The GAO says that the prevalence of food insecurity rose to nearly 15 percent (or about 17 million households) in 2008, and that the federal government spent more than $62.5 billion on 18 different food and nutrition assistance programs that year.

Although the programs are poorly coordinated and often overlap, streamlining them is not easy and involves trade offs.  The GAO recommends that USDA:

identify and develop methods for addressing potential inefficiencies among food assistance programs and reducing unnecessary overlap among the smaller programs while ensuring that those who are eligible receive the assistance they need. Approaches may include conducting a study; convening a group of experts…considering which of the lesser-studied programs need further research; or piloting proposed changes.

More research needed!

Fortunately, we have some.  The Robert Wood Johnson Foundation has studied the question of whether food insecurity is linked to obesity.  Past research suggested that it is.

Foundation researchers reviewed studies examining a possible relationship between food insecurity and obesity, and those examining links between federal nutrition assistance programs and an increased risk of obesity.

The report, “Food Insecurity and Risk for Obesity Among Children and Families: Is There a Relationship?, finds no evidence of a direct relationship between food insecurity and obesity.  It also does not find a direct relationship of use of food assistance to obesity.

Food insecurity is linked to a host of physical and mental health problems and it is difficult to distinguish the effects of lack of reliable food from those due to the lack of money, education, transportation, stable housing, and health care also common among low-income households.

Girls and boys should be taught the basic principles they will need to feed themselves and their families within the current food environment: a version of hunting and gathering for the 21st century. Through a combination of pragmatic instruction, field trips, and demonstrations, this curriculum would aim to transform meal preparation from an intimidating chore into a manageable and rewarding pursuit.

…Obesity presently costs society almost $150 billion annually in increased health care expenditures. The personal and economic toll of this epidemic will only increase as this generation of adolescents develops weight-related complications such as type 2 diabetes earlier in life than ever before. From this perspective, providing a mandatory food preparation curriculum to students throughout the country may be among the best investments society could make.

are pledging to take actions aimed at reducing 1.5 trillion product calories by the end of 2015. As an interim step to this goal, HWCF will seek to reduce calories by 1 trillion in 2012.

The energy gap?  That’s the 1.5 trillion excess calories that Americans consume each year on average.  This number assumes that the American population consumes an excess of 100 calories a day (the kids’ gap is less).  This number comes from some unexplained manipulation of 100 calories x 365 days per year x 300 million Americans.

How will food companies do this?

Healthy Weight Commitment Foundation manufacturing companies will pursue their calorie reduction goals by growing and introducing lower-calorie options; changing product recipes where possible to lower the calorie content of current products; or reducing portion sizes of existing single-serve products. These changes will help Americans reduce their calorie intake, improve their overall nutrition and close the energy gap.

How will we know they will actually do this?

To assess the impact of the pledge, the Robert Wood Johnson Foundation (RWJF) will support a rigorous, independent evaluation of how the Healthy Weight Commitment Foundation’s efforts to reduce calories in the marketplace affect calories consumed by children and adolescents. RWJF will publicly report its findings.

What are we to make of all this?  Is this a great step forward or a crass food industry publicity stunt?*  History suggests the latter possibility.  Food companies have gotten great press from announcing changes to their products without doing anything, and every promise helps stave off regulation.

On the other hand, the RWJF evaluation sounds plenty serious, and top-notch people are involved in it.  If the companies fail to do as promised, this will be evident and evidence for the need for regulation.

As I explained to Jane Black of the Washington Post, the White House efforts to tackle childhood obesity have been consistent and relentless.  What the White House is doing is holding food companies to the fire for making kids fat. That’s awkward for the companies.  They don’t see it as good for business.  Hence the agreement to change.

What the White House has not been able to get are similar pledges about marketing to kids, but that – and front-of-package labeling – are clearly the next targets.

So let’s give Michelle Obama a big hand for taking this on.  I will be watching for the evaluation with great interest although I hate the idea that we have to wait until 2015 to see the results.

*Added comment: see Michele Simon’s considerably less optimistic post on this.  As she puts it, “who needs policy when you’ve got promises?”

Update May 18: FoodSafetyNews covered the event.  The Atlantic’s political editor is skeptical and notes the absence of a

Calorie Measuring Authority, and the science of counting calories is not as exact as one might think. The Grocery Manufacturers Association, which helped to put together today’s event, spent $1 million in the first quarter of 2010 on lobbying, much of it for the maintenance of corn subsidies.

That means returning to a childhood obesity rate of just 5% by 2030. Achieving this goal will require “bending the curve” fairly quickly, so that by 2015, there will be a 2.5% reduction in each of the current rates of overweight and obese children, and by 2020, a 5% reduction.

This seems so modest that it might actually be achievable.

Like most such plans, this one has way too many recommendations, in this case, 70 (the summary table starts on page 89).  These are divided up in categories.  For example:

Recommendations for early childhood

• Educate and help women conceive at a healthy weight and have a healthy weight gain during pregnancy
• Encourage and support breastfeeding
• Prioritize research into chemicals in the environment that may cause or worsen obesity
• Educate and support parents in efforts to reduce kids’ TV and media time
• Improve nutrition and physical activity practices in child nutrition programs.

For empowering parents and caregivers:

• Government should work with local communities to promote the 2010 Dietary Guidelines for Americans and the 2010 food pyramid.
• USDA and FDA should work with the food and beverage industry to develop standard nutrition labels for packages.
• Restaurants and vending machines should display calorie counts of all items offered.
• The food and beverage industry should extend its voluntary self-regulation to restrict all forms of marketing to children. If this does not happen, federal regulation should be considered
• Media and entertainment companies should limit licensing of popular characters to healthy food and beverage products
• Insurance plans should cover services needed to help prevent, assess, and care for child obesity.

For healthier food in schools

• Update federal standards for school meals and improve the nutritional quality of USDA foods provided to schools.
• Increase funding for school meals.
• Encourage schools to upgrade cafeteria equipment to support healthier foods. Example: Swap deep fryers for salad bars.
• Connect school meal programs to local growers and encourage farm-to-school programs.
• Improve nutritional education in schools and make it more available.
• Increase the use of school gardens to educate about healthy eating.
• Promote healthy behaviors in juvenile correction facilities.

For improving access to healthy foods

• Launch a multi-agency “Healthy Food Financing Initiative” to make healthy foods more available in underserved urban and rural communities.
• Encourage local governments to attract grocery stores to underserved neighborhoods
• Encourage facilities that serve children (e.g., hospitals, recreation centers, and parks) to promote healthy foods and beverages.
• Provide economic incentives to increase production of healthy foods such as fruits, vegetables, and whole grains.
• Evaluate the effect of targeted subsidies on purchases of healthy foods through nutrition assistance programs.
• Study the effects of state and local sales taxes on calorie-dense foods.

For increasing kids’ physical activity

• School programs should stress physical activity as much as healthy nutrition.
• State and local school programs should increase the quality and frequency of age-appropriate physical education taught by certified PE teachers.
• Promote recess for elementary school students and activity breaks for older students.
• Federal, state, and local agencies should partner with communities and businesses to extend the school day in order to offer physical activity programs.
• The EPA should assist communities building new schools to place them on sites that encourage walking or biking to school.
• Increase the number of safe playgrounds and parks, particularly in low-income communities.
• Encourage entertainment and technology companies to continue developing new ways to engage kids in physical activity.

Good ideas, but there are some things I’m not so crazy about here.  The plan seems awfully voluntary and let’s be pals and all work together. Voluntary, as evidence demonstrates, does not work for the food industry.  Much leadership will be needed to make this plan work.  But these recommendations should give advocates plenty of inspiration to continue working on these issues.

The Washington Post has a particularly good summary of the key recommendations, and singles out the ones aimed at marketing to kids.

Jane Black of the Washington Post is cautiously optimistic.  Me too.

Kudos for first lady’s anti-obesity campaign

Nutrition and public policy expert Marion Nestle answers readers’ questions in this monthly column written exclusively for The Chronicle. E-mail your questions to food@sfchronicle.com, with “Marion Nestle” in the subject line.

Q: What do you think of Mrs. Obama’s “Let’s Move” campaign against childhood obesity? It doesn’t say much about junk food or food marketing. Isn’t this a cop-out?

A: Skeptic that I usually am, I have nothing but applause for Michelle Obama’s decision to adopt childhood obesity as the first lady’s official cause. Lady Bird Johnson’s legacy is the flowers that bloom throughout the nation’s capital. Obama must want hers to be the flowering of better health for our nation’s children.

Yes, Obama is sensitive to political realities. She calls her campaign “Let’s Move” rather than “Let’s Eat Less Junk Food.” But its goals are crystal clear. Her campaign aims to improve food in schools and eliminate “food desert” areas without access to healthier foods.

The White House organic garden is an integral part of this effort. It is no accident that Will Allen, the charismatic head of Growing Power, the group that runs urban farms in Milwaukee and Chicago, spoke at the campaign news conference. Good food, he said, is about social justice. Every child should have access to good food.

This campaign reveals real leadership on a desperately important issue. Obama brings diverse groups to this table. She presses government agencies to take action. She exacts promises from Congress to make it easier for kids to eat low-cost meals in schools. She got her husband to create a task force to tackle ways to prevent childhood obesity.

In addition, she is asking professional and business groups to do more to help kids eat better. I’m particularly impressed by her speech to the Grocery Manufacturers Association, which represents the makers of processed foods and beverages.

With masterful tact, Obama nonetheless insisted that the association “entirely rethink the products that you’re offering, the information that you provide about these products, and how you market those products to our children.” We parents, she said, want assurance that food companies will stop “teaching kids that it’s good to have salty, sugary food and snacks every day.”

Yes, she avoids saying anything about soda taxes or other measures that might make it easier for kids and parents to make better food choices, but she is bringing childhood obesity to public attention in a fresh, new way.

Consider what her campaign is up against. Preventing obesity means eating less, often a lot less, of processed fast-food, snacks and sodas. This puts the makers of such foods in an impossible bind. Eating less is not good for business.

Short of going out of business, what can such companies do to help? They can reformulate their products to make them a little healthier. They can stop marketing their products directly to children. But this, too, is bad for business – unless it can be used for public relations.

Indeed, food and beverage companies are falling all over themselves – with much fanfare – to reformulate and to promise to restrict marketing that targets kids.

PepsiCo, the maker of soft drinks and Frito-Lay snacks, says it will stop pushing sales of full-sugar soft drinks to primary and secondary schools worldwide by 2012. The new policy is voluntary, encourages rather than mandates, and assures school districts in the United States and abroad that the company will not tell them what to supply.

It keeps vending machines in schools and allows for continued sales of branded sugary drinks such as Gatorade, juice drinks, and sweetened milk.

Kraft Foods says it will reduce the sodium in its foods by 10 percent, also by 2012. This sounds good, but has a long way to go. Kraft’s Macaroni & Cheese (the SpongeBob package) contains 580 mg sodium per serving and two servings per package. A 10 percent reduction takes 1,160 mg sodium down to 1,050 mg. Salt is 40 percent sodium, so this brings salt down to 2.6 grams – about half a day’s upper limit for adults.

Still, these are steps in the right direction. Are they meaningful? You decide.

In the meantime, the Center for Responsive Politics, a nonprofit research group focused on the effect of money on public policy, says soda companies have increased by ten-fold the amount of money they spend on lobbying – no doubt to counter the threat of soda taxes.

What are we to make of these responses? They raise my favorite philosophical question: “Is a slightly better-for-you processed food necessarily a good choice?”

What would be better for preventing childhood obesity would be to make eating real foods the default. These, as defined by Oakland’s Prevention Institute, are relatively unprocessed foods that contain nothing artificial. And they are produced in ways that are good for farmworkers, farm animals and the environment, and are available and affordable to all.

Getting to that point requires policy as well as voluntary actions. Perhaps I’m reading too much into Obama’s campaign, but that’s how I interpret it. I’m supporting it. How about you?

Perhaps as a result of Michelle Obama’s campaign (see yesterday’s post), companies are falling all over themselves – and with much fanfare – to tweak their products.

GROCERY MANUFACTURERS ASSOCIATION (GMA):  By all reports, GMA members applauded Mrs. Obama’s remarks.  GMA says its member companies are already doing what she asked.

Parke Wilde, a professor at the Tufts School of Nutrition (and food policy blogger), gave a talk at that meeting in a session dismissingly titled,  “The New Foodism.”  His comment:

I enjoyed hearing Michelle Obama’s talk, which was well written and delivered and fairly forceful in places. In my afternoon panel, I said grocery manufacturers would find some threatening themes in books and documentaries promoting local and organic and sustainable food, but that there is also much of substance and value. Then, Susan Borra [Edelman Public Relations] and Sally Squires [Powell Tate Public Relations] in the next session said that grocery manufacturers are frequent subjects of unfair criticism and have nothing to apologize for.

Take that, you new foodists!

MARS must think it knows more than the FDA about how to label food packages.  It is developing its own version of front-of-package labels. It volunteered to put calories on the front of its candies; its multi-pack candies ay 210 calories per serving on the front.  That number, however, remains on the back of the small candy store packs.  Mars’ new labeling plans use the complex scheme used in Europe.  I’m guessing this is a bold attempt to head off what it thinks the FDA might do – traffic lights.

KRAFT announces that it is voluntarily reducing the sodium in its foods by 10% by 2012.  Kraft’s Macaroni & Cheese (SpongeBob package) has 580 mg sodium per serving and there are two servings in one of those small boxes: 1160 in total.  A 10% reduction will bring it down to 1050 mg within two years.  The upper recommended limit for an adult is 2300 mg/day.

PEPSICO announced “a voluntary policy to stop sales of full-sugar soft drinks to primary and secondary schools worldwide by 2012.”  In a press statement, the Yale Rudd Center quotes Kelly Brownell saying that “tobacco companies were notorious for counteracting declining sales in the U.S. with exploitation of markets elsewhere, particularly in developing countries:”

it will be important to monitor whether the mere presence of beverage companies in schools increases demand for sugared beverages through branding, even if full-sugar beverages themselves are unavailable…This appears to be a good faith effort from a progressive company and I hope other beverage companies follow their lead…this announcement definitely represents progress [Note: see clarification at end of post].

According to PepsiCo, this new policy brings its international actions in line with what it is already doing in the U.S.  The policy itself is voluntary, uses words like “encourage,” assures schools that the company is not telling them what to do, and won’t be fully implemented until 2010.  It keeps vending machines in schools and still allows for plenty of branded sugary drinks: Gatorade, juice drinks, and sweetened milk for example.

Could any of this have anything to do with Kelly Brownell’s forceful endorsement of soda taxes?

LOBBYING: The Center for Responsive Politics says food companies spent big money on lobbying last year, and notes an enormous increase in the amount spent by the American Beverage Association (soda taxes, anyone?).  For example:

How to view all this?  I see the company promises as useful first steps.  But how about the basic philosophical question we “new foodists” love to ask: “is a better-for-you junk food a good choice?”

OK.  We have the Public Relations.  Now let’s see what these companies really will do.

Addendum: I received a note clarifying Kelly Brownell’s role in the PepsiCo press release from Rebecca Gertsmark Oren,Communications Director,The Rudd Center for Food Policy and Obesity,Yale University:

The Rudd Center did not work with PepsiCo on their initiative to stop sales of full-sugar beverages in schools worldwide, nor did we jointly issue a press release. A statement released by Kelly Brownell in response to PepsiCo’s announcement was simply intended to commend what appears to be a step in the right direction. As Kelly’s statement also mentioned, there is still plenty of work to be done. It’s also worth noting that the Rudd Center does not take funding from industry.

The GMA is a tough audience for messages about childhood obesity.  It represents the makers of processed foods and beverages who have much to lose from efforts to get kids to eat less of their products.

The speech itself is a masterpiece of tact, but Mrs. Obama clearly gets the issues loud and clear.  Here are some excerpts:

• we need you not just to tweak around the edges, but to entirely rethink the products that you’re offering, the information that you provide about these products, and how you market those products to our children.
• this needs to be a serious industry-wide commitment to providing the healthier foods parents are looking for at prices they can afford.
• what it doesn’t mean is taking out one problematic ingredient, only to replace it with another. While decreasing fat is certainly a good thing, replacing it with sugar and salt isn’t.
• it doesn’t mean compensating for high amounts of problematic ingredients with small amounts of beneficial ones — for example, adding a little bit of Vitamin C to a product with lots of sugar, or a gram of fiber to a product with tons of fat doesn’t suddenly make those products good for our kids.
• This isn’t about finding creative ways to market products as healthy.
• Parents are working hard to provide a healthy diet and to teach healthy habits — and we’d like to know that our efforts won’t be undermined every time our children turn on the TV or see a flashy display in a store.
• what does it mean when so many parents are finding that their best efforts are undermined by an avalanche of advertisements aimed at their kids?
• what are these ads teaching kids about food and nutrition? That it’s good to have salty, sugary food and snacks every day — breakfast, lunch, and dinner? That dessert is an everyday food? That it’s okay to eat unhealthy foods because they’re endorsed by the cartoon characters our children love and the celebrities our teenagers look up to?
• if there is anyone here who can sell food to our kids, it’s you. You know what gets their attention. You know what makes that lasting impression. You know what gets them to drive their parents crazy in the grocery store.

Well done, Mrs. O.

Apparently, GMA members applauded her speech.  Let’s hope they act on it.

(Actually, they claim they are already fixing these problems.  More on that tomorrow).

1.  Health Affairs: Thanks to Matt Gruenberg for alerting me to the issue of Health Affairs devoted entirely to obesity topics.  Here’s the Table of  Contents.

The Robert Wood Johnson Foundation had a hand in this and discusses some of the papers on its website.

Even better, Health Affairs has produced a series of “issue briefs” to go with the journal articles.  These are available on the Health Affairs blog. They cover:

• Overview: The State Of Childhood Obesity In America
• The Role Of Agriculture Policy In Reducing Childhood Obesity
• Food Marketing And Distribution’s Role In The Fight Against Childhood Obesity
• Speeding Up Progress In Fighting Obesity In Schools
• Lessons From States On Fighting Childhood Obesity
• The Pervasive Effects Of Environments On Childhood Obesity

2.  FoodNavigator.com has a “special issue” on childhood obesity from the business standpoint:

Giving children the best nutritional start: With childhood obesity rates apparently sky rocketing around the world, celebrity chefs redesigning school meals, and international initiatives to influence what our children eat, now is an interesting time for child nutrition.

Kids’ food trends in the spotlight: Some major trends in children’s eating habits could change as the economy recovers – but foods marketed as natural and healthful are here to stay, according to a senior analyst at Mintel. 

How characters can help children eat healthily: From Disney to Tony the Tiger, consumer groups have been campaigning hard to break the links between childhood icons and unhealthy foods. But furry friends and super-heroes are now putting in more of an appearance on healthy products.

Kids’ TV food commercials down, but cross-promotions soar: Cross-promotions on food packaging targeted at children increased by 78 percent between 2006 and 2008, according to a study from Yale’s Rudd Center for Food Policy.

3.  Michelle Obama’s campaign:USA Today reports on Mrs. Obama’s talk to the school nutrition association, the organization of people who work in school lunchrooms – those who Jamie Oliver refers to as “lunch ladies.”  Check out the coverage and see the video.

What is one to make of all this?  Childhood obesity is a huge public health issue and deserves the attention it is getting.  Let’s hope some of it works.

Thanks to NYU student Jessica Watkins for forwarding this video of his plans. The reactions of people in the community to Jamie’s ideas are especially interesting.

This is the start of a TV series.  Is his campaign about theater or is this real public health?  I guess we’ll have to watch and decide.

Update March 7: Here’s Jamie Oliver’s famous TED video.

Researchers at UCLA took a careful look at the correlation between watching commercials on TV and childhood obesity (Their paper is in the February 2010 American Journal of Public Health).  Kids who watch commercials on TV are more likely to be obese than kids who watch non-commercial TV.  Commercials, of course, are largely for junk food and kids see a lot of them.  The authors conclude:

steering children away from commercial television may have a meaningful effect in reducing childhood obesity…The existence of many high-quality, enjoyable, and educational programs available on DVD for all ages should make it relatively easy for health educators and care providers to nudge children’s viewing toward less obesogenic television content [my emphasis].

Relatively easy?  They have to be kidding.  Food commercials are ubiquitous in kids’ lives.

For example, Lisa Sutherland and her colleagues at Dartmouth took a look at the prevalence of food brands (mostly junk foods) in movies from 1996 to 2005 (Pediatrics, February 2010).  There are loads of such placements, and movies aimed at younger kids tend to have the most.

As for industry self-regulation, Kelly Brownell and his colleagues at Yale have plenty to say about how it’s not working and what would be needed to make it work (also in the February American Journal of Public Health).

Michelle Obama may not be able to touch this one, but Congress can.  And it should.