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Hungry and Heavy: What ingredients are needed for change?


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Debra Kibbe, senior research associate with the Georgia Health Policy Center, recently presented "Hungry and Heavy: What ingredients are needed for change?" at the Southeastern Executive Chef’s Table in Georgia. This event was a twelve-state summit on nutrition in the south and included a focus on outdoor activity and the use of Georgia State Parks.

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Hungry and Heavy: What ingredients are needed for change?

  1. 1. Hungry and Heavy: What ingredients are needed for change? The Paradox of Food Insecurity & first annual Southeastern Executive Chef’s Table on February 24th. Obesity in the Southeastern United StatesPresenter: Debra Kibbe, MS For: Southeastern Executive Chef’s TableGeorgia Health Policy Center February 24-26, 404-413-0287 Smithgall Woods State Park - Helen, GA
  2. 2. Objectives• Examine issues related to the hunger and obesity paradox• Explore existing initiatives• Discuss the Executive Chef’s ingredients for change to address hunger and obesity This [event] will be a tremendous opportunity for us to leverage our passion and our positions.” Holly Chute
  3. 3. The Hunger-Obesity Paradox• Research findings are complex – do not illustrate direct relationships• Food insecure women are at greatest risk for obesity• Factors related to both food insecurity and obesity stem from poverty! – Stretching the food dollar – Feast or famine (binge eating, storing) – Lack of safe places to play3
  4. 4. Issue: Hunger/Food Insecurity GOAL: FOOD SECURITY FOR ALL ―Access by all people at all times to enough food for an active, healthy life." C.C. Campbell
  5. 5. Issue: Food Insecurity & Obesity in SE US State Food Insecurity % Adult OB % Prevalence of (Rank) 1 (Rank)2 Household- Alabama 15% (7) 32.3% (2) Level Food Arkansas 17.7 (1) 30.6 (9) Insecurity Florida 14.2 (14) 26.1 (29) 2007-2009 Georgia 15.6 (4) 28.7 (17) Kentucky 13.4 (22) 31.5 (6)Southeastern U.S.: Louisiana 10 (45) 31.6 (5)• 7 of top 10 food Mississippi 17.1 (3) 34.4 (1) insecure states N Carolina 14.8 (9) 29.4 (14)• 8 of top 10 most obese Tennessee 15.1 (6) 31.9 (4) Texas 17.4 (2) 30.1 (12) W Virginia 13.4 (22) 32.2 (3) Source: 1) Food Research & Action Center. 2) F as in Fat Report, 2011
  6. 6. Issue: Hunger & Food Access Low Sales, Low Income, High Deaths Other Major Cities Park, forest or non-residentialRecommendation:Southeastern states must addressthe critical need for more super-markets in many communities, bothrural & urban. Sources: 1) The Food Trust. Food for Every Child: The need for more supermarkets in Georgia. June 2011, p. 9. 2) Treuhaft S, Karpyn A. PolicyLink and The Food Trust. The Grocery Gap: Who has access to healthy food and why it matters. Oakland (CA), 2010.
  7. 7. Issue: Obesity GOALS: Healthy People 2020 • Increase proportion of Adults 20+yrs who are healthy weight (from 30.8% to 33.9%) • Reduce the proportion of adults who are obese (from 34% to 30.6%) • Reduce the proportion of children and adolescents who are considered obese (from 16.2% to 14.6%) Source:, 2020 Objectives
  8. 8. Issue: Obesity & DisparitiesAmong 2 to 19 year olds1 in 2007—2008:• Boys: Hispanic more likely to be OB than non-Hispanic white.• Girls: Non-Hispanic black more likely to be OB than non- Hispanic white. Low income children & adolescents are more likely to be obese than higher income youth...‖2 Source: 1. CDC, Child Overweight and Obesity. 2. Ogden CL, Lamb MM, Carroll MD, Flegal KM. NCHS Data Brief, No. 51, Dec 2010. Obesity and Socioeconomic Status in Children and Adolescents: United States, 2005-2008.
  9. 9. Obesity & Food Insecurity1People with unreliable access tofood are:• Not getting healthy affordable food,• More likely to be obese, and• Exposed to higher levels of stress. 1. Food Insecurity and Obesity: Understanding the Connections. Washington: Food Research and Action Center, Spring 2011.
  10. 10. Obesity & Food Insecurity1,2Food-insecure households tend to:• choose foods high in fat,• choose foods that may satisfy hunger more easily, but they typically do not provide sufficient nutrients, and• overeat when they do have access to food. 1. Dinour LM, Bergen D, Yeh M. “The Food Insecurity-Obesity Paradox: A Review of the Literature and the Role Food Stamps May Play.” American Dietetic Association, 107(11): 1952-1961, 2007. 2. Food Research and Action Center.
  11. 11. Obesity: Energy Gap Among U.S. Children• Excess weight gain estimated based on 1988-1994 normal weight distribution1 • All adolescents: excess 0.43 kg/yr over 10 yrs ( .95 lbs) • Energy gap = 110-165 kcals/day • OW adolescents: excess 2.65 kg/yr over 10 yrs ( 5.8 lbs) • Energy gap = 678-1017 kcals/day• Energy imbalance in Hispanic children2: • median weight gain 6.1 kg in 1 yr ( 13.4 lbs) • 244 to 267 kcals/day (considers P.A. levels) 1) Wang et al, Pediatrics 2006;118:e1721. 2) Butte NF et al. Obesity 2007;15:3056.
  12. 12. Issue: Diet Quality Dont dig your grave with your own knife and fork. ~ English Proverb Source: Food Research and Action Center poll of 1,013 registered voters. Conducted by Hart Research Associates, January 11-17, 2012.
  13. 13. Top Sources of CaloriesAmong Americans 2 Years & Older1. Grain-based desserts – Cake, cookies, pie, cobbler, sweet rolls, pastries, donuts 2. Yeast breads – White bread and rolls, mixed-grain bread, flavored bread, whole-wheat bread, bagels3. Chicken and chicken mixed dishes – Fried and baked chicken parts, chicken strips/patties, stir-fries, casseroles, sandwiches, salads, other chicken mixed dishes4. Soda/energy/sports drinks – Sodas, energy drinks, sports drinks, and sweetened bottled water/ vitamin water5. Pizza Source: NHANES 2005-2006, Available at
  14. 14. Top Sources of Calories by Age Group  Alcoholic beverages are a major calorie source for adults  Sodas & pizza contribute more calories among adolescents than younger children  Fluid milk is a top calorie source for younger children Source: NHANES 2005-2006, Available at
  15. 15. Comparison of Consumption to Recommendations **solid fats andadded sugars U.S. Department of Agriculture Center for Nutrition Policy and Promotion
  16. 16. Reduce: Sodium Intake U.S. Department of Agriculture Center for Nutrition Policy and Promotion
  17. 17. Reduce: Solid FatsFood Sources of Solid Fats U.S. Department of Agriculture Center for Nutrition Policy and Promotion
  18. 18. Reduce: Added SugarsFood Sources of Added Sugars U.S. Department of Agriculture Center for Nutrition Policy and Promotion
  19. 19. Reduce: Refined Grains (especiallythose w/ solid fats, added sugars, and sodium) Food Sources of Refined Grains U.S. Department of Agriculture Center for Nutrition Policy and Promotion
  20. 20. Issue: Food Assistance Programs“Nutrition programs provide a safety net.”  Executive Director, Greater Chicago Food Depository Source: Food Research and Action Center poll of 1,013 registered voters. Conducted by Hart Research Associates, January 11-17, 2012.
  21. 21. Income Eligibility for WIC* Benefits WIC Family Annually Monthly Weekly Size Family of 1 $20,147 $1,679 $388 Family of 2 27,214 2,268 524 Family of 3 34,281 2,857 660 Family of 4 41,348 3,446 796WIC contributes approximately $3.3 billion to the GA’s economy.TX is the 2nd and GA is the 5th largest WIC programs in the U.S. *Special Supplemental Nutrition Program for Women, Infants and Children. Target: Women and their children 0-5 yrs.
  22. 22. WIC Food Package & Farmers Market ProgramIn 2009, USDA introduced a new set of WIC foodpackages based on IOM recommendations:• More fruits and vegetables• Increased whole grains• Increased farmers market vouchers• Reduced juice allowance• Reduced dairy & egg allowance, only reduced fat milk• More healthy food for breastfeeding mothers Source: USDA FNS
  23. 23. SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP): AVERAGE MONTHLY BENEFIT PER PERSON (Data as of February 1, 2012)State/Territory FY 2008 FY 2009 FY 2010 FY 2011 Alabama 96.79 119.14 126.90 135.18 Arkansas 95.17 115.53 122.59 123.72 Florida 101.87 126.70 141.40 139.55 Georgia 104.19 125.95 134.35 135.37 Kentucky 97.66 119.00 127.05 127.60 Louisiana 108.04 128.86 129.77 130.59 Mississippi 92.59 113.83 122.54 123.29 Tennessee 101.95 124.66 133.86 133.82 “We put healthy food on the table for more than 46 million people each month.” USDA Food & Nutrition Service
  24. 24. Why Change SNAP?• Virtually all food items allowed (no hot foods)• Long-term FSP* participation is positively and significantly related to1: – obesity and BMI for low-income women – BMI for low-income married men Website: 1. Gibson D. Food Stamp Program* Participation and Obesity: Estimates from the NLSY79. Jan 2002. On-line:
  25. 25. Objective #2 Explore existing initiatives Source: Food Research and Action Center poll of 1,013 registered voters. Conducted by Hart Research Associates, January 11-17, 2012.
  26. 26. Social Marketing: TACOS Eat more fingernails. They’re nutritionally more valuable than soda pop. Brought to you by the University of Minnesota School of Public Health.• Yr 1 - the # of promotions conducted in schools was significantly associated with % lower-fat food sales.• Yr 2 - the duration of promotions was significantly associated with % lower-fat food sales.• Conclusion: School-based environmental interventions to increase availability and promotion of lower-fat foods can increase purchase of these foods among adolescents.
  27. 27. Social Marketing Campaign: “do”• For Worksites & Community• Billboards, posters, TV ads, handouts, & other resources Site:
  28. 28. Social Marketing: Champion Moms (CA)Build support for and create a message campaign for Moms in your state
  29. 29. Examples from Southeastern States• Kentucky – Delta HOPE Initiative• Tennessee – Funded Coordinated School Health, TAKE 10!• Louisiana – Smart Bodies• Georgia –Youth Fit for Life (YMCA), Tons of Fun,• Arkansas – Delta Healthy Kids Project• Texas – Juntos y Saludables, CATCH Since 2000, documenting OB, PA & Nut programs – list is 35 pages long!
  30. 30. Georgia Dept. of Public Health CDC-funded Obesity Grant Healthcare Work Group / Obesity ActionFocus areas: Network Policy / Early Childhood Policy, Education: GA Work Group Health Policy /Bright from the Systems, & Center & PLAY Start DECAL: Day Initiative & cares, Head Start, GPAN Coalition WIC, etc. Environmental Change School Work GA DPH Nut & Community Work Group - Action for PA Initiative Group: Cooking Healthy Kids, Matters, Healthy HealthMPowers, Vending Project – Alliance for includes Parks & Healthier Rec, Boys & Girls Generation, Dept Club, Boys & Girl of Education Scouts, 4-H Faith Work Worksite Work Group: Annual Group: Health Conference Matters Toolkit (Jan) & Toolkit developed developed
  31. 31. Policy Level Action: GA DPH-fundingGeorgia Food Policy ProductionCouncil Consumption Processing Steering Committee Deliverables: • Expand members • Develop state plan • Host info gathering meetings: 3 Waste Recycling Distribution regional & 1 statewide
  32. 32. Systems Level Action GA DPH-funding Share Our Strength’s Cooking MattersTM Georgia Coalition for Physical Activity and Nutritionreceives support from GA DPH Nutrition & PA Initiative to implement Cooking Matters in Georgia
  33. 33. Cooking Matters Teaches… …Cooking …Nutrition 33
  34. 34. Cooking Matters Teaches Shopping & Food BudgetingGrocery Store Tour A family meal for 4 for $10 34
  35. 35. Cooking Matters Uses Volunteer Chefs & Nutrition Educators
  36. 36. Objective #3What are the ingredients for change to address hungry and heavy?
  37. 37. Source: Las Vegas Sun. The Associated Press. Monday, Feb. 20, 2012.Web:
  38. 38. Consider the Food System• Availability Roadblocks – Affordability – Access• Structural Roadblocks – Transportation Infrastructure – Retail Models – Supply Chain Development – Adequate Healthy Food Supply
  39. 39. Ingredient #1: Family Meals 1,2,3,4 Family meals provide opportunity for: • modeling food behavior, • influencing nutrition beliefs, and • controlling the family food environment by offering healthy foods Example -- Project EAT: M.S. & H.S. youth who had more frequent family meals: • ate more fruits, vegetables, grains, and calcium-rich foods • drank fewer soft drinks Key: help families address scheduling issues re: family meals (1) Neumark-Sztainer, Hannan, Story, Croll, & Perry, 2003; (2) Johannsen & Johannsen, 2006; (3) Neumark-Sztainer et al., 2003; (4) Story M, Neumark-Sztainer D, 2005.
  40. 40. Ingredient #2: Food Quantity Never order food in excess of your body weight. -- Erma Bombeck
  41. 41. Ingredient #3: Participation in Federal Food Programs ↓ Food Insecurity• SNAP benefits must be used for food & for plants and seeds to grow food for a household to eat. • Work with state SNAP, Cooperative Ext & Master Gardeners groups to encourage purchase of plants & seeds for gardens • Promote Wholesome Wave double value coupon program at farmers markets• WIC, SNAP & CACFP require nutrition education. • Work with programs like Cooking Matters, Community Gardens, etc. to improve the growing & cooking skills of low income families.• Support HHF Kids Act & School Nutrition: Chef’s Move in School, Farm to School, School Gardens; Quality of breakfast, lunch, dinner, summer meals & afterschool snacks Sources: USDA FNS, Let’s Move
  42. 42. Ingredient #4: Access and Hunger Take a lead role in your state’s ―No Kid Hungry Campaign.‖ Governor Deal Launches Feeding For A Promising Future - No Kid Hungry Campaign‘* (November 16, 2011) * with Share Our Strength and Georgia Food Bank Association
  43. 43. Ingredient #5: Access to & Adequate FoodSupply through Grocers/MarketsWork with your state governments and foodvendors/grocers: create a grant & loan program to support local supermarket development projects incent grocers to place a store or help to establish farmers markets in a low access area (and price products fairly!) which increases availability of affordable & nutrition food in underserved areas. e.g. Pennsylvania’s Fresh Food Financing Initiative – since 2004, 83 stores in 27 rural and urban counties
  44. 44. Our Goal:Healthy, hunger free families & communities in the Southeastern United StatesCollaborate. Convene. Catalyze.This [event] will be a tremendous opportunity for usto leverage our passion and our positions.” Holly Chute
  45. 45. Final Quotes… “Children have never been very good at listening to their elders, butthey have never failed to imitate them.‖ -- James Baldwin
  46. 46. How To Weigh Yourself Thank you! Questions? Comments? Contact: Debra Kibbe 404-413-0287