Presentation 3 marlene_schwartz
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Weitzman Symposium 2010
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Presentation 3 marlene_schwartz
- 1. When Personal Responsibility Is Not Enough: Improving Children’s Diets Through Public Policy Marlene B. Schwartz, Ph.D. Deputy Director Rudd Center for Food Policy and Obesity
- 2. Overview What influences our eating How the food environment has changed in the past 30 years A public health view of obesity What are “optimal defaults”? Policy ideas from around the country
- 3. How easy is it to self-regulate food intake?
- 8. Accessibility People eat the foods that are most easily available
- 9. On your desk or printer stand?
- 10. People eat what is visible
- 11. Teenage Milk and Soft Drink Consumption Over Time 0 5 10 15 20 25 1977-78 1994-96 1977-78 1994-96 Drinks per week Milk Soft Drinks BOYS GIRLS Source: USDA
- 12. Teenage Milk and Soft Drink Consumption Over Time 0 5 10 15 20 25 1977-78 1994-96 1977-78 1994-96 Drinks per week Milk Soft Drinks BOYS GIRLS
- 13. Teenage Milk and Soft Drink Consumption Over Time 0 5 10 15 20 25 1977-78 1994-96 1977-78 1994-96 Drinks per week Milk Soft Drinks BOYS GIRLS
- 14. Mounting evidence against sugar sweetened beverages Meta-analysis found significant detrimental effects on weight, energy intake, calcium, and risk of diabetes Funding source of research matters Each additional daily serving increases risk of obesity by 60% Vartanian, Schwartz & Brownell (2007) American Journal of Public Health Ludwig et al (2001) Relationship between consumption of sugar sweetened drinks and childhood obesity: A prospective, observational analysis. Lancet
- 15. Variety leads to increased consumption Sensory specific satiety The “buffet” effect The “dessert” effect
- 16. Doritos, Cheetos, pretzels, popcorn, Captain Crunch, m & m’s
- 18. Knowledge The Individual Motivation How Best to Make Change? Educate Implore Medicate Operate Less Obesity?
- 19. CDC, BRFSS % of US Population Getting Recommended Physical Activity (1986-2000)
- 20. Knowledge The Individual Motivation How Best to Make Change? Educate Implore Medicate Operate Less Obesity?
- 21. Knowledge The Individual Motivation How Best to Make Change? Educate Implore Medicate Operate Less Obesity
- 23. One Example – Pension Plans Automatic enrollment Employee must enroll near 100% < 50% in 1st yr Choi, Laibson et al, 2002 In Poterba (Ed). Tax Policy and the Economy
- 24. Another Example – Organ Donation Johnson & Goldstein, Science, 2003 “Do defaults save lives?”
- 25. How can we design policies that will create optimal defaults for children’s eating?
- 26. CT Healthy Food Pilot Study • Pilot schools removed all snacks and beverages in 2004-2005 that did not meet state nutrition guidelines • Comparison schools remained the same • Food service directors were given lists of “approved” beverages and snacks
- 27. Results on financial impact On average, the pilot schools did not lose money when they made the changes A la carte sales did go down But, lunch sales went up Wharton, C., Long, M., & Schwartz, M.B. (2008). Changing nutrition standards in schools: The emerging impact on school revenue. Journal of School Health.
- 28. Results • Middle school students in pilot schools • Ate more healthy snacks • Drank more water • Ate fewer unhealthy snacks • Drank fewer unhealthy beverages • No evidence of compensatory increases in junk food at home • No increase in body image concerns Schwartz MB, Novak SA, Fiore S (2009) Health Education and Behavior
- 29. • When a la carte options are removed entirely from elementary schools • student consumption of unhealthy food at school decreases • Students do not compensate by eating more of these foods at home
- 30. Total Ice Cream Consumption 0 0.5 1 1.5 2 2.5 3 3.5 2004 2005 School Home Year * Place Interaction (F = 56.1, p < .0001)
- 31. Total Potato Chip Consumption 0 0.5 1 1.5 2 2.5 3 3.5 2004 2005 School Home Year * Place Interaction (F = 60.3, p < .0001)
- 32. Total Frozen Dessert Consumption 0 0.5 1 1.5 2 2.5 3 3.5 2004 2005 School Home Year * Place Interaction (F = 18.5, p < .0001)
- 33. Total Cookie, Brownie & Donut Consumption 0 0.5 1 1.5 2 2.5 3 3.5 2004 2005 School Home Year * Place Interaction (F = 4.8, p < .03)
- 34. Offer vs. Serve: Changing the Fruit Default
- 35. Serving vs. Offering Fruit 0 10 20 30 40 50 60 70 80 90 100 Control schools - took Control schools ate Intervention - took Intervention - ate Juice Fruit
- 36. Serving vs. Offering Fruit 0 10 20 30 40 50 60 70 80 90 100 Control schools - took Control schools ate Intervention - took Intervention - ate Juice Fruit
- 37. Results • Surprisingly, children who “chose” fruit were just as likely to eat it as children who were “served” fruit • The proportion who ate fruit (once taken) was the same: 70% • As a result of this policy change, the percent of children eating fruit went from 33% to 55% Schwartz, M. (2007) International Journal of Behavioral Nutrition and Physical Activity.
- 38. School Wellness Policies • Required in 2006 • Allow districts to set their own policies • Potential for change • Impact has been mixed
- 39. Coding School Wellness Policies Scored for “comprehensiveness” and “strength” in 7 domains: 1. Nutrition Education 2. Standards for USDA Nutrition Programs 3. Nutrition Guidelines for Competitive Foods 4. Physical Education 5. Physical Activity 6. Communication & Promotion 7. Evaluation
- 41. Unhealthy a la carte snacks Elementary Schools 0 10 20 30 40 50 60 70 80 90 2006 2007 State Standards Local Standards
- 42. Unhealthy a la carte snacks Middle Schools 0 10 20 30 40 50 60 70 80 90 2006 2007 State Standards Local Standards
- 43. Unhealthy a la carte snacks High Schools 0 10 20 30 40 50 60 70 80 90 2006 2007 State Standards Local Standards
- 44. Conclusions • Wellness policies made some improvements • Greater changes require state action • Implementation unclear • Need state oversight
- 45. www.wellsat.org Action for Healthy Kids webinar: May 14, 2010
- 46. The Role of Food Advertising Directed at Children
- 47. www.CerealFacts.org For all cereal brands, we compared nutrition scores to the amount of marketing to children
- 48. Cereal facts • Cereals marketed to children have 85% more sugar, 65% less fiber, and 60% more sodium • $156 million per year marketing to children • The average preschooler sees 642 cereal ads per year • There are healthy cereals, but few are marketed to children
- 49. The influence of pre- sweetened cereal on children’s breakfast consumption
- 50. Key Questions • How does consumption of high- vs. low- sugar cereals differ? • How does overall cereal, sugar, fruit, juice, and milk consumption vary as a function of cereal type?
- 51. Procedure • Children in summer camp • Randomly assigned to condition • Chose one of the three possible cereals • Given entire box to pour • Also given • 1% low-fat milk • orange juice • cut strawberries and bananas • packets of table sugar • Instructed to eat as much / as little as they liked
- 52. Grams consumed 0 10 20 30 40 50 60 70 80 (n = 19) (n = 14) (n = 24) (n = 29) High sugar Low sugar High sugar Low sugar 5-7 years 5-7 years 8-12 years 8-12 years Grams Cereal (less sugar content) Sugar in cereal Sugar from packets Recommended Serving Size = 30 grams
- 53. • More refined sugar (24 g vs. 13 g) • Comparable calories (345 vs. 383) • Comparable milk consumption (2/3 cup) • Less likely to put fruit on cereal • 8% in high-sugar condition • 54% in low-sugar condition High vs low-sugar meals
- 54. Conclusions • Children will eat low-sugar cereals when they are available • When eating low-sugar cereals, children eat the appropriate amount of cereal, less sugar, more fruit, and comparable milk and calories
- 55. More Policy Ideas Menu labeling • Child care environment • After-school environment • Improve food access in underserved neighborhoods • Tax unhealthy foods / subsidize healthy foods • Eliminate food marketing to children
- 56. Watch out for…. • Diffusion of responsibility • “(fill in the blank) did not cause childhood obesity” • “Changing (fill in the blank) will not solve the obesity problem” • “You can’t legislate behavior” • “It’s about personal responsibility”
- 57. Framing the debate • Personal responsibility vs. Nanny state • There are no true “choices” • Default options already exist • Need to optimize the default
- 58. Policies are needed to create an environment that supports personal responsibility, instead of undermining it
- 61. www.yaleruddcenter.org Monthly e-newsletter Podcasts Facebook and Twitter Thank you!
Editor's Notes
- -stigma is defined as negative attitudes that color interpersonal interactions -lots of ways to look at these negative attitudes and I want to talk a little about one approach that we are using at Yale -to help you become familiar with the kinds of tasks we do, I am going to ask you to participate in a brief research project that involves classifying words related to insects and flowers then I’ll run you through the tasks that demonstrate particular attitudes and beliefs toward people who are overweight which we have been using with the general public
- -stigma is defined as negative attitudes that color interpersonal interactions -lots of ways to look at these negative attitudes and I want to talk a little about one approach that we are using at Yale -to help you become familiar with the kinds of tasks we do, I am going to ask you to participate in a brief research project that involves classifying words related to insects and flowers then I’ll run you through the tasks that demonstrate particular attitudes and beliefs toward people who are overweight which we have been using with the general public
- -stigma is defined as negative attitudes that color interpersonal interactions -lots of ways to look at these negative attitudes and I want to talk a little about one approach that we are using at Yale -to help you become familiar with the kinds of tasks we do, I am going to ask you to participate in a brief research project that involves classifying words related to insects and flowers then I’ll run you through the tasks that demonstrate particular attitudes and beliefs toward people who are overweight which we have been using with the general public
- -stigma is defined as negative attitudes that color interpersonal interactions -lots of ways to look at these negative attitudes and I want to talk a little about one approach that we are using at Yale -to help you become familiar with the kinds of tasks we do, I am going to ask you to participate in a brief research project that involves classifying words related to insects and flowers then I’ll run you through the tasks that demonstrate particular attitudes and beliefs toward people who are overweight which we have been using with the general public
- -stigma is defined as negative attitudes that color interpersonal interactions -lots of ways to look at these negative attitudes and I want to talk a little about one approach that we are using at Yale -to help you become familiar with the kinds of tasks we do, I am going to ask you to participate in a brief research project that involves classifying words related to insects and flowers then I’ll run you through the tasks that demonstrate particular attitudes and beliefs toward people who are overweight which we have been using with the general public
- HER Working Group 1 Reviewed model policies, CT Action Guide, and existing coding systems