KAREN NACHAY

Our waistlines are expanding. More than one-third of adults in the United States—in excess of 72 million individuals—were obese in 2005–06, and the prevalence of adult obesity doubled between 1980–2004, according to researchers at the Centers for Disease Control and Prevention (Ogden et al., 2007). They reported that the prevalence among men was 31.1% in 2003–04 and 33.3% in 2005–06. Among women, it was 33.2% in 2003–04 and 35.3% in 2005–06. While the 2003–04 and 2005–06 numbers are not statistically different, they do indicate a problem.

Combating Obesity“Since 1999, there appears to have been a leveling off in obesity among women, but the trend is less clear among men,” said Cynthia Ogden, a CDC researcher and lead author of the study. “We do know, however, that the gap between men and women has narrowed in recent years, with men catching up to the higher rates among women.”

Probably the most disturbing aspect of our national weight-control problem is the growing number of overweight and obese children. CDC (2006) reported that data collected in 2003–04 showed that the prevalence of overweight U.S. children age 2–5 was 13.9%; for ages 6–11, it was 18.8%; and for ages 12–19, it was 17.4%. And the World Health Organization reported that at least 20 million children under age 5 were overweight in 2005.

As more and more people are tipping the scales at alarming numbers, the government, public-health organizations, and the food industry are developing strategies to combat the growing numbers of obesity and overweight cases. This article will examine the numbers, the possible reasons for the increase in overweight and obesity cases, and the initiatives developed to combat this mounting public-health concern.

Affecting the Waistline and Pocketbook
Determining what is causing people to pack on pounds is difficult. Many are quick to point the finger of blame at others. Whether it is because of lifestyle choices, genetics, lack of exercise, the availability of low-cost processed foods, the growing number of fast-food establishments, the ways in which foods are processed, or a combination of these factors, one thing is sure: The ramifications on our health and the economy will be severe.

Obesity is a risk factor for many health conditions and diseases, including high blood pressure, diabetes, heart disease, stroke, sleep apnea, and osteoarthritis. As the number of patients with these conditions increases, so does the cost of treating them, which will place a burden on healthcare budgets. Finkelstein et al. (2003) estimated the U.S. medical costs associated with obesity to be as high as $93 billion. The Office of the Surgeon General, part of the U.S. Dept. of Health & Human Services, approximates the medical costs and lost productivity at $117 billion. The health and medical communities have been aware of the problem for more than 10 years, as have economists who analyze the implications these costs will have on the overall economy, said Sylvia Rowe, President, SR Strategy, and IFT Distinguished Lecturer.

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Not only will adults suffer the health and financial consequences of obesity, but obese children may face a lifetime of health problems and associated costs.

“I have personally worked with many 10-year-olds who have type 2 diabetes and/or hypertension due to obesity,” said Marilyn K. Tanner-Blasiar, a pediatric dietitian and study coordinator for TRIGR, Washington University School of Medicine, St. Louis, Mo., and a spokesperson for the American Dietetic Association.

In remarks made at the National Dialogue on Cancer held in September 2003, then U.S. Surgeon General Vice Admiral Richard H. Carmona said, “The good news is that obesity as we understand it today is completely preventable through healthy eating—nutritious food in appropriate amounts—and physical activity. The bad news is Americans are not taking the steps they need to in order to prevent obesity and its co-morbidities.”

So the question is this: How do we convince people to eat a healthful diet and to exercise in order to help prevent obesity? In the U.S., three ways to help combat overweight and obesity that have received plenty of attention over the past few years are changes to school lunches, food-industry initiatives, and food-product marketing.

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Changes in the Cafeteria
On June 30, 2004, President Bush signed Public Law 108-265, The Child Nutrition and WIC Reauthorization Act of 2004, which required schools that participate in programs authorized by the Richard B. Russell National School Lunch Act or the Child Nutrition Act of 1966 to establish a school wellness policy by the beginning of the 2006–07 school year. The law stipulates that school districts must develop the policies and set goals for nutrition education and physical activity, as well as other school-based activities designed to promote wellness. Nutrition guidelines for all foods available at schools; guidelines for reimbursable school meals (those that are part of the National School Lunch Program); and an implementation plan for a local wellness policy also are required.

The National School Lunch Act and Child Nutrition Act of 1966 regulate foods and beverages that are served through the National School Lunch Program. The decades-old federal standards do not apply to foods and beverages offered in school vending machines, school stores, and other venues operating outside of the school meal programs.

Senators Tom Harkin (D-IA) and Lisa Murkowski (R-AK) last year introduced an amendment to the pending farm bill that would set standards for these particular foods and beverages. The amendment would ban candy, soda (but not diet soda), and high-fat foods. It also sets restrictions for calories from total fat, saturated fat, sugar, and sodium.

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“The current standards for competitive foods sold in schools are out-of-date and do not include any of the current knowledge about the dangers of trans fats, high sodium, sugar, and cholesterol, and nutritional guidelines,” said Senator Murkowski in a press statement.

Some school districts across the U.S. have taken the lead in providing children with more-nutritious meals and food-vending options that go above and beyond the standards set by the federal government. Some parents do not monitor what their children eat and do not practice healthful eating habits and lifestyles, which are possible reasons why the number of overweight and obese children is increasing. Even if children eat only one healthy meal a day, that is a start, and some school districts around the country are making sure that they serve that meal.

In California, carbonated beverages are not offered for sale to elementary and middle-school students, and beginning July 1, 2009, they will not be available to high school students either. In New Jersey, only milk, water, and 100% fruit or vegetable juices may be sold to elementary-school students. Alabama allows the sale of snack foods with less than 10% Daily Value of total fat and less than 360 mg of sodium in school vending machines and stores and as a la carte cafeteria items. Many other school districts have cancelled contracts with fast-food chains and large beverage companies, limited or eliminated the sales of pizza and French fries, and added salad bars and vegetarian items to menus.

While some may question whether students will give up chips and candy bars for tomatoes and tofu, research conducted on the purchasing habits of students is encouraging. Wagner et al. (2007) showed that overall cafeteria sales do not decline after more-healthful food and beverage (e.g., low-fat and/or with less sodium and cholesterol) choices are offered, and that the more-nutritious products often do not cost more to produce. Grainger et al. (2007) examined the relationship between one school that gradually added more healthful food items to its menu (low-fat dressings and cheeses; whole-grain pizza crusts and breads; and fruits and vegetables) and the purchases made by students over the course of about three years. As the school added more healthful food items to the menu, there was an increase in the number of students purchasing these items, the study reports.

Although U.S. schools have made considerable improvements in their policies and programs to promote the health and safety of students, still more work is needed to strengthen school health and wellness policies and programs, according to CDC. CDC’s School Health Policies and Programs Study (SHPPS) 2006 is the largest and most comprehensive study of health policies and programs in the nation’s schools (Kann et al., 2006). Conducted every six years, SHPPS examines eight school health program components, including nutrition services; physical education and activity; health education; health services; mental health and social services; health and safe school environment; faculty and staff health promotion; and family and community involvement.

Comparison of the results from the 2000 and the 2006 studies showed that the number of schools that sold cookies, cake, or other high-fat baked goods in vending machines or school stores decreased from 38% to 25%; schools that offered deep-fried potatoes (French fries) a la carte decreased from 40% to 19%; states prohibiting schools from offering junk foods in vending machines increased from 8% to 32%, and school districts doing so increased from 4% to 30%; and schools selling water in vending machines or school stores increased from 30% to 46% (O’Toole et al., 2006).

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Despite these encouraging findings, the researchers said that there is still need for improvement because 77% of high schools sell soda or fruit drinks that are not 100% juice and 61% sell salty snacks not low in fat in their vending machines or school stores. They suggested that schools need to adopt food preparation practices that reduce fat, sodium, and sugar in meals.

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Industry Initiatives
Even though consumers are responsible for choosing what they eat, the environment needs to be more conducive to making healthy choices, said Rowe of SR Strategy. And this is where the food industry can take the lead, as the following examples show.

Ingredient suppliers are developing or sourcing healthier oils, grains, sweeteners and sugar alternatives, flavor enhancers, and products that increase satiety for use in foods and beverages positioned as more healthful.

Five food manufacturers in October 2006 signed an agreement with the Alliance for a Healthier Generation—a joint venture of the William J. Clinton Foundation and the American Heart Association—to establish voluntary guidelines for the types of foods sold in schools. Under the agreement, the companies—Campbell Soup Co., Dannon, Kraft Foods, Mars, and PepsiCo—invest in product reformulation and research and development efforts and follow guidelines developed by nutrition experts at AHA. The guidelines apply to sales of foods that are not part of the National School Lunch Program and place limits on calories, fat, saturated fat, trans fat, sugar, and sodium.

As part of the initiative, Campbell is promoting its products that are lower in calories, fat, and sodium; Dannon is reducing the amount of sugar in its Danimals yogurt cups for children; Kraft is applying the Alliance’s guidelines regarding sodium and calories to its vending products and products sold in schools; Mars is offering a line of snack products formulated to meet the nutritional needs of children; and PepsiCo is reformulating some of its products to meet the guidelines.

The use of symbols on packaged goods to—as many companies say—“help consumers make informed food choices” is increasingly popular. Some, like Kraft’s Sensible Solution, Pepsico’s Smart Spot™, and Unilever’s Choices  logos, were created to flag certain products in a company’s portfolio that are deemed healthful food choices, often with guidance from the National Academy of Sciences, Food and Drug Administration, and other health agencies. Some of the criteria that foods and beverages must meet include having lower amounts of calories, fat, sodium, and sugar or containing fiber, vitamins, or other nutrients.

Other symbols list the amounts of specific nutrients. Kellogg’s Nutrition at a Glance™ symbol, which appears on the front of packages of ready-to-eat cereals, lists the amount and percentage of calories, fat, sodium, and sugar, as well as up to two additional nutrients (fiber, calcium, magnesium, potassium, and vitamins A, C, and E). Like Kellogg’s symbol, General Mills’ Nutrition Highlights presents similar information on packages of ready-to-eat cereal sold in the U.S.

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“It is great that companies are trying to make healthy changes to their foods, and placing labels and logos on packages is one way to call attention to the consumer,” said Dawn Jackson Blatner, a registered dietitian and spokesperson for ADA.

In addition to recognizing these logos, she wants consumers to read the Nutrition Facts Panels to learn more about the serving size, number of calories, and amount of saturated fat and trans fat, as well as the types and amounts of nutrients and other ingredients.

Portion-control packaging is another tool that food companies are offering consumers. Portion-control snack products contain a moderate number of calories per package—usually 100—and are marketed as an easy way for calorie-counting consumers to monitor their intake. In March 2007, Good Humor-Breyers, part of Unilever, began offering Breyers® Double Churned100 Calorie Cups, Slim-a-Bear® 100 Calorie Ice Cream Sandwiches and Bars, and Fudgsicle® 100 Calorie Fudge Bars. Kraft and Kellogg also are among the companies that offer many 100-calorie products across their portfolios.

Keeping Advertising in Check
One hotbed of contention recently is the debate over whether advertising sugary and fatty foods to children contributes to childhood obesity. While there is compelling evidence of a possible link between the two, a definitive conclusion has not been reached.

An American Psychological Association task force recommended that advertisements targeting children under the age of 8 be restricted because the children’s cognitive development has not advanced to the point where they can distinguish advertising from reality, which means that they may be easily swayed by the marketing message (APA, 2004). This is problematic, the task force said, because much of the food advertising is for sugary cereals, sodas, and snack foods that do not offer many nutritional benefits, and children who view this advertising may develop poor nutritional habits that could last throughout their lifetimes.

As a result of this research and other reports conducted by government and health agencies such as the Federal Communications Commission and Institute of Medicine of the National Academies, some food companies have undertaken self-regulation initiatives. General Mills does not target advertising to children under age 6 or market to children in K–12 schools, and as of July 2007, it no longer advertises foods that contain more than 12 g of sugar/serving to children under age 12. Kellogg in June 2007 said that it would change what and how it markets to children under age 12 around the world, using internal nutrition standards developed by the company. The products that do not meet the criteria will either be reformulated to ensure that they do, or by the end of 2008, they will no longer be marketed to children.

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As our waistlines grow, so too, must our involvement in programs designed to prevent obesity. Changes to school lunch programs may help to introduce children to healthful foods. The food industry, acknowledging the problem, has taken steps to reformulate products for adults and children and to self-regulate the content of food and beverage advertisements directed toward children. The industry also is providing more information to help consumers make better choices. As a risk factor for many diseases, obesity may have far-reaching financial implications on healthcare systems, which is why all of the key players—government, public-health organizations, the food industry, and, especially, consumers—need to strengthen current efforts and develop new ones to combat obesity.

Karen Nachay, a Member of IFT, is Assistant Editor of Food Technology magazine ([email protected]ft.org).


Obesity Around the Globe
It is not just Americans who are increasing in girth. Around the world—in both developed and developing nations—the prevalence of overweight and obesity is increasing; in 2005, approximately 1.6 billion adults (age 15 and older) were overweight and 400 million adults were obese, according to the World Health Organization.

Many countries are taking action. But in some countries, specially developing nations that face economic, political, and social challenges, addressing obesity is not yet a priority.

• Canada. Canadians, like their American neighbors, are growing in girth. The Canadian Institutes of Health Research reported that in 2004, 23% of Canadian adults were obese. To combat obesity, the Canadian government is encouraging citizens to get active. About $5 million is slated to help fund ParticipACTION, which supports a national public awareness campaign to persuade Canadians to be more active.

• Europe. Eleven food and beverage companies joined the EU Pledge program in December 2007, agreeing to meet minimum standards regarding advertising food and beverage products to European children under age 12. The voluntary program is part of the EU Platform on Diet, Physical Activity, and Health Forum, established in 2005 to address obesity in Europe. The companies include Burger King, Coca-Cola, Danone, Ferrero, General Mills, Kellogg, Kraft, Mars, Nestlé, PepsiCo, and Unilever.

• Mexico. Researchers are noting the rise in diseases that stem from being overweight or obese. The Pan American Health Organization (2007) found that type 2 diabetes, for which obesity is a risk factor, is increasing in areas around the U.S.–Mexican border. It reported that 1.1 million residents age 18 and older suffer from type 2 diabetes, and 836,000 were pre-diabetic. About 90% of those who suffered from the disease were overweight or obese.