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The Rudd Center Health Digest

June 2013

Rudd ‘Roots Parents Has Expanded

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The Rudd Center’s parent advocate website, Rudd ‘Roots Parents, has expanded to include a section on food marketing in schools. The site has been redesigned, with enhanced features and functionality.

As with school food, the new section provides the relevant research, examples, and tools necessary for parents to address the marketing of unhealthy foods and beverages in schools.

“Focusing on food marketing in schools is a natural next step for parents looking to ensure a healthy school environment for their children,” said Carol Hazen, MS, Rudd Center Director of Advocacy Resources. “The hard work of improving foods served and sold in the cafeteria and classroom is undermined if students are seeing unhealthy products being marketed in their schools.”

Whether parents want to improve the food and beverages offered in schools or curb the marketing of unhealthy products to students, Rudd ‘Roots Parents can help. Feedback on the site is encouraged. Please email ruddroots.parents@yale.edu with any comments or suggestions.

USDA Releases Standards for Snacks Sold at School

The USDA released its standards for “competitive foods” sold in schools. Under the rule “Smart Snacks in School,” which is part of the Healthy, Hunger-Free Kids Act of 2010, foods that are sold outside of the regular school meal will have standards that limit calories, fat, sugar, and sodium for the first time ever.

Standards already regulate the nutritional content of school breakfasts and lunches subsidized by the federal government, but most schools also have vending machines and "á la carte" lunch lines that sell foods. The new standards will cover foods sold in these venues, and any other foods regularly sold at school.

The regulations largely mirror the USDA’s proposal from February. Under the new rule unhealthy snack options such as donuts, fruit snacks and candy bars offered at lunch and in vending machines will no longer be allowed and will be replaced with healthier foods such as nuts, light popcorn and fruit cups. According to the rule, elementary and middle school children can only purchase water, milk and juice. There are additional beverage options for high school students but these beverages must contain no more than 60 calories in a 12-ounce serving.

The standards are seen by health advocates as a critical step in improving students' nutrition. “The release of these standards is historic,” said Kathryn Henderson, PhD, Rudd Center Director of Director of School and Community Initiatives. “In combination with the new school meal regulations, these standards have the potential to impact the health of millions of children nationwide and support, rather than undermine, parental efforts to improve children’s diet. USDA is to be commended for stepping up to address the nutrition crisis in the United States and for protecting the health of children.”

"Thanks to the hard work of the USDA, we are witnessing a dramatic transformation of the school food environment in this country," said Marlene Schwartz, PhD, Rudd Center Acting Director. “Students and parents have been frustrated by the hypocrisy of teaching nutrition in the classroom and then undermining those lessons in the cafeteria and vending machines. Thanks to last year's changes to school meals and today's announcement, our nation's schools will practice what they preach and teach nutrition through action, not just words.”

Many children eat more than half of their daily calories at school. The regulations will cover 50 million children who are part of the federal school lunch program.

New York City’s Sugary Drink Size Limit Appealed in Court

The New York City Department of Health appeared before the Appellate Division of the New York State Court this month to argue against the March ruling that blocked Mayor Bloomberg’s initiative to limit the portion size of sugary drinks. The aim of the measure is to combat obesity by reducing consumption of sugary drinks.

A judge called the law arbitrary and beyond the Department of Health’s authority, one day before it was set to take effect.

“Portion sizes, especially for sugary drinks, have spun wildly out of control over the last 15 years,” said Marlene Schwartz, PhD, Rudd Center Acting Director. “New York City’s effort to limit the sale of sugary drinks to 16 ounces - which is still 2 servings - is a perfectly logical response. The Department of Health is responsible for protecting the health of the citizens they serve. Research shows that sugary drinks contribute to poor diet, weight gain, and the development of type 2 diabetes. Efforts to decrease sugary drink consumption are clearly aligned with their mission.”

American Medical Association Recognizes Obesity as a Disease

The American Medical Association (AMA), the nation’s largest organization of doctors, has officially designated obesity as a disease that requires medical treatment and prevention. The classification could change the way doctors and insurance companies treat and cover obese patients.

"The AMA's decision is an important step forward, and recognizes obesity as a serious and chronic condition that must be addressed as a priority for treatment in the medical field," said Rebecca Puhl, PhD, Rudd Center Director of Research and Weight Stigma Initiatives.

"Overall, this is a positive change because it will provide much needed resources and attention to the topic of obesity," said Marlene Schwartz, PhD, Rudd Center Acting Director. “At the same time, it is important to remember that BMI alone does not tell the whole story about any one individual's health status. Health professionals will still need to assess diet quality and physical fitness to determine treatment recommendations for each patient who has a BMI in the obese range."

According to the AMA, obesity rates in the United States have "doubled among adults in the last twenty years and tripled among children in a single generation" and that the World Health Organization, the U.S. Food and Drug Administration, and Internal Revenue Service already recognize the condition as a disease.

Report Calls for More Physical Activity in Schools  

The Institute of Medicine (IOM) recently released a report entitled Educating the Student Body: Taking Physical Activity and Physical Education to School, which makes recommendations for physical education requirements in schools.

The IOM recommends that students should be doing at least 60 minutes of vigorous or moderate-intensity physical activity at school, with more than half of the activity occurring during regular education hours and the remaining amount before and after school.

Estimates show that only about half of youth meet the current Physical Activity Guidelines for Americans’ recommendation of at least 60 minutes of daily vigorous or moderate-intensity physical activity.

The report urges that the U.S. Department of Education designate physical education as a core subject and state legislatures and departments of education adopt and/or strengthen physical education and recess policies.

Ads Disparage Healthy Foods 

Dannon’s latest ad campaign calls its Oikos Greek Yogurt “too delicious to be so nutritious.”

“This campaign sends a clear message that nutritious food does not taste good,” said Kathryn Henderson, PhD, Rudd Center Director of School and Community Initiatives. “Although Dannon probably did not intend to do so, its message undermines the efforts of parents, schools, and even national public health campaigns, to encourage young people to eat right."

Other food companies are also sending disparaging messages about healthy eating. A Tyson commercial shows children talking about how much they dislike vegetables. The commercial ends with a voiceover that says Tyson Chicken Nuggets are “the one thing that kids love 100 percent of the time.”

“The messages in advertising can have a powerful effect on social norms,” said Jennifer Harris, PhD, MBA, Rudd Center Director of Marketing Initiatives. “It’s unfortunate when companies use their influence to reinforce a perception that children will not eat healthful foods.”

Senators Address the Marketing of Energy Drinks to Children

Senators John Rockefeller IV and Richard Blumenthal recently sent letters to energy drink companies inquiring about their marketing practices targeting teens. The letters were sent to Monster Beverage Corporation, Rockstar, Red Bull North America, and Living Essentials.

The letters follow up on the American Medical Association’s (AMA) recent temporary ban on the marketing of energy drinks to children under 18. The AMA noted that the massive and excessive amounts of caffeine in energy drinks may lead to health problems. The AMA asserted that banning companies from marketing energy drinks to adolescents is needed to protect the health of American Children.

“Energy drink marketing to youth is a pervasive and troubling practice in light of the recommendation from the American Academy of Pediatrics that children and youth under 18 years of age never consume caffeinated energy drinks,” said Christie Munsell, MS, RD, Rudd Center Research Associate. “Our research has shown that teens saw an average of 124 television ads for energy drinks in 2012 and that they saw three times more ads for 5-hour Energy than any other sugary drink brand. In addition, this drink category is often marketed through social media, websites with high youth appeal, promotions, and sports sponsorships that disproportionately appeal to teen males.”

Just Published by the Rudd Center

Public Reactions to Obesity-Related Health Campaigns

Public health campaigns have emerged across the country to promote behaviors that can help reduce America’s waistline, but several of these campaigns have been criticized for reinforcing stigmatization of obese individuals. Research shows that stigmatization of overweight and obese individuals can exacerbate health effects already associated with obesity, impair weight-loss efforts, and potentially lead to increased weight gain.

In a new study that examined how the public perceives these campaigns, Rudd Center researchers found that campaigns that are viewed as stigmatizing are no more likely to instill motivation for improving lifestyle behavior compared to neutral campaigns. The study was published online in the American Journal of Preventive Medicine and highlights the need for careful selection of language and visual content used in obesity-related health campaigns.

More than one thousand adults were randomly assigned to view 10 obesity-related health campaigns that stigmatized obese persons (as identified in pilot research) or 10 campaigns that were more neutral in content. Participants evaluated each campaign and rated to what extent each stigmatized obese people, motivated people to improve lifestyle behaviors, and promoted self-efficacy.

Stigmatizing campaigns were rated as inducing less self-efficacy for behavior change and as having less appropriate visual content. These findings were consistent regardless of participants’ own body weight and across socio-demographic characteristics.

The authors asserted that campaigns that promote specific health behaviors which all individuals can engage in regardless of their body weight, as well as those that avoid stigmatizing depictions of obese persons may be most effective in instilling higher self-efficacy for health behavior change.

“The findings from our study challenge the notion that stigmatization is a necessary component of public health messaging about obesity, and suggest that this approach may be less effective than non-stigmatizing messages in efforts to encourage health behaviors,” said Rebecca Puhl, PhD, lead author and Rudd Center Director of Research and Weight Stigma Initiatives.

The study was co-authored by the Rudd Center’s Jamie Lee Peterson, MA, former Research Associate; and Joerg Luedicke, MS, Statistical Consultant. A video about the study by Dr. Puhl appears on SciVee.

Hispanic Youths’ Exposure to Food Advertising on Spanish- and English-Language TV

Researchers at the Rudd Center have quantified the number of food and beverage ads viewed by Hispanic youth on both Spanish- and English-language television. Regardless of language, the majority of ads promote nutritionally poor products, such as fast food, sugary cereals, and candy. The study was published in JAMA Pediatrics, and is the first of its kind.

Using data obtained from Nielsen, a media research company, researchers examined advertising viewed by Hispanic and non-Hispanic youth in 2010. On average, both Hispanic and non-Hispanic youth saw 12-15 television food ads every day and most of the ads were for fast food, breakfast cereals, restaurants, and candy. For Hispanic youth, 75 percent or more of these ads appeared on English-language television. Despite watching similar amounts of television, Hispanic youth viewed fewer food and beverage ads than their non-Hispanic peers because those ads appear less frequently on Spanish-language television.

Of special concern, Hispanic preschoolers watched 24 more minutes of television per day than their non-Hispanic peers, and those who spoke only Spanish watched more than 4 hours per day. These young viewers were exposed to a significant number of ads for fast food shown on Spanish-language television.

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.

Much of the advertising viewed by Hispanic children was for food products and for restaurants that are not approved for advertising to children by the Children’s Food and Beverage Advertising Initiative (CFBAI). Companies participating in the CFBAI voluntarily pledge to advertise only healthier dietary choices during children’s television programs.

Previous studies have shown that exposure to large numbers of television advertisements for unhealthy foods and beverages contribute to poor diet among youth. Given higher rates of obesity and overweight among Hispanic youth and recent introductions of new media and marketing campaigns targeted to bilingual youth, the authors noted the importance of continued monitoring of food and beverage marketing to Hispanic youth.

The paper was co-authored by the Rudd Center’s Frances Fleming-Milici, PhD, Research Associate; Jennifer Harris, PhD, MBA, Director of Marketing Initiatives; Vishnudas Sarda, MBBS, MPH, former Biostatistician; and Marlene Schwartz, PhD, Acting Director. A video about the study appears on YouTube.

The Latest Rudd Center Podcasts

Kathryn Henderson
Director of School and Community Initiatives, Rudd Center
Nutrition in Day Care Settings

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

Front Burner News

Policies Reduce the Availability of Junk Food in Schools

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State laws and local school district policies can effectively reduce the availability of high-fat and high-sugar foods and beverages in elementary schools, according to a study published in JAMA Pediatrics. Read more.

SNAP Users Drink More Soda and Eat Fewer Vegetables

Food stamp users drink more sugary beverages, eat fewer fruits and vegetables, and rely on starchy breakfast foods than other consumers, according to a survey by the NPD market research group. Read more.

Effects of Obesity

Obesity reaches beyond clothing size and cardiovascular risks and impacts every area of a person’s life including health, family, and income. Read more.

United Kingdom to Introduce Consistent Front-of-Pack Food Labeling

A new consistent system of front-of-pack food labeling will be introduced in the United Kingdom. The system will use a combination of color coding and nutritional information to show how much fat, salt, and sugar and how many calories are in products. Read more.

Cost of Food Contributes to Obesity

Produce prices have been growing quickly during recent decades while less healthy foods like sweets have remained relatively cheap, according to data from the Federal Reserve. Health experts say this trend may be contributing to the nation's obesity epidemic. Read more.

Children Consuming Fewer Sugary Treats and Drinks

Children are consuming fewer sugary drinks, desserts, and cereals than they did 15 years ago, according to data produced by the research specialist NPD Group for USA Today. Read more.

Family Structure Impacts Obesity

Children living in households where parents are married are less likely to be obese, according to researchers from Rice University and the University of Houston. Read more.

Adding Dip to Vegetables Encourages Children to Try More

Offering dip with vegetables encourages children to try vegetables they would normally push aside, according to a study published in the Journal of the Academy of Nutrition and Dietetics. Read more.

Prevalence of Smoking Compared to Obesity

The prevalence of smoking among U.S. adults is holding steady while the obesity rate has risen, according to a report by the Centers for Disease Control and Prevention. Read more.

Food Options in Neighborhood Influence Obesity Risk

People with healthy food options within a mile of their homes were less likely to become obese over a five-year period, compared with people who had to travel at least a mile away from home to get healthy food, according to a study published in the journal Obesity. Read more.

Connecticut Passes GMO Labeling

Connecticut is the first state to pass a bill requiring food manufacturers to label all products that contain genetically modified ingredients. Read more.

Fewer Doctors Warning Patients of Overweight Dangers

Fewer primary care physicians are warning their patients of the dangers of being overweight, according to researchers at the Penn State College of Medicine. Read more.

Using Exercise Times on Menus Instead of Calorie Counts

Fast food restaurants are required to add calorie counts to their menus under the Affordable Care Act, but researchers from Johns Hopkins University question whether describing a food’s caloric value in terms of exercise would be more effective. Read more.

Foods Labeled as Healthy Cause Confusion
Clever food labeling can fool-well intention comsumers into believing that foods labeled sugar-free, fat-free, or whole wheat are healthy choices, according to Kari Kooi, a registered dietician at the Methodist Hospital in Houston.

VOICES

Eliminating Sugary Drinks from African American Diets

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African American health concerns have reached epidemic proportions, according to Darcel Lee, the Executive Director of the California Black Health Network. He asserted that rates of obesity, cardiovascular disease, and diabetes among African Americans are high due to sugary drinks and junk foods. Read more.

Sports Drinks Not Needed for Hydration
Sports drinks such as Gatorade were originally designed for performance athletes, not growing children. Water is always the best option for children who need hydration after sports. Read more. 


SUGAR-SWEETENED BEVERAGES/TAXES

New York City Targets Sugary Drinks with Expanded Ad Campaign

New York City’s latest Pouring on the Pounds ad campaign shows that many beverages that “sound healthy,” like sports drinks, teas, and energy drinks, contain added sugars, and their consumption is contributing to obesity and diabetes. Read more.

Children Who Watch TV Drink More Sugary Beverages

Children who watch a lot of television and are exposed to TV advertisements have increased consumption of sweetened beverages, according to a study published in the International Journal of Public Health. Read more.


FOOD MARKETING

Senator Urges Nickelodeon to Stop Marketing Junk Food to Children

Senator Richard Blumenthal (D-CT) and Jennifer Harris, PhD, MBA, Rudd Center Director of Marketing Initiatives, recently held a press conference urging the children’s media network, Nickelodeon, to stop marketing junk food to children. Read more.  

WHO Calls for Stricter Food Marketing Rules

The World Health Organization (WHO) has called for tighter controls on food marketing to children, saying tougher regulations are crucial to winning the fight against childhood obesity. Read more.