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Tackling childhood obesity: A systems change approach

Murals in schools visually reinforce key healthy lifestyle messages. The above mural is at Sierra House Elementary School in Lake Tahoe.

On paper, the charge was clear: launch a statewide effort to integrate the nutrition education programs of USDA SNAP-Ed funded partners. Address childhood obesity and food insecurity holistically, yet specifically. Do this through policy, systems and environmental approaches that will leverage community participation and resources in order to create sustainability at the local level, and do it as funding is declining in SNAP-Ed programs.

But what would this integrated effort actually look like in practice? How could a single effort weave together the many agencies, actors, and systems that influence a child's earliest years, a family's food selection, and school and community activities? How could the people around a table, some meeting for the first time, coalesce around a shared vision, let alone mutually agreed strategies?

A problem as multifaceted as childhood obesity requires a similarly complex public health approach to meet the challenge. It is with this charge that over the past four years UC CalFresh has been working across California on nutrition education and obesity prevention with the California Department of Social Services, the California Department of Public Health, the California Department of Aging, and Catholic Charities to redefine Supplemental Nutrition Assistance Program-Education (SNAP-Ed, which is funded by the USDA Food and Nutrition Service). 

The SNAP-Ed mission in California is to inspire and empower underserved Californians to improve their health and the health of their communities by promoting awareness, education, and community change through diverse partnerships, resulting in healthy eating and active living.

SNAP-Ed work is executed through county-led integrated workplans which now embody policy, systems and environmental (PSE) change in the body of work previously seen as a direct education program in schools and communities. Adding PSE activities to SNAP-Ed work acknowledges that a systems change approach that comprehensively addresses nutritional health where people live, learn, work, shop and play most effectively assures that children and their families will benefit from SNAP-Ed educational efforts.

The first years of children's lives can determine the rest of their development.
Technical assistance through education on food and food resource management coupled with assisting community members in making changes to their environment is a viable method of creating sustainable change. These types of comprehensive changes in schools and communities have been cited by a recent Robert Wood Johnson report to help children grow up at a healthy weight.

  • Tackling obstacles such as access to affordable fresh fruit and vegetables, safe areas to recreate, safe routes to school, and programs/curricula that encourage physical activity are important aspects of initiating long lasting community health and lifestyle changes.

  • Teaming with the Department of Transportation or environmental programs such as Resilient Schools can fuse nutritional work with those working in other areas that contribute to and foster a safe, healthy community.

  • Wellness policies in schools that encourage good nutrition and physical activity institutionalize healthy lifestyle choices.

  • Programs like the Smarter Lunchroom Movement help schools and students make the healthy choice in food and beverages the easy choice.

  • Environmental supports such as murals in the lunchroom or on school/community grounds visually reinforce key messages. On the playground, stencils depicting fruits and vegetables with key messages help motivate student's movement and play while reinforcing lessons learned in the classroom.

  • Garden-based learning facilitates student and community members' exploration of low-cost methods to add fresh fruits and vegetables to their daily meal plan. Research shows that nutrition and gardening experiences, linked to academic standards for a specific age group, can increase vegetable and fruit consumption and physical activity.

Now, let's explore how these changes in the type of work executed through SNAP-Ed is poising California communities to tackle childhood obesity.

There is general agreement through research that the first years of children's lives can determine the rest of their development. Across ideological divides, there is consensus that investing early makes sense — it helps children develop healthy habits that can last a lifetime — creating a high return on the investment of public dollars.

As described, SNAP-Ed funded and non-funded partners in communities are tackling childhood obesity and food insecurity on multiple fronts. It has been initiated with five broad-based levers for change:

  • Offering evidence-based direct nutrition education curricula and technical assistance
  • Developing state and local partnerships
  • Using data to inform strategies
  • Building commitment among stakeholders
  • Tackling policy and practice change

However, in the end, support in counties from SNAP-Ed funded partners requires community leadership and long term ownership to succeed. Each community is armed with essential knowledge about local context to make sense of these levers and to pursue emergent opportunities.

At the state and local level, the development and implementation of integrated workplans with community members input is a blueprint charting each counties course.

At the state level, the past four years of developing SNAP-Ed integrated workplans created several lessons in systems change evolution:

Listen and learn

The more we listen and support community members, bringing their ideas to the forefront of our work, the more sustainable our efforts will be.

Connect the dots and engage

Fragmentation and silos create a diverse but disconnected sector. Communicate and connect as much as possible.

Create mission and values statements that unify - then operate transparently

As you get to know the community members and organizations that you are working with— together create your mission and values statement and make that your solidifying “call to arms” — then work transparently to fulfill your mutual objectives.

Embrace tensions

Different settings, standards, and social norms create tension — successful systems change efforts face, rather than circumvent, these tensions…be respectful and “lean in”.

Foster a long term approach/celebrate short term “wins”

As we review the many factors that lead to childhood obesity and food insecurity, use long term systems change strategies, foster sustained commitment, and celebrate successes, no matter how small.

Be adaptable but purposeful

Reflect on how different organizations work and understand that your perspective may be a result of your vantage point. Try to be in another organization's or person's shoes, recognize their impediments, then work together with this in mind. Good strategies are shaped by reflection and steered with an understanding that there may be a need for course correction.

Keep a unified resolve

A recent Robert Wood Johnson Foundation report concluded that between 2005 and 2010 California saw “a modest but significant decline” in childhood obesity of 1.1 percent in grades 5, 7 and 9. In addition, a 2013 Centers for Disease Control and Prevention report indicated progress in the health of California preschoolers enrolled in federal health and nutrition programs. The report cited that “obesity rates among 2-4 yr olds from low income families dropped 2.9 percent from 17.7 percent in 2008 to 16.8 percent in 2011.” This data speaks to the significance of a comprehensive approach in preventing childhood obesity. Further, it emphasizes the importance of the teamwork provided by a network of state and local agencies, acting with community members, to make a difference in the lives of children.

California data reported by the 2016 Robert Wood Johnson Foundation:

  • Since 2004, schools have removed soda and other sugar sweetened beverages from premises.
  • Since 2007, schools have limited the calories, fat saturated, fat and sugar in snacks sold on their premises.
  • Since 2012, school districts have been required to make free, fresh drinking water available in school food service areas.
  • Since 2006, $40 million has been committed in annual dedicated state funding for elementary school physical education.

 

Posted on Wednesday, July 13, 2016 at 8:30 AM

Keeping produce at its best

UC ANR's popular guide to fresh produce is now on sale.
Farmers markets, produce stands, and likely your own backyard garden are an exploding bounty as California strawberries, stone fruits, and tomatoes show the summer produce season is in full swing.

But have you ever wondered what to look for when selecting fruits and vegetables? Why does your refrigerator have separate bins for fruits and vegetables? Should fresh tomatoes be stored in the refrigerator or on the counter? And how do you keep fresh basil fresh until you're ready to use it?

These and many more questions are answered in the colorful handbook:  From the Farm to Your Table:  A Consumer's Guide to Fresh Fruits and Vegetables available at anrcatalog.ucanr.edu

And now through July 31 the publication is 40 percent off if you order through our online catalog. So you can grab a copy for under $5.

This guide is brimming with tips from the pros at the Postharvest Technology Center at UC Davis. You'll find information on storage and handling for quality and safety as well as handy tables explaining which fruits and vegetables should be stored in the refrigerator and which should be stored on the counter. You'll also learn what to look for when selecting popular produce items for best quality.

And if you've ever wondered the steps your produce takes to get from the field to your market, the journey is explained here.

Oh, and the answers to those questions?

Your refrigerator has separate bins so you can keep keep ethylene gas-producing fruits such as apples, peaches, and pears away from vegetables. The naturally occurring gas can hasten spoilage of vegetables.

Un-cut tomatoes should be stored on the counter, not in the refrigerator.

And keep your basil fresh by treating it as you would cut flowers; place the stems in a glass of water on the counter until you're ready to use it.

Posted on Tuesday, July 5, 2016 at 1:30 PM

Keep your 'Fourth' independent of food safety issues

It's barbecue season! Remember food safety. (Photo: USDA)
Happy Fourth of July! It's time to get your barbecues grilling, and your potlucks and pool parties started. So, Independence Day is also a great time to remember to keep “free and independent” of foodborne illnesses all year long.

Food poisoning is a serious health threat in the United States, especially during the hot summer months. In fact, 1 in 6 Americans will get sick from food poisoning this year,according to the U.S. Department of Food & Agriculture (USDA). That's not all. The Centers for Disease Control and Prevention (CDC) estimates that 48 million people get food poisoning each year, resulting in approximately 128,000 hospitalizations and 3,000 deaths.

That's why the USDA and The Ad Council have teamed up on a new national food safety campaign.  The campaign is designed to raise awareness of the risks of food poisoning, and motivate the public to practice safe food handling behaviors – Clean, Separate, Cook and Chill.

Primarily, the four steps towards food safety can be summarized as:

  • Clean: Clean kitchen surfaces, utensils, and hands with soap and water while preparing food.
  • Separate: Separate raw meats from other foods by using different cutting boards.
  • Cook: Cook foods to the right temperature by using a food thermometer.
  • Chill: Chill raw and prepared foods promptly.

The USDA reports the campaign includes English- and Spanish-language television, radio, print and online advertising. There's a Facebook page and Twitter account with more food safety tips, if you'd like to follow along.

Handling food safety on the road

Before you take off on a road trip, camping adventure or boating excursion, don't forget to pack along common sense food safety advice. You'll also need a good cooler.

Remember, warns the USDA, don't let food sit out for more than 1 hour in temperatures above 90 degrees F. And discard any food left out more than 2 hours; after only 1 hour in temperatures above 90 degrees F.

Get more food safety tips for traveling from the USDA.

Use an ice chest to keep food safe when traveling. (Photo: Pixabay)
Food safety tips for college students

As summer comes to an end, don't forget to pack along some food safety advice for those new college students in your life.

Many college students are starting to cook for themselves for the first time, and food safety isn't always at the top of their concerns. They might need a little guidance about how long that leftover pizza is still safe to eat, or why raw meat should be kept separate from other ingredients while cooking.

The USDA offers these food safety facts for college students. Consider packing a fact sheet alongside their bed linens and kitchen pans.

This story is also available in Spanish.

You might also enjoy reading:

UCSB fights food insecurity among students

Source: UC Food Observer blog

Posted on Thursday, June 30, 2016 at 9:43 AM
  • Author: Teresa O'Connor, assistant editor, UC Food Observer, toconnor@ucop.edu

As Americans struggle with obesity and diabetes, help is on the way

Introduction of new nutrition facts labels will provide more information to consumers.
The iconic black-and-white Nutrition Facts label for packaged foods in the U.S. is getting its first makeover in two decades. The federal government's decision last month to update the food label means that for the first time, beginning in 2018, labels will list how much added sugar is in a product.

The decision, reflecting the latest science, will be felt well beyond the label. University of California food experts praised the labeling changes and offered six key takeaways.

1. Listing added sugar is the most important label change.

The new label will list the amount of added sugar in a product, both in grams and as a percentage of the daily recommended allowance.

“That's key,” said Laura Schmidt, a UC San Francisco professor of health policy and UC Global Food Initiative subcommittee member. “That will be really helpful for consumers.”

Added sugar – any sugar added in the preparation of foods such as table sugar, high fructose corn syrup and others – can be found in hundreds of products such as cereal, yogurt, pasta sauce and salad dressing. But the biggest source is sugar-sweetened beverages, which account for nearly half of Americans' intake of added sugar.

One 20-ounce soda will take you over the recommended amount of sugar for an entire day,” said Pat Crawford, senior director of research for the Nutrition Policy Institute of UC's Division of Agriculture and Natural Resources. “The new label will allow people to reasonably see what they're doing when they're consuming high-sugar products.”

The current label lumps added sugar with naturally occurring sugars in the foods themselves, which is a deceptive practice, said Dr. John Swartzberg, a UC Berkeley clinical professor emeritus and editorial board chair of the UC Berkeley Wellness Letter. Listing added sugar “will hopefully guide people away from consuming products with a lot of added sugar,” he said.

Pat Crawford
2. Americans need to consume less sugar.

More than one out of three adults in the U.S. is obese. Nearly half of U.S. adults have prediabetes or diabetes, raising their risk of heart attacks, kidney failure, blindness and amputations. Among U.S. children, more than 1 in 6 is obese, and diabetes and prediabetes rates are rising. Amid these alarming statistics, there's a growing concern about too much added sugar in diets.

“It's important to give the public the information they need in order to modify their diets,” Crawford said. “We are now finding significant effects on diabetes and heart disease rates for those who regularly consume sugary beverages. A large study of women over an eight-year period found that the risk of diabetes among women who consumed one or more servings of sugar-sweetened beverages per day was nearly double the risk among women who consumed less than one serving per month. Further, drinking one 12-ounce soda a day increases the risk of cardiovascular mortality by almost one-third.”

Crawford noted that the new federal dietary guidelines for the first time recommend limiting added sugars in the diet to no more than 10 percent of one's daily calories.

“The average amount of added sugar in the American diet is more than 20 teaspoons per day, nearly all of which is added to our foods during processing,” Crawford said. “Since about half of this sugar comes in the form of beverages, we have to rethink our beverage choices. Water should be the beverage of choice.”

Consumers will be very surprised to see the percentage of daily value of added sugar in one soda drink, said Michael Roberts, executive director of the UCLA Resnick Program for Food Law and Policy and UC Global Food Initiative subcommittee member. “Time will tell whether this information changes human behavior, i.e., consuming less soda. To be fair, sugar pops up everywhere, not just soda, so the impact that these changes will have on consumers and manufacturers will be interesting to watch.”

3. Expect manufacturers to make product changes.

When the federal government required that manufacturers add trans fat information on the label a decade ago, the food industry responded by marketing more products with lower trans fats, Crawford said.

“Trans fats are now not allowed to be added to foods during processing, but it all began with labeling,” Crawford said. “We're going to see some big shifts in the marketplace with products lower in sugars such as cereals, yogurts, spaghetti sauces and beverages, of course. We can look forward to recipe reformulation, which will make products more competitive. It's a great first step for reducing sugar consumption. In preparation for the new labels, manufacturers are working on creating products with lower levels of added sugars.”

For manufacturers, the trick will be to keep food tasting good to consumers while reducing sugar, Roberts said. “Other large manufacturers will pursue new products that are not heavy on added sugars,” Roberts said. “For example, Coke and Pepsi sell bottled water.”

“There is a push to at least re-size products,” Schmidt added. “There certainly will be an effort for front-of-package labeling that says ‘low sugar.'”

4. The new label could lead to regulations limiting sugar.

“Including added sugar on the label will be a game-changer for those debates about what is a healthy diet for people in the federal food-assistance programs,” said Schmidt, lead investigator on the UCSF-led SugarScience research and education initiative. “Once you've got added sugar on the label along with a daily reference value, policymakers will be in the position to set standards for the quantity of added sugar allowed in school lunches and other federal food programs.”

Changes like this have happened before, Schmidt noted. “In the U.K., the government said salt consumption is way too high and mandated that packaged food manufacturers reduce the amount of sodium in their products. It worked like a charm – they just gradually reduced the excess salt in foods to everyone's benefit.”

5. The new label makes changes beyond sugar.

The new label also will list more realistic serving sizes and will list calories in a larger and bolder font. “This will help people assess how many calories they are actually consuming,” Swartzberg said. (View a complete list of label changes here.)

6. Further steps could help consumers.

While praising the label changes, UC experts say further steps could help consumers make more informed choices:

  • Adding front-of-package labeling that states whether the product is high in sugar, salt or fat: “This banner on the front of packages would make it simple for a consumer to see whether a food is healthy or whether it has ingredients that contribute to risk of heart disease, stroke, obesity or cancer,” Crawford said.
  • Having food vendors add “stoplight” stickers: “There is the stoplight idea of labeling products with green, yellow and red stickers – green for the low-sugar products and red for the high-sugar ones,” offered Schmidt.
  • Promoting environmentally sustainable food practices: “(We should) consume more plant-based foods and less meat,” Swartzberg suggested.
  • Increasing research: “The label change is not enough: Further research, education and sound policies will need to be developed to motivate more healthy eating,” Roberts said.

 

The new Nutrition Facts label shows calories in large, bold print and specifies the amount of 'added sugars.'

 

Posted on Friday, June 24, 2016 at 8:09 AM
  • Author: Alec Rosenberg

USDA school kitchen grants enable kids to make healthy food choices

Children at Ygnacio Elementary School in Concord pick up lunch from a new serving counter.
Thanks to new equipment in school kitchens, made possible by special USDA grants, schools around the country are now serving fresher, healthier and more appealing food to students, according to research by the UC Nutrition Policy Institute (NPI).

"Years of federal neglect have resulted in many poorly equipped school kitchens, making it impossible to serve the nutritious meals that students need, particularly in light of the obesity epidemic that has affected so many youngster," said Kenneth Hecht, NPI coordinator.

During the past six years, Congress provided nearly $200 million to help schools purchase new equipment. Pew Charitable Trusts engaged NPI to see whether the grants enabled schools to make more meals from scratch with locally grown food and lead children to make healthy food choices.

NPI researchers visited 19 schools across the country to see new equipment in action and interview food service professionals, administrators and students. Their report was issued this month by Pew Charitable Trusts.

“Just one new appliance or serving station can have surprising impact on meal programs and students,” Hecht said. “Because of the USDA's School Kitchen Grants, more students are choosing school meals and they are eating more fruits, vegetables and other healthy options.”

The Nutrition Policy Institute, a statewide program that is part of UC Agriculture and Natural Resources, contracted with Pew to take a close look at a sample of representative schools that received the USDA kitchen equipment grants. The 19 schools – in the states of Kansas, Kentucky, California, Pennsylvania, Hawaii, North Dakota and Maine – were chosen to represent a range of sizes, grade levels and community types (urban, suburban and rural).

One of the schools in the study was Ygnacio Valley Elementary School in Concord, where the worn and dimly lit serving line made meals look lackluster. With the USDA grant, the school purchased a new serving counter with heated and refrigerated serving wells to keep dishes at proper temperatures, a salad bar and under-counter lighting that draws attention to colorful produce and other healthy fare.

“Children are taking and eating more fruits and vegetables because they can actually see how beautiful the food is and get to it easily,” says Megan Webb, the school's food service manager.

Another California school involved in the research, Robertson Intermediate School in Daly City, used the grant funds to purchase a large, three-door refrigerator and a warming oven. The upgrades helped the school increase the number and appeal of its entrée options and made it possible to contract with a different meal vendor for the 2015-16 school year.

“We absolutely needed new equipment; what we had barely functioned,” said Audra Pittman, superintendent of the Bayshore Elementary School District.

“The food is really good,” said one student cafeteria helper. “It's much better than last year.”

 

Posted on Friday, June 17, 2016 at 8:45 AM

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