This research was performed for the University of Washington graduate course: Design Thinking Studio. The content of this presentation is on the topic of nutritional health in urban Seattle.

1. Secondary Research
Defining the Problem More Clearly

2. Table of Contents
1. CDC’s 2015-2020 Dietary Guidelines
2. CDC Strategies to Increase Consumption of Fruit and Veggies
3. CDC’s Healthier Food Retail
4. King County Residents Do Not Have Equal Access to Healthy Food
5. King County Heart Disease Deaths Information
6. King County Diabetes Deaths Information
7. King County Recent Unhealthy Days Information
8. King County Health Rankings
9. US Dept of HHS - Overweight and Obesity Statistics
10. Institute of Health Metrics and Evaluation - The Main Causes of Death and Disability in the USA
11. NPR - The Longevity Diet
12. NPR - Weight-Loss App Doesn’t Help Young Adults Shed Pounds
13. NPR - Health Labels May Change Online Ordering Habits
14. NPR - A Grocery Walk to Combat Food Deserts
15. NYT - Obesity Growth and the Rise of Fast Food in Ghana
16. Study - The Effect of Nutrition Knowledge on Food Label Use
17. Study - Are Food Labels Effective?
18. WHO - Pregnancy Recommendations
19. Study - Maternal Nutrition and Risk of Obesity in Offspring

3. CDC’s 2015-2020 Dietary Guidelines
“About three-fourths of the population has an eating pattern that is low in
vegetables, fruits, dairy, and oils.”
“Most Americans exceed the recommendations for added sugars, saturated fats,
and sodium.”
Advice: “Help individuals become more aware of the foods and beverages that
makeup their own or their family’s eating patterns and identify areas, such as
modifying recipes and/or food selections, where they can make shifts to align
with the Dietary Guidelines.”

4. Citation: U.S. Department of Health and Human Services and U.S. Department of
Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th Edition. December
2015. Accessed: 7 Oct 2017. Available at
http://health.gov/dietaryguidelines/2015/guidelines/.

5. CDC Strategies to Increase Consumption of Fruit
and Veggies
1. Promote food policy councils
2. Improve access to retail stores that sell fruits and veggies
a. Attract new food stores to underserved areas through financial incentives
b. Improve public transport to these stores
c. Upgrade facilities to accommodate produce
d. Increase supply of and shelf space dedicated to fruits and veggies
“Neighborhood residents with better access to supermarkets and other retail
stores that provide healthful foods tend to have healthier diets, including higher
intakes of fruits and vegetables.”
“Residents of rural, minority, and lower-income neighborhoods are more likely to
have poor access to supermarkets.”

6. “In rural, minority, lower-income neighborhoods, convenience stores and other
small grocery or corner stores may be more prevalent than supermarkets.”
“Improvements in access and availability are necessary steps in creating an
environment conducive to adequate fruit and vegetable consumption.”
“A separate study found that greater availability of fresh vegetables within 100
meters of residence was associated with higher vegetable intake, and a third study
found that proximity to food outlets influenced the diet quality of pregnant women.”
3. Start or expand farm-to-institution programs
4. Start or expand farmers’ markets in all settings
5. Start or expand community supported agriculture (CSA) programs

7. 6. Ensure access to fruits and veggies in workplace cafeterias
7. Encsure access to fruits and veggies at workplace meetings and events
8. Support and promote community and home gardens
9. Establish policies to incorporate fruit and vegetable activities into schools
10. Include fruits and vegetables in emergency food programs.
Citation: Centers for Disease Control and Prevention. Strategies to Prevent
Obesity and Other Chronic Diseases: The CDC Guide to Strategies to Increase
the Consumption of Fruits and Vegetables. Atlanta: U.S. Department of Health
and Human Services; 2011.3

8. CDC’s Healthier Food Retail
FACT: “The United States Department of Agriculture (USDA) estimates that nearly 30 million Americans
live in neighborhoods without easy access to affordable nutritious food, and persons living in lower-income
communities, communities of color, or rural communities are less likely to have healthier food available to
them.”
FACT: “Research has shown that residents with access to full service grocery stores tend to eat more
fruits and vegetables, and other studies have found an association between healthier food retail access
and lower prevalence of overweight and obesity among adults.”
FACT: “The prevalence of overweight and obesity is higher in areas where food is mostly available
through small stores and fast food outlets.“
Citation: Centers for Disease Control and Prevention. Healthier Food Retail: Beginning the Assessment
Process in Your State or Community. Atlanta: U.S. Department of Health and Human Services; 2014.

9. King County Residents Do Not Have Equal
Access to Healthy Food
“Food deserts are found in South Seattle and the South Region of King County.”
“Definition of food deserts: ‘… either urban areas lacking access to a supermarket
within one mile, or rural areas lacking similar access within 10 miles. Without a
convenient and affordable way to buy healthy food, individuals either spend hours
traveling or are forced to feed their families significantly less nutritious options,
many of which are often more expensive.’”
Citation:. “King County Residents Do Not Have Equal Access to Healthy Food,”
Communities Count: Social & Health Indicators Across King County, 2012. Web.
Accessed 16 Oct 2017.
http://www.communitiescount.org/index.php?page=Food-desert-2017.

10. King County Heart Disease Deaths Information
Includes deaths from congestive heart failure, cardiac dysrhythmias, acute
myocardial infarction (i.e. heart attack), and coronary artery disease.
Worst affected ethnic groups: Native Hispanic/Pacific Islander (265.7 deaths per
100,000); American Native/Alaskan Native (181.8); Black (161.1)
Affected groups by poverty level: high (154.2); low (106.4)
Worst affected group by King County region: South (144.7)
Worst cities: Auburn South (196.7); Federal Way Central/Military Rd (168.7);
Auburn (165.1)

11. Citation: King County Dept of Public Health. “Heart Disease Deaths” Assessment,
Policy, Development, and Evaluation Unit. Aug 2016.
http://www.kingcounty.gov/depts/health/data/~/media/depts/health/data/document
s/life-expectancy/heart-disease-deaths.ashx.

12. King County Diabetes Deaths Information
Description: : Deaths with diabetes mellitus as a primary cause of death.
Finding: The South region of King county, specifically, South Auburn (35.5), East
Federal Way (30), and Southeastern Kent (28.8) have the highest rates of
diabetes deaths per 100,000.
Citation: King County Dept of Public Health. “Diabetes Deaths” Assessment,
Policy, Development, and Evaluation Unit. Aug 2016.
http://www.kingcounty.gov/depts/health/data/~/media/depts/health/data/document
s/life-expectancy/diabetes-deaths.ashx.

13. King County Recent Unhealthy Days Information
Description: The number of days with poor physical or mental health in last 30
days among adults
FIndings:
Worst Affected Ethnicity: Black (4)
Worst Affected Income Bracket: <$15,000 (6)
Worst Affected City: Federal Way Central/Military Rd (4)

14. Citation: King County Dept of Public Health. “Average Number Of Unhealthy Days,
Physical and Mental (Adults)” Assessment, Policy, Development, and Evaluation
Unit. Jul 2016.
http://www.kingcounty.gov/depts/health/data/~/media/depts/health/data/document
s/behavior/mean-number-days-kept-from-usual-activity-poor-physical-mental-healt
h-adults.ashx

15. UW Population Health Institute - King County
Health Rankings
Citation: County Health Rankings & Roadmaps. “Washington: Food Environment
Index.” County Health Rankings. 2017. Web. Accessed: 16 Oct 2017.
http://www.countyhealthrankings.org/app/washington/2017/measure/factors/133/d
ata.

16. US Dept of HHS Overweight and Obesity
Statistics
Citation: National Institute of Diabetes and Digestive and Kidney Diseases.
“Overweight and Obesity Statistics.” U.S. Department of Health and Human
Services. Aug. 2017. Accessed 9 Oct 2017.
https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity.

17. Institute of Health Metrics and Evaluation
Citation: “United States,” Institute of Health Metrics and Evaluation. 2017. Accessed: 5 Oct 2017. Web.
http://www.healthdata.org/united-states

18. Citation: Institute for Health
Metrics and Evaluation
(IHME), US County Profile:
King County, Washington.
Seattle, WA: IHME, 2016.

19. Longevity Diet - NPR via The Blue Zones
The Blue Zone Solution - a book for Americans written by a National Geographic
explorer who sought to find the lifestyle secrets to longevity.
Blue Zone - communities largely free of afflictions like heart disease, obesity,
cancer, and diabetes
Conclusions from Book:
- Stop eating when your stomach is 80 percent full to avoid weight gain.
- East the smallest meal of the day in the late afternoon or evening.
- Eat mostly plants, especially beans. And eat meat rarely, in small portions of
3-4 oz. Blue Zoners eat portions this size just five times a month, on average.
- Drink alcohol moderately and regularly, i.e. 1-2 glasses a day.

20. Citation: Barclay, Eliza, “Eating to Break 100: Longevity Diet Tips From the Blue
Zones,” NPR.org, 11 Apr 2015. Accessed: 5 Oct 2017.
http://www.npr.org/sections/thesalt/2015/04/11/398325030/eating-to-break-100-lo
ngevity-diet-tips-from-the-blue-zones
Blue Zone Recipes: http://bluezones.com/recipes/

21. Weight-App Doesn’t Help Young Adults Shed
Pounds
“A third of the participants used an Android app specifically created for the study,
which not only tracked their calories, weight and exercise but also offered
interactive features like goal setting, games and social support.”
“The smartphone app didn't help young adults lose any more weight than if they
hadn't been using the app at all.”
“People have the tendency to stop using weight-loss apps after a while. ‘We know
that in general, the more engaged people are in intervention, the more they're
going to succeed from it,’ Svetkey [a professor of medicine at Duke University
School of Medicine] says. ‘And so perhaps we need to rethink how to make a
weight-loss intervention on your cell phone more engaging.’”

22. “More work is needed to understand how to harness the technology and leverage
its strengths in a way that will lead people to change their eating and exercise
behaviors.”
Citation: Shallcross, Lynne. “Weight-Loss App Doesn’t Help Young Adults Shed
Pounds.” NPR.org, 6 Nov 2015. Web. Accessed 16 Oct 2017.
http://www.npr.org/sections/health-shots/2015/11/06/454874728/weight-loss-app-d
oesnt-help-young-adults-shed-pounds.

23. Health Labels May Change Online Ordering
Habits
“In some restaurant settings, people made better choices when "traffic light"
color-coded labels helped them distinguish between healthful (green), less
healthful (yellow) and not-so-healthful (red) meals. Over the course of the
six-week study, people could select food on a website and then pick it up, skipping
the line at the office cafeteria. Each of the nearly 250 website users saw online
menus with either "traffic light" coding, exact calorie counts, both food label types,
or no labels. It turned out that employees who saw online menus with any
indication of a meal's caloric content — either the exact calorie counts or the more
indirect traffic light coding — ordered about 10 percent fewer calories than
people who didn't have access to health information.”

24. An additional study showed that “traffic light labels could help people make more
healthful choices, but actual calorie counts had little influence.”
“Dropping 10 percent of your lunchtime calories on the occasions that you happen
to eat from the office cafeteria isn't likely to improve your overall health. But if you
start also seeing these labels in restaurants, and cafeterias, and your local
supermarket, if as a society it becomes more of a cultural change, then yes, we'd
see health benefits."
Citation: Beans, Carolyn, “Click for Few Calories: Health Labels May Change
Online Ordering Habits.” NPR.org 28 June 2016. Web. Accessed 16 Oct 2017.
http://www.npr.org/sections/thesalt/2016/06/28/483269369/click-for-fewer-calories-
health-labels-may-change-online-ordering-habits.

25. NPR - A Grocery Walk to Combat Food Deserts
- 40 million Americans live in communities with these so-called grocery gaps.
- Washington DC has innovative food-access policies including:
- $10 vouchers for eligible residents to spend at farmers markets
- stocking corner stores with discounted produce
- mobile markets
Citation: Pipkin, Whitney. “Food Access Advocates Walk The Long Walk ... To The
Nearest Grocery Store.” NPR.org. 1 Nov 2017. Web. Accessed 2 Nov 2017.
http://www.npr.org/sections/thesalt/2017/11/01/560476160/food-access-advocates
-walk-the-long-walk-to-the-nearest-grocery-store

26. Obesity Growth in Ghana - New York Times
B “From 2011-2016, fast food sales grew 21.5% in the United States, according to
Euromonitor, a market-research firm, and 30% worldwide.”
B Crucial to the success of YUM! (KFC’s parent company) is “finding local
franchisees...who have knowledge of the local market and commitment to the
investment.”
X “Also crucial: mixing local culture with flavors company executives repeatedly
called ‘aspirational.’”

27. “The health effects of fast food are challenging to study, particularly in the
US...because it's hard to establish the specific influence of fast food on obesity.”
Fast Food is bad for you: “Singaporeans...who ate Western fast food twice a week
or more were 27% more likely to get type 2 diabetes, and 56% more likely to die
from heart disease, than subjects who didn’t regularly eat such food.”

28. Fast food (which is fast, easy, tasty)
is becoming more popular globally.

29. Citation: Seargey, Dionne and Matt Richtel, Obesity Was Rising as Ghana
Embraced Fast Food. Then Came KFC. New York Times. 2 Oct 2017. Date
accessed: 5 Oct 2017.
https://www.nytimes.com/2017/10/02/health/ghana-kfc-obesity.html?smid=fb-shar
e

30. The Effects of Nutrition Knowledge on Food
Label Use
“Nutrition information on food labels could be a cost-effective method of
communicating nutrition information to consumers because the information
appears at the point-of-sale for most packaged foods.”
“nutrition information on food labels is complex and does not always live up to its
potential to communicate effectively.“
“Many studies have shown associations between nutrition knowledge and dietary
behaviors“

31. “most consumers (78%)
accurately identified nutrient
differences between two
products; however, far fewer
(20%) were able to calculate
the contribution of a single food
to a total daily intake.”
“subjective and objective
measures of nutrition
knowledge were significantly
associated with self-reported
nutrition label use”
Citation: Miller, Lisa M.S. and Diana L.
Cassady. “The Effects of Nutrition Knowledge
on Food Label Use. A Review of the
Literature” Apetitie 2015: 92: 207-216.

32. Are Food Labels Effective? - Italian Study
“Despite the reported nutritional information is often clear and comprehensive,
consumers do not necessarily take the healthiest choice, but decision-making
process is also influenced by the ability to decode the label and its graphical
representation, by socio-economic status and self-perception of psychophysical
well-being.”
Study recommendation: “More efforts should be done to improve their
knowledge on nutrition fundamentals and basics about food labelling.”
Three main nutritional goals: “reduce salt, reduce saturated and trans fat intakes,
and increase consumption of fruit and vegetables.”

33. Recommendation: “Up-stream efforts should be done first of all on the educational
front, to improve general public basic knowledge about nutrition and the
relationship between diet and health status.”
Citation: Viola, Gaia C.V., et al. “Are Food Labels Effective as a Means of Health
Prevention.” Journal of Public Health Research. 2016. 5:768: 139-142.

34. WHO Pregnancy Recommendations
“Pregnancy may be an optimal time for behavior change interventions among
populations with a high prevalence of overweight and obesity, and the longer-term
impact of these interventions on women, children and partners needs
investigation.”
Citation: “WHO Recommendations on Antenatal Care for a Positive Pregnancy
Experience.” World Health Organization. 2016. PDF. Accessed 9 Oct 2017.
http://apps.who.int/iris/bitstream/10665/250796/1/9789241549912-eng.pdf.
“Obesity and overweight is associated with poor pregnancy outcomes.”
Popkin S, Slining MM. New dynamics in global obesity facing low- and
middle-income countries. Obes Rev. 2013;14(2):11–20. doi:10.1111/obr.12102.

35. Maternal Nutrition and Risk of Obesity in Offspring
“Epidemiological studies have shown that humans born small- or
large-for-gestational-age, have a higher likelihood of developing obesity as adults.”
“The amount and quality of food that the mother consumes during gestation
influences birth weight, and therefore susceptibility of progeny to disease in later
life.”
“Maternal nutrition contributes to a legacy of obesity. Thus, ensuring adequate
supplies of a complete and balanced diet during and after pregnancy should be a
priority for public health worldwide.”

36. “Males exclusively exposed to famine prenatally during the first two trimesters of
gestation had about 2-fold higher prevalence of obesity (2.77%) than control
counterparts (1.45%)...These results suggest that developmental plasticity
resulting from neonatal exposure to global maternal nutrient-restriction has a time
dependent, profound and opposing effect on the propensity to develop obesity.”
“Pre-pregnancy BMI is a strong predictor of birth weight and obese mothers
deliver large-for-gestational-age infants 1.4- to 18-times more frequently, which
predisposes to obesity in later life...Maternal nutrition remains an important
regulator of offspring obesity even when genetic contribution is controlled.”

37. “Given that pregravid obesity is associated
with poor nutrition during pregnancy,
including a high-fat diet, obese women, as
well as women consuming westernized
diets, may be endangering the future
health of their children by predisposing
them to a lifetime of obesity.”
Citation: Parlee, Sebastian D. and Ormond
A. MacDougald. “Maternal Nutrition and
Risk of Obesity in Offspring: The Trojan
Horse of Developmental Plasticity.”
Biochimica et Biophysica Acta. 2014, 1842:
495-506.

38. Other Secondary Resources to Explore / Document
http://www.seattle.gov/environment/food/food-action-plan
http://www.seattle.gov/environment/food/fresh-bucks
https://www.economist.com/news/international/21647641-childs-long-term-well-bei
ng-more-profoundly-shaped-influences-pregnancy
https://www.ers.usda.gov/data-products/food-environment-atlas/go-to-the-atlas/