thing I'm most excited about – helping those two arms, and everybody in between, talk to each other so that agricultural decisions are made thinking about human and planetary health, and nutrition decisions by consumers are made thinking about both planetary and human health,” Ritchie said. “We're going to need to do that to address climate change.”
‘We can see where the future is headed'
Meeting the challenges of the climate crisis – as well as incipient global health crises – will require a continued influx of talent, innovation and new ideas.
“The U.S. is now leading all nations in the prevalence of chronic disease, and what happens here, in terms of our food system, often gets exported all around the world,” Ritchie said. “We can see where the future is headed, and what we need to do is to figure out how to go back to a healthier lifestyle and a healthier diet. So the field of nutrition policy research, though there aren't that many of us, needs the brightest and best minds, the most enthusiastic and passionate people.”
The NPI Student Fellowship, established in 2019 in honor of Pat Crawford, has funded about a dozen students to work with NPI researchers on a variety of projects. While they gain hands-on research skills, glimpses of potential career paths, and access to nutrition professionals and resources, they also contribute their own diverse perspectives.
“We intentionally recruit students with this fellowship funding who bring a diversity of lived experiences.” Ritchie said.
“Students participate in interdisciplinary and cross-cultural discussions on research design and data interpretation,” Crawford added.
Brianna Aguayo, a second-year undergraduate studying nutritional sciences at UC Berkeley, is a first-generation Latina college student currently working at NPI through the fellowship program. Growing up in East Palo Alto, Aguayo saw how systemic barriers prevented community members from accessing vital nutrition assistance and resources.
Through her time at NPI, Aguayo has gained new insights on how researchers, policy analysts and communication specialists work together to generate the scientific evidence that can improve federal, state and local policies so they can potentially benefit more people. That knowledge will only enhance her ability to create positive change in her community, as she plans to incorporate that public health policy perspective along her journey to becoming a pediatrician.
“It's not just one sole person making this change,” Aguayo said. “But it really takes a group effort to help initiate change, and then make sure that that change is constantly being implemented.”
People interested in supporting and celebrating NPI's first decade of research, which has led to more healthful food offerings to vulnerable children and their families, can donate to NPI's Student Fellowship. It provides students from underrepresented groups the opportunity to work with NPI, learn from NPI and continue after graduation to improve nutrition for all. An anonymous matching gift of up to $10,000 will double every donation made through June 30, 2024.
/h3>/h3>/h3>/h3>/h3>/h3>/h3>/h3>/h3>- Author: Christina EA Hecht
- Editor: Danielle L. Lee
- Editor: Lorrene Ritchie
University of California's Research Consortium on Beverages and Health, with support from the American Heart Association, has released six short fact sheets to help educate both community members and decision-makers on the risks of over-consumption of sugary drinks. The fact sheets aim to provide the evidence base, expressed in simple talking points:
- What are Sugary Drinks? and 7 Reasons to Skip Sugary Drinks provide simple insights into sugary drink ingredients and how they can be harmful.
- The Health Harms of Sugary Drinks gives facts on the leading health risks of consuming these drinks.
- Sugary Drinks and COVID illustrates how sugary beverages, with their risk to cardio-metabolic health, can worsen the impact of diseases such as COVID-19.
- The Heavy Environmental Impact of Sugary Drinks provides data that illuminate the consequences of sugary drink consumption on the environment.
- How Four Cities in California are Using Sugary Drink Tax Revenue showcases how excise taxes levied on distributors of sugary drinks have funded projects to improve health in vulnerable populations in San Francisco, Oakland, Berkeley and Albany, California.
The Consortium is comprised of faculty working across the field of sugar science from all ten UC campuses and UC Agriculture and Natural Resources. The Consortium is coordinated by the Nutrition Policy Institute under the leadership of Christina Hecht, Ken Hecht, and Pat Crawford. Please contact Ken Hecht for more information about the Consortium and Christina Hecht for additional resources for community education on healthy beverage choices.
- Author: Danielle L. Lee
- Editor: Lorrene Ritchie
A new study from University of California and University of Michigan researchers suggests that a drive for thinness during the critical developmental years of adolescence may have long-term effects in adulthood, contributing to a greater drive for thinness and weight gain in midlife in women. Researchers compared data from 623 women from when they were in their teens to approximately 20 years later when they were in their late thirties or early forties. The data were collected through the National Growth and Health Study, a population-based cohort study of White and Black girls recruited from several U.S. communities. The study was published in the journal Obesity in November 2021. Study authors include Barbara Laraia from UC Berkeley, Cindy Leung from the University of Michigan, Janet Tomiyama from UC Los Angeles, Lorrene Ritchie and Patricia Crawford from the UC Division of Agriculture and Natural Resources, Nutrition Policy Institute, and Elissa Epel from UC San Francisco. The study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Heart, Lung, and Blood Institute and National Institute on Aging.
- Author: Liz Sizensky
- Author: Ann Brody Guy
There are direct lines from her resume to major policy advances in nutrition education and public health. Crawford's research and outreach have influenced nutrition policies and trends to improve the food environment at child care centers and schools, promote more nutritious food in programs serving low-income families and advance education and communication.
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, evaluator, educator and 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 center focused largely on food and nutrition policy to improve the health of children, and shared research results with community health workers. Local and state health professionals found 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, NPI Director Lorrene Ritchie.
Ritchie stated that in addition to Crawford's academic achievements, she is the consummate mentor — a “career godmother” for Ritchie and many others.
“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,” Ritchie said. “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.”
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 in the past four decades. 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.
To honor the work that Crawford does and to continue this kind of work, NPI has established a student fellowship fund to train the next generation of students on nutrition research and its policy impacts.
Read more about Crawford's accomplishments.
- Author: Jeannette E. Warnert
Real progress has been made in tackling the epidemic of childhood obesity since the first California Childhood Obesity Conference was held 20 years ago, but there is more work to be done.
“Collectively, we have come so far,” UC Nutrition Policy Institute Director Lorrene Ritchie told an audience of 1,025 public health, nutrition education, research, and other professionals at the event in Anaheim in July 2019. NPI was one of six conference hosts.
In the last 20 years:
- Federal school meal standards have been revised so that the food children eat at school is healthier than the lunches they bring from home.
- Sugar-sweetened beverages are no longer available to students during the school day.
- Foods provided by the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) are healthier and give mothers incentive to breast feed their babies.
- The Supplemental Nutrition Assistance Program (SNAP) education component is now linked to policy, systems and environmental changes.
- The Child and Adult Care Food Program now provides healthier meals and snacks to children in childcare centers and homes across the country.
The average quality of the diet of American children has improved, but the rate of childhood obesity in the United States is still too high.
According to the Centers for Disease Control and Prevention, 18.5% of U.S. children and adolescents 2 to 19 years old are obese – about 13.7 million youth in all. The rates trend higher in minority communities, with 25.8% of Latinx youth and 22% of African American youth obese. Obesity is also more prevalent among children in families with low incomes.
Obesity, which is defined in children as a body mass index at or above the 95th percentile of CDC growth charts, is associated with poorer mental health status, reduced quality of life, and increased prevalence of diabetes, heart disease, stroke and some types of cancer.
The vice president of UC Agriculture and Natural Resources, Glenda Humiston, pledged the organization's commitment to community health and wellbeing at the Childhood Obesity Conference. UC ANR is the umbrella organization of the Nutrition Policy Institute, UC CalFresh Healthy Living, UC Cooperative Extension, 4-H Youth Development, the UC Master Gardener Program and the California Naturalist Program, among others.
“Going forward, solutions to the obesity epidemic are multidisciplinary,” Humiston said. “NPI does world class work in conducting research to influence nutrition policy. We need to harness 4-H. Master Gardeners are increasingly focusing on edible gardens. CalNat is getting people out into nature. We are finding synergies in community wellness.”
Humiston has dedicated UC ANR resources to finding and implementing solutions to the obesity crisis.
“I'm looking forward to working with all of you – public and private organizations – to design a way to move forward,” she said.
The opening keynote presentation at the conference featured Patricia Crawford, NPI's Senior Director of Research emeritus, a pioneer in addressing the growing problem of childhood obesity during her long career. Beginning in the 1970s, she recognized that childhood obesity was on the rise and launched several studies to search for the causes and potential solutions.
In one study, Crawford followed a group of 9-year-old African American girls over a period of 10 years to determine why these youth were growing up heavier than other adolescents.
“Finally, we began to get some answers,” Crawford said. “We learned obesity wasn't the children's fault. They were living in environments that made the unhealthy choice cheaper and easier to find. It's so unfair for people who have fewer resources. Health disparities has to be the No. 1 thing we are working on to address chronic disease rates in this country.”
“The solution to obesity is prevention. It's cheaper and more effective than treatment,” Crawford continued. “Healthy food is a taste that is easy to acquire if it is not preempted by junk food.”
Crawford said she honed in on the best strategies for prevention by actively listening to people struggling to make healthy choices
“There is a chasm between research and community,” Crawford said. “We have to get people together from the research level and the policy level with folks on the ground. We need to learn from people.”