Category Archives: Nutrition
Late last month, the Bipartisan Policy Center, a think tank based in Washington, D.C., released a new white paper, Teaching Nutrition and Physical Activity in Medical School: Training Doctors for Prevention-Oriented Care, that strongly recommends providing greater training in nutrition and physical activity for medical students and physicians in order to help reduce U.S. obesity rates. The report was jointly published with the American College of Sports Medicine and the Alliance for a Healthier Generation, a nonprofit founded by the American Heart Association and the Clinton Foundation as a response to the growing rate of childhood obesity. The report found that current training for medical professionals and students in nutrition and exercise is inadequate to cope with the nation’s obesity epidemic.
A survey conducted for the new report found that more than 75 percent of physicians felt they had received inadequate training to be able to counsel their patients on changing diet and increasing activity levels. It also found that while some schools have stepped up their performance, fewer than 30 percent of medical schools meet the minimum number of hours of education in nutrition and exercise science recommended by the National Academy of Sciences.
“The health care marketplace needs to place greater value on preventive care,” said Jim Whitehead, Chief Executive Officer and Executive Vice President of the American College of Sports Medicine. “Doing so will provide medical schools with the incentive to train their students accordingly. And it will give medical professionals the leverage they need to address healthy lifestyles with their patients.”
NewPublicHealth recently spoke with Lisel Loy, director of the Nutrition and Physical Activity Initiative at the Bipartisan Policy Center, about the report and about how to improve training for medical professionals on nutrition and exercise.
NPH: What was the idea that propelled you to look into making changing to medical school education?
Loy: Well, the technical launching pad was our June 2012 policy report called Lots to Lose: How America’s Health and Obesity Crisis Threatens our Economic Future. And in that, my four co-chairs recommended a suite of policy changes that would improve health outcomes and lower costs for families, communities, schools and work sites. Within that community context they called out the need to improve training for health professionals—not just physicians but health professionals much more broadly defined than that—in pursuit of the goal of reducing obesity and chronic disease and cutting costs.
So that’s sort of the technical answer to your question. The more philosophical answer is as we as a country shift toward more preventive care, they really saw a gap in the education and training of health professionals in terms of being able to best support improved health outcomes. So that’s how they determined that that belonged in our report as a policy recommendation, and since we put out that report we prioritized a handful of recommendations, one of which had to do with health professional training.
A new article from The Atlantic Cities reports on a recent study that finds that restaurants are shifting to become the predominant teen hang-out spot, rather than the malls of the past. According to a recent report on teen behavior, teenagers now spend more money on food and events than on clothes. And while an increase in mall closings may be driving younger people to eateries, the report finds that a greater interest in hanging out at restaurants also drove some of the drop in mall traffic—along with competition from the Internet.
The report doesn’t say what the teens are eating while they mingle, but the trend comes at a good time for them to access information on healthier diets, as under the Affordable Care Act many restaurants must now post nutrition information. Though studies have been mixed about the results of menu labeling, the U.S. Centers for Disease Control and Prevention notes that, overall, public health studies may be beginning to show that menu labeling may influence consumers to choose healthier options. And while many food outlets have chosen to share that information online rather than on walls, digital-savvy teens may already have the tools to find it—though they may need a push from social media or other educational outreach channels to do so.
Read the article from The Atlantic Cities.
Eat well. That’s today’s theme for National Public Health Week—and it’s good advice. After all, according to the American Public Health Association, Americans are now eating 31 percent more calories than we did 40 years ago, including 56 percent more fats and oils and 14 percent more sugars and sweeteners. The average American eats 15 more pounds of sugar a year today than in 1970.
There are new food-oriented websites and smartphone apps (many free) that can help people keep track of what foods they’re eating and what’s in those foods.
At the Milk Street Café in Boston, for example, the restaurant’s ordering site lets you filter the full menu into just the categories you want. Click low “fat” and the tailored breakfast menu leaves off the breakfast pastries and zooms in on the yogurt parfaits.
Other recent apps include:
- Locavore, which points to farmers’ markets and produce stands in your neighborhood.
- Harvest, which offers tips for choosing ripe produce.
- Fooducate, a food database on your smartphone that includes basic nutrient and calorie information, plus high points of each food such as the fiber quantify of crackers.
- Substitutions, an app finds alternatives when you can’t use the ingredient in the original recipe because of an allergy or other dietary restriction. Popular tip: Swap in fat-free yogurt when the recipe calls for fat-free sour cream to save calories.
- The U.S. Department of Agriculture hosts the Food Access Research Atlas, which presents a spatial overview of food access indicators for low-income and other census tracts using different measures of supermarket accessibility. The app is valuable for community planning and research.
Much of the country is still facing at least a few more weeks of winter weather, so harbingers of spring are especially welcome. In Washington, D.C., one of those signs is an increase in the number of “TapIt” posters on the city’s metro system letting city dwellers and visitors know where they can get clean drinking water throughout the area for their reusable water bottles. TapIt is a six-year-old national network of cafes, coffee shops and some retail stores that offer free drinking water to anyone who asks and brings their own vessel to fill and drink from. Partners that have helped with costs often include local water utility companies.
"This network protects the environment, as well as people’s wallets," said TapIt Campaign Director Will Schwartz in a recent release. "In fact, users could save up to $700 per year if they were to use TapIt instead of buying a bottle of water each day."
Other reasons to actively look for easy access to water in the community include:
- A 2012 study in the American Journal of Clinical Nutrition found that replacing sugary drinks with water resulted in a 2 to 2.5 percent weight loss for study participants during a six month clinical trial.
- In 2011, the American Academy of Pediatrics issued a parents advisory urging them to make water the primary form of hydration for kids.
- A 2013 survey published in the U.S. Centers for Disease and Control and Prevention’s journal Preventing Chronic Disease found that low drinking water intake is common and associated with known unhealthful behaviors such as insufficient physical activity and unhealthy eating.
Local TapIt apps, available via the internet or on Android and iPhone smartphone platforms, fix on a user’s location and display a map of nearby outlets that offer water. Users click on map markers for names of locations, addresses and distances. Information includes beverage specifics such as whether the offered water is filtered, chilled, self-serve, or needs to be requested. For example, at the Birchwood Café in Minneapolis, Minn. consumers help themselves to chilled, filtered tap water from the soda dispenser, while at the Village Bean Co. in Des Moines, Iowa, water drinkers must ask wait staff for water and will be offered room-temperature, non-filtered tap water.
National outlets welcoming TapIt users include REI outdoor clothing retail stores and Whole Food supermarkets.
Also, if you don’t have a computer or smartphone at the ready, many of the water partners post TapIt stickers on storefront windows or doors to let people know they’re invited in for a drink.
>>Bonus Link: Read an FAQ on the TapIt program.
Harvard Pilgrim Health Care Foundation’s work on childhood obesity is driven by one startling fact: one in three Massachusetts children are overweight or obese. To find out why, Executive Director Karen Voci and her colleagues went to the places where children learn and play—schools, after school programs and child care centers— and found that children were sitting for most of the day and foods were heavy on starch and sugar. With a limited budget, Voci and her team found opportunities and partners in Massachusetts, New Hampshire and Maine to improve childhood obesity rates.
“It’s hard to measure what you’re accomplishing,” said Voci at one session during the American Public Health Association (APHA) 2013 meeting. “These environments look and feel different, but it’s hard to capture this feeling in a meaningful statistic that can be used further down the road.”
As a result, most of the results shared focused on process and intermediate outcomes rather than actual health outcomes—for now—but the communities are optimistic that they’re moving in the right direction.
Voci underscored the importance of staying committed, noting that Harvard Pilgrim and its partners had been at this for years and they were in fact moving the needle. Session presenters shared successes from Massachusetts, New Hampshire and Maine.
Harvard Pilgrim partnered with the Massachusetts Department of Public Health and other foundations and businesses on the Mass in Motion initiative to combat childhood obesity in its home state. Led by their elected officials, 14 communities developed health improvement plans and received technical assistance to improve local food sources and increase physical activity. The multifaceted initiative included a “call to action” report, as well as a Governor’s Executive order establishing a nutrition standard for the food procured for the state of Massachusetts. In addition, the program implemented a body mass index (BMI) regulation that required schools to screen children’s BMI in order to identify potential issues early. The Department of Public Health worked within these communities to share information on physical activity and nutrition, all culminating in growth of the program to 52 communities in the state.
Communities in Eastern Massachusetts are showing concrete signs of progress on the childhood obesity front. Reports from this summer have shown that the obesity rate for the region’s children under six years of age has decreased by 21.4 percent—likely due in part to initiatives such as Mass in Motion, the Cambridge Healthy Children Task force and Shape Up Somerville.
CATCH Kids Club is an evidence-based, after-school environment that has been adopted by 117 sites in nine of New Hampshire’s ten counties. The CATCH program promotes exercise and healthy eating in elementary school children with a four-phased approach:
- Curriculum development
- Staff and booster training
- Staff support
- Environment and policy assessment
In the environment and policy assessment phase, CATCH found that 93 percent of participating after-school programs made four or more changes to improve children’s physical activity and healthy eating. In addition, most sites now offer programs that promote these goals between three and five times a week.
In Maine, the Let’s Go! 5210 Goes to School program offers resources to help schools create a culture of health. It aims to take the focus off of the highly charged weight management issue and shift it toward four simple and embraceable goals for each day:
- Eat 5 fruits and vegetables
- Limit screen time to 2 hours or less
- Get at least 1 hour of exercise
- Drink 0 sugary drinks
While each school decides which of these four goals it would like to adopt, they often end up promoting all four points of the program as time goes on. In fact, the 5210 initiative reaches children in all 16 Maine counties in schools, after school programs, early childhood education, doctors’ offices and more locations.
One of the key lessons learned was to engage busy school representatives at a level that made sense for them. “Don’t ask them to do something unrealistic,” said Torey Rogers of the Let’s Go! 5210 Goes to School Program and The Barbara Bush Children’s Hospital at Maine Medical Center.
Representatives from each of these programs offered insights and lessons learned when it comes to working with schools. When speaking with school representatives, organizations are often successful when they relate the goal back to the mission of schools: education. By highlighting the secondary benefits to attendance and active participation of students, organizations can engage teachers as partners in public health initiatives.
>>For more information on the successes of state and community efforts to reduce childhood obesity, view an interactive map on the signs of progress on childhood obesity.
>>NewPublicHealth will be on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Follow the coverage here.
In 2012 alone, the fast food industry spent $4.6 billion to advertise mostly unhealthy products, with many of those ads specifically targeting children and teens. A new report, Fast Food FACTS 2013, examined 18 of the nation’s top fast-food restaurants, following up on a 2010 report to see how the food selection and advertising landscapes have changed. And while there have been some positive developments—healthier sides and beverages are available in most kids’ meals—the findings indicate there is still a very long way to go.
Detailed findings from the report, which was supported by a grant from the Robert Wood Johnson Foundation, will be presented today at the American Public Health Association’s (APHA) annual meeting in Boston.
>>Read more on the Fast Food FACTS 2013 report.
>>NewPublicHealth will be on the ground throughout the APHA conference speaking to public health leaders, hearing from attendees on the ground and providing updates from sessions, with a focus on building a culture of health. Follow the coverage here.
NewPublicHealth spoke with Jennifer Harris, the Yale Rudd Center for Food Policy & Obesity’s director of marketing initiatives and lead author of the report, and Marlene Schwartz, the Center’s director, about their findings and how fast food advertising continues to impact our nation’s youth.
NewPublicHealth: Has any progress been made in the nutritional quality of fast food kids' meals?
Jennifer Harris: There have been a lot of changes in kids’ meals over the past three years and a lot of it has been good. Most of the restaurants have added healthy sides and healthy beverages to their kids’ meals. Now it’s possible to get a fairly healthy kids’ meal at most of the restaurants we looked at. But the problem is it’s kind of like finding a needle in a haystack. Almost all of the meals they offer are high in fat, sugar or sodium.
Marlene Schwartz: The odds of you getting the healthy combination when you go are extraordinarily low. For every healthy combination, there are roughly 250 unhealthy combinations.
Tackling the problem of obesity in the United States cannot be done with a single step solution. There are many factors that need to be addressed at the family, school and community levels in order for obesity rates to continue to decline across the country. Unfortunately, not everyone has equal access to the education and options that allow us to make healthier food choices. Higher prices and lack of accessibility to fresh produce serve as barriers for lower income communities in the battle against obesity and improving public health.
In urban areas across the country, groups focused on healthy living and eating are working to develop programs to create more healthy options for everyone. Programs in cities such as New York, Los Angeles and Philadelphia—to name just a few—have caught on with local food vendors, store owners, public health departments and the general public as we start to see rates of obesity drop in those targeted areas.
>>Read more about the fight against childhood obesity and the signs of progress in different areas across the country.
We have found some great examples of programs across the country that are proving successful in their attempts to increase the number of healthy options available to at-risk children and the greater community.
- In New York City, pediatricians at Lincoln Medical Center in the Bronx and Harlem Hospital have started prescribing fruits and vegetables for children. The prescriptions allow them to use coupons for produce at local farmers markets and city green carts. Medical professionals see this as a longer-term solution to the issues they are seeing children come in with, rather than simply prescribing them medicine.
- With Philadelphia weighing in as the most obese city in the nation, The Food Trust’s Brianna Almaguer Sandoval has enlisted the help of corner store owners to start providing healthier options on their shelves. The Healthy Corner Store Initiative provides store owners with free marketing materials such as labels and recipe cards; trainings on how to select, price and display the healthier offerings; and for some even funding for new shelves and refrigerator cases to help better stock fresh food.
- Groups in Athens, Ohio, are joining together to host an event called “Bounty on the Bricks,” to raise money to create a new grant program to enhance the capacity for local food pantries to provide more healthy options for their visitors in need. Those who bought tickets to the event will enjoy a meal celebrating local farmers and fresh produce along one of the main streets in Athens. The dinner will be held August 10 and organizers have already surpassed expected ticket sales.
A recent post from FoodSafety.gov claims that Super Bowl Sunday is the second biggest food consumption day for Americans, after Thanksgiving. It’s easy to see why during the current onslaught of Super Sunday food ads, focused on sauce-drenched wings, cheese and beer.
But healthier options don’t have to put a damper on game day. North Shore Long Island Jewish Health System in New York recently published some recipes for Super Bowl Sunday that let you go long on taste without sacking your resolve to eat better. Find low-fat, lower-calorie recipes for taquitos, white bean dip and cabbage slaw on page 31 of the hospital’s winter newsletter.
And this year, the USDA is reminding Super Bowl fans that food left out from pre-game to post-game celebrations can go bad quickly, posing serious health risks. USDA offers a “food safety playbook”: Clean, Separate, Cook and Chill.
Check out, and print out, the graphic from the U.S. Department of Health and Human Services, U.S. Department of Agriculture and the Ad Council as a reminder for best game-day food practices.
Weigh In: What reactions do you expect by changing menu items from calorie-laden to healthier?