Healthy Food & Healthy Living by Dr. Ayala

Banning soda in school isn’t enough

It took the whole village a few decades to create the obesity epidemic.  We slowly allowed the development of a food environment in which junk, fast and highly processed foods became available everywhere and anytime. Marketing and advertising of these food products permeated every real and virtual space making every moment and every deed a consumption occasion.

When we noticed that obesity rates among kids tripled and looked at what kids consumed, it was shocking to see that sugar sweetened beverages contribute about 300 (empty) calories a day to a teen’s diet, making them the single largest source of added sugar.  Indeed, sugary drinks have become a way of life, and their makers make sure fueling stations are densely spread so a kid would never have to go without.

And since so much time is spent at school, where kids are a captive and impressionable audience, school became another sugary drink fueling station.  Vended sugary drinks offered schools a source for much needed funds, and so developed the unholy union between the companies that want to imprint their brand’s image in kids’ minds and the institution that’s trusted to teach kids critical thinking and prepare them for a healthy and productive life.

Does changing the vending machine’s content change kids’ habits?

When the Institute of Medicine called for the removal of all sweetened beverages from schools and the American Academy of Pediatrics advised their elimination, some school districts and states did nothing, some opted to replace soda with lower-sugar options, such as sports drinks and vitamin water, and other cities and states went further and placed all-out bans on sweetened drinks.

A new study published in the Archives of Pediatrics and Adolescent Medicine examines the effect of different policies using data gathered from almost 7000 middle school students from 40 states; 22 of these school districts had no policy governing sales of sugary drinks in middle schools, 11 banned sales of soda only allowing all other sugary drinks, and 7 banned all sugary drinks, including sports drinks and fruit drinks (but not 100% fruit juice).

So how would you expect the kids to respond to the different vending policies?

I think no one would be surprised to hear that in schools that banned only soda, kids bought the other vended sugary beverages instead.  Banning soda did nothing to reduce sugary drink consumption in schools with a partial policy. 

But here’s an even more discouraging result: In schools that banned all sugary drinks kids indeed consumed fewer sugary drinks at school, but their consumption did not decrease overall; kids were able to find sugary drinks out of school, and filled the sugar gap before and after school.

In other words, school vending policies only changed the school environment, and didn’t seem to be enough to change kids’ access and behavior overall.

So are school policies useless?

It will take a village

The study authors, led by Daniel Taber, suggest it would take a comprehensive alteration of kids’ environment to change their sugary drink habits

“Experts have recommended broader policies, such as SSB (sugar-sweetened beverage) taxes or regulations of food marketing aimed at children. Future research should explore the effect that school-based policies have on youth diet and weight gain when implemented in conjunction with policies in other sectors.”

It would be naive to expect that changes at school can result in instant improvement when other sectors aren’t cooperating.

But there’s enormous value in creating a healthy school environment.

Giving a yellow card to kids shouting obscenities on the athletic field doesn’t guarantee the same words won’t be used when refs are out of earshot, but it still does teach kids sportsmanship – this is as much as we should expect from our schools.  Teaching kids good nutrition doesn’t guarantee they’ll eat well given the many unhealthy options all around them, but demonstrating through a school policy that chips and a sports drink aren’t food sends an educational message.   Schools should be parents’ partners in teaching healthy eating habits.  But schools can’t to do it all on their own.

At this point it will take a village to change our habits.

Dr. Ayala

 

Full disclosure: I’m vice president of product development for Herbal Water, where we make organic herb-infused waters that have zero calories and no sugar or artificial ingredients. I’m also a pediatrician and have been promoting good nutrition and healthy lifestyle for many years.

Reposted in Fight Back Fridays.

Childhood obesity: Prepare for the flood

In contrast to adults, chest pain in kids is rarely of cardiac origin. A new article in the journal Pediatrics reassures us that an aching chest in kids, although a common complaint, was only rarely due to abnormalities of the heart.

But is the growing epidemic of childhood obesity threatening to change that? Could obesity in childhood result in heart attacks and other cardiovascular events when those children hit their 20s and 30s and even when they’re still teens?

Dr. David Katz’s piece in Childhood Obesity last year starts with a scary prediction, a prediction he hopes will never come true. 

Katz, an internist and leading authority on nutrition, weight management and the prevention of chronic disease, director and founder of Yale University's Prevention Research Center, warns that heart disease might become a routine pediatric condition.  Heart disease can follow the path of type 2 diabetes, – previously called “adult onset” diabetes, because it was an affliction of adults – which is spreading among kids like an epidemic and is diagnosed in obese kids under the age of 10 years.

Dr. Katz tells us that in adults, guidelines for healthcare providers suggest that any patient with diabetes should be treated as if they have some degree of heart disease, because diabetes is such a strong risk factor for coronary artery disease. 

Can we assume the same for kids?  Kids who’ve had diabetes for 10 years have been exposed to the damages this disease causes to blood vessels, and Katz suspects we’re going to see more and more kids in their late teens with chest pain and heart attacks.  He’s personally encountered a 25-year-old who’s had coronary angioplasty and a 17-year-old who’s had a triple bypass.

Stack a sandbag today

Katz is announcing this grim prediction so that action will be taken to prevent it from materializing.

We know what causes childhood obesity.  Overconsumption of all the wrong foods and lack of physical activity are now the default way of life for so many of our kids.  We live in an obesogenic environment, which is going to deluge us with disease.  To prepare for the rising tide and to block its toxic water we need, Katz suggests, any sandbag we can find:

“Programs that provide routine physical activity throughout the school day are a sandbag. Nutrition education is a sandbag. Cafeteria makeovers are a sandbag. Adding sidewalks to a neighborhood is a sandbag. Nutrition information on menu boards is a sandbag. Worksite wellness programs are a sandbag. Reliable nutrition guidance systems in the supermarket are a sandbag. Recognizing that neither children nor adults will get healthy unless both do, together, is a sandbag.

The flood waters are both menacing and high. Stacking sandbags to raise a levee is hard work—but it’s not complicated. So seize the moment; embrace the opportunity in this crisis. Stack a sandbag today. The child you save from our new-age plague might be your own.”

Whenever a solution is proposed critics are quick to scrutinize and announce, quite correctly, that it will not solve the obesity crisis.  But if we can’t stop the flood and dam the mighty river should we dismiss sandbags? I completely agree with Katz: The sandbags needn’t be perfect, but we do need many of them and a joint effort to stack them up real high.

Dr. Ayala

More from David Katz here.

 

Lunchrooms designed for healthy eating

Could lunchroom design drive better nutrition? Brian Wansink, Co-Director of the Cornell Center of Behavioral Economics in Child Nutrition Programs and author of "Mindless Eating", presented proof that it can, and shared some tried and true, low-cost healthy-eating-promoting ideas for school lunchrooms at the School Nutrition Association's New York conference recently. Here are a few of the environmental changes he suggested, all of which have been shown to affect eating habits and preferences:

• Decreasing the size of bowls from 18 ounces to 14 ounces reduced the size of the average cereal serving at breakfast by 24 percent.
• Creating a speedy "healthy express" checkout line for students not buying calorie-dense foods like desserts and chips, doubled the sales of healthy sandwiches.
• Moving the chocolate milk behind the plain milk led students to buy more plain milk.
• Keeping ice cream in a freezer with a closed opaque top significantly reduced the amount of ice cream taken.
• When cafeteria workers asked each child, "Do you want a salad?" salad sales increased by a third.

These tricks are neatly summarized in an interactive op-ed by Wansink and his colleagues in the New York Times.

It’s great to see research going onto school cafeteria behavioral psychology and I loved reading about these win-win techniques. They make sense, and if they sound familiar it’s because they’re similar to — or the exact opposite of — methods used to better sell food wherever food is sold.

It’s about time lunch-rooms started applying the methods the food and beverage service and retail industries have been studying and honing for decades. Industry has already discovered what makes us tick and what makes us buy — they have perfected the art of making stuff we had no idea we needed become the object of desire. Why not open their training books and steal some good ideas to try-out at school? Why not ask for their help?

Supermarket layout lessons

Whether you’re aware of it or not, the supermarket is laid out in a way that moves you where the owners want you to go. For starters, the necessities aren’t in any kind of sensible order, forcing shoppers to cover the entire floor for bread and milk. The necessities will then be occasionally shuffled around to prevent you from getting into too fast a rhythm while shopping.

It’s been established that most customers tend to look right when entering a supermarket — I have no idea why. That’s why special offers and promotions will be at your immediate right when you go beyond the supermarket’s wide open doors.

Shelf placement is very calculated. Since most shoppers are right handed placement on the right makes for better sales. Eye level products sell better, that’s why kid oriented food is lower on the shelf, and prime-time money making products are placed on shelves that are at adult shoppers' eye level.

Displays near checkouts and end-caps grab a lot of attention (while you’re waiting to pay) and can drive impulse shopping.

A good supermarket is inviting. It has nice signs outside and a welcoming, attractive appearance.

Food smells make you hungry. That’s why supermarkets bake bread, producing perhaps the most enticing food-smell of all.

School cafeteria ideas:

Why not try using the bag of tricks supermarkets established to lead kids towards the fruits and veggies? Why not bake whole wheat bread in the school cafeteria (the dough can be brought in, ready, as done in most supermarkets). “Checkout displays” in most school cafeterias include cookies and chips, a-la-carte items sold separate from the school lunch program (I suspect this placement isn’t by chance). Replace these with attractive fruit in an attractive basket, as the Cornell study suggests, and move the chips to a low bin under the salad bar.

Buying Incentives lessons

Discounts drive sales. Coupons drive sales. So do loyalty programs.

School cafeteria ideas:

Lots to think about here: Would a buy one get one free work for oranges? Should we be offering the 10th salad free? Homework-pass prized sweepstakes for the “I tried something new” club participants?

Lessons from restaurants

Big-time restaurant menus are carefully crafted by experts to get results. Menus are not written, they're engineered. The menu is designed to lead customers, subconsciously, to select the items that the restaurant wants them to go for. The name of the dish, the use of adjectives, the font and design, the placement on the page or menu board, the entrée’s paired sides— all these things matter. Descriptions matter too.

As we all know already, supersizing works. The size of the plate and of the portion on it affect consumption both ways.

School cafeteria ideas:

Give healthy dishes appetizing names — golden butternut squash puree sounds better than squash puree, and grilled tofu with summer green beans sounds so much more delicious than tofu and beans — studies show that a good name can lead to more trial and a more positive experience. Give the dish character; use some vivid adjectives. Give large portions of the veggie side, and small portions of the calorie dense entrée. Have at hand small dessert plates. Give artistic kids a chance to make the menu board entertaining and appetizing while promoting the healthy options.

I’m sure there are many more valuable ideas already in use by industry. Do you think the bright minds advising big-food and fast-food companies would mind sharing their expertise? After all the major food companies promised Michelle Obama and the Let’s Move campaign to support the effort to fight obesity as best they can, haven’t they? Just a suggestion.

Dr. Ayala

Reposted as part of Food Renegate's Fight Back Fridays--go join the food fight!

Seven thoughts on Jamie Oliver’s Food Revolution

Thanks to Hulu and a few sleepless nights due to jet lag, I’m finally caught up on all six episodes of Food Revolution.

In the series, celebrity British chef Jamie Oliver goes to Huntington, WV—noted in 2008 by the Centers for Disease Control as one of the unhealthiest and most obese cities in America—to reform the town’s school lunch program and teach it some healthy cooking.

Jamie won over Huntington’s hearts and minds. Those he didn’t charm with his personality and passion were persuaded by his arguments for health and community. Any remaining naysayers seemed to be swept away by his authenticity and generous spread of love and good cheer.

But was his food revolution a success? What can we learn from Jamie’s attempt to change a town’s eating habits? Here are some of my thoughts:

1. Let’s start with the kids

Jamie’s move to change targets kids’ food at school and at home; he motivates parents and other adults as he taps into our irresistible urge to do the right thing for our kids—because we love them and because they are the future.

And also because the kids actually are more open to change. It seems that in Huntington, too, kids were more receptive to Jamie’s ideas for change than the grown-ups were, and many were eager for the empowerment the ability to cook could give.

2. Placing kids’ interests first doesn’t mean letting kids rule

In our child-centric society we sometimes forget that making kids’ interests the priority doesn’t mean “kids rule”. Early in Food Revolution, kids got to chose between Jamie’s cooked-from-scratch meal and highly processed pizza and French fries, and between chocolate and strawberry milk (”more sugar than soda pop”) and plain milk.

Guess what they chose.

Don’t get me wrong, I don’t believe in authoritarian parenting or schooling, but I do think we have the duty and authority to lead kids to good choices.

It would be very easy for most kids to sleep in every single day, skip classes, rot in front of a TV or video game and not brush their teeth. We don’t give them those options.

So why do we buy into adding sugar to everything in order to please our kids? Of course meals with more sugar, fat and salt will be better liked by kids—it’s human nature. It’s hard—but very possible—to retrain kids’ taste buds with wholesome from-scratch cooking. But not if we’re competing against sugar, fat and salt.

We should give kids autonomy over their food choices—provided all options are acceptable ones. I wouldn’t argue with a kids’ preference for peas over broccoli (or for studying French rather than Italian for that matter). But the option of eating junk rather than healthy food shouldn’t be available in our homes or our schools, just like the option of skipping math doesn’t exist. We’re the grown-ups; it’s our duty to set some boundaries.

There’s a lot to undo here. Under the pretext of “kids will eat more of the good stuff” sugar, color and shapes have been added to food, making our kids food something completely removed from its natural state, and very unhealthy. Just last week the American Beverage Association senior vice president for science policy, Dr. Maureen Storey said to NPR about soda (“90 percent water”): “...Children who have been exercising may not drink enough water to get back to the hydration point that they need to be at. So with a little bit of flavoring and a little bit of sweetness, they will drink enough then to get back to where they need to be.”

Yes, kids will drink more water and milk if it’s loaded with sugar, and will eat more potatoes if they’re deep fried.

They’ll also sleep more if we give them sleeping pills.

But the ends don’t necessarily justify the means. Given time, good alternatives and less competition and brainwashing from junk and fast food, kids will eat real food, especially when they’re hungry.

3. It’s about money

It’s sad but true: better food costs more, and Jamie’s Food Revolution gives us a glimpse of how critical funding is to changing the food landscape. Cheap, processed food costs so much less than healthy food that it’s irresistible to budget-blasted schools; despite good intentions, it’s the cheap stuff that fills the freezers in school kitchens because price matters.

4. Food culture at an all time low

Just when gourmet food, fine dining and the food-as-entertainment trend hit new highs (especially in relatively well-off communities), Jamie shows us that, for many people, the understanding and experience of food has hit a hard-to-believe low. The elementary school in the show has no cutlery knifes (lunch is usually eaten with no cutlery), and the kids can’t recognize a potato or a tomato (we’re not talking leeks and rutabaga here—basic stuff).

5. “Rubbish guidelines”

That’s what Jamie calls the USDA nutrition rules under which a warmed-up highly processed chicken nuggets and French fries meal passes as a nutritious one, yet his cooked from scratch meal, with plenty of grain, vegetables and fresh meat doesn’t.

Our school lunch program, designed long ago during lean times, needs serious revision. It specifies a lower-calorie limit, but not an upper one. It emphasizes protein, vitamins and calories, regardless of their—usually highly processed and artificial—source. It doesn’t promote fruits and vegetables. And it usually supplies too many calories, fat and salt.

6. Can home cooking cure a town?

No. But it’s a good start. Jamie’s Food Revolution focuses on bringing back fresh from-scratch food to schools, and providing a kitchen where anyone could learn how to cook.

In many ways Jamie is selling the most attractive aspects of what needs to be done to improve our nutrition and health: bring back the pleasures of a food culture, and its connection to the land, our food makers, our health and our communities. The goal is romantic and gratifying, and achievable once you get over the difficulty of change.

But there’s another difficult reality to confront: we need to eat less.

Twelve-year-old Justin Edwards, featured in the show, weighs 318 pounds; his problems won’t be over once hamburgers are made from scratch.

The show doesn’t address the constant snacking and continuous sipping of high-calorie snacks and drinks, so typical of our times. Nor does it say a word about vending machines in schools and the a-la-carte foods sold in the cafeteria, which compete with the school lunch.

Jamie doesn’t address eating less; he concentrates on eating different.

7. More an evolution than a revolution

Just as we came to this sorry state of obesity and unhealthy eating slowly and gradually, there’s no quick fix that can undo the damage instantly. There’s no evil dictator to topple, and no oppressed public waiting to be freed from the grasp of fast-food. Most of us are comfortably stuck in our ways and resistant to change.

Jamie sows seeds in Huntington, and then goes back home. When he comes back to check on things three months later, he finds weeds have taken over, threatening his food revolution seedlings. The school freezer is full of processed food, which will be served on “processed food Fridays,” chocolate milk is back, and parents are sending paper bag lunches from home that contain an astounding array of candy and chips to compete with the from-scratch lunch the dedicated staff fought for and worked so hard to produce.

“This ain’t a happy ending,” says Jamie.

No, Jamie, it’s just the beginning. And it may not be a “revolution” that happens. I’d be perfectly happy with an “evolution” in thinking and actions.

Actually, I much prefer the term “movement” to the term “revolution” when it comes to our struggle for healthier food and less obesity. Things are moving. We may even be close to a tipping point. Last week the White House task force on childhood obesity presented to the President its recommendations and a more realistic goal: reverse obesity within a generation.

Jamie Oliver’s most significant contribution was to package some important ideas in an entertaining reality show. Whether most of what we saw was in fact reality or show, he certainly inspired more conversations and thinking around how we eat. I applaud Jamie for using his tremendous popularity and celebrity to promote this worthy cause, and for presenting a complex and we-don’t-want-to-hear-about-it subject is such an engaging way.

And I do think that talking about a revolution can start one.

What did you think of Jamie Oliver’s Food Revolution?
Dr. Ayala

Related post: Jamie Oliver's wish: Teach every child about food

Reposted as part of Food Renegate's Fight Back Fridays--go join the food fight!

Organic is healthier…but you can still get fat

We like to eat. We especially like indulgent foods – desserts, snacks and tasty treats.

We’d love to believe it’s okay to heap our plates with foods we perceive as “healthy".

In fact, studies have shown time and again that foods perceived as healthy or foods with a health aura drive us — if only subconsciously — to eat more. Foods with "low fat" or "low calorie" claims lead to overconsumption of snacks. A study using hidden cameras at Italian restaurants showed that people dipping their bread in olive oil will eat more fat and calories than if they instead spread some butter.

Organic food labels can lead to overeating, too. In presenting findings from their new study, Jenny Wan-Chen Lee and Brian Wansink showed that the organic seal appears to make people believe their organic snacks have a lot fewer calories than they do. For example, people who ate cookies labeled as "organic" believed that their snack contained 40% fewer calories than the same cookies that had no label.

Now, I’m a huge proponent and an early adopter of organic produce, but the organic seal, of course, has absolutely nothing to do with calories.

The benefits of organic food

The organic seal promises that the food and its ingredients have been farmed according to the organic standards — which are better for you and for the environment.

Organic practices are about sustainability, how we grow food, and how we treat our environment. These practices also tie to our personal health, given that the multitude of chemical fertilizers, pesticides and herbicides used to produce conventional food actually remain in the food. While it’s hard to prove that any single one of them, in small amounts, causes disease, it’s impossible to prove that they don’t; personally I’d rather minimize exposure to what’s clearly not meant for human consumption (read more about why organic matters in my post here).

The jury’s still out on whether organic produce has more measureable nutrients than conventionally-grown produce.

What organic food isn’t

Organic produce isn’t necessarily clean. All too often I see people skipping the washing of organic produce, forgetting that it comes from a field, and has been handled by many hands. Organic produce does need to be washed — thoroughly. While organic food isn't sprayed with chemicals, microbial life is teeming on and between the leaves. Wildlife visits the fields and can contaminate produce in any number of ways we don’t like to consider when we think of food. There’s also the bacterial mixture from a multitude of human hands that have touched your produce before it gets to your table.

Organic food isn’t automatically healthy, or something we should necessarily consume in large quantities. Organic candy, organic soda or organic French fries — while a tiny bit better for us because they’re free of pesticides — are still junk food, and should be eaten infrequently.

Bottom line

People are generally an optimistic and trusting bunch, and the temptation to believe what we want to be true sometimes overcomes lessons we’ve been taught about the prudency of healthy skepticism.

If you want to have a clearer idea of what you’re eating, just read the ingredient list and nutrition facts, regardless of the atmosphere created — or the claims-to-health — on the front of the package.

Read the labels on organic foods as carefully as you’d read any other food label. If the food is full of sugars, fats, salt or calories, it should be viewed as a dessert, and should be eaten in moderation.

Dr. Ayala

Reposted as part of Food Renegate's Fight Back Fridays--go join the food fight!

Michelle Obama to food makers: Make healthier food, now

First Lady Michelle Obama gave some tough love to the food industry last week.

In her remarks at the Grocery Manufacturers Association meeting in Washington D.C. last week Mrs. Obama was tactful, diplomatic and generous with praise for the advances already made by food makers.

Yet, she didn’t shy away from criticism, and explicitly described some of food makers’ obesogenic practices.

I’m going to peel away the praise, and serve just her between-the-lines reprimands, since I think that’s where we’ll find the bigger and most important messages.

You put stuff in our food that helps your sales yet undermines our health

• “We all know that human beings—I, for one, know—are hard-wired to crave sugary, fatty, salty foods. And it is tempting to take advantage of that—to create products that are sweeter, richer, and saltier than ever before."

• “But doing so doesn’t just respond to people’s natural inclinations—it also actually helps to shape them. And this can be particularly dangerous when it comes to our kids, because as all of you know, as parents, the more of these products they have in their diets, the more accustomed they become to those tastes, and then the more deeply embedded these foods become in their eating habits.”

You’re bombarding our kids with ads and marketing that shapes bad choices and eating habits

• “Our kids didn’t learn about the latest sweets and snack foods on their own. They hear about these products from advertisements on TV, the Internet, video games, schools, many other places. And any parent knows, this marketing is really effective. We’ve all had to endure those impassioned pleas in the grocery store for one product or another. Some of us have been treated to full-scale reenactments of TV commercials and jingles, word for word, right on key.”

• “More than 70 percent of foods marketed to kids were still among the least healthy, with less than 1 percent being among the most healthy.”

• “What does it mean when so many parents are finding that their best efforts are undermined by an avalanche of advertisements aimed at their kids? And what are these ads teaching kids about food and nutrition? That it’s good to have salty, sugary food and snacks every day—breakfast, lunch, and dinner? That dessert is an everyday food? That it’s okay to eat unhealthy foods because they’re endorsed by the cartoon characters our children love and the celebrities our teenagers look up to?”

You manipulate the food label to confuse us into buying your food

• “We can give parents all the information in the world, but they still won’t have time to untangle labels filled with 10-syllable words or do long division with these portion sizes.”

• “But we know those labels aren’t always as helpful as they could be. And it’s hard enough to figure out whether any one food item is healthy. It’s even harder to compare items. And folks just don’t have the time to line products up side by side and figure out whether these compare or not. And they shouldn’t have to. Parents shouldn’t need a magnifying glass and a calculator to make healthy choices for their kids.”

You’ve convinced us to eat more, when we need to eat less

• “While kids 30 years ago ate just one snack a day, we’re now trending toward three—so our kids are taking in an additional 200 calories a day just from snacks alone. And one in five school-age kids has up to six snacks a day.”

• “In the mid-1970s, the average sweetened drink portions were about 13.6 ounces. And today, our kids think nothing of drinking 20 ounces of soda at a time.”

• “All told, we’re eating 31 percent more calories than we were just 40 years ago—and that’s including 56 percent more fats and oil and 14 percent more sugars and sweeteners. In fact, we now add sweeteners to all kinds of products in amounts unimaginable just a generation ago.”

You’re very creative reformulating products that can be marketed as healthy without making them any healthier

• “But what it doesn’t mean is taking out one problematic ingredient, only to replace it with another. While decreasing fat is certainly a good thing, replacing it with sugar and salt isn’t. And it doesn’t mean compensating for high amounts of problematic ingredients with small amounts of beneficial ones — for example, adding a little bit of Vitamin C to a product with lots of sugar, or a gram of fiber to a product with tons of fat doesn’t suddenly make those products good for our kids.“

Finding common ground

Food makers are important and powerful players in shaping our food environment, and bringing them on board in the “Let’s Move” effort is really critical to its success. While fighting obesity will have to involve some “eat less” commitment—a message that clearly conflicts with food makers’ bottom line—Mrs. Obama’s focus is on finding common ground.

Her encouragement to food makers to join the healthy food movement is something that’s a win-win for all. Mrs. Obama pointed at the growing interest and demand for healthier foods—a trend she believes is here to stay and will only expand—and promises to food makers that if they make it healthy, consumers will come.

Speaking of demand: Food makers’ repeated lame excuse for the junk they make is that they only make what consumers want. And that’s why I especially love Mrs. Obama’s call to enlist the extraordinary marketing talent—which helped get us to our staggering obesity rates—for some good:

“If there is anyone here who can sell food to our kids, it’s you. You know what gets their attention. You know what makes that lasting impression. You know what gets them to drive their parents crazy in the grocery store. And I’m here today to ask you to use that knowledge and that power to our kids’ advantage. I’m asking you to actively promote healthy foods and healthy habits to our kids.”

Brilliant speech! I hope Mrs. Obama inspires some meaningful changes in the food industry that are indeed more than just tweaking and lip service—deep changes that would actually help kids and parents eat better and promote health.

Dr. Ayala

Full disclosure: I’m vice president of product development for Herbal Water, where we make organic herb-infused waters that have zero calories and no sugar or artificial ingredients. I’m also a pediatrician and have been promoting good nutrition and healthy lifestyle for many years.

Jamie Oliver's wish: Teach every child about food

Celebrity chef Jamie Oliver recently received the prestigious TED Prize, an annual award given to a speaker at the TED (Technology, Entertainment, Design) Conference, which entitles the speaker to one wish that can change the world and $100,000 as down payment for the magic wand.

Jamie's wish: "I wish for your help to create a strong, sustainable movement to educate every child about food, inspire families to cook again and empower people everywhere to fight obesity."

This is a wish that can come true--I truly believe that. We all have the power to help make Jamie's wish a reality--for our own sake.

You can jump right in and sign Jamie's petition.

You can take a look at Jamie's plan and needs and see if you can offer assistance.

Or maybe just have your Jamie Oliver moment with your own family tonight: I'll be teaching my kids another simple, nutritious dish they can cook by themselves when they come home from school.

One of the "TED commandments" is the strict time limit of 18 minutes per talk, which Jamie exceeds by a few minutes, but this video is well worth watching. I think it's awesome!

Dr. Ayala

Reposted as part of Food Renegate's Fight Back Fridays--go join the food fight!

”Let’s Move” to reform school food

School food received some major media attention in the past week.

Michelle Obama launched the Let’s Move anti-obesity campaign last Tuesday, with improving school food as a major program cornerstone. Congress will reauthorize the Childhood Nutrition Act this year—with some planned overhauls and budget proposals underway. And the Obama administration wants Congress to remove sugary snacks and drinks from school vending machines.

Say what? The federal government is trying to limit big food’s footprint in our schools?

If Agriculture Secretary Tom Vilsack gets his way, he intends to do just that: "Food served in vending machines and the a la carte line shouldn't undermine our efforts to enhance the health of the school environment,” he said.

A short introduction to school food

On any school day more than 30 million kids eat a school lunch and 10 million kids eat a school breakfast. Fifty-nine percent of the kids eating a school lunch are from low-income homes, as are 80 percent of school breakfast eaters. The school lunch program operates in all public schools and in many private schools.

The National School Lunch Program was created with a dual purpose—to feed kids and prevent dietary deficiency and to provide an outlet for surplus agricultural commodities. One can already see that the dual purpose of the program throws in some problematic conflicts of interest, but let’s go on.

The government provides $2.68 per day for kids qualifying for a free lunch, $2.28 per day for a reduced-price lunch, and $0.25 per day for all other kids. That sum includes the overhead and facility costs associated with the meal, which leaves just $1—or less—for the food itself. This is clearly not enough money to fund from-scratch cooking or quality, fresh produce. President Obama proposes bumping up the school lunch budget a tad—which will be better than nothing—but the additional funding probably won’t afford a huge amount of change.

What kind of meal can you get for $1?

An adventurous school teacher vowed to eat the school lunch every day this year, and she’s posting musings and photos of her cafeteria meal in a daily blog. Take a look at the pictures (take note of the amount of packaging) and you’ll get the idea.

I’ve devoted several posts to this subject and analyzed the typical school lunch menu, concluding that the best description for this food is “fast-food”. Overall, it’s salty, sweet and fatty; the meat is breaded and crunchy; and it’s been highly processed—even the fruit and vegetables aren’t fresh for the most part. Most of the schools have no kitchens and just heat and un-wrap low-grade foods. Nevertheless, the subsidized school lunch complies with some nutritional guidelines and provides plenty of protein and vitamins, and while I think guidelines based on the nutrient profile of foods alone are an ill-advised way to evaluate food quality, at least some rules exist.

But if the federally sponsored and regulated school lunch program leaves much to be desired wait till you get the full picture, because challenging the school lunch, are what’re called competitive foods.

These competitive foods—comprised of foods and beverages sold in the cafeteria or in a school store, from a vending machine or in fundraising events—are expressly marketed to our kids and make up a big part of what kids actually eat while they’re in school.

Kids love the vending machines and the school stores, but that’s not the only reason these outlets exist. Schools depend on the revenues that vendors bring in to fund much-needed programs. This creates an unusual and worrying conflict, in which schools share an interest with the manufacturers of snacks and junk foods.

School candy-land

Here are some facts about the scope of the competitive food problem. (The source is an article in the Journal of the American Dietetic Association that looked at data collected in 287 nationally representative schools and included 2,314 kids.)

Availability:

• One or more sources of competitive foods are available in 73 percent of elementary schools, 97 percent of middle schools, and 100 percent of high schools.

• À la carte foods sold in the cafeteria are common in all school levels.

• Vending machines are available in more than one quarter of elementary schools, 87 percent of middle schools and virtually all high schools.

Consumption of competitive foods :

• 40 percent of school kids consume these foods on any given day.
Consumption is much higher among high schoolers—55 percent.

Energy contribution of competitive foods:

• Kids consume about 280 calories per day from competitive foods, and almost two- thirds of these calories were from “low-nutrient” and “energy-dense” foods. (The study defines “low-nutrient, energy-dense food” to include cakes/cookies, desserts, donuts, toaster pastries, snack chips, French fries and caloric beverages, excluding milk and 100% juice.)

• A typical high school kid gets about 340 calories per day from competitive foods, 65 percent (or 220 calories) of which are from junk food.

The most commonly consumed competitive foods:

• Desserts, snacks (cakes, cookies, candy and ice cream) and sweetened beverages.

So, we have low-quality foods sold in the schools competing with a low-quality school lunch–a competition that’s a lose-lose for our kids. Wherever our kids turn they have snacking opportunities that contribute mostly empty calories.

The only existing federal restriction on foods sold in school is that foods of “minimal nutritional values,” such as candy and soda, won’t be sold in the cafeteria during meal times. That of course doesn’t mean they can’t be sold right outside the cafeteria doors. And although some school districts have taken initiatives to impose restrictions banning some junk food sales in schools, progress is very slow.

It is high time school food begins to resemble a lesson in how to eat healthfully. Right now, the school lunch—and especially the school foods for sale—resemble all that’s wrong in our popular food culture, and explain quite well why one in three American kids is overweight or obese.

Kids spend half their waking hours in school and consume half of their daily calories while on campus. Changing school food is critical in the effort to combat obesity.

I applaud the White House and especially our First Lady for taking on this important issue. “Let’s Move” is the politically savvy way to name what will have to really become a “Let’s Eat Less Junk” effort—but whatever it takes let’s indeed move it!

Dr. Ayala

Full disclosure: I’m vice president of product development for Herbal Water, where we make organic herb-infused waters that have zero calories and no sugar or artificial ingredients. I’m also a pediatrician and have been promoting good nutrition and healthy lifestyle for many years.

This entry has been posted as part of The Kathleen Show's Prevention not Prescriptions

Who’s shaping decisions about the school lunch program?

This is the last time I’ll be writing about the school lunch program for a while, I promise. I know it’s not the most cheerful of subjects, but it’s an important topic and, as you’ll see, a timely one: the School Lunch Program is up for renewal, and that’s why now’s the time to review and hopefully improve it.

I wanted to share with you Steven Greenstreet’s provocative video, “The Food Lobby Goes to School,” produced by the The American News Project. The video is of a hearing on school lunch nutrition regulations assembled at the Institute of Medicine. The institute will later this year advise the U.S. Department of Agriculture (USDA) on revisions to the School Lunch Program nutrition requirements.

I think that if videos of barfing people get hundreds of thousands of views on YouTube, this video should be viewed by at least as many, just to prove there are thinking people out there too, so please pass this video on!

There are many people weighing in on the subject of school food. I agree with Greenstreet that the food industry’s not a good source for unbiased information in what’s supposed to be a scientific meeting.

Here are two voices that the USDA should be hearing: Alice Waters and Katrina Heron, who co-authored an op-ed in the New York Times last week. Waters—the legendary founder and co-owner of Chez Panisse—is credited with single-handedly creating an American culinary revolution and for developing “Californian Cuisine", which is famous for using locally-grown and fresh ingredients.

Waters is also the founder and president of the Chez Panisse Foundation; Heron is a director of the foundation and a co-producer of civileats.com. The foundation advocates a nationwide public school curriculum that gives kids a culinary education, including hands-on experiences in school kitchens, gardens and lunchrooms, and inspires students to choose healthy food that helps the community and the environment.

One of the foundation’s priorities is replacing the unhealthy offerings in the schools with healthier and tastier meals.

Waters and Heron call the School Lunch Program a “poor investment” of taxpayer’s money. They describe the commodity foods which the schools get as “fast food” and “essentially leftovers from big American food producers.” School meals are valued at a little over 20 cents per meal and include high-fat, low-grade meats and cheeses and processed foods like chicken nuggets and pizza.

Most of the schools have no kitchens and just heat and un-wrap those low-quality foods.

The authors say:

“Every public school child in America deserves a healthful and delicious lunch that is prepared with fresh ingredients. Cash-strapped parents should be able to rely on the government to contribute to their children’s physical well-being, not to the continued spread of youth obesity, Type 2 diabetes and other diet-related problems. Let’s prove that there is such a thing as a good, free lunch.”

These are only two of the many voices that should to be heard on of the subject of our kids’ nutrition.

Personally, I hope that the final standards don’t end up concentrating only on ranges of fat, protein, carbohydrates, vitamins and minerals the way previous standards did, and actually address the issue of what wholesome, healthy food should look like.

Otherwise the only change in the lunch menu might be ‘new and improved’ junk foods that technically fit the new standards of macro and micro-nutrient recipes to a tee, while defying the spirit of what every expert in nutrition—and I daresay anyone with a bit of common sense—knows about healthy eating: namely that fast food, even if lower in fat and sugars, is unhealthy.

The food lobbyists are listening intently, and are ready to make lower saturated-fat burgers and pizzas, and lower-carb sugary drinks. I’m afraid that won’t stop the health crisis our kids face.

Who would you like to see advising the government on school lunches?

Dr. Ayala

Not a healthy choice: junk foods vs. the school lunch program

I devoted a recent post to the school lunch program, a federally sponsored and regulated program, which complies with some (if not altogether satisfactory) nutrition standards for nutrient content and portion size. I was grousing about the sorry state of the food our young ones are served under the guise of an “improved” lunch program.

But to get the full picture of the school food environment, we need to also look at the competitive foods sold in schools–foods that are expressly marketed to our kids–which make up a big part of what kids actually eat while they’re in school.

What are competitive foods? They’re anything sold, served or given to the kids that isn’t part of the school subsidized lunch. They are comprised of foods and beverages sold in the cafeteria or in a school store, from a vending machine or in fundraising events. The lunch money parents give their kids may very well be spent on these offerings, rather than on the school lunch.

Kids love the vending machines and the school stores, but that’s not the only reason these outlets exist. Schools depend on the revenues that vendors bring in to fund much-needed programs. This creates an unusual and worrying conflict, in which schools share an interest with the manufacturers of snacks and junk foods.

The US Department of Agriculture administers and regulates the school lunch program, but has practically no control over other foods and drinks available at schools (although some school districts have taken initiatives to impose restrictions banning some junk food sales in schools). In fact, the only existing federal restriction is that foods of “minimal nutritional values”, such as candy and soda, won’t be sold in the cafeteria during meal times. That of course doesn’t mean they can’t be sold right outside the cafeteria doors.

You can imagine that if the content of the regulated school lunch leaves a lot to be desired, the completely unregulated competitive food scene would be a free-for-all candyland galore.

The Journal of the American Dietetic Association’s special supplement this month analyzed the data from the third School Nutrition Dietary Assessment Study. One of the papers is devoted to competitive foods. The data was collected in 287 nationally representative schools and included 2,314 kids.

These were the main findings:

• Availability: One or more sources of competitive foods was available in 73 percent of elementary schools, 97 percent of middle schools, and 100 percent of high schools. À la carte foods sold in the cafeteria were common in all school levels. Vending machines were available in more than one quarter of elementary schools, 87 percent of middle schools and virtually all high schools.

• Consumption of competitive foods: Overall about 40 percent of the kids consumed these foods on any given day. Consumption was much higher in high school and reached 55 percent.

• Energy contribution of competitive foods: Overall kids consumed about 280 calories/day from competitive foods, and almost two thirds of these calories were from foods of low-nutrient and energy-dense food (the study defined “low-nutrient energy-dense food” to include cakes/cookies and other desserts, donuts, toaster pastries, snack chips, French fries and caloric beverages excluding milk and 100% juice). These numbers varied by school type, with middle and high school kids getting more calories from competitive foods. A typical high school kid gets about 340 calories/day from competitive foods, 65 percent (or 220 calories) of which are from junk food.

• The most commonly consumed competitive foods: Desserts and snacks were selected by just over 50 percent of kids; these products include cakes, cookies, candy and ice cream. Sweetened beverages were consumed by almost half the kids--these include juice drinks (not 100% juice) and carbonated soda.

The authors conclude:

“SNDA-III (third School Nutrition Dietary Assessment Study) data indicate that consumption of competitive foods was widespread, particularly in middle and high schools. Sources of competitive foods varied by type of school, with vending machines and à la carte purchases most common in middle and high schools and fundraisers and other school activities most common in elementary schools. The specific competitive foods consumed most frequently were low-nutrient, energy-dense foods such as fruit drinks/sport drinks, cookies/cakes/brownies, candy, and carbonated sodas. On average, children who consumed one or more competitive foods obtained 177 calories (8% of total daily energy intake) from low-nutrient, energy-dense competitive foods.”

So, we have low-quality foods sold in the schools competing with a low-quality school lunch–a competition that’s a lose-lose for our kids. Wherever our kids turn they have snacking opportunities that contribute mostly empty calories.

Many parents commented on my previous school lunch post, and told me that they opt to pack a lunch for their kids. It’s sad to say, but for most American kids the only potential source for a healthy nutritious lunch may be the lunchbox from home.

No matter how you approach the school lunch issue, I'm convinced that we as parents have more influence on our kids’ food choices–through what we do, what we say and how we eat–than anyone else. It’s within our reach to exert our influence to better our kids' diet and health.

More on vending machines and the foods they offer here.

Do you give your kids money to buy food at school? What advice do you give them about their choices for lunch?

Dr. Ayala

Hardly a healthy lunch: The sorry state of the school lunch program

The third School Nutrition Dietary Assessment Study, which evaluates the school meal program, came out recently. The Journal of the American Dietetic Association devoted over 130 pages in a special supplement this month to its findings. There’s much to read and think about in its data.

I’d like to devote this post to just one topic covered by the study, and talk about what our kids get served, and what they actually eat while in the school cafeteria for lunch. I, for one, am quite concerened.

A short introduction to the school meal program:

In 1946 the National School Lunch Act created the National School Lunch Program (NSLP) with a dual purpose—to feed kids and prevent dietary deficiency and to provide an outlet for surplus agricultural commodities. The school lunch program operates in all public schools and in many private schools too.

The School Breakfast Program was established in 1975 to help meet the nutritional needs of children from low-income families and is offered in fewer schools.

On any average school day more than 30 million kids eat a school lunch, and 10 million kids eat a school breakfast. Fifty-nine percent of the kids eating a school lunch are from low-income homes, as are 80 percent of school breakfast eaters.

The USDA-sponsored third School Nutrition Dietary assessment study was based on a sample of almost 400 public schools that offer subsidized school meals, and about 2,300 students grades 1-12.

Here’s a picture of what’s offered for lunch:

• Milk: Milk is offered in practically all schools. One percent fat milk was the most common milk served, and the majority of milk offered is flavored.

• Fruit: Ninety-four percent of schools offered fruit or fruit juices. Only 50 percent of schools offered fresh fruit. The rest offered canned fruit or fruit juice.

• Vegetables: This study considers starchy vegetables such as white potatoes a vegetable. By that classification, 96 percent of kids had a vegetable offering at lunch. But note that while 45 percent of high schools offered French fries (!) only 39 percent of schools offered lettuce salad, 29 percent offered orange or dark green vegetables, and 10 percent offered legumes.

• Grains/bread: The vast majority of grain products (bread, rolls, bagels, crackers etc.) were made of refined white flour. Only 5 percent of grain offering was whole wheat.

• Combination entrée: The most commonly offered combination entrée depended on age; in elementary school, 28 percent of combination entrees were peanut butter sandwiches, followed by meat sandwiches; in middle school the most commonly offered combination entree was pizza with meat, followed by cheeseburgers and sandwiches with breaded meat or poultry.

• Dessert: Those were offered in 47 percent of high schools, 41 percent of middle schools and 37 percent of elementary school. The leading deserts were cookies, cakes and brownies.

This is what the kids actually ate for school lunch:

• Milk: Seventy-five percent of kids drank milk, mostly 1 percent fat, and mostly flavored.

• Fruit: Forty-five percent of kids ate some fruit; most of the fruit eaten was canned. Only 16 percent of kids overall had fresh fruit, and among high school kids it was only 8 percent.

• Vegetables: Fifty-one percent of kids overall had some kind of vegetable, but that includes French fries. Lettuce salads were eaten by 6 percent of kids, orange or dark green vegetables were eaten by 6 percent, and legumes by 2 percent. French fries were eaten by 34 percent of high school kids!

• Grains/bread: Thirty-four percent of kids had grain products. Only 1 percent of grain products eaten were whole wheat.

• Combination entrée: 75 percent of kids selected these entrees, the most popular of which were pizza, sandwiches with breaded meat, fish or poultry, hamburgers or hot dogs.

• Dessert: Thirty-eight percent of kids had dessert, mostly consisting of cookies cake and brownies or candy.

In assessing the quality of the school meals and the school food environment, the study authors and commentators compare the school food to the recommendations set by the Dietary Guidelines for Americans. By these standards:

• The school lunch menu meets the standards for key nutrients such as protein, vitamins and minerals.

• The majority of lunches exceeded the recommendations for total fat (in over 80 percent of schools) and saturated fat (in 72 percent of schools). (The standards require fewer than 30 percent of calories come from fat, and less than 10 percent of fat be saturated fat.)

• Only 6 percent of schools met the standards for all nutrients: fat, saturated fat, protein, vitamins A and C, iron and calcium.

• Very few schools offered lunch that was adequate in fiber.

• Practically all school lunches contained too much salt.

I offer you a very different way to look at the subsidized school lunch. You don’t need to be a nutritionist, you don’t needs charts and a calculator, and you don’t even need to know the Dietary Guidelines for Americans to assess the quality of the offerings we’re serving our next generation.

Picture the food described above and it’s easy recognize and name it: The school lunch is fast food! It’s salty, sweet and fatty, the meat is breaded and crunchy, it’s been highly processed—even the fruit and vegetables aren’t fresh for the most part.

Speaking of vegetables, I have nothing against potatoes; I think they’re nutritious and good to eat in many forms, but French fries aren’t a vegetable by any stretch of the imagination! (And neither is ketchup.)

Most of school lunches are not prepared in the school kitchen—the surplus commodities our food industry produces make their way to our schools as processed food and not as fresh fruits, vegetables and whole grains.

For those who say that a better school menu would be too expensive, I want you to consider that treating a whole host of chronic diseases, ranging from diabetes to heart disease to cancer—which are the dangerous result of the childhood obesity epidemic and the current lack of healthy nutrition—will cost so much more. Forty percent of the public school kids in this study were overweight! We definitely can’t afford that!

There are a few schools that serve healthy, nutritious food, made from real ingredients. There are a few schools that teach kids how to cook healthy meals and even grow their own vegetables.

But what most kids learn from the institution that’s supposed to prepare them for life are really bad eating habits that will set them up for a lifetime of struggle with weight. Even worse is that kids from low income homes—who have less access to wholesome food out of school—get this low quality food at school for lunch and breakfast.

What do your kids eat for lunch at school?

Dr. Ayala