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.

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 States
Presenter: Debra Kibbe, MS For: Southeastern Executive Chef’s Table
Georgia Health Policy Center February 24-26, 2012
dkibbe@gsu.edu 404-413-0287 Smithgall Woods State Park - Helen, GA

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. 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 play
3

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. 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. Issue: Hunger &
Food Access
Low Sales, Low Income, High Deaths
Other
Major Cities
Park, forest or non-residential
Recommendation:
Southeastern states must address
the critical need for more super-
markets in many communities, both
rural & 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. 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: HealthyPeople.gov, 2020 Objectives

8. Issue: Obesity & Disparities
Among 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. http://www.cdc.gov/obesity/childhood/data.html
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. Obesity & Food Insecurity1
People with unreliable access to
food 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. Obesity & Food Insecurity1,2
Food-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. 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. Issue: Diet Quality
Don't 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. Top Sources of Calories
Among Americans 2 Years & Older
1. 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, bagels
3. Chicken and chicken mixed dishes
– Fried and baked chicken parts, chicken strips/patties, stir-fries,
casseroles, sandwiches, salads, other chicken mixed dishes
4. Soda/energy/sports drinks
– Sodas, energy drinks, sports drinks, and sweetened bottled
water/ vitamin water
5. Pizza
Source: NHANES 2005-2006, Available at http://riskfactor.cancer.gov/diet/foodsources/

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 http://riskfactor.cancer.gov/diet/foodsources/

15. Comparison of Consumption
to Recommendations
*
*solid fats and
added sugars
U.S. Department of Agriculture
Center for Nutrition Policy and Promotion

16. Reduce: Sodium Intake
U.S. Department of Agriculture
Center for Nutrition Policy and Promotion

17. Reduce: Solid Fats
Food Sources of Solid Fats U.S. Department of Agriculture
Center for Nutrition Policy and Promotion

18. Reduce: Added Sugars
Food Sources of Added Sugars U.S. Department of Agriculture
Center for Nutrition Policy and Promotion

19. Reduce: Refined Grains (especially
those w/ solid fats, added sugars, and sodium)
Food Sources of Refined Grains U.S. Department of Agriculture
Center for Nutrition Policy and Promotion

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. 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 3,446 796
WIC 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. WIC Food Package & Farmers Market Program
In 2009, USDA introduced a new set of WIC food
packages 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. 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. 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: http://www.fns.usda.gov/snap/
1. Gibson D. Food Stamp Program* Participation and Obesity: Estimates from the NLSY79.
Jan 2002. On-line: http://www.ipr.northwestern.edu/jcpr/workingpapers/wpfiles/gibson_obesity.pdf

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. 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. Social Marketing Campaign:
“do”
• For Worksites & Community
• Billboards, posters, TV ads,
handouts, & other resources
Site: http://www.do-groove.com/

28. Social Marketing: Champion Moms (CA)
Build support for and create a message campaign
for Moms in your state

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. Georgia Dept. of Public Health CDC-funded Obesity Grant
Healthcare
Work Group /
Obesity Action
Focus 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. Policy Level Action: GA DPH-funding
Georgia Food Policy
Production
Council
Consumption Processing
Steering
Committee
Deliverables:
• Expand members
• Develop state plan
• Host info gathering
meetings: 3
Waste Recycling Distribution regional & 1
statewide

32. Systems Level Action GA DPH-funding
Share Our Strength’s Cooking MattersTM
Georgia Coalition for Physical Activity and Nutrition
receives support from GA DPH Nutrition & PA Initiative
to implement
Cooking Matters in Georgia

33. Cooking Matters Teaches…
…Cooking
…Nutrition
33

34. Cooking Matters Teaches
Shopping & Food Budgeting
Grocery Store Tour
A family meal for 4 for $10
34

35. Cooking Matters Uses Volunteer
Chefs & Nutrition Educators

36. Objective #3
What are the ingredients for change
to address hungry and heavy?

37. Source: Las Vegas Sun. The Associated Press. Monday, Feb. 20, 2012.
Web: http://www.lasvegassun.com/news/2012/feb/20/us-white-house-chef/

38. Consider the Food System
• Availability Roadblocks
– Affordability
– Access
• Structural Roadblocks
– Transportation Infrastructure
– Retail Models
– Supply Chain Development
– Adequate Healthy Food Supply

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. Ingredient #2: Food Quantity
Never order food in excess
of your body weight.
-- Erma Bombeck

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. 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
http://strength.org/press_release/20111116/

43. Ingredient #5: Access to & Adequate Food
Supply through Grocers/Markets
Work with your state governments and food
vendors/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. Our Goal:
Healthy, hunger free families & communities
in the Southeastern United States
Collaborate.
Convene.
Catalyze.
This [event] will be a tremendous opportunity for us
to leverage our passion and our positions.”
Holly Chute

45. Final Quotes…
“Children have never been very
good at listening to their elders, but
they have never failed to imitate them.‖
-- James Baldwin

46. How To Weigh Yourself
Thank you!
Questions?
Comments?
Contact: Debra Kibbe
dkibbe@gsu.edu
404-413-0287