Posts Tagged: Lorrene Ritchie
Researchers contribute recommendations for national strategy on hunger, nutrition, health
At the first White House Conference on Hunger, Nutrition and Health convened since 1969, President Biden announced on Sept. 28 a national strategy “to end hunger in America and increase healthy eating and physical activity by 2030 so fewer Americans experience diet-related diseases.” Much of the foundational research undergirding the strategy has been informed in part by the Nutrition Policy Institute, a program of UC Agriculture and Natural Resources.
“Science is the work of many – and no one study answers all the questions – but we have a tremendous body of work that has contributed to this conference, building from all the programs and changes that were made from the last conference,” said NPI director Lorrene Ritchie.
The original Nixon-era conference produced about 1,800 recommendations – and 1,600 were eventually implemented in the subsequent years, according to Stacy Dean, U.S. Department of Agriculture Deputy Under Secretary for Food, Nutrition and Consumer Services.
A litany of far-reaching programs grew from or were propelled by the 1969 conference: the School Breakfast Program, WIC (the Special Supplemental Nutrition Program for Women, Infants and Children), SNAP (the Supplemental Nutrition Assistance Program)-Ed and CalFresh Healthy Living UC, the Expanded Food and Nutrition Education Program, and more.
This history illustrates the potential for sweeping change from this 2022 conference – which gathered about 500 experts and advocates (with 1,000 more participating online) – and from the national strategy that represents the Biden-Harris administration's “playbook.”
“Does that document have everything in it that we would like? No – but, oh my goodness, if we could accomplish all the things that they've laid out, what a transformational impact it would have,” said Ritchie, adding that she was thrilled that the highest levels of government are prioritizing hunger and nutrition-related chronic disease.
Including beverages in the conversation
In the course of gathering ideas and input from across the country, conference organizers asked Christina Hecht, NPI senior policy advisor, to author and submit NPI recommendations on encouraging the public to choose water instead of sugary drinks. Those suggestions – which range from including water in the “MyPlate” dietary guideline graphic to ensuring that every public school has a water bottle-filling station – crystallized extensive, rigorous scholarship by a broad community.
“NPI's recommendations were built on lots of work by many water researchers and advocates over the years; they're based on many years of thinking by many people,” Hecht said.
Christina and Ken Hecht, NPI policy director, also submitted recommendations as part of the Sugar-Sweetened Beverage Reduction Workgroup, which brings together experts from national, state and local organizations. Several of their key proposals, such as targeting the marketing of sugary drinks and clarifying front-of-package nutrition labels, appear as recommended steps in the national strategy document.
Other nutrition policy changes compiled by Christina Hecht – like updating the Federal Food Service Guidelines used on federal properties and in federal programs – are also reflected in the national strategy, albeit without specifically mentioning sugary drinks. Nonetheless, Hecht believes doors have been opened for future discussions that could incorporate and promote healthy beverages.
“What those doors require are continuing to develop the evidence base, continuing to translate and share the evidence base, and continuing the advocacy to bring that evidence base to the attention of decision makers,” she said.
University of California setting an example
Suzanna Martinez, an NPI-affiliated researcher who attended the White House conference, said she hopes the convening generates momentum for two bills before Congress that would help alleviate food insecurity in higher education: one that provides funding for campuses to address students' basic needs, and another that reduces barriers to SNAP (Supplemental Nutrition Assistance Program, formerly known as food stamps). The national strategy document explicitly acknowledges that “SNAP's college student eligibility restrictions are out of date given the current population who seek higher education credentials.”
Martinez, an associate professor in the Department of Epidemiology and Biostatistics at University of California San Francisco, was invited to the conference because she's part of a group driving the UC's effort to halve the number of students facing food insecurity across the system by 2030. That commitment, and UC Berkeley's work on basic needs, were highlighted by Second Gentleman Douglas Emhoff during the closing plenary session.
“The work that we're doing here in California tends to set the stage for what happens in other states,” said Martinez, who also cited California's pioneering effort to provide meals for all public school students.
NPI's ongoing work evaluating universal school meals in California and other states is just one example of how its academics and staff are refining innovative programs so they can be adopted more effectively and broadly (perhaps nationally). In fact, the White House identified “healthy school meals for all” as the top strategy for improving food access and affordability, and Ritchie applauds the administration's consistent emphasis on early interventions for healthier outcomes.
“The earlier you can create healthy habits – meaning in utero all the way through childhood – the more likely you are going to have adults who don't end up with nutrition-related chronic diseases,” she explained. “The last thing you want to do is to wait until people are really sick before they start to change their habits.”
Another overarching theme that excites Ritchie is the national strategy's “whole of government” approach to addressing a host of nutrition and hunger issues. One example is how the strategy calls for agencies not traditionally associated with food to contribute to reducing waste, such as the Department of the Treasury clarifying tax benefits for businesses that donate food.
“Throughout the document, over and over again, there are countless examples of creating synergies across government agencies and with local and state governments that can help move the needle,” Ritchie said. “It's just this kind of bold call to action that we really need.”/h3>/h3>/h3>
Nutrition Policy Institute researchers contribute to studies that inform policy changes
Marcela Gonzalez, who had wanted to be a physical therapist since she was a teenager, was in the final stage of realizing her dream.
But when she started in the PT program at the University of California San Francisco in 2021, a vexing struggle of her undergraduate years came back. Academic pressures and stomach troubles, compounded by financial worries, drained her of any energy and capacity to feed herself.
“I didn't eat; I lost a lot of weight because I just couldn't eat,” Gonzalez recalled. “I was too stressed out all the time; I was a mess.”
During her first year at UCSF, Gonzalez, for whom food has “always just been hard,” discovered that she qualified for CalFresh (California's version of the Supplemental Nutrition Assistance Program, formerly known as “food stamps”). Her participation in the program – as well as the presence of a campus food pantry – helped lift a heavy mental burden and allowed her to refocus on school.
To understand the mechanisms that connect eligible students with CalFresh benefits, which could greatly improve their lives and education, University of California researchers interviewed UC campus staff responsible for guiding undergraduate and graduate students through the application process. Their recently published study, which involved researchers at UC Agriculture and Natural Resources' Nutrition Policy Institute, illuminated several major facilitators and barriers to CalFresh enrollment.
Campus-county coordination, boosting staffing key factors
Ensuring that college students have access to CalFresh is especially crucial, given that food insecurity affects that segment of the population roughly four times the rate of the general population, according to the study's principal investigator and co-author Suzanna Martinez, an associate professor in the department of epidemiology and biostatistics at UCSF.
It's estimated that more than 40% of college students face uncertain access to healthy food – and inflation, the rising cost of attending college and increasingly unaffordable housing are likely to swell those numbers.
That's why researchers say it's critical for campus staff who work on CalFresh outreach to collaborate with the financial aid office and the county office that administers the CalFresh program locally. Through close coordination, staff members can determine if students meet the necessary exemptions and help them with the paperwork.
“When that happens, it's much easier than when a student applies without their campus Basic Needs coordinator, or when they just go to the county and apply on their own,” Martinez explained. “Maybe they don't know all of the verification documents that have to be included, or they might not know their financial aid status.”
Erin Esaryk, NPI research data analyst and first author of the study published in the Journal of Nutrition Education and Behavior, also highlighted the need for increased campus staffing to help with CalFresh enrollment, as well as more outreach by campus and county staff to student populations about the benefits.
“When there's a lot of outreach, that helps alleviate some of the stigma, to normalize the receiving of CalFresh,” Esaryk said.
Helping others worry less about food
Given her own history of travails, Gonzalez, the physical therapy student, wanted to help others at UCSF “de-stress” about food. In summer and fall 2021, she served as a “CalFresh ambassador” for her cohort of new PT students, developing presentations and guides that break down how to apply for or renew CalFresh benefits.
She became the go-to person for her classmates' questions on the logistics and details of applying for the program, and also encouraged fellow health-professional students who, like herself, did not think they would qualify.
“To take out less loans, or to not worry about food a little bit every week, is a great thing,” said Gonzalez, pointing out that subtracting food costs allows students to shave down their loans.
After helping introduce her classmates to CalFresh, she transitioned to working at the food pantry at the Parnassus campus. In addition to setting up and distributing the items, Gonzalez also posts on Instagram and TikTok (@ucsf_basicneeds) to promote the “food market,” which attracts about 100 students and campus community members every Thursday afternoon.
“You never know what you're going to get, but there's so much really good, fresh produce,” she said.
Campus food pantries deliver health benefits
Researchers are also studying how campus food pantries affect students' overall health, including easing the challenges of anxiety, depression and sleep deprivation. Another recent study published in the Journal of Nutrition Education and Behavior analyzed health-survey responses of 1,855 undergraduate and graduate students at all 10 UC campuses – before and after access to a campus food pantry.
“What we found was that students reported improvements in their perceived health and sufficient sleep,” said UCSF's Martinez, the lead author. “We also found that they reported fewer depressive symptoms, compared to before having access to the food pantry.”
By 2019, all UC campuses had established food pantries, although nationwide only about 25% of four-year colleges have one. The significant health benefits reported by UC students in this study give researchers hope that campus food pantries will see additional governmental support, in California and beyond.
“It was important to evaluate whether the food pantries were actually making a difference…if you don't have numbers or evidence, then you're not going to get funded to support future programming,” Martinez said.
Research guides state policy changes
Studies of food insecurity in the college setting have already informed policymaking aimed at smoothing the application process for CalFresh – benefits regarded by Martinez as a better long-term solution than food pantries, which constitute an emergency “short-term response” to the problem.
One example of the research's impact is a law passed last year in California that requires community colleges and California State University campuses to designate a campus-county liaison who would help students procure social services, including CalFresh. A separate law expanded the list of training programs within which students would potentially qualify for CalFresh, and another bill currently under consideration by the state Legislature would make the processing of students' CalFresh applications more consistent from county to county, through more standardized training of staff.
Meanwhile, on the research front, Esaryk, Martinez and their colleagues are completing a follow-up study on students and CalFresh enrollment, this time looking at the perspectives of county staff. And while their broader goal remains clarifying and streamlining student eligibility rules and processes at all levels, they remain focused on students and meeting their needs.
“Right now, our main mission is just to try to increase awareness of CalFresh for students and to let them know they may be eligible,” Martinez said, “and then assist them through that application process so they can actually get the benefits.”
In addition to Esaryk and Martinez, NPI director Lorrene Ritchie and Laurel Moffat of Washington State University are also authors of the CalFresh/SNAP benefits study, while co-authors of the college food pantry study are Ritchie, Gwen Chodur of UC Davis, Sevan Kaladijian of UC Irvine and Michael Grandner of the University of Arizona./h3>/h3>/h3>/h3>/h3>
University leaders, faculty and students from across the U.S. and around the world are working together to tackle a complex set of challenges that prevent millions of people from getting enough of the right foods. In March 2021, UC Davis, the UC Global Food Initiative and the UC Agriculture and Natural Resources Nutrition Policy Institute, in partnership with the Hunger Solutions Institute at Auburn University, hosted a summit for members of Universities Fighting World Hunger, where more than 500 attendees from 22 countries sought solutions to the tragedy of world hunger, food insecurity and malnutrition that results in chronic diseases and obesity.
The 16th annual summit, held virtually for the second time, introduced a new way to address hunger by focusing on its connections to global climate change and the catastrophic COVID-19 pandemic.
Opening keynote speaker Bill Dietz, director of the Redstone Global Center for Prevention and Wellness at George Washington University, called the multiple threats to human well-being a “syndemic” driven by political power, capitalism, social norms and structural racism.
He suggested triple-duty solutions to the syndemic. For example, for U.S. populations, increasing plant-based foods and reducing beef consumption leads to (1) healthier diets that reduce obesity, diabetes and cancer; (2) improves nutritional quality and food security; and (3) lowers greenhouse gas emissions from agriculture and cattle production.
“I don't mean to say we eliminate beef,” Dietz said. “Beef can be healthy if grass fed and contains micronutrients. We need to reduce it. I don't pretend that's an easy lift. There is resistance at the highest levels of government. But we need to generate the political will to turn that around.”
Dietz recommended the development of local and regional food systems for food resilience, health, equity and environmental sustainability. Regional systems are more agile and not devoted to monoculture, such as that found in the U.S. Midwest where great swaths of land are managed exclusively for corn production.
“The question is not what we need to do, but how to do it,” Dietz said. “We need to act now. We need to build political will. We need to hold leaders accountable.”
A new Green Revolution
On the world stage, increasing access to food must address poverty, inequality, wars and politics, said Rattan Lal, distinguished professor of soil science at Ohio State University.
The projections that the earth will have 2 billion more residents by 2050 means there's a need for a new “Green Revolution,” Lal said. In the 1950s, fears that food production was lagging behind population growth were rampant. The fears were not realized due to the mid-century Green Revolution, in which research and technology boosted agricultural production worldwide with advances in variety selection, irrigation, synthetic fertilizers and pesticides. Yields rose exponentially.
“This miracle saved hundreds of millions from starvation,” Lal said. “Despite all that progress, there is still hunger.”
To meet food demand anticipated in 2050, the new Green Revolution must be different.
“Rather than input based, it must be natural resources based,” Lal said. “The strategy is to produce more food from less land, less water, less fertilizers and less energy.”
Managing agricultural land with regenerative principles – such as maintaining year-round soil cover, eliminating tillage and applying integrated nutrient management – leads to healthy, sustainable and productive soils that lock up carbon and minimize greenhouse gas emissions to the atmosphere.
“Something I hope to see protected in the new Farm Bill – the rights of soil,” Lal said. “Soil is a living entity. It has rights. We have a Clean Air Act, a Clean Water Act. It is time for a Healthy Soil Act. I hope it will be in 2022 or 2023. That involves policy translating science to action.”
The benefits of soil health are research-proven, but not yet widely implemented on farmland around the world, an example of a dichotomy shared by summit keynote speaker Jeffrey Sachs, an economist with the Center for Sustainable Development. He quoted the well-known observation of science fiction writer William Gibson, “The future is already here – it's just not evenly distributed.”
“There are solutions. I call them pathways. They are not gimmicks,” Sachs said. “Our work is to build the public understanding and awareness of the importance of these pathways.”
Sachs encouraged summit attendees to advocate locally and at the state and federal levels to promote new food systems approaches.
“Write blogs, op-eds and suggestions. What can corporations commit to? What should governments commit to? What can the food industry commit to?” Sachs said. “A lot of agricultural policies promoted by large commercial interests neglect environmental objectives. What we need is a one-world approach to move beyond the narrow view of a powerful corporate lobby and move to ecosystem sustainability in agriculture, carbon storage, healthful diets and a culture of appreciation of agriculture and healthful food.”
A role for land grant universities
Lorrene Ritchie, director of UC's Nutrition Policy Institute, said she believes UC Agriculture and Natural Resources and other land grant institutions can help direct humanity along a pathway of human and planet health.
“We have nutrition programs, dairy and beef research, irrigation, pest control, production, and natural resources expertise, and are well positioned to work together,” Ritchie said. “As a nutrition researcher, I can bring expertise on human dietary needs, while others can identify the crops that are most environmentally sustainable in different ecosystems. How we can get the best nutrition with the smallest environmental impact is the key question to address.”
Consumers can also help protect the planet's health with information to make educated decisions about their food choices.
“I would like to see food labeling not only for nutrition, but also on the product's sustainability,” she said.
Impacts from food on the planet's health involve production, water use, transportation, packaging and other factors.
“It kind of makes you dizzy to think about balancing impacts to human health and planet health. At UC ANR, we have the expertise and we can contribute to making progress in California and beyond in that regard. Complex problems will require multiple solutions – the time to act is now,” Ritchie said.
At fast food and sit-down restaurants across California, kids' meals come with water or milk automatically. At least, that should be the case since state law requires restaurants to offer the healthy beverages by default to reduce the amount of sugary beverages served to children.
California Senate Bill 1192, authored by Sen. Bill Monning (D-San Luis Obispo), went into effect Jan. 6, 2019, but research by the UC Nutrition Policy Institute (NPI) has found that implementation has not been universal and more can be done. The results, along with results from a similar study in Wilmington, Del., were published Aug. 20 on HealthyEatingResearch.org.
Before the law, 10% of menu boards observed by the researchers in California listed only the healthy beverages. Data collected after the law went into effect showed 66% of menu boards list the healthy default beverages. The researchers also collected data on the proportion of cashiers who verbally offered only healthy beverages with kids' meals when orders were placed. This happened only 5% of the time before the law was enacted, and dropped to 1% after.
“Parents look at menu boards and kids look at menu boards, but it is likely that what the cashier says also influences which drink they choose,” said Lorrene Ritchie, NPI director and UC Cooperative Extension nutrition specialist. Ritchie was the lead researcher on the California portion of the study. “In our data collection, we would order a kids' meal and wait for them to offer a drink. But mostly they said, ‘What drink do you want?' instead of ‘Do you want water or milk with that?'”
The law doesn't specify whether the cashier must offer the default beverages, but the spirit of the law suggests they should, as it would likely have a greater impact on the selections that children and parents make, Ritchie said.
According to Gail Woodward-Lopez, an NPI researcher and co-investigator on the study, most restaurant managers expressed support for the legislation, but didn't know much about it.
“NPI in partnership with the California Department of Public Health is working with some local health departments to provide training and materials to help restaurants comply with the letter and spirit of the law,” Woodward-Lopez said. “Our next step is to measure whether this health department support is effective.”
The dire need to direct children away from sugary sodas is clear. Empty calories from soda and other sugar-sweetened beverages is the No. 1 cause of obesity in children, Ritchie said. Obese children are at least twice as likely as non-obese children to become obese adults. Obese children and adults are at greater risk for Type 2 diabetes, heart disease, stroke, high blood pressure, high cholesterol, certain cancers, asthma, low self-esteem, depression and other diseases. The Centers for Disease Control and Prevention names obesity as one of the conditions that increase risk of severe illness from COVID-19.
Many open questions remain, such as how drinks are portrayed on drive-thru signs and offered by drive-thru order takers. The COVID-19 pandemic has also altered the way Americans purchase food, with increased online ordering, delivery and drive-thru usage. In-store kiosk ordering is also growing in popularity.
“The role of default beverage policies in this context is important and not well understood,” Woodward-Lopez said.
Woodward-Lopez and Ritchie are working with colleagues around California and across the country to design follow-up studies of newer food technologies and beverage policies being passed elsewhere, to determine how government policies can protect children's health by steering them toward healthy beverage consumption.
The newly published research was funded by the Robert Wood Johnson Foundation and by the California Department of Public Health with funding from the United States Department of Agriculture.
A study of the first University of California campus (UC San Francisco) to ban the sale of soda on campus has shown that employees reduced their consumption by nearly 50 percent. UCSF staff who took part in the study also reduced their waist measurements and weight.
“This was not a ban on the consumption of sugared beverages,” emphasized co-lead author Laura Schmidt, PhD, MSW, MPH, UCSF professor in the Philip R. Lee Institute for Health Policy Studies. “This was a ban on sales on sugary beverages in vending machines, break rooms and cafeterias...People could still bring them from home or buy them off campus.”
The study was published Oct. 28, 2019, in the Journal of the American Medical Association, Internal Medicine.
California Assembly Member Richard Bloom (D–Santa Monica) noted the importance of workplace and governmental restrictions on soda sales while communities are prohibited from establishing local soda taxes for the next 12 years. In June 2018, the beverage industry strong-armed the California Legislature and Governor into enacting a “preemption” law that prohibits communities from passing local soda taxes.
“Workplace restrictions enable communities to take charge of their own health as we build momentum to pass AB 138, my bill that establishes a statewide soda tax that will fund prevention efforts. The bill will reduce soda consumption and generate positive health outcomes in impacted communities, where most needed, just like the UCSF effort,” Bloom said.
Lorrene Ritchie, UC Cooperative Extension specialist and director of the UC Nutrition Policy Institute, which conducts nutrition research to strengthen public policy, commented: “I am so impressed with both UCSF's sales ban and this very well-done study. Sodas are such a huge contributor to our obesity crisis that it is heartening to recognize a solution that any employer can adopt to help people improve their lives.”
Speaking of the UCSF study, lead author Elissa Epel, PhD, UCSF professor of psychiatry and director of the UCSF Aging, Metabolism, and Emotions Center, said: “This shows us that simply ending sales of sugary drinks in the workplace can have a meaningful effect on improving health in less than one year. There is a well-known pathway from soda to disease. High sugar intake leads to abdominal fat and insulin resistance, which are known risk factors for diabetes, heart disease, cancer and even dementia. Recent studies have also linked sugar intake to early mortality.”