applying new research, dg 2010, ssb’s, and sofas · soda 30.8 35.5 4.7 gal fruit drinks 10.2 13.9...
TRANSCRIPT
Pat Crawford, DrPH, RDCE Nutrition Specialist,
Adjunct Professor and DirectorAtkins Center for Weight & HealthUniversity of California, Berkeley
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APPLYING NEW RESEARCH, DG 2010, SSB’S, and SOFAS
December 17, 2011
University of California, Berkeley
Then andNow
University of California, Berkeley3
University of California, Berkeley4
University of California, BerkeleyNHANES
University of California, Berkeley
0
2000
4000
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1975 1980 1985 1990 1995 2000 2005 2009
Num
ber o
f Pub
Med
ent
ries
Publication Year
University of California, Berkeley
Obese individuals Are at increased risk of disease
including diabetes, cardiovascular disease, arthritis, asthma and cancer.
University of California, Berkeley
$147 billion
University of California, Berkeley
University of California, Berkeley
Why is diet so critical to consider when addressing obesity?
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University of California, Berkeley
Energy Out
Energy In
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University of California, Berkeley
One big Mac = 564 Kcal
Energy Expenditure : (50 Kg /110 Pounds child)
Basketball Cycling ( 5.5 mph ) FootballSwimming , crawl, slow Walking normal pace
Minutes
821778588141
Courtesy of Dan Nemet, UC Irvine
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University of California, Berkeley
How can the research evidence be synthesized on the dietary determinants of obesity?
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University of California, Berkeley
1. Dietary fat2. Whole grains3. Sugar4. Protein5. Reduced fat foods6. Eating out7. Fast foods/eating out8. Caloric intake9. Energy density10. Portion size
11. Fruits and vegetables12. Dairy and calcium13. Breakfast skipping14. Sweetened beverages15. Fruit juice16. Eating frequency17. Dietary variety18. Snacking19. Parental restriction20. Breast feeding
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First, identify likely suspects
University of California, Berkeley
1. Dietary fat2. Whole grains3. Sugar4. Protein5. Reduced fat foods6. Eating out
7. Fast foods/eating out8. Caloric intake
9. Energy density10. Portion size
11.Fruits and vegetables12.Dairy and calcium13.Breakfast skipping14.Sweetened beverages15. Fruit juice16. Eating frequency17. Dietary variety18. Snacking19. Parental restriction
20.Breast feeding
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Key dietary factors
University of California, Berkeley
University of California, Berkeley
University of California, Berkeley
• New focus on environmental factors influence individuals choice
• More focus on foods (vs. nutrients) • Language simplification and more examples
provided• Obesity prevention theme throughout
University of California, Berkeley
Strong evidence:1. Sweetened beverages2. Eating out (fast food restaurants)3. Portion sizes4. Screen time (particularly television)Moderate to strong evidence:5. Total energy intake6. Energy dense foodsModerate evidence:7. Breakfast skipping8. Dietary fat9. Low whole grain10. Food environment and fruit and vegetable access
University of California, Berkeley
SodaDessertsPizza
Reedy, J and S. Krebs-Smith, JADA 2010
University of California, Berkeley
•“Discretionary Calories from the 2005 Guidelines are invisible”•An understanding of discretionary calories is key to understanding how to select healthy foods•“It is clear that all foods don’t fit”
*Briefel, RR, JADA 2009
University of California, Berkeley
Timing Foods & Beverages Extra Calories
AM Snack Donut (vs Toast) 99Lunch 12 oz soda (vs non-fat milk) 50Lunch Tater tots (vs mashed potatoes) 69PM Snack 20oz Sports Drink (vs water) 140Dinner Chicken nuggets (vs baked chicken) 96Dessert 1 cup Vanilla ice cream (vs NF vanilla
yogurt)61
Evening Snack
2 choc chip cookies (vs 1 cup plain popcorn)
86
discretionary calories eaten 601
Discretionary Calories Limit 200
University of California, Berkeley
SOFAS
University of California, Berkeley
Only 1-2% of children meet the dietary guidelines with almost 40% of children’s calories coming from solid fat and added sugars.
Reedy, C and S. Krebs-Smith. JADA 2010
University of California, Berkeleycenter foreight &
ealthh University of California, Berkeley
University of California, Berkeley
Selection criteria:Conducted in industrialized nationsLocated through PubMed database
and other cited articles
Four types of evidence:
National intake trends Mechanistic studies
Observational studies Prevention trials+
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University of California, Berkeley
What is the evidence on sweetened beverages as a determinant of obesity?
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University of California, Berkeley
0
10 0
2 0 0
3 0 0
4 0 0
50 0
# of
12-
oz s
vgs/
pers
on
1954 1974 1994 2003
(Source: USDA/ERS, 2003, 2008)
>Tripled!
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Soft drink production
University of California, Berkeley
Annual gallons per capita
1985 2005 Increase
Soda 30.8 35.5 4.7 gal
Fruit drinks 10.2 13.9 3.7 gal
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University of California, Berkeley
How many calories are in soda?
Fl oz 20 32 44 64
400550
800
250Calories
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University of California, Berkeley(Source: Harnack, 1999)
19842149 2312
2604
0500
10001500200025003000
0 0.1 - 12.9 13.0 - 25.0 26+Soda Consumption (oz/day)
Kca
l/day
31
323232
3333(Source: Mattes, 1996)
Liquid Sugar<9%
compensationSolid Sugar
64%compensation
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Absorbed quickly—fail to stimulate satiety Insulin response is unique Metabolic rate in response to eating lower with
fluid calories Thirst & hunger mechanisms not fully
integrated Cognitively not as satisfying; not seen as a
dessert or “extra food” High palatability
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For each additional serving of sweetened beverage consumed over 1.5 years, the risk of overweight increased by 60% in children
(Source: Ludwig, 2001)
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3-fold increase in soda consumption between 9 and 19 years. High soda intake predicts increase in BMI.
(Source: Striegel-Moore & Crawford, 2007)
What about adolescents?
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Women who drink soda or sweetened fruit drinks every day more likely to gain weight & develop type 2 diabetescompared to women who drank less
(Source: Schulze, 2004)
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Adults were given 3.5 servings/day soda for 3 weeks:
Increased total energy intake Increased body weight
(Source: Tordoff, 1990)
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Intake Trend?
Plausible Mechanism?
Positive Association with
Overweight?
Prevention Intervention
Impact?
Yes Yes Yes Yes
Conclusion:Reducing sweetened beverage intake is an excellent intervention strategy.
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• Provide nutrition education programs• Create greater financial incentives to consume vegetables
and fruit, whole grains, seafood, low-fat milk products, and lean meats
• Improve access to affordable fresh produce and food;• Encourage restaurants and the food industry to offer
health-promoting foods that are low in sodium, solid fat and added sugars, refined grains, and served in smaller portions;
• Remove sugar-sweetened beverages and high-calorie snacks from schools and recreational facilities;
• Promote zoning policies that limit the location of fast food restaurants near schools and places where children play
402010 Dietary Guidelines
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Multiple nutrition education activities (curriculum including parent/family outreach)
linked withPrograms and policies
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• During School• Staff training• Classroom curriculum• Enhanced recess
equipment• School foodservice • School wellness policy
Economos C. 2007)
• Before School• Foodservice• Taste tests• Walk to school campaign
• After School• Staff training• Curriculum • Walk from school campaign
• Home• Parent education• Family events• Child’s health report card
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Economos C. 2007)
0
1
2
3
4
5
6
lbs
Boys Girls
Weight Gain in School Year
WithoutInterventionWith Intervention
~1 lbdifference
444444
Linked nutrition education activities
and
food policy changes
CWH Intervention Review, 2009
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social marketing campaigns
andFood store access, in-store
promotion and/or price alterations
CWH Intervention Review, 2009
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Conclusions Focused multi-channel interventions of high
intensity were the most successful
Environmental and policy change + social
marketing and/or education
Synergy ( same population exposed to multiple
strategies)
Sustainability: institutional change and
accountability (policy with teeth)
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Basic, Clinical, Epidemiological
Research
InterventionsPolicy
Evaluations
Neighborhood
School
Family
Community
Children’s Health
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Tips from community folks:Provide guidance on what constitutes a healthy food.
Be simple, specific, clear, and give examples.
If guidance is not provided, others will fill in the blanks.
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Out of 124 chain restaurant websites –33 say they have healthy menus
7 have claims regarding low calories 19 have claims regarding low-fat or fat-free 8 have low-carb claims 4 have claims about sugar 1 claims their entire menu is healthy(
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Snack may have no more than:•35% of its calories from fat (excluding legumes, nuts, nut butters, seeds, eggs, vegetables that have not been deep-fried, and cheese packaged for individual sale);•10% of its calories from saturated fat (excluding eggs and cheese packaged for individual sale);•35% sugar by weight (excluding fruits and vegetables);•250 calories (middle and high schools).
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Frito Lay - munchies flamin’ hot snack mix General Mills – chex mix traditional snack mix Propel flavored fitness water Gatorade fruit punch Nature Valley – strawberry yogurt granola bar Nature Valley – crunchy-oats ‘n honey granola bar Tropicana strawberry melon drink Dole apple juice Nabisco – wheat thins crackers Corn nuts – ranch flavor Nabisco – oreo-100 calorie pack cookies
Samuels et al., 2010
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Frito Lay - munchies flamin’ hot snack mix General Mills – chex mix traditional snack mix Propel flavored fitness water Gatorade fruit punch Nature Valley – strawberry yogurt granola bar Nature Valley – crunchy-oats ‘n honey granola bar Tropicana strawberry melon drink Dole apple juice Nabisco – wheat thins crackers Corn nuts – ranch flavor Nabisco – oreo-100 calorie pack cookies
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An elementary teacher in Oregon City wanted her students to bring only healthy snack foods to school. Not knowing how to find a practical definition of a healthy food, she defined it herself: any food that does not list sugar (in any of its forms) as one of the first three ingredients.
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California Plate developed by UC Cooperative Extension Body Weight and Health Workgroup, 2007