Gail Woodward-Lopez

To what extent have sweetened beverages contributed to the obesity epidemic

OBJECTIVE A systematic literature review was conducted to determine whether sweetened beverage intake increases the risk for obesity, and the extent to which it has contributed to recent increases in energy intake and adiposity in the USA. DESIGN The search included studies published between 1970 and 2010 that examined secular trends, mechanisms, observational associations and intervention outcomes. Observational and intervention studies were abstracted and systematically evaluated for quality. SETTING Trends in obesity prevalence in the USA and studies from industrialized (developed) countries were included. SUBJECTS Studies were included for all ages, genders, ethnic and socio-economic groups for which data were available. RESULTS Obesity rates and sweetened beverage intake have increased in tandem in the USA. Studies consistently show that higher intake of sweetened beverages is associated with higher energy intake. Energy in liquid form is not well compensated for by reductions in the intake of other sources of energy. Well-designed observational studies consistently show a significant positive relationship between sweetened beverage intake and adiposity. More importantly, several well-conducted randomized controlled trials have shown statistically significant changes in adiposity as a result of corresponding changes in sweetened beverage intake. CONCLUSIONS All lines of evidence consistently support the conclusion that the consumption of sweetened beverages has contributed to the obesity epidemic. It is estimated that sweetened beverages account for at least one-fifth of the weight gained between 1977 and 2007 in the US population. Actions that are successful in reducing sweetened beverage consumption are likely to have a measurable impact on obesity.

Lessons Learned From Evaluations of California's Statewide School Nutrition Standards

OBJECTIVES We assessed the impact of legislation that established nutrition standards for foods and beverages that compete with reimbursable school meals in California. METHODS We used documentation of available foods and beverages, sales accounts, and surveys of and interviews with students and food service workers to conduct 3 studies measuring pre- and postlegislation food and beverage availability, sales, and student consumption at 99 schools. RESULTS Availability of nutrition standard-compliant foods and beverages increased. Availability of noncompliant items decreased, with the biggest reductions in sodas and other sweetened beverages, regular chips, and candy. At-school consumption of some noncompliant foods dropped; at-home consumption of selected noncompliant foods did not increase. Food and beverage sales decreased at most venues, and food service à la carte revenue losses were usually offset by increased meal program participation. Increased food service expenditures outpaced revenue increases. CONCLUSIONS Regulation of competitive foods improved school food environments and student nutritional intake. Improvements were modest, partly because many compliant items are fat- and sugar-modified products of low nutritional value. Additional policies and actions are needed to achieve more substantive improvements in school nutrition environments and student nutrition and health.

Alarming trends in pediatric overweight in the United States

SummaryObjectives:A comprehensive review of the pediatric overweight literature was undertaken to examine secular changes in the prevalence of pediatric overweight, the current magnitude and scope of pediatric overweight, and the identity of high-risk groups in the U.S.Methods:Articles published in the last two decades and studies of nationally representative numbers of children were highlighted.Results:An unprecedented three-fold increase in the prevalence of pediatric overweight has occurred in recent decades in the U.S. and evidence suggests that this trend is continuing unabated. While no sociodemographic or racial group has escaped this trend, particularly at risk are African American girls, Hispanic girls and boys, and children from low-income households.Conclusions:The rising prevalence of pediatric overweight in the U.S. is a harbinger of increases in diabetes, cardiovascular disease and numerous other health problems. Furthermore, disparities in pediatric overweight along ethnic and socio-economic lines are expected to further exacerbate current disparities in rates of chronic disease. Strategies and programs to prevent overweight among children are urgently needed.ZusammenfassungAlarmierende Trends in der Verbreitung von Übergewicht im Kindesalter in den USAZielsetzung:Eine umfassende Prüfung der Literatur zu Übergewicht im Kindesalter wurde vorgenommen, um langfristige Veränderungen im Vorkommen, das gegenwärtige Ausmass und die Reichweite von Übergewicht im Kindesalter zu untersuchen und um Gruppen mit besonders hohem Risiko in den USA zu identifizieren.Methoden:Spezifisch berücksichtigt wurden Artikel, die während der letzten 20 Jahre publiziert wurden und Studien mit national repräsentativen Teilnehmerzahlen.Ergebnisse:Eine noch nie da gewesene Verdoppelung der Prävalenz für Übergewicht im Kindesalter war in den letzten Jahrzehnten zu verzeichnen und die Datenlage deutet darauf hin, dass sich dieser Trend unvermindert fortsetzt. Keine sozio-ökonomische oder ethnische Untergruppe konnte sich diesem Trend entziehen. Afroamerikanische Mädchen und lateinamerikanische Mädchen und Knaben sowie Kinder aus Haushalten mit niedrigem Einkommen sind besonders gefährdet.Schlussfolgerungen:Die steigende Prävalenz für Übergewicht im Kindesalter in den USA ist ein Vorbote für eine Zunahme von Diabetes, Herzkreislauferkrankungen und zahlreichen anderen Gesundheitsproblemen. Weiterhin ist zu erwarten, dass die ethnischen und sozio-ökonomischen Ungleichheiten bei Übergewicht im Kindesalter die bereits bestehenden Ungleichheiten im Vorkommen von Krankheiten noch verstärken. Es bedarf dringend Strategien und Programme zur Vorbeugung von Übergewicht bei Kindern.RésuméTendance alarmante du surpoids pédiatrique aux Etats-UnisObjectifs:Une revue exhaustive de la littérature sur le surpoids pédiatrique a été effectuée pour examiner les changements au cours du siècle de la prévalence du surpoids, son importance actuelle et son extension, ainsi que pour identifier les groupes à haut risque aux Etats-Unis.Méthodes:Etude des articles publiés au cours des 20 dernières années et des études portant sur des échantillons d’enfants représentatifs au niveau national.Résultats:Un doublement sans précédant de la prévalence du surpoids pédiatrique s’est produit au cours des récentes décennies aux Etats-Unis et les données suggèrent que cette tendance se poursuit inexorablement. Bien que cette tendance touche tous les groupes socio-démographiques et ethniques, les filles africaines-américaines, les garçons et les filles hispaniques et les enfants de familles ayant un bas revenu sont particulièrement à risque.Conclusions:La prévalence croissante du surpoids pédiatrique aux Etats-Unis est une source d’accroissement du diabète, de maladies cardio-vasculaires et de nombreux autres problèmes de santé. De plus, les disparités de surpoids pédiatriques selon l’ethnie ou le niveau socio-économique ont probablement exacerbé les inégalités actuelles concernant les taux de maladies chroniques. Il est urgent de développer des stratégies et des programmes destinés à prévenir le surpoids chez les enfants.

Obesity : Dietary and Developmental Influences

Introduction The Obesity Epidemic The Obesity Prevention Network Determinants of Energy Imbalance Workgroup A Focus on Prevention Defining Target Behaviors: A First Step Methodology Search Process and Criteria Article Abstraction and Manuscript Format Lines of Evidence Critical Periods Intrauterine Growth and Birth Weight Infancy Adiposity Rebound Early Puberty Pregnancy Postpartum Menopause Elderly Dietary Influences on Energy balance Total Calories Energy Density Macronutrient Intake Minerals and Vitamins Vegetables and Fruits Sweetened Beverages and Fruit Juice Restaurant-Prepared Foods Dietary Patterns Variety of Foods Reduced-Fat Food Products Portion Size Meal and Snack Patterns Parenting Influences Breastfeeding Food Insecurity Conclusions When to Intervene: Critical Periods in the Development of Obesity What to Recommend: Dietary Influences on Energy Balance Implications Priorities for Further Research Reference Index

How Discretionary Can We Be with Sweetened Beverages for Children

Pediatric overweight has become the foremost public health issue for American youth. Rates of overweight (body mass index 95th percentile) for children and adolescents have increased more than for any other age group. Since the early 1970s, the prevalence of overweight has more than quadrupled among 6- to 11year-old children and more than tripled among 12- to 19-year-olds (1,2). A recent analysis of data on obesity prevalence in children from 1999 to 2006 shows that the rates appear to have peaked with nearly one in six of our nation’s children now overweight (body mass index 95th percentile) (3). Obesity crosses all ethnic and socioeconomic lines in the United States. No group—young or old, rich or poor— has escaped this epidemic. However, African Americans, Hispanics, and Native Americans are disproportionately more affected (2). Although many talk about the potential health consequences of obesity and the need for action, fewer are talking directly about the seriousness of behaviors that are at the heart of the problem. The issue of child overweight may serve as the canary in the coal mine, bringing attention to the state of our children’s diets. An examination of the diets of a nationally representative sample of children found that only 1% of children meet the dietary recommendations for the healthful core food groups (4,5) as set forth in the 1995 Dietary Guidelines for Americans (http://www.health.gov/dietaryguidelines/dga95/ default.htm). Yet with obesity on the rise, if children were simply eating too much of everything, including the healthful core food groups, many more would be meeting the dietary guideline recommendations for these foods. In that case, dietary change to prevent obesity would require a straightforward overall decrease in food intake. Instead, obesity is the outcome of poor food choices, not just generalized overconsumption of all foods. S o... wherein lies the problem? Which are the poor food choices that children and their parents (and the institutions that care for children) are making that contribute to the obesity epidemic? To answer this question, we need to examine the evidence linking dietary factors to adiposity.

Local wellness policy strength and perceived implementation of school nutrition standards across three states.

BACKGROUND Congress sought to address escalating rates of childhood obesity by mandating local wellness policies (LWP) (Child Nutrition and WIC Reauthorization Act of 2004). Previous research has examined LWP content and quality; however, data relative to LWP implementation is limited, and none has examined the relationship between LWP quality and implementation. The purpose of this study was to examine the influence of LWP strength on perceived implementation of LWP components. METHODS Data collected from school districts in California, Iowa, and Pennsylvania included district LWPs and online surveys at the district (n = 23) and school levels (n = 76). LWPs were scored using a standardized coding tool. Binary and multinomial regression models were used to examine the predictive ability of covariates and independent factors on perceived implementation of reimbursable school meals and nutrition guidelines for competitive foods sold and offered. RESULTS Overall LWP strength score did not predict perceived implementation of reimbursable school meals or nutrition guidelines for competitive foods. LWP component strength scores for reimbursable meals and nutrition guidelines did not consistently predict perceived implementation of those components. State and urban-centric locale did predict perceived implementation of some LWP components, particularly nutrition guidelines for competitive foods sold and offered. State was a particularly influential factor in the implementation of LWPs in this study, likely due to differences in state policies and laws. CONCLUSIONS Overall LWP, reimbursable school meals, and nutrition guidelines for competitive foods strength scores do not predict perceived implementation of reimbursable school meals and nutrition guidelines for competitive foods.

Is scratch-cooking a cost-effective way to prepare healthy school meals with US Department of Agriculture foods?

BACKGROUND Despite the resurgence of interest in scratch-cooking as a way to increase the quality and appeal of school meals, many school districts are concerned about the cost implications of switching to scratch-cooking. US Department of Agriculture (USDA) Foods are the single largest source of ingredients for school meals, and about half of USDA Foods are diverted for processing before being sent to the school district. OBJECTIVE We aimed to determine whether school lunch entrées made in a district from basic or raw USDA Foods ingredients can be healthier and less expensive to prepare than those sent to external processors. DESIGN/SETTING This cross-sectional study examined the relationship between the extent of scratch-cooking and the nutritional content and cost to prepare entrées. Information was gathered by interview with school foodservice personnel and from school foodservice records from a convenience sample of 10 school districts in California that employed varying degrees of scratch-cooking and is diverse in terms of geographic location and the sociodemographics of the student body. The sample included all elementary school lunch entrées that contain USDA Foods offered during October 2010 for a total sample of 146 entrées. STATISTICAL ANALYSES Ordinary least squares regressions were used to test for statistically significant differences in cost and nutrient content of entrées according to the level of scratch-cooking. RESULTS There was no significant relationship between total costs and level of scratch-cooking. Entrées with the highest scratch-cooking scores had significantly lower food costs, higher labor costs, and not significantly different total costs compared with entrées with no scratch-cooking. Nutrient content was not consistently associated with scratch-cooking, but scratch-cooked entrées did include a larger variety of non-fast-food-type entrées. CONCLUSIONS The findings suggest that scratch-cooking can be a cost-effective way to expand the variety of healthy school lunches prepared with USDA Foods.

Does Competitive Food and Beverage Legislation Hurt Meal Participation or Revenues in High Schools

BACKGROUND There is limited evidence to evaluate the influence of competitive food and beverage legislation on school meal program participation and revenues. METHODS A representative sample of 56 California high schools was recruited to collect school-level data before (2006–2007) and the year after (2007–2008) policies regarding limiting competitive foods and beverages were required to be implemented. Data were obtained from school records, observations, and questionnaires. Paired t-tests assessed significance of change between the two time points. RESULTS Average participation in lunch increased from 21.7% to 25.3% (p < 0.001), representing a 17.0% increase, while average participation in breakfast increased from 8.9% to 10.3% (p = 0.02), representing a 16.0% increase. There was a significant (23.0%) increase in average meal revenue, from

Improvements in Physical Activity Opportunities: Results From a Community-Based Family Child Care Intervention

0.70 to

Changes in Nutrition Policies and Dietary Intake in Child Care Homes Participating in Healthy Eating and Active Living Initiative

0.86 (per student per day) (p < 0.001). There was a nonsignificant decrease (18.0%) in average sales from à la carte foods, from