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.