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CDC, Nutrition, Pediatrics, Public Safety, Research, Stanford News

“Happy Meal ban”: Where are we now?

"Happy Meal ban": Where are we now?

MuppetBabiesA newly released Centers for Disease Control report of a study conducted at Stanford has examined the effects of San Francisco’s 2010 “Happy Meal ban.” The ban prohibited the free distribution of toys with unhealthy meals; the fast-food restaurants McDonald’s and Burger King instead sold the toys for 10 cents. Though neither restaurant complied with the ordinance’s specific calls for changes in nutritional content, improvements have been made.

As reported by SFGate.com:

…over the study’s two-year period, McDonald’s in particular made big changes to its Happy Meals, said [Jennifer Otten, MD,] of the University of Washington School of Public Health — first in California, then nationally.

The fast food giant cut the amount of French fries it serves in Happy Meals in half, replacing them with apples; stopped serving caramel sauce with apples; and began offering nonfat chocolate milk to customers. Otten said those substitutions were “pretty dramatic,” — they reduced the calories in a Happy Meal by 110, and cut the sodium and fat content of the meal as well.

Otten and her colleagues, including senior author Abby King, PhD, concluded in the study, “Although the changes…  did not appear to be directly in response to the ordinance, the transition to a more healthful beverage and default side dish was consistent with the intent of the ordinance. Study results… suggest that public policies may contribute to positive restaurant changes.”

Previously: How fast-food restaurants respond to limits on free toys with kids’ meals, Toying with Happy Meals, How food advertising and parents’ influence affect children’s nutritional choices and Living near fast food restaurants influences California teens’ eating habits
Photo by Ursala Urdbeer

Nutrition, Pediatrics, Stanford News, Videos

Where is the love? A discussion of nutrition, health and repairing our relationship with food

Where is the love? A discussion of nutrition, health and repairing our relationship with food

Maya Adam, MD, a lecturer on child health and nutrition in Stanford’s Program in Human Biology, associates food with love. “Through food, we learn about where we come from, who we are, and in many ways who we want to be,” she said in a recent TEDxStanford talk. But, as in human relationships involving love, our encounters with food may involve fighting – and even tragedy and betrayal, she noted. She pointed to an antacid commercial’s presentation of a “food fight” between foods we consume to taste but that cause us indigestion and larger health problems over time.

Early in her medical training, Adam said, she learned that “pain is a protective sensation; it helps us to avoid things that could cause damage to our bodies.” Ignoring pain or masking it with antacids, as the ad suggests, sends the message that “we should medicate that sensation away and continue consuming the foods that are hurting us.” What’s more, she said, a cultural “war on food” is depleting our time, energy and joy around eating, all in the midst of an obesity epidemic.

In her talk, Adam, who teaches a massive open online course called “Child Nutrition and Cooking,” recommends examining our modern-day relationship with food, which has grown distant. Regaining a healthy relationship involves learning where food comes from and what’s inside it, and taking care to prepare and cook real food for yourself and loved ones, she said: “May the foods you eat be worthy of you, and may they be made with love.”

Previously: A spotlight on TEDxStanford’s “awe-inspiring” and “deeply moving” talks and Free Stanford online course on child nutrition & cooking

Health and Fitness, Nutrition, Obesity, Parenting, Pediatrics, Stanford News

Childhood obesity expert to parents: Reduce your child’s screen time

Childhood obesity expert to parents: Reduce your child's screen time

screen-tvTake a few minutes to read a brief and informative piece about the negative health effects of too much screen time for children and how you can set boundaries for your kids – or perhaps yourself. In a Stanford Medicine News Q&A, pediatrician Thomas Robinson, MD, MPH, director of the Center for Healthy Weight at Lucile Packard Children’s Hospital Stanford, explains how watching TV or playing video games contributes to inactivity, overeating and obesity. Robinson also speaks to the modern-day concern of restricting access to screen devices that can also be educational tools, such as the iPad.

From the Q&A:

What’s the relationship between excessive screen time and childhood obesity?

It’s a true cause-and-effect relationship. The more time kids spend with screens, the less time they are spending being active. The best evidence supports two primary mechanisms—that kids eat more while watching screens and that exposure to food advertising leads to an increased eating of high-sugar, high-fat and calorie-dense foods. Lots of research shows that kids—and adults—eat more when distracted by a screen. So one of the most important things a family can do is eliminate eating while watching TV and other screens.

Previously:  Talking to kids about junk food ads, This is your 4-year-old on cartoons, Study: Too much TV, computer could hurt kids’ mental health, Does TV watching, or prolonged sitting, contribute to child obesity rates? and Paper explores effects of electronic media on kids’ health

Clinical Trials, Nutrition, Parenting, Pediatrics, Research, Women's Health

Stanford study investigates how to prevent moms from passing on eating disorders

Stanford study investigates how to prevent moms from passing on eating disorders

veggie-stirfryResearchers have known for some time that women who have previously had eating disorders face a special set of challenges when they begin feeding their own children: They may unintentionally pass on problematic eating behaviors to their kids.

Now a Stanford research team is studying how to help these moms. They are recruiting families with a child between the ages of 1 and 5 whose mother had anorexia nervosa, bulimia nervosa or binge-eating disorder in the past. In the 16-week study, the researchers will work with both the mother and her partner to build healthy family interactions around food.

From our announcement about the study:

“The data on feeding practices of mothers who have had eating disorders are very worrying,” said Shiri Sadeh-Sharvit, PhD, a visiting scholar at Stanford who is leading the new study. “These mothers are good parents who want only the best for their children, but they struggle with eating-disorder thinking. It’s something that comes and blurs their parenting.”

Prior research has shown that mealtime conflict is more common in families in which the mother has had an eating disorder. These mothers may overfeed or underfeed their children, though underfeeding is more predominant. They also have more difficulty recognizing hunger and fullness cues in themselves and their children, which makes it harder for them to help their kids learn to respond to these sensations. Children whose mothers have had eating disorders are more likely than other kids to be dissatisfied with their bodies and engage in emotional eating, binge eating or restrictive eating.

Sadeh-Sharvit is collaborating with James Lock, MD, PhD, who has a long track record of demonstrating the effectiveness of eating-disorder treatments that involve the patient’s family in the treatment process.

Local families who are interested in participating in the research can contact Sadeh-Sharvit at (650) 497-4949 or shiri_sade@yahoo.com for more information. Stanford’s Eating Disorders Research Program also maintains an online list of all of their eating-disorder studies that are currently seeking participants.

Previously: Promoting healthy eating and a positive body image on college campuses, A growing consensus for revamping anorexia nervosa treatment and Story highlights need to change the way we view and diagnose eating disorders in men
Photo by Indiana Public Media

Nutrition, Research, Sports

Elite rugby players may have more diverse gut microbiota, study shows

Elite rugby players may have more diverse gut microbiota, study shows

Andrew TrimbleThe Irish national rugby team might seem like a uniform study population, but it turns out their gut landscapes are highly diverse territories. That’s according to a new study published in BMJ’s Gut. Scientists from the Alimentary Pharmabiotic Centre at University College Cork and Teagasc Food Research Centre, Moorepark, in conjunction with the Irish Rugby Football Union studied forty male professional rugby players with a mean age of 29 in training leading up to the last Rugby World Cup and two male control groups. The researchers found that the rugby players, whose exercise and dietary habits tended to be more extreme than those of the Irish general public, also had gut microbiota that were more diverse.

From a release:

The athletes are an exceptional group in terms of their dietary intake, fitness/endurance and now we know, in relation to their gut microbiota! This high diversity is particularly linked with exercise and protein consumption and suggests that eating specific proteins and/or exercise can provide a means of increasing microbial diversity in the gut.

This is the first report that exercise increases microbial diversity in humans. While we and others have previously shown that diet influences microbial diversity, we can now report that protein consumption, in particular, positively correlates with microbial diversity.

According to the study, “The results provide evidence for a beneficial impact of exercise on gut microbiota diversity but also indicate that the relationship is complex and is related to accompanying dietary extremes.”

Previously: Stanford team awarded NIH Human Microbiome Project grant, How exercise may affect gut hormones, weight loss and Researchers manipulate microbes in gut
Photo by ASSOCIATED PRESS

Global Health, Microbiology, Nutrition, Pediatrics, Research

Malnourished children have young guts

Malnourished children have young guts

Bangladeshi_childrenChildren who grow up malnourished lag behind healthy kids in terms of their height and weight. But a new study finds that they also fall behind in the bacteria in their guts. The findings may explain why weight gains are often temporary, and malnourished children remain underweight compared to healthy children in the long-term.

Babies get their first gut bacteria from their mothers during birth. As they eat new foods, the community that live in the intestines changes and matures throughout the first few years of life. By age three, an “adult” community has taken up residence in the gut, and helps the body to break down food and boost the immune system. But in malnourished children, scarce or low-quality food and infections from poor sanitation result in an underdeveloped bacterial community that looks more like the inhabitants of a young child.

A study by Sathish Subramanian and colleagues published yesterday in Nature finds that children living in a slum in Dhaka, Bangladesh who were treated for malnutrition with nutrient-dense foods, have a temporary improvement in their gut bacteria. But the community will regress back to a younger state months after the therapy stops. The results correlate with observations that nutritional therapy saves lives, but cannot correct problems such as stunted growth, learning disabilities and a weakened immune system.

Initially, the researchers took stool samples from healthy children of a range of ages from the same slum. By looking at the identity of the bacteria from their intestines, the researchers could figure out what types of bacteria live in the gut at different times. They then looked at the bacterial communities from children receiving therapeutic foods to treat malnutrition to determine the “age” of their communities throughout the course of their treatment.

In a commentary on the study, Elizabeth Costello, PhD, and David Relman, MD, researchers in the Department of Microbiology and Immunology at Stanford, compare the gut communities of malnourished children to a degraded environment, such as a clear-cut rainforest that becomes choked with weeds. Just as it is difficult to clear the weeds and restore the original rainforest trees, it is challenging to rehabilitate the gut communities of chronically malnourished children.

“Degraded communities can be resistant or resilient to change, and although host health can be restored, youth cannot,” write Costello and Relman. “Thus, an ounce of prevention is likely to be worth a pound of cure and, as with other types of developmental delays, early intervention may be crucial.”

The study’s authors suggest that monitoring the gut communities of impoverished children may be one way to kept tabs on their health, and to measure if experimental nutritional treatments are working. Just like height or weight, the age of the gut bacterial community may be one way to track a child’s growth and development.

Patricia Waldron is a science writing intern in the medical school’s Office of Communication & Public Affairs.

Previously: Malnourished infants grow into impoverished adults, study shows and Who’s hungry? You can’t tell by looking
Photo by Mark Knobil

Genetics, Nutrition, Obesity, Research

Early findings show nutrigenomics could make weight loss more efficient

Early findings show nutrigenomics could make weight loss more efficient

Bieler2“Food is your best medicine,” a wise saying and a book by the late Henry Bieler, MD, holistic doctor to the stars, includes testimonials by Gloria Swanson and Greta Garbo and a recipe for an alkalizing broth comprising four green vegetables to which he attributes all kinds of health benefits. My former ballet teacher (1919-2012) used to eat the broth according to his instructions whenever she was sick, almost sick, or feeling “toxic” for any reason, and I make it now and then just in case it works.

Well, science is moving toward grounding some beliefs about the healing power of certain foods for certain people and the effectiveness of diets tailored to a person’s genetic makeup. A New Scientist piece reports that last week at the European Society of Human Genetics meeting in Milan, University of Trieste researcher Nicola Pirastu, PhD, and colleagues presented findings on nutrigenomics showing that diets shaped according to a person’s metabolism may be more effective than non-specialized calorie reduction in helping him or her lose weight.

From the piece:

The team used the results of a genetic test to design specific diets for 100 obese people that also provided them with 600 fewer calories than usual. A control group was placed on a 600-calorie deficit, untailored diet.

After two years, both groups had lost weight, but those in the nutrigenetic group lost 33 per cent more. They also took only a year to lose as much weight as the group on the untailored diet lost in two years.

I’ll keep eating four green vegetables in their cooking water (and adding Bieler-taboo salt and pepper) until a larger, randomized trial tells me otherwise, but it’s worth considering that “healthy” isn’t one-size-fits-all. The piece continues:

[John Mathers, PhD, director of the Human Nutrition Research Centre at Newcastle University, UK] says the effects of even a healthy diet can vary according to someone’s genetics. For instance, the APOE gene is linked to the breakdown of fat, and one variant of it confers a higher risk of getting cardiovascular disease and dementia. “People with that variant respond differently to certain fats in the diet,” he says. Another gene affects how much vitamin B9 people need.

Previously: Stanford geneticist talks tracking biological data points and personalized medicine, Ask Stanford Med: Genetics chair answers your questions on genomics and personalized medicine and How genome testing can help guide preventative medicine
Photo by Emily Hite

Global Health, Nutrition, Parenting, Pediatrics, Research, Rural Health, Stanford News

Seeking solutions to childhood anemia in China

Seeking solutions to childhood anemia in China

Chinese boyHow can health and nutrition education needs in rural China be addressed? Start by examining infant-feeding practices.

Scott Rozelle, PhD, director of the Rural Education Action Program, part of the Freeman Spogli Institute for International Studies (FSI) Center on Food Security and the Environment at Stanford, conducted a study on 1,800 babies in China’s Shaanxi province to address high rates of anemia and cognitive delays in children owing to poor nutrition, though not necessarily lack of funds for healthy food.

A recent piece on the FSI website describes the ongoing study:

One third of households were given a free daily supply of nutritional supplements for their children. Another third were given the same free supplements, and were enrolled in a text message reminder program. A final third of households served as a control group. The study is ongoing through April, 2015, but 12 months into the program, the researchers have found that the supplements have reduced anemia rates by 28 percent, although cognitive delays have persisted.

Text message reminders appear to have been modestly effective in improving program compliance. Caregivers who received the reminders gave their baby the micronutrient supplements, on average, 10 percent more often over the course of the first six months of the study. So far, however, this improved compliance has not led to a corresponding fall in anemia rates.

Rozelle commented in the piece, “To reach all of China’s at-risk babies – that’s our ultimate objective. And to do that, we need an effective government program.”

Previously: Who’s hungry? You can’t tell by lookingFeeding practices and activity patterns for babies vary with families’ race and ethnicity, study shows and Student inventors create device to help reduce anemia in the developing world
Photo by Kris Krüg

Nutrition, Public Health, Research

How the body’s natural defenses help protect cells from toxins in everyday foods and flavorings

How the body's natural defenses help protect cells from toxins in everyday foods and flavorings

Here’s some interesting findings to ponder as you reach for your afternoon caffeine fix: Compounds in your saliva may protect human cells from powerful plant-based chemicals, called pyrogallol-like polyphenols (PLPs) that are found in coffee, tea and other foods or flavorings.

The research is a continuation of a 2013 study showing that plant-based flavorings could be damaging to DNA. The earlier findings suggested that, in some cases, the impact of PLPs was comparable to the effect of chemotherapy drugs. So Johns Hopkins researcher Scott Kern, MD, and colleagues set out to understand why the toxins weren’t harming cells and causing illness. Futurity reports on the results of the latest study:

Kern and colleagues found that an enzyme in saliva called alpha-amylase, the blood protein albumin, and the muscle protein myoglobin all protect cells from DNA breakage by tea, coffee, and isolated PLPs.

Kern emphasizes that the saliva enzyme and the proteins don’t protect against chemotherapy drugs, which also damage DNA. That suggests that defenses against PLPs may have evolved, in response to natural plant compounds that have been part of human diets for a long time.

Surprisingly, cells do not seem to need the protein protectors after a period of exposure to the toxins.

Previously: What is coffee?, For new moms, coffee scores a point: Caffeine doesn’t seem to interfere with baby’s sleep in study and Does coffee lower the risk of prostate cancer?

Chronic Disease, Health Costs, Health Policy, Nutrition, Obesity, Stanford News

Study shows banning soda purchases using food stamps would reduce obesity and type-2 diabetes

Study shows banning soda purchases using food stamps would reduce obesity and type-2 diabetes

soda

In the late 1800s and early 1900s, carbonated beverages such as Coca-Cola, Dr Pepper and 7UP were sold as nerve tonics and health drinks. But, we now know that sugary sodas contribute to obesity, type-2 diabetes and cavities. Still, most Americans drink more soda than they like to admit.

Even though sugar-laden soft drinks have no nutritional value, they are still eligible for food stamps. Nutrition researchers and some politicians have advocated for a ban on buying sugar-sweetened drinks with food stamps but the U.S. Department of Agriculture, which runs the program, is under tremendous pressure from beverage company lobbyists to keep the existing regulations.

Sugary drinks are especially concerning because too many liquid calories put consumers at a higher risk of developing type-2 diabetes. Some nutrition experts are concerned that taxpayers are subsidizing an unhealthy diet, which will result in higher medical costs for Medicare and Medicaid down the road, when food stamp recipients experience the health problems associated with obesity and diabetes.

In a new study (subscription required) published in this month’s Health Affairs, Sanjay Basu, MD, PhD, an assistant professor of medicine at the Stanford Prevention Research Center, and his colleagues created a computer model to simulate the effects of a soda ban on the health of food stamp recipients. They found that obesity would drop by 1.12 percent for adults, and by 0.41 percent for children, affecting about 281,000 adults and 141,000 children. Type-2 diabetes would also drop by 2.3 percent.

The researchers also calculated the effects of reimbursing participants 30-cents for each dollar spent on fruits and vegetables. The subsidy did not affect obesity or diabetes rates, but doubled the number of people who ate the recommended number of fruits and vegetables each day. A county in Massachusetts tried the same reimbursement system as part of the USDA’s Healthy Incentives pilot study, and saw a similar increase in the fruit and vegetable purchases of food stamp recipients.

“It’s really hard to get people to eat their broccoli,” said Basu in a press release. “You have to make it really cheap, and even then, sometimes people don’t know what to do with it.” But, with one in seven Americans receiving food stamps, he points out that these small changes can have wide-ranging effects.

“It’s very rare that we can reach that many people with one policy change and just one program.”

Patricia Waldron is a science writing intern in the medical school’s Office of Communication & Public Affairs.

Previously: Food stamps and sodas: Stanford pediatrician weighs inCan food stamps help lighten America’s obesity epidemic? and Stanford’s Sanjay Basu named a Top Global Thinker of 2013
Photo by Andy Schultz

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