The New York Times, Duff Wilson, July 27, 2010

When the Robert Wood Johnson Foundation decided in 1991 to take on Joe Camel, it became the nation’s largest private funding source for fighting smoking. The foundation spent $700 million to help knock the cartoon character out of advertisements, finance research and advocacy for higher cigarette taxes and smoke-free air laws and, ultimately, to aid in reducing the nation’s smoking rate almost by half.

But a few years ago, the Johnson foundation, based in Princeton, N.J., added another target to its mission, pledging to spend $500 million in five years to battle childhood obesity. As the antiobesity financing rose to $58 million last year, a new compilation from the foundation shows, the organization’s antismoking grants fell to $4 million.

The steep drop-off in private funds illustrates the competition under way for money as public health priorities shift. In the race for preventive health care dollars, from charities and from federal and state government sources, the tobacco warriors have become a big loser. And the nation’s battle to shed pounds has in its corner the White House, with Michelle Obama leading a new campaign against childhood obesity. Shortly after the first lady kicked off the “Let’s Move” program, the administration awarded more funds to fight obesity than tobacco through two big new money sources for preventive health. The funds, totaling $1.15 billion, came from economic stimulus and health care reform legislation. They still provided more than $200 million for tobacco-use prevention, but much more to grapple with obesity.

The changes in financing are also evident across the country. State governments have used tobacco’s billions to balance their budgets while cutting $150 million from antitobacco programs over the last two years. On the airways, obesity public service announcements are lining up while a “Truth” campaign about tobacco languishes for lack of money.

“Don’t forget tobacco,” pleaded a commentary this month in The New England Journal of Medicine.

One in five Americans still smokes.

But one in three is obese.

And competition for attention is growing between the two biggest issues in public health.

“I don’t see anybody else rushing into the vacuum,” says Dr. Steven A. Schroeder, former president of the Johnson foundation. “The sad thing is, smoking, despite all the harm it does, is left pretty much an orphan.”

Dr. James S. Marks, senior vice president of the foundation, said it had to pick its targets. “When we made the commitment to spend $500 million in obesity, we made the commitment to see if we couldn’t do for childhood obesity what we did in tobacco,” he said.

The decline in state funding to prevent smoking has distressed advocates. The 1998 Tobacco Master Settlement Agreement between 46 states and cigarette companies provided more than $200 billion through 2025. For a while it financed preventive programs like the “Truth” media campaign from the antismoking group American Legacy Foundation. But as states used money elsewhere, “Truth” spending declined, to a low of $35 million last year from $104 million in 2000.

“The industry outspends us in a day what we spend in a year,” said David Dobbins, chief operating officer of Legacy.

And even as states were raising taxes on cigarettes to record levels — a proven way to deter smoking — they were shifting that revenue to general funds. Both tobacco industry analysts and antismoking groups say that states have become addicted to tobacco money but are using less of it for prevention efforts.

“Overall funding on tobacco control is down because of dramatic cuts in state spending in recent years,” Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, said in an interview. “In the last several years we’ve seen the rapid progress in both adult and youth smoking rates slow to a crawl largely because of a decline in overall spending at the state level on tobacco prevention and cessation.”

State funding for antitobacco programs dropped to $567 million last year, from $717 million two years earlier, a 21 percent cut, according to an advocacy groups’ report titled “A Broken Promise to Our Children.”

While the federal government has made up for some of the state decline in antitobacco funding, it is spending even more on antiobesity efforts. And despite politic statements, there is undeniable competition for public health money.

“In our reaction to the obesity epidemic, sometimes we have taken our eye off other issues,” Terry F. Pechacek, of the Centers for Disease Control and Prevention office on smoking and health, said in a recent interview.

But Dr. Howard K. Koh, assistant secretary for health, focused on what he said was unprecedented funding from the federal government for both issues.

“Rather than pitting one disease against another, we want to uphold comprehensive prevention policies,” he said in a phone interview. Dr. Koh said the administration was directing $722 million to tobacco control and research this year and $821 million to obesity control and research.

The tobacco funding includes industry fees to set up a new regulatory office in the Food and Drug Administration. About half of the tobacco funding and most of the obesity funding is in research financed by the National Institutes of Health, illustrating the relative newness of obesity research.

In addition, the 2009 economic stimulus package included $650 million for “prevention and wellness strategies.” In February, state smoking quit lines received more than $44 million. In March, obesity programs received 62 percent of a $372 million award while tobacco programs received 38 percent.

Kathleen Sebelius, secretary of health and human services, made the awards in March a month after joining with Mrs. Obama to help kick off the first lady’s campaign against childhood obesity.

Stanton A. Glantz, director of the Center for Tobacco Control Research and Education at the University of California, San Francisco, asked, “Given that tobacco kills four times as many people as obesity does, why is the government putting more money into obesity?”

Kenneth E. Thorpe, a professor of health policy and obesity researcher at Emory University in Atlanta, defended the shifting resources, noting that obesity rates had doubled since 1985. And health problems related to being overweight now account for about 30 percent of the increase in health care spending, he said.

“The smoking rate, fortunately, has been coming down. Not far enough, but that’s moving in the right direction. Obesity is moving in the wrong direction,” he said.

Congress also created a $15 billion, 10-year Prevention and Public Health Investment Fund as a part of health care reform.

The first $250 million went in June to increase the number of primary care doctors, nurses and other health care workers — more to battle sickness than promote wellness, critics said. Jeff Levi, executive director of the Trust for America’s Health, a nonprofit advocacy group, said he was disappointed that the money was “diverted.”

Dr. Koh, the assistant secretary, an oncologist and formerly a Harvard professor and Massachusetts state health chief, said, “It was a one-time investment and we need those providers to deliver preventive services.”

Out of the second $250 million, $16 million went in June to obesity prevention and $16 million to tobacco cessation. Parts of other funds could be used for those purposes. But the nation’s leading antismoking groups had written Ms. Sebelius in April asking for about 30 percent of the total, which would have been $150 million.

Next year the prevention fund from health care reform rises to $750 million and to $1 billion after that, so the dueling organizations fighting smoking or obesity will be competing for a much larger pot of money.

Antismoking Efforts Lose Ground to Obesity Fight – NYTimes.com.

Every five years the American public gets a newly tweaked directive on what we’re supposed to be eating.

And every five years the American public largely ignores it.

For example, the 2005 Dietary Guidelines for Americans recommend we eat 2 1/2 cups of vegetables and 2 cups of fruit a day. But according to the Centers for Disease Control and Prevention, only about 14 percent of adults are even coming close.

Special interest groups, however, watch the guidelines closely and are speaking out. Just last week, nearly 50 speakers from industry and the science and health communities went to Washington to provide oral comments on the proposed guidelines for 2010, which will be released at the end of the year.

The proposed recommendation to reduce salt intake dramatically drew a statement from Morton Satin, Salt Institute vice president of science and research, that “no modern society consumes so little salt.”

The Healthy Eating Pyramid displayed here is the one created by Harvard School of Public Health, and is the only pyramid solely based on scientific evidence.

Dr. Richard Feinman, on behalf of the Nutrition and Metabolic Society, invited members of the federal Dietary Guidelines Advisory Committee to a debate on the guidelines’ proposed decrease in saturated fat consumption, saying that carbohydrates eaten with saturated fats were the real problem. The Weston Price Foundation, which advocates the healthful properties of fat from pastured animals, also took issue.

A dietary supplements industry group called the Council for Responsible Nutrition objected to the proposed statement that “a daily multivitamin/mineral supplement does not offer health benefits to healthy Americans.” The council said the committee’s report implies “it’s reasonable to allow people to live with nutrient inadequacies.”

If the guidelines are largely ignored by the average American, why do health and industry groups care so much about influencing them?

“I think to a certain extent they are followed,” said Weston Price Foundation President Sally Fallon, whose organization also supports the consumption of whole, rather than processed, foods. “Schools who get federal money and prisons are supposed to be following them for their menus.”

Have questions about the new food guidelines? Many do. Reporter Monica Eng answers some of them at Trib Nation.

Dr. Robert Post, deputy director of the U.S. Department of Agriculture’s Center for Nutrition Policy and Promotion, said all public comments are taken into consideration along with scientific reviews and lively debate within the committee’s meetings.

He noted that last month the department debuted something called the Nutrition Evidence Library, a new online resource cataloging the latest science on nutritional matters and the ways the USDA interprets it to create policy.

But some observers still worry that the guidelines may be too influenced by industry concerns.

“I believe that by supporting low-fat products and grain products, rather than actual low-fat foods and whole grains like quinoa and teff, they are just trying to support the food industry,” said Adele Hite, a University of North Carolina public health graduate student who represented the Committee for a Healthy Nation during last week’s meeting.

The USDA started giving out nutritional advice more than 100 years ago with a table of food composition and dietary standards that later morphed into food shopping guides for various income levels. In 1992 the agency developed the food pyramid, an image in which horizontal bars represented food groups.

In 2005 the pyramid was given a new look (and renamed My Pyramid) in which the bars were replaced by vertical stripes that some argued made it hard to read at a glance.

“The new pyramid is not so much an information image as something to send people to the mypyramid.gov Web site,” explained USDA spokesman John Webster.

“While making it, there was a concern that it was not specific enough,” Webster said. “But as we added more information it started to look like a Christmas tree. Finally we said we can’t continue to add more information and still make it meaningful, and so decided to put the information on the Web.”

Congress mandates that a committee on the dietary guidelines convene every five years to review the latest science and state of the American diet to make adjustments, but the pyramid usually does not change as often. It will likely get another makeover in early 2011 as part of the national Let’s Move campaign against childhood obesity.

The main changes proposed for the dietary guidelines include reducing daily sodium intake from 2,300 milligrams to 1,500 milligrams, reducing the percentage of saturated fat in the diet from 10 percent to 7 percent, reductions in foods with added sugars and an avoidance of artificial trans fats altogether. The report also highlighted the importance of vitamin D, calcium, potassium and dietary fiber, and it recommends eating 8 ounces of seafood a week.

Because most Americans already consume more sodium than was recommended in the last version of the guidelines, the new target of 1,500 milligrams is likely to pose formidable challenges to American consumers, not to mention food processors who rely on sodium as a flavor enhancer, preservative and binder.

Some experts acknowledge that although the proposed guidelines may force manufacturers to reformulate processed foods for schools and prisons that follow the standards, they may have little effect on what consumers eat at restaurants or at home.

“I think people ignore them when it comes to eating more fruits and vegetables and reducing refined sugars, but they will listen when they see the permission to eat six to 11 servings of grain per day,” Fallon said.

The proposed 2010 guidelines are the first to acknowledge America’s dire obesity epidemic and the roles environment and communication play in actually getting the public to follow the suggestions.

They cite “powerful influences that currently promote unhealthy consumer choices, behaviors and lifestyles” in our environment and call for cooperation with the Department of Health and Human Services to encourage improvements in areas including health, nutrition and physical education in schools; greater financial incentives to purchase, prepare and consume healthful food; more health-promoting foods and portions offered in restaurants and by manufacturers; and more exercise-friendly communities.

Among the questions the committee considered for this year’s guidelines was how much and what kinds of fish consumption it could endorse given the latest research on mercury contamination.

Unlike the current food pyramid, the government’s latest proposed advice takes into consideration the health threats posed by mercury, a toxic metal that taints certain types of fish and can trigger learning difficulties in children and neurological and heart problems in adults.

The proposed guidelines reflect a 2004 joint advisory from the Food and Drug Administration andEnvironmental Protection Agency that cautions young children, pregnant women, nursing mothers and women of childbearing age not to eat swordfish, shark, king mackerel and tilefish because of high mercury levels. It also advises those groups to consume no more than 12 ounces of fish a week, including no more than 6 ounces of canned albacore tuna.

An online version of the current food pyramid continues to recommend swordfish and tuna, four years after the Tribune first reported on the government’s contradictory advice. The National Academy of Sciences has sharply criticized the government for not doing enough to advise consumers about which fish are safest to eat, a job that has fallen to nonprofit health groups.

Based on the government’s own testing, Consumers Union, the publisher of Consumer Reports magazine, says the chances that any type of canned tuna will contain high levels of mercury are great enough that pregnant women should never eat it.

“You can get all of the benefits of fish and avoid the dangers of mercury by eating low-mercury fish,” said Jean Halloran, the group’s director of food policy initiatives. “It’s been distressing to see the government isn’t doing a better job helping women make smart choices.”

The seafood industry has argued that advising women about high- and low-mercury types of fish would scare them away from eating seafood altogether. Yet a 2008 federal study found a decline in the number of women nationwide with high levels of the toxic metal in their bodies, even though those women were eating the same amount of seafood. The finding suggested that consumer advisories about mercury had started to work.

via Food pyramid: New dietary guidelines coming from U.S. government – chicagotribune.com.

The evening’s menu featured grass-fed, antibiotic-free beef over pasta, fresh seasonal vegetables and fresh organic peaches — items right at home in the city’s finest restaurants.

Instead, the dishes were prepared for visitors, staff and bed-bound patients at Swedish Covenant Hospital.

The Northwest Side hospital is one of 300 across the nation that have pledged to improve the quality and sustainability of the food they serve, not just for the health of their patients but, they say, the health of the environment and the U.S. population.

For many of these institutions, the initiative includes buying antibiotic-free meats. Administrators say they hope increased demand for those products will reduce the use of antibiotics to treat cattle and other animals, which scientists believe helps pathogens become more resistant to drugs. The Centers for Disease Control and Prevention estimate that antibiotic-resistant infections kill 60,000 Americans a year.

Although the U.S. doesn’t keep national records on antibiotic use in animals, the Union of Concerned Scientists estimates that up to 70 percent of all antibiotics used in the U.S. are administered to healthy animals to speed growth and compensate for crowded living conditions. Some of these drugs, such as penicillin and tetracycline, are also used to treat sick people.

Last week, as a congressional panel debated the nontherapeutic use of antibiotics in agriculture, Rep. Jan Schakowsky, D-Ill., presented a petition organized by the nonprofit coalition Health Care Without Harm and signed by more than 1,000 health care professionals supporting the Preservation of Antibiotics for Medical Treatment Act. Introduced by Rep. Louise Slaughter, D-N.Y., it would phase out the nontherapeutic use in animals of seven types of medically important antibiotics.

Last month the Food and Drug Administration also released draft guidelines for the “judicious use” of antibiotics for growth promotion in animals. The CDC and the U.S. Department of Agriculture support the FDA’s guidance, which states that “using medically important antimicrobial drugs for production or growth enhancing purposes … in food-producing animals is not in the interest of protecting and promoting the public health.”

Meat producers respond that there is not enough evidence to definitively link human antibacterial-resistant infection to animal use.

“The CDC, FDA and USDA all say that they believe there is a link, but we don’t know,” said Dave Warner, spokesman for the National Pork Producers Council. “They believe it, so they are going to ban these products because of a belief and not a scientific fact?”

Hospital administrators who have signed on to buy antibiotic-free meat say they hope to use their purchasing power to discourage the use of antibiotics in agriculture. According to the Association for Healthcare Foodservice, the institutions spend about $9.6 billion on food and drink a year.

An early adopter of healthier hospital menus, Swedish Covenant’s director of nutrition, Maria Simmons, started serving grass-fed antibiotic- and hormone-free Tallgrass beef nearly five years ago. While the hospital’s purchases of other sustainable foods have fluctuated with budgets and availability, this item has been a constant.

Simmons said the hospital uses the beef in one menu item a day served to patients and in the cafeteria, including “meat sauces, Salisbury steaks, meatloaf, beef stew and in our Korean seaweed soup.”

Diane Imrie, director of nutrition services at Fletcher Allen Health Care in Vermont, also started serving antibiotic-free beef at the hospital in recent years as part of her plan to switch to local, seasonal, sustainable food.

“When we started a sustainability council at the hospital a few years ago, antibiotic reduction was one of the first things on my list,” she said. “I think it has the most impact on farming, the environment and public health.”

Imrie estimated that her food costs rose about $67,000 last year when she switched to antibiotic-free chicken from conventional. “But that’s also about the same cost as treating a single MRSA infection,” she said, referring to drug-resistant staphylococcus bacteria.

Like Simmons, Imrie said she has found inventive ways to offset the cost of the antibiotic-free meats, such as choosing ground beef and stewing cuts instead of more expensive options. Simmons said the beef she buys ranges from 50 cents to $1 more a pound.

Simmons also said she is able to negotiate with vendors because the hospital buys food in large amounts. “Once they realize the volume and the fact that you will keep buying this, they work with you,” she said.

Carolyn Lammersfeld, national director of nutrition at Cancer Treatment Centers of America, oversees a menu full of organic, antibiotic-free chicken, beef and dairy at the organization’s facilities across the country.

Using the ingredients is primarily a response to patient demand, Lammersfeld said, but the centers are also “watching the controversy over the nontherapeutic use of antibiotics and their potential to cause resistant strains of bacteria.”

via Hospitals buy antibiotic-free meat, citing drug resistance concerns – chicagotribune.com.

The government says it will retain the Food Standards Agency, following concerns the independent watchdog would be scrapped under reforms.

But it will hand over some responsibilities to government, Health Secretary Andrew Lansley confirmed.

The Department of Health will oversee nutrition policy and the Department for Environment, Food and Rural Affairs will handle food labelling.

This, says the government, will leave the FSA to focus on food safety.

Related stories

Q&A: The Food Standards Agency

Charities said government must follow through with this reorganisation and “should not let the good things the FSA achieved disappear into a black hole”.

The FSA was set up as an independent food safety watchdog in 2000, in the wake of the BSE crisis and a number of high-profile outbreaks and deaths from foodborne illness.

More recently, the FSA has led calls for the Europe-wide introduction of a traffic light system requiring food companies to label the front of their products with red, amber or green symbols to denote the amounts of fat, saturated fat, salt and sugar contained per serving.

Mr Lansley said bringing some policy-based functions ‘in house’ made sense. Nearly 100 of the Agency’s posts will be moved, leaving 2,000 remaining staff.

“It’s absolutely crucial for the Food Standards Agency to continue providing independent expert advice to people about food safety. But bringing nutrition policy into the Department makes sense.

“It will enable a clear, consistent public health service to be created, as our Public Health White Paper later this year will set out.

“I believe – in the-long term – we’ll have a clearer and less bureaucratic system for public health. The end result will focus on turning expert advice and support into better health.”

Caroline Spelman, Secretary of State for Environment, Food and Rural Affairs said: “It makes perfect sense to bring policy on food origin and associated labelling to Defra to sit with wider food policy. The Government has made very clear its commitment to clear and honest labelling – particularly origin labelling.

“These changes will enable the FSA to focus on food safety and it is right that this should stay in the hands of an independent body.”

Lord Rooker, Chair of the FSA, said: “Food safety and hygiene have always been at the heart of what the Agency does. They are our top priorities in protecting the interests of consumers.”

Peter Hollins, Chief Executive of the British Heart Foundation, said: “The Government must follow through with this reorganisation, by recognising its responsibilities in relation to food labels now it has brought the issue in-house.

“The FSA did much to promote healthy diets and now the Government must demonstrate it will not let the good things the FSA achieved disappear into a black hole.

“Regardless of the European jurisdiction issues, the Government should recognise it has an opportunity to put the health of the UK population first and continue battling for traffic light colours on food labels.”

via BBC News – Food Standards Agency ‘will remain’ government promises.

Overweight women should slim down and have counselling before they get pregnant because being fat poses such a serious risk of them having a premature baby, doctors warn today.

Women carrying excess weight have up to a 30% greater chance of having a baby before it reaches 37 weeks gestation, medical researchers in Canada write in todays British Medical Journal. Premature babies are at much higher risk of dying or suffering a range of illnesses and impairments.

Those who are overweight or obese have an extra 30% risk of having their child induced before 37 weeks, and have a 26% chance of delivering their baby prematurely before it reaches 32 weeks, according to a team of researchers led by Sarah McDonald, an associate professor in the maternal-fetal medicine department at McMaster University in Hamilton, Ontario.

“Ideally, overweight or obese women should have pregnancy counselling so that they are informed of their perinatal risks and can try to optimise their weight before pregnancy,” the authors say.”

Unlike many causes of pre-term birth, maternal overweight and obesity represent a potentially preventable cause of the leading source of neonatal mortality and morbidity and morbidity through childhood,” they add.British doctors who look after pregnant women, mothers and children said they backed the proposals.Professor Sir Sabaratnam Arulkumaran, president of the Royal College of Obstetricians and Gynaecologists, said:

“Maternal obesity is a public health concern as there are consequences for both mother and baby. For the mother, it could lead to cardiac disease, diabetes and pre-eclampsia as pregnancy can aggravate these conditions. These women should therefore receive obstetric care

.”Health professionals, including family doctors, need to work with overweight women to help them slim down before conceiving, added Arulkumaran, the leader of Britains 5,500 maternity care doctors.”We have said in our Maternity Standards document that pre-pregnancy counselling and support, both opportunistic and planned, should be provided to women of childbearing age with serious existing medical conditions including obesity BMI > 30″, he said.”This requires a multi-disciplinary approach with GPs and midwives to encourage women to achieve an appropriate weight level during the pre-conception stage.

It is something which needs to be handled sensitively but we need to point out to women the long-term benefits of a healthy lifestyle for them and their children.”However, the Royal College of Midwives suggested that mere exhortation of would-be mothers to keep their weight in check may not work.Janet Fyle, the unions professional policy advisor, said:

“There is a public health message that needs to be conveyed to women considering becoming pregnant, of the potential impact of being overweight when pregnant.”Of course midwives know that they need to provide women with the information and support about eating healthily and exercise in pregnancy. We can tell women about the right diet and exercise, but this has to be done within the context of their lives.”Can they afford the right food? Can they get access to gyms or swimming pools? There are social contexts to consider and one size does not fit all.”Tam Fry, of the National Obesity Forum, said: “It is absolutely crucial that a woman who is serious about childbirth gets herself into shape before conception. If she doesnt, she is running the risk not only of endangering her own health but also that of her intended child.

“Not only is it a tragedy to have to have a Caesarean section delivery if you are a very overweight woman, because its the safest way of getting the baby out, but it could adversely affect the childs health and be crippling to NHS maternity services.”

via Obese women should slim before conceiving | Life and style | The Guardian.

Uncertainty about milk aside, the USDA’s recommendations are clear-cut.

In 2005, the agency in charge of the food pyramid started recommending three cups of dairy products a day for anyone over 8, a full cup more than before. By the USDA’s standards, one cup of yogurt, one and a half ounces of hard cheese, one-third cup of shredded cheese or two cups of cottage cheese counts as a cup of dairy. So, of course, does a cup of milk.

The USDA actively promotes dairy products — it administers the National Milk Processor Board that gave us the ubiquitous “Got milk?” media campaign — but the change in guidelines wasn’t simply an attempt to sell more milk, says Dr. Theresa Nicklas, a dairy researcher and professor of pediatrics with the Children’s Nutrition Research Center at the Baylor College of Medicine in Houston. According to Nicklas, the push for more dairy was driven by fears that Americans weren’t getting enough calcium, potassium and magnesium, nutrients that are relatively plentiful in milk.

“Low-fat dairy is a way to meet these nutrient needs without a lot of fat and calories,” she says. “It’s a unique nutritional package.” Like many milk researchers, Nicklas receives substantial research funding from the National Dairy Council.

Dairy products could obviously help people meet those goals, but Dr. Walter Willett, chairman of nutrition at the Harvard School of Public Health, feels the targets may be overly ambitious. He points out that much of the world doesn’t drink much milk or get anywhere close to 1,000 milligrams of calcium, “and their bones aren’t crumbling and falling apart all around us.”

The RDA for potassium is based on a small study measuring how much of the mineral it took to lower the blood pressure of hypertensive African American men.

In Willett’s mind, that’s a flimsy foundation for an RDA. On a break during a recent 150-mile bike ride, he paused to look at the label for the orange juice (another so-called good source of potassium). He calculated that he would need to get just about his entire day’s calories from juice to reach the 4,700-milligram mark. He decided he would just have to fall short.

Likewise, Willett says, one or two cups of milk might not be enough to help people reach guidelines for calcium and potassium. But he believes it’s enough for good health.

Milk: what USDA recommends and other opinions – latimes.com.

How do you prevent a deadly disease that is projected to afflict one third of all Americans born today and is caused largely by hard-to-change habits such as too much soda and snacks and too little physical activity?

You could combine the broccoli and cauliflower in the school cafeteria for more colorful eye appeal. Put out 30 basketballs in gym class instead of two. Teach the wonders of water for 15 weeks straight (and remove everything else from vending machines).

Those changes – along with hundreds of others, large and small – signficantly reduced several major risk factors for type 2 diabetes, researchers concluded last week after studying the most comprehensive attempt yet to attack the epidemic through the schools.

Lifestyle prescriptions – you should eat a balanced diet – are notoriously difficult to stick with. But these limits were impossible to avoid.

“Instead of selling candy for a fund-raiser, they were selling carnations. And those are the sort of things that made it holistic across the environment,” said Wayne Grasela, senior vice president for food services in the Philadelphia School District, where six middle schools took part in the three-year national program.

The plan was to intervene early, before diabetes develops – and at a young enough age to learn new habits that could prevent or reduce obesity, a major risk factor for the disease. Numerous physicians helped craft the program, but all the action took place in the schools.

“They are already there. They already take physical education and they already eat lunch in the school,” explained Barbara Linder, who oversaw the study for the National Institutes of Health.

So researchers set about changing the school.

In gym, for example, “instead of doing layups, with most kids standing in line, we had things set up so balls were being passed back and forth while they waited,” said Gary D. Foster, director of Temple University’s Center for Obesity Research and Education, who chaired the national study.

Dumbbells, jump ropes, and medicine balls were distributed to groups, with rotations every 45 to 90 seconds to keep everyone moving. Pop music was played so that gyms were seen as “fun places to be with cool things to do,” Foster said.

In the cafeteria, the standard pizza was replaced with the same manufacturer’s whole-grain, lower-fat version. That shaved nearly 100 calories per slice and the kids didn’t notice, said Amy Virus, a registered dietician at Temple who coordinated the study’s nutrition component.

Nothing but water – not even 100 percent fruit juice – was stocked in vending machines. “Did they miss the juice? Sure, in the beginning,” Virus said, “but they got used to it. And they were buying the water.”

Supporting the effort were posters in classrooms (kids dancing, kids eating fruit), decals sent home over Christmas (TAKE THE FAMILY TV TURNOFF CHALLENGE!) and postcards in summer (“Be active for 60 minutes every day.”), even a healthy version of Jeopardy!, with 25 cards in English and Spanish.

An estimated 24 million Americans have diabetes, a chief cause of kidney failure, limb amputations, blindness, heart disease, and stroke. Although type 1 diabetes is caused by an auto-immune disorder, type 2 – more than 90 percent of the cases – is often linked to lifestyle factors that lead to weight gain and a gradual loss of the ability to control blood sugar.

Once rare before adulthood, type 2 diabetes has been rising steadily in children. Blacks and Hispanics are at particularly high risk; the government now projects that half of all babies born in those minority groups will develop diabetes later in life.

The new program was designed by researchers at seven major universities and targeted schools that enrolled high percentages of poor and minority students.

They began the interventions in 21 schools – three in each city – in the fall of 2006, when the students were in sixth grade; another 21 schools were designated as controls. A total of 4,603 students completed the study in June 2009, at the end of eighth grade.

Analysis showed that there were significantly greater reductions in several diabetes risk factors – body-mass index scores, average insulin levels, and the percentage of students with the largest waists – at the intervention schools vs. the controls.

All those differences were more pronounced among the 50 percent of students who were overweight or obese to begin with. Within that group, the interventions were associated with 21 percent lower odds of being obese at the end of eighth grade, the researchers reported.

The results were published last week online in the New England Journal of Medicine.

via Battling the bulge | Philadelphia Inquirer | 07/05/2010.

The Guardian, Randeep Ganesh, July 7 2010

Beer companies, confectionery firms and crisp-makers will be asked to fund the government’s advertising campaign to persuade people to switch to a healthier lifestyle and, in return, will not face new legislation outlawing excessively fatty, sugary and salty food, the health secretary, Andrew Lansley, announced today.

In a move condemned by campaigners as the government “rolling over on their backs in front of the food lobby”, Lansley told a conference of public health experts that he wanted a new partnership with food and drink firms. In exchange for a “non-regulatory approach”, the private sector would put up cash to fund the Change4Life campaign to improve diets and boost levels of physical activity among young people.

The time had come, said Lansley, to accept that “lecturing or nannying” people to change their behaviour did not work. He said business people “understand the social responsibility of people having a better lifestyle and they don’t regard that as remotely inconsistent with their long-term commercial interest”.

Lansley added: “No government campaign or programme can force people to make healthy choices. We want to free business from the burden of regulation, but we don’t want, in doing that, to sacrifice public health outcomes.”

Health campaigners said they were “horrorstruck” at Lansley’s remarks. “This is nothing other than a bare-faced request for cash from a rich food and drink industry, to bail out a cash-starved Department of Health campaign. The quid pro quo is that the department gives industry an assurance that there will no regulation or legislation over its activities,” said Tam Fry, a spokesperson for the National Obesity Forum.

The forum took issue with claims by the health secretary that his hands were tied on many aspects of food regulation, including the level of saturated fats, because of European rules. Fry said this was “simply untrue”. “Denmark, America have all used laws, or the threat of laws, to get the industry to move.”

Conceived by Labour, the Change4Life campaign was costed at £75m over three years and was already backed by industry, with high street names such as Tesco, Coca-Cola, Nestle and Pepsi all offering expertise and support. However, Lansley is proposing a radical scaling back of the public contribution to allow “charities, the commercial sector, and local authorities to fill the gap”.

Alan Maryon-Davis, the outgoing president of the Faculty of Public Health, said that legislation had worked in the case of cutting back smoking and “saved us from ourselves”.

“Personally, I mistrust the notion of seeing public health campaigns being sponsored by companies that clearly sell products which are not the healthy option”.

Speaking to reporters after his speech to the Faculty of Public Health conference in central London, Lansley said Change4Life would also be expanded, to cover alcohol misuse which costs the NHS £17bn a year – the same as obesity, which now affects one in four Britons.

He said that in conversations with the food industry before the election, they had been anxious about their products being “stigmatised as junk food”. He said he did not want to “close companies out” by trading allegations of “good food and bad food”.

“It’s perfectly possible to eat a bag of crisps, to eat a Mars bar, to drink a carbonated soft drink, but do it in moderation, understanding your overall diet and lifestyle. Then you can begin to take responsibility for it.”

The food industry said it welcomed the new move and was keen to work in partnership with the government. “We agree that in complex debates, such as obesity, the best solutions will be delivered through a shared social responsibility and not state regulation,” said Julian Hunt, the Food and Drink Federation’s director of communications.

No anti-junk food laws, health secretary promises | Society | The Guardian.

What to do about the obesity epidemic? Here’s a thought: Substitute “tobacco” for “junk food.” That provides a pretty clear road map about what government authorities should be doing to safeguard public health.

Unfortunately, officials are instead just reheating the same old leftovers.

Dietary guidelines issued recently by the U.S. Department of Agriculture basically say Americans need to ease up on the salt, sugar and saturated fats, and instead eat more fruits and veggies.

In fact, more than two-thirds of adults over 20 are either overweight or obese, the CDC says. About a third of all American kids fall into that category.

“It’s not that we’re morons and have no idea what’s good for us,” said Harold Goldstein, executive director of the California Center for Public Health Advocacy, a nonprofit organization. “It’s the world around us. We’re influenced to eat by our environment.”

In other words, we might know in our heads that a Twinkie or a chocolate shake is a heart attack waiting to happen. But our gut just can’t resist the siren call of all that tasty sugar or fat. And so we eat.

And eat.

And eat.

Food and beverage companies have long argued that if their products are used in moderation, they don’t pose a danger to public health. They also say it’s unfair to blame them for causing the obesity epidemic.

“If we really want to solve this national public health challenge, we must focus on educating Americans through comprehensive approaches that include nutrition education based in fact and focusing on total diet and exercise,” Susan Neely, head of the American Beverage Assn., said in a statement.

Personal responsibility is certainly a factor — no one forces us to stuff our faces. But Goldstein and other health advocates say consumers are brazenly manipulated by an industry that spends billions of dollars annually getting us to consume what it knows is bad for us.

“Up to now, it’s been a complete free-for-all, with the food industry convincing us to eat more and more of their high-fat, high-salt, high-sugar products,” Goldstein said. “It’s time that this was addressed through public policy.”

And tobacco regulation shows the way.

The rate of adults who smoke peaked at 45% in 1954, according to Gallup. It remained around 40% through the early 1970s and then started dropping as awareness about the dangers of nicotine grew, and as state and federal officials enacted anti-smoking programs.

Today, the adult smoking rate is about 20%. The same percentage applies to older teens, while about 6% of younger teens are smokers, according to the CDC.

The answer seems obvious: If we want to protect ourselves from a deadly epidemic of heart disease, diabetes and other ailments, just as we’ve taken steps to protect ourselves from an epidemic of lung cancer, we need to act.

And that means strict — some might say draconian — measures to reduce consumption of what’s bad for us, and aggressive campaigns to get us to eat and behave in a healthier fashion.

“It doesn’t seem at all draconian to me,” said Toni Yancey, a professor of health sciences at the UCLA School of Public Health. “We need to change social norms to make certain foods less appealing, just as we made it less appealing to smoke.”

We’re already removing sugary sodas and junk food from schools, and we’re doing it to help kids be healthier. Surely the same rationale applies to the rest of society.

I’m not saying we close down all McDonald’s and Burger King outlets. I’m saying we significantly limit advertising and sponsorship by companies selling, as Goldstein put it, high-fat, high-salt, high-sugar products.

This has worked for tobacco. It’s worked (on a largely volunteer basis) for alcohol. It can work for junk food.

Yancey said a good place to start would be government buildings — eliminate all bad-for-you foods and beverages. Instead, make healthful alternatives available. Gradually, if the political will can be found, expand the junk food ban to all workplaces, just as smoking bans spread from the public to the private sector.

Meanwhile, we need to step up wellness efforts to get people to make healthier choices and exercise more. These programs should be funded by levies on the foods that contribute most to obesity, and the obvious place to start is soda.

The beverage industry fiercely opposes such ideas. The chief financial officer of Coca-Cola Co., Gary Fayard, said at an industry conference this month that soda makers need to band together to fight any new taxes on their products.

Researchers at Harvard University say soft drinks are a “major driver” of obesity in the United States, and that raising the price of a can of soda by about a third could cut consumption by as much as 26%.

Tax money could also be put to better use.

“Because we subsidize corn, it ends up as high-fructose corn syrup,” Yancey said. “Why not subsidize healthy foods instead?”

I asked her what she thinks the obesity rate will be 30 years from now.

“I think it will be even higher,” Yancey replied. “Adults will be fatter.”

But if we act now, she said, future generations of kids won’t be exposed to all the cues and temptations that contribute to runaway waistlines.

“Hopefully they’ll be less fat,” Yancey said. “That’s where we’ll turn the tide.”

Obesity and junk food: Taking a cue from tobacco control – latimes.com.

People bicycling in Amsterdam, adapted from Dutchonbikes.com

July 1, 2010

In short: Bicycling and brisk walking, but not slow walking (as most people do) is associated with less weight gain in this study by Anne Lusk. This is a major incentive to promote bicycling in cities around the world!

Biking for as little as five minutes a day can help women minimize weight gain as they enter middle age, especially if they’re overweight to begin with, a new study suggests.

The study followed more than 18,000 premenopausal women between the ages of 25 and 42 for 16 years. During that time, the women gained an average of about 20.5 pounds.

Anne C. Lusk, PhD; Rania A. Mekary, PhD; Diane Feskanich, ScD; Walter C. Willett, MD, DrPH Arch Intern Med.2010;170(12):1050-1056.

Women who started biking for just five minutes a day gained about 1.5 fewer pounds over the course of the study than similar women who didn’t take up biking, the researchers found. Women who increased their daily biking by 30 minutes during the study kept even more weight off, gaining about 3.5 fewer pounds than those whose biking habits stayed the same.

“Bicycling is an answer to weight control,” says the lead author of the study, Dr. Anne Lusk, Ph.D., a research fellow in nutrition at the Harvard School of Public Health, in Boston. “Walking is not necessarily an answer, unless the person is walking briskly.”

Indeed, Lusk and her colleagues found that women who increased the time they spent walking briskly by 30 minutes per day during the study gained about four pounds less than their peers who didn’t increase their walking. (A “brisk” pace is three miles per hour or more.) On the other hand, women who only walked slowly did not manage to prevent any weight gain.

Women who were overweight or obese at the start of the study experienced even better results than normal-weight women when they increased their daily physical activity. Overweight women who biked for 30 extra minutes per day over the course of the study gained about seven pounds less than those who didn’t, for instance.

The findings should encourage overweight women to not give up on exercise, says Dr. Suzanne Steinbaum, D.O., director of Women and Heart Disease at Lenox Hill Hospital, in New York City. “People tend to say, ‘I’m too fat. I can’t do it. It’s too difficult.’ A study like this reminds them not to give up. Do something.”

The study appears this week in the Archives of Internal Medicine. Previous research has shown the weight benefits of daily walking, but few studies have focused specifically on biking and none have compared walking with biking.

“A lot of information on physical activity provided to women is very general, encouraging daily activity, but not specifically what kind,” says Keri Gans, a spokesperson for the American Dietetic Association. “This study encourages an activity that is not expensive and that almost all women can easily engage in. And if a woman is presently a walker, it’s good to know that she must pick up her pace.”

Biking and walking are easier than many other forms of exercise to incorporate into everyday life, Lusk points out. “[They] can be a routine part of the day, so you can get your physical activity as a normal part of the day,” she says.

The study participants were all nurses and are part of a larger, national study on health and lifestyle that began in 1989. Women with physical problems that make regular exercise difficult were excluded from the current study, as were women who reported chronic health conditions such as heart disease, diabetes, or cancer.

At the start of the study, half of the participants reported walking slowly, 39 percent said they walked briskly, and 48 percent said they biked (including working out on a stationary bike).

By 2005, the average physical activity had increased slightly but remained very low overall. Participants walked briskly for just one hour per week, on average, and biked for only about 18 minutes per week. Meanwhile they sat around the house for about 2.5 hours a day.

Current guidelines recommend that adults get at least 30 minutes of moderate-intensity exercise on most days of the week, a goal that many women in the study appear to be well below.

Individuals can’t bear all of the blame for that inactivity, Lusk and her colleagues suggest. Their physical surroundings may also be partly responsible.

Although some cities and towns have encouraged walking and biking (by adding sidewalks and bike lanes, for instance), the U.S. remains a “car-centric nation,” they write.

Nine percent of commuters in the U.S. walk to work and just 0.5 percent bike, according to data cited in the study. By contrast, in the Netherlands, where the roads are more bike-friendly, 22 percent of commuters walk to work and 27 percent bike.

“We need to provide the infrastructure or facilities so that more people could comfortably bicycle,” Lusk says. “In the U.S., the emphasis has been on the walking environment and not on the bicycling environment.”

via Arch Intern Med — Abstract: Bicycle Riding, Walking, and Weight Gain in Premenopausal Women, June 28, 2010, Lusk et al. 170 12: 1050.