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The Rudd Center Health Digest

May 2013

Industry Self-Regulation of Food and Beverage Marketing to Children Expands Worldwide

The Rudd Center’s comprehensive database of industry pledges on food and beverage marketing to children around the world is a useful resource to help researchers, policy makers, and advocates analyze and improve food marketing targeted to young people. There have been several key changes to industry pledges since the database launched in December 2010.

A pledge is a voluntary statement made jointly by a group of food companies in a specific country or region (e.g., United States, European Union) that sets out basic principles to govern food marketing to children, including restrictions on certain types of marketing, definitions of child-directed media, and nutrition criteria for foods that are exempted from restrictions. A commitment is a statement or letter written by a participating company that states that the company supports the pledge and sets out specific standards that the company will follow.

Thirteen pledges existed in 2010, increasing to 23 pledges as of February 2013. The number of companies making these commitments increased from 52 to 90.

There have been improvements in many pledges. The definition of “child-directed” media has shifted from an audience made up of at least 50 percent children to a threshold of at least 35 percent by most pledging companies in the European Union and U.S., as well as by some companies worldwide. More companies and pledges have added company-owned websites, product placements, licensed characters, cell phones, interactive games, and specific aspects of sponsorship and promotions to the types of marketing covered. Some large transnational companies (e.g., Kraft/Mondelez, Nestle, Unilever, Mars, and PepsiCo) have also standardized their commitments in all countries.

Despite improvements, there are still numerous exemptions in, and inconsistencies between, different companies’ pledges and commitments in different countries. In addition, companies have not made specific commitments for 7 of the 11 pledges in non-Western countries.

The Rudd Center database is searchable by country and company, and provides details about individual pledges and commitments, including definitions of “audience” and "children" (based on age), communications channels and marketing methods covered, and foods exempted from restrictions.

Educational Film for Young People Addresses Body Image

The nonprofit program, Scenarios USA, has released a fictional short film called “The Tale of Timmy Two Chins” which examines body image, weight issues, and gender stereotypes through friendship, family, self-esteem, grief, and peer pressure, including bullying and shaming.

Teased at school for being “Timmy Two Chins,” Tim’s weight makes him feel unmanly and invisible. The story demonstrates Tim’s struggle to find his self-worth and serves as an educational resource for students. The film will be shown in schools across the country and comes with a lesson plan.

"Scenarios USA has helped give a voice to young people experiencing weight-based bullying,” according to Rebecca Puhl, PhD, the Rudd Center’s Director of Research and Weight Stigma Initiatives, who contributed her expertise to the film. “This film will help educate students across the country about this problem, and the importance of treating each other with respect and tolerance, regardless of one's body size."

Just Published by the Rudd Center

Strong Standards for School Snacks Increase Lunches and Revenue

Schools that implement strong nutrition standards for snacks sold at school increase student meal participation and school revenue, according to a study published by the Rudd Center and the Harvard School of Public Health. The study, published in the American Journal of Public Health, provides support for efforts to implement strong national nutrition standards for all food sold at school while promoting student participation in the National School Lunch Program (NSLP).

Federal meal programs, including the NSLP, provide an opportunity to improve young people’s diets. Previous research shows that the sale of snacks in schools outside the school meal programs, known as competitive foods, has been linked with unhealthy diet and increased risk of obesity. In response, the United States Department of Agriculture (USDA) was given authority to set nutrition standards for competetive foods sold throughout the school day, when Congress passed the Healthy, Hunger-Free Kids Act of 2010. The USDA is currently developing these standards.

Researchers analyzed six years of school lunch data from more than 900 public schools in Connecticut. The state began encouraging local school districts to meet stronger nutrition standards for school snacks in the 2006-2007 school year.

Researchers found that districts adopting these stricter standards saw 7 percent to 23 percent increases in middle and high school lunch participation and a slight decrease in elementary school lunch participation, compared to districts in the state that did not adopt stricter nutrition standards. In addition, researchers estimated that adopting the new standards resulted in roughly $30,000 in new revenue for an average district in the 2011-2012 school year.

“Connecticut’s experience demonstrates that protecting children’s health through stronger national competitive food standards is a winning solution for children, parents, and local districts,” said senior author Kathryn Henderson, PhD, Rudd Center Director of School and Community Initiatives. “Getting unhealthy foods out of schools and bringing more children to the lunch table will help build broader support for continued improvement of school meal programs.”

“The Healthy, Hunger-Free Kids Act has made great strides in improving the nutritional quality of school meals across the country, but these improvements will only matter if students participate in the meal program,” said lead author Michael Long, PhD, of the Harvard School of Public Health.

The paper was co-authored by Joerg Luedicke, MS, Rudd Center Statistical Consultant; Marice Dorsey, MS, former Rudd Center Biostatistician; and Susan Fiore, MS, RD, of the Connecticut State Department of Education.

Federal Food Assistance Program Encourages Healthy Beverage Purchases

Efforts to encourage healthy beverage choices by people receiving federal food assistance are paying off, according to a study published by the Rudd Center in Pediatrics. The study shows that purchases of 100 percent juice declined among participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) after the program changed in 2007 to offer foods that better reflect dietary recommendations for Americans.

While 100 percent fruit juices are widely marketed as healthy beverages, they contain the same amount of calories as soda and lack the fiber that is present in whole fruit. In addition, previous research in Pediatrics has shown that excessive consumption of 100 percent juice is associated with increased risk of weight gain.

The WIC program is designed to help meet the needs of pregnant and postpartum women, infants, and young children who are at nutritional risk. Prior to the WIC food package revisions, the federal monthly allowance of 100 percent juice exceeded dietary recommendations for juice consumption in young children. New WIC food packages provide considerably less juice.

Researchers examined 100 percent juice and other beverage purchases made at a New England supermarket chain by households participating in WIC, over a two-year period. The beverage type and amount were compared before and after the revisions.

Researchers found that juice purchases per household declined by 23.5 percent after revisions. The reductions in juice purchased with WIC funds were only partly compensated for by juice purchased with participants’ personal funds. Researchers also noted that the WIC revisions did not cause an increase in purchases of cheaper and less nutritious beverage substitutes such as soda.

Due to WIC’s broad reach and targeted impact on young, high-risk children, the authors said the program can help establish healthy eating habits and prevent obesity in low-income youth. The revision to WIC could significantly impact health outcomes related to excessive consumption of caloric beverages in underserved, vulnerable populations.

“Reducing juice and sugar consumption was one of the goals for revising the WIC food packages,” said Tatiana Andreyeva, PhD, lead author and Rudd Center Director of Economic Initiatives. “This study shows that the revisions were successful and necessary, given the high prevalence of obesity in very young children, particularly in low-income families.”

The paper was co-authored by Joerg Luedicke, MS, Rudd Center Statistical Consultant; Amanda S. Tripp, MPH, Yale doctoral student in public health; and Kathryn E. Henderson, PhD, Rudd Center Director of School and Community Initiatives.

Students’ Perceptions and Use of Nutrition Information in Dining Halls

Undergraduate students want nutrition information displayed in campus dining halls, and will use that information to make food choices, according to a study published in Health Education Journal. The study can guide university and college policies about providing nutrition information labels in dining halls.

Researchers conducted a survey of 487 undergraduate students at an urban university. The survey was conducted over a three-month period during the 2009–2010 academic school year and asked students about their perceptions and use of nutrition labels in dining halls.

Ninety-eight percent of the students surveyed indicated that it was a good idea to make nutrition information available either online or in the dining halls for each meal. In addition, the majority of students said that nutrition information would impact their food choices. Most students reported that the calorie and ingredient information were the most important aspects of the nutrition information cards, followed by fat content.

Results of existing research on menu labeling, which became federal law with the passage of the Patient Protection and Affordable Care Act and requires chain restaurants to post calorie information on menus and menu boards, have been mixed. According to the authors, some studies have found that menu labeling promotes the ordering and consumption of lower-calorie foods while others have found no effect.

The researchers recommended that colleges and universities consider implementing or maintaining nutrition labels in their dining halls. “As students try to navigate a new food environment filled with many different food choices and portion sizes, menu labels that provide nutrition information may be especially helpful for students,” said lead author Olivia Martinez.

The paper was co-authored by Martinez, Research Data Associate at New York University’s School of Medicine and former Yale University undergraduate student; Christina Roberto, PhD, Research Fellow at the Harvard Center for Population and Development Studies and former Yale University doctoral student; Jane Kim, former Yale University undergraduate student; Marlene Schwartz, PhD, Rudd Center Acting Director; and Kelly Brownell, PhD, former Rudd Center Director.

Food Commercials Excite Teen Brains

Regardless of body weight, teens had high brain activity while watching food commercials as opposed to nonfood commercials, according to researchers from the University of Michigan, the Oregon Research Institute, and the Rudd Center. The study, which appears in Social Cognitive and Affective Neuroscience, may inform the current debates about the impact of food advertising on minors.

Children see thousands of commercials each year designed to increase their desire for foods high in sugar, fat, and salt. Researchers analyzed how the advertising onslaught affects the brain by measuring the brain activity of teenagers while watching food and nonfood commercials.

Regions of the brain linked to attention, reward, and taste were active for all participants, especially when food commercials aired. Overall, they recalled and liked food commercials better than nonfood commercials.

Teens whose weight was considered normal had greater reward-related brain activity when viewing the food commercials compared to obese teens. Ashley Gearhardt, lead author of the study, said this suggests that all teenagers, even those who are not currently overweight, are affected by food advertising and that exposure could lead to future weight gain in normal-weight youth.

The study concluded that obese participants may attempt to control their responses to food commercials, which might alter the way their brains respond. But if these teens are bombarded with frequent food cues, their self-control might falter, especially if they feel stressed, hungry, or depressed. Gearhardt said brain regions that are more responsive in lean adolescents during food commercials have been linked to future weight gain.

The study's co-authors were Sonja Yokum, PhD, and Eric Stice, PhD, from the Oregon Research Institute, and the Rudd Center’s Jennifer Harris, PhD, and Kelly Brownell, PhD. The study was funded by the Rudd Foundation, the Robert Wood Johnson Foundation, and National Institutes of Health.

Menu Labeling Perceptions among Individuals with Eating Disorders

Individuals with eating disorders have difficulty estimating the number of calories in restaurant meals and are largely in favor of menu labeling laws, according to a study published in the journal Eating and Weight Disorders. This is the first study to evaluate the opinions of individuals with eating disorders on menu labeling legislation.

Menu labeling is included in the Patient Protection and Affordable Care Act and requires chain restaurants to post calorie information on menus and menu boards. While menu labeling is a public health policy meant to target obesity, there has been some concern that the initiative may impact individuals with eating disorders.

Researchers conducted an online survey and compared individuals with self-reported binge eating disorder, bulimia nervosa, and purging disorder and those without eating disorders, on restaurant calorie knowledge and perceptions of menu labeling legislation.

On average, people answered two out of six questions correctly on a calorie information quiz. Ninety-two percent of the people surveyed were in favor of menu labeling. The findings did not differ based on eating disorder, dieting, weight status, or race/ethnicity. 

While this study suggests individuals with eating disorders favor menu labeling, more research is needed to understand whether such labels can be detrimental to recovery from an eating disorder or promote eating disorder behaviors. 

The paper was co-authored by Martinez, Research Data Associate at New York University’s School of Medicine and former Yale University undergraduate student; Christina Roberto, PhD, Research Fellow at the Harvard Center for Population and Development Studies and former Yale University doctoral student; Jane Kim, former Yale University undergraduate student; Marlene Schwartz, PhD, Rudd Center Acting Director; and Kelly Brownell, PhD, former Rudd Center Director.

Proposed “Anti-Big Brother Government” Amendment Rejected

The Massachusetts’ House of Representatives has rejected a proposed amendment to the budget bill, titled “Anti-Big Brother Government,” that would have prohibited localities from limiting beverage serving sizes or restricting the use of toy incentives in meals.

Across the country, states and localities have always played a vital role in safeguarding the public’s health and safety. “Anti-Big Brother Government” would have undermined this historically recognized power, said Jennifer Pomeranz, JD, MPH, Director of Legal Initiatives at the Rudd Center.

“The Massachusetts’ House voted for rational government control over public health by rejecting this preemptive amendment. The people of Massachusetts are entitled to know that some of their elected officials are surreptitiously attempting to obstruct local government’s ability to protect citizens’ health. Unless there is a compelling reason to do so based on broader policy objectives, state governments should not preempt local jurisdictions’ ability to address public health and food safety,” said Pomeranz.

Healthy Eating and Physical Activity Support Academic Achievement

The Learning Connection: What You Need to Know to Ensure Your Kids Are Healthy and Ready to Learn, a report released by Action for Healthy Kids, demonstrates that physical activity supports academic achievement, well-nourished children learn better, and healthier practices in schools can increase school revenue. The report teaches parents, educators, school administrators, and school volunteers how to create healthier school environments so children are better prepared to learn.

The Latest Rudd Center Podcasts

Jennifer Pomeranz, JD, MPH
Director of Legal Initiatives, Rudd Center
The Law, Nutrition, and Obesity Prevention

The Rudd Center’s extensive library of podcasts is available for download on iTunes.

Front Burner News

Americans Consume Too Much Added Sugar

Sugar_Cubes

Many Americans consume too much added sugar in their food and most sugary foods are eaten at home rather than at restaurants, according to a study by the Centers for Disease Control and Prevention. Read more.

FDA to Investigate Added Caffeine in Food

The Food and Drug Administration will investigate the safety of added caffeine in food such as candy and nuts, and its effects on children and adolescents. Read more.

Fast Food Restaurants Have Made Minimal Nutrition Improvements

Fast food restaurants have made only minimal improvements to the nutritional value of items on their menus during the last fourteen years, according to a study published in the American Journal of Preventive Medicine. Read more.

Overweight Doctors Face Stigma

Just as overweight people are stigmatized in an array of professional and personal settings, overweight doctors are seen as less credible than normal weight doctors, and patients are less likely to follow their medical advice, according to a Rudd Center study. Read more.

Day Care Snacks Lacking Nutritional Value

Snacks provided in day care still lack nutritional quality, according to a study published in the journal Childhood Obesity. Read more.

Medical Students Have Bias Against Obese Patients

Two out of five medical students have an unconscious bias against obese people which may pose a barrier to the treatment of obesity, according to a study published in the Journal of Academic Medicine. Read more.

Mom’s Not Lovin’ It Campaign

The advocacy group, Corporate Accountability International, has launched a campaign called MomsNotLovinIt that urges mothers around the world to tell McDonald’s to stop its predatory marketing to kids. Read more.

Using Facebook to Track Obesity

Assessing Facebook “likes” to track obesity may be a useful tool, according to researchers from Boston Children’s Hospital. However, the feature that makes this strategy powerful may also make users vulnerable to exploitation, according to Jennifer Harris, PhD, MBA, Rudd Center Director of Marketing Initiatives. Read more.

SNAP Transparency Act of 2013 Proposed

A U.S. Representative has introduced the SNAP Transparency Act of 2013, which would require all grocers and retailers who accept food assistance benefits to report purchases to the federal government, and would require the U.S. Department of Agriculture to publish the information online. Read more.

Latino Children Exposed to Unhealthy Snacks at School 

Latino students are widely exposed to unhealthy snacks and drinks sold in schools, but implementing stronger nutritional standards can yield healthier school snacks, according to research by Salud America! The Robert Wood Johnson Foundation Research Network to Prevent Obesity Among Latino Children. Read more.

Restaurant Meals Loaded with Fat, Salt, and Calories

The average restaurant meal provides diners with most of the calories, fat, and salt they require for the entire day, according to two studies published in the journal JAMA Internal Medicine. Read more.

Researchers Create Food Map 

Researchers from the University of North Carolina at Chapel Hill are creating a map that shows what types of foods Americans are buying and eating the most. Read more.

Elementary School Implements Vegetarian Cafeteria

An elementary school in Queens, New York is the first public school in the country to implement a vegetarian cafeteria. Read more.

Location of Fast Food Restaurants Impacts Weight

African Americans who live near fast food restaurants have a higher body mass index than those living farther away, according to a study in American Journal of Public Health. Read more.

Food Revolution Day

Earlier this month communities across the world came together to celebrate Food Revolution Day, a campaign created by British celebrity chef Jamie Oliver that aims to inspire people to celebrate real food, where it comes from, and how to cook it. Read more.

Recess Contributes to a Better School Day

Recess has widespread benefits, including less bullying, more physical activity, and more time for teaching, according to a randomized controlled study of a popular recess program called Playworks. Read more.

Holding the Government and Food Industry Accountable for Obesity Epidemic

Governments and the food industry should be held accountable for the obesity epidemic, according to Dr. Adam Drewnowski, Director of the Center for Public Health Nutrition at the School of Public Health at the University of Washington. Read more.

VOICES

Fast Food Affects Our Culture

Fast_Food

Fast food has created a “fast food culture” that affects our laws, rituals and “ways of doing things” and permeates business, journalism, architecture and how we treat one another, according to celebrity chef, Alice Waters. Read more.

Children’s Story Book about Processed Foods

Lunch Tray blogger, Bettina Siegel, has created a children’s story book that shows kids how food companies may manipulate them into choosing fast food and packaged foods over more healthful options. Read more.

How the Food Industry Promotes Health 

The food industry equates health with how you look instead of outcomes such as quality of life and reduced disease risk, according to Patrick Mustain, freelance videographer and multimedia producer. Read more.

Home Cooked Meals to Fight Obesity 

There are many socio-cultural factors that promote over-eating and obesity, according to Jane Brody, personal health columnist for The New York Times. Brody encourages readers to take the time to create home-cooked meals and to avoid unhealthy ingredients and oversized portions. Read more.

SUGAR-SWEETENED BEVERAGES/TAXES

California Considers a Sugary Drink Tax

Momentum is building in California for a sugary drink tax that would make sugary snacks and drinks just as expensive as their healthier counterparts. Read more.

Denmark Abolishes Soda Tax

The Danish government has announced that it will phase out its existing soda tax by the end of 2013. Read more.

Coca-Cola’s Coming Together Campaign

As part of Coca-Cola’s Coming Together Campaign, the soft drink manufacturer has promised to stop advertising to children and place calorie counts on all its packaging. However, most of the promises made in the recent initiative are not new. Read more.