Search results: public health strategies

The World Health Organization (WHO) has a new, tough report out: “Set of recommendations on the marketing of foods and non-alcoholic beverages to children.”

It’s policy aim: to reduce the impact on children of marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt.

Here are some of its recommendations (edited):

• Given that the effectiveness of marketing is a function of exposure and power, the overall policy objective should be to reduce both the exposure of children to, and power of, marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt.
• To achieve the policy aim and objective, Member States should consider different approaches, i.e. stepwise or comprehensive, to  reduce marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt, to children.
• Settings where children gather should be free from all forms of marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt.
• Governments should be the key stakeholders in the development of policy and provide leadership, through a multistakeholder platform, for implementation, monitoring and evaluation. In setting the national policy framework, governments may choose to allocate defined roles to other stakeholders, while protecting the public interest and avoiding conflict of interest.
• Considering resources, benefits and burdens of all stakeholders involved, Member States should consider the most effective approach to reduce marketing to children of foods high in saturated fats, trans-fatty acids, free sugars, or salt.
• Member States should cooperate to put in place the means necessary to reduce the impact of crossborder marketing (in-flowing and out-flowing) of foods high in saturated fats, trans-fatty acids, free sugars, or salt to children.

The Rudd Center at Yale has just released Fast Food F.A.C.T.S., a thoroughly comprehensive report on the marketing of fast food to children and adolescents.

The report lavishly illustrates and extensively documents the ways in which fast food companies market to kids, the strategies they use, and the effects of these efforts on kids’ diets.

Readers: add it to your library!  FDA and FTC: get busy!

Addition: Advertising Age reports on the fast food industry’s response to the Rudd Center report.  All the industry can come up with, says Advertising Age, is a “canned response.”  Looks like the Rudd Center got it right.

Scientific debates about the role of sodium in high blood pressure go on and on.  Committees of scientists reviewing the research invariably conclude that people would be healthier if they ate less salt (salt is sodium chloride).  The 2010 Dietary Guidelines Advisory Committee is only the most recent group to urge population-wide reductions in sodium intake.

The Institute of Medicine has just issued a new report on reducing sodium.  Its Report in Brief gives a quick summary

As its primary strategy for sodium reduction, the committee recommends that the FDA set mandatory national standards for the sodium content in foods…beginning the process of reducing excess sodium in processed foods and menu items to a safer level. It is important that the reduction in sodium content of foods be carried out gradually…Evidence shows that a decrease in sodium can be accomplished successfully without affecting consumer enjoyment of food products if it is done in a stepwise process that systematically and gradually lowers sodium levels across the food supply.

But wait!  Hypertension rates have been increasing for years without any change in sodium excretion, says a report in FoodNavigator.com.  The report refers to new study in this month’s American Journal of Clinical Nutrition reviewing trends in sodium excretion from 1957 to 2003.

Sodium excretion, a precise reflection of intake, say Adam Bernstein and Walter Willett of the Harvard School of Public Health, has not changed in the last half century, despite rising rates of high blood pressure.   Instead, they suggest that rising rates of obesity might be the cause.

The accompanying editorial, by David McCarron and his colleagues, takes the argument even further as can be seen just from its title: “Science trumps politics: urinary sodium data challenge US dietary sodium guideline.^”

The editorial says that this new study provides:

plausible, scientific evidence of a “normal” range of dietary sodium intake in humans that is consistent with our understanding of the established physiology of sodium regulation in humans. This scientific evidence, not political expediency, should be the foundation of future government policies….Guidance for sodium intake should target specific populations for whom a lower sodium intake is possibly beneficial. Such an approach would avoid broad proscriptive guidelines for the general population for whom the safety and efficacy are not yet defined.

Is this review likely to change the Dietary Guidelines due out later this year?  The Advisory Committee was convinced that the preponderance of evidence favors the importance of sodium as a causative agent in high blood pressure.

Because so much is at stake for the processed food industry, this argument is not likely to be resolved quickly.  Stay tuned.

I’ve just read an enlightening paper in the July issue of the American Journal of Public Health (see Note below) about the tobacco industry’s role in and funding of “We Card,” a program ostensibly aimed at discouraging smoking among young people by encouraging retail cigarette sellers to “card” underage buyers.

The paper is an analysis of internal food company discussions about this program in cigarette company documents released as part of the 1998 Master Settlement Agreement.  These documents are now publicly available on the University of  California San Francisco (UCSF) website.

This analysis demonstrates that the actual purpose of tobacco industry support for the program was to make the industry look good (public relations) and to convince legislators and health officials that regulation would be unnecessary.

The industry effectively recruited astonishing numbers of private business, retail, and trade groups (expected) and state health, legal, and police agencies (which should have known better) as partners in this program.  The paper lists these groups in tables that take up nearly five pages.

As the paper explains:

Economic theory predicts that industry self-regulation will achieve social benefits far smaller than those gained from government regulation, although governments increasingly view self-regulation as a means to achieve public goals without public spending. However, industries and governments may have competing agendas, suggesting that public health advocates should be wary of self-regulation strategies…. This program’s success in reaching tobacco retailers and attracting independent allies has made We Card one of the tobacco industry’s major public relations achievements. However, despite industry claims that the program is effective, internal industry evidence suggests that We Card has not reduced tobacco sales to minors and that it was not designed to do so. Instead, We Card was explicitly structured to improve the industry’s public image and to thwart regulation and law enforcement activity.

The authors’ conclusion: “Policymakers should be cautious about accepting industry self-regulation at face value, both because it redounds to the industry’s benefit and because it is ineffective.”

Proponents of food industry self-regulation and of partnerships and alliances with food companies should read this study carefully.

Note: Only the Abstract is available to non-subscribers.  The reference is Apollonio DE, Malone RE, The “We Card” Program: Tobacco Industry “Youth Smoking Prevention” as Industry Self Preservation.. Am J Public Health 2010;100:1188-1201.

I’ve heard rumors that some members of the Dietary Guidelines Advisory Committee (DGAC) believe that commentators did not give a fair shake to their recently released report (see previous post).

I complained that the DGAC report is difficult to read because its pieces are presented online in a great many individual pdf files that must be downloaded separately.  Fortunately, Cornell student Daniel Green created a single Web-based file.

I have now read the report, or at least browsed through its 699 pages, and I agree that it is better than it first appeared and deserves a revisit (which I am doing in two parts, the second tomorrow).

As with previous Dietary Guidelines, both politics and science underlie this report.  The science components of this report are stunning—as good as such things get—and make this document an invaluable resource.

Why did everyone, including me, miss this?  Politics, of course.  The politics appear unchanged from previous versions (for that, see Food Politics).

The science in this report gives clear guidance for action.  But the report obfuscates its most important messages.

The Executive Summary makes the advice seem dull. The Summary is the part everyone reads first and often the only part anyone reads.  Try this:

The 2010 DGAC report concludes that good health and optimal functionality across the life span are achievable goals but require a lifestyle approach including a total diet that is energy balanced and nutrient dense…SoFAS (added sugars and solid fats) contribute approximately 35 percent of calories to the American diet….Reducing the intake of SoFAS can lead to a badly needed reduction in energy intake and inclusion of more healthful foods into the total diet.

Obesity, it says, is a big problem.  The food environment is a big problem.  What to do about them?  SoFAS.

The report introduces a new euphemism, SoFAS (Solid Fats and Added Sugars).  The meaning of added sugars is obvious.  But what are solid fats?  For that, you must wait until page 183 (on the Daniel Green file):

Solid fats are fats that are solid at room temperature. Solid fats come from many animal foods and can be made from vegetable oils through hydrogenation. Some common solid fats are butter, beef tallow (tallow, suet), chicken fat, pork fat (lard), stick margarine, and shortening. Foods high in solid fats include many cheeses, creams, ice cream, well-marbled cuts of meats, regular ground beef, bacon, sausages, poultry skin, and many baked goods (such as cookies, crackers, donuts, pastries, and croissants).

Earlier (p. 24), the report listed the principal food sources of SoFAS:

Solid fats (percent of solid fat intake)

• Grain-based desserts, including cakes, cookies, pies, doughnuts, and granola bars (10.9%)
• Regular cheese (7.7%)
• Sausage, franks, bacon, and ribs (7.1%)
• Pizza (5.9%)
• Fried white potatoes, including French fries and hash browns (5.5%)
• Dairy-based desserts, such as ice cream (5.1%)

Added sugars (percent of added sugars intake)

• Soda (36.6%)
• Grain-based desserts (11.7%)
• Fruit drinks (11.5%)
• Dairy-based desserts (6.4%)
• Candy (6.2%)

The report does not say to eat less of these foods; it talks about nutrients.  In various places in the report, the report says [with my comments in brackets]:

• Significantly reduce intake of foods containing added sugars and solid fats because these dietary components contribute excess calories and few, if any, nutrients. In addition, reduce sodium intake and lower intake of refined grains, especially refined grains that are coupled with added sugar, solid fat, and sodium. [Nutrients, not foods].
• Eat less of these: calories from SoFAS, added sugars, solid fats, refined grains, sodium, saturated fat. [Ditto]
• Significantly lower excessive calorie intake from added sugars, solid fats, and some refined grain products. [Ditto]
• Strategies to prevent childhood obesity should include efforts to reduce surplus energy intake, especially energy from foods and beverages that provide empty calories from added sugars and solid fats. [Ditto]
• Intake of caloric beverages, including SSB [sugar-sweetened beverages], sweetened coffee and tea, energy drinks, and other drinks high in calories and low in nutrients should be reduced in consumers needing to lower body weight.  [Only overweight people need to worry about these foods?]

Only once does the report say the clear and simple: “Avoid sugar-sweetened beverages” (p. 65).  Nowhere does it explicitly say to eat less steak, hamburger, French fries, pizza, cookies, or ice cream.

Like previous editions of the Dietary Guidelines, this one talks about foods in the context of eat more (fruits and vegetables).  For eat less advice, it switches to nutrients.  I’d call this obfuscation (and politics).

But the report—for the first time—emphasizes environmental influences on obesity:

The 2010 DGAC recognizes that the current food environment does not adequately facilitate the ability of Americans to follow the evidence-based recommendations outlined in the 2010 DGAC Report. Population growth, availability of fresh water, arable land constraints, climate change, current policies, and business practices are among some of the major challenges that need to be addressed in order to ensure that these recommendations can be implemented nationally.

What business practices?  It doesn’t say.  It does, however, recommend:

• Improve foods sold and served in schools, including school breakfast, lunch, and afterschool meals and competitive foods so that they meet the recommendations of the IOM report on school meals….
• Increase comprehensive health, nutrition, and physical education programs and curricula in US schools and preschools, including food preparation, food safety, cooking, and physical education classes and improved quality of recess….
• Remove sugar-sweetened beverages and high-calorie snacks from schools, recreation facilities, and other places where children gather.
• Develop and enforce responsible zoning policies for the location of fast food restaurants near schools and places where children play….

This is excellent advice.  But how about some suggestions about what individuals might do about it?

The report says little about food marketing.  Beyond “Develop and enforce effective policies regarding marketing of food and beverage products to children…,” the report says virtually nothing about the well documented impact of food marketing on children’s food choices, dietary intake, and health.  Unless I missed it someplace, the research review does not cite the Institute of Medicine’s 2006 landmark report, Food Marketing to Children and Youth: Threat or Opportunity.

It buries the need for policy changes in long wordy lists.  It states the needs for low-income Americans to have access to and afford healthier foods; to produce fruits, vegetables, and grains sustainably; to ensure household food security; to promote sustainable aquaculture; and to encourage the food service industry to serve healthier foods and smaller portions.  It does not—and perhaps cannot—recommend policy changes to achieve these important goals.

Overall, the report contains plenty of material for food, nutrition, and health advocates to work with, but you have to read between the lines to find it.

Recall the process.  This committee’s report is advisory. From 1980 through 2000,  dietary guidelines advisory committees actually wrote the final Dietary Guidelines.   No more.  Since 2005, the sponsoring agencies decide what the Dietary Guidelines will say.

The report is open for public comment until July 8.  If you think the Dietary Guidelines should provide clear, unambiguous advice about how people should eat to avoid obesity and how we can create a healthier food environment, now would be a good time to express your opinion.  Here’s how.

Tomorrow: The reason why this report is an invaluable resource—its science review.

The Washington Post reported yesterday that the FDA is about to launch an initiative to get food companies to reduce the amount of sodium in their foods.

If true, this would be a major big deal.  But by late afternoon, the FDA had issued a press release denying the Washington Post’s report (and see note below):

A story in today’s Washington Post leaves a mistaken impression that the FDA has begun the process of regulating the amount of sodium in foods. The FDA is not currently working on regulations nor has it made a decision to regulate sodium content in foods at this time.

Over the coming weeks, the FDA will more thoroughly review the recommendations of the IOM report and build plans for how the FDA can continue to work with other federal agencies, public health and consumer groups, and the food industry to support the reduction of sodium levels in the food supply.

The FDA is referring to a report also issued yesterday by the Institute of Medicine: Strategies to Reduce Sodium Intake in the United States. According to the IOM Summary, voluntary efforts by the food industry to reduce sodium intake have failed.  The report’s first recommendation is for the government to set standards for the sodium content of packaged foods.  And that sounds like what the Washington Post thought the FDA was about to do.

The idea is to get all companies to start reducing sodium.  USA Today quotes Jane Henney, the previous FDA Commissioner who chaired the IOM committee: “The best way to accomplish this is to provide companies the level playing field they need so they are able to work across the board to reduce salt in the food supply.”

The IOM is doing a public briefing on the report at 10:00 a.m. today, at the National Press Club in Washington DC.  You can listen to it via audio webcast at www.nas.edu.

The Center for Science in the Public Interest (CSPI) first asked the FDA to start regulating salt in processed foods in 1978.  Its press release and report, Shaving Salt, Saving Lives, explain why the FDA’s action would be such good news for public health.

Salt is as controversial as any nutrition issue can get.  I expect plenty of pushback from the Salt Institute and other industry trade groups if there is any hint that FDA might be about to regulate salt content.  Could the FDA’s denial be the result of industry pressure?  It would be interesting to find out.

Some basic facts: Recall that sodium is 40% of table salt (sodium chloride).  Too much raises the risk of high blood pressure and stroke.  Nearly 80% of salt is in processed and pre-prepared foods that are salted before they get to you.

The recommended maximum for adults is 2300 mg or about a teaspoon a day.  If you are at risk for high blood pressure, the maximum is just 1500 mg, or two-thirds of a teaspoon.  Americans consume more than twice that much on average.

Note added April 20: the FDA has produced a Q and A on its salt regulatory policy.

Additions April 21: Here’s the New York Times story on the IOM report.  The LA Times reports on the amounts of sodium in fast food restaurant meals.  Impressive.

In the latest issue of the American Journal of Public Health, Derek Yach and his colleagues at PepsiCo in Purchase, NY, say yes, it can, in answer to the question they pose in their article, “Can the food industry help tackle the growing global burden of undernutrition?”

If we are to successfully combat global undernutrition, efforts must be sustained by multiple stakeholders from various sectors. We believe that trust is built through industry’s demonstration of practical actions that improve health, and recognition of these actions by governments and nongovernmental organizations. Only through new and innovative public–private sector partnerships can we truly make a difference.

Three international public health leaders counter with no, it can’t, in an article entitled “The snack attack.”  They point to irreconcilable differences between the the goals of private industry and public health:

The problem lies with food, drink, and associated companies whose profits depend on products that damage public health and that also have damaging social, economic, and environmental impacts. These most of all include transnational companies, of which PepsiCo is one. To succeed, big business must sustain and increase annual turnover, profit, and share price…We suggest that public health professionals see papers such as those of Yach et al. as part of the marketing strategies of transnational food and drink companies…The privatization of public health does not work.

This argument reminds me of the editorial that David Ludwig and I wrote for JAMA late in 2008: “Can the food industry play a constructive role in the obesity epidemic?”  We concluded:

With respect to obesity, the food industry has acted at times constructively, at times outrageously. But inferences from any one action miss a fundamental point: in a market-driven economy, industry tends to act opportunistically in the interests of maximizing profit. Problems arise when society fails to perceive this situation accurately.

While visionary CEOs and enlightened food company cultures may exist, society cannot depend on them to address obesity voluntarily, any more than it can base national strategies to reduce highway fatalities and global warming solely on the goodwill of the automobile industry. Rather, appropriate checks and balances are needed to align the financial interests of the food industry with the goals of public health.

PepsiCo owns Pepsi Cola, of course, but also Gatorade, Frito-Lay snacks, and Aquafina water, among many other brands.  According to Advertising Age (June 22, 2009), PepsiCo earned $43 billion in worldwide sales in 2008. Its product-specific advertising expenditures in 2008, just for “measured media” (meaning run through advertising agencies) were, for example:

• $162 million for Gatorade
• $145 million for Pepsi Cola
• $27 million for Tostitos
• $14 million for Doritos
• $11 million for Fritos.

These figures, staggering as they may be, do not include the amounts Pepsi spends on lobbying, supporting the American Beverage Association’s efforts to fight soda taxes, funding medical research at Yale, or marketing to children and adults in India and other developing countries, as previously discussed on this site.

Is corporate “social responsibility” really responsible?  Or is it just marketing?  And what should be the checks and balances?  You decide.

Added April 17: This comes from a former employee of PepsiCo who asks that I post this anonymously:

I think you probably know that the “marketing dollars,” the share (ads/direct marketing), of companies like Pepsico are only a fraction of what are their actually marketing/promotions budgets.  Many years ago, PepsiCo made a conscious effort to redefine/shift budgets to what is called promotional spending from traditional marketing spending.  In doing so though, they keep the control and allocation of the funds in the hands of the marketing teams.

For Pepsi I know that the $145 million you mention is probably only 25% of what Pepsi “internally” considers consumer marketing spending.  For example, direct to retails “incentive” bonus funds are given for moving volume — those funds are almost entirely funneled into the retails increasing consumer marketing to their direct customers.  There are even examples where they can hide 10’s of millions of dollars at a time by linking event sponsorships (stadiums, etc.) to retailer agreements, thus moving those dollars to long-term “capital expenditures.”  I would guess that for Pepsi alone that that $145 million could be as much as a billion a year for direct and indirect consumer marketing spending.

It is not just obscene how much gets spent to increase volume… since, for companies like PepsiCo, Coke, etc.  Volume is the only way they generate higher profit to their shareholders.  As you say, to expect a corporation to do things for the good of the consumer just shows a misunderstanding of their primary function when they are a for-profit entity.

My latest column in the San Francisco Chronicle deals with an issue I discussed earlier on this blog: the ways in which agricultural and food interests are pushing back against advocates for a healthier and more sustainable food system.

Frank talk about food sometimes quashed

Marion Nestle, Sunday, November 1, 2009

Q: It must take courage to criticize the marketing practices of food companies. Doesn’t it get you into a lot of trouble?

A: Trouble? That depends on how you define it. Some pushback has to be expected as a normal consequence of advocating a food system that promotes better health for all and more sustainable agricultural production.

My latest experience with pushback occurred on World Food Day, Oct. 16. I had been invited by the U.S. Embassy in Rome to give the annual George McGovern lecture at the U.N. Food and Agriculture Organization. After my talk, our new ambassador to U.N. agencies in Rome, Ertharin Cousin, thanked me but told the audience that the opinions they had just heard were mine alone and did not represent those of the U.S. government.

What did I say that required a disclaimer? The point of my talk was to argue that international food issues such as hunger, obesity and food safety must be viewed as problems of society rather than personal choice.

As social problems, they are unlikely to be solvable by technical interventions such as functional foods, commercial weaning foods, irradiation or genetically modified foods. Instead, international food problems require social interventions that address underlying human needs for sustainability, social justice and democracy.

World insecurity

FAO had just released its 2009 report on the state of world food insecurity. Its date revealed how the economic crisis has caused the number of hungry people in the world to increase sharply. Some argue that genetic modification of crops is the only way to increase food productivity and reverse this trend. Whether food biotechnology really can fix world hunger is debatable, but one thing is clear: It is unlikely to create sustainability, social justice or democracy.

We know how to solve world hunger problems: promote breastfeeding, provide clean water and safe food, empower women, educate children, develop community food security, promote agricultural sustainability and ensure political stability. These strategies are social, not technological.

I ended my talk with praise for the Obamas’ leadership in promoting sustainable food production and initiating a new era in American agriculture.

Un-American? Under ordinary circumstances I would have shrugged off the ambassador’s remarks, but these are not ordinary times. I interpret her remarks as evidence that the food movement must be making real progress.

As further evidence, consider what happened to journalist and Berkeley professor Michael Pollan. His “Omnivore’s Dilemma” is high on the reading lists of many universities, yet twice this fall agricultural interests have attempted to force universities to cancel campus speaking invitations.

Pressure over Pollan

Washington State University had already bought 4,000 copies of “Omnivore’s Dilemma” for incoming freshman when a member of its Board of Regents, a wheat grower, objected to the way the book portrays industrial agriculture. The university canceled the reading program and Pollan’s lecture, saying it would cost too much at a time of budget crisis.

Bill Marler, a Seattle lawyer and WSU alumnus, called the university’s bluff by offering to pay the costs. Pollan’s book got distributed. He gave his talk. State agriculture did not collapse.

Much the same thing happened at Cal Poly San Luis Obispo. A local beef rancher, outraged that Pollan had been invited to speak unopposed, threatened to withdraw a promised $500,000 contribution. The rancher’s exchange of letters with Cal Poly’s president is available at links.sfgate.com/ZIMH, and well worth reading by anyone concerned about how industrial agriculture influences public policy.

Pollan offered the university a free lecture or panel with other speakers, but not both. The university chose the panel.

Although the rancher’s argument might appear to be about the value of presenting balanced views to students, universities are supposed to distinguish between academic and commercial interests. As university professors, Pollan and I base our opinions on our education, training, research and professional experience – not on how they might affect an industry. Our job is to teach students to read and think critically so they can form their own opinions about what we and others tell them.

Exerting influence

If our professorial opinions cannot be offered without public disclaimers and insistence on equal time for opposing views, I have to assume that what we are saying must be perceived as influential. If it indeed is influential, I expect even more pushback as the current food movement extends its reach and becomes stronger and more effective.

Trouble? Bring it on.

Reports about what to do about obesity in adults and children are coming out one after another.

The HSC Foundation has produced Fighting Obesity: What Works, What’s Promising? (click on Fighting Obesity Report).  Based on interviews, it reviews model programs that are having some success, such as The Food Trust, a Philadelphia-based nonprofit organization; The Consortium to Lower Obesity in Chicago Children (CLOCC); and The Coordinated Approach to Child Health (CATCH) Program.  Its main conclusion: a focus on pregnant women and children will have the biggest payoff.

NIH has New Tools to Promote Healthy Habits, one of which is “We Can!  Ways to Enhance Children’s Activities and Nutrition.”  The online program tells families how to improve food choices, increase physical activity, and reduce screen time.  [Question: do online programs do any good at all?  I’d really like to know.]

Finally (for now), the Institute of Medicine and Robert Wood Johnson Foundation have produced Local Government Action to Prevent Childhood Obesity, with a mind-numbing 58 steps that governments could take to do some good .  They also published a brief summary. Fortunately, the authors select the 12 actions most likely to succeed:

1. Create incentive programs to attract supermarkets and grocery stores to underserved neighborhoods
2. Require menu labeling in chain restaurants to provide consumers with calorie information on in-store menus and menu boards
3. Mandate and implement strong nutrition standards for foods and beverages available in government-run or regulated after-school programs, recreation centers, parks, and child-care facilities, including limiting access to unhealthy foods and beverages
4. Adopt building codes to require access to, and maintenance of, fresh drinking water fountains (e.g. public restrooms)
5. Implement a tax strategy to discourage consumption of foods and beverages that have minimal nutritional value, such as sugar sweetened beverages
6. Develop media campaigns, utilizing multiple channels (print, radio, internet, television, social networking, and other promotional materials) to promote healthy eating (and active living) using consistent messages
7. Plan, build and maintain a network of sidewalks and street crossings that connects to schools, parks and other destinations and create a safe and comfortable walking environment
8. Adopt community policing strategies that improve safety and security of streets and park use, especially in higher-crime neighborhoods
9. Collaborate with schools to implement a Safe Routes to Schools program
10. Build and maintain parks and playgrounds that are safe and attractive for playing, and in close proximity to residential areas
11. Collaborate with school districts and other organizations to establish agreements that would allow playing fields, playgrounds, and recreation centers to be used by community residents when schools are closed (joint-use agreements)
12. Institute regulatory policies mandating minimum play space, physical equipment and duration of play in preschool, afterschool and child-care programs

A 12-step program for preventing childhood obesity!  These are good ideas.  What will it take to get them put into practice?