When Fear Makes Us Fat

   In the past week, the Rudd Center released a report on the affects of childhood anti obesity campaigns including the one that is running in Georgia. I believe that I have already discussed it here.
   That campaign includes print, radio and TV spots that highlight obese children.  During the TV or radio spots, children are seen or heard in various situations that include dramatic music. The child may talk about being left out of activities, being unable to participate in activities, or having high blood pressure and diabetes.  Sometimes words are introduced in bold and dramatic manner on the screen.
   The point of the ads is to scare people.  Scare people into doing something about obesity.  They only succeed on the scare not the action. The main reason they fail is that they do not give suggestions for maintaining a healthy weight or for losing weight.  
   This is something I have talked about before - in regards to using fear appeals or fear messages.  They do have a place in health promotion and behavior change but ONLY if the intended audience (in this case the parents) is given a strategy and a means to access and apply it.  [think about smoking. You can scare people but you also have to tell them that quitting is possible, nicotine therapy helps, nicotine therapy (medications) can be obtained, where to get it and then provide it at no or low costs.]
   The Rudd study found that the obesity messages made things worse and for the very reasons I just explained.
   We do not need to tell parents or children that they are fat - we need to make it so they do not "passively" consume too many calories in the first place.
Please read the published Rudd study  HERE. 
   BTW, in the story I read, Rudd staff noted that menu labeling was one of the successful strategies that should be promoted.

Hot Dogs and Oxymorons

It is hard to point out faults or contradictions when people are doing their best and have a noble cause.  But I write a blog and some things people say or do are blog worthy...

So the first - at a planning meeting for a gathering where mini health screenings will take place refreshments were being discussed.   Hot dogs will be served.  In addressing this, the person who will be conducting the health screens explained that all the buns could not be whole wheat.  In fact, she said, some of the buns were to be whole grain and others white.  The person put great effort into explaining this issue.  I sat quietly, as this was not my show, and thought to myself "It really doesn't matter what you put it in, it is a HOT DOG!"

I am conflicted about the second part of this post because I really wouldn't want someone to read it and know I was talking about them.  Suffice it to say, calling yourself one of the "healthy obese" is using an oxymoron.  The two conditions are mutually exclusive (they cannot occur at the same time).  I know I alot of people will argue this fact, but arthritis (or wear and tear of our joints and discs) is caused by only a few things and being overweight is one of them.  

School Lunch Program

I have been reading up on the proposed rule regarding changes in the National School Lunch Program.  The program is to updated every time the Dietary Guidelines for Americans (DGA) is revised.  This is part of the school lunch law or act.  You can read the same material that I read, if you like, by clicking on this link.  I will highlight what appear to be the most significant changes.

The school lunch program has not been aligned with the DGA of 2005 and as you might know, we have a newer version, DGA 2010.  I am now in the process of reading the main conclusions of the DGA Committee .  I had quickly reviewed the summary when it was released, and likely noted it here, but the DGAC report is more detailed and has some very good statements that bear repeating, on another day.  

The USDA and Food and Nutrition Services (FNS) are the main agencies that work with the schools.  The USDA is following most of the  recommendations of the Institute Of Medicine in changing the nature of our school lunches.

The goal of the school lunch program is related to the health of our children, but the concerns have changed over time.  Now our kids are not deficient in nutrients but are over consuming calories and certain food components, much as are all Americans.  Thus, what is happening in our schools is the exact same thing that should be happening in our homes, restaurants and work places. I can see as I am reading the DGAC report that it is also the driver behind the IOMs recommendations for front of pack labeling.

Unfortunately, an assessment of the National School Lunch Program  has found that even the standards that are less stringent than those proposed are not being met.

The changes, for the most part are to take place at the time of implementation- school year 2012-2013.  The standards for whole grains will be entered in 2 phases and the standards for sodium which are DRASTIC will take place over a ten year period.  These stages are meant to give industry time to reformulate foods.

Without going into too much detail because my brain is sort of overflowing and needs a break:

The focus of the school meal will be to get adequate servings of certain food groups and limiting components that are related to chronic disease.  Thus the children will be given certain amounts of each food group (evaluated per week) to meet the child's needs and for reimbursement standards.  There will be monitoring.

The lunch will have more whole fruit and vegetables, with LIMITS on starchy vegetables and specific amounts of green, orange and legumes is mandatory.  There is to be 0 grams of trans fats on the label of any product used alone or to comprise a meal (and those only trace amounts would be in a meal).  Sodium is to be drastically cut so that the meal has 700 mg or so (there are differences based on grades for all of these).  I recently reviewed a lunch program at a school and the average daily sodium was over 1400mg.  Saturated fat is currently to be less than 10% of the total calories in that meal, which remains true(though it has been suggested that it be less than 7%). The use of lean sources of protein including meats and meat alternatives is strongly encouraged.  Whole grains are to replace refined ones - within the two year window.  Such that when implemented 51% of a grain serving must be from whole grain. I.e, if a product as 19g of grains, then 9g must be whole grain. Two years from implementation, the total 19g would need to be whole grain. There are to be limits on fruit juice (100% only) and as I have mentioned before - the milk provided to the students if unflavored, can be skim or 1% (ONLY) if flavored, it MUST be skim.  

If nothing else, open the link and go to page 2498 to review the chart of the changes.  I think this is fantastic! And by the way, the goal is to "safeguard the health of children." At this time the threat to kids is obesity with about 32% of school aged children either overweight OR obese and about 17% actually obese.  Sadly, what we see happening is NOT that the overweight kids turn into normal weight adults, but that they graduate into the obesity category. 

Oh, another change for the meals is that the is not a percent of carbs, or protein or a specific nutrient that the lunch has to meet.  Instead,  if the school lunch planners  follow the meal plan, the needs of the children will be met.

The changes are not without challenges, including costs - these are detailed in the linked document as well.

If you can't tax it - ban it

I am thrilled to attach the current newsletter from the Harvard School of Public Health.  It announces a policy change for the city of Boston. 
All new beverage contracts, for city owned properties, will include only low calorie beverages and NO SODA or sugar sweetened beverages (SSB)i.e sports drinks .  Diet soda will be allowed, but there is a limit on the proportion of diet soda to non diet drinks per total vending machine, or canteen menu.  If you click on one of the side links, you will see the report on diet drinks. In short, they are not considered the best alternative, but perhaps a step down from full sugar to no sugar beverages.  In that article,  some research is cited that indicates that having the sweetness without the calories confuses the brain.  The signals for satiety do not get sent and people over consume.  I drink a diet soda every day with a small snack and I am the least overweight person I know.  [this may be related to the fact that I am not drinking the soda to trick myself into thinking that I ate, but because I enjoy the taste. Also, I am consuming a low calorie snack at the same time - so I feel full AND have calories]

 Another research example they gave involved rats.  I am just thinking - rat studies - for calorie consumption - do not make a lot of sense because rats do not eat for all the reasons that people eat.  Much of our eating has to do with social pressure, happiness, sadness, etc - where as, I assume rats eat because they are hungry.

So back to the BAN.  Boston is also going to utilize my favorite Go Slow Whoa labeling  - Green means go -  water would be green, fruit juice (100% and small serving) would be yellow, and soda or whole milk would be red.  OK truth is that I did not open their traffic light guide, but I think I know this stuff well enough to guess correctly.  But that reminds me, though they will allow fruit juice, the serving size cannot be more than 8 ounces.  They are allowing low fat/no fat milk too - but again, in limited sizes.

I am so excited about this initiative that I emailed one of my professors to see how I could make something like this happen on my campus :)  I told him I would dedicate my summer to it.  I will keep you posted.

I also emailed it to the obesity coalition of which I am a part - perhaps we could influence my city :)

You are more than welcome to pass it on yourselves.  Here it is.  (I still think taxing or price differentials are good strategies too)  In this article, my hero, Walter Willett (MD) equates soda consumption with the greatest single cause of our obesity epidemic.  It was said that many people consume 200 calories a day in soda or SSB - well the average person.  That is only about one soda a day - I know many who drink several cans/bottles a day. 

Childhood Obesity - Attacking on all Fronts

Yesterday I linked you to a news story about a sugar tax.  In seeing the same story on Face Book my sister, quite understandably, suggested that we teach people to moderate as opposed to taxing them. 

Every public health graduate from the bachelors to the master's level enters the field with exactly those intentions.  We are taught strategies to motivate persons to make lifestyle choices that will reduce their risk of disease; chronic, communicable and acute as well as how to promote injury prevention.  As one of those MPH practitioner's I learned that even my favorite theory (Social Cognitive/Learning Theory)-  making things relevant and teaching skills - was falling short.  It has everything to do with why I am now in a doctorate program in NC.

The rates of obesity and the chronic health diseases that accompany it have not abated and so, we learn, the situation is complex.  It requires health education programs and everything else we can throw at it.  

Recalling another health crisis - raising taxes on cigarettes, after we educated on lung cancer and COPD, put in controls on advertising, and offered assistance for quitting is what finally got the smoke rates down from 43% to 19% in the USA.  It really took all of those actions.

The article I am linking to today is from a peer reviewed research journal and the scientists suggest ways to "create an environment in which youths are encouraged to eat a healthier diet."  It speaks to the magnitude of the problem and thus the complexity of the solution.