Accelerating Progress in Obesity Prevention Solving the Weight of the Nation (2012) / Chapter Skim
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6 Food and Beverage Environments
6 Food and Beverage Environments
Pages 153-234
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From page 153... ...
Such foods and beverages contribute little fiber and few essential nutrients and phytochemicals, but contain added fats, sweeteners, sodium, and other ingredients. Unhealthy foods and beverages displace the consumption of foods recommended in the Dietary Guidelines for Americans and may lead to the development of obesity.
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For the business community/private sector, nongovernmental organiza tions, and governments, potential actions include • making clean, potable water readily available in public places, worksites, and recreation areas; • making a variety of beverage options that are competitively priced readily available in public places, worksites, and recreation areas; • implementing fiscal policies aimed at reducing overconsumption of sugar sweetened beverages through (1) pricing and other incentives to make healthier beverage options recommended by the Dietary Guidelines for Americans more affordable and, for governments, (2)
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Potential actions include • developing a joint effort (modeled after the Healthy Weight Commitment initiative) to set a specific goal for substantially reducing the total annual calories served to children in these facilities; and • ensuring that at least half of all children's meals are consistent with the food and calorie guidelines of the Dietary Guidelines for Americans for moderately active 4- to 8-year-olds and are competitively priced.
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For the business community/private sector, potential actions include • the business community and private-sector entities that operate places fre quented by the public ensuring that a variety of food and beverage options are competitively priced and available for purchase and consumption in 4 "Government-owned and -operated buildings, worksites, and facilities" is defined broadly to include not only places of work but, also, locations such as government-owned and/or -operated child care centers, hospitals, and other health care/assisted living facilities, military bases, correctional facilities, and educational institutions. Accelerating Progress in Obesity Prevention 156
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. Potential actions include • states creating cross-agency teams to analyze and streamline regulatory processes and create tax incentives for retailing of healthy foods in under served neighborhoods; • states and localities creating cross-sectoral collaborations among the food and beverage industry, philanthropy, the finance and banking sector, the real estate sector, and the community to develop private funding to facili tate the development of healthy food retailing in underserved areas; and • localities utilizing incentive tools to attract retailing of healthy foods (e.g., supermarkets and grocery stores)
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From page 158... ...
Department of Agriculture (USDA) developing policy options for promoting increased domestic production of foods recom mended for a healthy diet that are generally underconsumed, including fruits and vegetables and dairy products, by reviewing incentives and dis incentives that exist in current policy; • as part of its agricultural research agenda, USDA exploring the optimal mix of crops and farming methods for meeting the current Dietary Guidelines for Americans, including an examination of the possible impact of smaller-scale agriculture, of regional agricultural product distribution chains, and of various agricultural models from small to large scale, as well as other efforts to ensure a sustainable, sufficient, and affordable supply of fresh fruits and vegetables; and • Congress and the Administration ensuring that there is adequate public funding for agricultural research and extension so that the research agenda can include a greater focus on supporting the production of foods Americans need to consume in greater quantities according to the Dietary Guidelines for Americans.
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• consume foods and drinks to meet, not exceed, calorie needs; • limit calorie intake from solid fats and added sugars; • increase intake of fruits, vegetables, and whole grains; • increase intake of fat-free or low-fat milk and milk products and replace higher-fat milk and milk products with lower-fat options; • choose water, fat-free milk, 100 percent fruit juice, or unsweetened tea or coffee as drinks instead of sugar-sweetened beverages; • choose a variety of foods from protein sources; • consume fewer foods and beverages high in solid fats, added sugars (includ ing sugar-sweetened beverages) , and sodium; • reduce intake of refined grains; • reduce portion sizes; and • cook and eat more meals at home rather than eating out and, when eating out, consider choosing healthier options.
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. Accelerating Progress in Obesity Prevention 160
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• Limit the consumption of foods that contain refined grains, especially refined grain foods that contain solid fats, added sugars, and sodium. • If alcohol is consumed, it should be consumed in moderation -- up to one drink per day for women and two drinks per day for men -- and only by adults of legal drinking age.
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Unhealthy foods and beverages displace the consumption of foods recommended in the Dietary Guidelines for Americans and may lead to the development of obesity. Accelerating Progress in Obesity Prevention 162
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Moderately active means a lifestyle that includes physical activity equivalent to walking about 1.5 to 3 miles per day at 3 to 4 miles per hour, in addition to the light physical activity associated with typical day-to-day life. Active means a lifestyle that includes physical activity equivalent to walking more than 3 miles per day at 3 to 4 miles per hour, in addition to the light physical activity associated with typical day-to-day life.
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. To change American's eating patterns, a sustained, systematic and compre hensive approach is required that empowers consumers to make healthy choices; Accelerating Progress in Obesity Prevention 164
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that gives them a variety of affordable, healthy options from which to choose; that promotes consistent messages about the importance of healthy eating in concert with daily physical activity; that makes healthy food options readily available 6-2 and accessible; and that cuts across all sectors of society -- from government, to schools, to restaurants and privately run places of public access, to health care settings, to farming. Absent a multifaceted approach, the nation will be no better off in 2022 than it is in 2012.
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STRATEGIES AND ACTIONS FOR IMPLEMENTATION Strategy 2-1: Adopt Policies and Implement Practices to Reduce Overconsumption of Sugar-Sweetened Beverages Decision makers in the business community/private sector, in nongovernmental organizations, and at all levels of government should adopt comprehensive strate gies to reduce overconsumption of sugar-sweetened beverages.83 For schools and other locations where children and adolescents are cared for, potential actions include • prohibiting access to sugar-sweetened beverages; • providing a variety of beverage options that are competitively priced and are recommended by and included in the Dietary Guidelines for Americans; and • making clean, potable water available. For the business community/private sector, nongovernmental organizations, and governments, potential actions include • making clean, potable water readily available in public places, worksites, and recreation areas; • making a variety of beverage options that are competitively priced readily available in public places, worksites, and recreation areas; • implementing fiscal policies aimed at reducing overconsumption of sugar sweetened beverages through (1)
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Context Consumption of sugar-sweetened beverages is the single largest contributor of calories and added sugars to the American diet (HHS/USDA, 2010; NCI, 2010b; Welsh et al., 2011)
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According to NHANES 2005-2006 dietary intake data, sugar-sweetened beverages are the largest contributor to added sug ars in the diets of all individuals aged 2 and above.105While added sugar intake has declined for Americans aged 2 and older, largely because of reduced consumption of regular sodas, added sugar intakes continue to exceed dietary recommenda tions, and rates of consumption of energy drinks as a source of added sugars have increased significantly over the past decade (Welsh et al., 2011)
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A decrease in caloric beverage consumption is just one of many necessary strategies in the effort to reduce obesity." Evidence Despite the complexity of the etiology of obesity and the difficulty of quantifying relative contributions to the obesity epidemic, researchers have found strong associations between intake of sugar-sweetened beverages and weight gain. Although the exact mechanisms of how sugar-sweetened beverages contribute to obesity are not fully known, their link to obesity is stronger than that observed for any other food or beverage, as described in the 2010 Dietary Guidelines for Americans advisory report (DGAC, 2010)
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(2011) by the maximum calories from solid fats and added sugars for the given age/sex, assuming a moderate physical activity level, from the Dietary Guidelines for Americans (HHS/USDA, 2010)
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. Because 100 percent fruit juice is suggested as an alternative to sugarsweetened beverages and there may be concern that its calorie content will promote obesity, the committee cites the DGAC report, which states: "limited and inconsistent evidence suggests that for most children, intake of 100 percent fruit juice is not associated with increased adiposity when consumed in amounts that are appropriate for age and energy needs of the child." The report also notes, however, that intake of 100 percent fruit juice has been prospectively associated with increased adiposity in children who are overweight or obese (DGAC, 2010)
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The Dietary Guidelines for Americans (HHS/USDA, 2010) , the American Academy of Pediatrics in association with the American Heart Association (Gidding et al., 2006)
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. Independent researchers reported that based on a nationally representative mail-back survey, high-calorie beverages and beverages not allowed by national guidelines were still available in 13 Because its charge was to focus specifically on strategies for accelerating progress in obesity prevention, the committee did not deliberate on the effects of low-calorie, artificially sweetened beverages on population health and did not take a position on this issue.
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. Replacing sugar-sweetened beverages with water is associated Accelerating Progress in Obesity Prevention 174
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to discourage consumption of unhealthy foods and beverages such as sugar-sweetened beverages or encourage consumption of healthier alternatives. Two committees (IOM, 2005, 2006b)
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encourages state and local policy makers, through finan cial or other incentives, to motivate restaurants to provide price reductions for healthier foods, and convenience stores and bodegas to provide affordable healthy Accelerating Progress in Obesity Prevention 176
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CDC also has issued a series of strategies for reducing consumption of sugar-sweetened beverages. Finally, the White House Task Force on Childhood Obesity (2010)
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or because their preferences for carbonated beverages are less entrenched, so their price sensitivity for these beverages is higher. Notwithstanding Accelerating Progress in Obesity Prevention 178
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They estimated an overall 23.5 percent drop in consumption of sugar-sweetened beverages and an average weight reduction of 1.7 pounds annually based on the assumption that half of the calorie deficit from reduced consumption of such beverages would be offset by increases in energy intake from other sources. Wang and colleagues (2012)
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observe that taxes on such beverages may be most beneficial to the former populations because they are disproportionately affected by obesity, may consume more soft drinks than other populations, and may be more price sensitive -- all supporting the argument that they may stand to benefit substantially from reduced consumption of sugar-sweetened beverages, especially if they are the focus of the obesity prevention programs funded by the taxes on these beverages. Furthermore, sugar-sweetened beverages are not an essential dietary component, and as explained above, hinder Americans from achieving dietary intakes aligned with the Dietary Guidelines for Americans.
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Social marketing campaigns aimed at reducing consumption of sugar-sweetened beverages are emerging rapidly and are encouraged by health professional organizations. For example, the American Academy of Pediatric Dentistry "encourages collaboration with other dental and medical organizations, governmental agencies, education officials, parent and consumer groups, and corporations to increase public awareness of the negative effects of frequent and/or inappropriate intake of sweetened drinks (carbonated and noncarbonated)
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Additionally, given the risk of dental caries associated with exces sive sugar consumption, the AAP Section on Pediatric Dentistry and Oral Health (2008) recommends that pediatricians counsel parents and caregivers on the importance of reducing children's exposure to added sugars in foods and bever Accelerating Progress in Obesity Prevention 182
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Indicators for Assessing Progress in Obesity Prevention for Strategy 2-1 Primary Indicator • Reduction in energy intake from consumption of sugar-sweetened beverages. Source for measuring indicator: NHANES Process Indicators • Reduction in consumption of sugar-sweetened beverages such that they account for a smaller proportion of solid fats and added sugars in the daily diet.
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to set a specific goal for substantially reducing the total annual calories served to children in these facilities; and • ensuring that at least half of all children's meals are consistent with the food and calorie guidelines of the Dietary Guidelines for Americans for moderately active 4- to 8-year-olds and are competitively priced. Accelerating Progress in Obesity Prevention 184
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includes just two restaurants, and the Healthy Weight Commitment includes just one. Thus, this avenue offers substantial potential for accelerating progress in obesity prevention.
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. And the Healthy Eating, Active Living Convergence Partnership has recommended encouraging restaurants to pro vide healthy foods and beverages by "reformulating existing menu items, adding healthier menu items (e.g., fruits, vegetables, and whole grains)
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. Some studies have had mixed results regarding the association between frequency of eating out and higher BMI or body fatness; however, two longitudinal studies found that greater intake of fast food in adolescence is associated with an increase in body weight or BMI in young adulthood (Niemeier et al., 2006; Thompson et al., 2004)
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Accelerating Progress in Obesity Prevention 188
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Source for measuring indicator: CFBAI • Increase in the percentage of chain and quick-service restaurants that join the Healthy Weight Commitment. Source for measuring indicator: HWC • Increase in the proportion of chain and quick-service restaurants that commit to offering at least 50 percent of all children's meals meeting the Dietary Guidelines for Americans.
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adopting and implementing a healthy food and beverage vending/concession policy. For the business community/private sector, potential actions include • the business community and private-sector entities that operate places fre quented by the public ensuring that a variety of food and beverage options are competitively priced and available for purchase and consumption in these places,161including food and beverages that are aligned with the recom mendations of the Dietary Guidelines for Americans.
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Evidence To maintain energy balance and focus on nutrient-dense foods and beverages, Americans must have access to a wide range of foods and beverages and not be inundated predominantly with those options that the Dietary Guidelines recommend limiting. Given that foods consumed outside of the home represented approximately 34 percent of the energy intake of children and adolescents by 2006 (Poti and Popkin, 2011)
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Strong evidence shows that worksite obe sity prevention and control programs can reduce weight in employees and create habits that could be modeled at home. Some of these effective programs include interventions that improve access to healthy foods by changing cafeteria and Accelerating Progress in Obesity Prevention 192
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Likewise, research suggests that in child care settings, the nutritional quality of meals and snacks can be poor, and activity levels may be inadequate (see the discussion of Strategy 1-4 in Chapter 5) (Ball et al., 2008; Padget and Briley, 2005; Story et al., 2006)
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. Governments nationwide are in fact adopting and implementing nutrition standards to ensure the availability of a wide variety of foods and beverages, including those recommended by the Dietary Guidelines for Americans, in government-run or -regulated facilities and programs and applying those stan dards to food and beverage procurement and contracting (see Box 6-3)
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New York City In 2009, New York City adopted standards for meals/snacks purchased and served by city agencies to agency clients that include schools, senior centers, homeless shelters, child care centers, after-school programs, correctional facilities, public hospitals and parks, and other agency facilities and programs and for beverage vending machines (New York City Department of Health and Mental Hygiene, 2011)
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This order is aimed at food served to clients by state agencies and their vendors. These clients are dependent on the state for a package of services that Association games -- all venues where food is sold for immediate consumption and all hosting a captive audience or consumer base seeking a wide range of food and beverage options, including those recommended by the Dietary Guidelines for Accelerating Progress in Obesity Prevention 196
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. Delaware State Parks In June 2010, Delaware State Parks adopted a "Munch Better" initiative that will provide healthy foods for sale and in vending machines.
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In sum, the committee believes that implementation of this strategy, in con cert with the other strategies recommended in this chapter and in the report as a whole, represents an important step toward reducing the obesogenic environ ment in which Americans live, work, and play. Implementation of this strategy by Accelerating Progress in Obesity Prevention 198
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. governments and the business community would go a long way toward providing Americans with access to foods and beverages recommended by the Dietary Guidelines for Americans in places where they spend their work and leisure time.
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Source for measuring indicator: NHANES Process Indicators • The federal government's expansion of its healthy vending/concession guidelines to include all federal government-owned, -operated, and -occu pied buildings, worksites, and facilities. Sources for measuring indicator: GSA and HHS • Increase in the proportion of states and municipalities that adopt and implement policies designed to ensure that foods/beverages sold and served in government-owned and -operated buildings, worksites, and facilities and other public places where foods and beverages are sold/served are aligned with the recommendations of the Dietary Guidelines for Americans.
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. Potential actions include • states creating cross-agency teams to analyze and streamline regulatory pro cesses and create tax incentives for retailing of healthy foods in underserved neighborhoods; • states and localities creating cross-sectoral collaborations among the food and beverage industry, philanthropy, the finance and banking sector, the real estate sector, and the community to develop private funding to facilitate the development of healthy food retailing in underserved areas; and 201 Food and Beverage Environments
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Additionally, strategies that actively promote the selection and purchase of healthy food options (e.g., in-store Accelerating Progress in Obesity Prevention 202
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Evidence Since 2005 a number of expert committees have recommended that communities improve access to healthy foods, particularly in low-income and underserved areas, through a variety of evidence-based strategies in order to improve healthy eating (IOM, 2005, 2009; Khan et al., 2009; Lee et al., 2008; RWJF, 2009; White House Task Force on Childhood Obesity, 2010)
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Access to affordable healthy foods does not neces sarily mean that consumers will purchase and consume them. Building a store is the first step toward increasing availability of healthy foods, but complementary strategies to promote dietary behavior change must be included in such initia tives.
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. Given the disproportionate lack of access to affordable healthy foods for a large number of Americans, the use of financial incentives, zoning, and crosssectoral collaborations can attract healthy food retailing and distribution (e.g., supermarkets)
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. In sum, the committee believes this recommended strategy would likely have a direct effect on the availability and accessibility of healthy and unhealthy foods in targeted neighborhoods and could encourage consumers to purchase foods that would help them meet the Dietary Guidelines for Americans.
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Agriculture Policy and Research to Include Implications for the American Diet Congress, the Administration, and federal agencies should examine the implications of U.S. agriculture policy for obesity, and should ensure that such policy includes understanding and implementing, as appropriate, an optimal mix of crops and farming methods for meeting the Dietary Guidelines for Americans.
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Department of Agriculture (USDA) developing policy options for promoting increased domestic production of foods recommended for a healthy diet that are generally underconsumed, including fruits and vegetables and dairy products, by reviewing incentives and disincentives that exist in current policy; • as part of its agricultural research agenda, USDA exploring the optimal mix of crops and farming methods for meeting the current Dietary Guidelines for Americans, including an examination of the possible impact of smaller scale agriculture, of regional agricultural product distribution chains, and of various agricultural models from small to large scale, as well as other efforts to ensure a sustainable, sufficient, and affordable supply of fresh fruits and vegetables; and • Congress and the Administration ensuring that there is adequate public funding for agricultural research and extension so that the research agenda can include a greater focus on supporting the production of foods Americans need to consume in greater quantities according to the Dietary Guidelines for Americans.
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The current farm system does not produce sufficient fruits and vegetables and dairy products to support a substantial increase in the availability of healthier food and beverage options at affordable, competitive prices. Indeed, even including imports, the supply of fresh fruits and vegetables would be inadequate if all Americans adopted a diet consistent with the Dietary Guidelines for Americans (Buzby et al., 2006)
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The International Obesity Task Force recommends a three-pronged strategy: include nutritional criteria in agriculture policies, undertake health impact assess ments of such policies, and provide support for agriculture programs aimed at meeting WHO's dietary guidelines (Hawkes, 2007)
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Some in the health professions believe that agriculture policies -- particularly farm subsidies -- have decreased the price of obesogenic foods, presumably leading to overconsumption of these foods and thereby contributing to the increase in obesity prevalence (e.g., Pollan, 2003; Schoonover and Muller, 2006; Tillotson, 2003)
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maintain that even if subsidy policies affect food prices, food consumption patterns are relatively unresponsive to changes in market prices. Production of foods recommended for a healthy diet While the evidence regarding the relationship between subsidies and obesity is mixed, what is clearer is that the current agriculture system fails to produce the mix and quantity of foods neces sary for Americans to consume diets recommended by the Dietary Guidelines for Americans.
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found that the average American is eating too much food made with refined grains, but would need to increase whole-grain consumption by more than 200 percent to meet the recommendations of the Dietary Guidelines for Americans (see Figure 6-1 earlier in this chapter)
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. In an Institute for Agriculture and Trade Policy webinar191 4 about the challenges to growing healthy foods, fruit and vegetable farmers stated that it was difficult to obtain insurance for growing fruits and vegetables, in part because banks are increasingly risk-averse and perceive those crops to be rela tively risky.
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conclude that compared with farm subsidies, public agricultural research policy has had much larger long-term effects on food prices and consumption. In summary, this strategy and the associated potential implementing actions address a gap in the current arsenal of obesity prevention strategies.
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Accelerating Progress in Obesity Prevention 216
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and decreasing consumption of solid fats and added sugars (e.g., sugar-sweetened beverages) , in particular, are critical steps toward achieving energy balance when implemented in concert with achieving recommended levels of physical activity (Chapter 5)
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. Accelerating Progress in Obesity Prevention 218
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2006. The role of race and poverty in access to foods that enable individuals to adhere to dietary guidelines.
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agricul ture from adoption of select dietary guidelines. Economic Research Report No.
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2010. Impact of water intake on energy intake and weight status: A systematic review.
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:300-307. DGAC (Dietary Guidelines Advisory Committee)
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2011. Healthy Weight Commitment Foundation triples membership in first year, launches program in all of its priority areas.
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2010. Dietary Guidelines for Americans.
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2009. Local government actions to prevent childhood obesity.
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2010. Planting the seeds for public health: How the farm bill can help farmers to produce and distribute healthy foods.
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2005. African Americans' access to healthy food options in south Los Angeles restaurants.
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. Accelerating Progress in Obesity Prevention 228
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2010a. Mean intake of added sugars & percentage contribution of various foods among U.S.
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:1175-1180. Accelerating Progress in Obesity Prevention 230
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2010. Dietary sources of energy, solid fats, and added sugars among children and adolescents in the United States.
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Presented at the Farm and Food Policy: Relationship to Obesity Prevention, May 19, 2011, Washington, DC. Accelerating Progress in Obesity Prevention 232
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2010. The grocery gap: Who has access to healthy food and why it matters.
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:923-925. Accelerating Progress in Obesity Prevention 234
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